How the 1977 World Health Organization report on alcohol-related disabilities came to be written: a provisional analysis

Background In 1977 the World Health Organization (WHO) published a report entitled ‘Alcohol-Related Disabilities’. The crucial contribution of this report was to differentiate between alcohol dependence, on one hand, and alcohol-related disabilities (or problems) on the other hand. Essentially, it offered a bi-axial mapping of the field of concern. Aims This paper seeks to identify the multiple influences which shaped the evolution of this report. Methods Use is made of unpublished archival material and recall of personal involvement, together with relevant published material. Results Three major influences made it possible to move beyond the confines of previous WHO thinking on alcohol: the multi-disciplinary nature of the input; the internationality of the enterprise; and the expectations set that the concepts developed should speak to the practical world. Conclusions The arena of drug and alcohol policy has, for more than a century, been rich in its reports. This case study, although limited in its immediate content, points to the need for further analysis of the history of such reports.     

世界卫生组织耐药结核病治疗整合指南(2020年版)解读

1993年结核病被世界卫生组织宣布为"全球公共卫生紧急事件"。在复杂和严峻的大背景下,世界卫生组织发布了耐药结核病治疗整合指南(2020年版),相信有助于加速推动终止结核病策略的进程,扭转当前耐药结核病防治的被动局面。本文分别从异烟肼耐药结核病、含贝达喹啉全口服短程方案治疗耐多药结核病(MDR-TB)和利福平耐药结核病...     

世界卫生组织《慢性乙型肝炎病毒感染预防、关怀和治疗指南》制定方法学和核心建议点评

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Long-term outcomes for unselected patients with acute myeloid leukemia categorized according to the World Health Organization classification: a single-center experience

The actual utility of a new classification system of acute myeloid leukemia (AML) recently introduced by the World Health Organization (WHO) has not been thoroughly investigated yet. In this study, we evaluated long-term outcomes of unselected AML patients categorized according to the new WHO classification. Between 1990 and 2002, 109 adult AML cases were referred to our hospital. For the entire population, the median survival duration was 1.2 yr with a 5-yr survival rate of 31%. AML with recurrent genetic abnormalities accounted for 26%, AML with multilineage dysplasia for 29%, therapy-related AML for 13%, and AML not otherwise categorized for 32% of classifiable cases. Among the four groups, a significant difference was observed in terms of overall survival (P < 0.0001). Univariate analysis showed that six variables affected survival: cytogenetic risk, age, multilineage dysplasia, prior chemo/radiotherapy, type of treatment (intensive or palliative), and transplantation. However, in multivariate analysis no adverse prognostic impact of multilineage dysplasia and prior chemo/radiotherapy was detected (P = 0.4979 and 0.8702), whereas cytogenetic risk and patient age maintained their prognostic value (P = 0.0005 and 0.0100). These results indicate that outcomes for AML patients appear to be distinguished on the basis of the WHO classification, but the prognostic significance of multilineage dysplasia and prior therapy is lost after adjusting for cytogenetic risk and age. Our findings suggest that the WHO classification may be strengthened by greater emphasis on genetic/cytogenetic information.     

WHO及美国糖尿病学会糖尿病诊断标准在老年人群中应用的分析和评估

目的　探讨 1985年WHO与 1997年美国糖尿病学会 (ADA)糖尿病 (DM)诊断标准在老年人群应用中的敏感性及特异性 ,确定在老年人群中诊断DM的理想空腹血糖 (FPG)切点。方法对在北京地区居住 5年以上的老年人群体检时进行口服葡萄糖耐量试验 (OGTT)的 12 0 4人 ,分别根据WHO标准与ADA标准划分不同血糖水平的人群 ,分析其分布的异同 ,并以OGTT 2h血糖 (2hPG)≥ 11.1mmol/L为DM诊断标准 ,分析ADA(FPG)≥ 7.0mmol/L的标准诊断DM的敏感性及特异性变化情况 ,并确定在老年人群中应用FPG诊断DM的理想切点。结果　按WHO标准 (2hPG)诊断DM的患病率为 16 .2 8% ,按ADA标准 (FPG)诊断DM的患病率为 3.16 %。ADA标准制定的FPG 7.0mmol/L所得出的诊断DM的敏感度为 15 .3% ,特异度为 99.2 %。WHO与ADA两项标准均诊断DM的符合率仅为 15 .3% ,糖耐量低减 (IGT)与空腹血糖异常 (IFG)的一致性仅为 4 .5 %。老年人群诊断DM的理想FPG切点为 5 .5mmol/L ,其受性别、年龄、BMI和有否高血压的影响。结论　WHO标准和ADA标准在本人群中缺乏一致性 ,以ADA(FPG)标准诊断老年人群DM时 ,在很大程度上不能替代WHO(2hPG)诊断标准。对 5 .5mmol/L≤FPG <7.0mmol/L老年人群应建议行OGTT检查。     

Severity of alcohol dependence is negatively related to hypothalamic and prefrontal cortical gray matter density in heavy drinking smokers

Background: While research has examined brain structure in individuals who use alcohol or nicotine, heavy drinking smokers comprise a unique subpopulation of substance users for whom less is known about the relationship between alcohol or nicotine use and structural brain abnormalities. Objectives: The present study examined gray matter morphometry in a sample of 39 heavy drinking smokers (24 males, 15 females) in relation to alcohol and nicotine dependence and quantity of use. Methods: Traditional voxel-based morphometry techniques were employed for preprocessing of imaging data. One multiple regression analysis for alcohol and nicotine dependence severity and another for alcohol and nicotine quantity of use were conducted, while controlling for age, gender, and total intracranial volume (ICV). Results: Alcohol dependence severity was significantly negatively associated with gray matter density in the hypothalamus (p < 0.001, uncorrected) and the right superior frontal gyrus (p < 0.001, uncorrected), while controlling for nicotine dependence severity, age, gender, and ICV. There were no significant relationships observed with respect to nicotine dependence severity, the quantity of alcohol use, or the quantity of nicotine use variables and gray matter density. Conclusions: These findings suggest that within heavy drinking smokers, alcohol dependence severity is significantly related to alterations in brain structure, while this effect is not seen for the quantity of alcohol or nicotine use, or severity of nicotine dependence. The current findings help clarify the contribution of alcohol and nicotine effects on brain structure, which could aid in understanding their neurocognitive consequences in heavy drinking smokers.     

Questions about the validity of the binge or heavy drinking criterion have implications for more than just treatment evaluation

Commentary to: Questioning the validity of the 4+/5+ binge or heavy drinking criterion in college and clinical populations     

An international collaborative study to establish a World Health Organization international standard for hepatitis B virus DNA nucleic acid amplification techniques

BACKGROUND AND OBJECTIVES: Twenty-two laboratories from nine countries participated in an international collaborative study to establish a World Health Organization (WHO) international standard for hepatitis B virus (HBV) DNA nucleic acid amplification techniques (NAT). MATERIALS AND METHODS: Three samples, AA, BB (both of which were lyophilized) and CC (which was a liquid preparation), were analysed using several different NAT assays. The mean HBV DNA content of each sample was determined from the study. RESULTS: Despite the range of assays (commercial and in-house) used by participants, there was good agreement among the overall mean 'equivalents'/ml obtained by the different assays, except for one laboratory (laboratory 4). The variation in estimates of log10 'equivalents'/ml was 1.75-1.25 for the three samples if results from laboratory 4 were excluded. The mean log10 'equivalents'/ml for all laboratories were 6.42 for sample AA, 6.30 for sample BB and 5.03 for sample CC (exclusion of results from laboratory 4 made little difference). The difference in titres between the two lyophilized samples (AA and BB) was not statistically significant but the titre of the frozen sample (CC) was significantly lower. Material AA (code 97/746) was accepted as the first WHO international standard for HBV DNA NAT assays and assigned a potency of 10(6) international units (IU)/ml. CONCLUSIONS: The titres (genome equivalents/ml) of three HBV preparations were determined by several laboratories using different NAT assays. This study enabled the establishment of an international standard, 97/746, for HBV DNA NAT assays.     

Comparison of National Diabetes Data Group and World Health Organization criteria for detecting gestational diabetes mellitus

Summary We compared the criteria for diagnosis of gestational diabetes mellitus (GDM) of the National Diabetes Data Group (NDDG) and the World Health Organization (WHO) and studied the outcomes of pregnancy. A 50-g glucose screening test and 75-g oral glucose tolerance test (OGTT) were scheduled for 709 pregnant women in the same week between the 24th and 28th week of pregnancy. Blood glucose was measured 1 h after the 50-g glucose screening test and if found to be 7.8 mmol/l or more, a 100-g OGTT was scheduled within 7 days after a 75-g OGTT. The prevalence of GDM was found to be 1.4% (10/709) and 15.7% (111/709) by NDDG and WHO criteria (2 h 7.8 mmol/l), respectively. Using NDDG criteria, all the GDM patients had abnormal 75-g OGTT by WHO criteria. NDDG and WHO criteria were significantly different when compared with normal OGTT by each criteria for age, BMI, pregnancy-induced hypertension, Caesarian delivery, macrosomia and neonatal hypoglycaemia. Of 14 women with macrosomic infants 6 had an abnormal WHO test while only 3 of 14 had an abnormal NDDG test. These findings suggest that WHO criteria GDM patients had significantly worse outcomes of pregnancy and fewer perinatal complications were missed than with the more cumbersome NDDG criteria, and no case of GDM as diagnosed by NDDG criteria was missed.Abbreviations GDM Gestational diabetes mellitus - NDDG National Diabetes Data Group - WHO World Health Organization - OGTT oral glucose tolerance test - BMI body mass index