Drug utilization studies: methods and uses
World Health Organization. Regional Office for Europe; Dukes, M. N. G. ( 1993 )
A multi-authored survey of instruments and methods developed to investigate patterns of drug consumption and to answer fundamental questions about prescribing practices, therapeutic value, and safety. By reviewing the state-of-the-art in research methodology, the book also aims to show how drug utilization studies can contribute to national health policies designed to promote the availability of safe and effective medicines, while also reducing costly over-medication. Information ranges from a list of studies for assessing the impact of regulatory policies, through a review of methods for monitoring adverse drug reactions, to a discussion of the reasons why a large proportion of currently marketed drugs have not been systematically evaluated for either efficacy or safety. Throughout, emphasis is placed on the methods needed to perform reliable studies in a standardized way. The book features 12 papers authored by experts in clinical pharmacology, drug policy, drug control, and consumer affairs. The opening papers discuss the relevance of randomized clinical trials to prescribing practice, and explain how drug utilization studies can support the concepts of therapeutic formularies and essential drugs. A paper devoted to descriptive tools and analysis describes different classification systems and units for the quantification of drug use and explains the defined daily dose (DDD) system. Other papers explore the application of drug utilization studies to assess drug risks, identify factors that influence drug use and patient compliance, and evaluate drug costs and expenditure. Another group of papers considers drug utilization from the perspectives of health authorities, health professionals, and consumer organizations. The concluding papers outline the elements of a teaching strategy on the rational use of drugs and discuss the extent to which research findings can be transferred from industrialized to developing countries.
Comprehensive cardiovascular community control programmes in Europe
World Health Organization. Regional Office for Europe; Puska, P.; Leparski, E.; Lamm, G.; Heine, H.; Pereira, J.; Pisa, Z.; Thelle, D. ( 1988 )
Evaluates the methods and findings of 9 European pilot programmes designed to determine whether interventions, aimed at entire communities, could modify risks for cardiovascular diseases and improve prevention and control. Experiences in different countries, most covering more than a decade, are critically compared in an effort to draw conclusions about the success of community-wide interventions in reducing population risk factor levels and decreasing the incidence of cardiovascular mortality.
Toxic oil syndrome: current knowledge and future perspectives
World Health Organization. Regional Office for Europe ( 1992 )
A collection of six state-of-the-art reviews summarizing current research on the epidemiology, etiology, pathogenesis, and clinical pathology of the toxic oil syndrome. Over 700 investigations, including numerous unpublished reports, were critically assessed. The explosive outbreak of the toxic oil syndrome, which occurred in Spain a decade ago, affected more than 20,000 persons, claimed more than 800 lives, and left many thousands more with permanent disability. Although contaminated rapeseed oil has been identified as the vehicle of the causative agent, the agent itself has not yet been identified and the mechanisms of pathogenicity remain unknown. Continuing research also responds to the need to find effective treatment for surviving victims and to monitor carcinogenic and other potential long-term effects on health. The first chapter reviews epidemiological findings from studies designed to determine the causal agent, the factors that influenced individual susceptibility, and the long-term evolution of disease manifestations. The second chapter presents the results of a systematic 31-month follow-up of the clinical status of patients. Problems discussed include the failure of all currently available treatments and the need to explain why disability is progressive in some patients, while others gradually improve. Other chapters summarize what has been learned, from autopsy studies and surgical specimens, about the pathology of the disease, present the results of various efforts to replicate the disease in experimental models, and summarize available data on the chemical composition of contaminated oils. The final chapter explores the involvement of immunological mechanisms in the disease, drawing direction from the similarity of symptoms to those seen in graft-versus host disease and in hydantoin-induced autoimmunity. In view of the many unresolved issues and gaps in understanding, the book concludes with an outline of further research needed, supported by guidelines for specific types of investigation.
WHO in Europa 1991
Weltgesundheitsorganisation. Regionalbüro für Europa ( 1991 )
L'OMS en Europe : quarante années : l'élaboration d'une politique commune de la santé
Organisation mondiale de la Santé. Bureau régional de l’Europe; Kaprio, Leo A. ( 1992 )
Forty years of WHO in Europe: the development of a common health policy
World Health Organization. Regional Office for Europe; Kaprio, Leo A. ( 1991 )
A chronological account of milestones in the history of the WHO Regional Office for Europe, moving from 1948 to 1990. In selecting events for analysis, the author concentrates on developments that help explain how the countries of Europe were able to reach consensus on health objectives and strategies despite considerable political differences. The author served as the WHO Regional Director for Europe from 1967 to 1985. The history, which begins with the reconstruction of health services in war-devastated Europe, covers a period that saw the secession and readmission of the socialists countries, tensions between the two Germany's, and the admission of Israel to the European Region. Concerning health and disease, the history moves from the elimination of malaria and the control of tuberculosis and cholera, through an epidemic of deaths from heart attacks, to the Chernobyl nuclear accident. The period also saw the introduction of the WHO goal of health for all by the year 2000 , a concept initially ridiculed as utopian or irrelevant. The author regards the European-wide agreement on 38 specific, time-linked targets for improving public health as one of the most important achievements. His personal behind-the-scenes account reveals the magnitude of this achievement, especially in view of the great political differences that existed at that time. A concluding chapter summarizes current WHO activities that are helping to create better health conditions and more humane health care, while also promoting the concept of preventive medicine and encouraging healthier life-styles.
Clinical pharmacology: the European challenge
World Health Organization. Regional Office for Europe ( 1991 )
Reports the results of a survey on the academic status of clinical pharmacology in the medical schools and health ministries of 21 European countries. The book opens with three articles assessing the status of clinical pharmacology in Europe. These articles discuss the main functions of clinical pharmacology in the national health system, patient care, teaching and research, describe basic principles for the teaching of clinical pharmacology and the training of specialists, and propose measures that can help bring the expertise of clinical pharmacology into routine medical care. The advantages of establishing clinical pharmacology as a permanent discipline in medical schools are also presented and explained. The main contributions of clinical pharmacology are identified as improving the scientific basis of therapeutic decisions, encouraging the individualization of drug therapy, and improving the research component of drug development. The main part of the book consists of brief reports on the organization and teaching of clinical pharmacology in the medical schools of each of 21 European countries. Points covered include the recognition of clinical pharmacology as a specialty, number of posts and departments, future plans, and national associations.
Gemeindenahe genetische Beratung in Europa
Weltgesundheitsorganisation. Regionalbüro für Europa ( 1993 )
Les services génétiques au sein de la collectivité en Europe
Organisation mondiale de la Santé. Bureau régional de l’Europe; Modell, B.; Kuliev, A.M.; Wagner, M. ( 1993 )
Community genetics services in Europe: report on a survey
World Health Organization. Regional Office for Europe; Modell, B.; Kuliev, A.M.; Wagner, M. ( 1991 )
A comprehensive and highly informative account of genetic diseases in Europe and the technologies and services now available for treatment and prevention. Adopting a critical approach, the book uses the results of a European-wide survey to assess the strengths and weaknesses of existing genetics services and map out precise strategies for improvement. Details range from estimated numbers of Europeans suffering from specific genetic diseases to the average annual costs, per patient, of treatment, from advice on the safety and reliability of screening tests to a point-by-point account of deficiencies in most existing services. Throughout, an effort is made to interpret the latest knowledge in clinical genetics in terms of its implications for the design of services, including their preventive and counselling components. The books analysis, which is supported by over 100 references, is presented in four main parts. The first part summarizes and interprets current medical knowledge about the causes, mode of inheritance, prevalence, management, and possibilities for prevention of congenital malformations, chromosomal disorders, and Mendelian (single-gene) disorders. Examples cited include prenatal screening for congenital malformations and chromosomal abnormalities, neonatal screening for phenylketonuria, hypothyroidism and sickle-cell disease, and population screening for carriers of inherited diseases such as the haemoglobin disorders and Tay-Sachs disease. Facts and figures are used to indicate the magnitude of the public health problem posed by these diseases, the costs and outcome of treatment, the future number of people likely to be effected, and the urgent need for rational planning of services based on both projected needs and the development of new screening tools. A review of data on social and ethical issues soundly refutes several common assumptions, including the belief that birth incidence of genetic abnormality increases if people with disabilities reproduce, and the fear that the ability to predict a wide range of genetic characteristics will lead to abortions for minor or even frivolous reasons. The second part evaluates the quality of Europe's existing community genetics services, focusing on the extent to which current tools for primary prevention are being effectively used. Techniques discussed include the use of ultrasound scanning and maternal serum alpha-fetoprotein estimation in screening for congenital malformations, the use of karyotyping to detect chromosomal abnormalities during pregnancy, and DNA methods for carrier diagnosis and prenatal diagnosis. For each method, readers are given advice on safety, effectiveness, advantages, limitations, and the extent to which current services are meeting population needs. To guide the improvement of services, the book sets out six rigorous requirements for quality assessment and technology control that must be met before testing and counselling services are implemented on a large scale. The third part discusses the infrastructure and organization of community genetics services needed to reach the goals of relieving anxiety, increasing the proportion of healthy children born, and allowing families to live normal lives. Detailed advice on cost-benefit analysis is also provided. The final part issues 11 precise recommendations for improvements that could, if adequately implemented, reduce the annual number of births of European children with serious congenital disorders by tens of thousands.
Health promotion research: towards a new social epidemiology
World Health Organization. Regional Office for Europe; Badura, Bernhard; Kickbusch, Ilona ( 1991 )
A collection of twenty-one state-of-the-art reviews illustrating the ways in which research in the social sciences can improve understanding of the social determinants of health and disease and shape policies that promote health. Examples of specific interventions and their results are also provided. The book has five main parts. The first part focuses on strategies for improving public health policy. Articles, which underscore the need for a rigorous interdisciplinary approach to policy decisions, describe various methodological and conceptual approaches that can be used to assess problems, identify risk factors, guide policy choices, and test programmes of health promotion. Of central concern is the need to expand health policy from its traditional concern with illness and curative medicine to include multisectoral policies that create healthy environments and encourage individuals to make healthy choices. Articles in the second part, focused on social and behavioural factors, discuss the links between economic status and disease and consider the extent to which stress, coping styles, social supports, and lifestyle factors will influence individual differences in susceptibility to disease. Papers in the third part explore the ways in which families, workplaces, and hospitals can serve as settings for communicating health messages and promoting healthy practices. Population-oriented health promotion is assessed in the fourth part, which considers how policies should be changed to meet the special needs of women, the unemployed, the elderly, and the chronically ill. Details range from the question of whether paid work is good for women's health to a conceptual model linking aggregate economic change to pathological outcomes. The book concludes with a discussion of the role of community-based action in health promotion, including information on the outcome of various European programmes for the prevention of cardiovascular diseases and on the contribution of voluntary organizations and self-help groups.
Psychosocial aspects of HIV and AIDS and the evaluation of preventive strategies : report on a WHO meeting, Lisbon, 28 May -1 June 1990
World Health Organization. Regional Office for Europe ( 1990 )
A succinct summary of the main conclusions reached during a meeting convened to assess the psychosocial aspects of HIV infection and AIDS in Europe and to consider the importance of behavioural factors in planning programmes for prevention and control. Discussions and conclusions are summarized under four main headings. These cover the uses of social and behavioural research, the monitoring and evaluation of educational campaigns, the selection of target groups, and measures needed to sustain public interest and counter denial. Key points include the need to focus on risk behaviours rather than risk groups, the reasons why fear-arousing media campaigns may be counter-productive, and the value of using local, as opposed to national, surveys to gather information on risk-related attitudes, behaviours, and practices.
WHO guidelines for indoor air quality: selected pollutants
World Health Organization. Regional Office for Europe ( 2010 )
This book presents WHO guidelines for the protection of public health from risks due to a number of chemicals commonly present in indoor air. The substances considered in this review, i.e. benzene, carbon monoxide, formaldehyde, naphthalene, nitrogen dioxide, polycyclic aromatic hydrocarbons (especially benzo[a]pyrene), radon, trichloroethylene and tetrachloroethylene, have indoor sources, are known in respect of their hazardousness to health and are often found indoors in concentrations of health concern. The guidelines are targeted at public health professionals involved in preventing health risks of environmental exposures, as well as specialists and authorities involved in the design and use of buildings, indoor materials and products. They provide a scientific basis for legally enforceable standards.
Surveillance Guidelines for Measles, Rubella and Congenital Rubella Syndrome in the WHO European Region
WHO Regional Office for Europe ( 2012 )
The WHO Regional Committee for Europe adopted the goal of eliminating indigenous measles transmission in 1998. In 2005, the Regional Committee expanded this commitment to include rubella and set a date for the elimination of both diseases by 2010. Although Member States did make progress, through the implementation of a strategic plan, the goal was not achieved. The WHO Regional Committee for Europe acknowledged at its sixtieth session (2010) that the regional goal of eliminating measles and rubella is achievable, and set a new target date of 2015. In the document Eliminating measles and rubella and preventing congenital rubella infection, WHO European Region strategic plan 2005–2010, key strategies are identified to meet the targets for interrupting transmission of indigenous measles and rubella and preventing congenital rubella infection. Strengthening surveillance systems by vigorous case investigation, including laboratory confirmation, is one of these key strategies. In line with the elimination goal, Surveillance guidelines for measles, rubella and congenital rubella syndrome in the WHO European Region are intended to provide technical advice on the design and implementation of surveillance programmes. Surveillance indicators defined in these guidelines will be critical for assessing whether Member States have achieved the level of disease surveillance necessary for documenting elimination of indigenous measles and rubella transmission, and verifying that the Region’s elimination objectives have been reached.