Magister Chirurgiae Dentium (MChD) / The dental clinic of the University of the Western Cape provides oral health care for many preschool children. The clinical observation was that these children presented with rampant dental caries. A recent report compi1ed by an international Joint Working Group of the Internationale Dental Federation and the World Health Organisation identified the changes in oral health in children and factors associated with these changes. South Africa presents a unique opportuni ty to study the oral health status of different ethnic and socio-economic groups. A review of the relevant literature indicated that there was a lack of published data, especially on the oral health status of preschool children. A study was designed to investigate the oral health status of a selected group of preschool children ages 2-6 years in the Western Cape. The examinations were conducted at twelve different créches by two calibrated examiners. The examinees' weight and height were also measured. The data was recorded on a revised World Health Organization Basic Oral Health Assessment form. A total of 547 children were examined with an almost equal distribution of males and females. Only 18% of the sample had a compl ete sound primary dentition, dmft = O. The mean dmft was 5.37 which ranged from 2.73 for the 2 year age group to 7.01 for the 5 year age group. The mean dt of 4.09 made up 76% of the dmft, the mean mt of 1.22 made up 23% and the ft was negligible. Seventy-eight percent of the sample had decayed teeth present and 28% had missing teeth recorded. The treatment chosen by or for these children appeared to be extractions. Observations of extensively decayed teeth and the high prevalence of dento-alveolar abscesses suggested that this treatment was of an emergency nature. There was much unmet treatment as only 22% of subjects were free of decay and those with decayed teeth present had an average of 5. The dmft distribution showed 48% had a dmft.)5. There was a statistically significant linear association between the dmf and age for all the tooth types except the cani nes. There was no significant difference in caries prevalence between males and females. The phenomenon of bilateral symmetrical occurrence of dental caries in the primary dentition was demonstrated in the present study. The maxillary central incisors were the most frequently affected teeth (55%), followed by the mandibular second molars (47%) and maxillary second molars (42%). This is contrary to the findings in European communities where the primary second molars are the most susceptible tooth types. The present study found the fifth year of 1ife to be the critical one for the primary dentition. It was at this age that the greatest increment in dmft was observed, the greatest decrease in the number of caries-free subjects, more than a twofold increase in rampant caries, and a twofold increase in the number of subjects with dento-a1veo1ar abscesses. Few hard tissue anomalies were recorded. Localized enamel hypoplasia was quite common especially of the upper incisors and second molars. Most children claimed their teeth were brushed at least once a day. But soft deposits were present in almost all age groups in all the segments. Sixty percent of the sample had the sole responsibility of brushing their own teeth with no assistance from their parents. Parental assistance with toothbrushing was limited to the younger age group. In the present study soft deposits and gingivitis were recorded mostly on the buccal of the upper posterior segments and on the lingual of the lower posterior segments. The anterior segmentshad less plaque than the posterior segments. Thi s may be due to children finding it easier to brush anteriorly than posteriorly when they do brush. Also, the other areas are less accessible and require greater manipulative skill. There was a weak correlation between the total soft deposits and total gingivits. Although 60% of the sample had six segments of soft deposits present, only 4% had )six segments of gingivitis present. However, it was found that the higher the number of segments of soft deposits present, the greater the tendency for the presence of gingivitis. The association between dmft and soft deposits was not significant but between dmft and gingivitis was significant. This may be more preci se as these two are both cumulative measures. Soft tissue lesions were generally uncommon in this age group. The children in this community were generally lighter in weight and shorter in height compared to the NCHS (1979) percentiles. Recommendations regarding ways of redressing the obviously inadequate general and oral health of this sample of children were made.

Master of Public Health - MPH / The World Health Organisation recommendations for breastfeeding in the general population, including mothers living with HIV, emphasise breastfeeding within one hour of birth, exclusive breastfeeding (EBF) during the first six months of life, and continued breastfeeding for up to two years or beyond. However, only 34.8% of infants worldwide are exclusively breastfed for the first six months of life, and as a result, about 1.4 million infants lose their lives due to undernutrition. In South Africa, only 31.6% of infants are exclusively breastfed for the first six months. Despite the benefits of exclusive breastfeeding, many mothers living with HIV do not initiate breastfeeding or discontinue breastfeeding prematurely. It is, therefore, crucial to determine the barriers inhibiting the uptake of EBF and factors promoting mothers living with HIV to adopt exclusive breastfeeding.

Bakgrund: Operationsteamet består av ett komplext samspel mellan olika professioner som tillsammans ska arbeta kring patienten vid kirurgiska ingrepp. Kirurgisk säkerhetschecklista [KSC] är ett redskap som ska bistå med hjälp för samarbetet och kommunikationen inom operationsteamet. Det finns en stor mängd forskning som bevisar hur KSC förbättrar mortalitet, morbiditet och patientsäkerheten, trots detta har operationsteamet bristande följsamhet gentemot KSC. Syfte: Syftet med denna litteraturöversikt var att beskriva operationsteamets uppfattningar av att använda KSC. Metod: Litteraturöversikten baserades på 14 vetenskapliga artiklar av kvalitativ, kvantitativ och mixad ansats. Artiklarna kvalitetsgranskades, analyserades, sönderdelades, tematiserades och sammanfogades till denna översikts resultat. Resultat: KSC kunde bidra till förbättrat teamarbete, kommunikation, och arbetsmiljö på operationssalen, samtidigt uppmärksammades olika hinder med samarbetet kring KSC. Personliga attityder, ställningstaganden och övertygelser hos de olika professionerna var faktorer som påverkade teamarbetet. Hur operationsteamet var lett påverkade även samarbetet kring KSC. Upplevelsen av tidsbrist och svårigheter med timing försvårade genomgången av KSC. Slutsats: Det är essentiellt att förstå den komplicerade arbetsmiljön på operationssalarna och hur KSC kan underlätta arbetet i operationssalen men även vilka faktorer som försvårar för operationsteamet att arbeta säkert. För att bilda en djupare uppfattning om operationsteamets komplexitet och arbete med KSC krävs vidare forskning. Resultatet av denna litteraturöversikt skulle kunna bistå med hjälp för klinikerna i sitt arbete kring säkerheten och samarbetet på operationssalarna. / Background: The surgical team consists of a complex interaction between different professionals who work together around the patient during surgical procedures. Surgical Safety Checklist [SSC] is a tool that should assist the interaction and communication within the surgical team. There is a great deal of research that proves how SSC improves mortality, morbidity and patient safety. The surgical team has despite that a lack of compliance with SSC. Aim: The aim of this litterateur review was to describe the surgical team’s perceptions of using the SSC. Method: The literature review was based on 14 scientific articles of qualitative, quantitative and mixed approaches. The articles were quality checked, analysed, broken down, thematized and merged into the result of this overview. Result: SSC was able to contribute to improved teamwork, communication, and work environment in the operating room, while at the same time various obstacles were highlighted with the collaboration around SSC. Personal attitudes, standpoints and beliefs within the various professions were factors that influenced teamwork. How the surgical team was led also affected the collaboration around SSC. The experience of lack of time and difficulties with timing made the performance of SSC more difficult. Conclusion: It is essential to understand the complicated work environment in the operating rooms and how SSC can facilitate the work in the operating room, also what factors hinder the operating team to work safely. In order to form a deeper understanding of the complexity of the operation team and their work with SSC, further research is needed. The result of this literature review could be of assistance to clinics in their work to improve safety and collaboration in the operating rooms.

Clinical practice, public health, and policy guidelines should be developed based on a systematic approach that uses the best available evidence. The advent of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework has facilitated this, resulting in a transparent approach to guideline development. GRADE suggests that guideline developers seldom make strong recommendations based on low or very low confidence in effect estimates (strong l/vl). The World Health Organization (WHO) produces recommendations that guide public health policy and, in 2003, WHO adopted the GRADE approach to guideline development. Initial anecdotal evidence suggested that WHO issues a large number of strong recommendations and particularly strong l/vl. Our research team evaluated the nature of WHO recommendations and conducted a qualitative study using interviews of guideline panel members. Key findings included: i) WHO makes a large proportion of recommendations as strong l/vl ii) many strong l/vl are inconsistent with GRADE guidance iii) reasons guideline panel members offered for strong l/vl included skepticism about the value of making conditional recommendations; political considerations; a high confidence in benefits despite formal ratings of low confidence; and long-standing practices, funding, and policy; iv) methodologist interviewees indicated panelists’ lack of commitment to conditional recommendations; a perceived tension between methodologists and panelists due to resistance to adhering to GRADE guidance; both financial and non-financial conflicts of interest among panel members as explanations of strong l/vl; and the need for greater clarity of, and support for, the role of methodologists as co-chairs of panels. The understanding of when and why strong l/vl are formulated at WHO is an important methodological issue that has implications not just for WHO, but for a wide range of guideline developers elsewhere. Our findings offer insights that may guide interventions to enhance trustworthiness of practice guidelines. / Thesis / Doctor of Philosophy (PhD)

Neglected tropical diseases are parasitic and bacterial diseases mainly prevalent in developing countries affecting people living in poverty. The World Health Organization’s human rights-based approach emphasizes the “prevention, control, elimination and eradication of neglected tropical diseases” through the use of preventative chemotherapy, such as the mass administration of deworming drugs to improve people’s health.This research paper will take a deeper look at how WHO has been communicating NTDs to make them less ‘neglected’ and how the NTD discourse has been shaping development organizations’ action. In addition, it aims to investigate how successful mass deworming has really been in terms of the recent debate.This study is using a combination of a discourse analysis and qualitative interviews in order to investigate how the NTD discourse and recent initiatives by international organizations have contributed to making NTDs less neglected. It deconstructs representations of the ‘Other’ – the superiority of the ‘West’ over the ‘Rest’ – in relation to the NTD discourse and its inherent power structures. Discourses are analyzed to identify power relations between governments, development organizations, pharmaceutical industries, and recipients of deworming drugs as part of Kenya’s 2013 deworming campaign.The results showed that the NTD discourse has helped raise awareness for NTDs. NTDs and their debilitating effect on populations have been better and more widely communicated, making them less ‘neglected’. WHO and other development organizations’ actions have contributed to making NTDs more visible and have given NTDs higher priority on the global health agenda. Findings from this research study revealed that the ongoing debate has not had a negative impact on international funding. More research and development of a vaccine against NTDs is needed to find more ways to tackle these devastating diseases.

No / The World Health Organization (WHO) was intended to serve at the forefront of efforts to realize human rights to advance global health, and yet this promise of a rights-based approach to health has long been threatened by political constraints in international relations, organizational resistance to legal discourses, and medical ambivalence toward human rights. Through legal research on international treatyobligations, historical research in the WHO organizational archives, and interview research with global health stakeholders, this research examines WHO's contributions to (and, in many cases, negligence of) the rights-based approach to health. Based upon such research, this article analyzes the evolving role of WHO in the development and implementation of human rights for global health, reviews the current state of human rights leadership in the WHO Secretariat, and looks to future institutions to reclaim the mantle of human rights as a normative framework for global health governance. (C) 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

The topic of this diploma thesis is Infectious diseases and migration. Its aim is to assess the distribution of selected infectious diseases in the world and in Europe, with a focus on Czech context. While from the literature it can be concluded that the spread of serious infectious diseases is conditioned by migration, based on the available data it cannot be confirmed that immigration currently constitutes a significant threat for Czech citizens.

La notion de Réadaptation à Base Communautaire (RBC), promue par l'OMS, a pour objectif de favoriser l'intégration des personnes en situation de handicap. Cette stratégie est née du constat de la nécessité de conjuguer les efforts des différents acteurs (les personnes handicapées et leurs familles, la communauté, les services sociaux, les services de santé, d'éducation et de formation) pour assurer la réussite et la pérennité des actions. Développé dans les pays en voie de développement, le concept de Réadaptation à Base Communautaire s'applique également aux pays industrialisés, où il est souvent appelé "désinstitutionalisation". La diversité des contextes, tant géographique, économique, politique que culturelle, nécessite une adaptation des modes de gouvernance et des actions. Cette adaptation résulte d'une évaluation poussée, qu'il s'agisse de l'évaluation ex ante, ou des évaluations en cours de programme ou de l’évaluation ex post.Cette thèse présente des outils d'évaluation et des modes de gouvernance adaptés aux programmes RBC. Elle présente également une étude sur la pertinence et les limites de ce concept.Alors est-ce que la RBC est une stratégie pertinente et efficiente, facilement adaptable à tous les contextes ? Quelles en sont les limites ? La présente recherche tentera d'apporter des réponses à ces questions à travers l'étude de trois contextes différents : la France, le Maroc, et le Cameroun / The notion of Community Based Rehabilitation (CBR), promoted by the World Health Organisation (WHO), has as its main objective the integration of individuals living with a disability. This strategy arose from an acknowledgment of the necessity of pooling the efforts of people involved (people with disabilities and their families, the community, social services, health services, educational and training services) to ensure the success and sustainability of the actions undertaken.Developed in emerging countries, the concept of Community Based Rehabilitation also applies to industrialized countries, where it is often called "de-institutionalisation". The diversity of contexts, including geographical, economical, political as well as cultural, requires the adaptation of governance models and actions. This adaptation is carried out following a thorough evaluation and the evaluation may be ex ante, ongoing or ex post. This thesis presents evaluation tools and governance models adapted to the CBR. It also presents a study on the relevance and limits of this concept.So, is the CBR a relevant and efficient strategy, easily adaptable to every context? What are its limits?The present research will attempt to provide answers to these questions through the study of three different geographical contexts: France, Morocco and Cameroon

Em sua maioria, as pesquisas que investigam a qualidade de vida de pessoas com deficiência intelectual (DI) apresentam a opinião dos atendentes pessoais e/ou familiares sobre a pessoa com deficiência ou sobre si mesmos, encontrando-se um número reduzido de estudos referentes à opinião das pessoas com DI a respeito de suas vidas. Sendo assim, o presente estudo teve como objetivos investigar a percepção de indivíduos com DI sobre sua qualidade de vida e comparar com a percepção de seus atendentes pessoais. Os participantes da pesquisa foram selecionados e incluídos no presente estudo a partir da indicação de equipamentos de saúde e assistência social, vinculados à Prefeitura do Município ou ao Estado de São Paulo, aos quais estão cadastrados. Foram incluídos no estudo 51 indivíduos com idade entre 19 e 59 anos, residentes na cidade de São Paulo com diagnóstico médico de deficiência intelectual, que não apresentaram como comorbidades deficiências físicas e/ou transtornos mentais, e 31 atendentes pessoais. Os participantes com deficiência responderam o questionário WHOQOL-bref-ID e seus atendentes pessoais responderam o questionário WHOQOL-bref-ID proxy e Questionário sobre Perfil Socioeconômico. Os dados obtidos foram analisados e relacionados com as variáveis: sexo, idade, raça, diagnóstico médico e perfil socioeconômico e percepção das famílias quanto à qualidade de vida destes indivíduos. Os indivíduos com DI apresentaram maior pontuação no domínio Psicológico e menor pontuação no domínio Discriminação do questionário, já os atendentes pessoais apresentaram maiores pontuações para o domínio Físico e menores para o domínio Autonomia. As variáveis sexo, raça e perfil socioeconômico apresentaram correlações significativas com o domínio Social do protocolo. Quanto à comparação entre a autoavaliação e a avaliação por representante foram observadas diferenças estatisticamente significativas em cinco dos sete domínios avaliados / There are few studies about how people with intellectual disability (ID) perceive their own quality of life, with research being focus, mainly, in the opinion of caregivers and/or family. For this reason, the aim of this study was to increase knowledge and understanding of how people with ID perceive their own quality of life. Participants were selected from the register of São Paulo city hall. Fifty-one participants, aged 19-59 years, living in São Paulo city with a diagnostic of ID, that did not present any comorbidities, as physical or mental disabilities, were included. Thirty-one caregivers were also included in this study. The participants with ID answered the WHOQOL-bref-ID and their caregivers answered WHOQOL-bref-ID proxy and the socio-economic profile questionnaire. Data was analyzed in relation to the following variables: gender, age, race, diagnostic, socio-economic profile and family\'s perception regard the quality of life of the participants with ID. The individuals with ID presented higher score on the psychologic domain and lower score in the discrimination domain of the questionnaire. The caregivers presented higher scores on the physical domain and lower scores in the autonomy domain. The variables gender, race and socio-economic profile presented significant correlations with the social domain of the questionnaire. Regard the comparison between self-perception and the perception of caregivers it was possible to observe significant differences in 5 of the 7 evaluated domains

Nas últimas décadas, verificou-se diferenças nas classificações da World Health Organization (WHO) de 2001 e da European Organization for Research and Treatment of Cancer (EORTC) de 1997 para os linfomas cutâneos primários. Em 2005, representantes dessas classificações se reuniram e em consenso estabeleceram a classificação WHO-EORTC que foi adotada pela última classificação da WHO de 2008. O presente estudo visa a avaliar a aplicabilidade dessa nova classificação em casuística retrospectiva de um único centro de referência no diagnóstico e tratamento de linfomas cutâneos. Assim, todos os casos de linfoma cutâneo de células T, excluindo-se micose fungóide (MF) e síndrome de Sézary (SS), no período de 1986 a 2009, foram analisados em relação aos aspectos clínicos, histopatológicos e imunofenotípicos, incluindo-se a realização de novas reações imunoistoquímicas. Os casos foram, então, classificados de acordo com critérios estabelecidos na classificação WHO de 2008. Houve, assim, 33 casos de linfomas cutâneos de células T não-MF e não-SS, sendo 08 (24,2%) de linfoma cutâneo de grandes células anaplásicas, 05 (15,2%) de papulose linfomatóide, 06 (18,1%) de linfoma extranodal de células NK/T tipo nasal, 05 (15,2%) de neoplasia de células dendríticas plasmocitóides blásticas, 05 (15,2%) de linfoma/leucemia de células T do adulto e 04 (12,1%) de linfoma de células T periféricas, sem outra especificação. Portanto, a classificação WHO de 2008 é aplicável à maioria dos casos de linfoma cutâneo de células T não-MF e não-SS. Entretanto, permanecem casos não classificáveis, alguns dos quais com curso clínico agressivo / Recent years have witnessed differences between the World Health Organization (WHO) 2001 and the European Organization for Research and Treatment of Cancer (EORTC) 1997 classification systems of primary cutaneous lymphomas (PCLs). In 2005, a joint WHO-EORTC classification system for PCLs has been reached and was adopted by last WHO 2008 classification. This study was performed to assess the applicability of this new classification to a single referral center. All cutaneous T-cell lymphoma (CTCL) cases, excluding mycosis fungoides (MF) and Sezary syndrome (SS), who were referred from 1986 to 2009 were included. The clinical features, histological and immunohistochemical stainings were reviewed, and additional stains were performed as needed. The cases were then reclassified according to the WHO 2008 classification. There were 33 cases of non-MF and non-SS CTCL, included 08 (24.2%) CD30+ anaplastic large-cell lymphomas, 05 (15.2%) cases of lymphomatoid papulosis, 06 (18.1%) extranodal NK/T-cell lymphoma nasal type, 05 (15.2%) blastic plasmacytoid dendritic cell neoplasm, 05 (15.2%) adult T-cell lymphoma/leukemia and 04 (12.1%) peripheral T-cell lymphomas, unspecified. The new WHO 2008 classification is applicable to most nonMF and non-SS CTCL cases. However, there is still a substantial subset of T-cell PCLs which cannot be classified beyond the unspecified peripheral T-cell category, some of which may have an aggressive course