Although Shiga toxin-producing Escherichia coli (STEC) have been isolated from a variety of food production animals, they are most commonly associated with ruminants from which we derive meat and milk. Because of the widespread and diverse nature of ruminant-derived food production, coupled with the... near ubiquity of STEC worldwide, there is no single definitive solution for controlling STEC that will work alone or in all situations. Instead, the introduction of multiple interventions applied in sequence, as a “multiple-hurdle scheme” at several points throughout the food chain (including processing, transport and handling) will be most effective.
This report summarizes the review and evaluation of interventions applied for the control of STEC in cattle, raw beef and raw milk and raw milk cheese manufactured from cows’ milk, and also evaluates available evidence for other small ruminants, swine and other animals. The information is presented from primary production, to the end of processing, providing the reader with information on the currently available interventions based on the latest scientific evidence.
This work was undertaken to support the development of guidelines for the control of STEC in beef, raw milk and cheese produced from raw milk by the Codex Committee on Food Hygiene (CCFH).
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Non-communicable diseases (NCDs) are the second common cause of death in sub-Saharan Africa (SSA) accounting for about 35% of all deaths, after a composite of communicable, maternal, neonatal, and nutritional diseases. Despite prior perception of low NCDs mortality rates, current evidence suggests t...hat SSA is now at the dawn of the epidemiological transition with contemporary double burden of disease from NCDs and communicable diseases. In SSA, cardiovascular diseases (CVDs) are the most frequent causes of NCDs deaths, responsible for approximately 13% of all deaths and 37% of all NCDs deaths. Although ischemic heart disease (IHD) has been identified as the leading cause of CVDs mortality in SSA followed by stroke and hypertensive heart disease from statistical models, real field data suggest IHD rates are still relatively low. The neglected endemic CVDs of SSA such as endomyocardial fibrosis and rheumatic heart disease as well as congenital heart diseases remain unconquered. While the underlying aetiology of heart failure among adults in high-income countries (HIC) is IHD, in SSA the leading causes are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart diseases. Of concern is the tendency of CVDs to occur at younger ages in SSA populations, approximately two decades earlier compared to HIC. Obstacles hampering primary and secondary prevention of CVDs in SSA include insufficient health care systems and infrastructure, scarcity of cardiac professionals, skewed budget allocation and disproportionate prioritization away from NCDs, high cost of cardiac treatments and interventions coupled with rarity of health insurance systems. This review gives an overview of the descriptive epidemiology of CVDs in SSA, while contrasting with the HIC and highlighting impediments to their management and making recommendations.
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INTRODUCTION: Lower extremity peripheral artery disease (PAD) is increasing in prevalence in low- and middle-income countries creating a large health care burden. Clinical management may require substantial resources but little consideration has been given to which treatments are appropriate for les...s advantaged countries.
EVIDENCE ACQUISITION: The aim of this review was to systematically appraise published data on the costs and effectiveness of PAD treatments used commonly in high-income countries, and for an international consensus panel to review that information and propose a hierarchy of treatments relevant to low- and middle-income countries.
EVIDENCE SYNTHESIS: Pharmacotherapy for intermittent claudication was found to be expensive and improve walking distance by a modest amount. Exercise and endovascular therapies were more effective and exercise the most cost-effective. For critical limb ischemia, bypass surgery and endovascular therapy, which are both resource intensive, resulted in similar rates of amputation-free survival. Substantial reductions in cardiovascular events occurred with use of low cost drugs (statins, ACE inhibitors, anti-platelets) and smoking cessation.
CONCLUSIONS: The panel concluded that, in low- and middle-income countries, cardiovascular prevention is a top priority, whereas a lower priority should be given to pharmacotherapy for leg symptoms and revascularisation, except in countries with established vascular units.
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The effective vaccine management (EVM) workshop, jointly organized by WHO and UNICEF, was attended by participants from 13 countries, who reviewed the various EVM benchmarks, identified the gaps in policies, guidelines, SOPs and job aids, and developed respective country action plans to fill these g...aps. This meeting report outlines the proceedings and outcomes of the workshop conducted in Bangkok, Thailand, in December 2024
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Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children. A task force supported by the European Respiratory Society has developed these evidence...-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
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Although asthma is very common, affecting 5–10% of the population, the diagnosis of asthma in adults remains a challenge in the real world, which results in both over- and under-diagnosis. A taskforce was set up by the European Respiratory Society to systematically review the literature on the dia...gnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendations for clinical practice.
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Adults and adolescents 12+ years. Asthma medication options: Adjust treatment up and down for individual patient needs
The primary goal of the guideline is to improve the quality of care and the outcome in people with type 2 diabetes in low-resource settings. It recommends a set of basic interventions to integrate management of diabetes into primary health care. It will serve as basis for development of simple algor...ithms for use by health care staff in primary care in low-resource settings, to reduce the risk of acute and chronic complications of diabetes. The guideline was developed by a group of external and WHO experts, following the WHO process of guideline development. GRADE methodology was used to assess the quality of evidence and decide the strength of the recommendations.
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The MSF malaria guidelines provide practical, evidence-based recommendations for diagnosing, treating, and preventing malaria, especially in low-resource settings. They cover uncomplicated and severe cases, recommend rapid tests and artemisinin-based therapies, and include special guidance for vulne...rable groups like children and pregnant women.
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In the European Union, over 20 million people suffer from asthma. During the 1990s there was a rapid decrease in asthma mortality, probably related to the increased use of inhaled corticosteroids (ICS). However, during the last decade, asthma mortality rates have plateaued, and a consistently high p...roportion of patients have uncontrolled asthma. As a result, many patients with asthma still have impaired quality of life and suffer from chronic respiratory symptoms, often including night-time symptoms, causing sleep disturbance, excessive daytime sleepiness and decreased work productivity.
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The document titled "Use of Non-Sugar Sweeteners: WHO Guideline" provides recommendations from the World Health Organization on the use of non-sugar sweeteners (NSS) to reduce sugar intake, manage weight, and prevent diet-related noncommunicable diseases (NCDs). It discusses the potential effects of... NSS on body weight, blood sugar control, and long-term health risks such as type 2 diabetes and cardiovascular disease. The guideline highlights limited evidence on the benefits of NSS for weight control and raises concerns about possible health risks with long-term use, leading WHO to suggest limiting NSS consumption as a preventive health measure.
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Over a period of two decades, under-5 mortality rate in Bangladesh has declined by 66% from 133 per 1000 live births in 1993-94 to 45 per 1000 live births in 2017-18. The country reached the MDG-4 goal in the reduction of child mortality on time. However, the comparison of neonatal and under-5 morta...lity rates in Bangladesh over the same years reveals that the reduction in the neonatal mortality rate was much slower than the child mortality rate. This led to a rise in the proportion of neonatal deaths in overall under-five deaths from 40% in 1993-1994 to 67% percent in 2017-2018. More than 75% of neonatal deaths occur within the first 7 days. To achieve SDG target 3.2, Bangladesh has to further reduce under-5 mortality rate by 44% and newborn deaths by 60%. Infection is the leading cause of preventable deaths among the neonates and the young infants and the standard recommendations for treating severe bacterial infections in infants under 2 months of age include hospitalization and 7-10 days of parenteral therapy.
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