WHO code for child health

WHO has published the first internationally agreed upon classification code for assessing the health of children and youth in the context of their stages of development and the environments in which they live.

The International Classification of Functioning, Disability and Health for Children and Youth (ICF–CY) confirms the importance of precise descriptions of children's health status through a methodology that has long been standard for adults.

Viewing children and youth within the context of their environment and development continuum, the ICF–CY applies classification codes to hundreds of bodily functions and structures, activities and participation, and various environmental factors that restrict or allow young people to function in an array of every day activities.

The rapid growth and changes that occur in first two decades of life were not sufficiently captured in the International Classification of Functioning, Disability and Health (ICF), the precursor to the ICF–CY.

The launch of the ICF–CY addresses this important developmental period with greater detail. Its new standardised coding system will assist clinicians, educators, researchers, administrators, policy makers and parents to document and measure the important growth, health and development characteristics of children and youth. Children who are chronically hungry, thirsty or insecure, for example, are often not healthy and have trouble learning and developing normally.

This classification provides a way to capture the impacts of the physical and social environment so that these can be addressed through social policy, health care and education systems to improve children's wellbeing. “The ICF-CY will help us get past simple diagnostic labels. It will ground the picture of children and youth functioning and disability on a continuum within the context of their everyday life and activities.

In this way it enables the accurate and constructive description of children’s health and identifies the areas where care, assistance and policy change are most needed,” said Ros Madden, Australian Commission on Safety and Quality in Health Care, and, Chair of the Functioning and Disability Reference Group of the WHO Family of International Classifications (WHO-FIC) Network. The ICF–CY has important implications globally for research, standard setting and mobilising resources.

“For the first time, we now have a tool that enables us to track and compare the health of children and youth between countries and over time,” said Nenad Kostanjsek of WHO's Measurement and Health Information team.

In a few years’ time, instead of fiddling with needle and thread, surgeons may simply use glue to connect implants to living tissue. They took their idea from mussels, which can stick to any surface, be it porous rock or the smooth hull of a ship.

It sounds like a venturous plan: Implants such as artificial heart valves and vessels are to be welded to the body’s own tissue using a special glue, completely obviating the need for bothersome sutures. The bond will be rapidly hardened by UV light, so that only 30 seconds later, the foreign object is firmly implanted in the patient’s body.

Dr. Klaus Rischka, a chemist at the Fraunhofer Institute for Manufacturing Engineering and Applied Materials Research IFAM in Bremen, is confident that this scenario will soon become reality.

In the course of this award-winning project, the Fraunhofer researcher and his partners at Frankfurt University Hospital, the Center of Biotechnical Engineering BitZ at Darmstadt University of Technology, the State Materials Testing Institute MPA and the implant manufacturer Straumann in Freiburg will initially demonstrate the glue’s suitability on the basis of a dental implant made of titanium.

The glue has been developed from mussels, which have a glue which works under water, but is also a particularly firm and lasting bonding agent. The strength of the bond is due to a particular protein.

Chemists at IFAM are able to synthetically reproduce the key elements of the substance, and have already used them in a joint project with the European Space Agency ESA to develop an adhesive intended for everyday repairs in manned spaceflight. The use of this substance in medical applications requires an additional ingredient: a growth protein, which can likewise be synthetically produced using the classic technique of solid-phase peptide synthesis.

Its purpose is to stimulate cell growth so that the body’s own tissue bonds as closely as possible with the implant. A third component, in the form of a classic polymer, is then added as a carrier substance. Over the next two years, the participating chemists, medics and engineers intend to create a basis for practical applications.

According to Rischka, it may then take another five to ten years before the glue is ready to be used on humans.

A newly released software program will let health authorities at the site of an infectious disease outbreak quickly analyse data, speeding the detection of new cases and the implementation of effective interventions.

The program, called TranStat, was developed by a team of epidemiologists and computer scientists from the Models of Infectious Disease Agent Study (MIDAS), an international programme supported by the US National Institutes of Health (NIH) to build computational models for studying disease spread.

“A main goal of MIDAS is to make the models developed by the researchers available to the public health community and policymakers,” said Jeremy M. Berg, PhD, director of the US National Institute of General Medical Sciences, the NIH component that funds MIDAS.

“TranStat is a great example of how MIDAS is providing tools to help communities prepare for emerging infectious disease outbreaks.” Available for free and downloadable at <www.midasmodels.org>, TranStat can be used by public health officials to systematically enter and store infectious disease data. These data include details about the infected individuals, such as their sex, age, and onset of symptoms; their close contacts; and any interventions they might have received. The program also prompts the field personnel to enter details about exposed but uninfected individuals.

The system does not collect names or other personally identifying information. Ira Longini, PhD, a biostatistician at the Fred Hutchinson Cancer Research Center and the University of Washington in Seattle, directed the research behind TranStat.

He said: “The faster we learn about emerging infectious diseases and their characteristics, the quicker we can contain and mitigate them. TranStat will help us do this by standardising data collection and analysis.” Future software enhancements that will allow field personnel to enter more refined data about the affected population and their social networks are under way.



Paediatric medicine

Efforts to ensure children have better access to medicines appropriate for them intensified recently with the unveiling of a new research and development agenda by WHO. The agenda, presented at the London launch of a campaign named “Make medicines child size”, targets a range of medicines – including antibiotics, asthma and pain medication – that need to be better tailored to children's needs.

It calls for further research and development of combination pills for HIV/AIDS, TB and malaria, as well as appropriate child therapy for a number of neglected tropical diseases. “The gap between the availability and the need for child-appropriate medicines touches wealthy as well as poor countries,” said Dr Margaret Chan, WHO director-general. “As we strive for equitable access to scientific progress in health, children must be one of our top priorities.”

WHO has already begun work to promote increased attention to research into children's medicines. WHO is building an Internet portal to clinical trials carried out in children and will publish the web site containing that information this year.

On 6 December WHO released the first international List of Essential Medicines for Children. The list contains 206 medicines that are deemed safe for children and address priority conditions.

“But a lot remains to be done. There are priority medicines that have not been adapted for children's use or are not available when needed,” said Dr Hans Hogerzeil, director of Medicines Policy and Standards at WHO. In industrialised societies more than half of the children are prescribed medicines dosed for adults and not authorised for use in children.

In developing countries, the problem is compounded by lower access to medicines. Each year about 10 million children do not reach their fifth birthday. Approximately six million of these children die of treatable conditions and could be saved if the medicines they need were readily available, safe, effective and affordable.

● Visit: www.who.int/childmedicines/



In-flight EMS criticised

An award-winning medical team has called for the aviation industry to develop a uniform approach to collating information after medical emergencies occur in flight.

Dr James Ferguson, a senior consultant at the university teaching hospital Aberdeen Royal Infirmary (ARI), and leading clinician for TheFirstCall, an advanced telemedicine services provider, presented the results of a five year clinical study at the Royal Society of Medicine in London recently.

He told his peers that when it comes to air ground medical services, many in the sector are “still working on decisions based on assumptions made 20-30 years ago”. One of the study findings, for example, was that older travellers are no more likely than younger people to need emergency care in flight.

Dr Ferguson said: “There is a misguided assumption that elderly people will be the cause of more emergency calls. We discovered that there is no relationship between old age and calls for assistance.

In fact, the most common age group to experience difficulties is the 21-30 yearolds.” Dr Ferguson has long advocated the use of ‘evidence based’ medicine, i.e. care based on looking at historical data, rather than ‘best guess’ diagnosis of symptoms as they present.

He would like to see a standard industry-wide diagnostic form used when inflight medical emergencies occur in order to provide the best medical care to improve patient outcomes and ultimately save more lives. Anonymous data taken from the forms should then be collated and made available to all EMS providers. A doctor on board could be a hindrance.

Dr Ferguson said: “Statistically in something like 80% of long-haul flights, there is likely to be a medical professional on board. However, that person is not necessarily skilled in emergency care, which is a particular expertise.

They are also frequently likely to have had a drink or taken a sleeping pill, so not in the best state to provide assistance. With a standardised alpha-numeric form it would be easy to download information to experts on the ground as quickly as possible. For example you could ask ‘is the person breathless’, where ‘breathless’ equates to A1, ‘very breathless’ equates to A2 etc.

This would be invaluable where voice connections are poor.” TheFirstCall also discourages people on board from making quick diagnoses, preferring rather to treat the symptoms as they appear.

Dr Ferguson also slamed the use of generic on board medical kits designed decades ago to cater for every possible eventuality. He said: “When you have a bag full of powerful drugs, you can limit your options and cause more harm than good.

The vast majority of emergencies can be treated with simple remedies, like oxygen. I’d recommend putting a few everyday medicines in the bag, such as ibuprofen, an epi pen and Imodium to treat the most common illnesses that present on board.” These kits could be more rationally designed from the evidence of what is occurring on board.



Neonatal paediatric award

A researcher who focuses on preventing brain damage in babies has won a highly prestigious award given by Finland every five years in honour of a pioneer in paediatrics. David Edwards, the Weston Professor of Neonatal Medicine at Imperial College, London, won the Arvo Ylppö medal, a 50,000 Euro prize.

Professor Edwards's research concentrates on how babies become brain damaged and how this can be prevented. With his collaborators he showed that it may be possible to reduce the risk of brain damage in a baby starved of oxygen at birth, simply by cooling the brain.

Newborns who are starved of oxygen during birth can suffer brain damage, which can in turn lead to cerebral palsy. Researchers now believe that this can be prevented by cooling the baby a few degrees.

This very simple and inexpensive treatment has the potential to be extremely valuable, particularly in parts of the developing world where problems during birth are common and healthcare resources scarce.

Professor Edwards's team is also using a unique Magnetic Resonance Imaging (MRI) scanner sited within the Neonatal Intensive Care unit to understand how premature birth injures the brain, and to carry out studies of treatments to prevent this.



$420m for CERF

Some 70 donors, ranging from wealthy industrialised countries to poor states to corporations, pledged (14 December) US$420 million for 2008 to the UN emergency fund that seeks to save the lives of millions of people by providing immediate aid in the case of sudden or neglected crises, be they natural disasters or man-made conflicts.

“Their generosity is really overwhelming and it is very good news,” UN Under- Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator John Holmes said at the end of the pledging conference for the Central Emergency Response Fund (CERF). Launched in March 2006 as part of the ongoing process of UN humanitarian reform, the CERF has now received more than US$1 billion, both donated and pledged, for the threeyear 2006-2008 period.

The pledges brought the Fund to within what Holmes called “touching distance” of its $450 million target for donations. A further $50 million revolving loan comprises the rest of the CERF's annual $500 million goal. “The CERF is crucial for our ability to assist quickly millions of vulnerable people around the globe, as it enables us to carry out immediate life-saving activities wherever and whenever required,” Holmes said.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) said the CERF has helped to save millions of lives during its first two years by providing quick initial funding for lifesaving assistance and rapid response in sudden onset, rapidly deteriorating, and under-funded humanitarian emergencies and natural disasters - lives that could have been lost to inevitable delays under previous less-funded arrangements.

The UK led the top pledges with $81.6 million, followed by the Netherlands with $58.9 million, Sweden with $55.9 million, Norway with $55.4 million, Canada with $39.5 million and the Republic of Ireland with $33.3 million.

It was not only the amount of money that was praised by Holmes, but the wide spectrum of donors, including poor countries who themselves are or have been beneficiaries of the Fund.

Among those making the pledge was the first major corporate donor to the CERF with a $100,000 pledge from Western Union. “We're also looking to increase our contributions from the private sector,”

Holmes noted. “We'll perhaps be launching in 2008 a particular targeted effort from the private sector, whether from high-worth individuals, or corporations or foundations.” He stressed that in conflicts the biggest single reason for humanitarian aid is to assist people who have been displaced, as in Sudan's strife-torn Darfur region where some 2.4 million people are now in camps and receiving aid, including money from the CERF.