Recent WHO publications

RecentWHO publications/Publications recentesOMS Readers living in developing countries receive a 30% reduction on the prices indicated in Swiss francs. Les lecteurs r6sidant dans les pays en d6veloppement b6n6ficient d'un rabais de 30% sur les tarifs indiqu6s en francs suisses. Chemical toxicology, carcinogenicity Polybrominated biphenylsa Geneva, 1994, 577 pages (Environmental Health Criteria, No. 152). ISBN 92 4 157152 7 Price: Sw.fr. 79.-/US$ 71.10 Polybrominated biphenyls (PBBs) were introduced as flame retardants in 1970 and used in the manufac- ture of small appliances and in automotive applica- tions, coatings, lacquers, and polyurethane foam. Research on PBBs has been especially intense fol- lowing a 1973 poisoning in the State of Michigan, USA, caused when the flame retardant FireMaster® was confused with magnesium-oxide-based cattle feed supplement. The flame retardant was added to animal feed and distributed to farms within the state. The ensuing contamination of farm animals resulted in the destruction of several thousands of cattle, pigs, and sheep, and more than a million chickens. Since the cause of contamination remained undetected for almost a year, thousands of farmers and other consu- mers were exposed to PBBs through the consump- tion of contaminated meat, eggs, and dairy products. Although production of PBBs has been halted or restricted in many parts of the world, these chemicals remain of enduring concern due to their extreme per- sistence in the environment, their concentration in the food chain, their marked tendency to bioaccumu- late in living organisms, including humans, and the potential for adverse health effects following long- term exposure to very low levels. Close to 600 stud- ies were assessed in an effort to reach conclusions conceming the risks posed by these chemicals. Sections concerned with the presence of PBBs in the environment and sources of human exposure summarize the ways in which PBBs can enter air, water, soil, and biota, including major losses to the environment during normal production. The report cites evidence indicating that the major part of the a Published by WHO under the joint sponsorship of the United Nations Environment Programme, the International Labour Organisation, and WHO (International Programme on Chemical Safety - IPCS). total volume produced will ultimely enter the envi- ronment, either as PBBs or their breakdown prod- ucts. Once in the environment, PBBs have been shown to be highly persistent, to bioaccumulate, and to undergo biomagnification in food webs, posing a severe threat to organisms at the higher levels of these webs. The report also cites evidence that PBBs are poorly metabolized, with half-lives in humans of 8-12 years or longer, and bioaccumulate in human milk. An evaluation of effects on organisms in the environment draws on studies of the clinical signs and pathological changes seen in contaminated farm animals following the Michigan case. An extensive section assesses the number of studies conducted in experimental animals and in vitro test systems. Toxic effects demonstrated in studies and in species include wasting syndrome, thymus atrophy, hepato- toxicity, liver cancer, skin disorders, and adverse effects on reproduction, including fetal wastage and decreased viability of offspring. Other studies have demonstrated the ability of PBBs to alter the biologi- cal activity of a variety of drugs and toxicants, to induce hepatic microsomal enzymes, to inhibit inter- cellular communication, and to cause profound alter- ations in vitamin A homoeostasis. Although the exact mechanisms of toxic action remain to be elucidated, the report notes the accumulation of some PBB con- geners, the poor ability of the body to metabolize and eliminate them, and resultant build-up of the chemical in the body to an extent that overcomes compensatory mechanisms. Although numerous clin- ical studies of exposed Michigan farm residents have been conducted, the report cites major flaws in most of these studies that make it virtually impossible to draw clear conclusions conceming the health effects of exposure. Neurological symptoms were the earli- est and most prominent symptoms recorded in the Michigan studies. Follow-up time was judged inad- equate to evaluate possible carcinogenic effects. Citing evidence from other sources, the report concludes that humans and the environment should not be exposed to PBBs and that commercial use of these compounds should cease.b b A summary, evaluation, conclusion and recommendations in French and Spanish are included in the book. Bulletin of the World Health Organization, 1994, 72 (6): 1009-1015 1009 Recent WHO publications Hexachlorobutadienea Geneva, 1994, 136 pages (Environmental Health Criteria, No. 156). ISBN 92 4 157156 X Price: Sw.fr. 22.-/US$ 19.80 Hexachlorobutadiene is essentially a waste product formed during the manufacturing of various chlori- nated hydrocarbons. It has limited use as an agricul- tural fumigant in some parts of the world and can also be used for the recovery of chlorine-containing gas in chlorine plants and as a wash liquor for removing certain volatile organic compounds from gas streams. Findings from both field and laboratory studies support the conclusion that hexachlorobuta- diene has a high potential to accumulate in sediment and to persist in water, and it is noted to be moder- ately to very toxic to aquatic organisms, with fish and crustaceans being the most sensitive. A review of experimental studies concentrates on the large body of evidence demonstrating short- and long-term effects on the kidney. These findings support the conclusion that the target organs for toxicity, in humans as well as experimental animals, are the kid- ney, and to a lesser extent, the liver. The report also cites evidence supporting the hypothesis that the nephrotoxicity, mutagenicity, and carcinogenicity of hexachlorobutadiene are dependent on the biosynthe- sis of a reactive sulfur metabolite following conjuga- tion with glutathione. In view of the shortage of human studies, the evaluation of effects on health draws upon experimental data supported by evidence that the metabolism of hexachlorobutadiene is simi- lar in humans and animals. The report concludes that hexachlorobutadiene should be regarded as a sensi- tizing agent. Evidence for carcinogenicity is limited in animals and insufficient in humans. Concerning the environment, the report concludes that aquatic animals may be at risk in polluted surface waters. In view of the toxicity of hexachlorobutadiene to mam- mals and its high potential to bioaccumulate, the consumption of benthic or aquatic organisms in pol- luted surface water by other species may constitute an additional cause for concem.c Hydroquinonea Geneva, 1994, 178 pages (Environmental Health Criteria, No. 157). ISBN 92 4 157157 8 Price: Sw.fr. 27.-/US$ 24.30 c A summary and evaluation in French and Spanish are includ- ed in the book. Hydroquinone is a chemical found, in natural form, in a number of plants and animals. It is manufactured for commercial applications, including use as a developer in black-and-white photography, in the production of medical and industrial X-ray films, in the manufacture of rubber antioxidants and antiozo- nants, and antioxidants for food preservation, and as a chemical intermediate for the production of agro- chemicals and performance polymers. Hydroquinone and products containing hydroquinone are used in cosmetics and medical skin preparations as a depig- mentation agent to lighten small areas of hyperpig- mented skin and to treat various disorders of pig- mentation. A review of data on the physicochemical properties of hydroquinone and its behaviour in the environment concludes that most of this compound is distributed to the water compartment, where it is degraded by both photochemical and biological pro- cesses. The report found no evidence of persistence in the environment or bioaccumulation. An evalua- tion of sources of human exposure cites data on occupational exposures during the manufacturing of hydroquinone, dermal exposure in photohobbyists developing their own films, and dermal exposure from the use of hydroquinone as a bleaching agent in skin lighteners for cosmetic or medical purposes. Studies of the kinetics and metabolism of hydroqui- none support the conclusion that this compound is rapidly absorbed, rapidly and widely distributed among tissues, and rapidly excreted. A section evalu- ates studies of toxic effects in experimental animals and in vitro test systems, which have concentrated on the investigation of dermal and ocular effects, effects on reproduction, immunotoxicity, neurotoxicity, neph- rotoxicity, and carcinogenicity. Attention is given to studies indicating that co-exposure to hydroquinone and other phenolic compounds can potentiate the toxic effects of the individual compounds, causing cytotoxic, immunotoxic, and genotoxic effects. An evaluation of effects on human health cites findings from case reports of accidental and intentional poisoning, short-term controlled human studies, and epidemiological studies of respiratory effects and carcinogenicity in occupationally-exposed workers. Studies designed to assess the safety of hydroqui- none in cosmetic skin-lightening products are also reviewed. Although data were judged inadequate to evaluate carcinogenic potential, the report notes a well-documented association between exposure to hydroquinone and various skin disorders. Long-term exposure to airbome hydroquinone has been observed to cause ocular disorders, including eye irritation, sensitivity to light, staining of the cornea and conjunctiva, comeal opacities and visual distur- bances. Citing evidence that skin-lightening creams 1010 WHO Bulletin OMS. Vol 721994 Recent WHO publications containing hydroquinone are frequently inadequately labelled and contain concentrations exceeding the permitted limit, the report recommends that over-the- counter sale of these products be restricted. The report also calls for the development of health educa- tion programmes to discourage the use of these creams for whole body skin lightening.d Hepatitis viruses Lyon, International Agency for Research on Cancer, 1994, 286 pages (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 59). ISBN 92 832 1259 2 Price: Sw.fr. 65.-/US$ 58.50 This book evaluates the carcinogenic risk to humans posed by exposure to three hepatotropic viruses: hep- atitis B virus, hepatitis C viruses, and hepatitis D virus, which exists as a satellite agent of hepatitis B virus. Among the several viruses than can cause hep- atitis, these three were selected for evaluation because of their potential to induce chronic liver infection. The volume marks the first time that an IARC Monograph has evaluated the carcinogenicity of a class of biological agents. Although experimen- tal work on the carcinogenicity of these viruses has been restricted by their narrow range of natural ani- mal hosts, investigations in humans have been facili- tated by sensitive serological methods for the detec- tion of exposure at different stages of infection. Some 1000 studies were reviewed. The first mono- graph evaluates the large body of experimental, epi- demiological, and clinical data suggesting a link between infection with hepatitis B virus and hepato- cellular carcinoma in humans. The evaluation takes on particular importance in view of the high preva- lence of chronic infection with this virus in many human populations, particularly in developing coun- tries. A summary of the structure of the virus and methods for its detection and analysis is followed by an assessment of human exposure data, including pattems of transmission and factors influencing the course and clinical manifestations of infection, stud- ies of cancer in humans, and studies of cancer in pri- mates, transgenic mice, woodchucks, ground squir- rels, ducks and other species. Data that shed light on possible oncogenic properties and mechanisms of carcinogenic action are also assessed. In view of the association between hepatocellular carcinoma and d A summary in French and Spanish is included in the book. chronic infection with hepatitis B virus demonstrated in numerous studies, the monograph concludes that chronic infection with hepatitis B virus is carcino- genic to humans. The second monograph evaluates data on hepatitis C virus, which is the etiological agent in most cases of post-transfusion hepatitis. Fol- lowing a similar format of evaluation, the mono- graph concludes that chronic infection with hepatitis C virus is carcinogenic to humans. The final mono- graph evaluates data on hepatitis D virus, a satellite agent of hepatitis B virus with no known natural host other than humans. Because of methodological prob- lems and inconsistencies in the evidence, infection with hepatitis D virus could not be classified as to its carcinogenicity to humans. Environment Concern for Europe's tomorrow Summary Copenhagen, WHO Regional Office for Europe, 1994, viii + 88 pages (WHO Regional Publications, European Series, No. 53). ISBN 92 890 1317 6 Price: Sw.fr. 14.-/US$ 12.60 People are increasingly concemed about the state of the environment and its effect on their health and well-being. They know of examples throughout the WHO European Region, of unacceptable levels of pollution, inadequate drinking-water and sewage facilities, uncontrolled dumping of waste and occa- sionally major man-made disasters. But what is the situation? "Concem for Europe's tomorrow" is a major Region-wide project, launched in 1991, to find out. The report that resulted is the most comprehen- sive survey of environmental health ever carried out in Europe. For the first time, information has been assembled from almost all the Member States of the Region, and this summary sketches the picture that has begun to emerge. The main areas of concem are microbiological contamination of food and drinking- water and urban air pollution. Over 100 million people, largely in central and eastem parts of the Region, lack safe drinking-water, while people everywhere suffer increasingly from illness caused by contaminated food, and hot spots of urban air pol- lution persist in some industrial areas. The inexor- able increase in road traffic not only contributes to air pollution, but is a major cause of death and injury among young people and, through noise and conges- tion, detracts considerably from the quality of city life. Rapid urbanization in the south and inner city WHO Bulletin OMS. Vol 72 1994 1011 Recent WHO publications decay in the west exacerbate these urban problems. The implications of some transboundary issues, such as acid deposition and the pollution of river basins, are of obvious concern. If the people of the Region share a common concern for Europe's tomorrow, they must also tackle the global problems of possible climate change, resulting from the generation of greenhouse gases, and ozone depletion by chloro- fluorocarbons, now. The countries of the Region can and must work, together to tackle all these issues before it is too late, and this summary makes recommendations about how they can do so. Human reproduction Challenges in reproductive health research UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Biennal report 1992-1993 Edited by J. Khanna, P.F.A. Van Look, & P.D. Griffin Geneva, 1994, 202 pages ISBN 92 4 156170 X Price: Sw.fr. 39.-/US$ 35.10 This biennal report explores the lines of research needed to meet the urgent - and growing demand for improved methods of fertility regulation. Arguing that the currently available contraceptive "hardware" may not be able to meet the heightened needs and expectations of all users, the book calls for a second contraceptive revolution that utilizes the powerful tools of molecular biology to develop a range of safer, more affordable, and more effective methods. To this end, the report documents the nature and extent of unmet needs in all areas of reproductive health, discusses future trends, and identifies priority problems that can be solved through carefully targeted research. Throughout, rec- ommendations are guided by an approach to repro- ductive health that moves away from an almost exclusive concern with reducing fertility rates and gives greater attention to the promotion of reproduc- tive health and well-being, particularly as perceived by women themselves. Although emphasis is placed on exciting advances in the development of new technologies, the report considers the need of research on the social and behavioural determinants of contraceptive use and on factors influencing the quality of family planning services. Maternal and child health and family planning Home-based maternal records Guidelines for development, adaptation and evaluation Geneva, 1994, viii + 85 pages ISBN 92 4 154464 3 Price: Sw.fr. 20.-/US$ 18.- The success of the child growth chart in reducing levels of infant morbidity and mortality chiefly by raising awareness of the contributory factors - has been the principal impetus to the development of the WHO prototype home-based maternal record. This record takes the form of a card, retained by the woman herself, on which information about her pregnancies, the births of her children, and her health between pregnancies can be recorded. A pre-eminent consideration in its design was that it should be use- ful to the individual to whom it refers, rather than exclusively to health professionals. It was also seen as essential that the record should be adaptable for use in societies with widely differing health needs, treatment facilities, and levels of literacy. This book is a comprehensive guide to all aspects of the devel- opment, adaptation and use of home-based maternal records in the context of primary health care, and draws heavily on the results of a WHO collaborative study. Other topics covered include the additional information that may be incorporated into records, such as health education messages and nutritional advice, and training of health personnel in using the records and evaluating the information they yield. Decision-makers at all levels, from health ministries to community health programmes, should thus find the book of immense value whenever the introduc- tion of these records is under consideration. Noncommunicable diseases Prevention of diabetes mellitus Report of a WHO Study Group Geneva, 1994, viii + 100 pages (WHO Technical Report Series, No. 844). ISBN 92 4 120844 9 Price: Sw.fr. 15.-/US$ 13.50 Diabetes mellitus, a chronic, often debilitating dis- ease with severe complications, including blindness, heart and kidney disease and neuropathy, affects many millions of people throughout the world. It is found in almost all populations and is emerging as a growing problem in developing countries. The costs of the disease in terms of human suffering, health care and loss of human resources are high. Improved WHO Bulletin OMS. Vol 72 19941012 Recent WHO publications/Publications r6centes OMS understanding of the causes and mechanisms of the major types of diabetes mellitus is now providing a basis for preventive activities. This report by an inter- national group of experts outlines the epidemiological situation, presents the current classification and diag- nostic criteria and reviews the possibilities for preven- tion of the main types of diabetes and its complica- tions. It also discusses the introduction of prevention and control programmes and their cost-effectiveness. While further research is needed, the report empha- sizes the potential for preventing complications of diabetes and for interventions in groups at high risk of developing the disease, and urges the implementa- tion of appropriate prevention and control strategies. Women, health and development Women's health and human rights R.J. Cook Geneva, 1994, vii + 62 pages ISBN 92 4 1576166 1 Price: Sw.fr. 14.-/US$ 12.60 Women's right to health is protected by intemational human rights law, yet States often fail to fulfil the obligations of the treaties they have signed. As a result, many women suffer "health disadvantages" compared with men. Human rights lawyer Professor Rebecca Cook argues that these disadvantages repre- sent injustice in terms of human rights agreements. The author explains what intemational human rights treaties say about women, health and equity, and describes in what ways women are more liable to ill- health than are men. She draws conclusions on how human rights treaties could be used as a lever to improve the health of women in the countries that have signed them. This book challenges States and govemments to do what they have legally bound themselves to do - take all steps necessary to ensure that women are fully enabled to live healthy and fulfilling lives. Environnement Penser c I'Europe de demain Resum Copenhague, Bureau r6gional de l'OMS pour l'Europe, 1994, viii + 104 pages (OMS, Publications r6gionales, S6rie europ6enne, NO 53). ISBN 92 890 2317 1 Prix: Fr.s. 14.- Nous nous preoccupons tous de l'environnement et des consequences de sa degradation sur la sante et la qualite de vie. Dans de nombreux pays de la Region europeenne de l'OMS, les exemples peu edifiants ne manquent pas: niveau de pollution inacceptable, eau impropre 'a la consommation, reseaux d'egouts inadaptes, deversements sauvages de dechets et par- fois de veritables catastrophes ecologiques. Mais quelle est objectivement la situation? Le programme "Penser 'a l'Europe de demain", lance en 1991, vise 'a repondre 'a cette question. Le rapport qui en a resulte constitue l'etude la plus complete de l'hygiene de l'environnement qui ait jamais ete realisee en Euro- pe. Pour la premiere fois, des informations ont ete rassemblees sur la quasi-totalite des Etats Membres de la Region et le present resume donne un apercu de la situation qui se degage des donnees recueillies. Les principaux sujets de preoccupation sont la conta- mination des denrdes alimentaires et de l'eau, et la pollution atmospherique dans les villes. Plus de 100 millions de personnes ne disposent pas d'eau verita- blement potable, principalement dans les parties cen- trale et orientale de la Region. Les maladies dues a la contamination des aliments sont encore frequentes dans l'ensemble de la Region et sur le plan de la pol- lution de l'air, des points noirs subsistent dans cer- taines zones industrielles. La circulation automobile, qui augmente inexorablement, contribue a la pollu- tion mais est en outre une cause importante de dec's et de traumatismes parmi les jeunes et nuit grave- ment a la qualite de vie des citadins. Ces problemes sont encore exacerbes dans le sud par l'urbanisation rapide et a l'ouest par la degradation des villes. Cer- taines questions transfrontieres par nature, telles que les retombees acides et la pollution des bassins hydrographiques, sont egalement preoccupantes. Si les citoyens de la Region se soucient de l'Europe de demain, ils ne peuvent rester insensibles aux pro- blemes mondiaux poses par d'eventuels changements climatiques, 'a la suite de la production de gaz de serre et de l'appauvrissement de la couche d'ozone. WHO Bulletin OMS. Vol 72 1994 1013 Publications r6centes OMS Les pays de la Region peuvent et doivent cooperer pour faire face a ces problemes avant qu'il ne soit trop tard et ce resume contient des recommandations sur la facon d'agir efficacement. Maladies diarrheiques Prise en charge et prevention de la diarrh6e Manuel pratique Troisieme edition Geneve, 1994, v + 50 pages ISBN 92 4 254454 X Prix: Fr.s. 12.- La diarrhee, qui reste l'une des causes les plus importantes de mortalite infantile dans le monde en developpement, est cependant l'une de celles qu'il est le plus facile de traiter par un recours judicieux a des mesures preventives et therapeutiques simples. Ce manuel pratique, soigneusement revu et mis a jour, est destine a servir de guide a tous les agents de sante qui ont la charge d'appliquer ces mesures, ainsi qu'a leurs superieurs hierarchiques et a leurs forma- teurs. I1 porte sur les points suivants: traitement de la diarrhee a domicile et dans les centres de sante, nutrition convenable - et notamment l'allaitement au sein - au cours des episodes diarrheiques, bilan des malades en etat de deshydratation, administration par voie orale et intraveineuse de liquides de rehy- dratation, traitement antimicrobien de la dysenterie, du cholera et de la diarrhee d'origine parasitaire. I1 donne egalement des conseils pratiques de preven- tion en insistant sur les precautions que l'on peut prendre efficacement a domicile. Pour faciliter l'apprentissage, chacun des principaux chapitres du manuel s'acheve sur une liste des notions essentielles que doivent acquerir les agents de sante. Maladies parasitaires Parasitoses et mise en valeur des ressources hydriques Un imperatif: la negociation intersectorielle J.M. Hunter, L. Rey, K.Y. Chu, E.O. Adekolu- John & K.E. Mott Geneve, 1994, x + 160 pages, et 8 planches en couleurs ISBN 92 4 256155 X Prix: Fr.s. 35.- Considerant les maladies parasitaires comme l'indica- teur le plus fiable et le plus spectaculaire des effets defavorables sur la sante, cet ouvrage a pour but de persuader les personnes qui financent, planifient et gerent les projets d'amenagement hydraulique de pla- cer les preoccupations sanitaires au centre du dia- logue sur le developpement. A cette fin, il s'appuie sur une masse d'elements tendant 'a montrer a la fois l'ampleur des risques pour la sante lies a ce type de projets et la faisabilite des mesures de prevention et de lutte. Mettant en cause le role traditionnellement passif du secteur de la sante, il vise egalement a inci- ter les autorites sanitaires a prendre part au processus d'elaboration des projets et a faire davantage entendre leur voix. Une attention particuliere est accordee a l'impact des nouvelles conditions ecologiques sur l'introduction, la propagation ou l'aggravation du paludisme, de la schistosomiase et de la filariose lym- phatique. S'appuyant sur des donnees provenant d'etudes realisees sur plus de 60 barrages ou reseaux d'irrigation, les auteurs mettent en evidence, cas par cas, 1'aggravation des risques pour la sante du fait de la transformation des ecosystemes. Le cas particulier des petits barrages est egalement aborde. Apres avoir demontre qu'il etait urgent d'apporter des change- ments au niveau des politiques, l'ouvrage propose des lignes de conduite. Un bilan des mesures techniques de lutte contre le paludisme, la schistosomiase et la filariose lymphatique montre que les maladies parasi- taires sont un risque evitable dans le cadre des projets d'amenagement hydraulique. Les raisons pour les- quelles ces techniques tres efficaces ne sont pas appliquees sont decrites, de meme que les differents moyens d'inflechir les politiques. C'est ainsi qu'il est propose d'utiliser une part du revenu brut du projet pour financer les couits de protection de la sante a tra- vers 1'elaboration de rdglementations nationales regissant l'exploitation a long terme d'un projet ou bien encore d'avoir recours a "l'endettement en vue de la sante" pour garantir le soutien financier. Enfin, l'ouvrage, qui s'adresse aux autorites sanitaires, contient des conseils pratiques sur la facon de nego- cier avec les autres secteurs et d'etablir un plan d'action sanitaire valable pour un projet d'amenage- ment hydraulique. I1 contient egalement une serie de six arguments cles qui peuvent constituer la base d'une strategie de negociation persuasive. Securite transfusionnelle Programmes d'assurance de la qualite pour les services de transfusion sanguine Principes directeurs Geneve, 1994, iv + 53 pages ISBN 92 4 254448 5 Prix: Fr.s. 12.- Cet ouvrage contient des renseignements indispen- sables pour la mise en place de programmes d'assuran- ce de la qualite dans tous les services de transfusion WHO Bulletin OMS. Vol 72 19941014 Publications r6centes OMS sanguine, qu'il s'agisse des banques de sang des petits hopitaux ou des centres de transfusion qui se consa- crent a la production 'a grande echelle de produits san- guins. Les mesures decrites visent 'a garantir l'innocui- te de toutes les procedures pour les donneurs, les transfuses et le personnel. Partant du point de vue qu'un systeme d'assurance de la qualite devrait etre mis en place dans tous les services de transfusion et toutes les banques de sang, la brochure souligne com- bien il est capital d'appliquer des procedures strictes de contr6le de la qualite 'a chaque etape de chaque mode operatoire, depuis la selection des donneurs jusqu'a la surveillance de la bonne utilisation du sang ou de ses constituants. Les renseignements foumis contiennent des indications sur les moyens de bien selectionner et de fideliser les donneurs, des conseils sur les situations dans lesquelles l'autotransfusion est pratiquee et appro- priee, et les raisons pour lesquelles un programme d'assurance de la qualite doit faire la preuve de sa ren- tabilite. Tout au long, un effort particulier est fait pour identifier les mesures 'a prendre pour evaluer et enre- gistrer objectivement la qualite de modes operatoires determines. Les moyens de reduire les cou'ts et les gas- pillages sont egalement pris en consideration. Technologies de laboratoire Bact6riologie clinique: techniques de base pour le laboratoire J. Vandepitte, K. Engbaek, P. Piot & C.C. Heuck Geneve, 1994, vii + 121 pages ISBN 92 4 254425 6 Prix: Fr.s. 21.- Ce manuel decrit diverses techniques normalisees pour le laboratoire, recommandees pour les analyses bacteriologiques. A l'usage des techniciens de labo- ratoire qui travaillent dans les hopitaux de district ou de niveau intermediaire, l'ouvrage porte sur des techniques simples utilisant l'examen microscopique et la culture comme methodes de detection, qui ont effectivement donne des informations fiables, cli- niquement pertinentes. Comme la qualite en micro- biologie se situe au-dela de la simple perfection technique, le choix des techniques doit prendre en compte des facteurs tels que la rapidite, le co-ut et l'utilite pour les maladies prioritaires, ainsi que la valeur diagnostique. Les tests diagnostiques necessitant un materiel et des reactifs d'un prix pro- hibitif sont exclus, de meme que les tests insuffi- samment sensibles et specifiques. Pour encourager l'usage le plus rationnel des ressources limitees, l'ouvrage appelle l'attention de ses lecteurs sur l'inefficacite de certains tests, explique quand il est superflu d'ajouter des etapes aux series de routine et designe les erreurs communes et la meilleure facon de les eviter.e e Voir aussi Parasitologie medicale: techniques de base pour le laboratoire (Geneve, OMS, 1993), analyse dans le Bulletin de l'Organisation mondiale de la sante, 1994, 72: 319. WHO Bulletin OMS. Vol 72 1994 1015