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. Cancer Cervical cancer screening programmes: managerial guidelines A.B. Miller Geneva, 1992, viii + 50 pages ISBN 92 4 154447 3 Price: Sw.fr. 1 2.-/US$ 10.80 This book provides a guide to the many factors that need to be considered when planning and managing a screening programme for the early detection of cer- vical cancer. Noting that screening programmes often fail to have an impact on incidence rates and mortality, the book concentrates on key managerial decisions, such as the definition of target groups and the frequency of screening, that will determine a pro- gramme's capacity to detect cervical cancer at an early, curable stage in the population at greatest risk. Advice and recommendations draw upon evidence from several large investigations as well as experi- ences with different programmes throughout the world. Policies that consume resources without improving results are clearly indicated. For example, in most developing countries, a high proportion of cases of cervical cancer are diagnosed at an advan- ced stage. Since these countries often lack the labo- ratory facilities or resources to realize population- wide screening in the foreseeable future, a new approach, called "downstaging", has been proposed, which aims to detect the disease at an earlier stage, involves use of a simple speculum for visual inspec- tion of the cervix - a procedure that can be per- formed by nurses and other non-medical health workers. Other chapters offer advice on the organ- ization of screening programmes in the context of primary health care, and outline programme require- ments in terms of information systems. Chemical toxicology, carcinogenicity Endrina Geneva, 1992, 241 pages (Environmental Health Criteria, No. 130). ISBN 92 4 157130 6 Price: Sw.fr. 28. -/US$ 25.20 Because of its high toxicity and persistence in the environment, endrin, an organochlorine insecticide used since the 1950s to protect cotton, rice, sugar cane, maize, and other crops against a wide range of agricultural pests, has been banned in many countries and severely restricted in others. However, a review of studies on kinetics and metabolism provides convincing evidence that endrin is rapidly eliminated and does not accumulate in the human body. Other sections review findings from experimental investi- gations of toxicity, case reports of accidental and sui- cidal poisoning, and epidemiological studies of occu- pationally exposed workers. Findings consistently point to the neurotoxicity of this pesticide and the rapid onset of convulsions following exposure. On the basis of the evaluations provided, the report concludes that endrin is unlikely to present a hazard to exposed workers where good work practices and recommended safety precautions are enforced. It further concludes that the occasional presence of low levels of endrin in air, food, and surface - and drinking-water is of little public health signifi- cance. Because of the high toxicity of this pesti- cide, the report recommends that endrin should be used only in cases where no less toxic altemative is available, and closes with advice on the medical treatment of endrin poisoning and on the emergency management of major status epilepticus.b 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). b A summary in French and Spanish is included in the book. Bulletin of the World Health Organization, 71 (3/4): 473-484 (1993) 473 Recent WHO publications Trichlorfona Geneva, 1992, 162 pages (Environmental Health Criteria, No. 132). ISBN 92 4 157132 2 Price: Sw.fr. 22. -/US$ 19.80 Trichlorfon is a broad-spectrum organophosphorus insecticide which acts as a "slow release" source of dichlorvos in the mammalian body. Marketed since the early 1950s, it is used to protect field and fruit crops, to control forest insects and internal and exter- nal parasites in domestic and farm animals. Formu- lated as metrifonate, trichlorfon has also been used for the pharmacological treatment of Schistosoma haematobium infection in millions of patients and is under investigation as a treatment for Alzheimer disease. One section concerned with the behaviour of this insecticide in the environment cites evidence of rapid degradation in soil, with negligible amounts detected one month after application. The next sec- tion concentrates on the significance of residues detected in crops, the milk of treated cows, and other food items as possible sources of exposure for the general public. Noting that detected levels are far below the established acceptable daily intake, the report concludes that trichlorfon does not constitute a health hazard for the general population. Concerning effects on environmental organisms, the report cites evidence that trichlorfon is moderately toxic for fish and birds, and moderately-to-highly toxic for aquatic arthropods, supporting the conclusion that it should never be sprayed over water bodies or streams. The report found no evidence that trichlorfon, when appropriately applied, posed a risk to organisms in the terrestrial environment, other than arthropods. The remaining sections evaluate data from toxicity studies in laboratory animals and in vitro test sys- tems, from several hundred case reports of accidental or intentional human poisoning, and from studies of schistosomiasis patients treated with metrifonate. Though poisoning may have serious effects, includ- ing delayed neurotoxicity, the report concludes that, when good work practices and safety precautions are followed, trichlorfon is unlikely to present a hazard for occupationally exposed workers. The report fur- ther notes that, in the millions of schistosomiasis patients treated with metrifonate, reported side- effects have been mild and rare.c c A summary, evaluation, conclusions and recommendations in French and Spanish are included in the book. Fenitrothiona Geneva, 1992, 184 pages (Environmental Health Criteria, No. 133). ISBN 92 4 157133 0 Price: Sw.fr. 22. -/US$ 19.80 Fenitrothion is a moderately toxic organophosphorus insecticide used since 1959 to control insect pests on rice, cereals, fruits, vegetables, stored grains, and cotton. It is also used in forest spraying to control insects and in public health campaigns aimed at the control of flies, mosquitos, and cockroaches. The report briefly reviews methods for deter- mining residues in food and environmental media, and describes sources of human and environmental ex- posure. The following sections consider mechanisms responsible for the rapid transformation and disap- pearance of this insecticide from the environment and summarize data on residues detected in forests, water, soil, fruits, vegetables, cereal grains, and other food items. Because residues in food decline very quickly, the report concludes that exposure of the general population via the ingestion of contaminated food does not constitute a health hazard. Studies on the kinetics and metabolism of this insecticide show that fenitrothion is readily absorbed via the oral route, is rapidly metabolized and excreted, and is therefore unlikely to remain in the body for a pro- longed period. Investigations of toxicity conducted in a large number of laboratory animals and in vitro test systems, case reports of accidental and intentional poisoning in humans, epidemiological studies of exposed workers, studies of spraymen and inhabi- tants following indoor spraying in large public health campaigns, and studies of effects on organisms in the environment are also evaluated. The report found no evidence of carcinogenic, mutagenic, embryotoxic, or teratogenic effects, of delayed neurotoxicity, or of an association between exposure to fenitrothion and the development of Reye syndrome. Evidence sup- ports the conclusion that this compound is unlikely to constitute a health hazard for occupationally ex- posed workers when good work practices, hygienic measures, and safety precautions are followed. Concerning effects on environmental organisms, par- ticularly following standard forest spraying opera- tions, the report notes that few, if any, adverse effects have been detected despite the widespread use of this insecticide for several decades. Because tests show that fenitrothion is highly toxic for non- target arthropods, the report recommends that appli- cation rates should be limited and that it should never be sprayed over water bodies or streams.c 474 WHO Bulletin OMS. Vol 71 1993 Recent WHO publications 1 ,1 ,1 -Trichloroethanea Geneva, 1992, 117 pages (Environmental Health Criteria, No. 136). ISBN 92 4 157136 5 Price: Sw.fr. 17. -/US$ 15.30 1,1,1-Trichloroethane, a chlorinated hydrocarbon used in the cleaning and degreasing of metal and as a solvent in many industrial and consumer products, spot removers, aerosol cans, and cosmetics, is also used as an intermediate in the production of vinyli- dene chloride and other chemicals. The abuse of this solvent has resulted in a large number of fatalities. A section describes the physical and chemical properties that make this solvent an especially hazard- ous compound. These include a density that is five times greater than that of air, and the formation of phosgene as a degradation product. A review of data on the environmental behaviour of 1,1,1-trichloro- ethane documents its ubiquitous presence in the atmosphere, its rapid transport to the troposphere, its long residence time, its depletion of ozone through the liberation of chlorine atoms, and its contribution to global warming. Levels detected in the environ- ment in terms of their significance as sources of human exposure are evaluated. While contamination of the atmosphere is judged to be the most important route of exposure for the general population, the report notes that indoor air may cause considerably higher exposures due to the use of numerous con- sumer products containing this solvent. Air is also noted to be the main source of exposure in the work- place, with workers using 1,1,1-trichloroethane for metal degreasing or dry-cleaning operations consti- tuting the group at greatest risk. A review of data on kinetics and metabolism concludes that 1,1,1-tri- chloroethane is widely distributed in body tissues and crosses the blood-brain and placental barriers. Concerning toxic effects investigated in a large num- ber of animal studies and in vitro test systems, the report confirms the significance of exposure via inhalation. Exposure may cause damage to the heart and liver. The final section evaluating effects on organisms in the field, concludes that environmental contamination is unlikely to pose a significant hazard for organisms. Because of its many other hazards, including its ozone-depleting potential, the report recommends that the release of 1,1,1-trichloroethane, which occurs mainly during use, be reduced to the greatest extent possible.b 2-Nitropropanea Geneva, 1992, 108 pages (Environmental Health Criteria, No. 138). ISBN 92 4 157138 1 Price: Sw.fr. 16. -/US$ 14.40 2-Nitropropane (2-NP) is an important industrial chemical used as a solvent for printing inks, paints, varnishes, adhesives, and other coatings, such as beverage container linings. It is also used in printing inks for flexible food packaging and in food proces- sing, primarily for the separation of oleic acid from polyunsaturated fatty acids. The physical and chemical properties that give 2-NP its desirable and occasionally unique charac- teristics as a solvent are discussed. Concerning its behaviour in the environment, a review of the limited data available indicates ready evaporation into the atmosphere, high mobility in the natural environ- ment, and a slow biological conversion to less toxic compounds. An evaluation of environmental levels and human exposure notes that this solvent has not been detected in water or in outdoor air away from areas of manufacture and use. Though smokers are regularly exposed to low concentrations, exposure of the general population from other sources is judged to be very low. The most important occupational exposures are observed after spills and during such operations as the filling of drums, when workers may be exposed to high concentrations. Studies conduc- ted in laboratory mammals and in vitro test systems show moderate acute toxicity for mammals, with considerable variation in the sensitivity of different laboratory animals. For example, studies conducted in the rat provide clear evidence of destructive changes in the liver, including hepatocellular carci- noma. The report found no conclusive evidence that 2-NP causes cancer in other laboratory species. Data on embryotoxicity, teratogenicity, and reproductive toxicity were judged inadequate. The report notes that human exposure to high concentrations, which are acutely toxic, is largely or entirely confined to the occupational setting. An evaluation of toxic effects draws upon seven reports of industrial fatali- ties attributed to inhalation of 2-NP fumes, with death due to acute hepatic failure in all cases. Although more research on long-term effects is needed, the report notes that available data provide no indication that chronic occupational exposure at concentrations usually encountered in the workplace induces hepatic or other neoplasms, or other long- term effects. However, because 2-NP is a potent car- cinogen in rats, the report recommends that occupa- tional exposure to this solvent, and its presence in consumer products, be minimized and replaced with a less toxic solvent whenever practical. The report recommends against the use of 2-NP in food proces- sing. Review of data on toxicity to environmental organisms concludes that 2-NP does not pose a threat to the environment.b WHO Bulletin OMS. Vol 71 1993 475 Recent WHO publications Partially halogenated chlorofluorocarbons (ethane derivatives)a Geneva, 1992, 130 pages (Environmental Health Criteria, No. 139). ISBN 92 4 157139 X Price: Sw.fr. 18. -/US$ 16.20 This book evaluates the environmental behaviour, toxicity, and ozone-depleting and global-warming potentials of six partially halogenated ethane deriva- tives selected as candidates to replace the fifteen fully halogenated chlorofluorocarbons that are being phased out in line with the provisions of the 1987 Montreal Protocol on Substances that Deplete the Ozone Layer.d The compounds considered are 1,1-dichloro-1-fluoroethane (HCFC 141b), 1-chloro- 1, 1-difluoroethane (HCFC 142b), 1,2-dichloro-1,1- difluoroethane (HCFC 132 b), 1-chloro-2,2,2-trifluoro- ethane (HCFC 133a), 1,1 -dichloro-2,2,2-trifluoro- ethane (HCFC 123), and 1-chloro-1,2,2,2-tetrafluoro- ethane (HCFC 124). With the exception of HCFC 142b, an intermediate in the production of vinylidene fluoride, none of these compounds is produced in large quantities. Data on environmental levels and exposure of the general population are extremely limited or, for some compounds, nonexistent. All the compounds were judged to have ozone-depleting and global-warming potentials considerably lower than those of CFC 11, the fully halogenated chlorofluoro- carbon with the highest ozone-depleting and global- warming potentials. Atmospheric lifetimes are esti- mated to range from 1.6 years for HCFC 123 to 19.1 years for HCFC 142b. Since no data on human expo- sures are available, the evaluation of toxic effects is confined to a review of findings in laboratory mam- mals and in vitro test systems. Although all six com- pounds have low acute toxicity, their toxic effects following repeated exposure differ markedly. HCFC 132b, an experimental chemical with no commercial application at present, depresses the central nervous system, produces signs of hepatotoxicity, and has an effect on spermatogenesis. Embryotoxicity has also been demonstrated. For HCFC 133a, which is pro- duced in small quantities for use as a chemical inter- mediate in the manufacture of the anaesthetic halo- thane, studies of repeated exposure have documen- ted a number of toxic effects, including lung damage, inflammatory changes in the mucosa of the nose, testicular atrophy, and serious effects on reproduc- d See Partially halogenated chlorofluorocarbons (methane derivatives). Geneva, WHO, 1991 (Environmental Health Criteria, No. 126), and Fully halogenated chlorofluorocarbons. Geneva, WHO, 1990 (Environmental Health Criteria, No. 113), reviewed in the Bulletin of the World Health Organization, 70(3): 400 (1992) and 69(1): 139 (1991), respectively. tion and development. HCFC 133a also causes cancer in rats. Although HCFC 133a and HCFC 132b were judged to pose a low risk to the environment, they could not be recommended as substitutes because of their potential threat to human health. HCFC 142b has a low toxic potential and is therefore not con- sidered to pose a significant risk to human health under non-accidental exposure conditions. Since its toxicity is low and the ozone-depleting and global- warming potentials are lower than those of the fully halogenated chlorofluorocarbons, the report concludes that HCFC 142b can be considered as a transient substitute for the chlorofluorocarbons included in the Montreal Protocol. In view of the paucity of toxico- logical data on HCFC 141b, HCFC 123, and HCFC 124, no evaluation of their potential effects on human health could be made.b Quality management for chemical safety testinga Geneva, 1992, 112 pages (Environmental Health Criteria, No. 141). ISBN 92 4 157141 1 Price: Sw.fr. 16. -/US$ 14.40 This book provides a highly detailed guide to the prin- ciples and specifics of quality management needed to ensure that studies of chemical safety produce accur- ate and meaningful results. Focused on the manage- ment of both laboratory and individual studies, the book stresses the need to establish and follow formal standard procedures for virtually every laboratory practice that can influence the quality of study results. Details range from a list of the types of records that must be kept, through advice on how to number the pages in standard operating procedures, to a descrip- tion of the precautions needed to make certain that chemicals used for cleaning or pest control in animal rooms do not interfere with the study. The objective is to help laboratory managers and staff think through all possible sources of error and plan appropriate mea- sures for their control. For those using laboratory data for chemical risk assessment, the book also serves as an alert to the many variables that can compromise the accuracy of reported data. Alpha-cypermethrina Geneva, 1992, 112 pages (Environmental Health Criteria, No. 142). ISBN 92 4 157142 X Price: Sw.fr. 16. -/US$ 14.40 Alpha-cypermethrin is a potent and versatile pyreth- roid insecticide used against a wide range of pests encountered in agriculture and animal husbandry. 476 WHO Bulletin OMS. Vol 71 1993 Recent WHO publications Main agricultural applications include the protection of oilseeds, pome fruits, peaches, fruiting vegetables, berries, leafy vegetables, maize and speciality crops such as hops and tobacco. Marketed since late 1983, it can be used with most crops for either curative or preventive treatment. Because of its high biological activity, application rates are low. Since no phyto- toxicity has been reported, alpha-cypermethrin can replace conventional insecticides in short-interval spray programmes. It can also be used against some nuisance and disease-carrying insects and in the control of parasites of veterinary importance. Studies conducted in water and soil conclude that this insecticide is absorbed strongly onto soil particles but is rapidly lost from water. An evalua- tion of the sources of human exposure draws upon crop residue data obtained from a large number of supervised trials conducted throughout the world. The report concludes that exposure of the general population is negligible when the pesticide is used in keeping with good agricultural practice. Toxicity stu- dies conducted in laboratory mammals and in vitro test systems indicate that alpha-cypermethrin has a moderate-to-high acute oral toxicity and is 3-4 times more toxic than cypermethrin. Signs of toxicity are observed to be characteristic of a strong excitat- ory action on the central nervous system. Short-term exposures have not been shown to cause toxic effects. No data on long-term toxicity, reproductive toxicity, teratogenicity, carcinogenicity, or immuno- toxicity were available for evaluation.e A single study of occupational exposure during the formula- tion of alpha-cypermethrin detected only mild and transient skin sensations. The report thus concludes that, when good work practice, hygiene measures, and safety precautions are followed, use of alpha- cypermethrin is unlikely to pose a hazard to exposed workers. Though laboratory studies have documen- ted high toxicity for fish, studies show that this tox- icity is not realized under field conditions, where the rapid loss of alpha-cypermethrin from water facili- tates the complete recovery of affected populations. The report concludes that significant toxic effects on non-target invertebrates and fish are likely to occur only in cases of spillage, over-spraying, and misuse. As a precaution, the report recommends that con- tamination of surface waters should be avoided. Because alpha-cypermethrin binds strongly to par- ticles, the report further recommends that studies be designed to investigate potential hazards for sediment-dwelling organisms.c e An evaluation of the full toxicological data on cypermethrin, an isomeric mixture containing alpha-cypermethrin, appeared in Cypermethrin. Geneva, WHO, 1989 (Environmental Health Criteria, No. 82). Evaluation of certain food additives and naturally occurring toxicants Thirty-ninth report of the Joint FAO/WHO Expert Committee on Food additives Geneva, 1992, viii + 49 pages (WHO Technical Report Series, No. 828). ISBN 92 4 120828 7 Price: Sw.fr. 9. -/US$ 8.10 Reports in this series, which has been issued since 1957, are used in the formulation of national food legislation intended to ensure the appropriate use of food additives and to protect consumers from haz- ardous contaminants, and by the Codex Alimentarius Commission in establishing international food stan- dards. They also give toxicology laboratories useful advice on the types of studies most relevant to the safety assessment of food additives. The present report considers the acceptable daily intakes for 25 food additives and 3 naturally occurring toxicants. Substances considered include emulsifiers, enzyme preparations, flavouring substances, solvents, thick- ening agents, waxes, curcumin, furfural, and potas- sium bromate. Acceptable daily intakes were establish- ed or revised for a number of these substances. The report also evaluates safety data on cyanogenic gly- cosides and on the closely related glycoalkaloids, solanine and chaconine, which are naturally occur- ring toxicants. For cyanogenic glycosides, which are present in a number of tuberous starchy crops, nuts and fruit seeds, bamboo shoots, and certain species of beans, and which can release hydrogen cyanide, no safe level of intake could be estimated. The report notes, however, that traditional users of foods containing cyanogenic glycosides normally have a basic understanding of the treatment required to render them safe for consumption. Though no safe level of intake could be determined for solanine and chaconine, which occur in potatoes and other tubers, the report concludes that normal glycoalkaloid levels found in tubers that have been properly grown and handled are of no concem. To support the conti- nued safe use of potato tubers, the report recom- mends that those developing new cultivars, and others growing, harvesting, storing, processing, and consuming potatoes, should be aware of the possi- bility of inadvertently increasing the content of glycoalkaloids to potentially toxic levels. The report concludes with a table summarizing recommended daily intakes and listing changes in the status of specifications for substances considered by the com- mittee. WHO Bulletin OMS. Vol 71 1993 477 Recent WHO publications Control technology for the formulation and packing of pesticides Geneva, 1992, 79 pages ISBN 92 4 154438 4 Price: Sw.fr. 15. -/US$ 13.50 This book describes the ways in which current tech- nologies and managerial procedures can be used to control the occupational health hazards inherent in the formulation and packing of pesticides. Measures needed to protect the general public and the environ- ment surrounding the plant are also described. Primarily addressed to developing countries that are establishing or expanding their industrial bases, the book emphasizes the many advantages gained when control technologies are introduced at the design stage. To this end, chapters draw upon extensive intemational experience to identify all possible sources of occupational exposure, to evaluate the strengths and weaknesses of different engineering and other control options, and to guide decisions that will result in a wise investment of resources as well as maximum protection of workers and the surroun- ding environment. The book also provides an expla- nation of criteria used for the classification of pesti- cides by hazard, followed by a sample list of precautions for the safe handling of two commonly used pesticides. Occupational exposures to mists and vapours from strong inorganic acids; and other industrial chemicals Lyon, International Agency for Research on Cancer, 1992, 336 pages (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 54). ISBN 92 832 1254 1 Price: Sw.fr. 65. -/US$ 58.50 This volume features monographs covering occupa- tional exposures to mists and vapours from sulfuric acid and other strong inorganic acids; sulfur dioxide and some sulfites, bisulfites, and metabisulfites; hydrochloric acid; diethyl sulfate; diisopropyl sulfate; and 1,3-butadiene. Evaluations draw upon numerous studies of occupational exposures in industries where the use of strong inorganic acids is particularly heavy. These include the manufacture of isopropa- nol, synthetic ethanol, phosphate fertilizers, lead bat- teries, soap and detergents, sulfuric acid, and nitric acid, and industries involving pickling and other acid treatment of metals. An early study of isopropanol manufacture using the strong-acid process demon- strated an excess of nasal sinus cancer. Studies of cohorts of workers in pickling operations within the steel industry showed excesses of laryngeal and lung cancer. A case-control study of workers in a petro- chemical plant showed an elevated risk for laryngeal cancer among those exposed to sulfuric acid. One case-control study of laryngeal cancer showed an increased risk for exposure to sulfuric acid, and a second case-control study suggested an excess risk of lung cancer. In all these studies, sulfuric acid mists were the commonest exposure. Additional sup- porting evidence was provided by a cohort study in the soap manufacturing industry, which showed an increased risk for laryngeal cancer. Studies of cohorts in the phosphate fertilizer manufacturing industry showed excess lung cancer. On the basis of these data, the monograph concludes that occupa- tional exposure to strong-inorganic-acid mists con- taining sulfuric acid is carcinogenic to humans. Con- ceming the other industrial chemicals evaluated, 1,3-butadiene and diethyl sulfate were classified as probably carcinogenic to humans; 1,3-butadiene, after inhalation exposure in mice and rats, produced tumours at multiple organs. Workers manufacturing 1,3-butadiene monomer showed an excess of lym- phosarcomas and reticulosarcomas. Those employed in styrene-butadiene rubber plants showed excess risk of cancers of the lymphatic and haematopoietic system, as well as leukaemia. Diisopropyl sulfate was classified as possibly carcinogenic to humans. Sulfur dioxide, sulfites, bisulfites, metabisulfites, and hydrochloric acid could not be classified on the basis of currently available data. Solar and ultraviolet radiation Lyon, International Agency for Research on Cancer, 1992, 316 pages (IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 55). ISBN 92 832 1255 X Price: Sw.fr. 65. -/US$ 58.50 This book evaluates carcinogenic risks associated with human exposure to solar and ultraviolet radia- tion from medical and cosmetic devices, general illu- mination, and industrial sources. The main objective of the evaluation was to determine- whether enough evidence is available to decide which segments of the radiation spectrum are responsible for its adverse effects. The report also considers the importance of human constitutional risk factors, such as skin type, hair and eye colour, and specific subtypes of exposure, such as occupational and recreational exposures. More than 1000 studies were assessed. WHO Bulletin OMS. Vol 71 1993478 Recent WHO publications The first part of the monograph provides an evaluation of sources of human exposure. Informa- tion ranges from a description of the types of com- mercial lamps on the market for cosmetic tanning, through an explanation of the differences between ocular and cutaneous exposures, to a review of the many industrial processes and occupations that entail exposure to artificial sources of ultraviolet radiation. Although the sun remains the main source of ultraviolet radiation exposure for humans, the report notes the increased opportunity for both intentional and unintentional exposure created by the advent of artificial sources, including sunbeds and solaria, and numerous industrial processes. Welders are singled out as the largest occupation- al group exposed to artificial sources of ultraviolet radiation. The second part assesses the large body of evidence implicating solar radiation and ultraviolet A, B, and C radiation in human cancer. Data from epidemiological studies on nonmelanocytic skin cancer, cancer of the lip, malignant melanoma of the skin and of the eye, and premalignant conditions are assessed. Exposures to solar and to ultraviolet radia- tion from artificial sources are considered separate- ly. The third part evaluates studies of cancer in ani- mals, drawing upon data generated by a number of well-designed experiments using exposures to ultra- violet A, B, and C radiation. The fourth part consi- ders studies that shed light on the mechanisms by which human skin defends itself against the carcino- genic action of sunlight, the nature of DNA damage caused by exposure, alterations in immune function, and the question of whether exposure can activate viruses, including the human immunodeficiency virus (HIV). Concerning DNA damage, evidence supports the conclusion that ultraviolet A exposure for cosmetic purposes can result in measurable levels of damage. The results of these evaluations are that solar radiation is carcinogenic to humans, causing cutaneous malignant melanoma and non- melanocytic skin cancer. Evidence for the carcino- genicity of ultraviolet A, B, and C radiation was judged sufficient in experimental animals. All three segments of the radiation spectrum were classified as probably carcinogenic to humans. Use of sun- lamps and sunbeds entails exposures that are probab- ly carcinogenic to humans. The carcinogenicity of exposure to fluorescent lighting could not be deter- mined on the basis of available data. Studies of topical sunscreens are reviewed in an appendix, which concludes that, although effective in prevent- ing sunburn, little is known about their protective value against harmful immunological changes, photo-aging, or skin cancer. Communicable diseases The global AIDS strategy Geneva, 1992, v + 23 pages (WHO AIDS Series, No. 11). ISBN 924 121011 7 Price: Sw.fr. 9. -/US$ 8.10 This book sets out a revised and expanded framework for national and international action needed to give the world a better chance of bringing the acquired immunodeficiency syndrome (AIDS) pandemic under control and coping with the millions of adults and children already infected. In line with improved knowledge of human immunodeficiency virus (HIV) infection, its epidemiology, and measures for con- trol, the global AIDS strategy, which was developed by the WHO Global Programme on AIDS in collab- oration with dozens of experts around the world, has been revised to reflect new priorities and approaches to enduring problems, new challenges, and a greatly heightened sense of urgency. Changes in the strategy respond to the rapid emergence of heterosexual intercourse as the dominant mode of transmission, the swelling number of AIDS or- phans, the increased risk of infection seen in disadvan- taged groups, and the added burden of the parallel tuberculosis epidemic. The strategy also responds to the need to treat other sexually transmitted dis- eases, which greatly increase the risk of transmis- sion, to upgrade the social and legal status of women, and to plan immediately for the pandemic's devas- tating impact on social and economic development. Pertinent facts and figures that profile the evolution of the pandemic and underscore the need for urgent action are presented. Projections for the year 2000 include 5-10 million children born infected with HIV, a 5-10% drop in life expectancy in certain African countries, and an estimated 10 million AIDS orphans in sub-Saharan Africa alone. In view of the sharp rise in seroprevalence recently seen in Asia, the book projects that, by the mid-to-late 1990s, more Asians that Africans will be infected each year. The revised strategy is described according to its three main objectives: to prevent HIV infection, to reduce the personal and social impact of HIV infection and AIDS, and to mobilize and unify national and inter- national efforts. Both long-term and short-term mea- sures are presented, which range from the creation of an environment in which mutual fidelity and the use of condoms are the social norms, through support to all groups that can help women protect themselves, to the provision of humane care that includes pain relief and treatment for common opportunistic infec- tions. Other measures include the provision of frank WHO Bulletin OMS. Vol 71 1993 479 Recent WHO publications information aimed at all, not just those at risk; advocacy to overcome complacency and counter dis- crimination; and the training of all laboratory per- sonnel and health care workers in standard procedures based on "universal precautions", whereby all blood is assumed to be potentially infectious. Diarrhoeal diseases Readings on diarrhoea Student manual Geneva, 1992, vi + 147 pages ISBN 92 4 154444 9 Price: Sw.fr. 20. -/US$ 18.- Addressed to medical students undergoing clinical training in paediatrics, the manual aims to equip them with all the knowledge needed to assess patients, plan treatment, and prevent deaths through proper case management. The first two teaching units provide fundamental information about the epi- demiology, clinical types of diarrhoea, causative agents, modes of transmission, pathophysiology, and implications for treatment. Subsequent units explain how the clinical assessment of patients should be performed and interpreted, discuss ways of teaching mothers to treat diarrhoea at home, describe clinical measures for the treatment of dehydrated patients, and discuss the special procedures to be followed during the treatment of dysentery, persistent diar- rhoea, and diarrhoea associated with other illnesses. The remaining units cover the nutritional manage- ment of diarrhoea in children, including those suffer- ing from severe malnutrition, and explain how phys- icians can promote prevention, particularly through the education of mothers and other family members. Each unit concludes with a list of exercises for test- ing the knowledge acquired. Further information is presented in a series of annexes, which set out guidelines for determining whether a child is mal- nourished, list antimicrobial agents for the treatment of specific causes of diarrhoea, and provide illus- trated instructions for intravenous rehydration and nasogastric rehydration. Environmental health The role of health centres in the development of urban health systems Report of a WHO Study Group on Primary Health Care in Urban Areas Geneva, 1992, iv + 38 pages (WHO Technical Report Series, No. 827). ISBN 92 4 120827 9 Price: Sw.fr. 7. -/US$ 6.30 Noting that a shortage of resources for urban health is a problem everywhere, this report concentrates on organizational and administrative changes that can upgrade the quality of health centres, extend cover- age to underserved populations, and reduce the inef- ficiencies that occur when hospitals are overburden- ed by patients suffering from minor complaints. The objective is to help health administrators and munici- pal authorities analyse the weaknesses in urban health systems, appraise options for strengthening primary health care, and introduce interventions that help obtain the maximum health gains from restric- ted budgets. Details range from a list of mistakes frequently made by municipal and public health auth- orities, through an explanation of methods for collec- ting basic data, to a series of questions to be asked when moving from an analysis of problems to a pro- gramme of action. The report cites evidence of an impending health crisis as urban populations con- tinue to grow and the incidence of chronic diseases rises alongside traditional health problems and the added burdens of HIV infection and AIDS, alcohol and drug abuse, and injuries caused by violence and road accidents. Against this background, the report introduces the concept of "reference health centres" that would provide an extended range of high-quality, round-the-clock health services in defined catchment areas and link with hospitals for referral support. A review of experiences to date in developing such centres in various urban settings underscores the potential contribution that reference health centres can make to urban public health. A guide to the development of on-site sanitation R. Franceys, J. Pickford, & R. Reed Geneva, 1992, viii + 237 pages ISBN 92 4 154443 0 Price: Sw.fr. 47. -/US$ 42.30 This book provides practical and technical advice intended to guide the selection, design, construction, and maintenance of on-site facilities for the removal of human excreta. Addressed to engineers, sani- tarians, medical officers, and project planners, the guide concentrates on technical options suitable for householders building their own latrines, whether in small communities, rural areas, or deprived urban settlements. Noting that efforts to improve sanitation depend on far more than the application of tech- nology, the authors draw upon their own experience in developing countries to alert readers to the many social, cultural, institutional, economic, and financial factors that determine the success of any sanitation scheme. The book provides information on the links WHO Bulletin OMS. Vol 71 1993480 Recent WHO publications between excreta and disease, on how sanitation can block transmission at one or more points, and on the numerous social and cultural factors that must be considered at the planning phase. Readers are remind- ed that the introduction of on-site sanitation entails considerable social change, and that individual users are the ultimate decision-makers in the acceptance or rejection of new technology. The most extensive part provides a technical guide to the design, construction, operation and maintenance of all the main options for on-site sanitation. Other chapters describe how the different types of latrine work, discuss their relative merits, and set out plans for the construction of latrines and their components, moving from the exca- vation of different types of pits and the construction of linings to methods for using locally available materials to produce slabs, seats, pans, ventilation pipes, and superstructures. The final part covers the planning and development of on-site sanitation pro- jects, underscoring the need for a thorough analysis of factors such as cost, cultural acceptability, simpli- city of design and construction, operation and mainte- nance, and local availability of materials and skills, and concludes with advice on the reuse of human excreta and on the safe disposal of sullage. Site selection for new hazardous waste management facilities by W.M. Sloan Copenhagen, WHO Regional Office for Europe, 1993, xiv + 118 pages (WHO Regional Publications, European Series, No. 46). ISBN 92 890 1309 5 Price: Sw.fr. 21. -/US$ 18.90 This book outlines the processes involved in select- ing appropriate sites where new facilities can be set up to manage hazardous waste. The first priority when dealing with hazardous waste is to limit uncon- trolled discharges. The second priority is the use of a four-tier system of waste management measures: reduce the amount of waste produced, recycle it, treat it, or secure it; and the third priority is to use state-of-the-art treatment and containment technol- ogy where possible. This is probably the first guide to touch on all elements of facility siting and to give equal weight to the social impact and the engineering and scientific considerations involved. The public's acceptance of the siting process as valid and fair is vital. The community that will play host to the facil- ity should be viewed as a resource rather than an adversary. Without this support, the siting process may fail. The book also draws on practical examples of how the recommended processes have been used successfully to select sites for new facilities. This guide should be read by those in govemment, indus- try, environmental and public interest groups and the general public who are involved in negotiations on site selection. Human reproduction Reproductive health: a key to a brighter future Special Programme of Research, Development and Research Training in Human Reproduction Biennial report 1990-1991 Special 20th anniversary issue Edited by J. Khanna, P.F.A. Van Look, & P.D. Griffin Geneva, 1992, xiii + 171 pages ISBN 92 4 156153 X Price: Sw.fr. 35. -/US$ 31.50 This biennial report assesses changes in human repro- ductive health over the past two decades, concentrat- ing on the specific ways in which scientific research has responded to the expanding needs for fertility regulation in developing countries. The book, which features 16 review articles, was issued to commem- orate the 20th anniversary of the WHO Special Programme of Research, Development and Research Training in Human Reproduction. Apart from its leading role in research on human reproduction, the programme has helped numerous developing countries to acquire the material and human resources needed to conduct their own research on priority problems. Maternal and child health Traditional birth attendants A Joint WHO/UNFPA/UNICEF Statement Geneva, 1992, 18 pages ISBN 924 156150 5 Price: Sw.fr. 9. -/US$ 8.10 This joint WHO/UNFPA/UNICEF statement re- examines the role that traditional birth attendants (TBAs) can be expected to play in efforts to reduce matemal morbidity and mortality. Addressed to policy-makers and planners, the booklet aims to encourage realistic decisions based on a firm under- standing of what TBAs can and cannot do and the extent to which their strengths and limitations might be affected by training programmes. Throughout, the use of TBAs is regarded as an interim solution in pursuit of the greater goal of giving all women and children access to acceptable, professional, modem health care. WHO Bulletin OMS. Vol 71 1993 481 Recent WHO publications Nomenclature CIOMS calendar of congresses of medical sciences, No. 54 Geneva, CIOMS, 1993, iv + 65 pages ISBN 92 9036 055 0 Price: Sw.fr. 10. -/US$ 9.- The Council for International Organizations of Medi- cal Sciences (CIOMS) publishes annually the Calen- dar of congresses of medical sciences (in English, and French when applicable), which is the most complete publication in this field for the guidance of organizations planning such meetings, as well as for participants. The 1993 edition gives a list of meet- ings for 1993 to 1996, and some that are expected to take place in 1997 and 1998. Each item gives the title of the meeting, the date, place and the name of the organizer.f Noncommunicable diseases Health promotion and chronic illness Discovering a new quality of health Edited by A. Kaplun Published in collaboration with the Federal Centre for Health Education, Cologne Copenhagen, WHO Regional Office for Europe, 1992, xviii + 461 pages (WHO Regional Publications, European Series, No. 44). ISBN 92 890 1307 9 Price: Sw.fr. 68. -/US$ 61.20 This book provides an overview and a scientific evaluation of some chronic conditions such as can- cers, myocardial infarction and chronic pain. It also takes stock of medical progress and practice, but goes much further by exploring new avenues to health. The authors ask questions and provide pos- sible answers, and give many examples of ways to enhance the well-being of those who have to live with chronic health problems. Underlying the book are the principles of the Ottawa Charter for Health Promo- tion, carrying as it does one of the most influential messages for the shaping of future health policies. This book is essential reading for all groups work- ing to reshape personal and public health in respect f CIOMS publications may be obtained directly from CIOMS, c/o World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland. They are also distributed by the World Health Organization, Distribution and Sales, Avenue Appia, 1211 Geneva 27, Switzerland, and are available from booksellers through the network of WHO sales agents. A list of these agents appears on the inside back cover of the Bulletin. of chronic conditions, as, for example, politicians, health planners and public health managers, doctors and other health professionals. However, and above all, it attempts to inform interested consumers about the many possibilities for actively transcending the often devastating knowledge of having to live with the uncertainties of a chronic disease. Oral health Recent advances in oral health Report of a WHO Expert Committee Geneva, 1992, v + 37 pages (WHO Technical Report Series, No. 826). ISBN 92 4 120826 0 Price: Sw.fr. 7. -/US$ 6.30 This report evaluates striking recent advances in oral health care technology, materials, and clinical methods in terms of their capacity to improve the prevention and treatment of oral diseases. Addressed to oral health authorities, the report makes a special effort to identify new methods and technologies that have proved their advantages, in terms of costs as well as effectiveness, and can thus be implemented at the public health level. Although many of these advances are universally applicable, particular atten- tion is given to methods and techniques than can improve oral health care in settings where resources are limited and high-technology equipment is scarce. The report also shows how dramatic improvements in scientific knowledge and technology have contri- buted to the minimally invasive, low-intervention approach to oral health care that is now recommended. Pharmaceuticals, biologicals Drug utilization studies: methods and uses Edited by M.N.G. Dukes Copenhagen, WHO Regional Office for Europe, 1993, viii + 218 pages (WHO Regional Publications, European Series, No. 45). ISBN 92 890 1308 7 Price: Sw.fr. 36. -/US$ 32.40 This book describes the latest research methods and how they have been used, as well as complement- arity of clinical trials and drug utilization studies, the development of therapeutic formularies, essential drugs lists, drug classification systems and standard dosage measures, and the quantification of drug risks. Discussed are the social and economic aspects of drug use, and the role that health authorities, health professions, teachers of health professionals, and 482 WHO Bulletin OMS. Vol 71 1993 Recent WHO publications/Publicatlons r6centes OMS consumers themselves play in drug utilization. Also explored are how far drug utilization studies are transferable between industrialized and developing countries. Every country needs a drug policy to make the most rational and cost-effective use of a very expensive part of the health service. Drug utilization research provides the tools for them to do so. This book is not just a record of what has been achieved so far in that field; it is also a guide to students and researchers as well as to those in the pharmaceuti- cal industry and administration. Women, health and development Women's health: across age and frontier Geneva, 1992, vii + 107 pages ISBN 92 4 156152 1 Price: Sw.fr. 20. -/US$ 18.- This book provides a visual presentation of selected facts and figures that document the inferior health status of women and illustrate the many gender- specific factors that contribute to health problems and undermine the ability of women to improve their lives. These facts and figures are used to demonstrate the complex determinants of female health status in different countries and at different stages throughout the lifespan, moving from discrimination against the female fetus to the health problems of elderly women. The book draws upon a growing body of evidence that shows how social, political, and econ- omic inequities are ultimately reflected in women's health status. It also raises a number of questions regarding the implications of women's health needs for health services, including questions concerning the importance of distance, cost, supplies and equip- ment, and the need to evaluate services from a woman's perspective. Ethique, nomenclature Directives internationales pour I'examen 6thique des enquetes epidemiologiques proposees par le Conseil des Organisations internationales des Sciences medicales Tire a part du Recueil international de L6gislation sanitaireg Geneve, 1992, 36 pages ISBN 92 4 254452 3 Prix: Fr.s. 6.- 9 D'aprbs: Bankowski, Z. et al. Ethics and epidemiology: Inter- national guidelines. XXVth CIOMS Conference. Genbve, CIOMS, 1991, ISBN 92 9036 048 8. Voir I'analyse de cette publication, en anglais, dans le Bulletin de l'Organisation mondiale de la Sante, 70(2): 289 (1992). Une note resumant les conclusions et recommandations de la conf6rence a paru dans le Bulletin de l'Organisation mondiale de la Sante, 69(3): 369-370 (1991). Les publications du CIOMS peuvent etre obtenues directe- ment du CIOMS, c/o Organisation mondiale de la Sante, avenue Appia, 1211 Genbve 27, Suisse. Elles sont egalement distri- buees par l'Organisation mondiale de la Sante, Service de Dis- tribution et Vente, avenue Appia, 1211 Genbve 27, Suisse, et sont disponibles aupres des agents de vente dont la liste figure au recto de la derniere page de couverture du Bulletin. Les presentes directives repondent aux preoccupa- tions exprimees face 'a I'ampleur des moyens dont dispose aujourd'hui l'epidemiologie pour recueillir, conserver et utiliser des informations de caractere individuel ou collectif, notamment en appliquant la technologie informationnelle 'a 1'etude de vastes fichiers. Des inquietudes se sont exprimees au moment du lancement d'enquetes sur la prevalence et la surveillance du virus de l'immunodeficience humaine (VIH) et avec le debut des essais de vaccins candidats anti-VIH et de medicaments pour le traite- ment de la maladie sur des populations de pays en developpement. Des apprehensions se font jour dans le public quant aux risques d'abus et des eclaircisse- ments sont demandes 'a propos des normes d'ethique applicables en la circonstance. Le Conseil des Organisations intemationales des Sciences medicales (CIOMS), en collaboration avec l'OMS, a lance un projet visant 'a etablir des direc- tives intemationales d'ethique relatives aux enquetes dpidemiologiques. I1 a mis en place un comite direc- teur, a entrepris de vastes consultations, organise une conference afin d'examiner une serie de projets de directives proposees et a obtenu en 1991 l'approba- tion du present texte par le comite. Ces directives WHO Bulletin OMS. Vol 71 1993 483 Publications recentes OMS doivent permettre aux pays d'elaborer une politique nationale en matiere d'ethique des enquetes epide- miologiques et d'adopter des normes deontologiques ainsi que des procedures appropriees d'examen. CIOMS, calendrier des congres des sciences medicales, No 54 Geneve, CIOMS, 1993, iv + 65 pages ISBN 92 9036 055 0 Prix: Fr.s. 10.- Le Conseil des Organisations intemationales des Sciences medicales (CIOMS) publie chaque annee le Calendrier des Congres des Sciences medicales (en anglais, et en francais selon le cas), qui represente la publication la plus complete dans ce domaine. Ce calendrier sert de guide pour les institutions organi- sant de tels congres ainsi que pour les participants. L'ddition 1993 contient une liste des reunions pour les annees 1993 'a 1996 ainsi que des renseignements concemant les congres prevus en 1997 et 1998. Chaque rubrique indique le titre de la reunion, la date, le lieu et l'adresse de l'organisateur. 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