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. Blood safety Guidelines for quality assurance programmes for blood transfusion services Geneva, 1993, iv + 50 pages ISBN 92 4 154448 1 Price: Sw.fr. 12.-/US$ 10.80 This book provides an authoritative guide to quality assurance programmes for blood transfusion ser- vices, whether established in a small hospital blood bank or in a transfusion centre dedicated to the large- scale production of blood components. Measures described are intended to ensure the safety of all pro- cedures for donors, recipients, and the staff them- selves. Arguing that a system of quality assurance should be implemented in all transfusion services and blood banks, the book emphasizes the vital importance of strict quality control procedures at each stage of each procedure, from the recruitment of donors to the monitoring of the appropriate use of blood or its components for recipients. Information ranges from indicators of successful donor selection and retention, through advice on situations where autologous collections are practical and appropriate, to the reasons why a quality assurance programme must demonstrate its cost-effectiveness in terms of savings and benefits. Throughout, a particular effort is made to identify measures for objectively assess- ing and recording the quality of specific procedures. Measures that can reduce costs and waste are also considered.a Chemical toxicology, carcinogenicity Methyl ethyl ketoneb Geneva, 1993, 161 pages (Environmental Health Criteria, No. 143). ISBN 92 4 157143 8 Price: Sw.fr. 22.-/US$ 19.80 a See also: Gibbs, W.N. & Britten, A.F.H. Guidelines for the organization of a blood transfusion service. Geneva, WHO, 1992, reviewed in the Bulletin of the World Health Organization, 71(1): 129 (1993). b 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). Because of its excellent properties as a solvent, methyl ethyl ketone (MEK) is widely used in the application of protective coatings and adhesives, in magnetic tape production, in the dewaxing of lubri- cating oil, and in food processing. It is also a com- mon ingredient in varnishes and glues. Intentional abuse of solvent mixtures containing this chemical is of particular public health concern, since injuries can be severe, permanently disabling, and even fatal. Sections outline procedures for analysis in environ- mental samples and describe the various sources of human and environment exposure. Data on its envi- ronmental behaviour, on levels detected in the envi- ronment, and on corresponding exposures for humans are also reviewed. Although MEK is a natu- ral component of many foods, the report notes that concentrations are consistently low and that food consumption cannot be considered a significant source of exposure for the general population. Other sources of population exposure include drinking- water, tobacco smoke, and volatilization from build- ing materials and consumer products, which can pol- lute indoor air to levels far above those found in adjacent outdoor air. Away from industrial areas, motor vehicles are noted to be a major source of atmospheric pollution. The report concludes that MEK does not pose a significant threat to the envi- ronment except in cases of major spills or discharg- es. Further sections concentrate on evidence, from animal studies, in vitro test systems, and observa- tions in humans, of the toxic effects of this chemical. Evidence from several outbreaks of poisoning linked to solvent abuse is considered. The report concludes that the principal toxic effects observed with MEK exposure stem from its well-documented ability to potentiate the toxicity of two classes of organic sol- vents: unbranched aliphatic hexacarbons and haloal- kanes. While MEK on its own appears to be a rela- tively safe organic solvent, chronic co-exposure with these other organic solvents represents a significant potential occupational hazard. A concluding section urges industries to take all precautions necessary to ensure that workers are not exposed to both MEK and solvents whose toxicity is potentiated by this chemical.c c A summary in French and Spanish is included in the book. Bulletin of the World Health Organization, 71 (5): 649-655 (1993) 649 Recent WHO publications Principles for evaluating chemical effects on the aged populationb Geneva, 1993, 159 pages (Environmental Health Criteria, No. 144). ISBN 92 4 157144 6 Price: Sw.fr. 19.-/US$ 17.10 This book provides a detailed review of research findings and methodological concepts that guide efforts to characterize the susceptibility of the aged population to the harmful effects of environmental chemicals. Noting that few, if any, of the hundreds of thousands of environmental chemicals have been tested for increased toxicity in the elderly, the book uses knowledge from gerontology and toxicology to propose methodological principles for investigating the elderly as a population at special risk. Particular attention is given to methods for determining chronic effects, including cancer, linked to the long-term exposures that may characterize this age group. Find- ings from close to 700 epidemiological, clinical, and experimental studies were critically assessed. The book has four chapters. The first introduces and dis- cusses the many complex factors that complicate efforts to link chemical exposure to adverse effects on the health of the elderly. The second chapter pro- vides a detailed review of age-related changes at the genetic, molecular and cellular level, and in individ- ual tissues, organs and systems. The third chapter explores age-related changes in chemical sensitivity as reflected in altered pharmacokinetics and changes in the pharmacodynamics of the central nervous system, endocrine system, kidney, immune system, and other systems and tissues. The fourth chapter describes the special methodological requirements that need to be met when investigating the effects of chemicals on the aged population. Noting that both the size of the elderly population and the number of chemicals in the environment are increasing, the book concludes that the adverse effects of chemical exposure on the aged population will become a health care issue of growing importance. Propachlorb Geneva, 1993, 1 10 pages (Environmental Health Criteria, No. 147). ISBN 92 4 157147 0 Price: Sw.fr. 16.-/US$ 14.40 Propachlor, a pre-emergence and early post-emer- gence herbicide in use since 1965, is derived from acetanilide; it is used in agriculture to control annual grasses and some broad-leaved weeds in several crops, including com, sorghum, pumpkins, flax and flowers. A section cites rapid degradation by micro- organisms in soil and water, and concludes that this chemical does not bioconcentrate or biomagnify. Other sections evaluate findings from toxicological investigations in experimental animals and, for humans, the limited data available from cases of con- tact and allergic dermatitis reported in farmers and production workers exposed to propachlor. For experimental animals, the liver and kidneys are iden- tified as the target organs. For human exposures, the report found no evidence of symptoms or diseases reported for either occupationally exposed workers or the general population, with the exception of scat- tered reports of dermatitis in workers. On the basis of these evaluations, the report concludes that, under conditions of normal use, exposure of the general population is unlikely. For occupationally exposed workers, it recommends the use of adequate safety and hygienic precautions to protect the skin, eyes, and respiratory tract. Though propachlor is judged to pose a low hazard to birds, earthworms, and honey- bees, evidence indicates high toxicity to some aquat- ic organisms, supporting the conclusion that direct contamination of water courses should be avoided.d Diarrhoeal diseases Guidelines for cholera control Geneva, 1993, vi + 61 pages ISBN 92 4 154449 X Price: Sw.fr. 15.-/US$ 13.50 This book sets out the facts and advice needed to guide public health actions in response to an out- break of cholera. Noting that the introduction of cholera into a country cannot be prevented, the book stresses the many things that can be done to prepare the health services, educate the general public, save the lives of patients, and prevent the further spread of an outbreak. The objective is to help managers of national diarrhoeal disease control programmes and nongovemmental organizations to make the most effective decisions, whether conceming the selection of medical supplies or the emergency response to an epidemic. The guidelines take their authority from three decades of intensive research and experience with the disease and the most effective measures for its management. Throughout, emphasis is placed on the importance of safe water, scrupulous personal hygiene, and careful food preparation as the most d A summary and evaluation in French and Spanish are includ- ed in the book. 650 WHO Bulletin OMS. Vol 71 1993 Recent WHO publications effective preventive measures. Readers are alerted to public health interventions, such as vaccination, mass chemoprophylaxis, and cordon sanitaire, which are ineffective, wasteful, and therefore to be dis- couraged. In five annexes, the book provides advice on the construction of a ventilated improved pit latrine, followed by a detailed guide to the manage- ment of cholera patients, a selection of sample health education messages, and rules for safe food prepara- tion to prevent cholera. It concludes with guidelines describing a simple and rapid method for the isola- tion and identification of Vibrio cholerae O1 in diar- rhoeal stools. Ethics, human rights Ethics and research on human subjects International guidelines Proceedings of the XXVIth CIOMS Conference edited by Z. Bankowski & R.J. Levine Geneva, CIOMS, 1993, ix + 291 pages ISBN 92 9036 054 2 Price: Sw.fr. 25.-/US$ 22.50 This book records the main presentations and discus- sions held at an intemational conference organized in 1992 by the Council for Intemational Organizations of Medical Sciences (CIOMS) to review the 1982 Proposed international guidelines for biomedical research involving human subjects. The 1993 guide- lines, which reflect the consensus of the conference, are also issued as a separate publication (see next review). The proceedings focus on several develop- ments in biomedical research and bioethics that had occurred over the previous decade and which pointed to the need to revise the 1982 guidelines. Major developments include the unique ethical issues raised by human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), by the asserted right of HIV-infected people to have access to incompletely tested new treatments, and by the prospect of field trials of candidate AIDS vac- cines and drugs. New problems have been raised by studies designed to detect HIV infection and other diseases in large populations, by externally spon- sored research, and by advances in the management of electronically collected and stored data, which call for a rethinking of the principles of confidentiality and informed consent. Chapters reflect a growing perception that research involving human subjects is beneficial rather than threatening and that vulnerable groups, such as women, children, the elderly, and prisoners, should not be deprived arbitrarily of the opportunity to benefit from investigational drugs, vaccines or devices. Other topics include ethical implications of the distinction between therapeutic, or clinical, and non-therapeutic research, the ques- tion of providing financial or other material induce- ments to research subjects, and the sponsor's obliga- tion to ensure that study subjects are compensated for any harm caused by participation as a research subject and are among the first to profit from the out- come of a research project. International ethical guidelines for biomedical research involving human subjects Geneva, CIOMS, 1993, 63 pages ISBN 92 9036 056 9 Price: Sw.fr. 10.-/US$ 9.- The fifteen guidelines formulated in this book, prepared by CIOMS in collaboration with WHO, provide an intemational tool for the protection of human rights in biomedical research involving human subjects, particularly in developing countries. The 1982 proposed guidelines,e issued largely as guidance on the application of the Declaration of Helsinki to developing countries, have been revised and refined in line with several recent developments. Addressed to biomedical researchers, ethical review committees, and sponsors, they centre on three main themes: informed consent of prospective subjects, the ethical review process, and the obligations of sponsors, particularly in the case of extemally spon- sored research. There has been extensive rewording of guidelines concerned with informed consent, research involving subjects in underdeveloped com- munities, exclusion of pregnant and nursing women, confidentiality, extemally sponsored research, and compensation for injury. Each guideline is accompa- nied by a commentary on how it should be applied in practice. Where appropriate, the commentaries indi- cate which judgements on the part of the investigator must be reviewed and approved by the ethical review committee. Annexed to the guidelines are the text of the Declaration of Helsinki and an explanation of certain ethical issues raised by clinical trials of vac- cines and drugs, which constitute a substantial part of all research involving human subjects. e Proposed international guidelines for biomedical research involving human subjects. A joint project of WHO and CIOMS. Geneva, CIOMS, 1982. CIOMS publications may be obtained directly from CIOMS, c/o World Health Organization, 1211 Geneva 27, Switzerland. They are also distributed by the World Health Organization, Distribution and Sales, 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. WHO Bulletin OMS. Vol 71 1993 651 Recent WHO publications/Publications r6centes OMS Family planning and population Female sterilization A guide to provision of services Geneva, 1992, x + 197 pages ISBN 92 4 154434 1 Price: Sw.fr. 41.-/US$ 36.90 While noting that sterilization is a highly effective and safe method of contraception, the guide concen- trates on the many issues and practical details that must be considered in order to ensure that services for female sterilization are voluntary, medically safe and effective, appropriate to the health care system, well managed, efficient, and acceptable to clients. Information ranges from advice on how to make newly available services known in the community, to a discussion of complications and ways to prevent them. Because the procedure involves surgery and is intended to be permanent, the book gives particular attention to the information and individualized coun- selling needed to ensure that each woman's decision is voluntary, fully informed, and free from induce- ments. A series of annexes refer readers to sources of assistance, list the equipment needed for laparoscop- ic sterilization, and offer advice on the preparation of instructions to clients and on the development and use of forms for medical records and periodic sum- mary reports. Tropical diseases The control of schistosomiasis Second report of the WHO Expert Committee Geneva, 1993, vii + 86 pages (WHO Technical Report Series, No. 830). ISBN 92 4 120830 9 Price: Sw.fr. 12.-/US$ 10.80 This report provides a comprehensive guide to the technical and practical factors that need to be consid- ered when designing and implementing programmes for the control of schistosomiasis. Noting the success of strategies focused on morbidity control, the report shows how the spectrum of programme goals can now be broadened to include reductions in the prevalence and intensity of established infections and decreases in the intensity of transmission. Emphasis is placed on knowledge and experiences that can help programme managers establish feasible goals and then select con- trol options in line with the form of infection, its pub- lic health importance, the degree and type of morbid- ity, available resources, and integration into the primary health care system. Information is specific to the different types of schistosomiasis and the distinc- tive epidemiological features, clinical manifestations, and response to treatment of each. The report also uses profiles of control programmes in 24 countries to doc- ument the feasibility of control and illustrate the diver- sity of approaches that can be applied according to dif- ferent national conditions, forms and prevalence of infection, health care systems, and available resources. It concludes with a list of indices recommended for use in establishing adequate baseline information, in monitoring operations and in evaluating schistosomia- sis control programmes.f I See note on treatment of schoolchildren for intestinal helminths and schistosomiasis in the Bulletin of the World Health Organ- ization, 71(3/4): 466 (1993). Environnement R6Ie des centres de sant6 dans le d6veloppement des systbmes de sant6 des villes Rapport d'un Groupe d'Etude de l'OMS sur les Soins de Sant primaires dans les Zones urbaines Genbve, 1992, iv + 43 pages (OMS, Serie de Rapports techniques, No 827). ISBN 92 4 220827 2 Prix: Fr.s. 7.- Notant que la penurie des ressources de sante dans les villes pose partout un probleme, ce rapport se concentre sur les changements 'a apporter 'a l'organi- sation et 'a l'administration pour ameliorer la qualite des centres de sante, etendre la couverture aux populations sous-desservies et reduire les dysfonc- tionnements qui se produisent lorsque les hopitaux sont surcharges de patients dont le cas est sans gra- vite. L'objectif est d'aider les administrateurs de la sante et les autorites municipales a analyser les fai- blesses des systemes de santd urbains, a apprecier les possibilites de renforcement des soins de sante 652 WHO Bulletin OMS. Vol 71 1993 Publications recentes OMS primaires, et a agir de fa,on a obtenir le maximum de benefices pour la santd avec des budgets res- treints. Apres avoir rappele les erreurs frdquemment faites par les autorites municipales et les respon- sables de la sante publique, on explique comment proceder pour rassembler les donnees de base et on enumere les questions a poser pour passer de l'ana- lyse d'un probleme a l'action. Le rapport appelle l'attention sur les signes avant-coureurs d'une crise imminente, r6sultant de l'augmentation continue des populations urbaines et de l'incidence croissante des maladies chroniques, parallelement aux problemes de sante classiques, auxquels viennent s'ajouter l'infection a VIH (virus de l'immunodeficience humaine) et le SIDA (syndrome de l'immunodefi- cience acquise), l'abus d'alcool et de drogue et les traumatismes dus aux actes de violence et aux acci- dents de la circulation. C'est dans ce contexte que se situe l'idee de "centres de sante de reference" destines a offrir une vaste gamme de services de sante de haute qualite et a fonctionner 24 heures sur 24, en liaison avec des hopitaux de recours. Le rap- pel de l'experience acquise jusqu'ici avec la crea- tion de tels centres dans divers contextes urbains montre bien ce que ces centres pourraient apporter a la sante publique dans les villes. Maladies tropicales Lutte contre la schistosomiase Deuxibme rapport du Comitd OMS d'Experts Geneve, 1993, viii + 99 pages (OMS, S6rie de Rapports techniques, No 830). ISBN 92 4 220830 2 Prix: Fr.s. 12.- Ce rapport 6numere l'ensemble des facteurs tech- niques et pratiques a prendre en consideration dans la mise au point et l'exdcution des programmes de lutte contre la schistosomiase. Notant le succes rem- port6 par les strategies axees sur la lutte contre la morbidite, il montre comment elargir maintenant la gamme des objectifs du programme, en y incluant la reduction de la prevalence et de l'intensite des infec- tions deja installees et la diminution de l'intensite de la transmission. L'accent est mis sur les donnees d'experience qui peuvent aider les directeurs de pro- gramme a se fixer des objectifs realisables et a opter pour des mesures de lutte en rapport avec le type d'infection, son importance pour la sante publique, le degre et le type de morbidite, les ressources dispo- nibles et l'integration au systeme de soins de sante primaires. Les informations donnees concement les diff6rentes formes de schistosomiase, leurs caracte- ristiques epidemiologiques, leurs manifestations cli- niques et la faqon dont elles repondent au traitement. Le rapport fait egalement le point d'un programme de lutte dans 24 pays afin de montrer sa faisabilite et d'illustrer la diversitd des approches possibles en fonction des conditions propres aux pays, des formes et de la prevalence de l'infection, des systemes de soins de sante et des ressources disponibles. II s'acheve sur une liste d'indices qu'il est recomman- de d'utiliser pour etablir une base de donnees conve- nable en vue de la surveillance des operations et pour evaluer les programmes de lutte contre la schis- tosomiase.9 Prevention de la cecite Pr6vention de la cecit6 chez I'enfant Geneve, 1993, vii + 51 pages + 8 planches couleur ISBN 92 4 256151 7 Prix: Fr.s. 15.- Abordant le probleme sous l'angle de la sante publique, le livre invite le lecteur a prendre connais- sance des tres nombreuses possibilites nouvelles de prevention offertes par les derniers progres des connaissances et des techniques. Les strategies de prevention, qui concement aussi bien les pays indus- trialises que les pays en developpement, decoulent de la conviction de plus en plus repandue, que la plupart des incapacites de l'enfance sont maintenant evi- tables. Le premier chapitre ouvre sur un bref resume de la prevalence et de l'epidemiologie de la cecite chez l'enfant dans le monde, notant que chaque annee un demi-million d'enfants deviennent aveugles. Le deuxieme chapitre explique en detail quels sont les facteurs complexes et nombreux qui agissent sur les quelque 20 causes potentielles de cecite des periodes prenatale, neonatale et de 1'enfance. Les descriptions sont appuyees par sept planches en couleurs qui illustrent les maladies de la cecite les plus r6pandues. Le troisieme chapitre, consacre aux strategies de pre- vention, resume en sept pages de tableaux les mesures applicables, aux niveaux primaire, secondai- re et tertiaire, pour prevenir chacune des causes majeures de cecite chez l'enfant. Le livre se termine par l'enumeration de 14 priorites a appliquer lors d'interventions futures. 9 Voir la note sur le traitement des ecoliers contre les helmin- thiases intestinales et la schistosomiase dans le Bulletin de l'Organisation mondiale de la Sant6, 71(3/4): 470-471 (1993). WHO Bulletin OMS. Vol 71 1993 653 Publications r6centes OMS Sante bucco-dentaire Progrbs r6cents en sant6 bucco-dentaire Rapport d'un Comite OMS d'Experts Geneve, 1992, v + 41 pages (OMS, S6rie de Rapports techniques, No 826). ISBN 92 4 220826 4 Prix: Fr.s. 7.- Ce rapport evalue les progres remarquables qui vien- nent d'e'tre enregistr6s en ce qui conceme les tech- niques, les materiaux et les methodes cliniques dans le domaine des soins bucco-dentaires, compte tenu de leur capacite a ameliorer la prevention et le traite- ment des maladies bucco-dentaires. Destine aux autorites responsables de la sante bucco-dentaire, il s'efforce tout particuli'erement d'identifier les methodes et techniques nouvelles dont les avantages, sur le plan des couts comme sur celui de l'efficacite ont ete prouves et qui peuvent, par consequent, e'tre appliquees en sante publique. Bien que la plupart de ces progres soient universellement applicables, une attention particuliere est vouee aux methodes et tech- niques susceptibles d'ameliorer les soins bucco- dentaires dans des situations oiu les ressources sont limitees et les equipements hautement technolo- giques sont rares. Il montre egalement comment les ameliorations spectaculaires des connaissances scientifiques et des techniques ont contribue a l'adoption d'une approche peu interventionniste et aussi peu invasive que possible, qui est maintenant recommandee en matifere de soins bucco-dentaires. Securite des ailments Strat6gies d'6valuation de la salubrit6 des aliments produits par biotechnologie Rapport d'une Consultation conjointe FAO/OMS Geneve, 1993, iv + 66 pages ISBN 92 4 256145 2 Prix: Fr.s. 1 1.- Le present rapport contient les conclusions d'une consultation conjointe FAO/OMS destinee a etablir les bases scientifiques d'une evaluation de la salu- brite des aliments, des ingredients alimentaires et des moyens de transformation des nouveaux produits par biotechnologie. I1 met l'accent sur la salubrite des technologies nouvelles qui laissent esperer une ame- lioration spectaculaire de I'approvisionnement en denrees alimentaires, que ce soit grace a la produc- tion de cereales d'une meilleure qualite nutritionnelle ou grace a l'introduction d'animaux r'sistant mieux aux maladies, donnant une viande maigre et presen- tant une croissance plus efficace. Les techniques nouvelles permettant d'accroitre l'efficacite et de reduire les couits de l'industrie de transformation ali- mentaire font egalement l'objet d'une 6valuation approfondie. Destine aux autorites de reglementation ainsi qu'a l'industrie alimentaire, l'ouvrage cherche a apporter une base scientifique solide pour la mise au point d'une reglementation alimentaire complete, bien appliquee et capable de suivre le progrfes tech- nologique. Toxicologie, des substances chimiques, carcinogenicite Evaluation de certains additifs alimentaires et de certains produits toxiques naturels Trente-neuvibme rapport du Comite mixte FAO/OMS d'Experts des Additifs alimentaires Genbve, 1992, vii + 53 pages (OMS, S6rie de Rapports techniques, No 828). ISBN 92 4 220828 0 Prix: Fr.s. 9.- Les rapports publies dans cette serie, dont les debuts remontent a 1957, sont utilises dans 1'elaboration des legislations nationales visant a garantir le bon usage des additifs alimentaires et a proteger les consom- mateurs de contaminants dangereux, ainsi que par la Commission du Codex Alimentarius pour l'etablisse- ment de normes alimentaires intemationales. Ils don- nent, en outre, des avis utiles aux laboratoires de toxicologie au sujet des types d'etudes les plus perti- nents pour l'evaluation de la securite des additifs ali- mentaires. Sont etudiees dans ce rapport les doses joumali'eres admissibles de 25 additifs alimentaires et de 3 produits toxiques naturels. Parmi les sub- stances etudiees, on rel'eve des emulsifiants, des pre- parations enzymatiques, des aromatisants, des sol- vants, epaississants et cires, ainsi que la curcumine, le furfural et le bromate de potassium. Les doses joumalieres admissibles pour un certain nombre de substances ont ete etablies ou revues. Le rapport eva- lue egalement l'innocuite des glucosides cyanogfenes et des glucoalcaloides etroitement apparentes, comme la solanine et la chaconine, qui sont des pro- duits toxiques naturels. Pour les glucosides cyano- genes que l'on trouve par exemple dans les tuber- cules, les amandes, les noyaux de fruits, les pousses de bambou et certaines espfeces de haricots qui peu- vent produire du cyanure d'hydrogfene, aucun seuil d'innocuite n'a pu eftre estime. Le rapport note toute- fois que les consommateurs traditionnels des ali- ments contenant des glucosides cyanogfenes savent normalement comment les preparer pour pouvoir les WHO Bulletin OMS. Vol 71 1993654 Publications r6centes OMS consommer sans danger. Bien qu'aucun seuil d'inno- cuite n'ait pu etre determine pour la solanine et la chaconine, que l'on trouve dans les pommes de terre et d'autres tubercules, le rapport conclut que les quantites normales de glucoalcaloides dans les pommes de terre convenablement cultivees et prdpa- rees ne posent pas de probleme. Pour que les pommes de terre puissent continuer a etre consom- mees sans danger, tous ceux qui mettent au point de nouvelles varietes, ou qui cultivent, recoltent, entre- posent, transforment ou consomment ces tubercules, devraient savoir qu'ils risquent de provoquer, par inadvertance, une augmentation de la teneur en glu- coalcaloides jusqu'a atteindre des concentrations potentiellement toxiques. Le rapport s'acheve sur un tableau resumant les doses journalires admissibles et enumerant les changements apportes aux specifi- cations des substances etudiees par le comite. WHO Bulletin OMS. Vol 71 1993 655