Recent WHO publications

Recent WHO publications Readers living in developing countries receive a 30% reduction on the prices indicated in Swiss francs. Chemical toxicology, carcinogenicity Acetaldehydea Geneva, 1995, 129 pages (Environmental Health Criteria, No. 167). ISBN 92 4 157167 5 Price: Sw.fr. 22.-/US$ 19.80 As a commercially manufactured chemical, acetal- dehyde, a metabolic intermediate in humans and higher plants and a product of alcohol fermentation, has important uses as an intermediate in the pro- duction of acetic acid, ethyl acetate, and other organic chemicals. It is also used as a flavouring agent in beverages, ice-cream and ices, candy, baked goods, gelatin desserts, and chewing gum. Although acetaldehyde formed during the metabolism of ethanol provides the greatest source of human expo- sure, the report is primarily concerned with the con- sequences of direct exposure to the substance. Data from studies of metabolically formed acetaldehyde are used only when data on direct exposure are lack- ing. Acetaldehyde can enter the environment dur- ing its manufacture, as a product of incomplete combustion, and as a by-product of fermentation. Because of the compound's high vapour pressure and low tendency for sorption onto soil, most envi- ronmental acetaldehyde has been detected in air, where it is readily biodegraded. While consumption of alcohol remains the major source of human expo- sure, the general population may be exposed to acetaldehyde present in cigarette smoke, in air, and in foodstuffs, especially in some fruit juices, alcoholic beverages, and- vinegar. Compared with these sources, exposure through drinking-water is negli- gible. Available data were judged inadequate to de- termine the extent of exposure in the workplace. Studies of kinetics and metabolism indicate that acetaldehyde is absorbed through the lungs and gastrointestinal tract, is distributed to the blood, liver, kidney, spleen, heart, and other muscle tissues, and crosses the placenta. Studies have identified the liver as the most important metabolic site. Concern- a Published by WHO under the joint sponsorship of the United Nations Environment Programme, the International Labour Or- ganisation, and WHO (International Programme on Chemical Safety - IPCS). ing effects on organisms in the environment, the report reviews the limited data indicating slight toxicity for fish, toxicity for microorganisms at rela- tively low concentrations, and inhibition of seed ger- mination in several plants. In view of the rapid biodegradation of the compound, the report con- cludes that adverse effects on the aquatic and terres- trial environments should be low. Other sections review the results of toxicity studies in experimental animals and assess the effects of exposure on human health. Toxic effects observed in animals include de- generative changes in the olfactory epithelium and trachea and, at higher concentrations, degenerative changes in the respiratory epithelium and larynx. Data in humans are restricted to reports of mild irritation to the eyes and upper respiratory tract, and were judged inadequate to assess the potential re- productive, developmental, neurological and immu- nological effects in humans.b Cresolsa Geneva, 1995, 144 pages (Environmental Health Criteria, No. 168). ISBN 92 4 157168 3 Price: Sw.fr. 22.-/US$ 19.80 Commercial cresols have a wide variety of uses as solvents and disinfectants and as chemical intermedi- ates for pharmaceuticals, fragrances, antioxidants, dyes, pesticides, and resins. They are also used in the production of lubricating oils, motor fuels and rub- ber polymers and in the manufacture of explosives. A section on the physical and chemical properties of cresols is followed by a review of data on sources of human and environmental exposure. For the envi- ronment, the main sources are identified as acciden- tal and process discharge during the manufacture, use, transportation and storage of cresols and associ- ated products. The report notes that the general population may be exposed to cresols present in air, drinking-water, food and beverages, and consumer products, such as soaps and disinfectants. A review of data on the environmental behaviour of cresols concludes that these substances are rapidly de- graded, and that persistence in the environment is unlikely. Studies of the kinetics and metabolism of b A summary in French and Spanish is included in the book. Bulletin of the World Health Organization, 1996, 74 (1): 117-119 © Word Health Organization 1996 117 Recent WHO publications cresols in laboratory animals and humans indicate rapid absorption via inhalation, ingestion, and der- mal routes, and ready distribution throughout the body. The most extensive sections evaluate data on toxic effects linked to different routes and levels of exposure. In laboratory animals, toxic effects, in- cluding damage to the respiratory and gastrointes- tinal tracts, are associated with the strong irritant and corrosive activity of cresols. Although acute poi- soning via inhalation is judged unlikely due to the low vapour pressure of cresols, dermal exposure causes irreversible tissue damage in experimental animals and can be fatal at high concentrations. In humans, toxic effects and clinical signs following ac- cidental or intentional ingestion are identified as burning of the mouth and throat, abdominal pain, and vomiting. More severe reactions can result in coma and death. Studies of acute poisoning in work- ers indicate that occupational exposure is usually the result of dermal contact, which can provoke severe burns and scarring of the skin, haematological changes, kidney failure, coma and death. Data were inadequate to evaluate potential reproductive ef- fects and the carcinogenic risk posed by exposure to these substances. The resport concludes that at the concentrations normally detected in the environ- ment cresols do not pose a significant risk to human health.b Food safety Evaluation of certain veterinary drug residues in food Forty-third report of the Joint FAO/WHO Expert Committee on Food Additives Geneva, 1995, vi + 59 pages (WHO Technical Report Series, No. 855). ISBN 92 4 120855 4 Price: Sw.fr. 12.-/US$ 10.80 This report presents the conclusions of an expert committee commissioned to evaluate the safety of residues of selected veterinary drugs used in food- producing animals, to establish acceptable daily intakes (ADI) for humans, and to recommend maxi- mum residue limits (MRL). On the basis of a review of available safety and residue data, the committee establishes international standards intended to pro- mote food safety and facilitate the harmonization of international trade in animal products. The report considers methodological issues that are specific to the safety assessment of veterinary drug residues in food. These include evaluation of older data on vet- erinary drugs with a long history of use, criteria for identifying veterinary drugs for priority considera- tion, and special issues surrounding use of veterinary drugs in aquaculture. It also provides summaries of the toxicological and residue data considered when evaluating each substance, identifying any potential hazards to consumer health, and allocating an ADI and MRL. Veterinary drugs considered include a 3-adrenoceptor-blocking agent (carazolol), seven antimicrobial agents (dihydrostreptomycin and streptomycin, enrofloxacin, gentamicin, neomycin, oxolinic acid, and spiramycin), a glucocorticosteroid (dexamethasone), and a tranquillizing agent (azaper- one). It concludes with a summary of recommended ADI and MRL for the substances under review, and a list of further toxicological studies and other information. Nuclear energy Health consequences of the Chernobyl accident Results of the IPHECA pilot projects and related national programmes Summary report Geneva, 1995, vi + 38 pages ISBN 92 4 156181 5 Price: Sw.fr. 11.-/US$ 9.90 This report summarizes the results of international investigations aimed at determining the health con- sequences of the Chernobyl nuclear accident, which occurred in 1986, and which resulted in the exposure of over five million people to ionizing radiation from the fallout of radioactive nuclides. Though the im- mediate emergency actions taken by government authorities, WHO, and other agencies are described, the report concentrates on findings from the large International Programme on the Heath Effects of the Chernobyl Accident (IPHECA). Established in 1991, IPHECA is a cooperative initiative of WHO, the governments of Belarus, the Russian Federation and Ukraine, and a number of other countries and institutions.c c The first comprehensive report- of approximately 800 pages- of results of the IPHECA pilot projects and related national pro- grammes is in preparation and will be reviewed in more detail in a later issue. 118 WHO Bulletin OMS. Vol 74 1996 Recent WHO publications Nutrition Physical status: the use and interpretation of anthropometry Report of a WHO Expert Committee Geneva, 1995, x + 452 pages (WHO Technical Report Series, No. 854). ISBN 92 4 120854 6 Price: Sw.fr. 71.-/US$ 63.90 This report presents recommendations, developed in consultation with more than 100 experts, for the ap- propriate use and interpretation of anthropometry as a method with great potential to guide clinical decisions and public health policy. As the single most universally applicable, inexpensive, and non- invasive method available to assess the size, pro- portions, and composition of the human body, anthropometry reflects both health and nutritional status and predicts performance, health, and sur- vival. The report aims to give scientists, clinicians, and public health professionals a framework and context for the present and future uses and interpre- tation of anthropometry. Public health and clinical applications in all age groups, from infancy, through adolescence, to old age, are discussed and substanti- ated by more than 400 references to the literature. For groups such as adolescents and the elderly, where previous research has been limited, the report provides a basis and impetus for future studies. For age groups such as infants and children, the report re-evaluates currently used reference data in the light of new knowledge and recommends important changes. Throughout, an effort is made to relate spe- cific anthropometric indicators to the actions that can be taken on behalf of individuals or populations in a range of different settings. The report sets out a series of tabular reference data, recommended by the Expert Committee, that have not been widely distributed by WHO previously. Succinct summaries of recommendations for the use of anthropometry, in individuals and populations and for different age groups are also provided.d Pharmaceuticals, biologicals WHO model prescribing information: drugs used in parasitic diseases Second edition d See also Matemal anthropometry and pregnancy outcomes. A WHO Collaborative Study. Geneva, World Health Organization, 1995 (Supplement to Volume 73, 1995, of the Bulletin of the World Health Organization, xi + 98 pages, ISBN 92 4 068730 3, price Sw.fr. 20.-) Geneva, 1995, iv + 146 pages ISBN 92 4 140104 4 Price: Sw.fr.35.-/US$ 31.50 This book, now in its second revised edition, pro- vides model prescribing information for around 40 essential drugs used for the prevention and treat- ment of protozoal and helminthic infections. The sections on malaria, African trypanosomiasis, cestode infections, schistosomiasis, and onchocercia- sis have been extensively revised in the light of new developments in the treatment of these diseases. The book is the product of a consultative process involv- ing internationally accredited experts, WHO's Expert Advisory Panel on Drug Evaluation, selected members of the various WHO expert advi- sory panels on parasitic diseases, and several nongovernmental organizations in official relations with WHO, including the International Federation of Pharmaceutical Manufacturers Associations, the International Pharmaceutical Federation, the Inter- national Union of Pharmacology, and the World Federation of Proprietary Medicine Manufacturers. The book is organized according to diseases, moving from amoebiasis and giardiasis to intestinal, liver, and lung flukes. Each disease or group of diseases is introduced with information about its causes, mode of transmission, clinical features, and geographical prevalence, followed by advice on prevention and treatment. Prescribing information is provided for first-choice and alternative therapeutic and prophy- lactic drugs. Information includes uses, dosage and administration, contraindications and precautions, use in pregnancy, adverse effects, drug interactions, and advice on storage. Prescribing precautions to be followed when treating infections in AIDS patients are indicated. Some parasitic disease, such as Babesia divergens infections and men- ingoencephalitis due to Acanthamoeba spp., which do not respond to chemotherapy, are none the less presented and discussed in order to help prescribers avoid ineffective medications. The book is part of a series of WHO publications intended to provide up-to-date and independent clinical information on essential drugs. The objective is to give national authorities, particularly in devel- oping countries, authoritative and reliable informa- tion that can guide the development of national drug formularies, drug compendia and similar material.e e For review of previous volumes published in this series, see Bulletin of the World Health Organization, 1992, 70: 147 (WHO model prescribing information: drugs used in mycobacterial dis- eases). WHO Bulletin OMS. Vol 74 1996 119