Recent WHO publications

Recent WHO publications/Publications recentes OMS Readers living in developing countries receive a 30% reduction on the prices indicated in Swiss francs. Les lecteurs r6sidant dans les pays en d6veloppement b6n6ficient d'un rabais de 30% sur les tarifs indiqu6s en francs suisses. Chemical toxicology, carcinogenicity Nickela Geneva, 1991, 383 pages (Environmental Health Criteria, No. 108). ISBN 92 4 157108 X Price: Sw.fr. 38.-/US$ 34.20 This book evaluates close to 900 studies in an effort to determine the role of various nickel compounds as environmental hazards and causes of human diseases, including cancer. A special effort is made to determine the specific exposure levels for nickel and nickel compounds that pose a threat to the en- vironment, the general public, and workers exposed, to nickel-containing dusts and fumes. The book opens with a discussion of the careful analytical procedures that must be followed to mini- mize the risk of contamination during sample collec- tion, storage, processing, and analysis. Exposure of the general population is noted to occur via inhaled air, ingestion of food and drinking-water, and dermal contact, particularly with jewellery and coins. The most extensive section reviews the large body of data from experimental studies of the effects of short- and long-term exposures on the respiratory tract, endocrine system, cardiovascular system, immune system, skin and eye. Tests for mutagenici- ty, embryotoxicity, teratogenicity, and carcinogen- icity are also reviewed. The final section assesses effects on the human respiratory system, kidney, car- diovascular system, skin and eye. Evaluation of the potential for carcinogenicity draws upon increased rates of nasal and lung cancer reported in several epidemiological studies of exposed workers. These studies provide evidence that inhalation of nickel dust and some soluble and insoluble nickel salts car- ries a risk of carcinogenicity. In terms of human health, nickel carbonyl was judged to be the most acutely toxic nickel compound. Clinical information includes a description of the two-stage manifesta- 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). tions of nickel carbonyl poisoning. The book also discusses the widespread problem, in workers and the general population, of nickel contact hypersensi- tivity.b Dimethylformamidea Geneva, 1991, 124 pages (Environmental Health Criteria, No. 114). ISBN 92 4 157114 4 Price: Sw.fr. 15.-/US$ 13.50 Dimethylformamide (DMF) is widely used in the chemical industry as a solvent, an intermediate, and an additive, with the largest quantities used in the production of acrylic fibres and polyurethanes. It is also used in the production of pharmaceutical prod- ucts. Although usually stable, DMF may cause fires and explosions when it comes into contact with halo- genated hydrocarbons or with strong oxidizing agents. Because of its complete solubility in water, DMF is noted to move readily through soils; accu- mulation in the food chain is judged unlikely. Conceming effects on organisms in the environment, the limited data available suggest low toxicity for aquatic organisms. The second half of the book reviews findings useful in determining the risks to health posed by exposure of workers and of the general population to DMF. Investigations of meta- bolic fate in animals and humans demonstrate that toxic amounts may be absorbed by inhalation and through the skin, and that metabolic transformation takes place mainly in the liver. The final section, which evaluates data from human studies, notes that symptoms associated with cases of acute accidental occupational poisoning are transient and followed by complete recovery. Biochemical signs of liver dys- function are observed to accompany long-term repeated occupational exposure, but evidence sug- gesting an increased risk of certain cancers in expos- ed workers was judged inadequate. Risks to the general population are determined to be negligible.' b A summary and conclusions in French and Spanish are includ- ed in the book. c A summary, conclusions, evaluation, and recommendations in French and Spanish are included in the book. Bulletin of the World Health Organization, 70 (1): 143-148 (1992) 143 Recent WHO publications Inorganic mercurya Geneva, 1991, 168 pages (Environmental Health Criteria, No. 118). ISBN 92 4 157118 7 Price: Sw.fr. 20.-/US$ 18.- This book evaluates recent research findings useful in assessing the risk to human health posed by the use of inorganic mercury in dental amalgam and in soaps and creams used to lighten the skin. Although such skin-lightening products are now banned throughout the European Economic Community, in North America, and in many African countries, the report reveals that mercury-containing soap con- tinues to be manufactured in several European coun- tries, is sold as germicidal soap to the Third World, and is illegally re-imported from African countries to European cities having a substantial black popula- tion. A brief discussion of physical and chemical properties is followed by a review of the most com- monly used analytical methods for the quantification of total and inorganic mercury compounds. Sources of environmental discharge and consequent human exposures are considered for both the general popu- lation and certain occupations. The most extensive sections review findings from toxicology studies in experimental animals and clinical reports and epide- miological studies in humans. Results from experi- mental studies show that inorganic mercury can induce autoimmune glomerulonephritis in all species tested, but not in all strains, indicating a genetic pre- disposition. Clinical manifestations of mercury poi- soning following both acute and long-term occupa- tional exposure are described in detail. Conceming the health hazards posed by dental amalgam, no firm conclusions could be reached in the light of severe weaknesses in the design of most epidemiological studies, which have tended to either overestimate or underestimate the daily dose of mercury and the degree of mercury uptake from dental amalgam. The book also includes information on reported levels of mercury vapour in dental clinics and the corre- sponding occupational risk to the dental profession. The concluding sections provide a broad characteri- zation of the risk assessment of exposure to mercury vapour and inorganic mercury compounds.b Hexachlorocyclopentadienea Geneva, 1991, 126 pages (Environmental Health Criteria, No. 120). ISBN 92 4 157120 9 Price: Sw.fr. 15.-/US$ 13.50 Hexachlorocyclopentadiene (HEX) is a chemical used in the production of several pesticides, includ- ing heptachlor, chlordane, aldrin, dieldrin, endrin, mirex, pentac, and endosulfan. The compound is also used as an intermediate in the manufacturing of flame retardants, resins, and dyes. In many countries, the use of HEX in the production of certain organo- chlorine pesticides has been restricted. A section devoted to sources of human and envi- ronmental exposure evaluates data on quantities released during production, processing, and use, during the incineration of hazardous waste contain- ing HEX, and from products contaminated with HEX. While exposure of the general population is judged to be very low, risk of exposure can be high in residential areas near HEX production, processing, and disposal sites or hazardous waste incinerators. Studies also show that HEX sorbs strongly to organ- ic matter and humus and may persist in soil sediment and ground water following waste disposal. Concerning risks to the environment, the report notes that HEX is toxic to many aquatic microorganisms at nominal concentrations. A review of the limited data available on human health effects yields evidence of severe irritation to the eyes, nose, throat, and lungs. The report also notes observation of systemic toxic effects following short-term exposure through inha- lation, suggesting that long-term inhalation of low concentrations of HEX could cause adverse health effects. A review of epidemiological studies uncov- ered no evidence of an increase, attributable to HEX or its metabolites, in the incidence of neoplasms at any site.d Aldicarba Geneva, 1991, 130 pages (Environmental Health Criteria, No. 121). ISBN 92 4 157121 7 Price: Sw.fr. 16.-/US$ 14.40 Aldicarb is a carbamate insecticide applied exclu- sively in granular form and below the soil surface to control certain insects, mites, and nematodes. It has been approved for use on a wide range of crops, including bananas, cotton plants, citrus fruits, coffee, maize, onions, sugar beet, sugar cane, potatoes, sweet potatoes, peanuts, pecans, and soybeans. Ingestion of contaminated food is the main route of exposure for the general population. Because aldi- carb is applied to the subsoil, the evaluation of its fate in the environment concentrates on its mobility and persistence in soil and on the circumstances under which it may contaminate shallow wells. The rapid uptake of aldicarb and its residues by food crops is another consistently reported finding. Studies in experimental animals point to the efficient d Summaries in French and Spanish are included in the book. 144 WHO Bulletin OMS. Vol 701992. Recent WHO publications absorption of aldicarb from the gastrointestinal tract and its wide distribution to all tissues, including the developing fetus. Acetylcholinesterase inhibition is identified as the primary mechanism by which aldi- carb exerts its toxic effects. Conceming risks to human health, the book draws on reports of several widespread outbreaks of aldicarb poisoning follow- ing the ingestion of contaminated cucumbers, melons, watermelons, and drinking water. In each of these cases, poisoning resulted from the use of aldi- carb on a non-approved crop. On the basis of these evaluations, it is concluded that aldicarb is one of the most potent and acutely toxic pesticides in use, that most cases of poisoning and toxicity arise from the use of aldicarb on non-approved crops or the failure to follow recommended safety precautions, that the symptoms of poisoning are transient and rarely fatal, and that aldicarb poses no risk to the general popula- tion when applied at recommended rates and using current techniques. The need to use protective equip- ment during manufacture, formulation, and applica- tion is stressed.c n-Hexanea Geneva, 1991, 164 pages (Environmental Health Criteria, No. 122). ISBN 92 4 157122 5 Price: Sw.fr. 20.-/US$ 18.- n-Hexane (normal hexane) is a chemical isolated from natural gas and crude oil and is used in food processing to extract vegetable oil from beans, nuts, and seeds. It is also used as a solvent, a cleaning agent, in the rubber industry, and in the manufacture of pharmaceuticals. The book reviews what is known about the behaviour of this highly volatile chemical in the en- vironment and its metabolic fate in experimental animals and in the human body. A review of inves- tigations in experimental animals and in vitro test systems concentrates on testicular lesions and neuro- toxicity as the principal effects of repeated exposure to n-hexane. Studies have also shown that neurotox- icity induced by n-hexane is enhanced by co-expo- sure to methyl ethyl ketone, methyl isobutyl ketone, and lead acetate; co-exposure to toluene decreases the neurotoxic effects of n-hexane. These findings are further supported by observations in humans, which draw upon several reports of peripheral neu- ropathy in workers exposed to n-hexane and in abus- ers of glues or solvents containing this chemical. The report notes that the majority of occupational cases have occurred in poorly ventilated small industries. While concluding that n-hexane is not likely to pre- sent a hazard to either the general population or the environment, the report stresses the need for precau- tions in the occupational setting, including the use of suitably designed work processes and engineering controls for reducing atmospheric levels below the recommended occupational exposure limits. The book further recommends the use of protective cloth- ing and the ready availability of respiratory protec- tion for use in enclosed spaces and in emergencies.e Communicable diseases Biosafety guidelines for diagnostic and research laboratories working with HIV Geneva, 1991, iv + 28 pages (WHO AIDS Series 9). ISBN 92 4 121009 5 Price: Sw.fr. 8.-/US$ 7.20 This is a concise didactic guide to the personal pre- cautions, facilities, and equipment needed to protect workers in diagnostic and research laboratories from accidental infection with the human immunodefi- ciency virus (HIV). Acknowledging that safe work practices provide the only protection against job- related HIV infection, the book sets out the basic safety information that can be used for continuous on-the-job safety training of all laboratory and sup- port staff. Particular attention is given to the needs of laboratories in developing countries, which may not have the resources or the expertise to apply sophisti- cated containment procedures! Environmental health Environmental health in urban development Report of a WHO Expert Committee Geneva, 1991, vi + 65 pages (WHO Technical Report Series, No. 807). ISBN 92 4 120807 4 Price: Sw.fr. 11 .-/US$ 9.90 This report of an intemational group of experts assesses what can be done to alleviate the many severe health problems associated with urban envi- ronments, where the living conditions of hundred of millions of people adversely affect their health, e A summary, evaluation, and recommendations in French and Spanish are included in the book. f See on this subject a note on the risk of transmission of AIDS and other blood-related diseases during routine malaria activities in the Bulletin of the World Health Organization, 69(2): 242-243 (1991). WHO Bulletin OMS. Vol 70 1992. 145 Recent WHO publications cause misery, and have potentially catastrophic social consequences. Recommendations and advice respond to the urgent need for an integrated approach to urban development that takes into ac- count all the environmental factors that affect human health and well-being. Particular emphasis is placed on informal settlements, slums, and shanty towns, where the most serious health problems are found. Insect and rodent control through environmental management A community action programme Published by WHO in collaboration with the United Nations Environment Programme Geneva, 1991, vii + 107 pages (plus 62 cards and 7 games) ISBN 92 4 154411 2 Price: Sw.fr. 90.-/US$ 81.- This kit assembles a range of materials designed to support a do-it-yourself, community approach to the control of insect and rodent infestations in urban slums and shanty towns. Noting that the residents of such settlements are often in the best position to combat insect and rodent pests, the kit concentrates on the feasibility of immediate community action, explaining and illustrating the many simple, inexpen- sive control measures that depend on behavioural changes as well as on improvements in housing, sanitation, and waste management. Throughout, sug- gested lines of action place firm emphasis on envi- ronmental cleanup and hygiene as opposed to the use of chemicals. Innovative measures, such as the culti- vation of fish that prey on mosquito larvae and the use of home-made rodent baits and fly traps, are also presented and explained. Packed in an attractive carrying case, the kit has three components: a manual for training selected community members to become experts in the recog- nition and management of disease vectors, a set of 62 illustrated "information and action" cards for use in educating and motivating individual residents, families, and community groups, and a series of seven model games that can help stimulate commu- nity interest and engagement. The information and action cards are visual aids conveying, via simple text and drawings, basic facts about the behaviour of individual insects and rodents, their favourite habi- tats, factors encouraging infestation and the spread of disease, and the actions that can be taken by indi- viduals and communities to outsmart these pests. Each card has been designed to allow the addition of explanatory text in the local language or dialect. Information in the kit was finalized after extensive field-testing and incorporates the advice and expert- ise of numerous medical entomologists, sanitary engineers, experts in community participation and communications, and national health authorities. Ethics, human rights Genetics, ethics and human values Human genome mapping, genetic screening and gene therapy XXIVth CIOMS Round Table Conference edited by Z. Bankowski & A. M. Capron Geneva, 1991, viii + 200 pages ISBN 92 9036 046 1 Price: Sw.fr. 20.-/US$ 18.- This book records the proceedings of a 1990 con- ference convened by the Council for Intemational Organizations of Medical Sciences (CIOMS), under the auspices of the Science Council of Japan and co- sponsored by WHO and UNESCO. It explores the unique ethical issues raised by spectacular recent advances in molecular genetics, including progress in mapping the human genome, the introduction of new tools for prenatal screening and for the detection of genetic defects in asymptomatic persons, and the development of experimental therapies that promise to cure genetic disorders by acting directly to correct the mutant gene. Predicting that researchers will, perhaps within a decade, identify every gene capable of harming human health, the book takes a future- oriented approach, concentrating on the need to an- ticipate ethical dilemmas and develop guidelines at both the clinical and research levels.9 Laboratory procedures, laboratories Basic laboratory methods in medical parasitology Geneva, 1991, viii + 114 pages ISBN 92 4 154410 4 Price: Sw.fr. 21.-/US$ 18.90 This manual provides didactic instructions for the safe and accurate performance of virtually all labora- 9 A note summarizing the issues of the Conference appeared in the Bulletin of the World Health Organization, 69(4): 487-488 (1991). CIOMS publications may be obtained directly from CIOMS, c/o World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland. Both CIOMS and WHO publications are distributed by the World Health Organization, Distribution and Sales Unit, Avenue Appia, 1211 Geneva 27, Switzerland and are available from booksellers through the network of WHO sales agents. A list of these agents may be obtained by writing to the above address. 146 WHO Bulletin OMS. Vol 70 1992. Recent WHO publications/Publications recentes OMS tory investigations required to recover and demon- strate parasites, identify the species, and establish a precise diagnosis. Addressed to laboratory workers in health centres and first-referral hospitals, the book places emphasis on simple, economical procedures that can yield accurate results under conditions where resources and scarce, equipment sparse, and the climate hot and humid. To facilitate comprehen- sion and help avoid mistakes, the book combines step-by-step instructions with numerous illustrations, lists of do's and don'ts, and alerts to common pit- falls. Diagnostic methods are restricted to microsco- py, though some advice on the preparation of speci- mens to be referred for serodiagnosis is also provided. The book concludes with a series of annexes, which list the materials and equipment needed in health centres and small hospital labora- tories, provide instructions for the preparation of reagents and culture media, and describe the pro- cedures for cleaning and storing slides to be used in preparing blood films. Pharmaceuticals, biologicals Basic tests for pharmaceutical dosage forms Geneva, 1991, v + 129 pages ISBN 92 4 154418 X Price: Sw.fr. 24.-/US$ 21.60 This manual, which is complementary to Basic tests for pharmaceutical substances,' describes simple and readily applicable tests for verifying the identity of 150 pharmaceutical dosage forms, most of which Environnement L'hygibne de l'environnement dans I'am6nagement urbain Rapport d'un Comit6 d'Experts de l'OMS Geneve, 1991, vi + 78 pages (OMS, S6rie de Rapports techniques, No 807). ISBN 92 4 220807 8 Prix: Fr.s. 1 1.- Que peut-on faire pour attenuer les nombreux et graves problemes de sant6 associes a l'environne- h Reviewed in the Bulletin of the World Health Organization, 65(5): 762 (1987). are included in the WHO model list of essential drugs.i The tests make it possible to confinn the iden- tity of pharmaceutical substances in tablet, capsule, solution, lotion and other forms in those cases where quality is in doubt. The basic tests detailed in this book may also be applied to determine whether gross degradation has occurred despite high standards of packaging. The book concludes with an extensive list of reagents, test solutions, and volumetric solutions needed for testing dosage forms. Preparation pro- cedures are also provided, in full detail, for those test solutions requiring special attention. Basic tests are not, in any circumstances, inten- ded to replace the requirements of The international pharmacopoeia i or other pharmacopoeial mono- graphs. These give an assurance of quality whereas basic tests merely confirm identity. WHO model prescribing information: drugs used in mycobacterial diseases Geneva, 1991, 40 pages ISBN 92 4 140103 6 Price: Sw.fr. 9.-/US$ 8.10 This book provides model prescribing information for a large number of essential drugs used for the prevention and treatment of tuberculosis, for the treatment of leprosy, and for the treatment of diseases caused by nontuberculous mycobacteria, including localized cutaneous lesions, pulmonary disease, lymphadenitis, and disseminated disease. Model prescribing information is produced by WHO to assist national authorities, particularly in devel- oping countries, when preparing drug formularies, data sheets, and teaching materials.k ment dans les villes, oCu les conditions de vie de cen- taines de millions de gens nuisent a la sante, provo- quent la misere et ont des repercussions potentielle- ment catastrophiques sur le plan social? Les See WHO Technical Report Series, No. 796, 1990, reviewed in the Bulletin of the World Health Organization, 69(1): 142 (1991). I The intemational pharmacopoeia. Third edition. Geneva, World Health Organization. Volume 1: General methods of analysis, 1979. Volume 2: Quality specifications, 1981. Volume 3: Quality specifications, 1988. kSee WHO model prescribing information: drugs used in anaes- thesia. Geneva, WHO, 1989, reviewed in the Bulletin of the World Health Organization, 68(1): 134 (1990), and WHO model prescribing information: drugs used in parasitic diseases. Geneva, WHO, 1990, reviewed in the Bulletin of the World Health Organization, 69(4): 503-504 (1991). WHO Bulletin OMS. Vol 70 1992. 147 Publications r6centes OMS recommandations et les conseils contenus dans le present rapport d'un groupe international d'experts repondent 'a la necessite d'offrir d'urgence une approche integree de l'amenagement urbain qui tien- ne compte de tous les facteurs ecologiques affectant la sante et le bien-etre de l'homme. L'accent est mis plus particulierement sur les etablissements margi- naux, les taudis et les bidonvilles, oiu se posent les problemes de sante les plus graves. Epidemiologie Manuel d'epidemiologie pour la gestion de la sante au niveau du district Sous la direction de J. P. Vaughan & R. H. Morrow Geneve, 1991, viii + 186 pages ISBN 92 4 254404 3 Prix: Fr.s. 35.- Cet ouvrage repond au besoin d'un guide simple, pratique, progressif sur l'utilisation de l'epidemiolo- gie en tant qu'outil destine a ameliorer la gestion des services de sante. A l'intention des agents de sante generaux, ce livre utilise des definitions claires, des analogies, des exemples, des listes de controle, des formules et des calculs d'echantillons ainsi que d'abondantes illustrations pour demystifier les me- thodes epidemiologiques et montrer comment elles peuvent s'appliquer dans des situations concretes. L'accent porte sur les connaissances et les compe- tences simples requises pour recueillir puis utiliser les donnees epidemiologiques permettant de sur- veiller les problemes de sante constants dans les pays en developpement. WHO Bulletin OMS. Vol 70 1992.148