This handbook for practitioners in environmental and public health, environmental management, toxicology and ecotoxicology has been prepared by an international group of experts from both developing and developed countries and covers a wide range of topics in both environmental impact assessment and environmental health impact assessment.

Diagnosis within psychiatry involves the consideration of a number of different features of mental state. In making a diagnosis, individual psychiatrists inevitably accord differing importance to certain features. By regulating the order and number of conditions to be recorded, a multiaxial framework provides for internationally comparable descriptions of mental state. This volume provides the psychiatric sections of ICD10 in a form that is adapted for ease of use of those dealing with mental disorders in childhood and adolescence. Descriptions have been grouped into axes which have been chosen to provide unambiguous information of maximum clinical usefulness in the greatest number of cases. Building on the popular original framework of four axes, the system has been greatly improved by the inclusion of a new axis for psychosocial situations and by the addition of a further sixth axis on adaptive level which enables clinicians to code an individual's current level of disability.

These specifications provide information on the identity and purity of food additives used directly in foods or in food production. The main objectives are to identify the food additives that have been subjected to testing for safety, to ensure that the additives are of the quality required for use in food or in processing, and to reflect and encourage good manufacturing practice. This publication and other documents produced by JECFA are is useful to all those who work with or are interested in food additives and their safe use in food.

The objectives of this Code are to establish voluntary standards of conduct for all public and private entities engaged in or associated with the management of pesticides, particularly where there is inadequate or no national legislation to regulate pesticides.

This report considers what can - and should - be done to comfort patients suffering from the distressing symptoms of advanced cancer. Prepared by nine renowned experts in oncology, neurology, pain management and nursing care, the book draws together the evidence and arguments needed to define clear lines of action, whether on the part of the medical and nursing professions or in the form of national legislation. Throughout, arguments for palliative care take their force from the magnitude of unrelieved suffering currently borne by the majority of terminally ill patients. Although methods for the relief of pain are emphasized, other physical, psychological and spiritual needs for comfort are also included in the report's comprehensive recommendations. The report opens with a review of global trends in the incidence of cancer and prospects for cure that show why, for many years to come, palliative care will remain the only realistic, humane treatment for many cancer patients. The concepts of palliative care is explained in terms of its concern with quality of life and comfort before death, emphasis on the family as the unit of care, dependence on a teamwork approach, organizational components and relationship to curative interventions. The relief of cancer pain is considered in two sections. The first reviews the types of cancer pain and factors influencing its severity, and explains the simple, yet highly effective method of pain relief developed by WHO. Because the WHO method requires the use of morphine and codeine, the second section goes through the steps, including legal and administrative procedures, required to assure the adequate availability and use of opioids for medical purposes. Theoretical problems, such as the risk that opioids will be diverted into illicit channels or that patients will become addicted, are soundly refuted. Subsequent sections concentrate on measures for the relief of other physical symptoms, the psychosocial needs of the patient and family, and the need for spiritual comfort. A section devoted to ethics provides a number of important statements concerning the legal and ethical distinction between killing the pain and killing the patient, the need to recognize the limits of both medicine and the patient's physical and moral resources, and the ethical responsibility of the society that encourages home care to look after the family care-givers as well as the patient. The report takes a firm stand against the legalization of euthanasia.

Lipid-based ready-to-use foods (RUFs) for the nutritional management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) are provided to children from 6 months to 59 months of age within the context of emergency feeding programmes supervised by governments. Based on the review, the expert committee considered that children with SAM have an increase in susceptibility to bacteraemia and sepsis that is probably between twofold and fivefold compared with children who are not malnourished and are of the same age and live in the same communities. On the basis of its common occurrence as a cause of infections and serious illnesses in children with SAM, and its documented ability to contaminate, survive in, and cause outbreaks of illness associated with low-moisture foods similar to RUFs, the expert committee concluded that Salmonella is the pathogen of most concern in lipid-based RUFs. Many outbreaks of foodborne salmonellosis have been determined to be associated with low-moisture foods that were contaminated at low levels. Therefore, the expert committee carefully considered the qualitative microbiological analyses of RUFs and the contamination levels that could be inferred, and entered into an extended deliberation of dose-response modelling to find a path toward a reasonable approximation of the likely morbidity and mortality in SAM children that could be anticipated from consumption of RUFs contaminated at the estimated levels and observed frequency. The expert committee described three approaches that purchasers of RUFs might use to establish microbiological criteria to assure the safety of RUFs and to communicate to manufacturers their safety expectations. These approaches are: (i) reference to existing standards established for similar low-moisture foods; (ii) determining an acceptable increase in risk over the pre-existing baseline of illness from other sources of exposure; and (iii) process verification sampling using the moving window technique. The microbiological criteria derived by each of these approaches accomplish different purposes, and which is most appropriate is determined by the conditions of manufacture and use

This document contains monographs on residue evaluations of certain veterinary drugs, prepared at the seventy-fifth meeting of the Joint FAO/WHO Expert Committee on Food Additives (JECFA), which was held in Rome, Italy from 8 to 17 November 2011. Four substances were evaluated for the first time for the animal species concerned -- amoxicillin, apramycin, derquantel and monepantel. Three subtances were reassessed, monensin, narasin and triclabendzole. This publication and other documents produced by JECFA contain information that is useful to those who work with or are involved with recommending or controlling maximum residue limits for veterinary drugs in foods of animal origins.

Worldwide, the application of information and communication technologies to support national health-care services is rapidly expanding and increasingly important. This is especially so at a time when all health systems face stringent economic challenges and greater demands to provide more and better care, especially to those most in need.The "National eHealth Strategy Toolkit" is an expert, practical guide that provides governments, their ministries and stakeholders with a solid foundation and method for the development and implementation of a national eHealth vision, action plan and monitoring framework. All countries, whatever their level of development, can adapt the "Toolkit" to suit their own circumstances.Representing one of the most significant collaborations in recent years between the World Health Organization and the International Telecommunication Union, the "Toolkit" is a landmark in understanding what eHealth is, what it can do, and why and how it should be applied to health care today.

This book describes a unique study on the usefulness of benzodiazepine tranquilizers given in conjunction with and compared to therapeutic counselling for the treatment of minor psychiatric disorders. International collaboration under the sponsorship of the WHO made this first cross-cultural comparative study possible. Important methodological findings about measurement instruments, as well as data about the effects of different treatments, resulted from the study. It also demonstrated the possibility of using quantitative scientific methods to measure milder forms of psychiatric disorders and their changes.

Perhaps you are called upon as a staff member or volunteer to help in a major disaster, or you find yourself at the scene of an accident where people are hurt. Perhaps you are a teacher or health worker talking with someone from your community who has just witnessed the violent death of a loved one. This guide will help you to know the most supportive things to say and do for people who are very distressed. It will also give you information on how to approach a new situation safely for yourself and others, and not to cause harm by your actions.Psychological first aid (PFA) has been recommended by many international and national expert groups, including the Inter-Agency Standing Committee (IASC) and the Sphere Project. Psychological first aid is an alternative to psychological debriefing. In 2009, the World Health Organization s mhGAP Guidelines Development Group evaluated the evidence for psychological first aid and psychological debriefing. They concluded that psychological first aid, rather than psychological debriefing, should be offered to people in severe distress after being recently exposed to a traumatic event.This guide was developed in order to have widely agreed upon psychological first aid materials for use in low- and middle-income countries. Endorsed by many international agencies, it reflects the emerging science and international consensus on how to support people in the immediate aftermath of extremely stressful events.This guide for field workers is to be used together with "Psychological First Aid: Facilitator's Manual for Orienting Field Workers."

The monographs in this volume summarize the safety data on 11 pesticides that could leave residues in food commodities. These pesticides are aminopyralid, atrazine, azinphos methyl, lamba-cyhalothrin, difenoconazole, dimethomorph, flusilazole, procymidone, profenofos, pyrimethanil and zoxamide. The data summarized in the toxicological monographs served as the basis for the acceptable daily intakes and acute reference doses that were established by the Meeting.This volume and previous volumes of JMPR toxicological evaluations, many of which were published in the "FAO Plant Production and Protection Paper" series, contain information that is useful to companies that produce pesticides, government regulatory officers, industrial testing laboratories, toxicological laboratories and universities.

Since its first publication in 2002, the "WHO Model Formulary" has become an indispensable source of independent information on essential medicines for pharmaceutical policy-makers and prescribers worldwide. The "Model Formulary" is the authoritative guide on how to make effective use of the medicines on the WHO Model List of Essential Medicines, so improving patient safety, and limiting unnecessary medical spending. For each medicine the "Model Formulary" provides information on use, dosage, adverse effects, contraindications and warnings, supplemented by guidance on selecting the right medicine for a range of conditions.The new edition, "WHO Model Formulary 2008," details changes made to the WHO Model List of Essential Medicines in 2007, with updated therapeutic information on existing medicines reflecting new clinical knowledge.

This annual edition presents the most recent statistics of over 50 health indicators for WHO's 193 Member States. It includes an expanded set of core statistics and a section with 10 highlights in global health statistics for the past year. This book has been collated from publications and databases of WHO's technical programmes and regional offices. The core set of indicators was selected on the basis of relevance for global health, availability and quality of data, and accuracy and comparability of estimates. The statistics for the indicators are based on an interactive process of data collection, compilation, quality assessment, and estimation between WHO technical programmes and its Member States. In this process, WHO strives to maximize accessibility, accuracy, comparability, and transparency of country health statistics. In addition to national statistics, this publication presents statistics on the distribution of selected health outcomes and interventions within countries, disaggregated by gender, age, urban/rural setting, wealth/assets, and educational level. Such statistics are primarily derived from the analysis of household surveys and are only available for a limited number of countries.

Adherence to therapies is a primary determinant of treatment success. Poor adherence attenuates optimum clinical benefits and therefore reduces the overall effectiveness of health systems. Medicines will not work if you do not take them. Medicines will not be effective if patients do not follow prescribed treatment - yet in developed countries only 50% of patients who suffer from chronic diseases adhere to treatment recommendations. In developing countries, when taken together with poor access to health care, lack of appropriate diagnosis, and limited access to medicines, poor adherence is threatening to render futile any effort to tackle chronic conditions such as diabetes, depression and HIV/AIDS. This report is based on an exhaustive review of the published literature on the definitions, measurements, epidemiology, economics, and interventions applied to nine chronic conditions and their risk factors. These are: asthma, cancer (palliative care), depression, diabetes, epilepsy, HIV/AIDS, hypertension, tobacco smoking, and tuberculosis. Intended for clinical practitioners, health managers and policy-makers, this report provides a concise summary of the consequences of poor adherence for health and economics. It also discusses the options available for improving adherence, and demonstrates the potential impact on desired health outcomes and health care budgets. It is hoped that this report will lead to new thinking on policy development, and action on adherence to long-term therapies.

Reference to Medical Technology and Radiation Medicine, including radiatiion dosage, protection, quality control and adverse effect levels; a manual of radiography standards.

This volume distills what is known about environmental health during an emergency or disaster. It draws on results from the International Decade for Natural Disaster Reduction, and on experience with sustainable development between the two Earth Summits, in Rio de Janeiro and Johannesburg. It is intended for practitioners, as well as for policy-makers and researchers, and thus covers both general and technical aspects of environmental health. In Part I of this volume, a conceptual framework is presented for understanding environmental health issues in the context of disaster management. The framework covers the entire disaster-management cycle, from preparedness and warning, to recovery and prevention. Guidelines are also suggested for planning and reducing the effects of extreme events on public health, and practical guidance is given in organizational and logistical matters. Throughout, the need for flexibility and innovation at the local level is emphasized, combined with solid advance planning. There is also a focus on the vulnerability of populations during an emergency or disaster, with the implication that such people have capacities and local knowledge that should be integrated into efforts to secure both environment and development against extreme events. The creative potential of balancing "top-down" and "bottom-up" approaches is emphasized in chapters on health promotion and community participation, and on human resources. Part II of this book is a detailed compendium of best practices and strategies for risk reduction and response in the fields of: * Shelter and emergency settlements; * Water supply; * Sanitation; * Food safety; * Vector and pest control; * Control of communicable diseases and prevention of epidemics; * Chemical incidents; * Radiation emergencies; * Mortuary service and handling of the dead; * Health promotion and community participation; and * Human resources. This book will be useful in planning for, responding to, and recovering from the movements of displaced persons and refugees in humanitarian crises, as well as the floods, storms, earthquakes and other extreme events that could confront health workers in the first decade of the 21st century. Given trends in the 1990s, it is unlikely that humanity has seen the last of these challenges.

Some 20-million low-birth-weight babies are born each year because of either preterm birth or impaired prenatal growth mostly in less developed countries. For many small preterm infants receiving prolonged medical care is important. However kangaroo mother care is an effective way to meet baby's needs for warmth breastfeeding protection from infection stimulation safety and love. Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a powerful easy-to-use method to promote the health and well being of infants. This document describes the kangaroo mother care method for care of stable preterm/low-birth-weight infants who need thermal protection adequate feeding frequent observation and protection from infection. It provides guidance on how to organize services at the referral hospital and on what is needed to introduce and carry out kangaroo mother care focusing on settings where resources are limited. Evidence for the recommendations are provided whenever possible. This book has been prepared for health professionals in charge of low-birth-weight and preterm newborn infants in first referral hospitals in settings with scarce resources. It is also aimed at decision-makers and planners at national and local levels.

Given the impact that good nutrition and keeping fit have on health and well-being in later life, WHO, in collaboration with the Tufts University USDA Human Nutrition Research Center on Aging, organized a consultation to review the scientific evidence linking diet and other factors - especially exercise - affecting nutritional status, disease prevention and health promotion for older persons. The consultation focused primarily on practical issues, including the establishment of explicit recommendations to improve the health and nutritional status of older persons in a wide variety of socioeconomic and cultural settings. During the production of a comprehensive report, representing the outcome both of the preparatory work and of the consultation itself, it was recognized that new information emerging in several key areas should also be included. The combined results presented here are intended as an authoritative source of information for nutritionists, general practitioners, gerontologists, medical faculties, nurses, care providers, schools of public health and social workers.The specific recommendations concerning nutrient intakes, food-based dietary guidelines, and exercise and physical activity should also interest a larger audience, including the general reader. The main body discusses the epidemiological and social aspects of ageing, health and functional changes experienced with ageing, the impact of physical activity, assessment of the nutritional status of older persons, and nutritional guidelines for healthy ageing. Additional material covers food-based dietary guidelines for older adults - with particular emphasis on healthy ageing and prevention of chronic noncommunicable diseases - and guidelines for promoting physical activity among older persons. "...This report is significant, representing an authoritative consensus related to the epidemiological and social aspects of ageing, health and functional changes experienced with age, and the impact of physical activity. This valuable source of information is relevant to a wide range of health professionals; the clear and specific recommendations concerning food/nutrient consumption and physical activity for older adults should also interest a larger audience."- The Journal of the Royal Society for the Promotion of Health "...The book is a timely publication, which provides an exhaustive review of studies...This publication will certainly serve as a reference manual for all those involved in nutrition, gerontology and geriatrics. " - Indian Journal of Medical Research

The longstanding debate over the optimal duration of exclusive breastfeeding has centered on the so-called "weanling's dilemma" in developing countries: the choice between the known protective effect of exclusive breastfeeding against infectious morbidity and the (theoretical) insufficiency of breast milk alone to satisfy the infant's energy and micronutrient requirements beyond 4 months of age. The primary objective of this review is to assess the effects on child health, growth, and development, and on maternal health, of exclusive breastfeeding for 6 months vs exclusive breastfeeding for 3-4 months with mixed breastfeeding (introduction of complementary liquid or solid foods with continued breastfeeding) thereafter through 6 months.

WHO in collaboration with the International Commission for Radiologic Education (ICRE) of the International Society of Radiology (ISR) and the other members of the Global Steering Group for Education and Training in Diagnostic Imaging is creating a series of "Manuals of Diagnostic Imaging." The full series of manuals will primarily cover the examination techniques and interpretation of conventional diagnostic X-ray procedures. These manuals will replace and update the WHO Manual of Radiographic Interpretation for General Practitioners and the WHO Manual of Radiographic Technique.The present volume in this series, the manual Radiographic Anatomy and Interpretation of the Musculoskeletal System, provides an exhaustive description of radiographic normal anatomy as well as pathologic changes most frequently seen in musculoskeletal system including trauma, infections in bone and joints, metabolic, endocrine, and toxic disorders, tumours, congenital and developmental disorders. Backed by high-quality reproduction of radiographs, this manual will prove essential reading to general practitioners, medical specialists, radiographers and radiologists in any medical settings, although focusing specifically on needs in small and mid-size hospitals.

Various types of traditional medicine and other medical practices referred to as complementary or alternative medicine are increasingly used in both developing and developed countries. In order to promote safe and appropriate use of these medicines and practices, as well as to ensure the quality of service and practitioners, national regulations are vital. Establishing national policies on traditional medicine, and/or complementary/alternative medicine and their medical practices, should therefore include creation of legal frameworks. This review summarizes the legal status of several major practices in traditional medicine and complementary/alternative medicine in 123 countries. It includes data on: the use of traditional and complementary/alternative medicine; the regulatory situation of traditional and complementary/alternative remedies and practitioners; health insurance coverage of traditional and complementary/alternative medicine; education and training of practitioners of traditional and complementary/alternative medicine. Information provided in this review will be useful not only to policy makers, but also to researchers, universities, the public, insurance companies and pharmaceutical industries.

This book evaluates the risks to human health and the environment posed by arsenic and arsenic compounds. Arsenic is widely distributed in the earth's crust and is emitted into the atmosphere by coal-fired power generation plants and volcanic activity. Inorganic arsenic of geological origin is found in groundwater, which is used as drinking-water in several parts of the world, e.g. Bangladesh. In these areas, drinking-water is the main source of arsenic intake, but elsewhere food is the principal source.

This book provides a practical guide to the design and implementation of health information systems in developing countries. Noting that most existing systems fail to deliver timely, reliable, and relevant information, the book responds to the urgent need to restructure systems and make them work as both a resource for routine decisions and a powerful tool for improving health services. With this need in mind, the authors draw on their extensive personal experiences to map out strategies, pinpoint common pitfalls, and guide readers through a host of conceptual and technical options. Information needs at all levels - from patient care to management of the national health system - are considered in this comprehensive guide. Recommended lines of action are specific to conditions seen in government-managed health systems in the developing world. In view of common constraints on time and resources, the book concentrates on strategies that do not require large resources, highly trained staff, or complex equipment. Throughout the book, case studies and numerous practical examples are used to explore problems and illustrate solutions. Details range from a list of weaknesses that plague most existing systems, through advice on when to introduce computers and how to choose appropriate software and hardware, to the hotly debated question of whether patient records should be kept by the patient or filed at the health unit. The book has fourteen chapters presented in four parts. Chapters in the first part, on information for decision-making, explain the potential role of health information as a managerial tool, consider the reasons why this potential is rarely realized, and propose general approaches for reform which have proved successful in several developing countries. Presentation of a six-step procedure for restructuring information systems, closely linked to an organizational model of health services, is followed by a practical discussion of the decision-making process. Reasons for the failure of most health information to influence decisions are also critically assessed. Against this background, the second and most extensive part provides a step-by-step guide to the restructuring of information systems aimed at improving the quality and relevance of data and ensuring their better use in planning and management. Steps covered include the identification of information needs and indicators, assessment of the existing system, and the collection of both routine and non-routine data using recommended procedures and instruments. Chapters also offer advice on procedures for data transmission and processing, and discuss the requirements of systems designed to collect population-based community information. Resource needs and technical tools are addressed in part three. A comprehensive overview of the resource base - from staff and training to the purchase and maintenance of equipment - is followed by chapters offering advice on the introduction of computerized systems in developing countries, and explaining the many applications of geographic information systems. Practical advice on how to restructure a health information system is provided in the final part, which considers how different interest groups can influence the design and implementation of a new system, and proposes various design options for overcoming specific problems. Experiences from several developing countries are used to illustrate strategies and designs in terms of those almost certain to fail and those that have the greatest chances of success

Reports the recommendations and conclusions of an expert committee convened to assess progress in implementation of the Global Malaria Control Strategy, adopted in 1992. Issued at a time when malaria control is one of the highest priorities at WHO, the report offers expert advice on the full range of questions - from the best measures for ensuring early diagnosis and prompt treatment to strategies for the prevention of drug resistance - that can help countries strengthen programmes for control. The report opens with fact, figures, and maps profiling the current global malaria situation, including trends in the spread and intensification of parasite resistance to antimalarial drugs. Section two considers the extent to which each of four technical elements of the global strategy has been implemented over the past decade. The relationship of malaria control programmes to health sector reforms is explored in the next section, which focuses on the impact of health system decentralization, reforms in health-care financing, and the growth of partnerships with communities and the private sector. Against this background, the components of proper disease management are presented and discussed in terms of their relevance to control programmes. Topics covered include the advantages and disadvantages of diagnosis based on clinical observations, the role of microscopical and other tests for parasite detection, and the factors to consider when deciding on treatment objectives and recommended drugs. The difficult question of drug supply in the absence of formal health services is also considered. Subsequent sections offer advice on techniques for monitoring drug resistance and therapeutic efficacy, strategies for the containment of parasite drug resistance, and methods for the prediction and control of malaria epidemics. A section on the prevention of malaria describes various approaches to vector control, including the use of insecticide-treated bednets and other materials, the management of malaria in development projects, and the current status of drugs used for chemoprophylaxis. The remaining sections discuss information systems and operational research, and describe WHO's new Roll Back Malaria initiative.