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Provides clinical descriptions, diagnostic guidelines, and codes
for all mental and behavioural disorders commonly encountered in
clinical psychiatry. The book was developed from chapter V of the
Tenth Revision of the International Statistical Classification of
Diseases and Related Health Problems (ICD-10). The clinical
descriptions and diagnostic guidelines were finalized after field
testing by over 700 clinicians and researchers in 110 institutes in
40 countries, making this book the product of the largest ever
research effort designed to improve psychiatric diagnosis. Every
effort has been made to define categories whose existence is
scientifically justifiable as well as clinically useful. The
classification divides disorders into ten groups according to major
common themes or descriptive likeness, a new feature which makes
for increased convenience of use. For each disorder, the book
provides a full description of the main clinical features and all
other important but less specific associated features. Diagnostic
guidelines indicate the number, balance, and duration of symptoms
usually required before a confident diagnosis can be made.Inclusion
and exclusion criteria are also provided, together with conditions
to be considered in differential diagnosis. The guidelines are
worded so that a degree of flexibility is retained for diagnostic
decisions in clinical work, particularly in the situation where
provisional diagnosis may have to be made before the clinical
picture is entirely clear or information is complete. "...As
befitting a publication of considerable influence, the amount of
work that went into preparing ICD-10 has been formidable..." - The
International Journal of Social Psychiatry
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.
A systematic authoritative classification of the many procedures
used in different branches of medicine. Chapters cover procedures
for medical diagnosis laboratory procedures preventive procedures
surgical operations other therapeutic procedures and ancillary
procedures. The volume, which follows the structure and system of
coding used in the International Classification of Diseases,
includes a tabular list of procedures followed by a detailed
alphabetical index.
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.
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
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.
This report issues a call for urgent action to combat the growing
epidemic of obesity, which now affects developing and
industrialized countries alike. Adopting a public health approach,
the report responds to both the enormity of health problems
associated with obesity and the notorious difficulty of treating
this complex, multifactorial disease. With these problems in mind,
the report aims to help policy-makers introduce strategies for
prevention and management that have the greatest chance of success.
The importance of prevention as the most sensible strategy in
developing countries, where obesity coexists with undernutrition,
is repeatedly emphasized.Recommended lines of action, which reflect
the consensus reached by 25 leading authorities, are based on a
critical review of current scientific knowledge about the causes of
obesity in both individuals and populations. While all causes are
considered, major attention is given to behavioural and societal
changes that have increased the energy density of diets,
overwhelmed sophisticated regulatory systems that control appetite
and maintain energy balance, and reduced physical activity.
Specific topics discussed range from the importance of fat content
in the food supply as a cause of population-wide obesity, through
misconceptions about obesity held by both the medical profession
and the public, to strategies for dealing with the alarming
prevalence of obesity in children.The report has eleven chapters
presented in five parts. Part one, which assesses the magnitude of
the problem, explains the system for classifying overweight and
obesity based on the body mass index, considers the importance of
fat distribution, and provides an overview of trends in all regions
of the world, concluding that obesity is increasing worldwide at an
alarming rate. Chapters in part two evaluate the true costs of
obesity in terms of physical and mental ill health, and the human
and financial resources diverted to deal with these problems.
Specific health consequences discussed include increased risk of
cardiovascular disease, cancer, and other noncommunicable diseases,
endocrine and metabolic disturbances, debilitating health problems,
and psychological problems. The health benefits and risks of weight
loss are also assessed.Part three draws on the latest research
findings to consider specific factors involved in the development
of overweight and obesity. Discussion centres on factors, such as
high intakes of fat, that may disrupt normal physiological
regulation of appetite and energy balance, and the role of dietary
factors and levels of physical activity. In terms of opportunities
for prevention, particular attention is given to the multitude of
environmental and societal forces that adversely affect food intake
and physical activity and may thus overwhelm the physiological
regulatory systems that keep weight stable in the long term. The
possible role of genetic and biological susceptibility is also
briefly considered.Against this background, the fourth and most
extensive part maps out strategies for prevention and management at
both the population and individual levels. Separate chapters
address the need to develop population-based strategies that tackle
the environmental and societal factors implicated in the
development of obesity, and compare the effectiveness of current
options for managing overweight or obese individuals. Specific
strategies discussed include dietary management, physical activity
and exercise programmes, behaviour modification, drug treatment,
and gastric surgery. While noting striking recent progress in the
development of drug treatments, the report concludes that gastric
surgery continues to show the best long-term success in treating
the severely obese. The final part sets out key conclusions and
recommendations for responding to the global obesity epidemic and
identifies priority areas where more research is urgently
needed...". the volume is clearly written, and carries a wealth of
summary information that is likely to be invaluable for anyone
interested in the public health aspects of obesity and fatness, be
they students, practitioner or researcher." - Journal of Biosocial
Science
This book evaluates the risks to human and animal health posed by
the consumption of maize and maize-based products contaminated with
fumonisin B1. This naturally occurring mycotoxin, produced by the
mold "Fusarium verticillioides" is found in high concentrations
throughout the world, and is believed to be the most prevalent and
toxic of the fumonisins. Consumption is known to cause two fatal
diseases in farm animals. Possible adverse effects on human health
are of particular importance in several developing countries, where
maize and maize-based products are the staple food for large
populations. A section on sources of human exposure considers
factors that influence the vulnerability of maize to contamination
during growth, storage, and processing. Weather conditions that
favor Fusarium kernel rot are noted to cause significant
accumulation of fumonisin B1. Studies of the effects of different
processing techniques demonstrate the toxin's stability. Dry
milling results in its distribution into the bran, germ, and flour.
In experimental wet milling, fumonisin has been detected in steep
water, gluten fibre, and germ but not in the starch. A review of
studies on the environmental fate of fumonisin B1 concludes that
fumonisins are heat stable, light stable, water soluble, poorly
absorbed, poorly metabolized, and rapidly excreted by animals. As a
result, most fumonisin is recycled into the environment in a manner
that concentrates its spatial distribution. A section on
environmental levels and human exposure reviews a large number of
studies measuring levels of contamination in maize and maize-based
foods for human consumption and in animal feeds. The highest levels
of contamination have been recorded in Europe, followed by North
America, Africa, Asia, and Latin America. The most extensive
section reviews toxicity data from studies in experimental animals
and "in vitro "test systems. Fumonisin B1 has been shown to be
hepatotoxic in all animal species tested, and nephrotoxic in
several species. The report found no evidence that consumption of
fumonisins causes adverse effects on development or reproductive
functions in farm animals or humans. Studies in some species
indicate an association between exposure and the development of
renal and liver cancers. The evaluation also drew on extensive
investigations of equine leukoencephalomalacia and porcine
pulmonary oedema syndrome, fatal diseases which have been causally
linked to the consumption of fumonisin-contaminated feeds. These
and other lines of evidence suggest that fumonisin B1 exerts its
toxic action by inhibiting cell growth and causing accumulation of
free sphingoid bases and alteration of lipid metabolism. The
evaluation of effects on human health draws on limited evidence
from correlation studies in South Africa and China, and an
analytical study from northern Italy, suggesting a link between
direct fumonisin exposure and esophageal cancer. Due to weaknesses
in all these studies, no firm conclusions could be reached. No
confirmed records of acute fumonisin toxicity in humans were
available for evaluation. A final section draws attention to the
urgent need for more knowledge about the effects of food processing
and cooking, especially in developing countries, on levels of
contamination for epidemiological studies of adverse health
effects, and for better understanding of the mode of toxic action
in humans.
A practical guide to the principles and methods of cost analysis as
a managerial tool for improving the efficiency of hospitals.
Addressed to managers and administrators, the manual aims to equip
its readers with the knowledge and skills needed to calculate the
costs of different activities or departments, analyze their
significance, and use this information to manage resources wisely.
Throughout, recommendations and advice are specific to the
different purposes of cost analysis and the different types of
decisions commonly facing managers. The manual, which is intended
for use as a training tool, was finalized following extensive
field- testing in workshops in Bangladesh, Egypt, and Zimbabwe.
Methods of cost-finding and cost analysis are thoroughly explained
and illustrated with practical examples and model step-by-step
procedures for performing calculations. Since hospital accounting
systems in developing countries may have gaps or inaccuracies, the
manual gives particular attention to reliable methods for
estimating costs when existing data are problematic. The manual
opens with an explanation of the many advantages of using
cost-finding and cost analysis as managerial tools. These include
the provision of data needed for informed decisions on operations
and infrastructure, investment, the planning of future budgets, the
establishment of charges for patient services, and the development
of mechanisms for ensuring that costs do not exceed available
revenues and subsidies. Against this background, the core of the
manual is presented in three chapters. The first, and most
extensive, chapter explains how to allocate costs to cost centers
and how to compute unit costs. Information and examples are
presented according to seven steps. Each is discussed in terms of
the types of data needed, how component cost items should be
treated, and how costs can be computed in particular situations or
cases. Practical examples are used to illustrate the types of
questions addressed in cost analysis and the value of this
information in guiding decisions. Chapter two explains how cost
data can be used to improve the management of an individual
hospital. Information is intended to guide decisions at both the
cost center, or department, level and the hospital level.
Managerial tasks covered include: budgeting; profitability;
efficiency improvements; contracting outside services or producing
in-house; and assessing fiscal solvency. Chapter three considers
the use of cost data in managing national and regional hospital
systems. Specific applications include improvements in the referral
system, the appropriate use of different providers of services, and
the comparison of similar hospitals to identify inefficiencies or
sources of waste. The manual concludes with a series of practical
exercises, followed by explanations of their answers.
The World Health Report 2000 is an expert analysis of the
increasingly important influence of health systems in the daily
lives of people worldwide. To an unprecedented degree it takes
account of the role of people as providers and consumers of health
services, as financial contributors to health systems, as workers
within them, and as citizens engaged in their responsible
management, or stewardship. Health systems provide the critical
interface between life-saving, life-enhancing interventions and the
people who need them. If health systems are weak, the power of
these interventions is likewise weakened, or even lost. Health
systems thus deserve the highest priority in any efforts to improve
health or ensure that resources are wisely used. In recent decades,
health systems have contributed enormously to better health for
most of the global population. As the new century begins, they have
the potential to achieve further improvements in human wellbeing,
especially for the poor. But very little has yet been done to
unravel the complex factors which explain good or bad performance
by individual health systems. Given equal resources, why do some
succeed where others fail? Is performance simply driven by the laws
of supply and demand, or does another logic apply? Why is
dissatisfaction with services so widespread, even in wealthy
countries offering the latest interventions? If systems need
improvement, what tools exist to measure performance and outcomes?
These are some of the many questions addressed in this report.
Drawing upon a range of experiences and analytical tools, the
report traces the evolution of health systems, explores their
diverse characteristics, and uncovers a unifying framework of
shared goals and functions. Using this as a basis for analysis, the
report breaks new ground in presenting an index of health system
performance based on three fundamental goals: improving the level
and distribution of health, enhancing the responsiveness of the
system to the legitimate expectations of the population, and
assuring fair financial contributions. As the report convincingly
argues, good performance depends critically on the delivery of
high-quality services. But it relies on more than that. Health
systems must also protect citizens from the financial risks of
illness and meet their expectations with dignified care. The report
goes on to show how the achievement of these goals depends on the
ability of each system to carry out four main functions: service
provision, resource generation, financing, and stewardship.
Chapters devoted to each function offer new conceptual insights and
practical advice on how to assess performance and achieve
improvements with available resources. In doing so, The World
Health Report 2000 aims to stimulate a vigorous debate about better
ways of measuring health system performance and thus finding a
successful new direction for health systems to follow. By shedding
new light on what makes health systems behave in certain ways, WHO
also hopes to help policy-makers understand the many complex issues
involved, weigh their options, and make wise choices.
This manual provides expert practical guidelines for the management
of severely malnourished children. Addressed to doctors and other
senior health workers, the manual explains exactly what must be
done to save lives, achieve successful management and
rehabilitation, prevent relapse, and thus give these children the
greatest chance of full recovery. Throughout, the importance of
treating severe malnutrition as both a medical and a social
disorder is repeatedly emphasized. As successful management does
not require sophisticated facilities and equipment or highly
qualified personnel, the manual also performs a persuasive
function, encouraging health professionals to do all they can to
save these children and meet their great need for care and
affection. Recommended procedures draw on extensive practical
experience as well as several recent therapeutic advances. These
include improved solutions of oral rehydration salts for the
treatment of dehydration, better understanding of the role of
micronutrients in dietary management, and growing evidence that
physical and psychological stimulation can help prevent long-term
consequences of impaired growth and psychological development.
Noting that the physiology of malnourished children is seriously
abnormal, the manual gives particular attention to aspects of
management - whether involving the interpretation of symptoms or
the use of specific interventions - that differ considerably from
standard procedures for well-nourished children. Details range from
the reasons why IV infusion easily causes overhydration and heart
failure, through a list of treatments that have no value and should
never be used, to the simple reminder that underarm temperature is
not a reliable guide to body temperature in a malnourished child
during rewarming. Further practical guidance is provided in eight
appendices, which use numerous tables, charts, sample recording
forms, instructions for preparing feeds, and examples of easily
constructed toys to help ensure that management is thorough, safe,
and in line with the latest knowledge.
A collection of 28 monographs covering the quality control and
traditional and clinical uses of selected medicinal plants. Plants
were selected for inclusion on the basis of their widespread use,
particularly in countries that rely heavily on medicinal plants to
meet primary health care needs. Monographs are provided for a
number of phytomedicines traditionally used to treat such common
complaints as diarrhoea, constipation, headache, appetite loss,
sleep disorders, fatigue, and mild respiratory, gastrointestinal,
and skin disorders. Additional medical applications assessed range
from the lipid-lowering potential of garlic powder preparations,
through the possible antiplasmodial activity of Fructus Bruceae, to
the role of curcumin in promoting peptic ulcer healing and reducing
the associated abdominal pain. In preparing and publishing these
monographs, WHO aims to encourage standardized scientific
approaches to ensuring the safety, quality and efficacy of
medicinal plants and their products. The monographs are also
intended to promote international harmonization in the quality
control and use of herbal medicines and to serve as models for the
development of national formularies. Draft monographs were
finalized following review by over 100 experts in 40 countries.
Some 1400 references to the literature are included. Each monograph
follows a standard format, with information presented in two parts.
The first gives pharmacopoeial summaries for quality assurance,
botanical features, distribution, identity tests, purity
requirements, chemical assays, and active or major chemical
constituents. A section on definition provides the Latin binomial
pharmacopoeial name, the most important criterion in quality
assurance. Latin pharmacopoeial synonyms and vernacular names,
listed in the section on synonyms and selected vernacular names,
are those names used in commerce or by local consumers. The second
part of each monograph begins with a list of dosage forms and of
medicinal uses categorized as uses supported by clinical data, uses
described in pharmacopoeias and in traditional systems of medicine,
and uses described in folk medicine, but not yet supported by
experimental or clinical data. Each monograph also includes an
extensive review of available data on experimental and clinical
pharmacology, followed by information on contraindications, such as
sensitivity or allergy, warnings, precautions, particularly in such
special groups as pregnant and breast-feeding women, adverse
reactions, and dosage. A list of references concludes the
monograph. Plants covered in volume 1 Bulbus Allii Cepae Bulbus
Allii Sativi Aloe Aloe Vera Gel Radix Astragali Fructus Bruceae
Radix Bupleuri Herba Centellae Flos Chamomillae Cortex Cinnamomi
Rhizoma Coptidis Rhizoma Curcumae Longae Radix Echinaceae Herba
Echinaceae Purpureae Herba Ephedrae Folium Ginkgo Radix Ginseng
Radix Glycyrrhizae Radix Paeoniae Semen Plantaginis Radix Platycodi
Radix Rauwolfiae Rhizoma Rhei Folium Sennae Fructus Sennae Herba
Thymi Radix Valerianae Rhizoma Zingiberis
This book provides a collection of ten protocols for conducting
rapid health assessments in the immediate aftermath of different
types of emergencies. Noting the vital importance of rapid and
accurate information in the earliest stage of an emergency, the
protocols respond to the urgent need for common standardized
technical tools for assessing damage, gauging health risks, and
gathering the information immediately needed by decision-makers at
the national and international level. The protocols were prepared
by WHO in collaboration with a large number of international
agencies and experts with broad experience in the field of
emergency management. Although all protocols follow a common
format, each is specific to the circumstances, potential hazards,
and immediate information needs that characterize a distinct type
of emergency. Emphasis is placed on the exact information needed,
the best sources of data and methods for rapid collection, and the
specific questions that need to be answered in order to draw
initial conclusions and direct immediate actions.Although the
advantages of using experienced assessments teams are stressed, the
book also explains how the protocols can be used to train general
health workers as part of emergency preparedness. The book opens
with an introductory protocol covering the aims and methods,
responsibilities, complexities, and inherent difficulties of rapid
health assessments. Addressed to health authorities as well as
assessment teams, the chapter also includes abundant advice on
preparedness for emergencies. Details range from the comparative
need for speed in different types of emergencies, through a
suggested format for presenting the results of assessments, to a
list of common logistic, organizational, and technical errors.
Advice on the best working practices, including ways to avoid being
an "emergency tourist", is also provided. Against this background,
the additional nine protocols are presented according to a common
format which covers the purpose of the assessment, preparedness,
the steps to follow during the assessment, assessing the impact on
health, assessing local response capacity and immediate needs, and
presenting results.A general protocol on epidemics of infectious
origin is followed by protocols specific to meningitis outbreaks,
outbreaks of viral haemorrhagic fever, including yellow fever, and
outbreaks of acute diarrhoeal disease, with information specific to
dysentery and cholera. Sudden-impact natural disasters are covered
in the next protocol, which includes a day-by-day list of
information priorities for different stages of the disaster. A
protocol dealing with sudden population displacements offers
guidelines for conducting rapid health assessments in all
emergencies caused by sudden displacement of refugees or population
groups within a country. Included are a sample checklist for rapid
assessments and a sample form for weekly reports on morbidity and
mortality. Subsequent protocols deal with the special situations of
nutritional emergencies and chemical emergencies, including those
caused by food contaminated with chemicals or toxins. The final
protocol addresses the difficult task of conducting assessments in
complex emergencies in which the cause of the emergency, as well as
the assistance to the afflicted, is complicated by intense levels
of political considerations.The protocol includes a form which has
recently been used for rapid health assessment at local level in
Bosnia and Herzegovnia. The book concludes with a brief summary of
survey techniques, followed by a tabular presentation of reference
values for assessing needs, hazards, and logistic requirements in
developing countries.
A state-of-the-art review of methods and procedures for assessing
the risks to human health posed by environmental chemicals.
Addressed to regulatory authorities, risk managers and other
decision-makers, the book aims to demystify the principles of risk
assessment and thus encourage wider use of this powerful tool for
protecting populations. Since the detection of chemical hazards may
have socioeconomic and political consequences, the book gives
particular attention to methods for the accurate identification of
risks and determination of their severity. The book has four
chapters covering each logical step in the process of risk
assessment. The first, on hazard identification, explains how data
on a chemical's toxicity and mode of action can be used to
determine whether the chemical will cause adverse effects on
health. The strengths and limitations of different types of data
are discussed together with criteria commonly used to establish
causality. Methods for assessing dose-response relationships are
reviewed in chapter two, which explains how to characterize the
relationship between the dose administered or received and the
incidence of an adverse effect. Exposure assessment is covered in
the next chapter, which describes methods for determining the
nature and extent of contact with chemical substances and discusses
the characteristics of exposure in the general environment, in the
workplace, and from consumer products. The final chapter explains
the procedure of risk characterization as a decision-making tool
that brings together estimates of exposure levels and risks and
summarizes sources of uncertainty in the scientific data. Practical
options for risk management are presented asa range of regulatory,
non-regulatory, economic, and technological measures.
Provides model prescribing information for essential drugs used in
the treatment of skin diseases. Emphasis is placed on skin diseases
commonly found in developing countries, since rural communities in
these areas continue to experience considerable disability,
disfigurement, and distress caused by curable or controllable
diseases. Some rare but life-threatening disorders, such as
pemphigus, are also briefly discussed. The aim is to provide
reliable guidelines for treating these diseases - safely,
effectively, and at the lowest possible cost - in the community and
knowing when patients must be referred for highly specialized care.
Though emphasis is placed on management using drugs in the WHO
Model List of Essential Drugs, the book also discusses prevention
through improvements in hygiene, nutrition, housing, sanitation,
and other environmental factors. The book has two parts. The first
briefly profiles common skin diseases, moving from parasitic
infections, through fungal, bacterial, and viral infections, to
papulosquamous diseases, pigmentary disorders, and malignant
melanoma. Conditions common in children, acne vulgaris, cutaneous
reactions to drugs, and urticaria are also covered. Each disease or
group of diseases is introduced with facts about its prevalence,
manifestations, and causes, followed by advice on prevention and
management, including recommended drugs and dosage schedules. The
second part presents model prescribing information for essential
drugs used in the treatment of skin diseases. Each drug is
described according to a common format which covers clinical
indications, dosage and administration, contraindications and
precautions, use in pregnancy, adverse effects, druginteractions,
and proper storage.
Provides authoritative guidelines for the establishment or
improvement of national programmes for poison control. Addressed to
policy-makers and the administrators of specialized facilities, the
book responds to the need for comprehensive advice on the most
rationale and effective ways to manage the greatly increased number
of poisoned patients seen throughout the world. Strategies for the
prevention of poisoning are also described. The guidelines draw on
the practical experiences of numerous well-established poison
centres in different parts of the world. Although recommended lines
of action have universal relevance, the book gives particular
attention to the situation in developing countries, where a basic
infrastructure for the care of poisoned patients is often absent
and special problems arise from the lack of adequate
communications, transportation, drugs, and support services.
Throughout, emphasis is placed on the role and functions of a
poison information centre as a crucial component of any national
programme for poison control. The book has nine chapters presented
in two parts. Part one provides an overview of the policy issues
surrounding decisions to introduce measures, including specialized
facilities, for the prevention and management of poisoning. Arguing
that a poison information centre should be available in every
country, part one also describes the benefits of such centres,
outlines their principal functions, and suggests various options
for their logical and cost-effective operation. Against this
background, part two provides detailed technical advice on how to
organize and operate the various facilities and services that make
up a comprehensive system for poisoncontrol. Separate chapters
describe the functions and requirements of information services,
clinical services, and analytical toxicological and other
laboratory services, and discuss the importance of toxicovigilance
as a strategy for prevention. Subsequent chapters explain how to
deal with major emergencies involving toxic chemicals, and outline
solutions to the problem, encountered in most developing countries,
of obtaining essential antidotes. Part two concludes with advice on
the design and content of forms for collecting, storing, and
reporting data, followed by a detailed list of the main literature
required in a poisons information centre. Additional practical
information is provided in a series of annexes, which describe a
computer software system for the management of poisons data,
reproduce several model record and reporting forms, and classify a
large number of antidotes and related agents according to their
proven effectiveness and urgency of availability. ..." For those
involved in improving safety, this book is a bible... It is very
difficult to be critical of this outstanding work ... an essential
reference for all those involved in the use and handling of
chemicals. For regulators and those concerned with government
policy issues, it should be compulsory reading..." - Chemistry and
Industry
Draws together twenty-two WHO guidelines relevant to the quality
assurance and control of pharmaceutical products. Most of these
guidelines have appeared as annexes in various reports of the WHO
Expert Committee on Specifications for Pharmaceutical Preparations.
Others are published here for the first time. By making these
available in a single reference work, the book facilitates access
to the complete body of WHO guidelines and recommendations issued
to assist national drug regulatory and control authorities,
particularly in developing countries. When viewed together, the
collected guidelines also underscore the need for a comprehensive
system of quality assurance and illustrate its various technical
and administrative components in a logical way. The book has nine
chapters organized to reflect the sequence of administrative and
technical procedures needed to ensure that drugs meet acceptable
standards of quality, safety, and efficacy. Chapter one sets out
guiding principles for small national drug regulatory authorities.
The second and most extensive chapter, on product assessment and
registration, gives guidelines for the assessment of herbal
medicines, the stability of drug dosage forms, the stability
testing of products containing well established drug substances,
and registration requirements to establish the interchangeability
of multisource (generic) pharmaceutical products. Other chapters
present recommendations for quality assurance in pharmaceutical
supply systems, use of the International Pharmacopoeia to control
the identity, purity and quality of products, and the development
of simplified tests for verifying the identity of pharmaceutical
products. A chapter onlaboratory services contains proposed models
for a first-stage laboratory for drug surveillance, and a
medium-size drug control laboratory. The remaining chapters provide
guidelines for international trade in pharmaceuticals,
recommendations for dealing with the new threat posed by
counterfeit products, and advice on training programmes for
personnel conducting drug analysis for regulatory purposes.
Issues authoritative recommendations concerning nutritional
requirements and safe ranges of intake for nineteen trace elements
important to human health. Representing the consensus reached by a
large number of international experts, the book aims to give
scientists and those responsible for nutrition planning a solid
basis for assessing dietary intakes of trace elements, detecting
deficiencies and excesses, and recognizing the clinical features of
related disorders. Throughout, guidelines and advice respond to
greatly expanded knowledge about the significant impact that even
subtle differences in trace elements can have on health and
disease. The core of the report, which has three parts, provides
authoritative recommendations on the nutritional significance,
requirements for health, and safe range of daily intakes for
nineteen trace elements in three categories. These include
essential elements, such as iodine and zinc, probably essential
elements, such as manganese and silicon, and potentially toxic
elements, such as fluoride, lead, cadmium and mercury, which may
also have some essential functions at low levels.
Summary Evaluates the risks to human health and the environment
posed by exposure to chlorinated paraffins. These complex mixtures
are widely used throughout the world as a secondary plasticizer in
polyvinyl chloride, as extreme pressure lubricant additives in the
metal-working industry, and in fire-retardant and water-repellent
fabric treatment. Chlorinated paraffins are also added to paints,
coatings, and sealants to improve resistance to water and
chemicals. The most extensive section assesses findings from
toxicity studies in experimental mammals and in vitro test systems.
Studies demonstrate low acute oral toxicity and suggest that acute
toxicity by the inhalation and dermal routes is also low. Repeated
dose toxicity studies by the oral route consistently show that the
liver, kidney and thyroid are the primary targets of toxic action.
Long-term carcinogenicity studies in rodents have demonstrated
increases in the incidence of hepatic, renal, and thyroid tumours
following exposure to a short-chain compound. Following exposure to
a long-chain compound, an increased incidence of malignant
lymphomas and tumours of the adrenal gland has been observed. In
reviewing the limited data on human health effects, the report
notes that, despite widespread use of these compounds, no case
reports of skin irritation or sensitization have been recorded.
This observation is supported by studies of dermal exposure in
human volunteers. The report concludes that, when proper personal
hygiene and safety procedures are followed, risks to the health of
exposed workers should be minimal. Since chlorinated paraffins
bioaccumulate and are toxic to environmental organisms, the report
recommends that use anddisposal of these compounds should be
controlled to avoid release to the environment.
Summary: Explains the many simple things that community health
workers can do to treat malaria, prevent new cases, and thus help
reduce the alarming number of deaths, particularly in young
children and pregnant women. Practical in its approach, the manual
concentrates on activities that are within the competence of health
workers and feasible and affordable at the community level.
Information ranges from a basic explanation of the disease and its
transmission, to tables illustrating correct treatment schedules
for different age groups. The manual, which is abundantly
illustrated, can be used in training courses, as a support to the
health worker's day-to-day activities, or as a tool for health
education in the community. The main purpose is to communicate
basic facts and messages that, if widely understood within a
community, could do much to reduce the incidence and severity of
malaria. Chloroquine is presented as the first-line treatment. The
manual has three parts. The first explains what community health
workers can do to control malaria, and lists the essential
medicines and equipment needed.Part two introduces basic facts
about malaria and the behaviour of mosquitos, and elaborates three
main approaches to malaria prevention in communities. The third and
most extensive part sets out step-by-step instructions for the
recognition and treatment of malaria, giving particular attention
to standard malaria treatment schedules, measures for ensuring
compliance, what to do when standard treatment fails, and how to
recognize, treat, and refer severe cases. The management of malaria
in young children and pregnant women also receives special
attention.
A practical guide to the maintenance and repair of essential
laboratory and hospital equipment. Intended for use in institutions
that do not have specially trained technicians or engineers, the
book responds to the situation, frequently seen in developing
countries, where much of the equipment is imported and adequate
information on maintenance and repair is rarely provided by
suppliers. With these special needs in mind, the manual aims to
help staff using specific types of equipment to understand basic
principles of construction and operation, adopt good working
practices, avoid common errors, perform routine maintenance, and
spot the early signs of defects or deterioration. Advice on
equipment repair concentrates on common causes of problems that can
be solved without expertise in engineering. Throughout the manual,
line drawings illustrate features of construction and design, while
numerous checklists offer advice on periodic inspection and
cleaning, good working practices, and the essential do's, don ts,
must's, and never's of routine operation and maintenance.
Information ranges from the steps to follow when recharging
batteries, through advice on how to protect microscopes in hot
climates, to instructions for changing a blown fuse in an
ultrasound scanner. Basic safety procedures, for protecting staff
as well as patients, are also described. The most extensive chapter
covers the maintenance and repair of basic laboratory equipment,
moving from autoclaves and incubators, to cell counters and systems
for water purification. The remaining chapters describe the correct
use, maintenance, and repair of diagnostic equipment, anaesthetic
and resuscitation equipment, operating room equipment, and
ultrasound and X-ray diagnostic equipment."
Sets out guidelines that can help reduce the high levels of
maternal morbidity and mortality associated with abortion, whether
spontaneous or induced. Recommendations and advice are backed by
extensive practical experience and rooted in the principle that
emergency care for the complications of abortion should be
available 24 hours a day in every health care system. In view of
the need to prevent life-threatening complications, the book also
establishes standards of safe abortion practice for use in those
countries where abortion is permitted by law. Prevention of
abortion through education and family planning is likewise
discussed. Addressed to health managers, administrators, and care
providers, the book follows a step-by-step approach to the
provision of emergency and preventive care. The first three
chapters describe the magnitude of mortality and morbidity caused
by unsafe abortions, define the essential components of abortion
care at each level in the health system, and discuss the ways in
which legal and societal factors affect abortion behaviour and
care.Against this background, the remaining eleven chapters provide
technical and managerial guidelines for each component of service,
at each level of the health system, needed to ensure that all women
have access to care 24 hours a day. A chapter on planning is
followed by three chapters outlining the clinical elements of
emergency abortion care. Of particular value is a chapter on
patient information and counselling, which emphasizes the
importance of providing information in a supportive manner. Other
chapters offer detailed guidance on the facilities, equipment and
drugs needed for abortion care, on the training and supervision of
staff, and on ways to overcome several obstacles that make it
difficult for women in remote rural areas to receive timely care.
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Chloroform (Paperback)
World Health Organization (Who)
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R913
Discovery Miles 9 130
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Ships in 10 - 15 working days
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Evaluates the risks to human health and the environment posed by
exposure to chloroform, a volatile liquid used in pesticide
formulations and as a solvent and chemical intermediate. Its use as
an anaesthetic and in proprietary medicines has been discontinued
in many countries following well-documented reports of adverse
effects on respiratory, cardiac and liver function. Exposure of the
general public occurs via food, drinking-water, and indoor air,
with water use in homes making a substantial contribution to levels
in indoor air. Studies have demonstrated significant dermal
absorption while showering. The most extensive chapter reviews the
results of toxicity studies in laboratory animals and in vitro test
systems. While both the liver and the kidneys are target organs,
the most universally observed toxic effect is damage to the liver.
Studies indicate that cytotoxicity followed by cell proliferation
is the most important cause for the development of liver and kidney
tumours following experimental exposure to chloroform. The severity
of toxic effects was observed to vary according to species,
vehicle, and route of administration. A chapter on health effects
in humans notes disturbances in respiratory and cardiovascu-lar
functions observed following short-term exposure. As in animals,
liver and kidney damage was the most frequently reported adverse
effect of long-term exposure. Data were judged inadequate to
implicate chloroform exposure via drinking-water as a cause of
human cancer. Concerning effects on the environment, the report
concludes that the low levels of chloroform in surface water should
not pose a hazard to aquatic organisms. .,." produced with the
usual conciseness andreadability..." - International Journal of
Environmental Studies
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