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.

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