THE NEWSLETTER OF THE INTERNATIONAL PROGRAMME ON CHEMICAL SAFETY IPCS NEWS Issue 8 December 1995 CICADs - a new EHC-like risk evaluation series At its first meeting in Stockholm in 1994, the Intergovernmental Forum on Chemical Safety called for international assessment of 200 additional chemicals by 1997 and a further 300 by the year 2000 as steps towards the achievement of the targets of Programme Area A of Chapter 19, Agenda 21 of the United Nations Conference on Environment and Development. Several international organizations are coordinating their activities to achieve this target. Thus, in the Environmental Health Criteria (EHC) series, the IPCS provides comprehensive assessments of risks posed by chemicals to human health and environmental integrity. More targeted risk assessments for chemicals in food are provided by the Joint FAO/WHO Expert Committee on Food Additives and the Joint FAO/WHO Meeting on Pesticide Residues. Initial assessments of high production volume chemicals are conducted by the OECD with the aim of identifying data gaps and prioritizing existing chemicals. Evolution of CICADs The task is immense. Given the time constraints and the need to make optimum use of available resources, it was accepted in Stockholm that reviews prepared by national institutions which meet agreed criteria as a basis for international assessments could be invaluable in achieving this ambitious goal. At the Joint IPCS/OECD Consultation on Priority Chemicals and Related Issues (Research Triangle Park, January 1995), it was recommended that the IPCS produce a new short document as a model for using existing national or regional reports to develop globally acceptable risk assessments. Such a document would provide a concise evaluation of risks to human health and the environment resulting from exposure to a given chemical. It would also contain an extensive summary of key studies supporting the evaluation, as well as more practical advice for risk management (as in the IPCS Health and Safety Guides). The IPCS has been requested to develop a pilot project to establish the process for producing such short international assessment documents. However, the EHC documents would still be available to meet the need for a comprehensive assessment document. In May 1995, the first meeting of the IPCS Steering Group on Development of Concise International Assessment Documents (held in Washington, DC, and hosted by the Pan American Health Organization) considered the format, production process and contents of the new document, which was termed Concise International Chemical Assessment Document (CICAD). Pilot phase During the course of the pilot phase, 5 pesticides and 16 other chemicals will be evaluated. Drafts will be prepared by leading institutions in 8 countries. The choice of the chemicals has been based on selection criteria such as substances of transboundary concerns or of concern in more than one country, international interests in risk reduction programmes, probability of exposure (production volume, export/import data, etc.), and chemical toxicity. The availability of high quality national or regional assessment documents and the existence of other ongoing relevant assessment efforts have been taken into consideration. The quality of the supporting document (see box) is considered critical to the process. Although both pesticides and industrial chemicals have been selected for the CICAD project and could share a common initial development from national/regional documents, it would be appropriate for peer-review and publication of pesticide CICADs to be managed through the Joint FAO/WHO Meeting on Pesticides. Developing countries and countries in transition will be prime users of CICADs. However, if CICADs are produced in place of internally commissioned reports and can meet some countries' legal requirements, there will also be an opportunity for productivity gains in developed countries. Economies might also be made if CICADs are developed instead of updating individual national, regional or existing international reports. Further information on this subject may be obtained from the Director, PCS. Box Format of a CICAD CICADs will follow the general format of EHC documents (as described in the EHC Preamble) with emphasis on key studies and primary conclusions. A national or regional report will serve as the source and supporting document for the CICAD. This source report should be comprehensive regarding end-points addressed (similar to EHCs), include a critical assessment of the data, sufficient level of detail on individual studies and a comprehensive reference list, should reflect a transparent review process, be written in English and be available publicly. The text of the CICAD will be more concise than the source document and include a general preface describing the purpose, terms of reference and overall context of the process used to prepare the CICAD. The CICAD will provide a detailed rationale for the conclusions drawn. It will also include the type of information found in sections 4 and 5 of a Health and Safety Guide (which describe prevention of exposure and human health and environmental protection) and section 7 (which contains details of existing guidelines and standards). It will be adequately referenced and able to function as a stand-alone document. INTOX Package now available The IPCS INTOX Project was established in 1988 to develop a poison information package which would help developing countries, particularly, to set up poison information centres. The Project is now making available the INTOX Package on a subscription basis. Over one hundred experts have participated in the development of the Package which is designed to provide sophisticated information management at poison centres. Through international consensus, harmonized data collection formats using a controlled vocabulary have been established as an integral aspect of the Package. This provides users of the Package with a basis for international sharing and comparison of data. The information management software, known as the IPCS INTOX System, is currently available in English; French, Portuguese and Spanish versions of the System will be issued in early 1996. The software system contains five classification schemes: i) chemical and pharmaceutical substances ii) poisonous plants iii) animals iv) clinical features of poisoning v) a use or function classification Accompanying the IPCS INTOX System as part of the Package is an IPCS INTOX CD-ROM, issued on a biannual basis, which contains a database on substances commonly implicated in cases of poisoning worldwide. Whilst the CD-ROM contains a range of IPCS publications and data from CCOHS, the majority of information on diagnosis and treatment of poisoning is contained in a series of Poison Information Monographs (PIMs). These monographs are intended to provide up-to- date information to assist a poison centre in responding to inquiries about exposures and suspected poisoning. In the first version of the CD-ROM there are 83 PIMs dealing with chemical substances, pharmaceuticals, poisonous plants and venomous animals, plus over 400 additional publications covering aspects of the toxicological effects of a further 500 substances. A further one hundred PIMs are in preparation and are expected to be available on the CD-ROM by the third issue at the end of 1996. Although a number of PIMs do not yet contain analytical sections, these sections are expected to be completed in time for the third issue of the CD-ROM. The Package is accompanied by a detailed user manual containing a training tutorial. It has been agreed by consensus among Project participants that the maintenance, updating, enhancement and user support of the Package will be supported by a users annual subscription. This has been set at US$ 1000 per annum for the software system and US$ 500 per annum for the CD-ROM for single PC use, with a graduated subscription fee for network versions, depending on the number of terminals. During the first year of issue there is an introductory subscription rate for the Package (both the software system and CD-ROM) of US$ 1000. However, a special concessionary rate of US$ 500 for the whole Package has been set for those participants in the Project who have contributed to the development of the Package. For those who require only the CD-ROM, the price remains at US$ 500, i.e. there is no special introductory price for the CD-ROM alone. Further information may be obtained from Dr J. Haines, INTOX Protect Leader, IPCS (Fax: 41-22-7914848; E-mail: IPCSINTOX@WHO.CH). Forum update The second Intersessional Group meeting of the Forum will be held in Canberra, 3-8 March 1996, at the invitation of the Government of Australia. Thirty-one countries are members of the Intersessional Group. In addition, full participation from non-governmental and intergovernmental organizations is anticipated. It is proposed that the meeting develop a number of specific topics so that there can be full networking between countries and other participants. IPCS welcomes Maged Younes The most recent addition to the IPCS Central Unit is Dr Maged Younes, who in May took up the responsibilities of Chief of the Assessment of Risks and Methodologies Unit. He obtained an M.Sc in 1975 and Ph.D in 1978 at the University of Tbingen, Germany, both degrees being in Biochemistry. Dr Younes then worked at the Institute of Toxicology, Medical University of Lbeck, Germany, until 1989. During this period he conducted research in the field of biochemical toxicology with special emphasis on mechanisms of toxic action, free radical toxicology and lipid peroxidation, biotransformation reactions and organ-related toxicity. He also qualified as an Expert in Toxicology through the German Society of Pharmacology and Toxicology, and was nominated Professor of Toxicology and Biochemical Pharmacology. In the summer of 1985 he spent a sabbatical at the Commonwealth Institute of Health, University of Sydney. In 1991, Dr Younes was nominated Head of the Biochemical Toxicology Unit at the Max von Pettenkofer-Institute of the German Federal Health Office in Berlin. From November 1991 till April 1995, he was the responsible manager for the European Chemical Safety Programme of the World Health Organization at the Bilthoven Division of the WHO European Centre for Environment and Health. One of his major responsibilities there was the updating and revision of the WHO Air Quality Guidelines for Europe, which was conducted in cooperation with the IPCS. Dr Younes has come to Geneva with his wife and young daughter and should certainly find plenty of opportunities here to indulge in his enthusiasm for travelling. ALUMINIUM IN THE ENVIRONMENT This major component of the earth's crust has been proposed as a cause of Alzheimer's disease. Does science support this relationship? Aluminium is one of nature's building blocks. It is the third most abundant element after oxygen and silicon, making up 8% of the earth's crust. It is truly ubiquitous, naturally found in soils, clay, minerals, food and water across the globe. Aluminium is chemically very reactive; it is never found free in nature, preferring to combine with oxygen, silicon, fluorine and other elements. The aluminium industry is just over 100 years old. Over the last 50 years the production and use of aluminium and its compounds has increased rapidly, worldwide production of the metal now being more than 14 million tonnes. Aluminium metal is currently an integral part of the automobile, aircraft, electrical and construction industries, and is also used to prepare cooking utensils, food packaging, insulation and corrosion-resistant machinery. Compounds of aluminium find wide uses in the food industry as additives and in the purification of beverages, including drinking- water. Other uses include the preparation of abrasives, cosmetics, deodorants and pharmaceuticals (e.g., antacids). Given the extremely high level of production and the dispersive uses for aluminium and its compounds, concern over the levels to which humans and other organisms in the environment are exposed has increased over the last two or three decades. There is concern that human activities have increased the risk of adverse effects on the environment and on human health. The World Health Organization and the IPCS have reflected this concern of Member States by evaluating health risks from aluminium in foods through the Joint FAO/WHO Committee on Food Additives and Contaminants (JECFA). In addition, a drinking-water guideline has been developed in view of the widespread use of aluminium sulfate in the purification of drinking-water. In April 1995, the IPCS with the generous support of the Commonwealth and State Governments of Australia, convened a Task Group, composed of 16 experts from 10 countries, to evaluate the human health and environmental risks from exposure to aluminium and its compounds. This article summarizes the major conclusions of this group, which will be published as monograph in the Environmental Health Criteria series in 1996. Exposure pathways Given the low solubility of aluminium at pH values in the neutral range, levels in natural waters are extremely low. However, human activities that result in acid materials being deposited in environments with low buffering capacity can result in the mobilization of natural aluminium to levels which are toxic to many organisms. Such toxic levels of aluminium can result in decreased biological diversity at all levels of the food chain. Humans can be exposed to aluminium from air (dust and particulate matter), soil, food and water. Workers manufacturing, repairing and using the metal are exposed to airborne metallic particles, fumes and dusts. Humans cannot avoid exposure to aluminium in view of the natural levels found in soil and food. The total weekly intake of between 0.04 and 1.5 mg/kg body weight is largely dependent upon the food-stuffs consumed, the permitted use of aluminium-containing food additives, and whether aluminium salts are used to purify drinking-water. Over 95% of human intake (other than antacids) comes from the food supply. Consumption of antacids can increase this intake by a factor of 100 to 1000. No matter the source of aluminium (water or food), less than 1% is absorbed and over 95% of this amount is excreted from the body. Absorption can be increased by the presence of organic acids such as citrate, lactate and gluconate. Health effects The toxicity of aluminium is considered to be low for humans. This low toxicity has been confirmed in animal studies. The major end- points of concern are neurotoxicity and effects on bone. For almost 100 years aluminium has been known to be neurotoxic. However, the animal studies that showed this used routes of administration not relevant to the human situation, particularly those involving direct injection into the brain. The neurotoxicity of aluminium has been confirmed in humans with renal failure, where aluminium in dialysis fluids has led to a form of dementia that is fatal if not reversed. Such cases often exhibit bone disease, which is not found in people with Alzheimer's disease; it is a completely different disease from the irreversible progression to dementia in Alzheimer's disease. There is some support from animal studies for the neurotoxic effect of aluminium after oral dosing, but only with high doses of an extremely bioavailable salt which affects the usual absorption processes. Both the animal experiments and human epidemiology are inadequate to conclude that exposure to aluminium can affect learning and memory in humans. Although a few scientists have concluded that aluminium in drinking-water can cause Alzheimer's disease, a thorough review by the Task Group of the studies available did not support such a causal relationship. Workers producing or repairing aluminium are at risk from the respiratory effects of the metal particles and fumes, dusts and other chemicals present in the workplace, and there have been a few reports of the production of diseases such as pulmonary fibrosis and irritant induced asthma. However, given the mixed exposures encountered, it is impossible to conclude with any degree of certainty the actual role of aluminium in the production of these adverse effects. Information gaps A summary of the major conclusions reached by the Task Group is given in the box. It is evident that this group of experts did not feel that science supported the hypothesis that aluminium was causally related to Alzheimer's disease. However, the Task Group made very specific recommendations for the studies needed to fill the current information gaps. These will be presented in the EHC monograph, as well as in an internal report PCS/EHC 95.36 available now from the Director, IPCS. It is essential that the research needed to decrease the uncertainties in the Task Group's conclusions be carried out. As long as there are conflicting scientific data based largely on inappropriately designed studies, there are those who will report and interpret the data to their advantage. Public pressure based on such reports often leads to inappropriate and costly regulatory strategies, which waste precious public health resources worldwide. Further details of all these activities may be obtained from Dr G. Becking, IPCS/IRRU, World Health Organization, P.O. Box 12233, Mail Drop EC-07, Research Triangle Park, NC 27709 USA (tel: 919-5417537; fax: 919-5412712; E-mail: IN%"Foster@NIEHS.NIH.GOV"). Box 1 WHO guidelines for maximum levels of aluminium exposure __________________________________________________________________ Source Maximum level __________________________________________________________________ Total exposure1 7 mg/kg body weight per week Water2 < 0.2 mg/litre (based on aesthetics only) __________________________________________________________________ 1 JECFA Report, WHO Technical Report Series 776 (1989) 2 WHO Guidelines for Drinking-water Quality, 2nd Edition, Volume 1: Recommendations (1993) Box 2 Aluminium in drinking-water Aluminium compounds are widely used in the treatment of drinking- water to increase its clarity and to remove organic material before disinfection. From the aesthetic standpoint, unacceptable levels (> 200 ęg/litre) of aluminium result only from a lack of control of this process. Levels of aluminium in excess of 200 ęg/litre often lead to consumer complaints due to deposition of aluminium salts and an increase in the discoloration by iron. There are conflicting opinions on whether aluminium in drinking- water causes Alzheimer's disease. Some scientists, without consideration of the total intake of aluminium, have postulated a unique toxicity for water-borne aluminium. However, this is not supported by the appropriate interpretation of available data on the chemistry and kinetics of aluminium in the body. In addition, the strength and weight of evidence on the biological effects of aluminium does not support a causal role in the production or acceleration of the onset of Alzheimer's disease. Box 3 Summary of some conclusions from the IPCS Task Group on Aluminium1 Hazards to neurodevelopment and brain function from aluminium have been identified through animal studies. However, aluminium has not been demonstrated to pose a health risk to healthy, non- occupationally exposed humans. There is no evidence to support a primary causative role for aluminium in Alzheimer's disease and aluminium does not induce Alzheimer's disease pathology in vivo in any species, including humans. It has been hypothesized that: a) exposure of some elderly populations to elevated levels of aluminium in drinking-water may increase the incidence of Alzheimer's disease or accelerate its onset; b) particular exposures, either occupational or via drinking-water, may be associated with non-specific impaired cognitive function. The data put forward in support of these hypotheses are currently inadequate. There is insufficient health-related evidence to justify altering existing WHO Guidelines for aluminium exposure in healthy, non- occupationally exposed humans. Patients with renal failure are at risk of neurotoxicity from aluminium. In people of all ages with impaired renal function, aluminium accumulation has been shown to cause the clinical syndrome of encephalopathy, vitamin-D-resistant osteomalacia and microcytic anaemia. Therapeutic use of aluminium-containing preparations poses a hazard to patients with chronic renal failure and premature infants; every effort should be made to limit their use in these groups. Intestinal absorption of aluminium can be increased by the use of citrate-containing products. Workers with long-term high-level exposure to the fine aluminium particulates may be at increased risk of adverse health effects. However, there is insufficient data from which to develop, with any degree of certainty, occupational exposure limits with regards to the adverse effects of aluminium. _____________ 1 Collective views from the IPCS Task Group, 24-28 April 1995, Brisbane, Australia, PCS/EHC 95.36. Essential trace elements Several elements are essential to human health in trace quantities but harmful at higher concentrations. The IPCS is currently preparing comprehensive Environmental Health Criteria documents on copper and zinc which will provide international assessments of the risks to human health and the environment. For both metals, the Institute of Terrestrial Ecology (UK) is examining the environmental effects. In the case of copper the chapters relating to human health are being prepared by the Australian National Research Centre for Environmental Toxicology in Brisbane, where the Task Group meeting will be held in mid-1996. For zinc, support is being given by the Fraunhofer Institute for Toxicology (Hanover, Germany), and the Australian Commonwealth Department of Human Services and Health will be responsible for integrating the various sections. Planning is also well advanced for the preparation of a methodology Environmental Health Criteria document entitled Principles and Methods for the Assessment of Risks from Essential Trace Elements. This will examine elements (e.g. iron, chromium, fluoride and selenium), in addition to copper and zinc, considered both potentially toxic and essential to life. The scope and content of the document will be determined by a small group of experts, who will consider: i) criteria to establish essentiality; ii) conceptual aspects of essentiality and toxicity; iii) nutrient interactions and toxicokinetics; iv) toxic effects from trace mineral deficiency; v) the effect of environmental standards on total daily intake by humans and biota; vi) susceptible populations. A few case studies will be provided (e.g. zinc, copper, iron, chromium) to illustrate the use of the principles developed. Authors of individual papers will be experts in specific fields (e.g., environmental toxicity, physiology, nutrition, toxicology, etc.). After revision by experts and examination by the IPCS peer review network, a Task Group will finalize the monograph. Further details of all these activities may be obtained from Dr G. Becking, IPCS/IRRU, World Health Organization, P.O. Box 12233, Mail Drop EC-07, Research Triangle Park, NC 27709 USA (tel: 919-5417537; fax: 919-5412712; E-mail: IN%"Foster@NIEHS.NIH.GOV"). Pesticide Poisoning in China A total of 42 812 new cases of pesticide poisoning, including 3900 fatal cases, was reported from 28 provinces in 1994. Among them, 13 210 cases were caused by pest control operations in agriculture, accounting for 30.9% of total cases, and the fatality rate was 0.5%. Among these, poisoning by insecticides accounted for 92.0%. Organophosphorous pesticides were the major cause of new cases (92.7%), followed by carbamate compounds (3.4%). Over half (51.8%) of poisonings were induced by parathion, 14.3% by methamidophos and 6.1% by dichlorvos. Chemical safety in Thailand The Food and Drug Administration, Ministry of Public Health of Thailand, is the focal point for the National Coordinating Committee on Chemical Safety, and is responsible for establishing the National Master Plan on Chemical Safety for the period of 1997-2001. The 10 principles of coordinated policies concerning the Master Plan have been approved by the National Committee on Chemical Safety. The objectives of the Plan are to: 1) encourage collaboration among contributing organizations to carry out the National Programme on Chemical Safety; 2) develop coordinated strategies for keeping adverse effects of chemicals on the environment and human health to a minimum; 3) reduce the redundancy of contributing organizations' responsibilities concerning the National Programme on Chemical Safety. Forthcoming meetings 13-14 December 1995 2nd Meeting of the Working Group for the Global Information Network on Chemicals Project Tokyo, Japan 6-15 February 1996 46th meeting of the Joint FAO/WHO Expert Committee on Food Additives (JECFA), Geneva, Switzerland 21-23 February 1996 Meeting of the Steering Group on Concise International Chemical Assessment Documents, Ottawa, Canada February 1996 Task Group Meeting on Environmental Health Criteria for Hexachlorobenzene, Geneva, Switzerland 11-15 March 1996 Peer-review meeting on International Chemical Safety Cards, Carshalton, United Kingdom 18-20 March 1996 Meeting of the IPCS INTOX Analytical Working Group United Kingdom 18-23 March 1996 Task Group Meeting on Environmental Health Criteria for Phosgene and for Selected Chlorinated Alkyl Ethers, Carshalton, United Kingdom 21-23 March 1996 Meeting of TOX-score investigators United Kingdom 4-13 June 1996 47th meeting of the Joint FAO/WHO Expert Committee on Food Additives (JECFA), Rome, Italy June 1996 Task Group Meeting on Environmental Health Criteria for Copper Brisbane, Australia It should be noted that these meetings are being attended by specifically invited experts only. Recent publications Environmental Health Criteria 166 Methyl bromide 167 Acetaldehyde 168 Cresols 170 Guidance values for health-based exposure limits 172 Tetrabromobisphenol A and derivatives 173 Tris- and bis(2,3-dibromopropyl) phosphate 174 Isophorone 175 Anticoagulant rodenticides Health and Safety Guides 91 Isophorone 92 Morpholine 93 Brodifacoum 94 Bromadiolone 95 Difenacoum 96 Warfarin 97 Methomyl Joint FAO/WHO Expert Committee on Food Additives (JECFA) Evaluation of certain veterinary drug residues in food. 43rd report of the Joint FAO/WHO Expert Committee on Food Additives. WHO Technical Report Series No. 855, 1995. Joint FAO/WHO Meeting on Pesticide Residues (JMPR) Pesticide Residues in Food - 1994. Report of the Joint Meeting of the FAO Panel of Experts on Pesticide Residues in Food and the Environment and the WHO Expert Group on Pesticide Residues. FAO Plant Production and Protection Paper 127, 1994. Pesticide Residues in Food - 1994 Evaluations. Part II - Toxicology. World Health Organization, WHO/PCS/95.2, 1995. Other publications Mycotoxins and toxic plant components. Proceedings of the EC, WHO/IPCS, FAO and ILSI Europe Joint Workshop, Lisbon 1994. Natural Toxins, 3(4): 181-342, 1995. Available from John Wiley & Sons, 605 Third Ave., New York 10158-0012, USA. Methods to assess the effects of chemicals on ecosystems. Ed. R.A. Linthurst, P. Bourdeau, & R.C. Tardiff. IPCS Joint Activity 23, New York, John Wiley & Sons. Available from John Wiley & Sons (address as above). Box: Unless stated otherwise, these publications are obtainable from the Office of Distribution and Sales, World Health Organization, 1211 Geneva 27, Switzerland Occupational Disease Reporting System in China A nationwide network for occupational disease reporting has gradually been built up in China since 1982. The Institute of Occupational Medicine, Academy of Preventive Medicine, was designated by the Ministry of Health as the national centre for the reporting system in 1987. Information on occupational disease reporting derives from various occupational disease diagnostic panels, general hospitals or clinics that report acute occupational poisoning, and various factories or mines that are obliged to report fatal cases of pneumoconiosis. Reportable occupational diseases are those on the ``List of Occupational Diseases'' issued by the Ministry of Health, which include eight classes of occupational diseases such as occupational poisoning caused by toxic chemicals, pneumoconiosis, occupational diseases induced by physical factors, etc. In addition, acute pesticide poisoning during agricultural use and accidents (suicide or misuse) came within the reporting system in 1991. Poisoning resulting from pesticide formulation, transportation and distribution has been reported under Occupational Poisoning since 1982. Forthcoming publications Environmental Health Criteria 169 Linear alkylbenzene sulfonates 171 Diesel fuel and exhaust 176 1,2-Dichloroethane (2nd ed.) 177 1,2-Dibromoethane 178 Methomyl 179 Morpholine 180 Immunotoxicity 181 Chlorinated paraffins 182 Thallium Health and Safety Guides 98 Chlorothalonil 99 Diflubenzuron 100 Cresols 101 Hydroquinone Joint FAO/WHO Expert Committee on Food Additives (JECFA) Evaluation of certain food additives and contaminants. 44th report of the Joint FAO/WHO Expert Committee on Food Additives. WHO Technical Report Series No. 859. Toxicological evaluation of certain food additives and contaminants. Prepared by the 44th meeting of the Joint FAO/WHO Expert Committee on Food Additives. WHO Food Additives Series No. 35. Joint FAO/WHO Meeting on Pesticide Residues (JMPR) Pesticide Residues in Food - 1995. Report of the Joint Meeting of the FAO Panel of Experts on Pesticide Residues in Food and the Environment and WHO Environmental Core Assessment Groups. FAO Plant Production and Protection Paper. Issued by the International Programme on Chemical Safety, World Health Organization, 1211 Geneva 27, Switzerland Telephone: 7913589 Telefax: 7914848 This newsletter is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in this newsletter do not necessarily reflect those of the WHO, the International Labour Organisation or the United Nations Environment Programme. For a free subscription, please write to the above address. Editor: Philip Jenkins Design and production: Marilyn Langfeld ISSN 1019-0150 IPCS Multilevel Course on the Safe Use of Pesticides in China A multilevel course on the Safe Use of Pesticides and on the Diagnosis and Treatment of Pesticide Poisoning, organized by the IPCS and the Institute of Preventive Medicine, Ministry of Health, was held on 8-19 May 1995 in Beijing and in the agricultural areas of Shanghai and Jiangsu Province. The main objectives of the course were to train selected technical officers and medical personnel to become trainers at various levels in the safe use of pesticides, and to discuss risk reduction measures. Specific topics relevant to the target audience were presented and discussed, and appropriate field visits were made. The participants suggested that four advanced courses were needed for specific target audiences; medical doctors for improving diagnosis and treatment; managers in agricultural and public health activities for poison prevention; decision makers for implementation and enforcement of regulations at the national level; and biochemists and medical personnel for monitoring of exposure to pesticides. IPCS Chemicals compact disc The Canadian Centre for Occupational Health and Safety is preparing a compact disc which will contain all the IPCS outputs and include search capabilities. This will be provided on subscription with two issues per year, the first due to be available in March 1996. EHC 106: Beryllium A minor error has been noted in Table 8 (page 59) of Environmental Health Criteria - 106: Beryllium. The middle column should be headed range (ęg/litre) and the next column to the right, mean (ęg/litre). How to receive IPCS publications rapidly The fastest way to obtain an IPCS product that has been published by the World Health Organization is as follows. Send by fax details of the publication that you require (be sure to give the exact title) to the WHO Distribution and Sales Office (Fax no. 41 22 7914857). Supply details of your credit card (e.g. Visa, American Express, Eurocard, Access, Mastercard, Diners Club), including the card number, expiry date and the card holder's name. Specify if you come from a developing country since this will permit a 30% reduction in cost. All prices include postage by surface mail. Inside Aluminium 4-5 Essential trace elements 6 Meetings and publications 7 Disease reporting in China 7  .