EXECUTIVE BOARD Thirty-third Session
Provisional agenda item 2.2
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Евзз/26
4 December 196) ORIGINAL: ENGLISH
REPORT ON EXPERT COMMITTEE MEETINGS Report by the Dire сtor-General
1. Introduction
In compliance with paragraph 10.6 of the regulations for Expert Advisory 1
Panels and Committees, the Director-General is reporting, in this document, on the action to be taJken with reference to meetings of expert committees•
2. Reports
The reports of expert committee meetings which have been prepared in both working languages since the thirty-second session of the Executive Board and are now available for annexation to this report are as following:
(1) Expert Committee on Gonococcal Infections (2) Expert Committee on Insecticides
(3) Joint FAO/WHO Expert Committee on Food Additives
(4) Expert Committee on Maternal and Child Health: Social Aspects in the Teaching of Obstetrics and Gynaecology
(5) Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel: Promotion of Medical Practitioners 1 Interest in Preventive Medicine
(6) FAO/WHO Expert Panel on Veterinary Education
1 Basic Documents, l4th e d ” p. 92
2 In view of the interest of FAO in this report its title conforms to the terminological practice of that Organization,
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(7) Expert Committee on Rehabilitation of Patients with Cardiovascular Diseases
(8) Expert Committee on General Practice (9) Expert Committee on Malaria
2.1 Expert Committee on Gonococcal Infections 2,1.1 Background information
1 2 3
Three reports of the WHO Expert Committee on Venereal Infections, ' and two reports of the WHO Expert Committee on Venereal Infections and Treponematoses, as 4 5
well as the report of the WHO Study Group on the Revision of the Brussels Agreement of 1?24, dealt only marginally with therapy aspects of gonorrhoea» The general , 6 recrudescence of gonococcal infections in developing and developed countries in the
7
last few years, and a growing evidence of its occurrence In many areas, led to the need for WHO to appraise the world-wide failure to control the infection and,
through the convening of this Committee, to define the Organization's role in the promotion of research and of measures against the disease, as contained in the first report of this Committee•
о 2Л.2 The report
The initial therapeutic success of sulfonamides and antibiotics resulted in the false assumptions that gonococcal infections had become of minor public health
importance, that the frequency of complications had become of no consequence,
1 Off, Rec, VJld Hlth Org. 8 , 19^8
2 Off. Rec. Wld Hlth Org. 13, 1950
1950 1953 190, I960 130, 1958
262 3 Wld Hlth Org> techn. Rep. Ser, 4 Wld Hlth Org, techn. Rep, Ser, 5 W l d Hlth Org, techru Rep, Ser, 6
Wld Hlth Org, techn. Rep. Ser,
7 Document WHO/VDT/^OO, 1962 g
Wld Hlth Org, techn. Rep> Ser.
particularly in the female, and that ophthalmia neonatorum and vulvovaginitis in children no longer occurred. A general attitude of indifference to gonococcal infections has developed in health administrations, the medical profession and the public, and' reduced attention has been paid to these conditions in medical training and teaching.
The Committee reviewed documentation from countries in all regions which indicated an increasing incidence of gonococcal infections in the last few years.
The Committee emphasized the failure to control the spread of the disease in and
between countries, in spite of the continued wide availability of effective antibiotics, even in highly-developed countries with substantial budgets and seemingly adequate
personnel and organization.
The apparently reduced role of professional prostitution in the transmission of the infection in developed countries., was offset by adolescent behaviour changes and sex activities which facilitated its spread. The very short incubation period of gonorrhoea was still an obstacle to an adequate epidemiological control of the disease.
The emergence of gonococcal strains "resistant" mainly to penicillin and streptomycin, while only partially contributing to the over-all failure to control gonorrhoea, has focused attention on the need for uniform, international laboratory methods for the determination of sensitivity.
The various possible directions of increased national and international efforts to improve the control of gonococcal infections were discussed by the Committee, including epidemiological, laboratory^ health education and other aspects. Strong emphasis was placed on the need for biochemical research to develop improved diagnostic and immunological tools, on which depends the solution of many outstanding problems in the control of gonococcal infections.
2 . 1 0 Re с ommendat ions
The report contains recommendations on all phases of gonococcal infections, relating to： (l) improvement of reporting and epidemetric procedures;
(2) intensification of control; ⑶ improvement of diagnostic laboratory
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p a g e 4
facilities in developing countries; and (4) standardization of methods, techniques and reagents used in the laboratory. The Committee also recommended that WHO
sponsor a limited number of special studies arid pointed to the urgent need for the inclusion of biochemical, immunological and other investigations on Neisseriae as a group in the intensified medical research programme of WHO.
2,1.4 Implications for the OrganizationT s programme
.The preliminary investigations intended to map out antibiotic sensitivity patterns in different countries and immunological studies need to be expanded in co-operation with the Internat ional Neisseriae Centre in Copenhagen.
WHO will further promote inter-laboratory assays required for standardization of drug sensitivity determination methods by supporting laboratories working on basic biochemical^ immunological and other problems involved»
The approach envisaged is in terms of Neisseriae as a group, including meningitidis> The limited assistance provided by WHO in the cerebrospinal meningitis area ("CSM” belt) of the African Region will, under the Special Account for Medical Research, be extended to include field collection of strains and field and laboratory studies. ^ 1 2
• 3 It is proposed to convene a Scientific Study Group on Neisseriae Research,
as recommended by the Expert Committee on Gonococcal Infections»
2.2 Expert Committee on Insecticides 2.2.1 Background information
This meeting is the fourth of a series on the subject of vector control and 4 insecticide resistance. The first, held in 1956, had recommended a long-term programme of work with particular emphasis on the development of standard test
1 Off. Rec. Wld Hlth Org. 121， 444
2 Off, Rec. Wld Hlth Org. 121,斗斗斗
5 Off. R e o / W l d Hlth Org, 121,斗斗5 Wld Hlth Org* techru Rep, Ser, 125
procedures for determining levels of insecticide resistance and on the establishment 1
of recommended methods for vector control. The second took place in 1957- At this meeting the results of over 15 monthsr research were reviewed, test procedures for adult and larval mosquitos were established and recommendations for the control of vectors of public health importance were made• After a further two years of 2 research the Committee met again, at which time procedures for seven insects were established and the recommended methods for vector control brought up to date.
2.2.2 The report乂 3
I The report of the thirteenth meeting of the Expert Committee takes this field of work one step further. It reviews the present status of insecticide resistance and recommends further research on the subject. The remainder of the report is devoted to (a) the revision of certain established methods for determining resistance,
(b) the establishment of new procedures for flies, Triatoma, cockroaches, ticks and other insects not considered before, (c) clarifying the interpretation of results obtained with these procedures, and (d) bringing the recommended methods for vector control up to date.
2.2.3 Re commendat ions
The re commendations for research made by the Committee will be of value to WHO in the further development of its programme on insecticide resistance and
’ vector control.
2.2.4 Implications for the O r g a n i z a t i o n ^ programme
The re commendations made by the Committee for research on resistance ensure a sound basis for future work in relation to the problems that confront field operations. The establishment of test procedures for determining resistance in
1 Wld Hlth Org, techa. Rep. Ser. 153
2 Wld Hlth Org, techn. Rep. Ser. 191
) W l d Hlth Org, techn. Rep. Ser. 2б5 ..、..• ’ ,
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all insects of public health importance will enable global surveys to be undertaken by WHO as well as aid field workers to guage accurately the reaction of insect populations to insecticide pressure»
The recommended methods for vector control will give support to the vector-borne disease control programmes for which the Organization has technical responsibility and will provide advice to Member governments on the most up-to-date procedures currently available.
2.3 Joint FAQ/WHO Expert Committee on Food Additives Background information
This is the seventh meeting of the Joint Expert Committee.
The Joint PAO/WHO Conference on Food Additives held in 19551 led to a series of meetings of the Joint FAO/WHO Expert Committee on Food Additives• One of the re commendations in the sixth report of that Joint Expert Committee was that a further meeting should be: held "to draw up specifications for emulsifiers, stabilizers and related substances used as food additives, and to evaluate the toxic hazards involved in their use"»
2.3.2 The report 2
The Joint Expert Committee, which met in Rome from 18-25 February 1963, drew up specifications for the identity and purity of a certain number of emulsifiers and stabilizers. In addition it considered toxicological and related data on these compounds with the object of recommending acceptable daily intake zones for man.
The specifications for and evaluation of each compound are set out in a series of monographs.
The need for collaboration between FAO and WHO in the compilation of the report, the size and complexity of the series of monographs that will figure in the
appendices to the report, as well as the difficulties of translating a highly
1 Wld Hlth Org* techn. Rep, Ser. 107
2 Document MHO/PA/255.63
technical terminology have led to an inevitable delay in preparing this report for publication， However, to ,_enáble the Board to undertake a timely consideration of the report it has been decided to submit to it the text of the report itself without the appendices, which time did not permit to reproduce in the mimeographed version but which are in the process of being printed.
2.),) Recommendations
The joint committee made the following recommendations:
1. FAO and WHO should continue to use all means available to encourage more
complete publication of the results of investigations necessary for the toxicological evaluation of food additives.
2.• РАО and WHO should explore the possibility of expanding their current activities on collecting and disseminating information on the toxicological and legislative
aspects of food additivies, and of developing further co-operation with IUPAC
(International Union of Pure and Applied Chemistry) and other international organizations on the compilation of specifications and the establishment of standard methods of
analysis.
A Joint FAO/WHO Expert Committee on Pood Additives should be convened as soon as practicable to evaluate the toxic hazards involved in the use of food colours•
A further Joint FAO/WHO Expert Committee on Food Additives should be convened as soon as practicable to draw up specifications for additional emulsifiers,
stabilizers, bleaching and maturing agents, as well as other food additives, and to evaluate the toxic hazards involved in their use. This Committee might also review the specifications and toxicological evaluations of previous Committees in the light of subsequent published work.
2.3•斗 Implications for the OrganizationTs programme
In accordance with re commendat ions 3 and 4 above, it is proposed to plan two
• » .
further meetings of the Joint Expert Committee in collaboration with FAO.
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26 page 82.4 Expert -Commit-tGe.on Maternai глА Child Health; Social Aspects in the Teaching of Obstetrics and Gynaecology
2.4.1 Background information
In 19斗9 the first Expert Committee on Maternal and Child Health recommended that WHO activities in the field of maternal and child health include the giving of.
"Advice and assistance in the teaching of social and clinical paediatrics and
obstetrics • • The Expert Committee on Maternity Care, in 1951, described 1 2 the preventive role of prenatal care and formulated standards for high-quality
maternity care, considering it important that the undergraduate student should be trained in preventive and social aspects. In 1955 the Expert Committee on Maternal and Child Health) discussed the administration of maternal and child health services.
The Committee pointed out the interdependence of health and social factors and the fact that the training of physicians in ICH programmes in many countries is deficient in paediatrics and in preventive medicine. The next meeting of the Committee took
4
place in I960 to consider public health aspects of low birth weight. The Committee was not concerned with training as such but pointed out the association of certain social factors with low birth weight and considered them of sufficient importance to recommend that the WHO Study on Birth Weight be continued, with special attention to socio-economic factors. The Study is being carried out as part of the
Organization1 s programme of research in public health practice.
Many other expert committees have dealt with social and preventive aspects in medical education. Among the most recent were meetings of the Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel which discussed
1 Off. R e c . Wld Hlth Org, 19, 3 5 , 19^9
2 W l d Hlth Org, techru Rep, Ser. 51> 1952 -…
) W l d Hlth Org, techru Rep. Ser* 115, 1957 к W l d Hlth Org, techn. R e p . Ser> 217, 196l
preventive aspects in the teaching of pathology,1 the training of the physician for 2
family practice, and, in August 1963^ the promotion of medical practitioners' interest in preventive medicine.
The education and training of the physician for the preventive and social aspects of medical practice was considered so important that it was selected as the subject for the technical discussions during the Sixteenth World Health Assembly.
2.4.2 The report 3
The Committee recognized that in many countries the teaching of obstetrics and gynaecology is still entirely clinical, neither teaching nor practical experience being provided to the future physician in the broader aspects of maternity care.
Attention was given to the relationship between obstetrics and gynaecology, the place of obstetrics and gynaecology within the total curriculum, and to the
definition and relevance of the social aspects of obstetrics and gynaecology* This was followed by a detailed discussion of the teaching programme and departmental
organization, both in regard to undergraduate as well as to post-graduate and specialty training.
The Committee considered it desirable to define the social aspects of obstetrics and gynaecology as ”those aspects of personal and community life which have an impact on the child-bearing potential, habits and efficiency of a population and the health and treatment of the individual woman, with particular reference to her' reproductive system
The Committee pointed to the close relationship between obstetrics and gynaecology and the consequent need for combining them in a single department under one full-time head competent in both fields.
The health services and the teaching programme would both benefit were the professor of obstetrics and gynaecology to advise the maternity services of a region and were a maternity liaison committee established.
1 Wld Hlth Org, tecbn. Rep, Ser, 175，1959
2 Wld Hlth Org, techn. Rep, Ser. 257， 19бЗ ) W l d Hlth Org> techn. Rep, Ser. 226，19бЗ
ЕВЗЗ/2б page 10
The Committee recommended that the length of theoretical and practical training in obstetrics and gynaecology should not be less than that assigned to paediatrics and be as close as possible to the time devoted to medicine or surgery. It suggested that the aim in the education of the specialist should be the harmonious blending of clinical, practical and social aspects.
2.4.3 Recommendations
It was emphasized that more information and research are needed on the role played by social influences in ensuring adequate antenatal care for the population.
The implications of the social factors involved required greater consideration in both teaching and practice•
Urgent work was needed on the impact of earlier age at marriage and earlier child-bearing resulting from earlier maturation, on rates of illegitimacy and premarital conception. The effect of teen-age pregnancy on adolescent growth and on the birth weight of the offspring needed attention as well as the problem of maternal deaths resulting from illegal abortion.
Finally, the Committee pointed out the need for some organization, preferably at the international level, which would collect, collate and exchange information about past and current research in this field.
2.4.4 Implications for the Organization's programme
The recorranendations of the Committee will be reflected in the Organization's programme of assistance to countries in the field of maternal and child health, particularly in providing consultant assistance for the teaching of obstetrics and gynaecology.
Many social aspects Influencing child-bearing and the reproductive system still require clarification. Stimulation and support of relevant research will therefore be taken into consideration in the Organization^ programme•
2^5 Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel: Promotion of Medical PractitionersT Interest in . Preventive Medicine
2«5»1 Background information
Apart from meetings concerned with post-graduate education and training in public health, to which no reference will be made here, numerous conferences and seminars and other meetings dealt with the subject of education and training in preventive medicine. The Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel has^ in the last decade or so, studied
successively: (1) various aspects of medical training, including preventive
medicine; (2) the role of preventive medicine in: the teaching of pathology, 1 2
the teaching of the basic medical s c i e n c e s , and the training for family practice. 3 4 A conference explored the subject of preventive medicine in connexion with public health training of general practitioners, and the Study Group on Internationally 5
g
Acceptable Minimum Standards of Medical Education made suggestions regarding the medical curriculum generally, including preventive medicine. Various other expert committees and groups have studied the role of preventive medicine in such specialties
Wld Hlth Org. techn. Rep. Ser. 69, 1953 2 Wld Hlth Org. techn. Rep. Ser. 175, 1959 ) Wld Hlth Org. techn. Rep. Ser. 209， 1961 4 Wld Hlth Org. techn. Rep. Ser. 257., 1963 5 Wld Hlth Org. techn. Rep. Ser.. 140, 1957 6 Wld Hlth Org, techn. Rep. Ser. 239, 1962
ЕВЗД/2б page 12.；
1 2 3 as： paediatrics, health education of the public, mental health, and gynaecology and „；：EhûJEÊiaiaiÊCkJM^çlù^i.çînS^kJMillisfelrftJi^ççljl Heal坫 Assembly.二 were d e v o t e d — … T T ^ a î t t î r i g ^ é r f — " t h e - p h y s i t î - i a n ^ b r -the-Epewêntivei and
Social Aspects of Clinical Practice.5 “ 一 二 . _ 、 . . - 。
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r j r ••-•- ——--•：• '-.. • •
2.5.2 The report - - -
...“.——• - ... ； .-•:.‘’，.
This is the twelfth report of the Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel. In it the Committee
reviews the need； for prevention, ..examines the undergraduate teaching of preventive medicine, as well as .post-graduate training, .and discusses the means of promoting the interest the practitioner in'prevention. The undergraduate medical
- .. • • • ； ；. .. . v. ；
curriculum should be permeated by the idea of prevention; there should be in each medioal SGhool a professorial department of preventive medicirie staffed with highly- qualified teachers who co-operate ~ efficiently with other departments and with community Services.
'• “ “ •; . '• ‘ • • • 、+ V ...., A new urgency for prevention in - all f ields of medicine, particularly in general practice, stems largely from socio-economic considerations and new knowledge about preventing disease and disability; this requires adequate training.
2.5^3 The recommendations
To play his proper role in prevention the medical practitioner needs the
support of the medical schools， medical associations and health authorities:…Pôst-
… • ...一二 _л」... • ‘
graduate education of *che medical practitioner requires a special approach. For
1 Wld Hlth Org, techn. Rep, Ser, 2 Wld Hlth Org, techn. Rep. Ser.
"5
夕 Wld Hlth Org, techn. Rep, Ser‘
Wld Hlth Org, techn. Rep. Ser.
W l d Hlth Org, techn. Rep, Ser>
4
W l d Hlth Org, techn. Rep, Ser,
^ Unpublished WHO document Al6/Technical Discussions/б Rev.l Document мно/рА/257.63
119, 1957 “-!._+ ‘ ‘ s»
156, 1958 208, 1961 235/' I96¿
252, 1963
‘ - •
266， 1963
this purpose appropriate organizational and financial pro vis ion should be made, within the community, for various preventive medicine activities, including post- graduate training. The latter should comprise methods of interesting the medical practitioner in preventive medicine and include teaching of communication techniques for educational work with patients and families; the use of various demonstrations, e.g., in pre-symptomatic screening for chronic diseases; genetic counselling;
and the rehabilitation of the disabled; participation in immunization and other campaigns, exchange of information on new techniques, provision of manuals and textbooks, as well as the general practitionerTs involvement in teaching and re se arch •
2.5.4 Implications ^or the OrganizationT s programme
The above recommendations do not call for any special programme to be developed, but can be implemented within the educational activities normally conducted by the Organization, such as educational meetings and advisory services.
2.6 FAQ/WHO Expert Panel on Veterinary Education 2.6.1 Background information
A second meeting of the Panel was held in 196) to continue the work started a year earlier at the first meeting1 on laying down internationally acceptable
standards and guiding principles for new veterinary schools. At the second meeting, the Panel examined the information gathered since the earlier one and paid particular attention to the construction and content of curricula for
undergraduate veterinary teaching and technical assistance for veterinary education in developing countries,
2.6.2 The report 2
A major part of the report contains a discussion of the factors to be considered in determining the contents of the undergraduate curriculum, the scope of the
subjects to be dealt with and the hours to be devoted to theoretical and practical
1 FAO document AN 1962/4 (received by Executive Board at its thirty-second session - EB32/6)
2 PAO document AN I963/3
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i n s t r u c t i o n . D e t a i l s ó f c o u r s e s i n e a c h s u b j e c t c o n s t r u c t e d o n t h e s e p r i n c i p l e s •
— .： • ‘ •； • . •• ..:• '• •••'• •.... • . .
a r e g i v e n i n a n n e x e s ' w h i c h m a y b e u s e d a s m o d e l s t o b e m o d i f i e d a ^ e ç p d i n g t o l o c a l c o n d i t i o n s . T h e n e e d f o r t e c h n i f c á l a s s i s t a n c e t o v e t e r i n a r y e d u c a t i o n i n d e v e l o p i n g c o u n t r i e s i s d i s c u s s e d ' w i t h s p e c i a l r e f e r e n c e t o A f r i c a ^ O t h e r s u b j e c t s dealj: w i t h i n t h e r e p o r t a r e "the n u m b e r o f v e t e r i n a r i a n s a n d a u x i l i a r i e s r e q u i r e d u n d e r
d i f f e r e n t c o n d i t i o n s , wa'stage o f v e t e r i n a r y s t u d e n t s , t r a i n i n g o f a u x i l i a r y p e r s o n n e l a n d t r e n d s i n t h e d e v e l o p m e n t o f v e t e r i n a r y s c h o o l s .
A p a r t f r o m s u g g e s t e d c u r r i c u l a , t h e a n n e x e s c o n t a i n r e c e n t f a c t u a l i n f o r m a t i o n o n v e t e r i n a r y e d u c a t i o n a n d r e l a t e d m a t t e r s g a t h e r e d f r o m s c h o o l s , e t c ” t h r o u g h o u t t h e w o r l d .
2 , 6 . 3 T h e r e c o m m e n d a t i o n s ’ :…二 .’• :: - - … ： : ‘
T h e P a n e l r e c o m m e n d e d a m i n i m u m r a t i o o f o n e v e t e r i n a r i a n t o 3 0 0 0 0 l i v e s t o c k 1. ~
u n i t s a s a n i m m e d i a t e o b j e c t i v e f o r d e v e l o p i n g c o u n t r i e s a n d h o p e d t h a t t h e y w o u l d a t t a i n i n 1 0 - 2 0 y e a r s t h e r a t i o p r e v a i l i n g i n d e v e l o p e d c o u n t r i e s ( o n e v e t e r i n a r i a n t o e v e r y 3 0 0 0 - 5 0 0 0 u n i t s ) • N e w s c h o o l s s h o u l d b e . o p e n e d o n l y w h e n r e s o u r c e s a r e a d e q u a t e a n d e x i s t i n g s c h o o l s a r e a l r e a d y f u l l y u t i l i z e d .
T h e P a n e l m a d e r e c o m m e n d a t i o n s c o n c e r n i n g t r a i n i n g o f t e a c h e r s o n t h e j o b a n d e l s e w h e r e ; t h é p r o v i s i o n o f t e a c h e r s t o d e v e l o p i n g s c h o o l s u n d e r t e c h n i c a l a s s i s t a n c e p r o g r a m m e s a n d b y s e c o n d m e n t f r o m e s t a b l i s h e d s c h o o l s a n d p o s t — g r a d u a t e c o u r s e s a t v e t e r i n a r y s c h o o l s a n d r e s e a r c h i n s t i t u t e s .
O t h e r r e c o m m e n d a t i o n s c o n c e r n： t h e f u t u r e w o r k o f t h e Paiiel^ P A O / w H O p u b l i c a t i o n s i n t h e f i e l d o f v e t e r i n a r y e d u c a t i o n a n d t h e p r e p a r a t i o n o f a s e c o n d e d i t i o n o f t h e W o r l d D i r e c t o r y o f V e t e r i n a r y S c h o o l s , w h i c h s h o u l d t h e r e a f t e r b e r e v i s e d a t f i v e - y e a r l y i n t e r v a l s .
2. 6 * 4 I m p l i c a t i o n s f o r t h e O r g a n i z a t i o nTs p r o g r a m m e
T h e s e r e c o m m e n d a t i o n s a r e b e i n g u s e d i n a d v i s i n g m e m b e r c o u n t r i e s a n d i n
.-• '•‘ -1 “ • . . .
d e v e l o p i n g t e c h n i c a l a s s i s t a n c e p r o g r a m m e s .
“ . ‘ 、••:： ; ‘ ... :г ; . •
丨 •• 1 1 1 11 “ ‘ 1
L i v e s t o c k u n i t s a r e c o n s t i t u t e d a c c o r d i n g t o a n i m a l species； a s f o l l o w s : e q u i n e s , ] _ •〇；d a i r y c a t t l e , 1 . 0 ; b e e f c a t t l e , 0 . 5 - 0 . 1 ; b u f f a l o e s , 1 . 0 ; s h e e p a n d g o a t s , 0 Л - 0 . 0 1 ; p i g s , 0.2-0Л; p o u l t r y , 0 . 0 1 \、：•；• • • " :，.’.:;、
Work on preparing the publication to be presented at the proposed Internat ional Meeting on V e t e r i n a r y Education, 1965, is in progress, and t h e revision of the World Directory of Veterinary Schools will be included in the programme at a suitable opportunity,
2.7 Expert Committee on Rehabilitation of Patients with Cardiovascular Diseases 2.7^1 Background information
1
The first session of the Committee on Medical Rehabilitation, which met in 1958， considered the basic principles and aims of medical rehabilitation of persons suffering from disabilities of the locomotor apparatus. It pointed out the need for developing similar principles for the rehabilitation of persons disabled from circulatory, respiratory and digestive diseases, urging WHO to pay attention in particular to the disabled cardiac.
The report 2
This report deals with rehabilitation of patients with heart disease (congenital rheumatic, ischaemic, hypertensive or pulmonary). The Committee discussed the
principles of rehabilitating these patients from the clinical, physiological, psychological, vocational and socio-economic standpoints with special emphasis on the psychological reactions of the patient to the disease and the excessive fear and anxiety on the part of the patient as well as the attending physician which may-
hinder successful rehabilitation.
Many patients could be restored to lead a useful life and/or return to gainful employment; prolonged bed-rest and inactivity may be harmful except in severe cases. . Functional capacity of these patients can be evaluated in a majority of cases by simple clinical means whose accuracy could be enhanced by exercise tests
1 Wld Hlth Org, techn. Rep, Ser, 15S, 1958 о / Document MH0/PA/258.6J
ЕВЗЗ/2б page 1639
and laboratory examinations when available. Various parameters for functional evaluation were* described and the need for developing simple exercise tests for general adoption as a standard of reference was stressed,
‘ •• ‘ ‘...:.: ...i..‘...
Vocational retraining and selective placement of these patients required the close co-operation of the attending physician and the vocational personnel.
The Committee made recommendations concerning post-graduate refresher training of general medical practitioners; health education campaigns, aimed at dispelling misconceptions and fostering a realistic attitude towards heart disease; co-operation between public and voluntary agencies in promoting rehabilitation of cardiovascular patients; the need' for a multi-disciplinary approach and for further research in problem areas.
2 D Recommendations
WHO should, in collaboration with interested international and national organizations, (a) intensify the dissemination of information on modern concepts through seminars, symposia and conferences with a multi-disciplinary participation;
(b) consider organizing advanced training courses for physicians specializing in rehabilitation.óf patients with cardiovascular diseases; (c) stimulate further research in problem areas outlined in the report; ' (d) assist in the organization of centres' for further studies on the standardization of methods and procedures
for a s s e s s i n g working capacity of cardiovascular patients, and through conferences
promote their general adoption.
Ц 斗 Implications for the OrganizationTs programme
These recommendations will be taken into account when formulating future WHO programmes and research activities. Their implementation in the WHO programme will be effected in co-operation with interested international or national
organizations. ……‘
2.8 Expert Committee on General Practice
2.8.1 Background information
The WHO Scientific Group on Research in Public Health Practice (29 August 3 S e p t e m b e r 196)) a n d the Expert Committee on the Organization o f Medical C a r e1
called attention to the importance of ambulatory medical care and to the role of the
1 Wld Hlth Org, techn. Rep* Ser. Ij6, 1959
general practitioner. This role has also been studied by the Expert Committees on:
(a) The Role of Public Health Officers and General Practitioners in Mental Health -
Care; (b>) Training of the Physician for Family Practice; and (c) Promotion of i 2
, 3 .
Medical practitioners Interest in Preventive Medicine. •
2.8.2 The report - . . • 4
The Expert Committee on General Practice was held in July 19бЗ to study the relationship of general practice to its environmental, social, administrative, technical and institutional components, in order to make recommendations on the conditions which should improve Its efficiency. This study is the focal point for organizing medical care for the benefit of patients who should not be
hospitalized»
The Committee discussed the definition and function of the general practitioner
• • * * , • . • » • •. . - » • the various present forms of general practice, its relations with other fields：
preventive medicine, health education, mental health, auxiliary workers^ research, training, and the future of general practice, including its relationship with hospitals.
2.8.3 Re commendations
The Experts Coimittee recommended (a) that WHO should study the organization, operation, efficiency and acceptability of general practice in as many forms as possible over a wide area, how general practitioners use diagnostic facilities
through hospital out-patient departments, hospital services, and their participation
1 Wld Hlth Qrg> techn. Rep, Ser, 2)5, 1962 2 Wld Hlth Org, techn. Rep. Ser, 257，1963 ) D o c u m e n t MHO/PA/257.6^
ii .Document MHO/PA/256.63
ЕВЗЗ/2б page 1 8
in hospital activities; and (b) co-ordination at the international level:
research in general.practice, such as the possibility of standardizing general practitioner records and the utilization of auxiliary personnel by.general practitioners,
2.8.4 Implications for the Organization's programme
The main patterns of organisation of general practice, the recording systems and use of records> as well as the relations of general practitioners with
hospitals under different conditions will be studied,
A survey will be undertaken of the different kinds of medical auxiliaries and how they could help general practitioners in the curative field, especially in
emerging countries. • 2.9 Expert Committee on Malaria
2.9.1 Background information .
t. • • .. • ... .,‘..： •" . . . •
The first five reports of the Committee belong to the period before the policy of malaria eradication was adopted. The sixth report dealt with the feasibility of malaria eradication, and the principles, planning, organization and techniques involved. The seventh report gave further guidance on malaria eradication
campaigns and dealt with their evaluation, resistance to insecticides, chemo- therapeutics and health education. The eighth report reviewed the status of malaria eradication and the prospects for the future, and considered evaluation techniques, the criteria for malaria eradication, and the methodology for
confirming eradication. It formulated the concept of pre-eradication programmes as an approach to malaria eradication in developing countries. The ninth, report^
dealt with several aspects of malaria eradiCation—邸汰.espeç.ialiy t^UPtó.^P11^..
requirement of rural public health services for the support of such a programme.
2.9.2 The report1
The Committee was convened to advise on epidemiological aspects of the global malaria eradication programme, particularly those relating to the later stages of country programmes
1 Document MHo/PA/264.63
The Committee examined in detail two questions. The first related to problem areas where, despite proper coverage with residual insecticides over an adequate periods. the transmission of malaria persists in a defined geographical area and where additional measures are required in order to prevent the occurrence of new cases. The Committee suggested methods for the study of causative factors and the interpretation of results and advised on remedial measures» The second
：• • ： . . . 广 . . . . .
question concerned the prevention of re introduction of malaria into areas from which it has been eradicated. The Committee considered this in collaboration with experts in international quarantine and dealt with ways and means by which malaria may be reintroduced, giving detailed advice on measures to prevent such reintroduction.
. . . • • . • ..
The Committee clarified and amplified the criteria for the interruption of transmission, for the start of the consolidation phase, and for confirmatiori of malaria eradication, especially where Plasmodium malariae infections are involved.
It also reviewed the research and immunology, epidemiology, biological control.
2.9*3 Recommendations
in malaria eradication in the fields of parasitology entomology, chemotherapy, and insecticide and
The Committee recommended that：
(1) WHO should continue and, if possible, intensify the study of problem areas with a view to their early recognition and definition in eradication
, - . . . " .. •• • • • > . : • • .... . : • . • prograirnies';
,:.+ •.:• . ；•• . . . .. . - •• ... ' , . . .
(2) field trials of new insecticides should be extended and adequate field trials of the new repository antimalarial drug should be carried out urgently;
⑶ health administrations should apply strict antimosquito measures and control and treatment of migrants, the crews of ships and aircraft at inter- national ports and airports and, as appropriate, maJtce bilateral or multilateral arrangements for preventing the importation of infection across borders;
ЕВЗЗ/2б page 20
(4) the Committee on International Quarantine consider enlarging the scope of Article 103 of the International Sanitary Regulations relating to the application of additional sanitary measures to certain groups;
(5) WHO add to its periodical information: (a) a list of international ports and airports which, although located in malarious zones, do not present risks of malaria transmission; (b) a classified list of malaria cases imported into all countries in the phase of maintenance; and (c) a list of localities where chloroquine-resistant strains of parasites have been described;
(6) WHO apply the recently-developed statistical method for the objective assessment of the interruption of transmission;
(7) ft future meeting of the Expert Committee to consider case detection and a special technical meeting on drug resistance be convened as early as
practicable;
(8) WHO research programme related to malaria and malaria eradication be pursued and expanded»
2.9•斗 Implications for the Organization^ programme
These recommendations will be implemented by compiling up-to-date records
of problem areas and the organization of field trials of new insecticides and of the new repository antimalarial drug; by drawing the attention of health administrations to the danger of reintroduction of malaria; by applying statistical methods to the objective assessment of the interruption of transmission; by studying the problems associated with P. malariae; and by preparing to hold a technical meeting on the
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important matter of drug resistance as early as practicable.
