RESUMO
The welfare of research participants must be guaranteed by international ethical standards. This article communicates the procedures of the Research Ethics Committee of the School of Medicine, University of Chile (CEISH). The new Chilean legislation on research in human beings is also discussed. Law 20.120: "On scientific research in human beings, its genome and forbidding human cloning" establishes the ethical principles that must be accomplished in every research involving human beings. Article 28 of the Law 20.584 "Regulation of the rights and duties of health care users", forbids the participation of handicapped people who cannot express their will in scientific research. Article 13 states that people not related directly with patient care cannot have access to his clinical records (with the exception of people with notarial authorization by the patient). CEISH proposes that, in case of people with intellectual deficiency, the decision to approve a scientific research should be analyzed on an individual basis. If the person is capable of expressing his or her will or has stated his or her consent beforehand, the research can be authorized. If the person cannot express his or her will, the scientific research cannot take place. In prospective studies, a consent from the patient and an authorization of the health authority should be required to access clinical records. In retrospective studies, consent should be obtained from the patient when personal information is going to be used. If the information is nameless, the consent can be disregarded.
Assuntos
Comitês de Ética em Pesquisa , Regulamentação Governamental , Experimentação Humana/ética , Experimentação Humana/legislação & jurisprudência , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Chile , HumanosRESUMO
We used a modified acid-fast stain to detect Cryptosporidium oocysts in unconcentrated stools from 824 Haitian children less than 2 years of age with acute diarrhea. Oocysts were identified in stools from 17.5% of 291 children seen at a rural dispensary and in 16.3% of stools from 533 children in an urban hospital. Children with cryptosporidiosis were identified throughout a 22-month period from October 1982 to July 1984, without seasonal predilection. Cryptosporidiosis was twice as common in infants greater than 6 months of age than in younger infants. Cryptosporidium oocysts were rarely found in stools of infants receiving only breast milk. The clinical presentation of children with cryptosporidiosis was similar to other patients with diarrhea who did not have cryptosporidiosis. No asymptomatic Cryptosporidium infections were detected among 71 family members of 31 children with cryptosporidiosis. Three of the 71 family members less than 3 years of age were found to have diarrhea and Cryptosporidium oocysts. In follow-up studies of 31 patients, oocysts persisted in stools for a mean of 14 days (range 5-31 days). Duration of oocyst excretion was directly correlated with duration of diarrhea. These findings suggest that Cryptosporidium is an important cause of acute self-limited diarrheal illness to Haitian children.
Assuntos
Criptosporidiose/epidemiologia , Aleitamento Materno , Criança , Pré-Escolar , Criptosporidiose/etiologia , Diarreia/parasitologia , Fezes/parasitologia , Haiti , Humanos , Lactente , Contagem de Ovos de Parasitas , População RuralRESUMO
Cardiorespiratory and transcutaneous oxygen monitors were used on 13 preterm neonates to examine physiologic changes during ductus arteriosus ligation. Transcutaneous oxygen decreased 30 seconds after left lung deflation; all infants required increases in inspired oxygen and ventilation to correct abnormal values after the left lung was compressed. Transcutaneous oxygen decreased 30 seconds after ductus arteriosus ligation (mean delta tcPO2 = -17 mm Hg +/- 11.4) but increased 150 seconds after left lung inflation (mean delta tcPO2 = 46.9 mm Hg +/- 28.8). Arterial blood pressure increased (mean delta systolic BP = 17.9 mm Hg +/- 9.5) and heart rate decreased 10 seconds after ductus arteriosus ligation. In five neonates, gradual closure of the ductus arteriosus over 40 to 75 seconds resulted in a more gradual increase in blood pressure. Intraventricular hemorrhage was confirmed in two patients after surgery. Ligation of the ductus arteriosus results in an abrupt increase in blood pressure, which may be related to the pathogenesis of intraventricular hemorrhage. We suggest that the ductus arteriosus be closed gradually to allow a more gradual increase in blood pressure.
Assuntos
Permeabilidade do Canal Arterial/cirurgia , Doenças do Prematuro/cirurgia , Pressão Sanguínea , Hemorragia Cerebral/etiologia , Frequência Cardíaca , Humanos , Recém-Nascido , Complicações Intraoperatórias , Ligadura/efeitos adversos , Pulmão/fisiologia , Métodos , Fatores de TempoRESUMO
PIP: For the past 25 years the Albert Schweitzer Hospital in Deschapelles, Haiti has been providing a wide range of maternal and child health services to the people of its rural district. Numerous special services for mothers and children have been added over the years, but these began to realize considerably greater potential with the creation of the hospital's Community Health Department in 1967. This department has carried out numerous preventive health programs and services designed to accommodate these groups' special health needs. Attention is directed to neonatal tetanus control; surveillance, treatment, and prevention of malnutrition; and other maternal and child health services (school programs, immunization activities, prenatal and postnatal care, family planning, the midwives' program, the "cord-cut" unit, the low birth weight project, and dispensaries and health agents). In 1967 the hospital began to develop programs especially designed to control neonatal tetanus. Communities were immunized systematically. By establishing outdoor immunization clinics at the hospital and at major marketplaces in the district and by working with traditional midwives, these programs were responsible for a sharp decline in the incidence of neonatal tetanus. Malnutrition has remained the most frequently occurring health problem among children in the hospital district. Several services and programs have been established throughout the years to meet the identified needs. These include the following which are described: the nutrition clinic; courtyard education; "weigh-ins;" nutrition recovery centers; the 3-day center at Deschapelles; nutrition intervention and case follow-up program; and malnutrition treatment. The hospital's family planning program has gradually increased its use of community education to reach the population and to try to gain acceptance of the need to space and limit births. This community education has been disseminated by dispensaries, mobile health team workers, public health nurses, and physicians. Implementation of immunization, health surveillance, health education, and improved tuberculosis control activities have produced gratifying reductions in overall maternal and child morbidity and mortality in the Schweitzer hospital district.^ieng
Assuntos
Serviços de Saúde da Criança , Serviços de Saúde Materna , Saúde da População Rural , Adulto , Serviços de Saúde da Criança/história , Atenção à Saúde/tendências , Feminino , Haiti , Educação em Saúde , História do Século XX , Humanos , Imunização , Recém-Nascido , Masculino , Serviços de Saúde Materna/história , Distúrbios Nutricionais/terapia , GravidezRESUMO
In 1958-72, 985 cases of tetanus (excluding tetanus of the newborn) were admitted to a hospital in Haiti. Mortality was 22%, and in later years (1966-72) mortality fell. During this period the dosage of tetanus antitoxin was lowered to 10,000 units and, for sedation, diazepam has satisfactorily replaced multiple-drug regimens used in earlier years. However, good nursing, including close attention to breathing, is probably the most important item in treatment. As a result of a programme of maternal immunisation, admissions for neonatal tetanus have fallen, and mortality for this condition has been reduced to 26%.