AIDS: the rights of patients.
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Biomedical subjects
Publications and source records attributed to D Reviron.
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This bibliographical study involved first the exploitation of four data-banks: Medline, CNRS, Bioethics and AIDS, with the following key words (in conjunction with AIDS): ethics, human rights, confidentiality, legislation, jurisprudence. A total of 412 references were listed between 1983 and the end of 1987. Examination of the quantitative increase of articles over these years shows that, while references to AIDS and/or HIV infection--referred to as 'AIDS' for brevity--increased by about one third per year, the number of papers treating ethical problems linked to AIDS doubled each year. This increase makes it clear that these problems are important and pressing, that they are evolving rapidly and can be given no easy solution. After reading and analysis of accessible articles in readily comprehensible languages, the different themes can be classified in two categories: 1: Measures intended to protect society (starting with the most coercive); quarantine and isolation; discriminatory measures concerning specific groups; non-respect of the confidential nature of medical information; application of the penal code; screening; obligatory declaration and registration; testing of blood given by donors; vaccination and medical innovations, therapeutic assays; information, education. 2. Measures intended to protect the individual: fundamental rights of the patient: his/her right to confidentiality, to information and to treatment; civil rights: civil liberty, right to education, right to work, etc...; rights of the healthy individual: right of those in contact with the patients, safety of hospital staff, of those receiving blood-transfusions, etc... The legislation adopted in the various countries and the main opinions to be found in these articles are listed and analysed, and for each particular theme it is possible to refer to a list of the 232 most important articles. While the debate seems to concentrate on the conflict between the right of society to protect itself against the spread of infection and the 'civil' rights of the infected minorities, our conclusion tends to reduce this antagonism, showing that, particularly as far as the confidential nature of medical information is concerned, measures intended to protect the individual also protect society.
Screening for phenylketonuria and hypothyroidism in neonates is currently performed on blood samples collected on the 5th day of life. The efficacy of blood-sampling is evaluated subsequently. Double-sampled and non-sampled children are not always identified. We present a system which provides complete control of child, and was tested experimentally over one year on the 4,260 births in a maternity hospital. The sampling done by the maternity hospital as very thorough: only 0.47% of the children were not sampled spontaneously (ET = 1.07 10(-3)). The sampling of children transferred to pediatric units before the 5th day was a little less rigorous: 6.06% were not sampled before the telephone reminder (ET = 1.86 10(-2)). After a year our system ensured a 100% sampling after identification and telephone reminder for non sampled children, and allowed us to spot and count cases of double-sampling.
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BACKGROUND: Ethnic-historic sources have considered the Comorian population to be the result of an amalgamation of African, Arabian and Southeast Asian groups. AIM: This study seeks to determine the genetic relationships and contributions from Sub-Saharan Africa and Indian Oceania and to reconstruct past migration events. SUBJECTS AND METHODS: The human leukocyte antigen (HLA) polymorphism of a Comorian population was described and analysed. RESULTS: Genetic distances and multidimensional scaling analyses showed complex patterns of genetic differentiation in the Indian Oceanian area as a result of continuous gene flow occurring within the past approximately 2500 years. Nevertheless, the Comorian genetic pool appears to be a mix of Bantu-speaking and Arab populations as testified to by admixture estimations of almost 50-60% and 27-33%, respectively. CONCLUSION: The Comorian population may represent the eastern limit of the recent and massive eastward Bantu expansion. In contrast to the population from Madagascar (Merina), only a restricted influence of Austronesian populations was found.
The authors report the case of a 49-year-old woman with an asymmetrical, seronegative and peripheral polyarthritis with erosions, who subsequently developed Crohn's disease. She was diagnosed as having an erosive Crohn polyarthritis as no evidence of rheumatoid arthritis was found. However, the patient was homozygote for DR4 and the HLA DRB1 oligotyping was 0401/0404. This corresponds to two susceptibility alleles for rheumatoid arthritis responsible for the severity of this disease. Erosive polyarthritis is rarely encountered in inflammatory bowel diseases. The underlying mechanism of the erosions in these conditions is unknown but granulomatous synovitis with contiguous erosive bone changes has been reported. HLA DR has not been previously reported in erosive Crohn polyarthritis. The homozygosity for DR4 with DRB1*0401/0404 subtypes suggests that DR4 could contribute to the erosive course in this patient. This question is of interest, and HLA DR must be further studied in inflammatory bowel diseases with erosive arthritic manifestations.
A population of 512 adults (men: 266, 52%, women: 246, 48%) with mean age 41.4 years (S.D. 10.7) was investigated. This population was subdivided into five groups: Marseilles city, Manosque a small town in a prealpine area, the area surrounding the Etang de Berre, a rural area in Northern Bouches du Rhône and Chateaurenard, a small town in an intensive agricultural area. RASTs to a panel of eight allergens (Lolium perenne, Parietaria officinalis, Cupressus sempervirens, Olea europea, Cat dander, Alternaria tenuis, Dermatophagoides pteronyssinus, and Castor bean seed) were done. 99 subjects were found to have a RAST positive to one or several allergens. The main positives found by RAST were a grass pollen (Lolium perenne) and the mite Dermatophagoides pteronyssinus with respectively 10.1% and 11.3% of the results followed by the pollens of Olea Europea 4.4%, Parietaria officinalis 3.1% and Cupressus sempervirens 1.9%, Castor bean seed 1.7% Cat dander 0.9% and Alternaria tenuis 0.9%. Allergy to cstor bean (Ricinus communis) seed was found mostly in the Chateaurenard area where castor castor bean pomace is used in the fields as a fertilizer. There is an almost equal number of RAST positivities to mites (13.3%) than to pollens (11.1%). The prevalence of RAST positive was higher in men (24.1%) than in women (14.2%), p < 0.01). This prevalence is lower when age is increasing. Thirty four subjects (6.6%) had clinical symptoms: This group has a higher prevalence of positive RAST in cases of allergic rhinitis (p < 0.01) and of asthma (p > 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)