Reviving Human Research in Costa Rica.

Costa Rica is a small developing nation in Central America with a well-regarded universal health care system and a strong human rights tradition. In the latter part of the twentieth century, it became a popular site for clinical trials funded by multinational pharmaceutical companies. In light of concerns about ineffective oversight and alleged research abuses, the Constitutional Chamber of the Supreme Court passed a moratorium on all biomedical studies involving humans. This moratorium was in place between 2010 and 2014, when the Legislative Assembly passed a new national law to protect participants' rights and welfare. This case study reviews the history of human research protections in Costa Rica and provides recommendations for how Costa Rica can move forward responsibly as a leader in human research for the region.

'These schemes will win for themselves the confidence of the people': irish independence, poor law reform and hospital provision.

This article examines hospital provision in Ireland during the early twentieth century. It examines attempts by the newly independent Irish Free State to reform and de-stigmatise medical relief in former workhouse infirmaries. Such reforms were designed to move away from nineteenth century welfare regimes which were underpinned by principles of deterrence. The reform initiated in independent Ireland - the first attempted break-up of the New Poor Law in Great Britain or Ireland - was partly successful. Many of the newly named County and District Hospitals provided solely for medical cases and managed to dissociate such health care provision from the relief of poverty. However, some hospitals continued to act as multifunctional institutions and provided for various categories including the sick, the aged and infirm, 'unmarried mothers' and 'harmless lunatics'. Such institutions often remained associated with the relief of poverty. This article also examines patient fee-payment and outlines how fresh terms of entitlement and means-testing were established. Such developments were even more pronounced in voluntary hospitals where the majority of patients made a financial contribution to their treatment. The article argues that the ability to pay at times determined the type of provision, either voluntary or rate-aided, available to the sick. However, it concludes that the clinical condition of patients often determined whether they entered a more prestigious voluntary hospital or the former workhouse. Although this article concentrates on two Irish case studies, County Kerry and Cork City; it is conceptualised within wider developments with particular reference to the British context.

[Joanna de Sá: medicine, politics and morality in the pages of O Monitor]. / Joanna de Sá: medicina, política e moral nas páginas de O Monitor.

Fruit of the struggle of the medical profession and the interests of the State in resolving a serious public health question, the Bahian São João de Deus asylum for the alienated was inaugurated in June 1874, surrounded by the optimism and confidence of everyone involved. Meanwhile, its history would soon take an unexpected direction when the pregnancy and birth of an internee involved the Santa Casa de Misericórdia, the State and the press in an entangled web of interests and conflicts, revealing that the reality of an asylum institution was far from that imagined by its creators. At a time when Bahian psychiatry was beginning to take its first steps, the case produced serious doubts regarding the capacity of this medicine to wholly assume responsibility for the treatment of insanity.

Exploring the benefits of user education: a review of three case studies.

This paper builds on Leslie Morton's vision of enabling users through education and training. It describes three different approaches to mediated training for medical students and clinicians provided by peers, juniors (i.e. medical students) and information specialists (i.e. clinical librarians) and considers the benefits to the participants. The training was provided either on a one-to-one basis or within teams in their work environments (e.g. offices, wards, team meetings). The first two projects (peer tutoring and reverse mentoring) suggest that contextualized training, using intermediaries, provides the direct benefit of cost-effective IT skill development and the indirect benefits deriving from the interactions between the trainers and the target groups. The third project, the outreach librarian study, provides evidence of both direct benefits (i.e. time saved, quality of service, skills acquired, financial savings and improved evidence-based medicine implementation) and indirect, long-term benefits relating to more social issues (e.g. perceptions of the library, clinical teams, job satisfaction and patient interactions). The general conclusion to emerge from this review of case studies is that the concept of educational benefits is very broad and that empirical studies need to look at both obvious and less obvious benefits.