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PubMed1989

Influence of legislation in toxicology.

The influence of toxicology on legislation is quite clear in countries where chemicals are regulated by the authorities. There is normally a toxicological evaluation--in addition to other considerations--behind sales and use permissions and the levels that are accepted in food, air, water, etc. How does legislation affect toxicology? If there is no legislation, then clinical and forensic toxicology will be the most used toxicological disciplines (accidents and other cases of poisoning). The more sophisticated and restrictive the legislation becomes, the more toxicology is used not only to permit the use of chemicals but also to ban them. In addition, legislation for the protection of experimental animals has a profound influence in toxicology and accelerates the use of in vitro and other alternative methods. This paper discusses whether countries in the "developed" world are overdoing it, thereby maybe hampering the essential use of chemicals in the developing countries.

Animal Testing Alternatives↗
PubMed1989

The impact of AIDS on state public health legislation in the United States: a critical review.

This article reviews and analyzes the current public health legislation in 17 states and the District of Columbia in the United States. These states were selected and grouped into high, medium, and low incidence based on their annual AIDS incidence rates. Data were collected through a combination of library research and direct communications with the various state health departments. Four major areas of legislation were reviewed: HIV antibody testing and reporting; confidentiality and partner notification; personal control measures: and AIDS antidiscrimination laws. In general, majority of the states have treated the AIDS epidemic as a public health problem and not as a moral or criminal issue. Some states with higher incidence such as New York and California have developed the least restrictive laws and responded with stronger AIDS antidiscrimination legislation. The states with medium incidence have more restrictive measures and the low incidence states have less legislation and fewer regulations related to AIDS. AIDS educators should be aware of the implications of the varied legislation and regulations on AIDS education and prevention. They should play a strong advocacy role in promoting the development and application of measures that will facilitate the prevention and control of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Non-legislative interventions for the promotion of cycle helmet wearing by children.

BACKGROUND: Helmets reduce bicycle-related head and facial injuries for bicyclists of all ages in all types of crash. We aimed to identify non-legislative interventions that are effective in promoting helmet use among children, so future campaigns can be designed on a firm evidence base. OBJECTIVES: to assess the effectiveness of non-legislative interventions (compared to a lack of interventions) in increasing helmet use among children; to identify possible reasons for differences in the effectiveness of interventions; to evaluate effectiveness with respect to social group; to identify any adverse consequences of interventions. SEARCH STRATEGY: We searched 11 electronic databases and manually searched other sources of potentially relevant data. SELECTION CRITERIA: We included randomised controlled trials, cluster randomised controlled trials and controlled before and after studies. Studies included participants aged 0 to 18 years and described interventions to promote helmet use not requiring enactment of legislation. Studies had to report at least one of the following outcomes: observed helmet wearing; self-reported helmet ownership; self-reported helmet wearing. DATA COLLECTION AND ANALYSIS: Data were extracted by two reviewers working independently. Study results were adjusted to account for clustering. A random-effects model was used to pool data in meta-analyses. Heterogeneity was explored with sub-group analyses. MAIN RESULTS: Twenty-two studies were included. The odds of observed helmet wearing were significantly greater amongst those receiving non-legislative interventions (OR 2.30, 95% CI 1.37 to 3.85). Sub-group analysis indicated the effect may be greater for community-based studies (OR 4.30, 95% CI 2.24 to 8.25) and those providing free helmets (OR 4.35, 95% CI 2.13 to 8.89) than for those providing subsidised helmets (OR 2.02, 95% CI 0.98 to 4.17) and for those set in schools (OR 1.82, 95% CI 0.94 to 3.52). We found no significant effect of non-legislative interventions in increasing self-reported helmet ownership, but they were associated with a significant increase in self-reported helmet wearing (OR 3.90, 95% CI 1.42 to 10.69), particularly amongst interventions set in schools (OR 4.73, 95% CI 1.09 to 20.49) but there was significant unexplained heterogeneity between effect sizes for these two outcomes. AUTHORS' CONCLUSIONS: Community-based studies that include the provision of free helmets alongside an educational component increase observed helmet wearing in the areas in which they are set. There is some evidence that interventions in schools and those providing subsidised helmets may increase observed helmet wearing, but possibly to a lesser extent than those set in communities and those providing free helmets.

Adolescent↗
PubMed2004

An assessment of the effects of increased regulatory enforcement and legislative reform on occupational hearing loss workers' compensation claims: Oregon 1984-1998.

BACKGROUND: Hearing loss from occupational exposures is a serious and widespread problem. This study measured the outcomes that increased enforcement of regulations and legislative interventions had on hearing loss workers' compensation claims. METHODS: Workers' compensation claim data from Oregon was analyzed for the period of 1984-1998 to examine trends and severity of hearing loss claims. In 1987 and 1990, Oregon enacted legislative reforms to improve enforcement and promulgation of safety standards in the state. This study examined hearing loss claims between the periods of pre- and post-legislative reforms. RESULTS: It was found that hearing loss claims decreased significantly following the legislative reforms, although the average cost per claim increased. Age and tenure effects, and evidence of moral hazard were also discovered. CONCLUSIONS: Increased enforcement of regulations and legislative interventions by Oregon improved working conditions leading to occupational hearing loss. Nevertheless, hearing loss remains problematic, and continued efforts are required to improve worker safety.

Adult↗
PubMed2007

[Genetic diagnostics as a legislation project. Regulatory initiatives and main areas of regulation].

The legislation project of a law on genetic diagnostics appears to have come to a standstill; however, it should be taken up again. The national and international discussion underlines the need for regulation. This assessment is based on the dynamic developments in the field of biological and medical sciences and the resulting problems for medical practice, the healthcare system, commercial in terests and, not least, patients, volunteers and clients. The German legislators cannot only build on the preparatory work of political advisory institutions and commissions; besides current legislation in neighbouring countries, several regulatory drafts have been prepared in Germany, which provide important normative material for legislative work. However, these drafts also reflect the conflicts of interest and assessment arising from such a project. Legislation on genetic diagnostics is not only concerned with differing focal points of regulation and numerous questions of detail but also with decisions on fundamental normative orientations and principles of regulation.

Conflict of Interest↗
PubMed2005

Bicycle safety helmet legislation and bicycle-related non-fatal injuries in California.

The objective of this study was to determine whether the bicycle safety helmet legislation in California, enacted in 1994, was associated with statistically significant reductions in head injuries among bicyclists aged 17 years and under who were subjected to the law. The study used 44,069 patient discharge cases from all public hospitals in California, from 1991 through 2000, and a case-control design to make direct comparisons between those subjected to the law (Youth) and those who were not (Adult) across the pre- and post-legislation periods. An aggregate data analysis approach and a pooled disaggregate data fitting technique using multinomial logit models were applied. The legislation was found to be associated with a reduction of 18.2% (99% confidence interval: 11.5-24.3%) in the proportion of traumatic brain injuries (Head-TBI) among Youth bicyclists. The proportions of other head, face, and neck injuries were not significantly changed across the pre- and post-legislation periods in this age group but there was a corresponding increase of 9% (5-13%) in the proportion of all other injuries. On the other hand, there was no statistically significant change in the proportions of injury outcomes for Adult bicyclists. The youngest riders, aged 0-9 years, had the greatest decrease in the proportion of Head-TBI. The reduction was the same for motor vehicle and non-motor-vehicle-related incidents. The bicycle safety helmet legislation was associated with a decrease in the likelihood of Head-TBI for non-urban residents but not for urbanites, for males but not for females, and for Whites, Asians, and Hispanics, but not Blacks and others.

Bicycling↗
PubMed2004

Legislation with respect to dioxins in the workplace.

Legislation of chemicals is complex and doubts have often been expressed as to its effectiveness, but there are many problems involved in regulating chemicals from synthesis and use through to disposal. Using dioxins as an example of a chemical currently with complicating factors surrounding its control, this paper reviews its occupational legislation, chemistry, formation, toxicity, occurrence, and disposal in industrial situations, and sets this information in context by reference to its environmental occurrence and associated legislation. The role and limitations of legislation to control chemicals like dioxins, which are micropollutants and not intentionally produced, are discussed. Dioxins were chosen as the example because they are widespread, exposure occurs through a variety of routes, and they possess a reputation that ensures public concern. Because dioxins are ubiquitous and are predominantly produced by incineration, whether accidental or deliberate, intake is a total of all exposures from diet, environment and occupation. Occupational exposure is only one factor in this total, but this exposure may push total intake above recommended levels. Although overall exposure is reducing, public concern is rising, and this may be a consequence of greater scientific knowledge. Potential workplace exposures have been evaluated, and a sampling survey was recently undertaken in some of these sectors. The legal options are discussed, and the reasons for some decisions explained. Regulators have an unenviable task, and I believe there is only a fine balance between effective control and over-complicated prescriptive legislation.

Data Collection↗
PubMed2002

Congressional voting behavior on firearm control legislation: 1993-2000.

Firearm morbidity and mortality place an enormous burden on the health care enterprise and society at large. Recent research has shown strong public support for strategies to regulate firearms yet effective federal legislation to control the types of firearms sold, conditions of sale and purchase, limitation in transportation and storage, and responsibility for use of personally owned firearms has been limited. Thus the purpose of this study was to evaluate the relationship between Congressional voting on firearm control legislation and the following: political affiliation, military service, geographic location of representation, education level, sex, and gun rights and gun control contributions. This was accomplished using a retrospective assessment of Congressional voting records from the 103rd-106th Congresses (1993-2000) regarding firearm control legislation. The study found that $6,270,553 was donated to members of Congress, $5,394,049 to members of the House and $876,504 to members of the Senate by groups concerned with firearm legislation. In the House, males (Odds Ratio [OR], 3.87), Republicans (OR, 13), those from the South (OR, 5), and those who received gun rights funds (OR, 13 to 203, depending on level of donations) were more likely to vote pro gun rights. In the Senate, support for gun rights occurred more often for those from the West (OR, 3.56), Republicans (OR, 130.50), or those who had received gun rights donations (OR, 28.00). This study has found a strong and consistent relationship between a Congressional member's position on firearm legislation and the amount of money received, political affiliation, and geographic location of representation.

Conflict of Interest↗
PubMed2004

Legislative approaches to the obesity epidemic.

Legislative bodies in the United States have often passed laws to regulate food in its production, content, and sale. Additionally, legislatures have created economic policies that directly affect the food supply and determine both the type and quantity of food available. Legislatively-enacted federal programs, such as the National School Lunch Program, also provide opportunities to promote good nutrition. These traditional areas of legislation represent the most efficient means to affect the food environment legislatively. While exploring legislative solutions to obesity, it is also imperative to monitor attempts by the legislature to constrain other public health strategies by limiting private enforcement and limiting the regulatory freedom of traditional public health authorities.

Adult↗
PubMed2001

Legislative advocacy for health professions educators.

Because much of health professions education in the US is publicly financed, the actions of politicians have profound effects on the organization of health professions education. The success of health professions education programs, therefore, depends in part on the ability of educators to advocate for change in the legislature. Successful legislative advocacy requires a general understanding of the legislative process and the needs of politicians combined with effective communications strategy. The tools of individual legislative advocacy include position papers, letter writing, politician meetings and visits, and using the media. Professional associations advocate on behalf of their members through coalitions, key contact programs, grassroots campaigns, and lobbyists. Successful legislative advocacy depends on credibility and the development of long-term relationships with members of the legislature. The process of legislative advocacy is straightforward and should be viewed as an integral part of health professions education.

Journal Article↗
PubMed2004

A review of the legislative mechanisms available to protect the social participation rights of people with depression in the Asia Pacific region.

OBJECTIVE: To conduct a review of the legislative mechanisms potentially available to protect the social participation rights of people with depression in the Asia Pacific region. METHODS: Questions were sent to the SEBoD International Advisory Board and Internet and legal database searches were conducted to supplement responses from advisors. RESULTS: While it cannot be said that comprehensive antidiscrimination legislation in relation to disability exists in all countries in the Asia Pacific region, most countries have commenced the process. Many have implemented either human rights or antidiscrimination legislation and most have set up a Human Rights Commission to protect social participation rights and allow complaints to be lodged. CONCLUSIONS: This review highlighted the difference between legislation and practice. While many countries have enacted laws, insufficient resources have been committed to support the objectives to realise the protection of rights enshrined in legislation. Additionally, many people may not know that the laws exist or do not have the money or social supports to fight for their rights. Many countries, however, have commenced a concerted approach to tackling the larger issues and have developed comprehensive action plans to address the social participation rights of people with disability.

Asia, Southeastern↗
PubMed2001

State legislation concerning individuals with dementia: an evaluation of three theoretical models of policy formation.

PURPOSE: This study examined the formation of state government policies concerning persons with dementia. In particular, we identified variables associated with the passage of pertinent state laws by testing three theoretical models of policy formation: the iron triangle, the policy system, and an integrated model. METHODS: We sampled 44 states and counted the number of laws concerning individuals with dementia that passed during the 1998 legislative sessions. We constructed nine independent variables to represent the three theoretical models of state policy formation. Then the number of legislative actions were regressed onto each model. RESULTS: The integrated model that consisted of political actors, legislative features, and environmental inputs met goodness-of-fit criteria for a maximum likelihood regression analysis (chi2/df = 1.55). The advocacy effort of the Alzheimer's Association, number of legislative champions, supply of special care beds for persons with dementia, and recent policy activity were related significantly with increased legislative activity concerning individuals with dementia. IMPLICATIONS: Policy responses concerning persons with dementia increasingly have been created within state governments, and we identified variables associated with the passage of pertinent state laws. This research also contributed to the advancement of comparative state policy research by contrasting the three theoretical models of policy formation.

Aged↗
PubMed2000

The application of Ontario human rights legislation to the practice of occupational medicine.

Although human rights legislation has important implications for occupational physicians, these implications may be overlooked in the practice of occupational medicine in other countries where human rights legislation may be different. The potential for significant oversights becomes greater as organizations continue to centralize international business support functions, such as occupational health services, operating from a single site. Human rights legislation has important implications with respect to policy decisions upon which an occupational physician has influence. This includes decisions about whether to conduct drug and alcohol testing; the performance of medical examinations; evaluating issues related to health and safety concerns of pregnant employees; and the need to work accommodate those with handicaps as defined by human rights legislation. This article examines the application of the Ontario human rights legislation in these areas.

Health Policy↗
PubMed2005

Guardianship and financial management legislation: what doctors in aged care need to know.

Demographic and epidemiological changes have resulted in increasing numbers of elderly people, and in increasing numbers of elderly people suffering from various degrees of cognitive impairment, including dementia. It is well recognized that the presence of cognitive impairment may impact upon an older person's decision-making capacity, which has, in turn, been associated with increased acknowledgement of the need for greater accessibility to methods by which substitute decision-makers are appointed. To this end, legislation has been enacted throughout Australia to enable the appointment of substitute decision-makers in the form of guardians and financial managers. Medical practitioners are the largest group of health professional whose opinion is sought when appointments are being considered. Despite the significance of the legislation to the evaluation of elderly people with impaired cognition, many health professionals remain unaware of the provisions of the legislation and are unclear about what information will be required. The aims of this review are first, to provide health professionals with the legal context within which their evaluations of disability and capacity take place, by way of a review of the relevant guardianship and financial management legislation in each of the states and territories of Australia; and second, to discuss how these provisions relate to existing clinical practice, with suggested guidelines for the capacity assessment. The focus and quality of information that health professionals provide will be enhanced by them having a greater understanding of their role within the wider legal context by placing in their hands knowledge of the provisions of the relevant legislation.

Aged↗
PubMed2006

Legislative and regulatory measures for preventing alcohol-related drownings and near-drownings.

OBJECTIVE: Alcohol contributes to about 30% of drowning fatalities associated with recreational aquatic activity and to 35% of drownings associated with boating. We consider regulatory and legislative strategies for preventing such deaths. METHODS: We contacted water police in each Australian State and Territory to identify legislation creating alcohol-related offences for operators of recreational boats in their jurisdiction and to determine whether they conducted random breath testing (RBT). We also sought information from all 152 (81 urban and 71 rural) local government councils in NSW regarding restrictions on consumption of alcohol in public places within their shires. RESULTS: Four Australian States (New South Wales, Queensland, Victoria and South Australia) have legislation prescribing maximum blood alcohol concentrations (BACs) for operators of recreational boats; all support this with RBT. Western Australia, Tasmania and the Australian Capital Territory define more general offences for operating vessels while under the influence of alcohol. Prohibitions or restrictions on consumption of alcohol in public places exist in 78 of the 86 shires in NSW that responded: 69 councils had alcohol-free zones, 53 restricted consumption of alcohol in public parks and reserves, and 33 had prohibitions or restrictions in some aquatic environments. CONCLUSIONS/IMPLICATIONS: Legislation restricting BACs for recreational boat operators should be adopted in all Australian States and Territories. Optimal legislation would require that all occupants of recreational boats are required to comply with prescribed BAC levels, including when vessels are at anchor. Extension of by-laws prohibiting or restricting the consumption of alcohol specifically in aquatic environments warrants consideration.

Alcohol Drinking↗
PubMed2004

The effects of state mental health parity legislation on perceived quality of insurance coverage, perceived access to care, and use of mental health specialty care.

OBJECTIVE: To assess the impacts of recent state mental health parity legislation on perceived quality of health insurance coverage, perceived access to needed health care, and use of mental health specialty services by individuals with likely need for mental health care. DATA SOURCES: The study sample came from two waves of a national household survey first fielded in 1997-1998 and then in 2000-2001. The analysis used a subset of the sample. STUDY DESIGN: The study took the Difference-in-Difference-in-Difference approach to investigate changes in self-perceived quality of health insurance coverage and access to needed health care, and use of mental health specialty care by the group with mental disorders (relative to those without) in states with parity legislation of different comprehensiveness (relative to the nonparity states) in the years after the law (relative to before the law). PRINCIPAL FINDINGS: Overall, there were no significant or consistent effects of the parity legislation. Descriptive statistics showed significant changes in some (but not all) outcome variables, but these results disappeared in detailed statistical analyses by controlling for important covariates. CONCLUSIONS: The null findings of the effects of state mental health parity mandates suggest that under ERISA (Employee Retirement Income Security Act), the scope of state parity legislation may have been restricted because of large proportion of self-insured employers. Furthermore, comprehensiveness of state legislation appears to be related to the traditional level of use of mental health specialty care, which becomes another confounder for the potential policy effects.

Attitude to Health↗
PubMed2004

Late pregnancy termination within a legislated medical environment.

AIMS: To review the indications and outcomes for abortion beyond 20 weeks' gestation within an environment of legislated notifiable pregnancy termination. METHODS: In Western Australia legislation allowing abortion > or = 20 weeks' gestation for serious maternal-fetal conditions was enacted in May 1998. Late abortions are only permitted in a single state institution and are notifiable by law. All pregnancy terminations > or = 20 weeks' gestation performed since this legislation were prospectively identified with the indications and outcomes reviewed. RESULTS: During the study period, 219 women underwent abortion > or = 20 weeks' gestation, representing 0.5% of all abortions in the state. Comparison with 438 contemporanous medical abortions for fetal anomaly at 14-20 weeks' gestations was made. Misoprostol was the primary abortifacient for both. The median maternal age for termination at 14-20 weeks was 32 years (interquartile range (IQR) 27, 36) and 30 years (IQR 26, 34) at > or = 20 weeks' gestation (P < 0.001). There was no significant difference in maternal gravidity or parity. The principal indications for terminations > or = 20 weeks were: karyotypic (28.8%); cardiac anomalies (15.5%) and neural tube defects (11.9%). Cardiac anomalies represented 5.0% of fetal anomaly terminations at 14-20 weeks (P < 0.01). The median time for medical abortion was 15.4 h (IQR 11.5, 23.2) at 14-20 weeks' gestation compared with 18.3 h (IQR 13.3, 26.1) at gestations greater than 20 weeks (P < 0.001). A total of 13.2% of terminations were performed at gestations beyond 24 weeks. CONCLUSIONS: Abortion > or = 20 weeks' gestation under medically regulated legislation is used primarily for serious fetal anomalies. The women are younger and the abortion duration is greater for late pregnancy termination compared with those conducted at earlier gestations. The majority of late terminations occur < 23 weeks' gestation and the incidence has remained stable since the legislation was enacted.

Abortion, Eugenic↗
PubMed2003

Seatbelt legislation in Japan: high risk driver mortality and seatbelt use.

OBJECTIVES: To clarify why seatbelt legislation did not achieve the expected reduction in mortality in Japan. LOCATION AND BACKGROUND: Seatbelt legislation was enacted in Japan in September 1985 and penalties were introduced in November 1986. METHODS: The driver deaths per vehicle km traveled (D/VKT) were calculated to adjust for changes in traffic volume. Decreases in D/VKT were compared with the reduction expected after legislation. The association between percentage changes of driver D/VKT, seatbelt use rate, and seatbelt non-use rate were explored. Deaths of passengers, pedestrians, and cyclists were also examined. Mortality data were obtained from vital statistics, traffic volume figures from the Ministry of Land, Infrastructure, and Transport, and seatbelt use rates from the National Police Agency. RESULTS: Although the decrease in D/VKT after the law was enforced was larger than the absolute number of deaths, it was far less than predicted. The percentage decrease in seatbelt non-use rate showed the strongest correlation with the percentage decrease in driver mortality. Mortality did not increase among other road users after the law was enacted. CONCLUSION: Accurate evaluation of the effect of seatbelt legislation must take into account changes in traffic volume. The selective recruitment hypothesis-that high risk drivers were less responsive to seatbelt legislation-fits well with the findings. There was no conclusive evidence supporting risk compensation-that is, an increase in injuries among other road users.

Accidents, Traffic↗