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PubMed2000

Regulating radiology: ethical issues in mammography and federal legislation.

One in nine women can expect to develop breast cancer over the course of a lifetime, which suggests that a posture of vigilance is appropriate. The form of breast imaging known as mammography will detect masses that self-examination and yearly clinical examinations may miss. Given that most types of breast cancer are not clinically preventable, early detection of such masses offers the best opportunity for survival for the affected women. Recognizing the need to ensure quality testing and interpreting procedures for so many women, the federal government has enacted legislation that requires breast imagers to read 240 mammograms in 6 months to qualify for certification and another 960 mammograms in the following 2 years. The burdensome nature of these requirements has had the effect of reducing the number of radiologists certified to read mammograms, and this has decreased the overall availability of this service to women. I explore two possible rationales for instituting such strict federal regulation of breast imagers: that breast cancer is more prevalent than other diseases that affect women and that legislating such high standards ensures the accuracy of interpretation. On neither ground is such legislation justified. Instead, I contend that this regulation was instituted as a way for politicians to make up for disregarding women and women's health concerns in the past by focusing on a current issue that predominantly affects women. As a consequence, I argue that more women may be harmed than benefited by such legislation.

Breast Neoplasms↗
PubMed1998

Oocyte donation: the legislative framework in Western Europe.

Relatively few countries have legislation addressing oocyte donation. Where such legislation does exist it is entirely in the context of broader legislation concerned with the regulation of in-vitro fertilization (IVF) or assisted reproduction more generally. Within Western Europe only nine countries so far have passed Acts addressing assisted reproduction. These countries fall into two groups in their approach to oocyte donation: those which do not allow gamete donation, and hence oocyte donation, in the context of IVF (Austria, Germany, Norway and Sweden) and those which specifically permit the use of donor oocytes in the treatment of infertility or to avoid the transmission of disease (Denmark, France, Spain and the UK). In Switzerland, a federation of cantons, where legislation relating to assisted reproduction is primarily a cantonal matter, except where it affects constitutional rights, the picture is similar. The Canton of Aargau does not allow gamete donation in the context of IVF, the Cantons of Glarus and Basel do not permit gamete donation at all and the remaining cantons follow the guidelines of the Swiss Academy of Medical Sciences.

Aborted Fetus↗
PubMed1991

Legislative change to permit direct access to physical therapy services: a study of process and content issues.

The purpose of this study was to examine process and content issues related to legislative change to permit direct access to physical therapy services. Data sources were survey questionnaires sent to the presidents of the 52 chapters of the American Physical Therapy Association (APTA), APTA publications, state statutes, and personal contacts. Results were based on the experiences of 35 chapters, 17 in direct-access states and 18 in non-direct-access states. The majority of direct-access states obtained their status in a single legislative campaign; the majority of non-direct-access jurisdictions attempting legislative change have been unsuccessful for 2 or more years. Over 80% of the chapters reported using legislative lobbyists. Opposing forces varied from state to state and included hospital and medical associations, physicians, chiropractors, and physical therapists. The following limitations on practice in a direct-access mode are found in the various practice acts: diagnosis requirements, eventual referral requirements, physical therapist qualifications, patient consent requirements, and practice setting restrictions.

Health Occupations↗
PubMedDate not supplied

Issues of transplantation: ethics of potential legislative changes.

Advances in transplantation technology and greater numbers of transplants have created an increasing disparity between the supply and the demand for organs. The new required-request legislation is only the beginning of legislation in this area. New legislation needs to increase the opportunity for donations without harming the rights of the patient. This author who has participated in the Surgeon General's Workshop on Organ Donation describes the issues involved in possible future legislation on organ and tissue donation.

Cultural Diversity↗
PubMed2002

Analysis of Australian legislation dealing with contaminated land.

An analysis of past and present Australian legislation for managing and regulating contaminated sites confirms that such legislation must deal with a number of specific matters. Australian legislation is effective in some of these areas but poor in relation to others. The analysis will assist other countries and jurisdictions to create effective legislation more speedily by avoiding identified problems.

Australia↗
PubMed2006

Structural elements in achieving legislative tobacco control in NSW, 1955-95: political reflections and implications.

OBJECTIVE: To analyse structural factors revealed by politicians that shaped legislation on tobacco control in New South Wales, 1955-95. METHODS: Parliamentary debates and other records were collected. Open-ended interviews were conducted with 17 Members of Parliament (MPs) who were significantly involved, and then analysed for structural elements. RESULTS: Tobacco industry lobbying had a significant but limited influence on policy making, being exerted largely through social interactions with executives and based on concerns about the economic impact on third parties. MPs saw health advocates' chief functions as (1) generating community concern about the issue and support for control measures, and (2) bringing any new information to political attention, providing pro-control arguments and data through the media. Factors that delayed tobacco control policies included: the conservative stance of Premiers and major parties, commitments to unanimous federal action, and rivalry between parties. Factors that facilitated control policies included: reforms that gave the Legislative Council increased power, the use of parliamentary committees, and backbencher and grass roots support. CONCLUSIONS: Tobacco control policy and legislation has been the product of political structures that gave power to those MPs in the least powerful positions--minor parties, Members of the Legislative Council (MLCs), backbenchers, women and party rank and file--rather than to major parties and their executives. IMPLICATIONS: Advocates should make the most of their access points to the political process, providing information, arguments and support and demonstrating public opinion in favour of further control.

Humans↗
PubMed2001

Effects of legislation restricting pack sizes of paracetamol and salicylate on self poisoning in the United Kingdom: before and after study.

OBJECTIVE: To evaluate the effects on suicidal behaviour of legislation limiting the size of packs of paracetamol and salicylates sold over the counter. DESIGN: Before and after study. SETTING: UK population, with detailed monitoring of data from five liver units and seven general hospitals, between September 1996 and September 1999. SUBJECTS: People who died by suicidal or accidental overdose with paracetamol or salicylates or who died of undetermined causes; patients admitted to liver units with hepatic paracetamol poisoning; patients presenting to general hospitals with self poisoning after taking paracetamol or salicylates. MAIN OUTCOME MEASURES: Mortality from paracetamol or salicylate overdose; numbers of patients referred to liver units or listed for liver transplant; numbers of transplantations; numbers of overdoses and tablets taken; blood concentrations of the drugs; prothrombin times; sales to pharmacies and other outlets of paracetamol and salicylates. RESULTS: Numbers of tablets per pack of paracetamol and salicylates decreased markedly in the year after the change in legislation on 16 September 1998. The annual number of deaths from paracetamol poisoning decreased by 21% (95% confidence interval 5% to 34%) and the number from salicylates decreased by 48% (11% to 70%). Liver transplant rates after paracetamol poisoning decreased by 66% (55% to 74%). The rate of non-fatal self poisoning with paracetamol in any form decreased by 11% (5% to 16%), mainly because of a 15% (8% to 21%) reduction in overdoses of paracetamol in non-compound form. The average number of tablets taken in paracetamol overdoses decreased by 7% (0% to 12%), and the proportion involving >32 tablets decreased by 17% (4% to 28%). The average number of tablets taken in salicylate overdoses did not decrease, but 34% fewer (2% to 56%) salicylate overdoses involved >32 tablets. After the legislation mean blood concentrations of salicylates after overdose decreased, as did prothrombin times; mean blood concentrations of paracetamol did not change. CONCLUSION: Legislation restricting pack sizes of paracetamol and salicylates in the United Kingdom has had substantial beneficial effects on mortality and morbidity associated with self poisoning using these drugs.

Acetaminophen↗
PubMed2006

Legislative advocacy is key to addressing teen driving deaths.

The increased crash risk of young, novice drivers, especially in their teenage years, has been a growing concern at both the state and federal levels. Teenage drivers are involved in fatal crashes at more than double the rate of the rest of the population per 100 000 licensed drivers. The best way of stemming these losses is to enact laws adopting graduated licensure systems that restrict young, novice drivers to conditions that reduce crash risk exposure when they first operate motor vehicles and to educate the public on the need for this legislation. Legislated teenage driving restrictions involve night-time vehicle driving restrictions, prohibitions on other teenage passengers, and the required presence of supervising adults. These restrictions are relaxed as teenage drivers successfully progress through initial and intermediate stages of graduated licensure before being granted unrestricted driver licenses. Unfortunately, many states have incomplete graduated licensing systems that need further legislative action to raise them to the desirable three-stage system that has been shown repeatedly to produce the greatest safety benefits. These state efforts should be buttressed by federal legislation that has proved to be crucial in allied driver behavioral concerns. Because reducing crash risk involves other strategies, stringent enforcement of primary seat belt laws as well as improved motor vehicle crash avoidance capabilities and crashworthiness must accompany efforts to reduce young driver crash risk.

Accidents, Traffic↗
PubMed2005

From strange bedfellows to natural allies: the shifting allegiance of fire service organisations in the push for federal fire-safe cigarette legislation.

BACKGROUND: Cigarettes are the leading cause of fatal fires in the USA and are associated with one in four fire deaths. Although the technology needed to make fire-safe cigarettes has been available for many years, progress has been slow on legislative and regulatory fronts to require the tobacco industry to manufacture fire-safe cigarettes. METHOD AND RESULTS: We conducted a case study, drawing on data from tobacco industry documents, archives, and key informant interviews to investigate tobacco industry strategies for thwarting fire-safe cigarette legislation in the US Congress. We apply a theoretical framework that posits that policymaking is the product of three sets of forces: interests, institutions, and ideas, to examine tobacco industry behaviour, with a special focus on their and others' attempts to court fire service organisations, including firefighters' unions as allies. We discuss the implications of our findings for future policy efforts related to fire-safe cigarettes and other tobacco control issues. CONCLUSIONS: Tobacco control advocates ought to: continue efforts to align key interest groups, including the firefighters unions; contest tobacco industry "diversionary" science tactics; and pursue a state based legislative strategy for fire-safe cigarettes, building towards national legislation.

Consumer Product Safety↗
PubMed1995

Looking at legislative and judicial views of psychic trauma--fluctuating recognition and discrimination.

OBJECTIVE: To describe how Canadian courts and legislation have viewed psychic or emotional trauma in the past century and the principles that are used. METHODS: The author reviews major trends in legislation and judicial findings pertaining to emotional trauma and gives examples of the fluctuating and ambivalent recognition by the courts. RESULTS: The courts have progressed from refusing to acknowledge emotional trauma, to accepting emotional trauma when accompanied by physical trauma, and finally acknowledging emotional trauma even in the absence of physical injury and the "indirect" emotional trauma suffered by the relatives of victims. However, from time to time, the courts or legislation may appear to deny the distress, dysfunction or the rights of a person who suffers significant emotional symptoms after an injury. This occurred recently in Ontario where injured persons in motor vehicle accidents who suffered emotional trauma were not allowed to sue for compensation from June 1990 to January 1994. Combined efforts by a coalition of mental health professionals with victims of trauma at least partially reversed the discriminatory laws. CONCLUSIONS: Psychiatrists must continue to play a vital role in the education of the courts, politicians and the public about the realities of emotional trauma and mental illness and their long-term impact so that fair compensation can be assessed by the courts and discriminatory legislation reversed.

Canada↗
PubMedDate not supplied

HIV/AIDS, advocacy and anti-discrimination legislation--the Australian response.

This paper will address the role of mass communication strategies in the reduction of HIV/AIDS discrimination in Australia. It will focus on the interdependence of mass communication and legislation in health promotion campaigns with particular reference to the Disability Discrimination Act 1992. This will be discussed in the context of other HIV/AIDS strategies in Australia. The public health impact of discrimination is explored in relation to HIV/AIDS and the role of anti-discrimination legislation is discussed. Public health legislation can serve as a symbolic reflection of public opinion or actively change it. Laws can transform the practices of both public and private institutions and thus decrease discrimination. They can also provide specific remedies for people adversely affected by discriminatory attitudes and practices. Mass communication can maximize the impact of legislation by promoting awareness of new laws and, more importantly, lead changes in the attitudes of the polity and the wider public.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Resist and redirect: physicians respond to breast cancer informed consent legislation.

During the 1980s, former breast cancer patients initiated efforts to introduce Breast Cancer Informed Consent legislation in twenty-two state legislatures. Their general intent in proposing this legislation was to insure that women patients were included in the decision-making process regarding their breast cancer treatment. A qualitative analysis of the reactions of medical professional organizations to these efforts revealed a pattern of change over time. Because professionals were not aware of early efforts for Breast Cancer Informed Consent, these met little or no resistance. Subsequent efforts in the early 1980s were met with organized resistance; physicians' organizations responded to the legislation as if it were a threat to their professional autonomy. By the middle of the decade, professionals had co-opted the efforts, shaping the legislation to their benefit. The challenge to physician authority that former breast cancer patients mounted had mixed results, but ultimately illustrated that professions are quite effective at retaining power.

Attitude of Health Personnel↗
PubMed2003

The role of early newborn discharge legislation in influencing policy development: understanding the Kansas experience.

Early newborn discharge legislation began a movement in health policy towards incremental changes in how medical consumers receive services. While well intentioned, these initiatives may undermine national efforts to address problems through more comprehensive reform, while stifling smaller efforts to address the problems locally. This paper discusses early newborn discharge legislation in Kansas: its origins, apparent impact, and implications. Findings from a hospital survey and two-year follow-up suggest a minimal effect of the legislation on health services in the state. Though acute hospital care appeared to replace home-based programs in many hospitals we spoke with, the more longstanding impact of the legislation seems to have been its precedent in how health policy is now made.

Female↗
PubMed2000

Snowmobile injuries and deaths in children: a review of national injury data and state legislation.

BACKGROUND: Snowmobiling is a popular family sport, with annual expenditures over $9 billion. The size and speed of snowmobiles make them potentially dangerous to children. Pediatric snowmobile-related trauma has not been studied in the United States. METHODS: We analyzed 291 pediatric snowmobile- related injuries and 75 deaths reported to the Consumer Product Safety Commission from 1990 to 1998. We reviewed snowmobile legislation in the states that reported at least 1 death to the Consumer Product Safety Commission during this time period. RESULTS: The most common sites of injury were the extremities (48.8%) and the head, neck, and face (28.2%). Head and neck injuries were the predominant cause of death (66.7%). The most common diagnosis was contusion/abrasion (30.9%), followed by laceration (22%), fracture (20.3%), and strain/sprain (14.4%). Nonfatal injuries most often involved ejection from the snowmobile (26.1%), but striking a stationary object was the most common mechanism in fatal crashes. The review of state legislation revealed that few age restrictions or helmet laws exist. Children as young as 8 years old may legally operate a snowmobile in some states. Often, restrictions do not apply to snowmobile use on private property, where 43% of pediatric snowmobile-related injuries occurred. CONCLUSIONS: Head, neck, and face injuries are common nonfatal injuries and are the most common cause of death. State legislation often lacks age restrictions on private property, and laws requiring helmet use are rare. Legislators have not addressed the dangers of pediatric snowmobile-related injuries. Helmet laws and age restrictions similar to those enacted for motorcycle riders are necessary and appropriate.

Adolescent↗
PubMed2005

Devastating injuries in healthcare workers: description of the crisis and legislative solution to the epidemic of back injury from patient lifting.

The purpose of this report is to describe a crisis in healthcare, disabling back injuries in US healthcare workers. In addition, outlined is the proven solution of safe, mechanized, patient lifting, which has been shown to prevent these injuries. A "Safe Patient Handling--No Manual Lift" policy must be immediately instituted throughout this country. Such a policy is essential to halt hazardous manual patient lifting, which promotes needless disability and loss of healthcare workers, pain and risk of severe injury to patients, and tremendous waste of financial resources to employers and workers' compensation insurance carriers. Healthcare workers consistently rank among top occupations with disabling back injuries, primarily from manually lifting patients. Back injury may be the single largest contributor to the nursing shortage. Reported injuries to certified nursing assistants are three to four times that of registered nurses. A national healthcare policy for "Safe Patient Handling--No Manual Lift" is urgently needed to address this crisis. Body mechanics training is ineffective in prevention of back injury with patient lifting. Mandated use of mechanical patient lift equipment has proven to prevent most back injury to nursing personnel and reduce pain and injury to patients associated with manual lifting. With the national epidemic of morbid obesity in our country, innovative devices are available for use in emergency medical systems and hospitals for patient lifting and transfer without injury to hospital personnel. The US healthcare industry has not voluntarily taken measures necessary to reduce patient handling injury by use of mechanical lift devices. US healthcare workers who suffer disabling work-related back injuries are limited to the fixed, and often inadequate, relief which they may obtain from workers' compensation. Under workers' compensation law, healthcare workers injured lifting patients may not sue their employer for not providing mechanical lift equipment. Discarding healthcare workers disabled by preventable back injuries is an abuse which legislators must remedy. In addition, Medicare reimbursement policies must also be updated to allow the disabled community to purchase electrically operated overhead ceiling lifts. The US lags far behind countries with legislated manual handling regulations and "No Lifting" nursing policies. England and Australia have had "No Lifting" nursing policies in place since 1996 and 1998, respectively. The National Occupational Research Agenda (NORA) recognized a model in 2003 for reduction of back injuries to nursing staff in US healthcare facilities. Also in 2003, the American Nurses Association called for elimination of manual patient handling because it is unsafe and causes musculoskeletal injuries to nurses. The first state legislation for safe patient handling passed both houses in California but was vetoed by the Governor in September 2004. California and other states are preparing to (re)introduce legislation in January 2005. A national, industry-specific policy is essential to quell the outflow of nursing personnel to disability from manual patient lifting.

Adult↗
PubMed2002

International regulation of wildlife trade: relevant legislation and organisations.

Trade in wildlife brings into play a variety of legislation from several distinct areas of law. Many species of wildlife are subject to restrictions on international movement with the aim of protecting wild populations from over-exploitation. Animal health legislation is strictly applied to the movement of most animals to prevent the spread of infectious diseases between importing and exporting counties. The welfare of animals in the course of trade requires consideration and relevant legislation has been put into place, particularly in respect of transportation. A number of institutions have an impact on the trade itself or on the legislation that regulates wildlife trade on an international basis.

Animal Identification Systems↗
PubMed1998

The impact of mammography quality improvement legislation in Michigan: implications for the National Mammography Quality Standards Act.

OBJECTIVES: This study examined the impact of state legislation on mammography quality and access in Michigan. METHODS: The impact of state legislation was analyzed with respect to utilization, numbers of machines and facilities, and image quality. RESULTS: The legislation had a positive effect on image quality improvement, had no impact on utilization by women aged 50 years and above, and resulted in few facility closures. CONCLUSIONS: Michigan's legislative intervention appears to have had a positive effect on efforts to improve mammography quality assurance with implications for other federal and state efforts to achieve quality assurance in health care delivery.

Aged↗
PubMed2001

The short-term impact of national smoke-free workplace legislation on passive smoking and tobacco use.

OBJECTIVES: This study sought to evaluate the short-term impact of national smoke-free workplace legislation on employee exposure to environmental tobacco smoke at work and on employee smoking habits. METHODS: We performed 2 cross-sectional studies in 9 medium-sized and large Finnish workplaces, before and after implementation of national smoke-free workplace legislation. We assessed tobacco smoke exposure via questionnaire and indoor air nicotine measurements. RESULTS: Exposure to environmental tobacco smoke declined considerably after the legislation was implemented. Tobacco consumption among smokers diminished. Nicotine concentrations fell significantly. CONCLUSIONS: Legislation was more efficient than voluntary workplace-specific smoking restrictions in reducing passive smoking and cigarette consumption.

Adult↗