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PubMedDate not supplied

Maternal postpartum health care utilization and the effect of Minnesota early discharge legislation.

PURPOSE: To describe maternal postdischarge follow-up and health care utilization in the context of Minnesota's early discharge legislation, which mandates coverage for a home visit for a mother and baby who voluntarily leave the hospital early. METHODS: Claims data from a large managed care organization were used to identify 22,944 women giving birth from January 1995 through February 1999. Study variables included home or clinic visits within 1 week of discharge (early follow-up), readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge. RESULTS: After enactment of Minnesota's legislation, the percentage of mothers with short stays decreased from 52% to 16% for vaginal births and from 87% to 63% for cesarean births (P =.001). Overall, 33% of mothers with vaginal births and 40% with cesarean births had early home or clinic follow-up (P =.001). Mothers who stayed 0 or 1 hospital days after vaginal births were more likely to have early follow-up than those with longer stays (37% vs 32%, P =.01). However, mothers who stayed 2 or 3 days after cesarean birth were no more likely to have early follow-up than mothers who stayed 4 or more days (39% vs 42%, P =.08). Rates of early follow-up were significantly higher after enactment of Minnesota's legislation, regardless of length of stay. CONCLUSIONS: Implementation of Minnesota's early discharge legislation corresponded with significantly increased lengths of stay and an increase in the percentage of mothers who received early follow-up visits. However the majority of mothers with short stays continued to lack early follow-up.

Adolescent↗
PubMed1996

The relative impact of presumed-consent legislation on thoracic organ donation in the Eurotransplant area.

A country's organ donation rate and hence the availability of thoracic organs can be increased by organizational measures, by legislative incentives, and by increasing awareness among the public and healthcare professionals. We analyzed the relative impact of organ procurement legislation or policy on heart and lung donation rates per million population per year in the four countries participating in the Eurotransplant organization (population, 112.7 million) between January 1992 and December 1994. Within this organization, Austria and Belgium have presumed-consent legislation, whereas Germany and the Netherlands have an opting-in (explicit-consent) policy. Although practices vary even among countries with similar policies (eg. in Belgium, relatives of the donor retain the right to object to procurement of organs in the absence of an explicit consent from the deceased before death), rates of heart and lung donation were at least twice as high in the two countries with presumed-consent legislation as in the two countries that rely on a policy of explicit consent from the donor's next of kin.

Europe↗
PubMed2000

An overview of European Union tobacco control legislation.

The European Union (EU) has been active in tobacco control policy since 1985 when the Milan Council announced its intention to establish a Europe Against Cancer (EAC) Programme, although it had previously adopted several Directives on aspects of tobacco taxation prior to this date. Shortly after the establishment of the EAC first action plan the European Commission presented its first legislative proposals on tobacco control. Three of these proposals on labelling and maximum tar yields became Directives by 1992. The fourth on tobacco advertising finally became law in 1998 and is currently being transposed into national law in the 15 EU Member States. In 1996 the Commission published a Communication on the future of EU tobacco control and in 1999 at the 2nd European Conference on Tobacco or Health the Social Affairs Commissioner announced his intention to bring forward further legislative proposals to amend an consolidate existing EU legislation in this sector. This article is intended to present an overview of EU tobacco control legislation from 1970 until 1998 and to look at future options post year 2000.

Advertising↗
PubMed2001

EU policy on nutrients emissions: legislation and implementation.

After 25 years of EU water legislation the European Union has just thoroughly restructured its water policy. The European Parliament and the Council, following a tough conciliation procedure between the two legislators, have in summer 2000 agreed a proposal by the European Commission for a Water Framework Directive. This legislation will have the following main objectives: integrated river basin management across borders, with coordinated programmes of measures protection of all waters, surface waters and groundwater, in quality and quantity with a proper ecological dimension emissions and discharges controlled by a "combined approach" of emission limit values and quality standards, plus the phasing out of particularly hazardous substances introducing water pricing policies strengthening public participation This new Water Framework Directive adopted in September 2000 will complement existing EU water legislation on nutrients reduction--the 1991 Directive on nitrates pollution from agricultural sources and the 1991 Directive on urban waste water treatment. These Directives will remain main pillars of EU water policy whilst at the same time being integrated into the river basin management in a coherent way.

Agriculture↗
PubMed2001

Transfer of risk: "right to sue" legislation and managed care organization stock performance.

We examined whether Congress's consideration of legislation that gave consumers the right to sue managed care organizations impacted the performance of these companies' stocks relative to that of the market. For each company examined, the total return related to such legislation was negative and substantially lower than that expected from the market model; losses in market value were from 17 percent to 48 percent for individual companies and 22 percent for a capitalization-weighted portfolio. The study suggests that equity markets responded to the proposed legislation quickly and that the impact of proposed legislation is felt through loss of market value and increased corporate risk.

Employee Retirement Income Security Act↗
PubMed2001

Pennsylvania's early discharge legislation: effect on maternity and infant lengths of stay and hospital charges in Philadelphia.

OBJECTIVE: To assess the effect of maternal length of stay (LOS) legislation on LOS and hospital charges associated with Philadelphia resident live births from 1994 through 1997. DATA SOURCE/STUDY SETTING: This was a descriptive epidemiological study involving secondary data analyses of linked birth record and hospital discharge data pertaining to all Philadelphia resident live births occurring between January 1, 1994 and December 31, 1997. STUDY DESIGN: Using these linked data, trends in median and mean maternal and infant LOS and hospital charges were described for three distinct time periods: (1) a "prelegislative" period (January 1, 1994 through June 30, 1995); (2) a one-year period during which LOS legislation was introduced, debated, modified, and eventually passed by Pennsylvania lawmakers (July 1, 1995 through June 30, 1996); and (3) a "post-LOS law" period immediately following enactment of Act 85 mandating minimum LOS for mothers and their newborns (July 1, 1996 through December 31, 1997). LOS variables for both mothers and infants were calculated based on the actual number of hours elapsing between birth and discharge; hospital charges were obtained directly from information available in the Hospital Discharge Survey data. PRINCIPAL FINDINGS: Maternal median charges and LOS per delivery for vaginal births rose from 5,270 dollars to 6,333 dollars and from 35 to 47 hours following the enactment of Pennsylvania maternal minimum LOS legislation. Median infant cost and LOS per delivery mirrored these trends. CONCLUSIONS: Pennsylvania LOS legislation had a profound effect on maternal and infant discharge practices in Philadelphia. As much as $20 million may have been added to annual health care costs associated with Philadelphia resident births.

Adult↗
PubMed2002

Involuntary hospitalisation and the rights of mental patients in recent Croatian legislation.

This paper presents and critically analyses the provisions of the Croatian Act of 1998 on the Protection of Persons with a Mental Illness relating to involuntary hospitalisation and the rights of psychiatric patients. This analysis also encompasses the amendments and supplements of 1999. The paper identifies the problems that have arisen in the application of this Act and discusses the causes of these problems. The paper concludes that the passing of new psychiatric legislation or any radical reform of the existing legislation must be preceded by a comprehensive discussion by professionals, scientists and the broader public, which would result in the passing of legislation which can be implemented in terms of organisation, staffing and financing. Without this, any new psychiatric legislation, even if it met the highest international legal standards, would be exposed to the danger of being merely declarative, which would bring most harm to mental patients themselves.

Commitment of Persons with Psychiatric Disorders↗
PubMed1989

Involvement in the legislative process through the state association.

Speech-language-hearing professionals need to develop a proactive posture regarding legislative issues. The first steps must begin at the local level. The state association is a reasonable and logical organization from which broader issues may be addressed, issues affecting the professionals as well as the patients/clients/students who require their services. The ideas that we generate at conferences and meetings to improve our educational and health care systems can be funneled into meaningful legislative action. The legislative issues of today become the governing regulations of tomorrow. Involvement in the legislative process helps strengthen our collective voices.

Audiology↗
PubMedDate not supplied

A population survey on legislative measures to restrict smoking in Ontario: 1. Design, methodology, and sample representativeness.

Legislative measures restricting cigarette smoking have the potential to influence whether a person begins or continues to smoke and to affect the impact of passive smoking. We surveyed a representative sample of the adult population in Ontario on their knowledge of existing legislation and of the adverse effects of primary and secondary smoking on health. We also assessed their attitudes toward a range of restrictions and changes in legislation as well as their views on the enactment and enforcement of such legislation. This paper reports on the sample design, methods, response rates, and representativeness of the respondents. We used a three-stage stratified cluster design, covering both urban areas (with or without existing smoking bylaws) and rural areas and incorporating telephone interviews using random-digit dialing. The total number of respondents was 1,383, for an overall response rate of 67.5 percent. Despite attempts to ensure anonymity and to convey the importance of participation, we did not achieve total representativeness in sex ratio, age distribution, and certain educational and occupational categories. A companion paper reports on the population estimates of the variables under study.

Canada↗
PubMedDate not supplied

A population survey on legislative measures to restrict smoking in Ontario: 2. Knowledge, attitudes, and predicted behavior.

From the results of a population survey (n = 1,383) in the province of Ontario on legislative measures to restrict cigarette smoking we conclude that more is known about the adverse effects of active smoking than about those of passive smoking. Most people supported some degree of restriction in 13 specified locations. A majority supported total bans on smoking in day care and health-related facilities. Most respondents thought municipal governments should be responsible for legislating such bans and owner/managers responsible for enforcing them. However, there were a variety of opinions on the effectiveness of legislation in helping people to quit smoking. Responses differed slightly according to the geographic locations of the respondents, with residents of urban areas with bylaws being more restrictive. We suggest that such opinions and attitudes be studied further before legislative measures are enacted, so that all segments of the population are satisfied and unnecessary conflicts can be avoided.

Attitude to Health↗
PubMed1995

[Promotion of mother-infant health: a comparative study of legislation of pregnancy protection].

OBJECTIVE: To describe the legislative measures aimed at protecting working women during pregnancy, which exist in France, Italy, the United Kingdom and Spain. DESIGN: The aspects studied were employment protection and modifications in work conditions for the pregnant woman. Existing Spanish legislation, the third Programme of Community Action for Equal Opportunities and some relevant scientific articles were reviewed. MEASUREMENTS AND MAIN RESULTS: Regarding protection of pregnant women from dismissal, legislation is more explicit in France and Italy, where protection covers the whole of the pregnancy, extending in France until 4 weeks after the end of the period off-work for the birth and in Italy until the child is one year old. Likewise, both in France and Italy, there is a long list of jobs which a pregnant woman is not allowed to do, with the possibility of a change of post if necessary. In Spain there is a Health at Work draft law, where measures relating to this question have been assembled. CONCLUSION: In general, the legislation referring to the protection of pregnant women at work is not widely known and leaves without protection those women in a more vulnerable work situation. Health professionals could support the equality and health of working women by informing them adequately of their rights.

Adolescent↗
PubMed1995

Bicyclist head injury prevention by helmets and mandatory wearing legislation in Victoria, Australia.

After a decade of promotion and education, legislation for mandatory helmet wearing by bicyclists in Victoria was introduced on 1 July 1990. The legislation was a world first. Comparison of 1710 bicyclist casualties wearing and not wearing helmets has demonstrated that wearing helmets certified to the Australian Standard reduces the head injury risk by at least 39% and lessens head injury severity. Simulated impact testing of helmets has shown that they provide protection in most impacts including collisions involving a motor vehicle. Legislation for mandatory helmet wearing in Victoria has led to increased wearing rates and marked reductions in bicyclist fatalities and head injuries. The Victorian experience gives substantial support to the introduction of legislation for mandatory helmet wearing by bicyclists.

Accidents, Traffic↗
PubMed1993

[Statistical study of ocular injuries--effect of the seat belt legislation in traffic ocular injuries].

Three hundred and eighty cases of eye injuries treated at Kyushu University Hospital during from January, 1984 to December, 1989 were statistically analyzed. Ocular injuries comprised about 10% of the total number of in-patient cases. Males were five times more than females. Among the age groups, those in their teens were the most affected. The most frequent cause of injuries was blunt trauma in sports. The effect of the seat belt legislation in November 1986 in traffic ocular injuries was examined. Traffic ocular injury cases were about 20% of all cases of ocular injuries. In the ocular injury, perforating injury was the most among traffic eye injuries and the visual outcome was poor. However, after the seat belt legislation the rate of traffic ocular injuries in total ocular eye injuries decreased from 26% to 14%. Furthermore, the incidence of perforating eye injuries caused by shattering windshields decreased significantly and the final visual acuity was better than before legislation. From these results, we conclude that the seat belt legislation has been effective in decreasing traffic eye injuries.

Accidents, Traffic↗
PubMed1996

[Current legislation in public health--an example for post-modern social ethics?].

Social ethics of affirmative postmodernists are discussed in relation to recent German health care legislation. It could be shown that: 1. the health care legislation 1989 and 1993 only partially fulfills the postmodern call for "cultivation of individual responsibility", 2. both laws largely fail to enforce the principle of subsidiarity, and 3. postmodernist thinking is weak on the question of global strategies but strong In the area of individualism and subjectivity. We conclude that postmodern social ethics are useful to compensate areas largely neglected by recent German health care legislation, rather than that the legislation is an example of postmodern social ethics.

Ethics, Medical↗
PubMed1998

Short report. How provincial and territorial legislators view tobacco and tobacco control: findings from a Canadian study.

We report on legislators' attitudes and experiences regarding tobacco and tobacco control using findings from a 1996/97 telephone survey of provincial and territorial legislators in Canada. Across all jurisdictions, legislators showed support for a number of tobacco control policies and for a major government role in implementing programs and policies to discourage youth from smoking. Further, substantial numbers of legislators indicated they did not have enough tobacco-related contact with medical and non-profit health organizations. These findings can guide the activities of health agencies, researchers and advocates in support of effective strategies to reduce the public health impact of tobacco use in Canada.

Attitude to Health↗
PubMed1998

[Evaluation and comparison of tobacco control legislation in member states of the European Union].

BACKGROUND: Nowadays, tobacco use represents the main cause of avoidable deaths in Europe. Public health authorities have several means at their disposal to fight against this epidemic. For instance, legislative action can operate on the supply side as well as on the demand side, with the aim of reducing tobacco consumption in the targetted populations. METHODS: A systematic data collection of all legislative texts dealing with tobacco control was carried out within the framework of the EuroLego project. This was done, either through direct contact with the countries or through a systematic computer and manual search of data bases concerning the 15 member states of the European Union. RESULTS: At present, the legislative context varies widely from one country to another, whether regarding the number of texts adopted or the subject that is covered. Since the 1950s, a marked increase in the number of legislative texts has been noted as well as a trend towards harmonization of the texts among the different member states. CONCLUSIONS: Several health recommendations can be put forward in the context of public health activities with priority to be given to the protection of the children and the young and to the defense of the rights of non-smokers.

Europe↗
PubMed1976

Interpreting legislative voting patterns on health issues: a method and rationale.

Crucial decisions affecting the health field are increasingly being made in the political arena. To interpret and effectively influence these political events, the health specialist must become acquainted with the political decision maker's perspective on health issues. This report presents a method for analyzing legislative voting patterns to determine the issue structure within which health-related legislative decisions are made. Once this issue structure has been determined for a given legislative body, relevant strategies for influencing the decision-making process can be designed.

Decision Making↗
PubMed2002

European medicines and feed additives regulation are not in compliance with environmental legislation and policy.

Environmental legislations for water and soil aim at the protection of quality of these compartments. This legislation has major consequences for product registration, amongst others the setting of environmental quality standards. A thorough risk assessment at registration of all products is crucial for the proper operationalisation of the environmental policy. A regulatory problem arises when the registration procedure is harmonised at a European level by the communautarian authority, while the authorities at the national level are responsible for maintaining the desired environmental quality. This problem can be tackled in two ways: firstly, the environmental risk assessment (ERA) should be based on common principles based on EU regulations and policy that steer the national authorities; secondly, the ERA should be developed under the supervision of competent authorities. Both options are not reflected in the forging of the ERA for medicines and feed additives. The formalisation of the contents and the procedure is not transparent nor open to input by scientists and other interested parties; the formalisation has no legal status, and European legislation cannot provide common protection goals in a global setting. The VICH Phase I and the EMEA Phase II guidance do not contain all communautarian environmental quality criteria, nor clear acceptability standards, nor harmonised methodology. Assessments are not made for all products, and the decision-making principles and practical procedures are not operational. It is therefore unlikely that any result of an ERA can be taken into consideration at registration, which undermines the legitimacy of the process. Both applicants and assessors are uncertain how to perform the risk assessment. The current developments may ultimately not only compromise product availability but also fail to protect the environment.

Animal Feed↗