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PubMed1988

Fifty years of federal legislation and programs affecting PM&R.

The accomplishments of 50 years in matters of federal legislation and programs affecting PM&R were made possible in large part through the dedication of specialists in PM&R who, first and foremost, were advocates of measures which would serve best the interests of the nation's handicapped and disabled. The contributions of certain individuals have been mentioned throughout this article, but a few have provided the essential continuity of effort in federal advocacy for the handicapped and PM&R. In my experience, this distinguished list of advocates has included Rusk, Kottke, Lowman, Lehmann, Spencer, Ditunno and Materson. These individuals were either defacto or dejure chairs of Academy of ACRM legislative and health policy committees from the 1960s to the present. They devoted endless hours of volunteer work on behalf of the handicapped and PM&R. In addition, Rusk and Betts have been magnificent in attracting the public's attention to the needs of the disabled. The dedication, passion, sense of justice and persistence of all these men have served PM&R, the handicapped and the public admirably. The field of PM&R will always produce leaders of such quality, given its basic commitment to the needs of the handicapped and disabled and its passion for patient advocacy and social justice. It is my wish to dedicate this article, to the extent it is accurate, intelligent and well written, to Edward Lowman, MD, now deceased, who was a key link in the chain of advocacy. If the article is not perceived as described, it would not be appropriate to dedicate it to this man. Dr. Lowman was always all of those things.(ABSTRACT TRUNCATED AT 250 WORDS)

History, 20th Century↗
PubMed1988

Anti-smoking legislation--an international perspective applied to South Africa.

Legislation is an essential component of any effective anti-smoking programme, and is being used increasingly in many countries. Legislative measures may control or ban tobacco advertising, require that cigarette packets carry a health warning and contents statement, limit the tar and nicotine content of cigarettes, restrict sales, impose taxes on tobacco products, restrict smoking in public places and workplaces, make health education mandatory or provide for the establishment of a national anti-smoking agency. A major objective is to establish non-smoking as the norm. We recommend that the government of South Africa introduces a comprehensive anti-smoking programme that will include the following steps: (i) putting extra taxes on cigarettes to fund health education, (ii) prohibiting the sale of cigarettes to minors, (iii) making health warnings and contents labelling on both cigarette packets and advertisements prominent, and (iv) encouraging public and private sector involvement in protecting non-smokers' rights and helping smokers to stop smoking.

Health Education↗
PubMedDate not supplied

Legislation on contraception and abortion for adolescents.

The serious health and social consequences of adolescent pregnancy call for the examination of the laws that affect adolescents' access to contraception and abortion. The general law of any country relating to the availability, sale, or distribution and financing of contraceptives affects adolescents. Similarly, a country's general law on abortion applies to adolescents faced with unwanted pregnancy and affects them accordingly. In addition, special legislation relating to adolescents, particularly legislation or court decisions concerning parental consent for contraception or abortion for a minor, has an important influence on the access that sexually active young people have to services.

Abortion, Legal↗
PubMed1983

delta 9-Tetrahydrocannabinol and therapeutic research legislation for cancer patients.

The Controlled Substances Board evaluated the implementation of the National Cancer Institute (NCI) program in Wisconsin that distributes delta 9-tetrahydrocannabinol (delta 9-THC) to cancer chemotherapy patients with nausea and vomiting refractory to conventional antiemetic drugs. The board concluded that the distribution mechanism for delta 9-THC is appropriate and adequate in Wisconsin. The drug does relieve nausea and vomiting in some cancer chemotherapy patients, but adverse side effects are prevalent. Important questions about its safety and effectiveness remain and should be resolved through scientific research and within the existing framework for testing investigational drugs that are controlled substances. "Marijuana therapeutic research" legislation, similar to that passed in 32 states, was introduced in Wisconsin after implementation and evaluation of the NCI program, but failed to recognize the existing legal framework for approving new drugs and threatened to disrupt the NCI program. With assistance from the American Cancer Society, the State Medical Society, and volunteers and professionals in cancer research, the legislation was adapted to the existing legal and administrative framework.

Antineoplastic Agents↗
PubMed1984

A nutrition fair cosponsored by dietitians and legislators.

A nutrition fair was held in New York City through the cooperative efforts of the local Consulting Nutritionists in Private Practice, the Greater New York Dietetic Association, and two state assembly members. This event was undertaken to market the services of registered dietitians and to enhance the dietitian's role in the local legislative arena. The three-hour fair provided a forum at which the public could obtain direct information and educational materials on various nutrition topics and receive referrals for further consultation. The attendees were mostly women (72%); 63% were in the 21 to 50 age group; and 32% were more than 50 years old. The public response was positive, and the majority of attendees found answers to specific questions. The collaboration of the dietitians and the legislators was also positive. The two assembly members were able to communicate with their constituents and to see how dietitians practice.

Adult↗
PubMed1995

Kronenberg vs. Henry Ford Health System, et al. addresses constitutionality of malpractice reform legislation.

In November 1994, a Wayne County Circuit Court judge rendered an opinion upholding the constitutionality of the 182-day pre-suit notice and waiting requirements under the Malpractice Reform Legislation which became effective April 1, 1994. The Court's opinion is well written and will lend support to other constitutional attacks taking place in other circuit courts. It is expected that the Kronenberg case will be appealed. MSMS legal counsel will monitor this and other cases contesting the constitutionality of the Malpractice Reform Legislation and keep MSMS members apprised.

Humans↗
PubMed1976

Federal health planning, part 1: legislative background.

U.S. federal health planning legislation is discussed. The Hill-Burton, Comprehensive Health Planning and Regional Medical programs--early legislative initiatives in health planning--are described, and their effectiveness is discussed.

Financing, Government↗
PubMed1993

Patients' rights and legislative strategies.

Legislation to ensure patients' rights plays a more and more important role, both nationally and internationally. Countries from the civil law family have the option to legislate patients' rights in their Civil Codes. It is suggested that this choice will ensure more 'doctors' compliance' than would be the case had administrative law been chosen as a vehicle.

Confidentiality↗
PubMedDate not supplied

Implementation of legislative requirements for emergency medical services in prepaid group practice organizations.

The Health Maintenance Organization Act of 1973, the Emergency Medical Services (EMS) Systems Act of 1973, and other laws are examined for their effects on the organization and management of emergency services in prepaid group practice plans (PPGP). The study was conducted in 1974-75 by the Group Health Association of America. The data were gathered through interviews with administrators and providers of seven PPGPs and with leaders of health planning agencies in the same communities, as well as through reviews of internal documents and a 1-month utilization survey of emergency and urgent care services in each PPGP. Effects of the laws were found to be limited, with the health maintenance legislation appearing to have the greastes effect on the design of emergency servide models. In most localities, two parallel systems may operate in offering round-the-clock emergency care and programs to educate members and the public about the appropriate use of emergency facilities. The EMS legislation has had minimal effects on the design of emergency services in the PPGPs. The emergency services component is the most transitional aspect of the PPGS nad the one most amenable to change. Revisions have come through changes in internal management policy and from demands of subscribers. A regulating inference in the operation of the PGP, in the area of emergency services as well as in the delivery of primary care services, is that the plans must compete, both in costs and benefits, with available indemnity insurance coverage. The market dictates premium levels without regard to associated benefits. Additional costs for broader coverage and administrative regulatory mechanisms must be borne by the subscriber in the form of increased premiums. As a result, the utilization of expensive emergency care must be carefully controlled, and this restraint is often accomplished by requirements specifying which health problems are appropriate for the provision of emergency care, rather than by delaying assistance until the plan's office hours. The furtherance of the PPGP concept, that the entire health care of the individual person is provided and financed by one organization, definancedby one organization, detracts from the viability of a central body charged with the coordination of the delivery of all emergency services in the community. It results not only in duplication of effort but often in the establishment of potentially antagoistic organizations.

Consumer Organizations↗
PubMed1997

[Development of the occupational carcinogen legislation in the European Community].

The aim of this study is to sum up the development of European Community legislation concerning occupational carcinogens. In terms of prevention, 4 periods were studied. From 1951 to 1972, only a few texts of law were promulgated. From 1972 to 1984, after the ratification of the convention 139 of the International Labour Office, more texts were promulgated. Then, from 1985 to 1992, the protection against occupational carcinogens increased for workers, especially after the specific european directive edicted in 1990. Since 1992, most of the countries in the European Union have included this directive in their legislation. In terms of compensation for occupational cancer, a recommendation of the European Commission stated in 1962 had already proposed a list of compensable diseases. Because of the diversity of compensation means, it is difficult for the European Community to impose a common status.

Carcinogens↗
PubMed1976

[Bioavailability, proof of efficacy and their consequences for drug legislation (author's transl)].

Drugs should be effective for the indicatons stated, they should not involve risks which would not be justified in relation to their benefit and they should be of the necessary quality. It is the objective of drug legislation to warrant these requirements in its area of jurisdiction. It has become a necessity to revise current legislation; it is going to be replaced by a new law. A corresponding bill is being considered by Parliament at present. The present and the future legal situation with regards to proof and safeguarding of the bioavailability of pharmacologically active substances and the necessary prerequisites and rules for the procedure of clinical testing of drugs to prove their efficacy and safety is described.

Animals↗
PubMed2004

Noncommunicable disease mortality in the Russian Federation: from legislation to policy.

Political, social and economic transitions that occurred as a result of the regime change in Eastern Europe and the Russian Federation from the late 1980s to the early 1990s led to a sudden increase in mortality across the region, with more than 80% of deaths being attributable to preventable causes, such as cardiovascular disease, lifestyle factors and injuries. The Russian Federation has experienced some of the most dramatic population declines in the world. Countrywide health reforms have been implemented, although they continue to ignore the impact of the epidemic of noncommunicable diseases (NCDs) in the Russian Federation. Improvements in mortality patterns in the Russian Federation are possible only with the broader engagement of organized nongovernmental groups within the civil society that is strongly supported by Federal legislation to address NCDs. We discuss the Russian Federal legislation germane to the prevention and control of NCDs in the light of the current mortality crisis and suggest possible policy responses to this crisis.

Acute Disease↗
PubMed1997

Effect of education and legislation on bicycle helmet use in a multiracial population.

OBJECTIVE: To observe the effect of new legislation and a boroughwide bicycle helmet educational campaign on bicycle helmet use in a multiracial population. DESIGN: A prospective observational study. Observations were made at randomly selected sites in Queens (study group) and Brooklyn (control group), NY, in May 1994, before a New York State law affecting both boroughs was enacted and before a bicycle helmet educational campaign was conducted in Queens. Variables observed included age, sex, race, and whether the child was wearing a bicycle helmet while riding. A bicycle helmet campaign was conducted in late May 1994. New York State bicycle helmet law was effected on June 1, 1994, requiring all children aged 1 to 14 years to wear helmets while riding their bicycles. Follow-up observations were made at the same sites in July or August 1994. SETTING: Queens County, New York, which is the most racially diverse county in the United States, according to 1990 census data. PARTICIPANTS: Cross-sectional observations of children aged 1 to 14 years made at randomly selected sites. INTERVENTIONS: A boroughwide bicycle helmet educational campaign conducted in May 1994 in Queens. RESULTS: The overall use of helmets increased from 4.7% (13/276) to 13.9% (44/316) (P < .001) in the study group. Helmet use decreased from 5.6% (19/342) to 4.2% (13/312) (P = .10) in the control group during the same period. CONCLUSIONS: In a multiracial population, a statistically significant (P < .001) increase of helmet use was demonstrated after a campaign and distribution of educational material. Legislation alone is inadequate for ensuring increased bicycle helmet use.

Adolescent↗
PubMed2006

Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places.

CONTEXT: Scotland prohibited smoking in confined public places on March 26, 2006. OBJECTIVE: To investigate the association of smoke-free legislation with symptoms, pulmonary function, and markers of inflammation of bar workers. DESIGN, SETTING, AND PARTICIPANTS: This prospective observational study was conducted in Tayside, Scotland from February-June 2006. One hundred five nonasthmatic and asthmatic nonsmoking bar workers were initially enrolled, of whom 77 completed the study per protocol. MAIN OUTCOME MEASURES: Respiratory and sensory symptoms, spirometry measurements, serum cotinine levels, peripheral inflammatory cell count, asthma quality-of-life scores, and exhaled nitric oxide levels were evaluated before and after introduction of the smoking ban. RESULTS: For the per-protocol analysis, the percentage of bar workers with respiratory and sensory symptoms decreased from 79.2% (n = 61) before the smoke-free policy to 53.2% (n = 41) (total change, -26%; 95% confidence interval [CI], -13.8% to -38.1%; P<.001) and 46.8% (n = 38) (-32.5%; 95% CI, -19.8% to -45.2%; P<.001) 1 and 2 months afterward. Forced expiratory volume in the first second increased from 96.6% predicted to 104.8% (change, 8.2%; 95% CI, 3.9% to 12.4%; P<.001) and then 101.7% (change, 5.1%; 95% CI, 2.1% to 8.0%; P = .002), and serum cotinine levels decreased from 5.15 ng/mL to 3.22 ng/mL (change, -1.93 ng/mL; 95% CI, -2.83 to -1.03 ng/mL; P<.001) and then 2.93 ng/mL (-2.22 ng/mL; 95% CI, -3.10 to -1.34 ng/mL; P<.001). The total white blood cell and neutrophil count was reduced from 7610 to 6980 cells/microL at 2 months (-630 cells/muL; 95% CI, -1010 to -260 cells/microL; P = .002) and from 4440 to 4030 cells/microL (-410 cells/microL; 95% CI, -740 to -90 cells/microL; P = .03), respectively. Asthmatic bar workers also had less airway inflammation, with a reduction in exhaled nitric oxide from 34.3 parts per billion (ppb) to 27.4 ppb 1 month after the ban (0.8-fold change; 95% CI, 0.67 to 0.96 ppb; P = .04), and Juniper quality-of-life scores increased from 80.2 to 87.5 points (7.3 points; 95% CI, 0.1 to 14.6 points; P = .049). CONCLUSIONS: Smoke-free legislation was associated with significant early improvements in symptoms, spirometry measurements, and systemic inflammation of bar workers. Asthmatic bar workers also had reduced airway inflammation and improved quality of life.

Adult↗
PubMed2000

Coping with change: intellectual property rights, new legislation, and the human mutation database initiative.

In 1996, the European Union issued a directive requiring member states to protect databases against unauthorized copying. Similar legislation is currently being considered and will probably be enacted in the US. Such database legislation 1) will almost certainly increase existing pressures on human mutation databases to commercialize, and 2) could inadvertently make human mutation data harder to acquire and use. Strategies for minimizing these difficulties are discussed. Alternatively, a nonprofit, community-wide "depository" could probably support itself by selling sophisticated bioinformatic products to the private sector. The proposed depository would offer substantially similar databases to academic and government users at little or no cost.

Databases, Factual↗
PubMedDate not supplied

Health system reform under the Russian health insurance legislation.

The Russian (1993 amended) health insurance legislation initiated a far-reaching reform in the financing, organization and management of the Russian health system. However, the implementation of the legislation has been slow and unstructured due to a lack of appropriate administrative and financial mechanisms: these concern entitlement, private-public mix, financial responsibilities of government at all levels, investment instruments, reimbursement and compensation systems, and a well-defined role of government. These issues are discussed in this article in the context of the Russian economy, the state of the health system, and the reform effort in the system.

Financing, Government↗
PubMed1992

Implementing right-to-know legislation for health care workers in Manitoba: a bipartite sectoral train-the-trainer approach.

In October 1988, right-to-know legislation was introduced in Canada. This presented a technical and administrative challenge to the health care sector. With over 170 health care facilities in Manitoba to be brought into compliance, some large, some small, some rural, some urban, a cooperative approach was needed. A labor-management steering committee with representatives from a cross-section of facilities as well as the various health care unions was formed to design and implement a train-the-trainer program. A small-group, highly participatory modular program was developed with input from all parties, and delivered across the province by trainers selected jointly by labor and management. The program achieved its goal of assisting member facilities to implement the legislation. Follow-up surveys and discussions with health care workers showed improved understanding of labelling requirements, material safety data sheet interpretation, and requirements for hazard control. This first bipartite program empowered the health care workforce to use its newly acquired right-to-know, and has provided the incentive to implement other cooperative safety and health programs.

Evaluation Studies as Topic↗
PubMed1993

Current trends in state child labor legislation and enforcement.

There is much current child labor law activity, none of it reflecting concern with occupational health hazards. The focus of the legislation is on time for and dedication to education as youth's foremost priority. The only areas of state legislative change that could affect children's health and safety in the workplace are a general movement toward monetarily increasing fines and penalties and some minor inclusions of agricultural restrictions on young workers. Enforcement efforts are in all cases a primary indication of state commitment to child labor law protections, and these efforts are decreasing.

Adolescent↗