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PubMed1999

Factors influencing implementation of the legislated smoking ban on school property in Ontario.

BACKGROUND: Implementation of legislation in Ontario, Canada, that banned smoking on school property gave rise to perceptions of problems in some schools. A telephone survey was conducted to assess these problems. This analysis identifies risk or protective factors in the school environment associated with administrators' reports of problems. METHODS: Survey data were obtained from key informants in 213 high schools. Multiple logistic regression was used to identify school-related characteristics associated with: (1) major problems in implementing the ban and (2) recommendations that schools return to designated smoking areas. RESULTS: A protective factor against both outcomes was having a school no-smoking policy prior to the ban. Also protective against major problems was a perceived decrease in student smoking during the school day. The identification of safety risks to students who leave school property to smoke was a strong risk factor for both outcomes. Beliefs that the ban was not effective and opposition to it from teachers/staff were associated with desires for its repeal. CONCLUSIONS: In implementing legislated school smoking bans, attention should be given to informing teachers and gaining their support. Strategies for dealing with potential safety risks to students who leave school property to smoke should also be devised.

Attitude to Health↗
PubMed1992

Legislative interventions to increase access to screening mammography.

Although numerous studies have established that breast cancer mortality can be significantly reduced through early detection, only a small percentage of women obtain screening mammograms at intervals recommended by the National Cancer Institute, the American Cancer Society, and other major medical organizations. This paper examines the importance of cost as a barrier to routine screening and the state legislative movement to make screening mammography a basic health insurance benefit. Mammography "knowledge, attitudes, and behavior" studies offer conflicting findings on the extent to which cost enters into the decision to have a mammogram. Women seldom report cost as a major reason for postponing or failing to have a mammogram; yet, descriptive studies show a consistently positive relationship between income and mammography use. State mammography reimbursement laws vary greatly with respect to whether screening mammography is a required or optional benefit, payment limits, and eligibility and referral requirements. Although state-specific data on the percentage of women with private health insurance are not available, 1987 National Medical Expenditure Survey estimates for U.S. Census geographic divisions suggest that the New England, East North Central, West North Central, Middle Atlantic, and Mountain states have the highest percentages of women who are privately-insured and, thus, potentially eligible for legislated mammography benefits. Access to screening mammography also is likely to be influenced by the proportion of employer-sponsored health plans that are self-insured and, therefore, exempt from minimum benefit mandates and the extent to which women are aware of the screening coverage.

Adult↗
PubMed1998

Radiation protection legislation.

Recent legislation which has been passed in Europe comprises the Basic Safety Standard (BSS) [1] and the Medical Exposure Directive (MED) [2]. These documents are the implementation of ICRP's report 60 [3], and ICRP publication 73 [4] expands ICRP60 for medical applications. The BSS repeals 80/836/EURATOM and 84/467/EURATOM amongst other EURATOM directives. The MED repeals 84/466/EURATOM, which is the patient protection directive. Member States (MS) are required to implement both the BSS and the MED by the 13 May 2000, and this is where input from individual members of the EANM is very important. Within every MS it is vital to ensure that the key points are debated properly, so that legislation in the countries of Europe is reasonable.

Breast Feeding↗
PubMed2006

Medical-legal issues in headache: penal and civil Italian legislation, working claims, social security, off-label prescription.

Primary headaches can be considered simultaneously as symptom and disease itself, while secondary headaches are expressions of a pathological process that can be systemic or locoregional. Because of its subjective features, headache is often difficult to assess and quantify by severity, frequency and invalidity rate, and for these reasons it has often been implicated in legal controversies. Headache has seldom been considered in the criminal law, except when it represents a typical symptom of a disease whose existence can be objectively assessed (i. e. raised intracranial pressure). Therefore, in civil legislation it is not yet coded to start claiming for invalidity compensation. In particular, one of the most debated medical-legal questions is represented by headaches occurring after head injury. Headache is often the principal symptom at the beginning of several toxic chronic syndromes, with many implications, especially in working claims, and, more recently, it may be referred to as one of the most frequent symptoms by victims of mobbing (i. e. psychological harassment in the workplace). The National Institute for Industrial Accident Insurance (INAIL) scales (instituted by the law 38/2000) mention the "Subjective cranial trauma syndrome" and give an invalidity rate evaluation. With reference to other headache forms, no legislation really exists at the present time, and headache is only considered as a symptom of a certain coded disease. Requests for invalidity social pension and the question of off-label prescriptions (drug prescription for a disease, without formal indication for it) are other controversial matters.

Disability Evaluation↗
PubMed1994

Seat-belt legislation and risk homeostasis: further analysis of the British data.

It has been suggested that seat-belt legislation may result in drivers' feeling overprotected and their consequent riskier driving may lead to more injuries to other road users (the risk homeostasis or compensation theory). We have examined data in Britain before and after legislation made seat-belt use compulsory for front-seat occupants of specified vehicles. The relative numbers of injuries to cyclists and pedestrians in collisions with vehicles requiring and not requiring seat-belt use were compared, using a log-linear analysis taking into account possible confounding variables. It was not possible directly to incorporate vehicle distance travelled for the two categories of vehicle. However, a simple adjustment for differential vehicle use accounted for most of an apparent effect. The revised odds ratio (for mandated seat-belt use vehicles versus nonmandated, post- versus prelegislation) was 1.04 for cyclists and 1.06 for pedestrians, showing minimal, if any, evidence for the theory.

Accidents, Traffic↗
PubMed1994

A time series evaluation of California's 1982 driving-under-the-influence legislative reforms.

This study evaluated the impact of 1982 legislative reforms, including enhanced penalties, greater sentencing uniformity, and the introduction of an illegal per se standard, on California's driving-under-the-influence (DUI) countermeasure system. Intervention time series analysis was used to evaluate the general deterrent effects of these laws, as measured by alcohol-related fatal and injury accident rates, both statewide and in counties sharing similar demographic and enforcement patterns. In combination with the legislative effects, analyses also assessed the significance of prelegislative publicity associated with an emerging antidrunk driving sentiment largely popularized by the formation of Mothers Against Drunk Driving (MADD). Both implementation of the DUI statutes and the publicity and societal dynamics surrounding the creation of MADD were found to be associated with reductions in subsequent alcohol-related fatal and injury accident rates, with evidence of more pronounced effects among injury accidents.

Accidents, Traffic↗
PubMed1993

Does handgun legislation change firearm fatalities?

When comparing firearm fatalities for children under 16 years of age before and after handgun legislation enactment in Maryland, firearm fatalities increased overall. A decrease in accidental deaths in the home perhaps reflects a response to public education and awareness. More aggressive handgun legislation is imperative to reverse this public health trend.

Adolescent↗
PubMed1982

Study of atmospheric pollution in an urban zone deprived of measurement systems, for purposes of legislation application to the city of Tunis.

In order to legislate on and provide against the atmospheric pollution specific to a country in a region deprived of measurement systems, it is first necessary to examine the following points: - location of chief pollution sources, - emission characteristics of the main source, - effects of the source on the environment, - predictable effects of applied legislation. In the city of Tunis for example the road traffic was identified as the major source of pollution. Ways to cut down the pollution level are proposed on the basis of different short-term measurements. Calculation shows that if rules similar to those laid down in France were applied and the traffic flow organised the levels of certain pollutants (CO, NoX) would be substantially reduced.

Air Pollution↗
PubMed1996

Home care policy in the Netherlands. Reforming legislation to facilitate the provision of multi-disciplinary home care.

In the Netherlands, it is considered necessary to provide multidisciplinary home care to meet the demands of a growing number of patients. Existing legislation must be changed to facilitate the provision of such care. Although this has been an important government policy goal for several years, it has been extremely difficult to fundamentally change legislation. This article presents an analysis of the Dutch system of decision-making on government policy, to explain why this is the case. Using theoretical concepts such as 'interdependence' and 'steering', the authors studied empirical data published by the Willems Subcommittee, a governmental advisory body.

Decision Making, Organizational↗
PubMed1995

Current legislation governing clinical waste disposal.

The paper considers UK and EC Legislation regulating clinical waste disposal. The legal definition of clinical waste is distinguished from both 'health care waste' and 'infectious waste'. Waste can be pre-treated so as to enable it to be disposed of through the normal waste stream. The legislation is looked at by reference to (i) production and storage; (ii) handling and transportation; and (iii) disposal. It is vitally important to draw up a waste management strategy. Effective segregation at source is a key factor in the waste management strategy and it will enable hospital authorities to make economic savings in waste disposal costs. The Paper considers the Duty of Care under the Environmental Protection Act 1990 and stresses the obligation on each person in the waste disposal chain to discharge the Duty. Landfilling as a method of disposal is discouraged except for waste where no possibility of infection arises. There are problems with hospital incinerators meeting modern emission standards. Requirements for licensing new incinerators are examined. The new Waste Management Licensing Regulations 1994 require applications for Waste Management Licenses to demonstrate technical and financial competence as 'fit and proper persons'. The Paper concludes by examining penalties for breach of regulatory provisions.

England↗
PubMed1992

The European Community of twelve and the drug demand. Excerpt of a comparative study of legislations and judicial practice.

The imminent birth of a United Europe has called forth a survey of national 'drug' legislations in the twelve member countries of the European Community. Chapters of possible interest and concern to the professions addressed by Drug and Alcohol Dependence are reproduced, the permission for which is gratefully acknowledged. The divergence of concepts and measures embodied in national legislations is staggering--not the least in the light of results of scientific research. The original document CEC/LUX/V/E/1/28/91 is obtainable from the Commission of the European Community, DG V. Building Jean Monet, L-2920 Luxembourg.

Cross-Cultural Comparison↗
PubMed1994

Reproductive medicine--a field of contradictory legislation in Germany.

A brief survey is given on the German legislation concerning reproductive medicine which is contradictory both in juridical and ethical terms. Being under strong ideologic and/or populistic pressure, it favours negative family planning measures such as all kinds of birth control including induced abortion, and handicaps, on the other hand, the more sophisticated procedures of assisted fertilization to overcome infertility. Thus, legal restrictions in this country halt the scientific progress and set back the clinical standard in comparison to our neighbouring countries, all of which are more liberal in their respective legislation.

Ethics, Medical↗
PubMedDate not supplied

The correction of interhospital "dumping" by legislation.

This paper analyzes three years' accumulation of interhospital transfers to the emergency department of University Medical Center in Las Vegas. Seventy-nine percent of the 1,672 patients were classified as inappropriate transfers. The collection rate indicates bad debt write-off charges of approximately one million dollars a year. The Nevada Legislature passed bill AB 289 during the 1987 legislative session, which became effective July 1, 1987. Transfer information shows inappropriate transfers to UMC have been eliminated by this legislation. This paper demonstrates the importance and necessity of being able to control the financial "dumping syndrome."

Academic Medical Centers↗
PubMed1996

Opinions of Dutch dentists on the introduction of new legislation in the field of informed consent. A pilot study.

This article describes the results of four group discussions held with 34 Dutch dentists to examine their opinion on the introduction of new legislation in the field of some patient rights, particularly the duty to inform patients and the patient's authorization of a dental treatment procedure. From all the discussions it appears that most are ignorant of the contents of the legislation. A number of important consequences for the practice are mentioned. Amongst the negative consequences which are often named are: loss of income, a greater time investment per patient, the selection of patients, more insurance claims and an increase in administration and keeping dossiers. The positive remarks that emerge are working with protocols, an increase in the quality of care and a better education of the patient. The discussion draws attention to the legal framework of the dentist-patient relationship, although it is not yet clear how certain aspects will take shape in the daily dental practice.

Adult↗
PubMedDate not supplied

HIV serosurveillance of newborns. A clinician's perspective on legislative, political, and ethical issues.

This article reviews the complex issues surrounding the anonymous HIV testing of newborns to monitor the prevalence of HIV infection in women of childbearing age. This serosurveillance of newborns has become a topic of legislative debate focusing on disclosure of currently anonymous results of HIV antibody tests of newborns, thus revealing the serostatus of the mother. This, in effect, would mandatorily test women without their consent. The discussion includes the following topics: (a) the historical demographics of incidence rates of AIDS, (b) current political and legislative issues raised by serosurveillance, (c) professional and ethical issues confronting health care providers, and (d) why HIV testing of newborns is a mandatory testing of all women of childbearing age. It is recommended that principles of patients right of self-determination be respected, that mandatory testing would be counterproductive and would disproportionately impact on minorities. The integration of education, counseling, and voluntary testing will result in the most effective way to get both women and children into the health care system.

AIDS Serodiagnosis↗
PubMed2006

Bicycle helmet legislation: can we reach a consensus?

Debate continues over bicycle helmet laws. Proponents argue that case-control studies of voluntary wearing show helmets reduce head injuries. Opponents argue, even when legislation substantially increased percent helmet wearing, there was no obvious response in percentages of cyclist hospital admissions with head injury-trends for cyclists were virtually identical to those of other road users. Moreover, enforced laws discourage cycling, increasing the costs to society of obesity and lack of exercise and reducing overall safety of cycling through reduced safety in numbers. Countries with low helmet wearing have more cyclists and lower fatality rates per kilometre. Cost-benefit analyses are a useful tool to determine if interventions are worthwhile. The two published cost-benefit analyses of helmet law data found that the cost of buying helmets to satisfy legislation probably exceeded any savings in reduced head injuries. Analyses of other road safety measures, e.g. reducing speeding and drink-driving or treating accident blackspots, often show that benefits are significantly greater than costs. Assuming all parties agree that helmet laws should not be implemented unless benefits exceed costs, agreement is needed on how to derive monetary values for the consequences of helmet laws, including changes in injury rates, cycle-use and enjoyment of cycling. Suggestions are made concerning the data and methodology needed to help clarify the issue, e.g. relating pre- and post-law surveys of cycle use to numbers with head and other injuries and ensuring that trends are not confused with effects of increased helmet wearing.

Australia↗
PubMed2005

New Belgian legislation regarding the limitation of transferable embryos in in vitro fertilization cycles does not significantly influence the pregnancy rate but reduces the multiple pregnancy rate in a threefold way in the Leuven University Fertility Center.

After the introduction of new Belgian legislation limiting the number of transferable embryos to prevent multiple pregnancies after assisted reproductive technology, the implantation rate per embryo remained stable at 26% and the clinical pregnancy rate per embryo transfer did not change significantly (37.5% before and 32.5% after legislation), whereas the multiple pregnancy rate per clinical pregnancy decreased threefold from 25.9% to 8.0%) in the Leuven University Fertility Center.

Academic Medical Centers↗
PubMed2006

Fault-lines in community treatment order legislation.

This article discusses the major tension points in the legislation that authorises involuntary outpatient treatment for mental disorder in six British Commonwealth jurisdictions. Particular attention is paid to the role of competence (or capacity) principles in the ruling legal criteria, to the precise powers of community treatment conferred, and to the potential impact of the legislation on clinicians' liability concerns. It is argued that the conferral on clinicians of a power to administer 'forced medication' in community settings is not required to promote active use of involuntary outpatient care, and that such a power should not be provided. The article concludes with discussion of the reasons why community treatment orders are used more frequently in some jurisdictions than others.

Ambulatory Care↗