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PubMed2006

The impact of presumed consent legislation on cadaveric organ donation: a cross-country study.

In the U.S., Great Britain and in many other countries, the gap between the demand and the supply of human organs for transplantation is on the rise, despite the efforts of governments and health agencies to promote donor registration. In some countries of continental Europe, however, cadaveric organ procurement is based on the principle of presumed consent. Under presumed consent legislation, a deceased individual is classified as a potential donor in absence of explicit opposition to donation before death. This article analyzes the impact of presumed consent laws on donation rates. For this purpose, we construct a dataset on organ donation rates and potential factors affecting organ donation for 22 countries over a 10-year period. We find that while differences in other determinants of organ donation explain much of the variation in donation rates, after controlling for those determinants presumed consent legislation has a positive and sizeable effect on organ donation rates. We use the panel structure of our dataset to test and reject the hypothesis that unmeasured determinants of organ donation rates confound our empirical results.

Cadaver↗

PubMed2005

Iodine status as determined by urinary iodine excretion in Lesotho two years after introducing legislation on universal salt iodization.

OBJECTIVE: Mild to severe iodine deficiency has been documented in Lesotho since 1960. To eliminate the persisting iodine deficiency, legislation on universal salt iodization was introduced in 2000 as a long-term public health intervention strategy. We assessed the urinary iodine status of school children and women of child-bearing age in Lesotho 2 y after the introduction of legislation on universal salt iodization. METHODS: A 31-cluster national survey was conducted in 2002 by using the proportion to population size method. In each cluster, 30 women ages 15 to 30 y and 30 primary school children ages 8 to 12 y were randomly selected to provide urine samples for urinary iodine analysis. Data were interpreted according to criteria of the World Health Organization, United Nations Children's Fund, and International Council for Control of Iodine Deficiency Disorders (2001). Statistical analysis was performed using SAS. RESULTS: We analyzed 912 urine samples from children and 924 from women. The median urinary iodine concentrations were 214.7 microg/L for children and 280.1 microg/L for women, indicating more than adequate iodine intake. Median iodine concentration was higher in the lowlands (256.0 microg/L in children and 329.9 microg/L in women) than in the mountains (99.30 microg/L in children and 182.6 microg/L in women). Analysis of the distribution of the data showed values below 50 microg/L in 10.1% of children and in 9.8% of women. In addition, 21.5% of children and 17.9% of women had urinary iodine excretion values below 100 microg/L. In contrast, 36% of children and 47.2% of women had urinary iodine concentrations in excess of 300 microg/L. CONCLUSION: Results of urinary iodine excretion measurements indicated that iodine deficiency has been eliminated as a public health problem in Lesotho. However, the high median urinary iodine concentration of women in the lowlands indicated the possibility of a risk of iodine-induced hyperthyroidism in vulnerable people.

Adolescent↗

PubMed2005

Changes in the EU legislation on Trichinella inspection--new challenges in the epidemiology.

The European Union (EU) countries are searching for new ways to certify meat free of Trichinella; however, with the expansion of the EU, the acceptance of a unilateral method is complicated by the variability of pig and human trichinellosis among EU countries, where significantly higher prevalence rates have been observed in the newly added eastern countries. Several attempts have been made to define Trichinella-free areas, but certification of Trichinella-free pig production farms appears to be the only feasible approach. The increasing prevalence of the non-encapsulating species, Trichinella pseudospiralis, in game, domestic pigs and humans has eliminated the compression technique from the new EU legislation to be enacted in 2006. Also, the observation that several species of Trichinella tolerate freezing in horse meat for up to 4 weeks has forced a change in legislation as well where freezing is no longer an option for certifying horse meat. Because current serological detection methods are not suited for meat inspection, classical direct detection methods and inactivation by freezing remain the methods of choice for pork. It has been proposed, therefore, to automate direct inspection methods as a cost effective alternative to certify pig farms free of Trichinella.

Animal Husbandry↗

PubMedDate not supplied

Are women better off because of the new Medicare drug legislation?

The passage of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 will help to reduce the out-of-pocket burdens women will face in 2006 once the full drug benefit is introduced. Nonetheless, the legislation is less than ideal and creates a number of issues that should be improved to meet women's needs. Three key elements of the legislation that were essential in gaining its passage stand in the way of such improvements: limits on the amount spent on the benefit, requirements to rely on the private sector, and a failure to adequately arrange for future financing. A major overhaul is unlikely, but it is possible that modest improvements to aid Medicare beneficiaries will be considered in the future. Several of those improvements are described here.

Aged↗

PubMed2001

Long-term effects of legislation and local promotion of child restraint use in motor vehicles in Sweden.

The main objective is to study long-term effects of legislation and promotion of child-restraint use in motor vehicles. Subgoals are to describe the level of restraint use in cars and changes in mortality and morbidity patterns in regard to differences among age groups and geographical areas (morbidity). The study areas were; 'The First Four', 'The Six Counties', 'The Rest of Sweden', and 'Sweden as a whole', and the population were two age groups--0-6 and 7-14 years. The incidence of restraint use comes from observations of car-seat-belt usage. Outcome evaluation was based on hospital-discharge data 1978-1996 and mortality statistics 1970-1996. The level of restraint use for children in the front seat was 97% in 1988 and was equal to 1995. Mortality data shows a decrease of 2.8% on an average per year, 76% over the study period. A significant change over time in the two intervention areas was shown (annual changes of -2.8 and -1.8%), but not in the rest of Sweden. The local authorities that started early with preventive programs, such as safety seat loan schemes and those having an organised safety-promotion program showed a much better improvement than the rest of Sweden. There is a need for appropriate information for local action on childhood injury prevention to accompany national legislation.

Accidents, Traffic↗

PubMed1998

Impact of bicycle helmet safety legislation on children admitted to a regional pediatric trauma center.

PURPOSE: The regional pediatric trauma center in Buffalo, NY, has been active in pediatric injury prevention programs, including community education and distribution of bicycle helmets, since 1990. Since June 1, 1994, the use of bicycle safety helmets for children under 14 years of age has been mandated by a state law in New York. The authors undertook this study to assess the impact of this legislation on the frequency of helmet use in children involved in bicycle crashes presenting to the regional pediatric trauma center, and to assess the impact of helmet use on the number and severity of head injuries. METHODS: Bicycle crash victims (n = 208) admitted to a regional pediatric trauma center from 1993 to 1995 were studied retrospectively. Head injuries were classified as concussion alone, skull fractures, intracranial hemorrhages (ie, epidural, subdural, and subarachnoid), cerebral contusions, or diffuse cerebral edema alone (without any other intracranial injury). Helmeted children (HC) were compared with nonhelmeted children (NHC) using chi2 and Fisher's Exact test. P value less than .05 was considered significant. RESULTS: Only 31 children (15%) wore helmets at the time of the crash. Helmet use increased from 2%, during the period of education alone, to 26% after the legislation went into effect (P < .00001). The proportion of children suffering head injuries was similar in both groups (HC, 68%; NHC, 61%; P = NS). However, the type of head injury was different. HC were more likely to sustain concussion alone (HC, 65%; NHC, 44%; P < .03). HC were less likely to have skull fractures (HC, 0%; NHC, 13%; P < .02), and exhibited a trend toward less intracranial hemorrhages (HC, 0%; NHC, 9%; P = NS), cerebral contusions (HC, 3%; NHC, 5%; P = NS), and cerebral edema (HC, 0%; NHC, 0.6%; P = NS). Excluding the isolated concussions, head injuries were noted in only one HC, compared with 30 NHC (P < .04). None of the three children who died wore helmets at the time of the crash, and all died of multiple head injuries. CONCLUSIONS: The bicycle helmet safety law resulted in a 13-fold increase in the use of bicycle helmets among the children admitted to a regional pediatric trauma center after bicycle crashes, but the helmet use remains inadequate. Helmet use reduced the severity of head injuries, and might have prevented deaths caused by head injuries.

Bicycling↗

PubMed1997

Strategies to implement helmet legislation for child bicyclists.

Research in the area of injury prevention has shown that legislation combined with education is the most effective way to increase helmet use in child bicyclists. Legislative activities have been proven to reduce injuries. Nurses can join with other interested stakeholders to form community coalitions, to educate the public, and to influence public policy.

Bicycling↗

PubMed1995

Working conditions, maternity legislation, and preterm birth.

The review of the scientific literature on the role of employment-related physical activity suggests that prolonged standing and long working hours may increase the risk of preterm delivery. Although maternity legislation in many European countries has regulated work schedules and working conditions for pregnant women, none of the European countries except for France seems to have experienced a reduction in preterm rates. France has had both a comprehensive maternity legislation and a national program specifically aimed to reduce preterm birth. Despite the lack of reduction in preterm rates, paid maternity leave, guaranteed job protection, and regulation of hazardous working conditions remain a desirable societal goal for any industrialized nation.

Europe↗

PubMed1979

Comparison of state legislation regarding professional liability.

The so-called malpractice crisis of the mid-1970s alerted physicians to the need for legislative involvement in order to achieve needed malpractice tort reform. There has been a positive effort to modify the medical liability situation in each of our 50 states. A review of this legislative activity from 1975 through 1977 is presented. It is anticipated that a new malpractice crisis may develop during the early 1980s. Actuarial data now being collected plus the effects of such innovations as arbitration, pretrial screening panels, collateral source rules, and periodic funding of malpractice claims may provide an equitable approach to any future malpractice tort reform.

Humans↗

PubMed2000

Inadequate hospital reimbursement for victims of motor vehicle crashes due to health reform legislation.

STUDY OBJECTIVE: Effective for 1997, health reform legislation in New York resulted in a change in hospital reimbursement for victims of motor vehicle crashes. We evaluated the impact of this change from no-fault to Medicaid rates on the financial viability of a regional trauma center within an academic medical center. METHODS: This study represents a retrospective review of the trauma registry for all motor vehicle-related injuries (meeting the statewide definition of trauma) admitted to a regional trauma center for a 9-month period just before the legislation implementation date. Charges, costs, and projected reimbursement were calculated by standard hospital accounting methods. Profit or loss (reimbursement minus costs) was calculated by standard hospital accounting methods for each admission using no-fault and Medicaid reimbursement rates. RESULTS: One hundred seventy-three cases during the 9-month period generated total charges of $4,112,174, total costs of $3,447,110, and estimated total profit of $800,084 ($4,625 per case) using no-fault reimbursement and a total loss of $184,154 ($1,064 per case) using Medicaid reimbursement. For the 31 patients with diagnosis-related groups (DRGs) that were specifically created in New York to ensure adequate reimbursement for multiple significant trauma (730 through 734 and 792 through 794), no-fault reimbursement resulted in an average profit of $371 per case and Medicaid generated a loss of $6,118 per case. Actual payments for the study population were almost $500,000 less than estimated. CONCLUSION: Changes in rates of no-fault insurance payments to hospitals will result in inadequate reimbursement for motor vehicle crash victims admitted to a regional trauma center, undermining the viability of the regional trauma system.

Accidents, Traffic↗

PubMed2000

Experiences from the Danish programme for eradication of bovine virus diarrhoea (BVD) 1994-1998 with special reference to legislation and causes of infection.

The main experiences from the Danish bovine virus diarrhoea (BVD) eradication programme over 5 years from 1994 to 1999 are presented. The last 3 years of the programme has been strongly supported by legislation. The most important regulations have been blood testing of live animals before movement to other herds, common pastures or exhibitions, and monitoring of all herds at regular intervals for the presence of the infection. Nevertheless, free herds have experienced infection, e.g., 204 dairy herds in 1998. Of herds found to be infected in the period from July 1997 through June 1998 after previously having been registered to be BVD-free, 67 herds were thoroughly investigated. Nineteen herds (28%) were found infected because of purchase of pregnant cows or heifers which delivered persistently infected (PI) calves, and 24 (36%) and two (3%) because of PI animals on neighbouring pastures or in neighbouring farm houses, respectively. In five herds (7%) pregnant heifers had become infected on one and the same common pasture, while in 17 herds (25%) no immediate cause of infection could be demonstrated. Yet, airborne spread from PI herds as a source of infection was suspected in some of these cases. It was furthermore concluded from investigations presented, that antibody-positive AI bulls were a remote but unlikely possibility. Free-living deer in Denmark had to be considered uninfected. Presence of PI-animals in sheep on infected farms has been seen and is paid attention to in individual cases. The results underline the need for legislation to be used in eradication programmes in areas with a high prevalence of infection and to be introduced right from the beginning in order to minimise the risk of infection for free herds.

Animal Husbandry↗

PubMed2001

Legislation and regulations addressing workplace violence in the United States and British Columbia.

OVERVIEW: For as long as workers have had contact with customers, coworkers, the public, and others, they have faced risk of assault. However, in the 1980s and 1990s, a number of highly publicized incidents occurred that involved multiple fatalities, and reliable statistics showed homicide to be a major cause of worker deaths. As a result, violence in the workplace became a subject of concern among the public and policymakers. This article reviews a number of legislative and regulatory efforts from the past decade that were designed to prevent violence against employees. Some states and localities have enacted legislation to address specific types of violence in the workplace, such as robbery-related violence, and violence against health care workers and taxi drivers. In addition, the U.S. Occupational Safety and Health Administration (OSHA), as well as a number of state OSHA programs, has attempted to reduce the risk of assault to workers through new and existing statutes and administrative regulations. To provide a contrast with developments in the United States, the author will also discuss requirements for prevention of assault in the workplace in the Canadian province of British Columbia.

British Columbia↗

PubMed2002

Legislative issues. The federal financing and regulation of physical medicine and rehabilitation services.

This article describes major elements in the federal legislative system of the United States affecting the financing and delivery of rehabilitation and related services to persons with disabilities. It deals with existing federal statutory law and regulations, as well as pending legislation dealing with patients rights in health care that has been passed by both bodies in Congress but is not law as of late 2001. The recently revised federal Medicare law financing much of the inpatient hospital rehabilitation and outpatient rehabilitation services is described in detail, as is the Medicare law financing graduate medical education. The article also discusses the Americans with Disabilities Act as it affects PMR professionals and the application of the Stark Physician Referral law as it applies to typical business transactions in the field of physical medicine and rehabilitation services. This information should assist PMR professionals in better understanding the legal regulatory system in which they provide services and support to their patients.

Persons with Disabilities↗

PubMed1995

The politics of patent legislation in biotechnology: an international review.

The realization of the economic value of the genetic resources has prompted an international debate about property rights to genetic resources. The international debate pertaining to patenting of genetic material is the main theme of this chapter. As a backdrop for the international debate, the chapter starts out with a summary of the main events and arguments in the expanding scope of patent legislation in biotechnological inventions. Summing up, the new biotechnologies represent a tool which meets the legal requirements for patenting biological material. From the industry's point of view, biotechnology also necessitates patenting. On the negative side, defending a patent is often a long and costly business, and the trend is that patenting will mainly benefit the bigger and stronger companies and thus weaken public control over the rapid developments in biotechnology. A central argument in the chapter is that without sophisticated biotechnological tools, trained scientists, and adequate infrastructure, patenting is, as yet, hardly a viable solution for the majority of developing countries. Gene-rich developing countries fear that developments in patent legislation will pave the way for increased Northern control over Third World natural resources. The International Convention on Biological Diversity goes some way in making amends to this situation, but the gene-poor, least developed countries may still have reason to fear that they will lose access to breeding material. In a long-term perspective, the implications may be detrimental for resource conservation in developing countries. In conclusion, the patent question seems to remain unresolved and may still be one of the most likely stumbling blocks for future ratifications and implementation of the Biodiversity Convention.

Animals↗

PubMed2004

The new Italian IVF legislation.

Last February, the Italian Parliament gave final approval to a new Law regulating assisted reproduction technology. The new legislation fell short of the expectations of infertile couples and of all specialists in the field. There are three problems with the new Italian law; they involve social issues, human rights and the application of technology. The present paper focuses on the fact that the new rules infringe upon basic human rights and the proper application of IVF technology, because they mandate procedures that are against the best interest of the woman seeking pregnancy. The main point of controversy is the combination of a mandatory limit of three embryos for transfer, and an obligation to reimplant all produced embryos; cryopreservation of excess embryos is prohibited. Obviously, this decreases the chances of most women to achieve pregnancy, while at the same time it increases the number and complexity of procedures they need to undergo and may expose some to an unacceptable increase in the risk of multiple pregnancy. The new law is inspired by the desire to protect every newly produced embryo; this is a commendable aim, although it is in total opposition to a law passed over 25 years ago that liberalized voluntary termination of first trimester pregnancies. This means that today Italy has a law that protects every early, pre-implantation embryo, and another that allows the 'suppression' of every post-implantation one. From a technical point of view, given the low level of human fecundity, the only way to prevent the 'loss' of even one preimplantation embryo is to simply ban IVF altogether, an option that Italian legislators obviously did not have the courage to opt for. The tragedy is that Italian infertile couples are now confronted with new rules that not only severely limit the ability of physicians to correctly apply IVF technology, but are so confused that, depending on the interpretation, anyone may try to nullify the main ideological premise upon which the entire law has been structured.

Embryo Implantation↗

PubMed1993

Making clinical policy explicit. Legislative policy making and lessons for developing practice guidelines.

Promulgation of practice guidelines in medicine has increased interest in the structure of clinical policy making. It is argued that with a generic definition of policy as "the rules governing the behavior of individuals or institutions," clinical policy making is analogous to legislative policy making. Practice guidelines emphasize the advantages of making clinical policy more explicit. The structure of legislative policy making has evolved over many years to meet the challenge of making both the policies and the process of policy making explicit. Processes to promulgate clinical policies may be able to exploit this experience to improve clinical policy making and thereby retain control of the process within medicine. Generic steps are outlined for making decisions with incomplete information; synthesis of facts, vested interests, and values; involvement of stakeholders; and implementation of policy. An illustration of the use of the generic steps to make and implement a clinical policy for cesarean birth follows, with evaluations of its impact on the behavior and satisfaction of clinical stakeholders.

Canada↗

PubMedDate not supplied

Hospital preparedness for chemical accidents: the effect of environmental legislation on health care services.

BACKGROUND: Chemical accidents occur often across the United States, endangering the health and safety of many people. The Superfund Amendments and Reauthorization Act of 1986 (SARA) requires that communities increase their planning for medical response to these accidents. So far, little evidence has come forth that supports the notion that environmental legislation, such as SARA, improves preparedness for such accidents. METHODS: A one-group pretest/post-test longitudinal design was used to survey the medical directors of emergency departments in all acute care hospitals in the State of New York. Data were collected by mail survey and telephone follow-up in 1986 before the passage of SARA (Time1), and in 1989 after its implementation (Time2). RESULTS: Ninety-four percent of the directors responded at Time1 and 72% at Time2. In New York State, hospital preparedness for chemical accidents improved significantly during the study interval. The longer a hospital had a plan for response to chemical accidents, the more elements of preparedness were in place. Further, as a group, the hospitals that were the least prepared were located in the areas at highest risk. CONCLUSION: Environmental legislation can influence the manner by which health care organizations prepare for environmental emergencies.

Accidents, Traffic↗

PubMed1999

[Modular nursing system in pediatric ambulatory care according to nursing insurance legislation XI].

UNLABELLED: In the compulsory nursing insurance according to German legislation, the assessed degree of disablement in children is dependent on their daily quantitative need for nursing care with respect to 19 distinctive items belonging to the four sectors "personal hygiene", "mobility", "nutrition", and "household duties", that exceeds normal age-dependent requirements. In ambulatory nursing, exactly that care is given to the clients. OBJECTIVE: Are there typical combinations of items scoring positively, delivering the basis for a simplified billing schedule? DESIGN AND METHODS: 4500 records from the expert assessment of children < 18 years underwent a hierarchical cluster analysis (SPSS, Ward's method). RESULTS: The resulting dendrogram revealed distinct relationships between items. The items clustered into 4 main groups. Each cluster comprised items with a common thematic relationship (A = household duties, B = mobility, C = personal hygiene, D = nutrition/leaving one's home--scoring positively may indicate extra severe disablement). CONCLUSION: Remarkably enough, the resulting four clusters are very similar to the four sectors as defined by legislation (see above), although each single item is assessed independently. Our results are similar to that found in adults (Michel et al., 1998). Here we deliver the statistical basis for a modularised system of ambulatory paediatric nursing care, or its costing.

Activities of Daily Living↗