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PubMed2004

Vision screening for children: current trends, technology, and legislative issues.

PURPOSE OF REVIEW: The purpose of this review is to examine current trends in vision screening for children. RECENT FINDINGS: Literature within the past year regarding children's vision screening has been dominated by clinical validation studies of autorefractors or photoscreeners that allow the detection of amblyogenic refractive errors, misalignment of the eyes, or media opacities. New technologies reported include wave-front analysis for amblyogenic factors and a visual evoked potentials-based screening tool for the preverbal child. Studies evaluating the goals of the screening program, the target population, and the physical limitations of the screening environment have prompted multipronged or hybrid studies designed to more accurately detect vision problems, particularly in the preschool child, in whom cooperation and cognitive development affect reliability of results. State and federal legislation in the United States has been proposed or adopted to regulate and partially fund pediatric vision screening and comprehensive examinations. SUMMARY: Through improvements and new developments in technology, study design, the efforts of organized medicine, and legislative initiatives, vision screening for children continues toward the goal of bringing all children with eye disease or vision problems to treatment in a timely fashion.

Child↗

PubMed2006

Impact of new legislation on presumed consent on organ donation on liver transplant in Singapore: a preliminary analysis.

Demand for the liver organ for transplantation vastly exceeded the availability of deceased donor organs. A new law, the revised Human Organ Transplant Act (HOTA), was implemented in Singapore in July 2004, which allowed for recovering four organs, including liver, for transplant unless the deceased give objection prior to their demise. We set to study the impact of the revised legislation by comparing the number of potential suitable donors, liver recovery surgery, and liver transplants two years before and one year after the implementation. There was no change in the number of suitable donors, but there was an increase in the number of liver recovery surgeries and liver transplantation, and a lower refusal rate among suitable donors. Although the revised legislation helped improve the availability of deceased donor organs moderately, other nonlegislative, supplementary measures are needed to further improve the low organ donation rate.

Female↗

PubMed1997

The politics of "Drive-through deliveries": putting early postpartum discharge on the legislative agenda.

Since May 25, 1995, twenty-nine states have adopted "early discharge" legislation or comparable regulations, mandating insurers to cover minimum postpartum hospital stays. The topic of early discharge moved onto the agenda with notable speed, despite a lack of empirical evidence to support either those insurers who reduced the postpartum length of stay for mothers and babies or the new statutes that protected their right to longer stays. The new laws' simplicity and low cost as unfunded mandates accounted for much of their appeal, as did the symbolic power of the issue to doctors and patients, frustrated by managed care. Emotional constituent anecdotes, unsupported by definitive research findings, also influenced legislators.

Health Policy↗

PubMed2006

Does being against euthanasia legislation equate to being anti-euthanasia?

This study investigated issues raised in qualitative data from our previous studies of health professionals and community members, which suggested that being opposed to euthanasia legislation did not necessarily equate to being anti-euthanasia per se. A postal survey of 1002 medical practitioners, 1000 nurses and 1200 community members was undertaken. In addition to a direct question on changing the law to allow active voluntary euthanasia (AVE), four statements assessed attitudes to euthanasia with or without a change in legislation. Responses were received from 405 doctors (43%), 429 nurses (45%) and 405 community members (38%). Compared with previous studies there was a slight increase in support for a change in the law from medical practitioners, a slight decrease in support from community members and almost no change among nurses. Different interpretations of the results of the four attitude questions are possible, depending on the perspective of the interpreter.

Adult↗

PubMed2006

Health services research as a source of legislative analysis and input: the role of the California Health Benefits Review Program.

This article examines the role of the California Health Benefits Review Program (CHBRP) as a source of information in state health policy making. It explains why the California benefits review process relies heavily on university-based researchers and employs a broad set of criteria for review, which set it apart from similar programs in other states. It then analyzes the politics of health insurance mandates and how independent research and analysis might alter the perceived benefits and costs of health insurance mandates and thus political outcomes. It considers how research and analysis is typically used by policy makers, and illustrates how participants inside and outside of state government have used the reports prepared by CHBRP as both guidance in policy design and as political ammunition. Although there is consensus that the review process has reduced the number of mandate bills that are passed out of the legislature, both supporters and opponents favor the new process and generally believe the reports strengthen their case in legislative debates over health insurance mandates. The role of the CHBRP is narrowly defined by statute at the present time, but the program may well face pressure to evolve from its current academic orientation into a more interactive, advisory role for legislators in the future.

California↗

PubMed2000

The impact of legislation on psychotropic drug use in nursing homes: a cross-national perspective.

OBJECTIVES: To quantify the impact of legislation on nursing home residents, psychotropic drug use, and the occurrence of falls in the US compared with five countries with no such regulation. DESIGN: A retrospective cross-sectional study SETTING: Nursing homes in five US states and selected nursing homes in Denmark, Iceland, Italy, Japan, and Sweden. PARTICIPANTS: Residents in nursing homes in five US states and the aforementioned countries during 1993-1996. MAIN OUTCOME MEASURES: Using data collected using the Minimum Data Set, logistic regression provided estimates of the legislative effects on the use of antipsychotics and antianxiety/hypnotics while simultaneously adjusting for potential confounders. The occurrence of falls was evaluated similarly. RESULTS: Prevalence of antipsychotic and/or antianxiety/ hypnotic use varied substantially across countries. After adjustment for differences in age, gender, presence of psychiatric/neurologic conditions, and physical and cognitive functioning, residents in Denmark, Italy, and Sweden were at least twice as likely to receive these drugs (Denmark Odds Ratio (OR)=2.32; 95% Confidence Intervals (CI), 2.15-2.51; Italy OR=2.05; 95% CI, 1.78-2.34; Sweden OR=2.50; 95% CI, 2.16-2.90); in Iceland, the risk was increased to greater than 6 times (OR=6.54; 95% CI, 5.75-7.44) that of the US. Residents were less likely to fall in Italy, Iceland, and Japan compared with the US, despite more extensive use of psychotropic medication, whereas residents in Sweden and Denmark were more likely to fall. CONCLUSIONS: Policy has had an impact on the prescribing of psychotropic medication in US nursing homes compared with other countries, but it is unclear if this is translated into better outcomes for residents.

Accidental Falls↗

PubMed1998

Reconsidering genetic antidiscrimination legislation.

In response to the awareness that genetic discrimination is a significant problem, many states have passed or are passing legislation regulating the use of genetic information. Authors discuss the weaknesses as well as the strengths of such legislation, and recommend that the laws be redrafted to prohibit discrimination on the basis of any type of predictive medical information.

Civil Rights↗

PubMed1995

Implications of health and safety legislation for the professional sportsperson.

There are a large number of injuries in most professional sports every year, and research interest has usually centred around the medical aspects of these injuries. However, health and safety legislation also applies to professional sport, and it is important, as with any other occupation, to understand the underlying causes of the incidents leading to the injuries and to take steps to minimize future injuries. The introduction of the Management of Health and Safety at Work Regulations 1992 formalized a risk assessment approach to health and safety issues; an approach that has always been implicit in the Health and Safety at Work etc. Act 1974. This review assesses how the relevant UK health and safety legislation impacts on the professional sportsperson.

Accidents, Occupational↗

PubMed2005

Legislation for smoke-free workplaces and health of bar workers in Ireland: before and after study.

OBJECTIVES: To compare exposure to secondhand smoke and respiratory health in bar staff in the Republic of Ireland and Northern Ireland before and after the introduction of legislation for smoke-free workplaces in the Republic. DESIGN: Comparisons before and after the legislation in intervention and control regions. SETTING: Public houses in three areas in the Republic (intervention) and one area in Northern Ireland (control). PARTICIPANTS: 329 bar staff enrolled in baseline survey; 249 (76%) followed up one year later. Of these, 158 were non-smokers both at baseline and follow-up. MAIN OUTCOME MEASURES: Salivary cotinine concentration, self reported exposure to secondhand smoke, and respiratory and sensory irritation symptoms. RESULTS: In bar staff in the Republic who did not themselves smoke, salivary cotinine concentrations dropped by 80% after the smoke-free law (from median 29.0 nmol/l (95% confidence interval 18.2 to 43.2 nmol/l)) to 5.1 nmol/l (2.8 to 13.1 nmol/l) in contrast with a 20% decline in Northern Ireland over the same period (from median 25.3 nmol/l (10.4 to 59.2 nmol/l) to 20.4 nmol/l (13.2 to 33.8 nmol/l)). Changes in self reported exposure to secondhand smoke were consistent with the changes in cotinine concentrations. Reporting any respiratory symptom declined significantly in the Republic (down 16.7%, -26.1% to -7.3%) but not in Northern Ireland (0% difference, -32.7% to 32.7%). After adjustment for confounding, respiratory symptoms declined significantly more in the Republic than in Northern Ireland and the decline in cotinine concentration was twice as great. CONCLUSION: The smoke-free law in the Republic of Ireland protects non-smoking bar workers from exposure to secondhand smoke.

Cotinine↗

PubMed1992

Legislation on euthanasia: recent developments in The Netherlands.

Recently, new developments took place in the Dutch debate on the legislation of euthanasia. After a brief account of that debate, the article discusses a new government proposal for legislation in this field, which was submitted to the Dutch parliament in November 1991. This proposal relates not only to euthanasia but also to some other medical decisions concerning the end of life. The author concludes that, for several reasons, it is unsatisfactory.

Euthanasia↗

PubMed2006

Impact of privacy legislation on the number and characteristics of people who are recruited for research: a randomised controlled trial.

BACKGROUND: Privacy laws have recently created restrictions on how researchers can approach study participants. METHOD: In a randomised trial of 152 patients, 50-74 years old, in a family practice, 60 were randomly selected to opt-out and 92 to opt-in methods. Patients were sent an introductory letter by their doctor in two phases, opt-out before and opt-in after introduction of the new Privacy Legislation in December 2001. Opt-out patients were contacted by researchers. Opt-in patients were contacted if patients responded by email, free telephone number or a reply-paid card. RESULTS: Opt-in recruited fewer patients (47%; 43/92) after invitation compared with opt-out (67%; 40/60); (-20%; [-4% to -36%]). No proportional difference in recruitment was found between opt-in and opt-out groups varied by age, sex or socioeconomic status. The opt-in group had significantly more people in active decision-making roles (+30%; [10% to 50%]; p = 0.003). Non-significant trends were observed towards opt-in being less likely to include people with lower education (-11.8%; [-30% to 6.4%]; p = 0.13) and people who were not screened (-19.1%; [-40.1% to 1.9%]; p = 0.08). Opt-in was more likely to recruit people with a family history of colorectal cancer (+12.7%; [-2.8%, 28.2%]; p = 0.12). CONCLUSIONS: The number of participants required to be approached was markedly increased in opt-in recruitment. Existing participants (eg, screening attendees) with a vested interest such as increased risk, and those preferring an active role in health decision making and with less education were likely to be recruited in opt-in. Research costs and generalisability are affected by implementing privacy legislation.

Age Factors↗

PubMed1996

The legislation of active voluntary euthanasia in Australia: will the slippery slope prove fatal?

At 2.00 am on the morning of May 24, 1995 the Northern Territory Legislative Assembly Australia passed the Rights of the Terminally Ill Act by the narrow margin of 15 votes to 10. The act permits a terminally ill patient of sound mind and over the age of 18 years, and who is either in pain or suffering, or distress, to request a medical practitioner to assist the patient to terminate his or her life. Thus, Australia can lay claim to being the first country in the world to legalise voluntary active euthanasia. The Northern Territory's act has prompted Australia-wide community reaction, particularly in South Australia, Tasmania and the Australian Capital Territory where proposals to legalise euthanasia have already been defeated on the floor of parliament. In New South Wales (NSW) the AIDS Council of NSW has prepared draft euthanasia legislation to be introduced into the Upper House as a Private Member's Bill some time in 1996. In this paper, we focus on a brief description of events as they occurred and on the arguments for and against the legalisation of euthanasia which have appeared in the media.

Adult↗

PubMed2003

Knowledge of the legislation governing proxy consent to treatment and research.

OBJECTIVE: To assess the knowledge of four groups of individuals regarding who is legally authorised to consent to health care or research involving older patients. DESIGN: A provincewide postal survey. SETTING: Province of Quebec, Canada. PARTICIPANTS: Three hundred older adults, 434 informal caregivers of cognitively impaired individuals, 98 researchers in aging and 136 members of research ethics boards (REBs). MEASUREMENTS: Knowledge was assessed through a pretested postal questionnaire comprising five vignettes that describe hypothetical situations involving an older adult who requires medical care or is solicited for research. The respondent had to identify the person who is legally authorised to provide consent. RESULTS: Nearly 80% of all respondents provided the correct answer when the hypothetical scenario depicted a person who was competent to consent or incompetent but legally represented. Knowledge was worse (from 2% among older adults to 44% among REB members) for the scenario describing a research situation that involved an incompetent adult without a legal guardian. CONCLUSION: The observed lack of knowledge raises doubts about the ability of current legislation to truly protect the rights of older adults with diminished decision making capacity. It points to the need for educational programmes aimed at increasing public awareness of the legislation put in place for those requiring special protection.

Aged↗

PubMed1983

Symposium 1: The Arthur case--a proposal for legislation.

Following the acquittal of Dr Leonard Arthur in the case of the Down's syndrome infant the co-authors of the first paper in this symposium prepared a draft bill on the treatment of chronically disabled infants which has since been informally commended by the Director of Public Prosecutions. A second contributor, a law student, also argues for legislation as being the most effective way for society to have its standards clarified and observed. In a final paper Dr Havard, Secretary of the British Medical Association, opposes legislation believing it would raise far more problems than it would resolve. The first article was originally published in the Law Society's Gazette.

Down Syndrome↗

PubMed1984

Two decades of involuntary hospitalization legislation.

In 10 of the 13 cases the author examined, after passage of a state statute affecting involuntary admission to state psychiatric hospitals the percentage of involuntary admissions changed significantly in the direction intended by the legislature. The findings support the hypothesis that state laws significantly influence involuntary admission rates and, consequently, clinical practice. The findings also demonstrate that legislative intent in the late 1960s and early 1970s supported restriction of involuntary hospitalization and that a move toward liberalization of its use occurred in the late 1970s. The author recommends greater involvement by psychiatrists in the formulation of legislation that has an influence on their clinical work.

Attitude of Health Personnel↗

PubMed1998

Consultant psychiatrists' knowledge of mental health legislation in Scotland.

There has been increasing concern recently over an apparent lack of knowledge of mental health law among psychiatrists and other medical practitioners involved in its use. This has been particularly highlighted by the introduction of new and complex legislation intended to facilitate care in the community. As a result of findings from previous studies of other groups of medical practitioners in Scotland, a national survey of consultant psychiatrists working there was undertaken to determine their level of understanding of the statutory provision for the care of the mentally disordered. A purpose-designed instrument was used at interview with 72 consultants chosen at random from all psychiatric specialties. Their knowledge of even the most basic definitions and fundamental areas was limited, with only just over half being able to give the correct title of one relevant piece of legislation and only one in 10 being able to define mental disorder in terms of the Act. Otherwise knowledge was generally patchy. Greater emphasis should be placed upon training in mental health law for consultant psychiatrists in general, as the findings are unlikely to reflect purely localized patterns. Attitudes to the use of compulsory measures also need to be addressed.

Commitment of Persons with Psychiatric Disorders↗

PubMed2002

Injuries among female army recruits: a conflict of legislation.

In the final decade of the 20th century, the British Armed Forces came under intense pressure to open up traditionally male roles to female recruits. For training, women were initially given lower entry and exit standards, but it became apparent that many did not possess the strength necessary for their work. This 'gender fair' policy was therefore changed to a 'gender free' policy, whereby identical physical fitness tests were used for selection of male and female recruits and the training programme made no allowances for gender differences. To determine the effects of this policy change, data from medical discharges were examined for the periods before and after implementation, with reference to musculoskeletal injuries of the lower limbs. In the first cohort there were 5697 men and 791 women, in the second 6228 men and 592 women. The cross-gender (F/M) odds ratio for discharges because of overuse injury rose from 4.0 (95% CI 2.8 to 5.7) under the gender-fair system to 7.5 (5.8 to 9.7) under the gender-free system (P=0.001). Despite reducing the number of women selected, the gender-free policy led to higher losses from overuse injuries. This study confirms and quantifies the excess risk for women when they undertake the same arduous training as male recruits, and highlights the conflict between health and safety legislation and equal opportunities legislation.

Adolescent↗

PubMed1990

Road traffic accidents before and after seatbelt legislation--study in a district general hospital.

Injuries among samples of car accident cases attending the Accident & Emergency (A & E) department of a District General Hospital (DGH) in the year before and after the introduction of seat belt legislation were classified applying the Abbreviated Injury Scale using information recorded in the patient case notes. Those who died or did not attend an A & E department were not included in the sampling frame. The number of those who escaped injury increased by 40% and those with mild and moderate injuries decreased by 35% after seatbelt legislation. There was a significant reduction in soft tissue injuries to the head. Only whiplash injuries to the neck showed a significant increase.

Abbreviated Injury Scale↗