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Finance issue brief: women's health: a legislative overview of selected mandates.

From pregnancy to breast cancer screening and osteoporosis prevention, women have a need for a gender-specific set of health services. Dialogue that once occurred only between women and their physicians has evolved into debate between representatives from the insurance industry and state legislators. Therefore, women's health issues have risen on the legislative agenda, illustrated by the increased volume of bills introduced and enacted during the past five years.

Female↗

[Chemical substances used in plastics intended for manufacture of food packaging in light of European Union legislation].

In the EU countries the use of the chemical substances for plastics intended to come into contact with foodstuffs is regulated by Directive 89/109/EEC and the several specific Directives. Positive lists of the chemical substances for plastics intended to manufacturing of food packaging are placed in Directive 90/128/EEC on plastics materials. This 90/128/EEC Directive so-called "Monomer Directive" has been amended five times by Directives 92/39/EEC, 93/9/EEC, 95/3/EC, 96/11/EC and 99/91/EC. Directive 90/128/EEC so-called "Monomer Directive" provides: list of monomers and other starting substances that can be used in the manufacture of plastics materials and articles, placed in two Sections (A and B), and list of additives initiated from Directive 95/3/EC. Other additives will be added to this list on the basis of their positive national regulatory status in the EU countries and limits of migration (global, specific). According to the EU legislation all the substances before placing on the positive lists are the evaluated and authorized by the scientific bodies (SCF and/or JECFA). The EU legislation on the plastics materials and articles intended to come into contact with foodstuffs will be implemented into Polish law. However all the regulations relating to the chemical substances and limits of migration (global and specific) are already accepted by the National Institute of Hygiene.

European Union↗

[Legislation of ritual slaughtering in Germany since 1933].

The article surveys the development of legislation to the slaughtering of warm-blooded animals in Germany since 1933. It examines the ritual slaughtering of the Jews (Schechita) on the one hand, and of the Moslems (Dabh) on the other hand. While 1933 the legislation was coined by the political situation, after 1949, legal setting and decisions reflected the changing sensibility to animals' protection. Before 1945, Schechita was the matter of legal dispute, more recently, the discussion has centred on the ritual slaughtering of the Moslems, with different arguments. The "Law on the Slaughtering of Animals" of 21-04-33 was part and parcel of the Third Reich's policy against Jews implicating a nation wide practical inhibition of Schechita by decreeing a general obligation of stunning before slaughtering. In 1945, the inhibition of Schechita became invalid after the occupation of the Reich by the Allied Forces. For the first time, the "First Amendment to the Animal Protection Law" of 1986 permitted ritual slaughtering by the way of exception as long as it was covered by the religious obligations. In 1995 the Federal Administrative Court judged that an inhibition of the ritual slaughtering by Moslems could be possible, because there are no religious obligations for Moslems. Nowadays, the ritual slaughtering of the Moslems is, de facto, forbidden, Schechita is performed in some cities for the needs of the residential Jewish population.

Abattoirs↗

[Contribution of Communal Hygiene Department to creation and development of norm-setting basis of water sanitary legislation].

Legal regulation of problems related to drinking water supply to the population is a pressing social problem, particularly during the transitional period of Russian economic development. Communal Hygiene Department participated in the formation and development of norm-setting base of drinking water supply to the population since the thirties. During recent 5 years the Department contributed to development of the "Law on Drinking Water and Drinking Water Supply" (the first in Russia), basic normative legislative acts regulating hygienic requirements to drinking water quality, choice and exploitation of sources of drinking water supply, zones of their sanitary protection, and many methodological documents. The paper sums up the principal basis of new generation documents of sanitary legislation concerning water.

Guidelines as Topic↗

Controlling the processes. Legislation governing decontamination and sterilisation.

Time was, in the not so distant past, that any piece of equipment we wanted to re-use in the Theatre Sterile Services Unit (TSSU) was either autoclaved or 'sterilised' in chemicals. The words 'single use' were virtually never used, and I certainly knew very little about the legislation surrounding the whole issue. Indeed, just a little while further back than that, we used to wash and pack and autoclave whole sets of instruments ourselves (it was a good way of learning the sets for the student nurses!). Now we have the whole issue of traceability and responsibility to consider. Martin Williams discusses some of the legislation and issues arising. I wonder who my Authorised Person is? Do you know yours?

Disposable Equipment↗

[Health protection of workers in the European legislation of the Rome Treaty today].

Occupational hygiene and prevention of occupational accidents and diseases are institutional objectives of the social policy of the European Union as stated in the Treaty establishing the European Community (firstly Treaty of Rome, signed on 25 March 1957). In this report the legislative activity of the European Community aimed at the improvement of the working environment to protect workers' health and safety is considered through its historical development, up to the present situation. The first part of the report briefly describes the Institutions established by the European Community, with specific tasks relating to occupational hygiene and health and safety at work. Then European laws grouped in categories according to their subjects are considered, especially with regard to the development and progress of the legislation, to point out main features and historical trends.

Europe↗

Physicians' attitudes towards patients' rights legislation.

Patients' rights laws, bills and charters aim at delineating the patient-physician relationship in regard to consent to medical treatment, confidentiality and related issues. The need to shape such an intimate relationship by way of legislation seems anomalous to some, but imperative to others. We present for the first time an insight into Israeli physicians' attitudes towards Israel's patients' rights laws, in a changing medical and socio-legal environment. The research results suggest that physicians are reluctant to participate in the implementation of such laws, demonstrated by the level of their misunderstanding of the law's norms and regulations, and subjective attitudes and perceptions. In order to ensure the medical community's participation in augmenting patients' rights, efforts should focus on improved legal and ethical education, enhanced cooperation of professional associations and joint action with legislators to assure a productive composition of these important acts.

Attitude of Health Personnel↗

Has Israel and the Russian Federation legislation a full set of laws securing the protection of mental patients relative to United Nations' proposals and do they require modification?

This paper compares sections of laws dealing with the care and protection of mental patients in Israel and in the Russian Federation and matches them with the 24 recommendations on the subject proposed by the United Nations (UN) in 1988. Particular attention is given to issues related to forensic and ethical subjects. The UN proposals constitute a most laudable reform-inducing guideline for global mental health care systems, especially because of their emphasis on the preservation of mental patients' basic human rights. The proposals' strength springs from their influence regarding the prevention of misuse of psychiatry with focus on the care of inpatients and control over executive agencies. The detailed analysis of the similarities between the Israeli and Russian legislative approach reveals some badly matched organizational structure of many articles in comparison with the UN mandate. Forensic and ethical concepts present in the UN 1988 proposals are well addressed in both the Israeli and Russian mental health legislation. We conclude that the 1991 UN recommendations would demand further modification of the national standards.

Commitment of Persons with Psychiatric Disorders↗

Cost-Shifting from Private to Public Payers: The Scene Before Parity Legislation.

BACKGROUND: Analyses that have been conducted previously on the implications of parity have focused on the concern that mental health costs of private payers will substantially increase. A complete analysis of the cost implications of parity, however, also needs to consider whether the mental health costs of public payers may increase particularly if employers or private insurers attempt to extrude enrollees with severe mental illness. This study examines the extent of mental health cost shifting from private to public payers during two separate two-year periods prior to the implementation of parity legislation. The results of the analyses can serve as a necessary baseline against which the consequences of parity legislation on this direction of cost-shifting can be examined. METHODS: The study utilizes an all payer data set that contains information on the use of specialty mental health services (excluding private practitioners) by adults in an urban and a rural county in New York State. For each year of two time periods -1991/1992 and 1995/ 1996 - consumers were classified into payer groups based on whether their services were paid for by "Private Only", "Public Only", "Private/Public", "Self Pay" or "Other" payers. The proportion of individuals who moved from one payer group to another from one year to the following year of each time period and the average yearly costs under these payers were examined. Logistic regression models were used to identify the characteristics of persons most likely to remain with Private Only Payers in contrast to those likely to shift to Private/Public Only payers or to Public Only Payers. RESULTS: In both two-year time periods, the percent of persons who shifted in one year from Private Only to either Private/Public or Public Only payers was small. In contrast, a person in the Private/Public group has more than a 12 percent likelihood of shifting to a Public Only payer in the subsequent year. The average annual costs of the Private/Public group were higher than that of any other payer group. The average annual costs of persons who shifted into the Private/Public group from any other payer group or remained there from the previous year were even higher. The logistic regression analyses for both time periods showed that persons who shifted from Private Only to Private/Public or Public Only payers in contrast to those who remained with Private Only payers were more likely to have subsidized incomes, be younger and have a mental health disability. In 1995, the likelihood of the shift was also increased for those who were nonwhite and/or had a substance abuse disability. IMPLICATIONS: This study has found that individuals rarely shift directly from private payers to public payers. Rather, they first shift to having services reimbursed by both private and public payers, and during this period their average total service costs are extremely high. Persons who shift from private payers to having at least some of their services paid by public payers in subsequent years appear to be either young employees or young dependents who have severe mental illness or mental illness disabilities. Abusing substances and/or being nonwhite also increase the likelihood of a shift to public payers. Along with parity mandates, there has been an increase in managed care controls. The extent to which these controls will be used to accelerate the movement of these high cost persons from private to public payers needs close watch.

Journal Article↗

Legislative connection: summary on the nursing shortage--March 6, 2002.

The panel was very well received and very informative to the legislators. The nursing shortage crisis in Colorado was succinctly identified. No single solution will fix the nursing shortage. Replacement of registered nurses by unlicensed assistive personnel, or using licensed personnel with less education, will add to increased patient safety issues, provide fewer learning experiences for nursing students, and decrease job satisfaction for current nurses. If a practice that decreases quality of care is put into law as a "quick fix," that standard is very difficult to change. Legislators must listen to experienced nurses so that the decisions they make on health policy will positively influence the nursing shortage issues.

Colorado↗

[Experimental animal research in the EU legislation].

The legislation of the European Union captures experimental animal research only in part. Binding standards can be found in various legal records of the community-legislation, and in particular in the so-called guideline for animal experimentation 86/609/EWG. But these guidelines do not represent an actual animal protection measure but rather one of harmonisation with the primary goal of unification of the regulations of the participating states in order to prevent distortions of competition and trade barriers which could harm the common market. Although the guideline contains some practicable approaches in the direction of an up-to-date animal experimentation law, it only defines general goals which allows for considerable leeway in national implementation within the individual EU countries, and it has only a limited area of legal operation. On the one hand, only vertebrae are being included, and on the other, the law is only being applied in the area of applied research and protects only animals used in product- and substance-development or test procedures as well as those used in the framework of environmental protection. Various important fields of research are thus not subject to a common regulation and are assigned to national regulation. This concerns animal experimentation in education and training or for military or so-called defence-relevant medical purposes and, in particular, the whole area of basic research including the field of genetic engineering in animals with it's growing significance. The guideline is in need of widening it's scope of application as well as of various adjustments to recent scientific findings and developments in order to become suitable as a more restrictive animal protection law on the community level. It could also be desirable to include animal protection into the catalogue of community-goals in order to make it an independent component of the politics of the Union and to establish the groundwork for a decree of comprehensive and efficient regulations.

Animal Rights↗

[No entry: legislation concerning immigration in France, the United Kingdom, and the United States].

"Recent developments in the legislation on immigration and nationality in France (1980-1986), in Britain (1981 and 1988) and in the United States (1986) are set in historical perspective in order to throw light on the legislators' choices in these three countries. The analysis shows common points in the definition of the problems to be dealt with and in the nature of solutions envisaged in a context of economic crisis: 'closing' the borders or specifying 'acceptable' types of immigrants and redefining the means for their integration. Some important distinctions are however highlighted, which can largely be explained by the different histories, particularly colonial, of the three countries studied." (SUMMARY IN ENG)

Americas↗

Assessment of public opinion on legislation to deter drunk driving.

Existing legislative measures on blood-alcohol control of drivers failed to show a substantial effect in reducing the incidence of crash injury and mortality. Recently, a government initiative to limit locations and operating time (service hours) of nighttime entertainment venues was introduced. A telephone interviewed-survey of 500 random-samples to assess public opinion on the initiative and other legislative measures was conducted in Bangkok. The results showed that 88 per cent of the respondents supported the idea of prohibiting alcohol sale to youngsters aged <21 years old and 91 per cent agreed to limit the operating time of pubs, bars and nightclubs to no later than 2 a.m. The majority asserted that laws against drink driving were seldom enforced. More than half of the respondents agreed with the ideas of restricting medical care benefit for injured drunk drivers, and of prosecuting the related alcohol-sellers. Eighteen per cent of male respondents had drunk alcohol and driven in the past one month. A telephone survey is an efficient tool for providing timely information for policy decisions. More stringent enforcement of laws against drunk drivers should be implemented in parallel with traffic safety programs and other social control initiatives.

Adolescent↗

Coroner's Rule 9 is necessary for health protection: implications of possible legislative changes concerning the use of human organs and tissues.

Legislation around the retention and use of human organs and tissues is currently being reviewed to ensure that there is an appropriate emphasis on consent, human dignity and sensitivity towards bereaved relatives. In a public health emergency such as an outbreak of severe unexplained illness, the priorities are to treat the affected and prevent further cases. Human tissue retention can have a vital role to play and there may be a conflict of interest between individual and public health needs. It is essential to ensure that any legislative changes are compatible with effective and efficient responses to public health emergencies.

Disease Outbreaks↗

[Legislative Decree 25 of 2/2/2002: prevention of chemical agents risks].

The Authors, with the present contribution, illustrate and comment the recent legislation aimed to protect workers from risks due to chemical agents and compare it with the previous legislation. A careful analysis makes it clear the urgent need to realize optimal safety standards for workers in the chemical industry, in order to protect them from avoidable risks.

Chemical Industry↗

Animal transport needs reasonable legislation.

The paper describes practical problems of animal trade. It is written from the point of view of an animal breeding organisation and does therefore not discuss in detail physiological indicators or the development of the EU legislation in that field. Based on the practical experiences it is assumed that animals can be transported in a reasonable and responsible way, without significant and long lasting negative effects, even over long distances. The current rules for animal transport in the EU, which have been developed between 1991 and 1998 still show serious shortcomings as they appear to have been laid down prematurely and in the absence of sufficient scientific knowledge. The paper points to some of the shortcomings and provides for proposals to change the current legislation: Unloading and loading at staging points should be dropped, loading densities should be derived from practical experience, driving and resting times for animals and driver must be harmonised, the regulation of staging points needs to be simplified and the control and sanctioning system must be uniform and transparent.

Animal Welfare↗

A comparison of firearms--related legislation on four continents.

Firearms are produced in great quantities. Their use is universal, widespread and often lethal. The control and supervisory systems of these weapons differ from country to country and are an expression of specific attitudes and cultural trends of each society on the subjects of individual rights, violence and the meaning of firearm possession. This paper presents a comparative study of firearm use legislation of four different countries in four different areas of the world (Sweden, United States, Japan and Israel). Particular attention will be paid to the traditions and cultural characteristics underlying the differences in legislative approach.

Cross-Cultural Comparison↗