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PubMed2006

Radiation protection and safety in medical use of ionising radiation in Republic of Bulgaria--harmonization of the national legislation with Euratom directives.

From February 2002 to November 2003 the National Centre of Radiobiology and Radiation Protection conducted a PHARE twinning project 'Radiation Protection and Safety at Medical Use of Ionising Radiation'. The main purposes of the project were the harmonization of Bulgarian legislation in the field of radiation protection with EC Directives 96/29 and 97/43 Euratom, and the establishment of appropriate institutional infrastructure and administrative framework for their implementation. This paper presents the main results of the project: elaboration of Ordinance for Protection of Individuals from Medical Exposure; performance of a national survey of distribution of patient doses in diagnostic radiology and of administered activities in nuclear medicine and establishment of national reference levels for the most common diagnostic procedures.

Bulgaria↗
PubMed1981

Physicians' opinions toward legislation defining death and withholding life support.

We explored attitudes and practices of Alabama physicians regarding two bills considered in the 1978 State Legislature. One bill defined death to permit the withdrawal of life supports; the other permitted the cessation of active treatment when demanded by terminal patients. Members of the Medical Association of the State of Alabama (MASA) in practices permitting independent action in such cases composed the sample. Twenty percent of 1,300 questionnaires were returned. Most participants idealistically resented legislative interference but realistically were resigned to or welcomed legal clarification of physicians' rights and responsibilities. Respondents encountering demands for life-support withdrawal generally acceded, usually after consultation with family and/or colleagues. Most used analgesics to control pain, if necessary, even to a point compromising respiration. Most considered withdrawal of life support, and most approved of "living wills." Alabama physicians are in the mainstream of American medicine in this area of bioethical concern.

Alabama↗
PubMed1983

Historical review of legislative and national initiatives for sickle cell disease.

The genes responsible for the transmission of sickle cell syndromes from one generation to the next were introduced into the new world during the 17th century. However, this disease was not recorded in the medical literature in the United States until 1910 by Herrick of Chicago. During the next 40 years, many additional cases were reported and a fairly large bibliography developed which dealt essentially with descriptive, clinical and pathological aspects of the disease. New interest in the syndrome occurred in 1949 when Pauling and his associates, employing chemical and electrophoretic techniques, showed that an abnormal hemoglobin was responsible for the sickling phenomenon. In the same year, Neel and Beet, working independently of each other, clarified the inheritance of the disease on the basis of the heterozygous-homozygous hypothesis. In 1958, Ingraham combined the techniques of electrophoresis, chromatography, and trypsin digestion ("fingerprinting") to show that the difference between hemoglobins A, C, and S was in the amino acid sequence of the polypeptide chains which make up the hemoglobin molecule. However, despite these notable advances, interest in the disease remained at a relatively low scientific and health care priority until February 1971, when President Nixon in his message to Congress indicated that greater attention and support for sickle cell disease should be made available at the national level. This paper will review some of the important legislative, political, and organizational initiatives which have had a significant impact on the development and implementation of the current national sickle cell disease program in the United States.

Anemia, Sickle Cell↗
PubMed1977

The effects of seat belt legislation on road traffic injuries.

The compulsory wearing of seat belts, first introduced in the world in Victoria in 1970, has effectively reduced the number of deaths and injuries by approximately one-third for car occupants involved in motor vehicle crashes. Initially, the legislation did not apply to children under the age of eight years, but in 1975 a further law was introduced banning children from the front seat of any vehicle unless properly harnessed. Seat belts offer the best protection for front seat drivers and passengers involved in frontal impacts, but offer less protection to the recipient of a side impact. Ten per cent of car occupants admitted to hospital after a frontal impact show injuries, mostly minor, directly attibutable to the wearing of seat belts.

Accidents, Traffic↗
PubMed1979

Abdominal injuries in survivors of road trauma before and since seat belt legislation in Victoria.

At St Vincent's Hospital, Melbourne, the number of patients admitted annually with road crash injuries has remained almost constant for the past 14 years. Comparing admissions in the seven years before and during the seven years since enactment of seat belt legislation in Victoria, there has been no change in the proportion of those admitted with abdominal injuries, in the number of associated non-abdominal severe injuries, or in the death rate of those admitted with abdominal injuries. There has, however, been a significant increase in the number of patients admitted with injuries of the gastrointestinal tract and diaphragm. It is suggested that this increase is due to incorrect wearing of the lap component of seat belts with resulting acute abdominal compression.

Abdominal Injuries↗
PubMed1978

Legislation: regulation and strangulation or option for innovation?

Frequently, we in the health professions are reactive (or even reactionary) in response to the evolutions and revolutions in our system of health care. In fact, at times the best that can be said for us is that we are responsive (and we hope, responsible) to the need for change. I would suggest that we must be innovative in dealing with the plethora of health legislation.

Humans↗
PubMed1985

Brief history of Italian psychiatric legislation from 1904 to the 1978 Reform Act.

A brief survey is given of the evolution of Italian psychiatric legislation. The following acts are examined: the 1904 law, stating that people affected by mental derangement must be kept in custody and treated in mental hospitals when they are dangerous to themselves or to others or create public scandal; the 1909 regulations, in which various aspects of mental hospital organization are dealt with; the 1968 law, sanctioning the institution of voluntary admission; the 1978 Reform Act. It is emphasized that the 1978 Italian mental health law is the only one, in the Western industrialized world, in which: 1) patient's dangerousness is not used as a criterion for commitment, and compulsory admission is restricted to therapeutic emergency cases; 2) it is established that compulsory admission of psychiatric patients must be implemented in general hospitals; 3) prolonged hospitalizations are discouraged, by stating that compulsory treatment should last as a rule seven days; 4) it is sanctioned the abolishment of mental hospitals. Moreover, stress is laid on the law's attention to community-based facilities, described as the places in which preventive, therapeutic and rehabilitative interventions relevant to mental diseases should be implemented as a rule.

History, 20th Century↗
PubMed1986

Eye injuries in Northern Ireland two years after seat belt legislation.

Two hundred and forty-six patients with ocular perforation were treated at the Royal Victoria Hospital, Belfast, between 1 February 1981 and 31 January 1985. Road traffic accidents were responsible for 63 injuries, all of which affected front seat occupants, and 45 occurred before implementation of the seat belt law on 1 February 1983. Following legislation there was a 60% reduction in ocular injuries, which confirms the protective effect on front seat occupants of wearing a seat belt.

Accidents, Traffic↗
PubMed1986

AIDS legislation--turning up the heat?

This paper is not about the medical condition of AIDS. Nor is it about the history of the condition since it was first reported in Atlanta, Georgia in 1981. It looks rather, at the catalogue of legislative and other legal responses to the spread of AIDS. The paper analyses the AIDS condition in its historical context. The hysteria accompanying the outbreak of AIDS is contrasted with the similar hysteria associated with other previous epidemics experienced in Australia over the past two centuries. The paper categorises the responses of lawmakers to the condition, according to the approach taken; from 'full blast', through 'moderate heat' to 'low key' or an attempt to avoid or minimise legal intervention. It is suggested that the appropriate response should depend upon such factors as the present magnitude of the condition, its likely future course, the availability of cures and protections against its spread and objectives being sought by intervention. Unless these factors are taken into account gross over-reaction can occur, causing social disruption and much personal injustice.

Acquired Immunodeficiency Syndrome↗
PubMed1978

Dying while living: a critique of allowing-to-die legislation.

Several US states are enacting 'right-to-die' laws, in the wake of the Karen Quinlan case. But the way such a law is drafted may cast doubt on a patient's existing common law right to control all aspects of his own treatment; it may give legal sanction to a lower standard of medical care that society at present expects from doctors; and it may lead to conflict between the patient's directive and his doctor's clinical judgement which cannot readily be resolved. The laws themselves are categorised as a) legalising active killing or b) defining rights of patients to control treatment or c) assigning to others the rights to control treatment where the patient is not competent. The California law is discussed critically. The conclusion is that such legislation is not a satisfactory answer to the ethical problem of euthanasia.

Adult↗
PubMed1976

Syphilis, homosexuality and legislation.

The proportion of cases with fresh syphilis in males contracted by homosexual contacts in Helsinki before and after the change of the criminal law in 1971 was studied. Since 1971, homosexuality is by law no longer a crime in Finland. In 1964, only 2% of males with fresh syphilis admitted a homosexual contact. The same figure was 8% in 1970, and increased to about 50% in 1974 and 1975. It was concluded that a change of legislation concerning homosexuality, probably by several different routes, changed the proportion of cases of detected homosexually transmitted early syphilis. This was thought to be of special importance for case finding and controlling of the spread of syphilis.

Finland↗
PubMed1992

Judicial and legislative responses to cost containment.

Cost containment through reduction of insurance benefits and aggressive utilization review is increasingly risking the sacrifice of good clinical care in the pursuit of financial objectives. This article provides examples of judicial and legislative responses to perceived fiscal intrusions into clinical practice. Principles for asserting clinical goals in the cost containment process are also provided to assist in the inevitable negotiations and battles ahead.

Adult↗
PubMed1977

Obtaining state legislation for insurance coverage of day hospitalization.

Whether a patient receives treatment in a 24-hour inpatient setting or a less restrictive day hospital program often depends strongly on what kinds of care the patient's health insurance policy covers. In 1974 advocates of partial hospitalization programs in Maryland began working for a state law requiring third-party payers to provide day hospital benefits to all policyholders. After realizing that the bill as drafted would not pass the legislature, its advocates negotiated with insurance carriers, legislators, and others. The bill was rewritten so that day hospital coverage must be offered as an option in group policies only, and at an adjusted premium if necessary. It was enacted into law in 1976 and became effective in January 1977.

Day Care, Medical↗
PubMed1999

Teaching students about nursing and the environment: Part 2--Legislation and resources.

This 2-part series is designed to assist faculty in teaching students about the impact of the environment on health. Part 1 (Gerber & McGuire, 1999/this issue) provides historical background, the role of nursing, a basic curriculum, and student learning activities. Part 2 presents national environmental health objectives, pertinent legislation, organization of environmental health services, global environmental health, and student learning activities. We designed the material to be practical, so that this critical area becomes a routine part of assessment data for nurses as they care for clients.

Education, Nursing↗
PubMed1984

Congressional voting behavior on hospital legislation: an exploratory study.

This paper analyzes Congressional voting behavior on the Gephardt Amendment to President Carter's hospital cost containment legislation. The impact of opposing interest groups is examined: on one side were hospital and medical interest groups; on the other was the Carter Administration and its political party, as well as states with large Medicaid expenditures. The effect of political contributions from MEDPACs is evaluated, and the relative importance of various factors affecting the vote's outcome is analyzed.

Cost Control↗
PubMed1993

The cost of ethics legislation: a look at the Patient Self-Determination Act.

The Patient Self-Determination Act (PSDA) requires hospitals to ask patients upon admission whether they have an advance directive. Although the PSDA has received extensive criticism, little attention has been paid to the cost of the law, either during its legislative course or following its implementation. Nonetheless, several tangible and intangible costs are associated with the PSDA. Such costs may be incurred by different parties. This paper examines the costs and benefits of the PSDA and illustrates the extent of some of its tangible costs. The incremental start-up cost for one institution's response to the PSDA is estimated to be $49,304 ($1.31 per admission) and the total implementation cost of the program to be $114,528. In addition, the national incremental start-up cost for hospitals to implement the PSDA is estimated to be between $43,625,114 and $101,569,922. Finally, the potential implications of the PSDA for future governmental health care ethics regulation are discussed.

Advance Directives↗
PubMed2001

Trends of analgesic nephropathy in two high-endemic regions with different legislation.

Analgesic abuse is related to a specific form of interstitial nephritis, but the exact nature of the causal agent remains controversial and this has resulted in differences in regulation. In Flanders, the free sale of phenacetin was banned, but the consumption of other combined analgesics remained free. In New South Wales, phenacetin was also banned, but 2 yr later the sales of all combined analgesics were also prohibited. This study compared the evolution of end-stage renal disease as a result of analgesic nephropathy (AN) in these two high-endemic regions with different legislation. In both regions, the time trend of the age-specific incidence of end-stage renal disease as a result of AN is similar in the age group 45 to 54 yr. In all age groups combined, the time trend of the percentage of AN among the patients admitted for renal replacement therapy is also similar. This finding does not support the hypothesis that non-phenacetin mixed analgesics play a significant role in the occurrence of AN.

Adult↗
PubMed2003

The veterinary surgeon in natural disasters: Italian legislation in force.

Law No. 225/1992 established a National Service of Civil Protection, with the important role of 'safeguarding life, goods, settlements and the environment from damage deriving from natural disasters, catastrophes and calamities' (art. 1). This law arranges civil protection as a co-ordinated system of responsibilities administrated by the state, local and public authorities, the world of science, charitable organisations, the professional orders and other institutions, and the private sector (art. 6). The President of the Republic's Decree No. 66/1981 'Regulation for the application of Law No. 996/1970, containing norms for relief and assistance to populations hit by natural disasters--Civil Protection' mentions veterinary surgeons among the people that are called upon to intervene. In fact, in natural disasters the intervention of the veterinary surgeon is of great importance. The authors examine these laws and other legislation relating to the National Service of Civil Protection.

Animals↗