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PubMed2005

Knowledge and attitudes about abortion legislation and abortion methods among abortion clients in Latvia.

OBJECTIVE: To assess knowledge of abortion legislation and knowledge and attitudes about medical and surgical abortion among women seeking a legal abortion in Latvia. METHODS: Data are drawn from a survey of 371 abortion clients from 16 purposively selected abortion clinics in Latvia. A semi-structured questionnaire was used to collect socio-demographic data and information on women's knowledge of and attitudes toward abortion law and abortion methods. RESULTS: Most women knew that abortion is legal either under any (53%) or certain (37%) circumstances. Almost one third (31%) of women interviewed were aware of medical abortion. After hearing a description of medical abortion, respondents felt the method as described would be advantageous because it could avoid a surgical intervention (33%) or found it simple, easy, convenient, or natural (12%). Women were concerned that the method might not be completely effective (38%) or be associated with side-effects (22%). CONCLUSIONS: Respondents were interested in medical abortion as a less invasive option to surgical abortion. Efforts should be undertaken to inform women about the safety and efficacy of the method.

Abortion, Induced↗
PubMed1995

Confidentiality and telemedicine: the need for a federal legislative solution.

Legal and ethical rules for the confidentiality of health records are incomplete, unclear, and inadequate. Structural and technological changes in the health care industry are resulting in increased uses and disclosures of patient records without adequate guidance to recordkeepers or protections for patients. Because of the interstate nature of medical practice, especially telemedicine, federal legislation based on a code of fair information practices is the best solution.

Confidentiality↗
PubMed1997

Legislating community care: the British experience, with U.S. comparisons.

In 1990, Great Britain enacted the National Health Service and Community Care Act to reduce unnecessary institutionalization, improve coordination of community-based long-term care, and stimulate private service provision. An overview of four major principles of the legislation is provided: the elevation of the assessor/care manager role, the emphasis on inter-agency collaboration across the health and social care divide, privatization of service, and support of carers (caregivers). Preliminary findings related to their implementation indicate incremental rather than sweeping change. The elements of the new policy that borrow from American models of community care--and may be difficult to transplant--are highlighted.

Aged↗
PubMed1985

Legislating health care coverage for the unemployed.

Because the unemployed and their families are often likely to develop stress-related health problems, ensuring them access to health care is a public health issue. Congressional efforts thus far to legislate health coverage for the unemployed have proposed a system that recognizes people's basic need for coverage but has several limitations.

Delivery of Health Care↗
PubMed1999

Promises in the plague: passage of the Ryan White Comprehensive AIDS Resources Emergency Act as a case study for legislative action.

In a conservative political climate, it is very important that social workers and others who are concerned with social welfare understand how to affect social change through legislative advocacy. This article presents a case study in successful intervention using the passage by the Congress of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990. The major influences in the passage of this landmark bill were building a diverse coalition that provided a very broad base of advocacy; securing bipartisan support; using recognizable personalities to call attention to the problem; and defining the issue as one that affected people from all socioeconomic and ethnic groups.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Workers' right-to-know legislation: does it work?

Workers' right-to-know (WRTK) laws and regulations were established to empower workers to protect their health by providing them with information about the hazards to which they are exposed while at work. The present study was conducted to examine the implementation of WRTK regulations in Israel. We interviewed 552 workers and 33 safety officers from a random sample employed at 50 industrial plants. The workers' questionnaire included items on awareness and self-management of workplace hazards, and the safety officers answered questions about job experience and hazards communications to workers. In 36% of cases workers and their safety officers disagreed about the existence of hazards in the workplace (p < 0.001). Most (78%) of the workers' knowledge about work hazards was based on informal sources, i.e., not those stipulated by the regulations. There were also discrepancies between worker and safety officer reports regarding the provision of safety training upon employment (p < 0.001), recent instructions about special risks and distribution of relevant printed material. We found that more than 5% of workers were unable to read the language in which the hazards material was written and 22% had levels of education below that required to comprehend the technical terms used. There are serious problems in the implementation of WRTK regulations in Israel. We recommend that employers be made aware of the importance of these laws and of their proactive duty to comply with them and that the material distributed to workers be written in simpler terms and/or explained orally in a language they understand. These findings have important implications for all countries with similar legislation and should form the basis for further and more comprehensive studies world-wide.

Adolescent↗
PubMed2002

Operationalizing advanced practice registered nurse legislation: perspectives from a clinical nurse specialist task force.

Many state boards of nursing are currently examining advanced nursing practice and determining a process to recognize and regulate it appropriately. In 1999, Minnesota state law was altered to define and provide title protection for advanced practice registered nurses. After passage of the new law, the Minnesota Board of Nursing convened 4 task forces, representing each of 4 advanced practice nursing groups, to develop recommendations regarding issues of certification, criteria for determining acceptable certifying organizations, procedures in the event of examination failure, and a process for communicating this information to the nursing community. This article provides an overview of the legislation and describes the process used to obtain and operationalize the new law. The process undertaken in the clinical nurse specialist task force is also described, including the key issues that emerged and lessons that were learned.

Certification↗
PubMed2001

The effect of state legislation on eye donation.

PURPOSE: Pennsylvania Act 102 implemented in March 1995 required all acute care hospitals in Pennsylvania to routinely refer all deaths to the Organ Procurement Organization for determination of suitability for organ/tissue donation. This study analyzed the effect of the law on eye donation. METHODS: Retrospective analysis of the total number of referrals and the actual number of eye donations from 62 hospitals in Pennsylvania to the Lions Eye Bank of Delaware Valley was performed for the years 1993 to 1998. Information gathered included donor's age, gender, race, cause of death, referring institution, and result of referral. RESULTS: From 1993 to 1998, the total numbers of referrals were 988, 1,647, 8,101, 21,123, 21,783, and 22,987, and the numbers of donors were 570, 574, 660, 644, 594, and 568, respectively. The increase in the number of donors after implementation of the law was not commensurate with the number of referrals. This was caused by a disproportionate increase in the number of referrals older than 70 years of age (from a mean of 33% to 52%), which exceeded the donor age limit of 69 years, and also to a lower family consent rate (from a mean of 48% to 24%). CONCLUSIONS: Well-designed state legislation with proper implementation greatly increased hospital referrals for eye donation. However, there was only a small increase in the number of eye donors because many of the referrals were beyond the acceptable upper age limit for eye donation. A small increase in the donor age limit would increase the number of eye donations without having to expand the potential donor pool. Education of the public may help to improve the family consent rate.

Adolescent↗
PubMed2001

What should we expect from California's minimum nurse staffing legislation?

In 1999, California passed the first legislation in the United States to establish minimum staffing levels in hospitals for registered nurses (RNs) and licensed vocational nurses. The author provides estimates of the increase in RN expenditures required by this mandate, by hospital size and for regions of California. Issues related to the implementation of minimum ratios also are discussed. Attention must be paid to other staffing regulations, special concerns of rural hospitals, the possibility that minimum ratios result in lower RN staffing, and the effect of the nursing shortage on the ability of hospitals to meet requirements.

California↗
PubMed1979

Consumer participation and community organization practice: implications of national health legislation.

This paper reviews ten federal health laws from the perspective of the extent to which consumer participation had been incorporated as an integral aspect of health program, identifies some issues and dilemmas of implementing consumer participation activities, and offers suggestions for the involvement of consumer advocates. The review of the laws showed uncertainty of outcomes, conflicting philosophies, conflicting purposes, conflicting strategies, and conflicts relating to representativeness, legitimacy and consumer role. Despite the inconsistent record of Congress to legislate consumer participation, two recent health laws, P.L. 93-641 and Title III of P.L. 94-63, appear to offer major opportunities in promoting consumer involvement in planning and policy development activities. However, because these laws continue to delegate the responsibility for implementing consumer involvement programs to providers, established institutions and state agencies, consumer advocates are urged to increase their knowledge of the laws and to assist consumers to realize their right of self-determination. The cause is worthy and represents a desirable goal for public health--and in the final analysis, for the survival of our democratic society.

Community Mental Health Centers↗
PubMed1985

Private health insurance of the Medicare population and the Baucus legislation.

The appropriateness of the benefits associated with the private insurance coverage of the Medicare population has been the subject of considerable concern. Section 507 of the Social Security Amendments of 1980, also known as the Baucus legislation, reflects public concerns about the level of benefits in relation to premiums, duplicative coverage, the complexity and difficulty of insurance terminology, and marketing abuses. Data from the National Medical Care Expenditure Survey can provide useful baseline data on the distribution of Baucus-like plans. In 1977, private insurance held by the Medicare population was more likely to cover inpatient than outpatient services and to emphasize "first dollar" benefits for long-term care. Multivariate analyses show that the distribution of Baucus-like insurance policies is highly associated with health status, source of insurance, region, and place of residence. The importance of state regulations, suggested in other research, may account for these patterns.

Aged↗
PubMed1981

Health manpower legislation.

In response to the desires of Congress, medical schools dramatically enhanced their ability to perform biomedical research and to educate health professions personnel. Initially, Congress viewed health professionals as a national resource in terms of being willing to subsidize their education. Congress continues to view the health professions as a national resource, but the philosophy of Congress has become substantially modified: Congress is unwilling to subsidize the education of physicians, but perceives that it must regulate their specialty and geographic distribution. Medical students and medical schools have, in a major sense, been left "holding the bag." A cogent argument can be offered that the natural history of health-care evolution has been confused by excessive meddling with the system. Additional legislatively induced confusion should not be imposed, at least until the results of the previous meddling have been observed. Unfortunately, the foregoing presentation raises considerably more questions than it answers: Medical schools: What will be the source(s) of financial support? Medical students: What will be the impact of tuition indebtedness? Practicing physicians: What will be the result(s) of severe competition? Health professions educational institutions must address fundamental issues concerning their financial survival. That is, will they accept the carrot-and-stick philosophy and pursue federal funding? or will they seek financial independence toward the goal of assuming responsibility for their own destiny? The philosophy of federal funding "without strings attached" does not exist.

Education, Medical↗
PubMed1996

Early impact of new health care legislation on the pediatric surgical experience of surgical residents.

On January 1, 1994, Tennessee implemented TennCare, an insurance program for the state's medically uninsured and those who were previously covered by Medicaid. To determine how this change has affected the pediatric surgical experience of residents in training, we reviewed our institution's operative case logs from the first quarter of 1994 and compared them with logs for the first quarter of the years 1990 through 1993. Cases were classified according to urgency and necessity of surgical procedures. No significant change was noted in the number of patients having operations for the most necessary or urgent conditions, such as solid tumors or appendicitis. In contrast, the number of elective operations, principally for hernias, decreased significantly during the same period. While Tennessee's legislative change apparently has not affected the volume of urgent surgical cases, it has significantly decreased surgical residents' elective pediatric surgical experience.

Appendicitis↗
PubMed1995

Experiences in developing legislation protecting reproductive health.

The law regarding special maternity leave for pregnant women in hazardous work situations has been in effect since 1981 in Denmark. In Finland, legislation regarding the protection of the reproductive health of working men and women and of pregnant women has been in effect since 1991. According to the special maternity leave law, women who are exposed to certain chemical, physical, or biological agents that are considered to be harmful to the fetus may be entitled to special maternity leave and benefits. In Denmark and in Finland, approximately 1% and 0.1%, respectively, of pregnant women have used the special maternity leave due to a risky work situation. In Finland, the yearly costs of the leave have been US $200,000 to $250,000. Trained occupational physicians can facilitate changes at the workplace that will decrease the need for special maternity leave.

Denmark↗
PubMed2003

Preschool vision screening in primary care after a legislative mandate for diagnostic eye examinations.

BACKGROUND: Kentucky legislation now requires that children entering public school receive a diagnostic eye examination. METHODS: Mail survey of randomly selected office-based primary care pediatricians (PDs, n = 221) and family physicians (FPs, n = 207) in Kentucky to assess the impact of the mandated eye examination. RESULTS: The response rate was 71% PDs and 51% FPs. Most offer preschool vision screening (PD 86%; FP 79%; P = 0.16), but many report they will be less likely to offer it in the future because of the mandated diagnostic eye examination (PD 61%; FP 50%; P = 0.09). Perceived barriers to the diagnostic eye examination include lack of parental knowledge about the requirement, belief by parents that they will need to pay, difficulty in getting an appointment, and lack of endorsement by primary care physicians. CONCLUSION: Most primary care physicians in Kentucky offer preschool vision screening, but many now are likely to reduce their screening effort. Until more data are available regarding the impact of the required eye examination, primary care providers should not change their screening practices.

Attitude of Health Personnel↗
PubMed2004

Choice, participation and accountability: assessing the potential impact of legislation promoting patient and public involvement in health in the UK.

Abstract Recent legislation enabling increased patient and public involvement in health decision-making will increasingly interact with the maturing independent patient movement to open up accountability systems across healthcare. Lay people will develop new roles, building on learning from the independent advocacy sector, self management, and wider active participation. Inevitably, this means a profound cultural challenge for healthcare organizations, and for citizens, as they begin to understand the implications of the new policies, including patient choice.

Choice Behavior↗
PubMed1998

Can non-prosecutory enforcement of public health legislation reduce smoking among high school students?

BACKGROUND: Smoking by adolescents has been identified as a major public health issue. Raising the legal age of cigarette purchase from 16 to 18 years has attempted to address the issue by restricting adolescents' access. METHODS/STRATEGY: A prospective study evaluating the impact of non-prosecutory enforcement of public health legislation involving 'beat police' was conducted in the Northern Sydney Health region. Secondary students, aged 12 to 17 years, from both intervention and control regions were surveyed about cigarette smoking habits by means of a self-completed questionnaire administered pre- and post-intervention. RESULTS: 12,502 anonymous questionnaires were completed. At baseline, 19.3% of male students and 21.2% of female students indicated they were current smokers. Age and sex stratified chi-squared analysis revealed significantly lower post-intervention smoking prevalence for year 8 and 10 females and year 7 males among the intervention group. Higher post-intervention smoking prevalences were demonstrated for year 7 and 9 females and year 8 males among the intervention group and in year 10 males and year 11 females among the control group. The analysis of combined baseline and follow-up data from coeducational schools with logistic regression techniques demonstrated that the intervention had a significant effect in reducing smoking prevalence among year 7 students only (OR = 0.54). CONCLUSION: Our study demonstrates the difficulties in restricting high school students' access to cigarettes. Isolated non-prosecutory strategies are likely to only have a limited impact on reducing smoking prevalence among high school students.

Adolescent↗
PubMed2005

The impact of age on the epidemiology of incomplete abortions in South Africa after legislative change.

OBJECTIVE: In 1996 termination of pregnancy was legalised in South Africa. This article examines the impact of age on the epidemiology of incomplete abortion after legislative change. It draws comparison with the findings of a similar study undertaken in 1994. DESIGN: Multicentre, prospective, descriptive study. SETTING: Forty-seven public hospitals in all nine provinces. SAMPLE: A stratified random sample of all hospitals treating gynaecological emergencies was drawn. All women of gestation under 22 weeks who presented with incomplete abortion during three weeks of data collection in 2000 were included. METHODS: A data capture sheet completed by a clinician from the case notes. MAIN OUTCOME MEASURES: Demographic characteristics and clinical findings on admission by age of women. RESULTS: Overall, there was a significant increase in the proportion of cases with no signs of infection on admission (from 79.5% to 90.1%) and a significant decrease in evidence of interference on evacuation (4.5% to 0.6%) between 1994 and 2000. Substantial age differentials were seen. Women over 30 were significantly less likely than those 21-30 years or under 21 to be low severity (65.5% vs 75.2% vs 76.4%, P= 0.0087) and more likely to have offensive products (16.3% vs 6.0% vs 6.4%, P= 0.01) than the younger women. CONCLUSIONS: Legalisation of abortion had an immediate positive impact on morbidity, especially in younger women. This is an important change as teenagers had the highest morbidity in 1994. The trend is supported by evidence from the 1999-2001 Confidential Enquiry into Maternal Deaths, which further suggested that abortion mortality dropped by more than 90% since 1994.

Abortion, Incomplete↗