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PubMed1999

State licensing laws and the interstate practice of occupational medicine.

In 1996, the Occupational Health Law and Policy Section of the American College of Occupational and Environmental Medicine (ACOEM) was asked to undertake a study of state licensing regulations after the prosecution of an ACOEM member for practicing medicine without a license. In response to that member's experience, the ACOEM House of Delegates passed a resolution asking the College to lobby individual states for an exclusion to their licensing acts for occupational and environmental physicians. Recognizing the tremendous obstacles to this task, the ACOEM Board of Directors then referred the issue to the Occupational Health Law and Policy Section for further study and analysis. What follows is a report of that study, including the results of a survey mailed to the licensing authorities of the 50 US states and four US territories. The results of this study are not meant to offer advice to College members regarding compliance with specific state licensing regulations, nor does it define the official position of the states that responded. States that responded were careful to disclaim their responses as the official position of their states' agencies and were assured that the responses were provided for informational purposes only. The purpose of the survey was not to provide information for reference but simply to identify general trends and document the various positions that states may take on certain licensing issues.

Humans↗
PubMed1994

Licensed midwife-attended, out-of-hospital births in Washington state: are they safe?

The safety of out-of-hospital births attended by midwives who are licensed according to international standards has not been established in the United States. To address this issue, outcomes of births attended out of hospital by licensed midwives in Washington state were compared with those attended by physicians and certified nurse-midwives in hospital and certified nurse-midwives out of hospital between 1981 and 1990. Outcomes measured included low birthweight, low five-minute Apgar scores, and neonatal and postneonatal mortality. Associations between attendant and outcomes were measured using odds ratios to estimate relative risks. Multivariate analysis using logistic regression controlled for confounding variables. Overall, births attended by licensed midwives out of hospital had a significantly lower risk for low birthweight than those attended in hospital by certified nurse-midwives, but no significant differences were found between licensed midwives and any of the comparison groups on any other outcomes measured. When the analysis was limited to low-risk women, certified nurse-midwives were no more likely to deliver low-birthweight infants than were licensed midwives, but births attended by physicians had a higher risk of low birthweight. The results of this study indicate that in Washington state the practice of licensed nonnurse-midwives, whose training meets standards set by international professional organizations, may be as safe as that of physicians in hospital and certified nurse-midwives in and out of hospital.

Adult↗
PubMed1980

On professional power and conflict of interest: state licensing boards on trial.

Licensing of the health professions is an issue of public policy which has been under fire for years. Economists argue that licensing stifles competition and increases health care costs. Manpower specialists contend that statutory scopes of practice create arbitrary barriers to both geographic and career mobility, and contribute to the reduced utilization of newer, emergent categories of health personnel. This paper addresses a subject that is often overlooked in the literature on licensing: the inherent conflict-of-interest in professional licensing boards, where the predominant voice on the boards is that of the regulated profession and, more directly, of practitioners who have a vested interested interest in their own policy making. A number of seminal court decisions are examined that address this issue and a new model for licensing boards is proposed. While this model would do away with the present structure of the boards, it would not sacrifice the critical role of technical information that only the licensed professions can provide.

Licensure↗
PubMed1999

Changes in association of the Xenopus origin recognition complex with chromatin on licensing of replication origins.

During late mitosis and early G1, a series of proteins are assembled onto replication origins that results in them becoming 'licensed' for replication in the subsequent S phase. In Xenopus this first involves the assembly onto chromatin of the Xenopus origin recognition complex XORC, and then XCdc6, and finally the RLF-M component of the replication licensing system. In this paper we examine changes in the way that XORC associates with chromatin in the Xenopus cell-free system as origins become licensed. Restricting the quantity of XORC on chromatin reduced the extent of replication as expected if a single molecule of XORC is sufficient to specify a single replication origin. During metaphase, XOrc1 associated only weakly with chromatin. In early interphase, XOrc1 formed a strong complex with chromatin, as evidenced by its resistance to elution by 200 mM salt, and this state persisted when XCdc6 was assembled onto the chromatin. As a consequence of origins becoming licensed the association of XOrc1 and XCdc6 with chromatin was destabilised, and XOrc1 became susceptible to removal from chromatin by exposure to either high salt or high Cdk levels. At this stage the essential function for XORC and XCdc6 in DNA replication had already been fulfilled. Since high Cdk levels are required for the initiation of DNA replication, this 'licensing-dependent origin inactivation' may contribute to mechanisms that prevent re-licensing of replication origins once S phase has started.

Animals↗
PubMed2000

Infant sleep position policies in licensed child care centers after back to sleep campaign.

BACKGROUND: Since the Back to Sleep (BTS) campaign was initiated in 1994, the rate of prone sleeping has decreased to approximately 20%. However, child care centers may have an increased rate of prone sleeping in infants. In 1996, a study of licensed child care centers demonstrated that 43% were unaware of the association between sudden infant death syndrome (SIDS) and prone sleeping and that 49% positioned infants prone. OBJECTIVE: To determine effectiveness of a mailing from the BTS campaign to licensed child care centers by assessing the following: 1) child care center awareness of the recommendations of the American Academy of Pediatrics regarding infant sleep position and 2) implementation of the recommendations of the American Academy of Pediatrics in child care center practice. DESIGN: A descriptive, cross-sectional survey of licensed child care centers in the metropolitan Washington, DC, region. All licensed child care centers caring for infants <6 months old in Washington, DC, and Montgomery, Prince Georges, Howard, Anne Arundel, Frederick, and Charles Counties in Maryland were recruited for the study. RESULTS: Out of 236 eligible centers, 172 completed the survey. Seventy-five percent (129) of the centers were aware of recommendations regarding infant sleep position. Infants were placed prone in 27.9% of centers, although only 2.9% placed infants exclusively in the prone position. The most common reasons for avoiding prone position entirely were SIDS risk reduction and licensing regulations. Half of the centers had a written policy regarding sleep position. Twenty centers who were aware of the dangers of prone sleeping continued to placed infants prone at least some of the time, largely because of parental request. Only 56.9% of centers had heard of the BTS campaign despite the mass mailing. The mailing resulted in policy change for 14 centers. CONCLUSIONS: Since 1996, the percentage of licensed child care centers in the greater Washington, DC, area that are aware of the association between SIDS and infant sleep position has increased from 57% to 75%. In addition, the rate of placing infants prone in these centers has declined from 49% in 1996 to 27.9% in this study. When child care centers are aware of the risk of prone sleeping, the most likely reason for continued prone placement is parental request. Although media and mailings have been largely effective in communicating BTS information to many child care centers, nonprone positioning is not universal among child care providers. Additional educational efforts toward child care providers and parents remain necessary.

Child Day Care Centers↗
PubMed2006

Graduated driver licensing programs and fatal crashes of 16-year-old drivers: a national evaluation.

CONTEXT: Implementation of graduated driver licensing programs is associated with reductions in crash rates of young drivers, but graduated driver licensing programs vary in their components. The impact of programs with different components is unknown. OBJECTIVE: The purpose of this work was to determine which graduated driver licensing programs are associated with the greatest reductions in fatal motor vehicle crashes involving 16-year-old drivers. METHODS: We conducted a retrospective study of all 16-year-old drivers involved in fatal crashes in the United States from 1994 through 2004 using data from the Fatality Analysis Reporting System and the US Census Bureau. We measured incidence rate ratios of fatal motor vehicle crashes involving 16-year-old drivers according to graduated driver licensing programs, adjusted for state and year. RESULTS: Compared with state quarters with no graduated driver licensing program components, reductions of 16% to 21% in fatal crash involvement rates of 16-year-old drivers occurred with programs that included > or = 3-month mandatory waiting period, nighttime driving restriction, and either > or = 30 hours of supervised driving or passenger restriction. Reductions of 18% to 21% occurred in state quarters with programs that included > or = 5 of the 7 components examined. Drivers aged 20 to 24 or 25 to 29 years did not experience significant reductions. CONCLUSION: Comprehensive graduated driver licensing programs are associated with reductions of approximately 20% in 16-year-old drivers' fatal crash involvement rates. The greatest benefit seems to be associated with programs that include age requirements and > or = 3 months of waiting before the intermediate stage, nighttime driving restriction, and either > or = 30 hours of supervised driving or passenger restriction.

Accidents, Traffic↗
PubMed2002

Effect of the licensing process on hygiene in retail butchers' premises in the West Midlands, United Kingdom.

As the result of a change in legislation, all retail butchers in England were required to be licensed by 1 November 2000. A fully implemented hazard analysis critical control point plan was a condition of the license. This longitudinal study assessed the effect of licensing on hygiene in a group of retail butchers in the West Midlands, England. A hygiene audit and environmental sampling were used to determine if the licensing process improved hygiene in the study group. At the end of the study, 30% of the original group were no longer trading as they had been, having either altered the product they were selling or ceased to trade. The remaining butchers showed a significant improvement in the hygiene of their premises, both in the audit scores and in the environmental sampling. The mean audit score for the group had improved from an initial score of 47.54 to 54.95 (P < 0.02). The contamination with Enterobacteriaceae on equipment used for cooked meat had also improved, decreasing from mean contamination levels of 1.38 log CFU/cm2 before licensing to mean contamination levels of -0.11 log CFU/cm2 after licensing (P < 0.00001).

Animals↗
PubMed1998

Reporting health care professionals to state licensing boards--VA. Final rule.

It continues to be the policy of the Department of Veterans Affairs (VA) to report to State Licensing Boards any separated physician, dentist, or other licensed health care professional whose clinical practice so significantly failed to meet generally accepted standards of clinical practice as to raise reasonable concern for the safety of patients. This document provides that, in addition, VA will report to State Licensing Boards any currently employed physician, dentist, or other licensed health care professional (one who is on VA rolls) whose clinical practice so significantly failed to meet generally accepted standards of clinical practice during VA employment as to raise reasonable concern for the safety of patients. Some health care professionals who are VA employees also provide health care outside VA's jurisdiction. Accordingly, the reporting of currently employed licensed health care professionals who meet the standard for reporting is necessary so that State Licensing Boards can take action as appropriate to protect the public. Examples of actions that meet the criteria for reporting are set forth in the text portion of this rulemaking. Also, nonsubstantive changes are made for purposes of clarity.

Clinical Competence↗
PubMed2001

Licensed nursing staff reductions and substitutions in Pennsylvania hospitals, 1991-1997.

Nurses report a decline in RN/patient and skill mix in the 1990s while quantitative studies fail to confirm this. This study examines aggregate hospital nursing staff in Pennsylvania from 1991-1997, focusing on changes in licensed nursing staff. It finds that licensed nursing staff declined while nursing assistants increased in this period. With adjustment for patient acuity, there was a slight decrease in RN/adjusted patient days of care (APDC), a 23% decrease in LPN/APDC, and a 4% decrease in licensed nurse/APDC. The RN/nurse ratio increased slightly, and licensed nurse/nurse fell slightly. Since RNs often operate in environments which make use of teams of licensed staff, nurses' perceptions of a decline in the RN/patient ratio is a result of the decline in licensed staff/APDC, and of an increase in patient acuity.

Clinical Competence↗
PubMedDate not supplied

The role of licensing in child placement and protection.

Regulation of child residential care facilities requires licensors who have professional experience in child welfare. Licensing requirements must be applied within a context of professional knowledge and experience, particularly in regard to child placement and child protective services. The licensing of facilities for out-of-home care of vulnerable children generally has not been viewed as a mainstream social service or child welfare function. Although licensing differs from placement services and protective services in that licensing is basically a nonservice approach to protection each of the three elements forms a triangle of comprehensive protection for vulnerable children. Recognition of both the similarities and the distinguishing characteristics of the three elements reduces individual and organizational role conflict and, furthermore, holds promise for mature and effective coalitions in achieving the common goal of protection for vulnerable children in out-of-home care. The strength of a statewide licensing program is founded in centralized organizational and supervisory structure. Licensing must fulfill its partnership role in coordination with child placement and child protective services to achieve genuine community protection for vulnerable children.

Child↗
PubMed1983

Lung cancer and other causes of death among licensed pesticide applicators.

The mortality experience of a cohort of 3,827 white men licensed to apply pesticides in Florida was evaluated to investigate health effects associated with chronic exposure to pesticides. Although the overall standardized mortality ratio (SMR) for these structural pest control workers was not significantly elevated (SMR = 103), excess deaths were observed for leukemia, particularly acute myeloid leukemia (3 observed vs. 0.9 expected), and cancers of the brain (SMR = 200) and lung (SMR = 135). The risk of lung cancer rose with the number of years licensed with SMR of 101, 155, and 289 among those licensed for less than 10 years, for 10-19 years, and for 20 years or more, respectively. Ratios of directly adjusted rates showed similar patterns with observed-to-expected ratios of 100, 175, and 186 for the length of licensure categories. Mortality from lung cancer was greater among persons first licensed before age 40 (SMR = 234) than among those first licensed after age 40 (SMR = 115). Although information on tobacco use was not available, the increasing risk of lung cancer with number of years licensed and the capacity of certain pesticides to produce neoplasms in laboratory animals suggested that some pesticides may be carcinogenic in humans.

Adult↗
PubMedDate not supplied

[The driving license and epilepsy (author's transl)].

Italy is one of the few countries in Europe with no legislation specifically concerning driving licenses and epilepsy. We made a survey of 321 epileptics all over 18 years of age; 80,4% of them had epilepsy (temporal lobe). 47,7% of the 321 had a driving license, 2,8% had their license withdrawn because of epilepsy. The frequency of attacks among those with licenses was as follows: 52,9% rarely had attacks (1 every 2 years or even less often), 17,7% had attacks yearly and 29,4% had frequent attacks (1 a month, 1 a week or even daily). About 2% of the patients examined had had accidents because of attacks; none of the accidents were very serious. In spite of the lack of legislation, a high number of patients has driving license. However our investigations have shown that they were careful in their driving and scrupulous about treatment and medical check-ups. The main problem is that epileptics with a driving license may encounter serious difficulties with insurance companies if they have a car accident. It is to be hoped that in Italy appropriate measures are taken parallel to those of other European Countries.

Accidents, Traffic↗
PubMed2001

Initial effects of graduated driver licensing on 16-year-old driver crashes in North Carolina.

CONTEXT: Since 1997, 32 states have enacted graduated driver licensing (GDL) systems to reduce crash rates among young novice drivers. OBJECTIVE: To determine the initial effect of the North Carolina GDL system on crashes among 16-year-old drivers. DESIGN, SETTING, AND SUBJECTS: Comparison of population-based North Carolina motor vehicle crash rates before (1996-1997) and after (1999) 16-year-old drivers were licensed under the GDL system. To control for other factors that might have influenced crashes, changes for 16-year-old drivers were compared with those of drivers 25 to 54 years of age. Crashes per licensed driver were also examined. INTERVENTION: The North Carolina GDL system, enacted December 1, 1997, requires beginning drivers 15 to 17 years of age to hold level 1 licenses, allowing driving only while supervised by a designated adult for a full year; followed by level 2 licensure, allowing unsupervised driving from 5 AM to 9 PM and supervised driving at any time for at least 6 months; and, finally, level 3-a full, unrestricted license. MAIN OUTCOME MEASURES: Rates of motor vehicle crashes among 16-year-old drivers in 1996-1997 vs 1999, overall and by crash severity (fatal, injury, and noninjury), time (night vs day), type (single vs multiple vehicle), driver alcohol use, and driving environment (more vs less rural counties). RESULTS: Crash rates declined sharply for all levels of severity among 16-year-old drivers after the GDL program was implemented. Following GDL, 16-year-old driver crashes were substantially less likely. Comparing 1996 with 1999, fatal crashes declined 57%, from 5 to 2 per 10 000 population (rate ratio [RR], 0.43; 95% confidence interval [CI], 0.27-0.70); crashes with no or minor injuries decreased 23%, from 1068 to 826 per 10 000 (RR, 0.77; 95% CI, 0.75-0.80). Nighttime crashes were 43% less likely (156 vs 88 per 10 000; RR, 0.57; 95% CI, 0.52-0.61) and daytime crashes decreased by 20% (951 vs 764 per 10 000; RR, 0.80; 95% CI, 0.78-0.83). Single-vehicle crashes (245 vs 175; RR, 0.71; 95% CI, 0.67-0.76) declined somewhat more than multiple-vehicle crashes (866 vs 681; RR, 0.79; 95% CI, 0.76-0.81). CONCLUSION: In its initial years, the North Carolina GDL system produced substantial declines in 16-year-old driver crashes.

Accidents, Traffic↗
PubMed2001

Replication licensing of the EBV oriP minichromosome.

The latent EBV genome may persist in the integrated form as well as the circular episomal form. However, most of the latent viral DNA molecules are known to exist in the circular episomal form, which binds to host chromosomes during mitosis. The DS element of oriP in the circular episomal DNA functions as a replication origin. As it replicates once in a single S phase, it is possible that oriP is regulated by the cellular replication licensing mechanism including the MCM family of replication licensing factors. Transient replication analysis using the oriP plasmid and HeLa/EB1 cells revealed that the DS element requires early G1 phase for the next round of replication, the same cell-cycle window in which the replication licensing of cellular chromatin occurs. After this phase, the sedimentation velocity of the oriP minichromosome increases. MCM2 associates with the oriP minichromosome at late G1 but not at G2/M, and this association requires the DS element in the plasmid. The interaction of EBNA1 and the MCM proteins on the DS element was also suggested. These results suggested that the cellular licensing mechanism controls the replication from oriP. This also suggested a similarity in the replication machinery of the cellular chromatin and the latent EBV genome. In addition to DS-dependent replication, the EBV genome replicates in a manner independent of the DS element in several cultured cell lines. The DS-dependent replication is likely to be suppressed in these cell lines by the expression of other viral proteins. In contrast, EBV-positive Burkitt's lymphoma and circulating EBV-infected B cells express only EBNA1 or both EBNA1 and LMP2. DS-dependent replication may play a major role in these EBNA1-only cells, and the licensing regulation of oriP is important for maintenance of the EBV genome during this latent period of the viral life cycle. EBNA1 is required for efficient nuclear retention and partitioning of oriP-carrying plasmid by its binding to the FR element, thus providing stable persistence of the latent EBV genome during cell division. The copy number of latent EBV DNA molecules in B-cell lines remains fairly constant during multiple passage in culture. However, very little is known about the mechanism by which the viral DNA molecules are equally segregated into daughter cells. To understand the mechanisms responsible for stable nuclear retention and partitioning of the latent viral genome, it is essential to analyze the episomal and integrated viral DNAs at a single-cell level by FISH and other techniques.

Cell Cycle↗
PubMed2003

Determinants for drug prescribing to children below the minimum licensed age.

OBJECTIVES: In the light of the undesired effects that unlicensed and off-label drug use might have, it is necessary to study the determinants affecting the prescribing of such drugs. Prescription of drugs to children younger than the minimum licensed age may carry the highest risk of adverse reactions. To obtain insight into the factors that affect prescription of drugs to children below the minimum licensed age, we conducted a population-based case-control study. METHODS: The case-control study was nested in a cohort of 13,426 children aged 0-16 years, who were registered in the Integrated Primary Care Information (IPCI) project, a longitudinal observational general practitioners' database in the Netherlands. "Cases" were children who received a drug prescription for which they were below the minimum licensed age. To each case we matched up to four controls based on GP practice and patient age. As potential risk factors we evaluated the use of health care resources, and acute and chronic morbidity. RESULTS: We identified 447 cases who were matched to 1355 controls. The cases consulted their GPs significantly more often during the preceding half year, had more drug prescriptions, and had more specialist referrals than the controls. Respiratory diseases were the most important determinants for the prescription of drugs to children below the minimum licensed age. In adolescents, migraine and other headaches were the most important reasons. CONCLUSIONS: This study showed that children suffering from respiratory disease or migraine have the highest risk of receiving a drug prescription for which the patient is below the minimum licensed age. Regulatory authorities and the pharmaceutical industry should be stimulated to improve the evaluation of drug efficacy and safety in children.

Adolescent↗
PubMed1991

The long-term traffic safety impact of a pilot alcohol abuse treatment as an alternative to license suspensions.

During the 4-year period following a repeat driving under the influence (DUI) conviction, participants in 12-month treatment programs had worse overall traffic safety records than did recipients of license suspensions. The results from a series of analyses using repeated measures analysis of covariance showed that, in comparison with license-suspension recipients: (i) participants had significantly higher rates (70%) of nonalcohol-related accidents and convictions, (ii) participants had a significantly lower rate (9%) of alcohol-related convictions, but no difference was found on alcohol-related accidents, and (iii) participants had a significantly higher rate (30%) of total accidents (p less than .05). These results suggest that the use of license-suspension waiver as an incentive to participate in a drinking driver program had a negative impact on traffic safety. The predicted reductions in alcohol-related accidents among program participants did not occur, and reductions in nonalcohol-related accidents, which could have been achieved with license suspensions, were sacrificed. It was recommended that some other alternative besides license-suspension waivers be used as an inducement for repeat DUI offenders to participate in treatment.

Accidents, Traffic↗
PubMed1996

Evaluation of California's commercial driver license program.

This study evaluated the traffic-safety impact of the California Department of Motor Vehicles' Commercial Driver License (CDL) program. The program, initiated on 1 January 1989, began a new commercial-license classification and endorsement system, implemented stronger licensing standards and more comprehensive tests of knowledge and driving competency, required drivers to report specific violations to employers, and provided for more stringent post-licensing sanctions on negligent operators. The effect of the program on fatal and fatal/injury accidents involving heavy vehicles operated by drivers licensed in California was assessed using intervention time-series analysis. The results indicate that the CDL program did not have a statistically significant effect on either accident measure.

Accidents, Traffic↗
PubMed2004

Driver's licenses as a source of data on height and weight.

We investigated the feasibility of using driver's license records to obtain height and weight data of individuals. First, we linked Washington State driver's license records (DOL) to the state birth files to assess how well driver's licenses can be linked to a public health database. We were able to match 78.4% of mothers and 71.7% of fathers on birth records to driver's license records. Then we assessed the accuracy of DOL height and weight data by comparing them to heights and weights measured on control women enrolled in a cancer etiology study (CES). There is a close relation between CES and DOL heights, but not a close relation between weights. Our results suggest that driver's license files are a good source of information for women's heights, but are not as good for women's weights.

Automobile Driving↗