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PubMedDate not supplied

[Brain death and the donation of organs. A review in the light of current Spanish legislation].

INTRODUCTION: Primary brain death (BD) is a clinical situation characterised by the total and irreversible absence of functioning in the brain as a consequence of its being destroyed, while heartbeat and breathing are maintained by artificial means. The Royal Decree 2070/1999, dated 30 December, lawfully regulates the diagnosis of BD and the activities concerning the donation of organs for transplant in Spain. METHOD: In certain patients who have suffered structural injury to the brain, serious intracranial hypertension occurs which blocks the blood flow throughout the brain, while breathing is maintained by mechanical means, together with heartbeat. The diagnosis of BD is eminently clinical and is based on the verification of three circumstances: the existence of a non reactive coma, the disappearance of brain stem reflexes and activity in its parasympathetic nuclei, and the absence of spontaneous breathing. The diagnosis can be reinforced with certain complementary tests, which in some cases are compulsory. In the paper we describe the explorations that are considered to be appropriate by current Spanish legislation. We also review the most important clinical and legal aspects of organ donation. CONCLUSIONS: BD is an iatrogenic state, known only since the development of reanimation and assisted ventilation techniques, which amounts to the death of the person. Obtaining organs for transplants is currently possible in Spain from donors in this situation, but also from those who have died from an initial cardiopulmonary arrest and from live donors.

Brain Death↗
PubMed2003

Legislative recognition in France of psychological harassment at work.

The recent French Law on Social Modernisation of 17 January 2002 introduced into the French Labour Code and into the French Criminal Code, the concept of "moral" harassment. The definition of psychological harassment under this law adopts quite a broad conception of the notion of psychological harassment. The legislator has established a means for "friendly" settlement of disputes: mediation. When it has not been possible to settle the dispute internally, the Courts have a number of sanctions available to them. The French Labour Code provides that any termination of the contract of employment resulting from a situation of psychological harassment is automatically null and void. Such nullification should therefore be applicable whatever the nature of the termination: dismissal, resignation or negotiated departure and it punishes psychological harassment at work by imprisonment for one year and a fine of 3,750 Euros. The French Criminal Code prescribes penalties of one year and 15,000 Euros.

Civil Rights↗
PubMed2003

Medigap reform legislation of 1990: a 10-year review.

The 1990 Medigap reform legislation sought to make it easier for consumers to compare policies, provide market stability, promote competition, and avoid adverse selection. Evidence is that the standardization of benefits has simplified consumer choice and is strongly supported by consumers and State regulators. The 1990 reforms also decreased carrier and agent abuses. However, loss ratios (the proportion of premiums paid in benefits versus being retained for administration and profit) have changed little since 1990, bringing into question whether price competition has been enhanced. The prescription drug benefit, which is included in 3 of the 10 standardized plans, provides only limited financial protection yet is expensive, one reason being adverse selection. Access to coverage for Medicare disabled beneficiaries is problematic in most States.

Aged↗
PubMed2003

The UNGASS Declaration of Commitment on HIV/AIDS: a review of legislation in six Southern African countries.

This article reviews legislation of six Southern African countries to determine what progress has been made after the UNGASS Declaration of Commitment on HIV/AIDS, particularly with regard to paragraph 58 on human rights and paragraph 69 on rights in the workplace. The article notes the complexities introduced by the coexistence of customary laws and practices and codified law. It describes certain features of specific codified and customized laws. It concludes that, with the possible exception of South Africa, the countries under review have not responded to the challenges the HIV/AIDS epidemic have confronted their legal systems with. They have resorted in the first instance to criminal law, and have allowed discriminatory customary laws and practices, which propel the epidemic, to continue to operate.

Africa, Southern↗
PubMed2003

A history of child health equity legislation in the United States.

The mission of the Maternal and Child Health Bureau (MCHB) is comprehensive in scope and establishes the capacity, structure, and function for the MCHB to continually improve the health and well-being of pregnant women and children. The MCHB works in partnership with states and has broad authority to improve access to care and ensure the provision of quality preventive and primary care services. Specific provisions of legislation establish the framework for accomplishing this mission. With the increasing recognition of the social, economic, and environmental determinants of child health and the inequities that exist in access and quality of care for children, the Maternal and Child Health Bureau (MCHB) has set the following 3 goals for year 2003: 1) To eliminate disparities in health status outcomes through the removal of economic, social, and cultural barriers to receiving comprehensive, timely, and appropriate health care; 2) To ensure the highest quality of care through the development of practice guidance and data monitoring and evaluation tools; the use of evidence-based research; and the availability of a well-trained, culturally diverse workforce; and 3) To facilitate access to care through the development and improvement of the maternal and child health infrastructure and systems of care to enhance the provision of necessary, coordinated, quality health care. Priority MCHB strategies to accomplish these goals include improving and expanding 1) the cultural competence of providers (in particular to decrease sudden infant death syndrome [SIDS] among minorities), 2) emergency medical services for children, 3) health and safety in child care, 4) quality of primary pediatric care, and 5) the providing of every child with a medical home.

Child↗
PubMed2003

[Clinical trials on medical products for human use in the case of acutely incapacitated patients within the fields of neurology and neurosurgery; implications of the new European legislation].

To comply with the European directive on clinical trials on medical products for human use, an amendment to the Dutch Medical Research Involving Human Beings Act was formally submitted in the Netherlands on the 27th February 2003. The objective is harmonisation of legislation and the protection of patients participating in clinical trials within the European Union. An important element of the directive is additional protection for incapacitated patients. In the fields of neurology and neurosurgery much research, mainly phase III, is conducted into the safety and efficacy of pharmaceutical products in emergency situations such as traumatic skull-brain injury or an acute cerebral infarct. Future emergency research in patients with acute cerebral disorders will be hindered by the (shortly legal) requirement that prior proxy consent is mandatory and the fact that individual patients must directly benefit as a result of their participation. This unintended negative effect may be considered contrary to the ethical principals for conducting good scientific research to improve treatment results. Also, it may lead to a scientific backlog compared to countries outside of the European Union. In the case of emergency phase-III research among acutely incapacitated patients we recommend that the Central Committee on Research Involving Human Subjects [Dutch acronym: CCMO] tests the research, that trials have an independent committee to monitor the data and safety, that an independent physician may grant consent for the patient to participate and that the consent of the patient's representative(s) is obtained within 24 hours of the patient being included in the trial.

Clinical Trials, Phase III as Topic↗
PubMed1992

[Social medicine aspects in expert assessment according to the new long-term care legislation].

According to the new German 'Betreuungsgesetz' (BtG) legislation concerning care for the mentally and or physically disabled, instituting a "case of care" requires an expert opinion on the patient's mental and physical impairments as well as on the question as to what degree the patient lacks the ability to manage his or her own affairs. The respect for the personal autonomy has to be weighed against the need to take action for the patient's benefit. The concept of 'neglect' ('Verwahrlosung') plays an important role in judging a patient's situation. Criteria for the use of this term are derived from a study carried out by the author, and lead to a questionnaire designed for preparatory investigations. As to the question of who should act as an expert in BtG cases, the author argues that the public health offices qualify best for this task.

Disability Evaluation↗
PubMed2003

Class orders now possible under Ontario's public health legislation.

In April 2003, the Ontario Legislature amended the province's public health legislation as part of a package of amendments related to the recent outbreak of Severe Acute Respiratory Syndrome (SARS). Although the amendments to the Health Protection and Promotion Act (HPPA) were clearly designed to address emergency situations like SARS, they may have unintended and negative consequences for people living with HIV/AIDS.

HIV Infections↗
PubMedDate not supplied

[Proposal for an outline to be used in the assessment of chemical risk according to the legislative decree 25/20002].

We present an operative outline for the evaluation of chemical risk in the work environment, according to the legislative decree 25/2002. It includes the following points: identificative data of the company, scope and field of application, description of the working activities, preventive and protective measures, medical report (including biological monitoring), environmental monitoring, conclusive evaluation. The scheme is a quali-quantitative instrument for the employer and his collaborators to establish whether the chemical risk present in the single productive sites can be considered "moderate" or "not moderate".

Chemical Industry↗
PubMed2002

Ontario adopts "blood samples" legislation.

Under the new legislation, a Medical Officer of Health can order blood testing when victims of crime, emergency service workers, "good Samaritans," and others have reason to believe that they may have been exposed to a communicable disease.

AIDS Serodiagnosis↗
PubMed2001

Behavioral health benefits for public employees: effect of mental health parity legislation.

With the passage of the Mental Health Parity Act of 1996 (MHPA), Congress took an important first step toward equalizing treatment under medical plans between physical and mental illnesses by requiring parity in annual and lifetime dollar limits between physical and mental illness. But the Act was limited in scope: it did not mandate mental health benefits nor prohibit other common types of differentials between physical and mental illnesses, such as higher cost-sharing or lower limits on outpatient visits or inpatient treatments. Before Congress' action in 1996, a few of the states had adopted some type of parity requirement. Since 1996, state parity activity has accelerated.Recently, the Center for Health Services Research and Policy through a grant from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services, examined contracts providing for mental health benefits for state employees in eight states to assess whether legislative attempts to require parity between physical and mental illnesses resulted in noticeable differences in behavioral health benefits for state employees. We concluded that, except in states that have mandated full parity for some or all types of mental illnesses, behavioral health benefits for state employees have not changed significantly as a result of the state parity laws, since they still remain subject to traditional restrictions, such as higher cost-sharing and greater limitations on outpatient visits and inpatient treatment days, than those imposed on physical illnesses. Thus the considerable state activity surrounding mental health parity may have little effect on state employees' access to mental health services, since although state laws required parity in dollar limitations, they generally permitted the continuation of other plan design features that are more restrictive for mental health coverage. However, many of the contracts we examined were multi-year contract and may not have fully reflected recent state activity. Moreover, if Congress renews the Mental Health Parity Act when it expires in September, 2001, and expands the scope of the Act to cover some of these other plan design features, states with more limited parity laws are likely to follow. In that case, perhaps state employees with mental illnesses may see significant change in the future.

Contracts↗
PubMed2002

[Patient's rights in Polish legislation].

The knowledge of medical law and rights of citizen seeking professional treatment is particularly crucial in relationship to health service. Such knowledge enables patients to be better oriented in this complicated matter and may contribute to their satisfaction from medical services. It also enables to settle a rising argument by means of negotiations between partners knowing their rights and obligations. Patient's rights have been widely discussed in Poland recently. The movement involved in improving and complying with patients' rights has increased with social, cultural, ethical and political development. In Polish legislation there are many regulations concerning patients' rights.

Ethics, Medical↗
PubMed1999

Taking care of legislative business.

The New Jersey Hospital Association (NJHA) works with legislative leaders to shape policy that will benefit the state's 120 hospitals and the people they serve. The NJHA "to-do" list includes protecting providers against insolvent HMOs; guaranteeing children health care; and making the most of the tobacco settlement money. Attention also is being given to the damage caused by the Balanced Budget Act.

Budgets↗
PubMed2003

Parkinson disease of ranking lawyer and legislator SJV Chelvanayakam: a hypothesis.

SJV Chelvanayakam (1898-1977), a ranking civil lawyer and legislator, was probably the well known Parkinson disease victim in the 20th century Sri Lanka. He was born in Ipoh, Malaya, where his father had moved in the last decade of the 19th century for professional advancement. Ipoh was then an attractive location for migrants from China and the Indian subcontinent since it was in the Kinta valley--touted then, as the world's richest single tin field. Chelvanayakam was brought to Jaffna peninsula when he was aged four (in 1902 or 1903) by his mother, who returned to her native Tellipalai town partly due to indifferent health during her stay in Kinta region. In this communication, I present a hypothesis that organotin exposure as a foetus or during infancy at his place of birth is likely to have been a contributing factor to Chelvanayakam's Parkinsonism. It seems to fit the available circumstantial evidence.

Famous Persons↗
PubMed2000

Legislating sharps safety.

Various state laws, passed and pending, stress the need for federal legislation on needle-stick prevention.

Accidents, Occupational↗
PubMed2004

Asthma among California's children, adults and the elderly: a geographic look by legislative districts.

Asthma is a chronic lung condition characterized by wheezing, breathlessness, chest tightness, and nighttime or early morning coughing; it has been on the rise in the United States over the past two decades. In California, about three million children and adults who have ever been diagnosed with asthma also experienced asthma symptoms at least once in 2002. This policy brief provides data for California legislative districts to highlight the variation in asthma symptom prevalence for children and adults across the state. Asthma symptom prevalence rates at the district level are estimates created by a small-area methodology, based on rates from the 2001 California Health Interview Survey (CHIS 2001) that are applied to population data from the 2000 Census and 2002 California Department of Finance. This first-of-its-kind sub-county data are relevant for policy makers, advocates, and medical providers to illuminate the problem of asthma throughout California and within local communities.

Adolescent↗
PubMed2004

[Protection of health care personnel from occupational exposure to blood borne pathogens: problems in legislative and other documents adopted in different countries].

Contact with human blood is one of the vital issues concerning occupational exposure to biological factors. The fact that pathogens that create high health risk may be transmitted by blood must not be ignored. Considering the problem of biological exposure at workplace, HIV, HBV and HCV are recognized as the most essential viruses. Health care workers belong to the occupational group characterized by the most frequent contact with blood. Infections induced by blood borne pathogens are mostly observed among nurses, laboratory personnel and physicians. In the European Union countries, the USA and Canada, there are relevant legal regulations pertaining to the management of potentially dangerous biological materials, whereas in Poland such regulations have not as yet been developed. Poland's accession to the European Union in 2004, commits the Polish government to harmonize Polish and European Union legislation also in this regard.

Blood-Borne Pathogens↗