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PubMed1989

Joint custody: historical, legal, and clinical perspectives with emphasis on the situation in Canada.

The search for ways to mitigate the effects of family breakdown on parents and children includes legislative and clinical efforts which to some extent influence each other. In the past year much public interest has been aroused in Canada, and particularly in Ontario, in the issue of legislative changes which would make joint custody the usual or "preferred" legal disposition of custody cases. This paper provides a discussion of the legislated preference, or "rebutable presumption" of joint custody from a historical, legal and clinical point of view. Definition and elaboration of what joint custody is from the legal and practical perspectives is provided with an emphasis on Canadian laws and practice. The legal rights of the non-custodial parent are explained, and relevant case law is highlighted. The relationship between joint custody, support orders and relitigation rates are elaborated. Following this is a critical overview of the empirical research on joint custody as it relates to the adjustment of children and parent satisfaction is included. It is concluded that while there is little question that shared parenting can be beneficial to children, the enthusiasm of legislators for joint custody has not been supported by empirical data. It is necessary to examine under what circumstances and for which kinds of parents and children joint custody might be beneficial since it is unlikely that one solution will fit the needs of all families and all stages of family life.

Canada↗

PubMed1987

Workers' health and safety in Australia: an overview.

In this article we explore some of the precursors and background to the recent wave of administrative and legislative change in the field of occupational health and safety in Australia. The influences of the New Left and women's movement in the late 1960s and early 1970s are seen to be crucial in creating a climate in which the issue of workers' health could be raised. It is then argued that the labor movement has been fundamentally important in determining the shape and extent of reform. Current organizational and legal developments are described and discussed in the context of Australian society.

Accident Prevention↗

PubMed1992

Changes in smoking legislation, attitudes, and behavior.

Legislative changes and attitude campaigns are generally acknowledged to be effective in the battle against smoking and its health hazards. In some instances it seems as if these means are insufficient to produce necessary change. In this study, the following general hypotheses were posed: (1) an advertising ban leads to reduced tobacco sale and (2) to reduced smoking; (3) attitude campaigns improve attitudes about regulation of smoking and (4) reduce smoking. In addition, two national hypotheses were formulated. The results supported neither hypothesis! It is concluded that it is important to follow the development closely with scientific methods of high quality. Further, smoking campaigns must include a broad spectrum of interventions to be sufficiently effective.

Adolescent↗

PubMed1992

Drug education: an appraisal of a popular preventive.

Drug education is a popular preventive. In this paper, school-based drug education programs as currently conceived and implemented are critically appraised. The evidence indicates that while such education influences knowledge and attitudes, it has little impact on behavior. It is contended that in most drug education programs the value and meaning of being a drug user is misunderstood and the benefits of drug use underestimated. It is argued that existing health promotion models have in the main failed to adopt a systemic approach to drug use and have focused too much attention on individual change at the expense of a broader social understanding of behavior. It is proposed that with regard to illicit drugs, future educational endeavors should take the form of training in "low(er) risk" drug use within a harm-reduction paradigm, and that with regard to alcohol, such strategies need to be augmented by social and legislative changes. It is concluded that if a harm-reduction and systemic approach is adopted, then education will lose some of its popularity, since such an endeavor will be a more challenging, politically difficult, and socially complex enterprise.

Adolescent↗

PubMed1991

Meeting the mental health needs of elderly clients.

1. Older individuals in both community and institutional settings have traditionally underused mental health services. Providers of such care devote a minimum of their professional time to those over 65 years of age. 2. Ageism and difficulty with diagnosis are the most frequent explanations for inadequate mental health care to the elderly. This study found that lack of referrals and failure of the aged to seek services partially accounted for underuse. 3. Legislative changes mandating that aged persons be screened for and receive appropriate mental health services will increase the demand for qualified providers. 4. Nursing's approach to care of the older adult, which focuses on both physiological and psychological needs, can facilitate the delivery of comprehensive effective mental health interventions in and out of the institutional setting.

Aged↗

PubMed1992

Whiplash in Australia: illness or injury?

OBJECTIVE: To provide a perspective on "whiplash" injury in Australia by examining conflicting evidence, which suggests on the one hand that the disorder is a culturally conditioned and legally sanctioned illness and on the other, that it is an occult injury which can cause chronic pain. DATA SOURCES: The published English language literature derived from MEDLINE covering epidemiological, pathogenetic and psychological aspects of "whiplash" injury, post-traumatic stress disorder, abnormal illness behaviour and iatrogenicity; the Australian legal literature; the printed news media; the Transport Accident Commission of Victoria and the State Government Insurance Commission of South Australia. DATA SYNTHESIS AND CONCLUSIONS: Comparative studies suggest that "whiplash" is an illness reinforced by legal and social sanction. Evidence from Victoria indicates that the reported incidence of "whiplash" can be reduced by minor legislative change. Occult injury to cervical intervertebral discs, vertebral end plates and cervical zygapophysial joints may be responsible for "whiplash" symptoms in some who are involved in motor vehicle accidents. This is likely to be confined to a small number of those involved in unexpected rear-end collisions.

Accidents, Traffic↗

PubMed1992

New federal policy for children with special health care needs: implications for pediatricians.

Title V of the Social Security Act of 1935 established the nation's first categorical health care program for children: the Crippled Children's Service. In 1985, federal legislation changed the name of the Crippled Children's Service to the Program for Children With Special Health Care Needs. Four years later, new amendments to Title V dramatically altered the Program's mission. States are now required to spend 30% of the funds from the Maternal and Child Health Services block grant on children with special health care needs and to take specific steps toward improving the service system for these children and their families. The new mandate is the only current foundation of a national health policy for children with special health care needs. The 1989 law substantially broadens the mission of the state programs and explicitly recognizes that all children with a special health care need should have access to an appropriate, community-based system of care monitored by state Children with Special Health Care Needs agencies. In addition, states are now required to conduct needs assessments pertaining to these children, to foster local systems of care, and to ensure a high quality of community-based services. Understanding the implications of the new amendments is essential because pediatricians and other child health care professionals have key roles to play in implementing these new policies.

Child↗

PubMedDate not supplied

Occupational health: developing safe handling policies.

This article is based on a paper given by the author at the Royal College of Nursing's Congress in April 1992, and is the first John Goodland Memorial Lecture. It examines the need for safe handling policies, and highlights the essential components of any new policy. With legislative changes due to come into force on December 31 1992, managers and staff are urged to be aware of the impact of safe handling training and how it can affect care delivery.

Biomechanical Phenomena↗

PubMed1992

Private enterprise occupational health.

A private company in Palmerston North is providing occupational health services to the Manawatu. From an initial concept in mid-1987, the business commenced operations in early 1988. The concept has changed, the shareholding has changed but the business has survived and, by means of plenty of hard work, grew rapidly in 89 and 90, looks likely to achieve a 20% increase in gross turnover in 91/92 and has budgeted for an 11% increase in turnover for 92/93. A.C.C. legislative changes have provided a new opportunity and this is being explored. The new Health and Safety legislation should provide increased opportunities but so far there is little evidence of this occurring. However hope springs eternal and we are confident that we can see through the current hard times and that eventually an improved economy and a settled down health system will allow us to provide increased services for the benefit of the local community.

Humans↗

PubMed1992

Case comment: Moore v. Regents of the University of California.

The increasing use of human tissues in medical research has spawned a host of ethical and legal debates. Legal analysis in this area has almost exclusively focused on the question of property rights in both the tissues used in research and in the resulting products. One illustrative case is Moore v. Regents of the University of California, in which a patient sued his doctor for conversion of his spleen which had been removed for therapeutic purposes. The doctor later used the spleen to develop a patented and profitable cell-line. This Comment examines and rejects the property law approach to this issue. Instead, this Comment proposes two legislative changes which would 1) eliminate any trade in human tissues and 2) require doctors to inform their patients of any research interest in proposed medical procedures. These proposals resolve the problem presented in Moore, and avoid the misleading, and inevitably unanswerable, question of property rights.

Humans↗

PubMed1991

Private fostering. Racial and health implications.

Why should health visitors be concerned with private fostering? First, writes Carol Woollard, because it affects a small but significant number of children, both in London and in county areas throughout England, whose particular health needs should not be ignored. Second, because the Children Act 1989 is bringing in legislative changes which have clear implications for health policies and practices relating to private fostering. It is essential that health visitors be aware of these changes and be able to act on them appropriately.

Africa, Western↗

PubMed1991

Radiation dose rates from paediatric patients undergoing 99Tcm investigations.

Infants or children undergoing nuclear medicine investigations may subsequently come into close contact with nurses or parents responsible for their care. In order to estimate the radiation dose to these individuals, and to formulate appropriate recommendations, dose rates were measured at distances of 0.1, 0.5 and 1.0 m from 148 paediatric patients who had undergone one of 12 99Tcm studies. The maximum dose rates of 70, 14 and 5 microSv h-1 at these distances were not greater than the corresponding maximum values found in an earlier study of adult patients. However, the maximum dose rates per unit activity of 0.5, 0.2 and 0.1 microSv h-1 MBq-1 were greater than the corresponding maximum 99Tcm adult values, consistent with a general increase of dose rate per unit activity with decrease of body weight observed in the paediatric measurements. A parent caring for and feeding a young infant is most unlikely to receive a dose equivalent of 1 mSv, and a nurse attending to one young radioactive patient is most unlikely to receive a dose equivalent in a working day of 60 microSv. The data obtained should allow radiation doses to be estimated and appropriate recommendations to be formulated for other circumstances, including any future legislative changes in dose limits or derived levels.

Adolescent↗

PubMedDate not supplied

Reproductive health in Romania: reversing the Ceausescu legacy.

As a result of the restrictive reproductive health policies enforced under the 25-year Ceausescu dictatorship, Romania ended the 1980s with the highest recorded maternal mortality of any country in Europe--159 deaths per 100,000 live births in 1989. An estimated 87 percent of these maternal deaths were caused by illegal and unsafe abortion. Under the Ceausescu regime, all contraceptive methods were forbidden and induced abortion was available only for women who met extremely narrow criteria. Immediately after the December 1989 revolution that overthrew Ceausescu, the new government removed restrictions on contraceptive use and legalized abortion. This legislative change has had beneficial effects on women's health, seen in the drop in maternal mortality in 1990 to 83 deaths per 100,000 live births--almost half the ratio in 1989. In addition, changes instituted since the revolution have led to the improved availability of reproductive health services and to the creation of new educational and training opportunities related to reproductive health services and to the creation of new educational and training opportunities related to reproductive health. The newly created contraceptive and abortion services have presented health system managers and policymakers with many challenges as they work to expand the availability of high-quality, comprehensive reproductive health care in a setting of economic hardship, political unrest, insufficient infrastructure, and outdated medical knowledge and practice.

Abortion, Legal↗

PubMed1990

Projections for the future development of international drug control policies.

With the adoption of the Declaration and the Comprehensive Multidisciplinary Outline of Future Activities in Drug Abuse Control by the International Conference on Drug Abuse and Illicit Trafficking (ICDAIT) in 1987 and the formulation in 1988 of the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances, the United Nations has made significant contributions to international drug control policy, in line with its responsibilities under article 55 of the Charter. Governments are acting, separately and through regional and other collective organizations, to adapt these policies to their own particular needs and to make the legislative changes needed to enable ratification of the new Convention. Simultaneously, the Commission on Narcotic Drugs continues to carry out its policy-making function by identifying areas of concern on which consensus can be achieved as well as appropriate techniques for achieving effective international co-operation as foreseen in the Charter of the United Nations. The present article draws attention to recent developments pointing to possible areas of policy formulation. These include enhanced cooperation of law enforcement agencies with overlapping jurisdictions; judicial methodology and inter-system co-operation to follow on from seizures from the illicit traffic and detention of suspects to consideration of treatment methodology; and adaptation of demand reduction techniques to target groups beyond the reach of formal educational institutions. The trend towards horizontal integration of trafficking networks is examined in the context of indications linking illicit traffic in psychotropic substances to the production and trade of chemical weapons, such as poison gas, and to the cultivation of new markets in response to the saturation of certain North American markets for specific illicit drugs.

Drug and Narcotic Control↗

PubMed1990

Attitudes of dental practitioners towards advertising and competition.

This paper examines the attitudes of dental practitioners towards competition and advertising and the changes that have occurred there between 1985 and 1988. It provides an insight into the views of members of the profession as they dealt with the issue of commercialisation. The study came at a time when proposed legislative changes would profoundly impact upon the profession's stance on business ethics and upon the business practice of its members. The data were derived from a self-completion questionnaire, 1,500 of which were evenly distributed among the members of five professions, doctors, dentists, lawyers, accountants, and veterinarians. The main findings were that the dental profession had moved along the collegiality-competition continuum only slightly, preferring to shun the use of overtly competitive behaviour while seeking to improve the efficiency of practice management.

Advertising↗

PubMed1989

New laws on patient treatment decisions.

These recent legislative changes should assist physicians in implementing appropriate health care decisions by patients and their families. The Natural Death Act amendments authorize the withholding and withdrawal of life-sustaining procedures from patients with incurable or irreversible conditions if death will result within a relatively short time without use of such procedures. The amendments are effective Sept 1, 1989, and apply to directives executed on or after that date. The durable power of attorney bill, effective June 14, 1989, provides a comprehensive method for allowing decision making by a surrogate. Education of the public and advance planning by principals are needed for it to be effective. Because HB 2098 requires advance execution of the power of attorney, in all likelihood most decisions to withhold or withdraw life-sustaining procedures from patients with a terminal condition will continue to be made using the procedures set forth in the Natural Death Act.

Humans↗

PubMed1989

Increasing access to quality dental hygiene care. An educational model.

Restrictions on the manner in which dental hygienists practice are determined by individual state laws, each state's dental practice act, and how those are interpreted by the state board of dental examiners. Prior to 1986, state laws or regulations did not permit dental hygienists to practice independently of a dentist's supervision in public and private settings. These restrictions on the way hygienists practiced have been a barrier to expanding access to preventive dental hygiene care. Recently, the number of states that have eased the restrictions related to dental hygiene practice has increased. More hygienists have actively pursued legislation that would permit minimal supervision, and one state, Colorado, secured unsupervised practice. In addition to these legislative changes, the ADHA has made a commitment to expand the scope of dental hygiene practice. Given this focus, it is critical that dental hygiene practitioners receive the appropriate education to support their providing care directly to the public-functioning independently as licensed professionals. The purpose of this paper is to propose an educational model which will describe the advanced clinical and practical management skills necessary to practice unsupervised. Implications for how this model will increase access to care will also be addressed.

Dental Care↗

PubMed1988

Intravenous drug abuse and AIDS transmission: Federal and State laws regulating needle availability.

This paper has surveyed the laws restricting the use of hypodermic needles and syringes for injection of illegal drugs. It has reviewed the constitutional basis for these laws and concluded that they are on sound footing. There is a new Federal law regulating needles and syringes in interstate commerce, but it is too early to tell how expansively it will be implemented. A large majority of States have drug paraphernalia laws that govern needles and syringes, and a smaller number have laws that require prescriptions for the sale and possession of needles and syringes. Some local jurisdictions also have laws, but these were not specifically reviewed. Altogether, a breadth of relevant laws govern the manufacture, sale, use or possession, advertisement, and interstate commerce of needles and syringes intended for use with illegal drugs. Any attempt by scientists or public health officials to accurately study the effect of these legal restrictions on the HIV infection rates in differing jurisdictions must comprehensively consider the applicable laws. Likewise, attempts at legislative change must also identify each law that would apply. Prosecutorial discretion has been discussed as it relates to the decision not to prosecute offenses involving the illegal use of needles and syringes. While prosecutorial discretion is most likely to be used by prosecutors in individual cases, it provides a legally sound approach for a prosecutor who decides not to enforce the needle and syringe laws across the board as part of an HIV infection control program. Although this approach has not yet been adopted in this country, a prosecutor's decision not to enforce these laws might allow the establishment of an experimental program, such as one for needle exchange, that could serve as a laboratory for legislative initiatives.

Acquired Immunodeficiency Syndrome↗