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Results for “Legislation--changes”

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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↗

PubMed1986

Capitation in California--an analysis of at-risk financing of Medicaid services.

Recent legislative changes have fostered the growth of a highly competitive health care market in California. In addition to selective hospital contracting for Medicaid (Medi-Cal) services, the California Medical Assistance Commission is attempting to initiate pilot projects to capitate Medi-Cal beneficiaries in selected geographic areas throughout the state. Selective contracting with county capitated organized health systems is also underway in Santa Barbara County, with plans for other counties on the drawing boards. This paper describes these capitated programs as well as addressing problems that may arise in this transition from a fee-for-service to a capitated Medi-Cal system. Specifically considered are issues related to underutilization, quality of care, implementation, eligibility and effects on existing patterns of care.

California↗

PubMed1982

Recent trends in the Social Security Disability Insurance Program.

Earlier analysis documented the rapid growth of the Disability Insurance (DI) program from 1966 to 1975; this article discusses trends since 1975. Over the decade of the 1970's, the population insured for disability increased by 34 percent, and women as a proportion of the insured population rose from 32.4 percent in 1970 to 39.1 percent in 1980, reflecting the increase in female labor-force participation. Of disabled workers receiving benefits, the proportion that were women rose from 28.4 percent in 1970 to 32.4 percent in 1979. Although inflation caused total benefit costs to rise over the entire period, the number of DI beneficiaries began to decline in 1978. Disabled-worker awards reached a peak in 1975 and fell subsequently so that the 1969 and 1981 figures are approximately equal. Relative to 1970, the fraction of awards going to women increased, the share for persons aged 50-54 rose, and the proportion received by those aged 60-64 declined. Decreased in total awards, and hence recipients, stemmed primarily from higher rates of denial at both the initial application and the reconsideration stages. Higher denials were countered by substantial rises in the number of hearings and reversals by administrative law judges (ALJ's). in 1980, only 65 percent of all awards came from initial applications, while over a fourth resulted from ALJ reversals. In future years, recent legislative changes may be expected to curtail program expansion further.

Adult↗

PubMed1984

A 10-year review of the Supplemental Security Income program.

January 1, 1974, marked the beginning of the Supplemental Security Income (SSI) program for the aged, blind, and disabled, and also marked the end of a 14-month period of preparation that began on October 30, 1972, when President Nixon signed into law the Social Security Amendments of 1972 (Public Law 92-603). As a way of marking SSI's 10th anniversary, it seems appropriate to review the development of the program since its enactment and compare the program's performance with its original goals and expectations. This article looks at the SSI program in the context of the program's goals as set out by Congress and discusses the legislative changes--and the motives behind those changes--since its implementation. Statistical data are examined to determine whether the program is accomplishing what it was designed to do, and whether, as a result of legislation or because of changes in the characteristics of the recipient population, trends are developing that may have a future impact on the program.

Aged↗

PubMed1980

The dental educator and the law.

Dental educators become vulnerable to student lawsuits if they ignore legislative changes and judicial decisions that affect all academic units in higher education. Issues involving contractual considerations, privacy and grading, and recent copyright revisions are of particular interest to those faculty actively engaged in teaching. Knowledge of these issues as they relate to the course director's daily responsibilities will better prepare the dental educator to avoid litigation and to know when to seek advice of institutional counsel.

Clinical Competence↗

PubMed1982

How children travel in cars in New Zealand.

Two years ago a nationwide observation survey of children (0-14 years) in cars demonstrated that only 20 percent were appropriately restrained. Parent education material was prepared and the law was altered so that children over eight years of age were required to use a seat belt. A repeat observation study was undertaken to determine what effect, if any, these measures had produced. Altogether 21 554 children 0-14 years were observed. Twenty-five percent were appropriately restrained. The older the child, the less likely he was to be restrained. Fifty-six percent of children over eight years of age, and travelling in the front seat were wearing seat belts--unchanged from 1978. However only 23 percent of a random sample of 1000 adults correctly identified the new traffic rule. It is necessary to improve current attempts at health education. Any future legislative changes should be widely publicised.

Adolescent↗

PubMed1981

Psychiatric problems of physicians and their families.

Motivation for medicine is a complex issue, as is the motivation for other accomplishments in life. There are both conscious and unconscious factors that impel an individual to pursue the long and arduous training necessary to become a physician. Some of these factors meet neurotic needs of the individual and may set the stage for the later development of overt conflicts and psychiatric problems. The most common difficulties of physicians and their families are depression, alcohol and drug dependency, and marital conflicts. These and other issues may involve conflicts concerning unresolved dependency needs. Unfortunately, once problems develop in the physician, attempts at formal evaluation and therapy are often met with denial and resistance. An increased awareness of the problem, and guides for appropriate management of the psychiatrically ill physician by the American Medical Association Council on Mental Health and subsequent legislative changes in a few states, accompanied by an enlightened view by state medical boards, have helped in dealing with this difficult problem. Further, attempts to evaluate impaired physicians objectively and provide helpful and understanding therapy are needed. The prevention of psychiatric difficulties among physicians and their families is an important yet poorly studied area. Likewise, retirement poses special problems for many physicians and efforts should be made by organized medicine to develop educational programs directed toward the prevention of problems at all stages of the professional career.

Alcoholism↗

PubMed1995

Informed consent by children: the new reality.

Recent legislative changes in British Columbia and New Brunswick allow children to make their own decisions about health care, something that used to be the prerogative of their parents. In this article, Eike-Henner Kluge argues that the changes hold profound implications for physicians. He says they increase the responsibility placed on doctors, who must now consider whether a child is indeed competent, and whether the decision made by a competent child is indeed in the child's best interests.

Adolescent↗

PubMed1995

Workers' compensation introduction for physicians.

Workers' compensation is an important part of the employment system in this country, and its development was born out of necessity. In 1991, over 93 million employees were covered by workers' compensation statutes and laws for work related injuries and conditions. The costs over the past 20 years have increased at an overwhelming rate. These increases are being met by various cost containment strategies that are not omnipresent in all jurisdictions but instead, are being accepted and structured independently by each jurisdiction. Legislative changes are expected in the next few years to deter rising costs. The emerging patterns of cost containment are: limited initial provider choice, limited provider change, medical fee schedule, hospital payment regulation, utilization review, and bill review. The medical evaluation of impairment is a process that is not precise; however, impressive gains have arisen in this area through the use of the AMA Guides and DSM-IV.

Cost Control↗

PubMedDate not supplied

The dilemma in saving children from child labor: reform and casework at odds with families' needs (1900-1938).

Early in this century, reformers lobbied for regulation of child labor and compulsory school attendance. This article draws on their publications, agency case records, professional literature, and historical studies to examine the role of social workers in implementing the new reforms and the reactions of parents and children in low-income households who were affected by the legislative changes. The precarious nature of family self-sufficiency and social workers' ambivalence toward child labor led to conflict between professionals and client families. Missing at the time was professional acknowledgment of economic security for families as a fundamental necessity for children's welfare.

Adolescent↗

PubMed1994

Disability trends in the United States: a national and regional perspective.

Between 1978 and 1993, the number of persons receiving disability benefits under either the Supplemental Security Income program or the Old-Age, Survivors, and Disability Insurance program increased more than 43 percent--from 4.7 million to 6.7 million. In 1993, 4.08 percent of the U.S. resident population aged 18-64 were receiving a disability benefit under one or both of the programs, compared with 3.37 percent in 1978. This ratio had declined to 2.93 percent in 1983. The article examines the change in growth since 1975 in each of the two disability programs and provides an overview of key legislative changes occurring during the period. The emphasis is on regional and State changes during the 1987-92 period, identifying those areas where growth has been the most dramatic.

Adolescent↗

PubMed1994

Motor vehicle occupant injuries in New Zealand children, 1981-90.

AIM: To determine the incidence of motor vehicle occupant injuries in New Zealand children and to consider future directions for prevention. METHODS: The Ministry of Health's national mortality and morbidity files for the years 1981-1990 were examined to identify all deaths and hospital discharges for motor vehicle occupant injuries in children between the ages of 0-14 years. RESULTS: Over the 10 year period, there was an average of 26 deaths and 433 hospitalisations annually. Fatality rates were highest for the age group 0-2 years, whereas hospitalisation rates were highest for those aged 3-4 years. Although mortality rates were similar for Maori and nonMaori children, the hospitalisation rate for Maori children was more than three times that for nonMaori children. No significant trends in either fatality or hospitalisation rates were evident. DISCUSSION: Motor vehicle occupant injury is an important public health problem in New Zealand children. Reductions in the numbers of motor vehicle occupant deaths and hospitalisations will require not only legislative changes aimed at increasing restraint use, but also the development of strategies to ensure compliance with the legislation. The identification of barriers to the use of child restraints is likely to facilitate the development of effective strategies aimed at increasing occupant restraint use.

Accidents, Traffic↗