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At least 19 recordsLinked to original sources
PubMed1991

Legislative change to permit direct access to physical therapy services: a study of process and content issues.

The purpose of this study was to examine process and content issues related to legislative change to permit direct access to physical therapy services. Data sources were survey questionnaires sent to the presidents of the 52 chapters of the American Physical Therapy Association (APTA), APTA publications, state statutes, and personal contacts. Results were based on the experiences of 35 chapters, 17 in direct-access states and 18 in non-direct-access states. The majority of direct-access states obtained their status in a single legislative campaign; the majority of non-direct-access jurisdictions attempting legislative change have been unsuccessful for 2 or more years. Over 80% of the chapters reported using legislative lobbyists. Opposing forces varied from state to state and included hospital and medical associations, physicians, chiropractors, and physical therapists. The following limitations on practice in a direct-access mode are found in the various practice acts: diagnosis requirements, eventual referral requirements, physical therapist qualifications, patient consent requirements, and practice setting restrictions.

Health Occupations↗
PubMed1991

Guidelines for safe transportation of children in wheelchairs.

Advocacy efforts by health care professionals have prompted state legislative changes mandating the use of car seats and seat belts by children. These initiatives have greatly improved the level of safety in transportation of nonhandicapped children. Despite these positive changes, the transportation needs of nonambulatory children have not been addressed. In addition, implementation of Public Law 99-457 will result in larger numbers of young children with motor impairments requiring transportation to preschool early intervention programs. This study sought to describe how safely children in wheelchairs are transported. Observations of subjects were made as they were transported by their families or agencies at a residential summer camp, a preschool program for children with developmental disabilities, and a school for children with cerebral palsy. A safety score system was developed based on laboratory studies conducted on wheelchair restraint systems. This observation tool described the position of the wheelchair in the vehicle, the occupant restraint system, and the wheelchair restraint system. These structured observations revealed inadequate safety measures. Comparisons of safety scores of subjects transported by families with those transported by agencies were not found to have statistically significant differences. The findings of this study demonstrate a gap between minimal safety standards in wheelchair transportation and actual observed practices. In an effort to promote safe transportation practices of children regardless of their developmental differences, we present guidelines for health care providers for monitoring safe wheelchair practices in family, school, and community settings.

Adolescent↗
PubMed1989

Epidemiological appraisal of the active role of women in the decline of infant mortality in Spain during the twentieth century.

This paper is concerned with the question of the role which the psycho-cultural development experienced by women in developed countries throughout this century may have played in the decline of infant mortality, taking in Spain between 1900 and 1979 as a basis for observation. We think that, by studying the psycho-cultural development of women, included under the general concept of standard of living, we can take a step forward in explaining such a frequently investigated but nonetheless incompletely understood subject as is that of the marked decline of infant mortality which has taken place in this century in developed countries in general, and in Spain in particular. To this effect, we have attempted to demonstrate the need to consider socio-cultural factors, in addition to the already repeatedly studied economic and biomedical ones; the more so when we take into account the marked decline in infant mortality which occurred in Spain in the 1940s, in which period there was a pronounced stagnation in the economy. To this purpose, we have studied fertility, not only as a gauge of the biological risks which generate a certain reproductive pattern for infant mortality, but also as an indicator of the socio-cultural development of women. Similarly, and through a review of historical documents, we have analysed the role of women in birth control, their incorporation into more qualified jobs, their level of education, their growing awareness of their own situation in society, as well as pertinent legislative changes. All these processes affect the health of children through factors which, although they are very difficult to evaluate and quantify, have previously been described and examined in other studies. Our study has shown the probable relationship between the decline of fertility and the decrease of infant mortality, in view of the fact that there has been a pronounced decrease of parity and fertility in women belonging to the oldest fertile age groups. Similarly, the indications pointed out with respect to the processes mentioned above lead us to infer that in Spain the woman has played a significant role in the decline of infant mortality produced in this century, and especially in the first half of the century. We have embarked on a scantily developed line of investigation, and suggest the need for new studies on the subject.

Adult↗
PubMed1991

Achieving openness in adoption: some critical issues in policy formulation.

Despite some recent attitudinal and legislative changes, release of adoption information is largely limited and conditional. This paper identifies several issues inherent in the sealed records controversy and argues that cohesive policy formulation depends on systematic examination of the views of those most directly affected. Findings of a three-year study of adoptees, adoptive parents, birth parents, and adoption agency workers are presented.

Adolescent↗
PubMed1988

Parliament and disability in Britain.

There is a large number of people with disabilities in Britain, yet politically disability issues have a low profile. This paper presents evidence from a study of the attitudes to welfare of 96 Members of Parliament (MPs) illustrating that their general level of awareness of future challenges to policy is low. Overall, whether at a general level or when questioned about specific policy preferences, the needs of people with disabilities rarely figured in MPs' responses. Yet, despite this, the passage of the private members' Disabled Persons' (Services, Consultative and Representative) Act, 1986 shows that there is some prospect both for legislative change and for raising further MPs' awareness of the needs of people with disabilities.

Attitude↗
PubMed1991

Radiation dose rates from adult patients undergoing nuclear medicine investigations.

Adult patients undergoing nuclear medicine investigations may subsequently come into close contact with members of the public and hospital staff. In order to expand the available dosimetry and derive appropriate recommendations, dose rates were measured at 0.1, 0.5 and 1.0 m from 80 adult patients just before they left the nuclear medicine department after undergoing one of eight 99Tcm studies, an 123I thyroid, an 111In leucocyte or a 201Tl cardiac scan. The maximum departure dose rates at these distances of 150, 30 and 7.3 microSv h-1 were greater than those found in similar published studies of adult and paediatric patients. To limit the dose to an infant to less than 1 mSv, an 111In leucocyte scan is the only investigation for which it may be necessary to restrict close contact between the infant and a radioactive parent, depending on the dose rate near the surface of the patient, the parent's habits and how fretful is the infant. It is unlikely that a ward nurse will receive a dose of 60 microSv in a working day if caring for just one radioactive adult patient, unless the patient is classified as totally helpless and has undergone a 99Tcm marrow, bone or brain scan. The data and revised calculations of effective exposure times based on a total close contact time of 9 h in every 24 h period should allow worst case estimates of radiation dose to be made and recommendations to be formulated for other circumstances, including any future legislative changes in dose limits or derived levels.

Adult↗
PubMed1978

A review board for determining the dangerousness of mentally ill offenders.

Partly as the result of legislative changes made in 1975 and 1977, Texas has a workable system for dealing with mentally abnormal offenders and assessing the dangerousness of committed offenders. The author summarizes provisions of the law related to pretrial evaluation, competency to stand trial, dispositions after a ruling of incompetency, and the insanity defense. He describes the activities, during the first two years, of multidisciplinary review boards for manifest dangerousness; the boards met monthly to assess the dangerousness of patients committed to a state hospital's maximum-security unit after rulings of incompetency (without the probability of attaining competency in a foreseeable period) or of not guilty by reason of insanity. During the two years, the boards declared 171 of 364 patients to be not manifestly dangerous and thus ready for transfer or release, but they became more conservative in making judgments of not dangerous as time passed.

Adult↗
PubMed1989

Fitness to plead and psychiatric reports.

The role of the psychiatrist in the determination of fitness to plead is reviewed by reference to 77 pre-trial psychiatric reports prepared on 31 Special Hospital patients detained under the provision of Section 5(1)(c) (Unfit to Plead) of the Criminal Procedure (Insanity) Act 1964. Each psychiatric report was analysed using a standardized checklist which addressed the legal criteria used to determine fitness to plead, the nature of the alleged offence and the clinical diagnosis. The results showed that almost 40% of the reports made no mention of fitness to plead at all and that only one-third of the reports made a statement about fitness to plead which was supported by reference to standard legal criteria. The results of this study support earlier work which has suggested that psychiatrists have a poor understanding of the issues surrounding fitness to plead and criminal responsibility. These findings are discussed in relation to recommendations made by the Report of the Committee on Mentally Abnormal Offenders, 1975 (Butler Report) and legislative changes introduced by the Mental Health Act 1983.

Forensic Psychiatry↗
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↗
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↗