Legislation for Ukraine's public health: the current situation and paths to further development

The paper contains the findings of an analytical study of the current national health care legislation of Ukraine and identification of priority areas in its further development. One of the key objectives of the above study was to identify the compliance of the national healthcare legal framework with the approaches to health policy formation, which are set out in the documents of global and European regional international organizations, and to assess whether the national legislation includes that spectrum of functions that are to be covered by the health care legislation. The analysis showed that Ukraine's national healthcare legislation is rather strong and well developed. Though the national healthcare legislation is mostly in line with international approaches to the state health care policy formulation, the issue of enforcing already adopted laws and by-laws and ensuring their compliance by all legally established bodies, including state authorities and self-governments, citizens, NGOs, etc, is problematic.     

Dying with dignity: developments in the field of euthanasia in The Netherlands

The development of the debate on euthanasia in The Netherlands, the role of the courts and proposals for legislation are discussed. In foreign newspapers and other publications an erroneous picture of the Dutch situation on euthanasia is sometimes given. In Parliament two proposals for legislation are pending. The parliamentary debate is expected to be reopened in 1989.     

A historical look at alcohol abuse trends in army and civilian populations, 1980-1995

OBJECTIVES: The purpose of this study was to compare civilian and Army alcohol-related hospitalization trends and to plot temporal changes in rates relative to alcohol-related legislation and social policies. METHOD: We compared population-based civilian and Army annual hospitalization rates for overall alcohol-related diagnoses and for alcohol-related diagnostic subgroups (1980-1995) and plotted them against civilian and military substance abuse regulations. Civilian data were adjusted to Army age, gender, and race. RESULTS: Although overall civilian and Army alcohol hospitalization rates were similar, alcohol subgroup rates varied. Simultaneous drug and alcohol abuse (polyabuse) rates were higher among civilians (16.6 per 10,000) than Army soldiers (5.1 per 10,000). Army rates for dependent alcohol-related disorders were higher and increased. Army nondependent alcohol disorders tracked with alcohol-related regulations as rates fell 69% between 1985 and 1995. CONCLUSION: Army and civilian alcohol abuse trends vary by abuse type. Without longitudinal, diagnosis-specific subgroup analyses, these trends would not have emerged. Army policies and screening may explain divergent nondependent alcohol abuse and lower polyabuse rates.     

Dying in the arms of Dutch governmental authorities

Thorough investigation of deaths related to police actions or of persons placed under the ‘care’ of governmental authorities is anchored in the legal systems of every democratic system. The quality of this investigation should be guarded by an adequate set of control measures. Recently the Dutch Ombudsman published a report about this issue In the Netherlands no central registry of these deaths exists. The estimates based on the available data number some 400–500 deaths in custody in the past 10 years in the Netherlands of which only in 193 cases a legal postmortem was performed. We present an overview of these cases and discuss the present Dutch practice in the perspective of national and international legislation.     

Mental health and quality of mental health care

Mental health is an intrinsic part of health. Its prevailing position as secondary to physical health and its consequent neglect are based on inaccurate assumptions about mental health. Nowhere in the world, in either the developed or the developing countries, has mental health work been given priority as part of social policy, health policy or public policy. Yet all countries readily admit the major impact of mental health disturbances on the national economy and public health. The mentally sick are at the bottom of the list in service systems the world over, and the common attitude towards them tends to be highly negative. Meanwhile there is convincing evidence of the global and growing need for mental health services. The international debate on mental health policy has its origins in two arenas: in human rights issues and in service reform issues. The debate on human rights concerns legislation on mental health, compulsory treatment and coercive measures. As to the service reform process, the universal focus has been on the financing of health care, on cuts and downsizing, where no priority has been given to the quality of care. The social consequences of mental illnesses may be far more seriously marginalising for the patient than is the illness itself. They are caused by the inexperience and the exclusion mechanisms of the social community. They are evident also in non-institutional services, causing isolation and rejection. The state of mental health patients will not improve without the strong involvement of health policy planners, quality assurance developers and the medical and scientific community. We need far more studies and research in the field. We need also the empowerment of the patients themselves and their relatives.     

Firearm-assisted suicide: Legislative,policing and clinical concerns

Until recent years the Republic of Ireland had one of the most restrictive regimes on firearms access with the Irish police (An Garda Siochana) consistently refusing to grant certificates for a wide range of guns including handguns, high calibre rifles and shotguns capable of holding more than three cartridges. In 2004 the High Court ruled that this policy was without legislative backing and since then the police began to issue certificates for firearms where the applicant is not disentitled under law from possessing a gun. Set against this backdrop, this paper explores the consequences of liberal gun regimes in the context of access to firearms by those suffering from mental illness and who pose a threat of parasuicide or suicide. Consideration is given to experiences in other jurisdictions and international research on firearm suicide prevention. Finally some recommendations for changes in legislation, policy and protocol in the Irish context are presented.     

Prevention and management of problems related to alcohol abuse in Papua New Guinea through primary health care

This study is designed to answer three questions: 1) What is the situation in Papua New Guinea today with respect of the use and abuse of alcohol? 2) What are the existing programmes for the prevention and management of problems related to alcohol abuse in PNG? 3) Are the existing programmes of prevention and management integrated into the primary health care system or do they operate separately? The instrument for the study is a questionnaire which was adapted and modified from a World Health Organization sponsored workshop on prevention and management of alcohol and drug abuse problems in Africa held in September 1985 in Lagos. The questionnaires were administered to two groups of Papua New Guineans. The first group comprised community and religious leaders attending a workshop on alcohol education held in Lae in February 1988. The second group consisted of mental health nurses and general nurses working in the capitals of the nineteen provinces and the National Capital District of PNG. The questionnaires were administered to the second group personally or by post. The completed questionnaires were statistically analyzed and form the basis of this article. Legal drinking of alcohol for all mature Papua New Guineans started in 1962 when the law on prohibition was repealed. 'In the twenty years since drinking of alcoholic beverages by everyone of legal majority was allowed in Papua New Guinea, a rather clear-cut national style of alcohol use has developed. This style, if continued, points in a disturbing direction. It will lead to a number of serious problems that can be predicted with assurance because they have occurred in many other parts of the world where similar drinking styles exist.'     

Breast Density Legislation: Discussion of Patient Utilization and Subsequent Direct Financial Ramifications for Insurance Providers

Now that New Jersey has become the 14th state in the United States to enact legislation regarding dense breast screening, its patients are eligible to receive screening breast sonography coverage from their insurance carriers. This law is intended to improve breast cancer detection in patients with dense breasts and create awareness of unique issues that come with dense breast tissue, while reinforcing already present efforts to reduce the incidence of and morbidity related to the diagnosis of breast cancer. The aim of this study was to examine data from months preceding the effective date of this legislation in a community hospital setting and compare these data with data from months immediately after, and 6 months after, its enactment to present patient participation data and estimate the legislation’s direct financial ramifications. Detractors of this type of legislation worry about overburdening the health care system with an influx of patients. Although there is a lack of present studies confirming this suspicion in other states with dense breast legislation, this study confirms a large increase in patient utilization after enactment, showing a minimum relative increase of 176.90% and a maximum relative increase of 335.56% in patient utilization of screening breast sonography. The investigators further include an estimation of an increased direct cost for insurers of $4,910,899.18 to $9,848,897.96 for a given month.     

Promoting physical activity with people in different places—A Dutch perspective

This paper describes five recent Dutch studies of the effectiveness of physical activity interventions carried out in diverse settings: general practice (GP), aged care facilities, and workplaces. The stage-based physical activity counselling carried out in the GP setting demonstrated a beneficial effect on the determinants of physical activity, but did not show any additional effect on physical activity behaviour, compared with standard physical activity advice. In contrast, the stage-based intervention through the workplace was effective in increasing physical activity, due mostly to an increase in vigorous-intensity activities. In the aged care setting, functional-skills training alone or in combination with resistance training showed functional improvement only in participants with high participation rates. Functional-skills training appeared to be more feasible than resistance training in this population of frail elderly. The two studies which aimed to promote earlier return-to-work among workers with sick leave due to non-specific low back pain also showed promising results. As a result, it was recommended that occupational physicians (OP) should refer workers with low back pain in the subacute phase of their sick leave to a low intensity intervention consisting of short meetings and exercises aimed at changing behaviour, and that the OPs contact other health care providers (GPs and physiotherapists) about the treatment strategy. Together, the results of these five Dutch studies suggest that it is feasible to successfully promote physical activity to groups of people in diverse places, with benefits in terms of both prevention and management of chronic disease and injury.     

Getting sports injury prevention on to public health agendas - addressing the shortfalls in current information sources

Public health policy is a successful population-level strategy for injury prevention but it is yet to be widely applied to the sports sector. Such policy is generally coordinated by government health departments concerned with the allocation of limited resources to health service delivery and preventive programs for addressing large community health issues. Prioritisation of sports injury prevention (SIP) requires high-quality evidence about the size of the problem and its public health burden; identification of at-risk vulnerable groups; confirmed effective prevention solutions; evidence of intervention cost-effectiveness; and quantification of both financial and policy implications of inaction. This paper argues that the major reason for a lack of sports injury policy by government departments for health or sport to date is a lack of relevant information available for policy makers to make their decisions. Key information gaps evident in Australia are used to highlight this problem. SIP policy does not yet rank highly because, relative to other health/injury issues, there is very little hard evidence to support: claims for its priority ranking, the existence of solutions that can be implemented and which will work, and potential cost-savings to government agencies. Moreover, policy action needs to be integrated across government portfolios, including sport, health and others. Until sports medicine research generates high-quality population-level information of direct relevance and importance to policy makers, especially intervention costing and implementation cost-benefit estimates, and fully engage in policy-informing partnerships, SIP will continue to be left off the public health agenda.     

State regulation of donor insemination: an Israeli case study

Donor insemination (DI) in Israel is state regulated. The Ministry of Health dictates a policy of total medicalization and secrecy. In this paper we analyze the state regulations in reference to their historical and cultural contexts. Our main argument is that in Israel, having children and establishing a family are of supreme importance, owing to Biblical myths as well as the Zionist ethos. The state, as the provider of health care services, encourages fertility treatments in general. However, DI, while assisting conception, results in a somewhat non-traditional family. In contradiction to trends towards openness observed in Western countries, Israel's state policy is one of hiding and camouflaging. We attribute this policy to the strict support of the 'natural family' paradigm, which equally gives DI-assisted families a problem no less than a solution.     

NRC inspections: risk-informed and performance-based

In 2002, the U.S. Nuclear Regulatory Commission (NRC) revised its regulations governing the use of byproduct materials for medical purposes (10 CFR Part 35). These changes were the result of a detailed, 4-year examination of the issues surrounding the medical use program of the NRC and are stated in the latest revision to its medical policy statement, published in the Federal Register on August 3, 2000. As part of an overall program for revising its regulatory framework for medical use, the NRC revised its medical policy statement in keeping with the goal of focusing regulation on those medical procedures that pose the highest risk and structuring the regulations to be risk-informed. NRC inspection procedures were also revised to focus on high-risk activities through a performance-based approach, that is, through observations and interviews with licensee personnel performing NRC-regulated tasks. The purpose of this article is to inform the radiation worker (nuclear medicine technologist or authorized user physician) of the revised focus of the medical use program of the NRC and inspection procedures relative to nuclear medicine-licensed activities. After reading this article, the radiation worker should be able to describe the concept of risk-informed, performance-based regulations and inspections, identify areas of high-risk activities in the nuclear medicine laboratory, and describe techniques used by the NRC inspector to determine the licensee's compliance with the regulations.     

The Mental Health Act 2007 in England and Wales: the impact on perceived patient risk profiles

The Mental Health Act 2007 in England and Wales introduces several amending measures to the Mental Health Act 1983, some of which re-emphasize a commitment to the facilitation of patients' rights. However, the dominant policy driver behind this reform process has been and remains risk and its management. Although this policy has been considerably diluted and is more subtle in form from Parliament's initial plans, it remains strong. This paper considers some early findings from an ongoing study that is concerned with evaluating how the risk agenda, as a policy driver, impacts upon institutions, individuals, and other key stakeholders involved in mental health decisions. The permeation of the risk agenda within the legislation could potentially bring about significant changes in the practice of professionals involved in decisions to compulsorily detain, discharge and treat individuals under the 1983 Act.     

European rules governing radiopharmaceuticals as medicinal products for human use in the EU

The development of EU legislation affecting radiopharmaceuticals is reviewed. The requirements for the preparation of a Summary of Product Characteristics are set out. It is concluded that, across the Community, there is wide variation in the effectiveness of implementation of the regulations.     

Health planning for computed tomography: perspectives and problems.

Computed tomography has been introduced to the health care system at a time when health care planning is still evolving. Unlike the recent past, final authorization of large expenditures and new services such as CT now lies outside the providers of care and is based on laws and regulations that are not familiar to many physicians. A brief review of the principal federal statutes is presented from the Hill-Burton Act to the National Health Planning and Resources Development Act of 1974. Recognizing the unique problems in certain special service areas such as CT, the state of Indiana has formed committees to collect information and develop recommendations to assist its health planners in their actions and decisions under the federal statutes. The quantitative problems which the Indiana CT committee must address are presented in some detail, problems that other health planners face as well.     

Human cloning and stem cell research: engaging in the political process. (Legislation review: prohibition of Human Cloning Act 2002 and the research involving Human Embryos Act)

Committees appointed by governments to inquire into specific policy issues often have no further role when the Committee's report is delivered to government, but that is not always so. This paper describes the activities of members of the Australian Committee on human cloning and embryo research (the Lockhart Committee) to inform Parliament and the community about the Committee's recommendations after its report was tabled in Parliament. It explains their participation in the political process as their recommendations were debated and amending legislation was passed by Parliament. It illustrates a method of communication about scientific and policy issues that explores people's concerns and what they 'need to know' to make a judgment; and then responds to questions they raise, with the aim of facilitating discussion, not arguing for one view. The paper considers whether this type of engagement and communication is appropriate and could be used in other policy discussions.     

Domestic violence on pregnant women in Turkey

Objective: Domestic violence is accepted worldwide as an important health problem. Besides diagnosis and treatment process, there are difficulties when considering of medico-legal evaluation of pregnant women subjected to domestic violence.As a signatory of the ‘‘Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW)’’ Turkey has certain commitments regarding domestic violence and made regulations on national law. The purpose of the present study is to demonstrate the prevalence of domestic violence during pregnancy among the women who applied to obstetrics clinics and evaluating of the participants’ knowledge level about the legal legislation concerning domestic violence.Findings: Pregnant women attending for antenatal care to department of Gynecology and Obstetrics were interviewed using an anonymous and confidential questionnaire. The questionnaire used was a version of Abuse Assessment Screen with guidance of references. 28 (13.4%) women stated that they had been subjected to violence before pregnancy. Only 10 (4.67%) women had stated experience of violence during pregnancy. 148 (69.2%) of them had stated that they had no knowledge about any legislation concerning domestic violence in our country. Conclusion: We believe that society awareness should be increased and the health workers should be informed about their ethical and legal responsibilities concerning domestic violence during pregnancy. The knowledge and sensitivity of health care personnel in Prenatal Clinics and Family Planning Services should be increased and examination protocols should be provided about domestic violence against pregnant women.     

Medical examination of fitness for police custody in two large German towns

Worldwide, there is a high risk of medical complications or death in police custody. This risk is often increased by unclear legislation, a lack of clearly defined responsibility and medical examination standards. Any solution to these problems requires as a very basis the systematic analysis of the medical examinations that determine whether a person is fit to be detained in custody. We analysed a total of 3,674 medical records on fitness for custody, taken from two large German towns (Halle/S and Bremen). The examined individuals were predominantly males or of a younger age. The indication in the majority of cases was acute alcoholic intoxication or drug withdrawal syndromes. Traumata and internal or mental diseases were also quite frequent. For approximately 50% of all cases, fitness for custody was declared on certain conditions. Only 39.8% were found to be unconditionally fit for detention in custody. In just under 10% of the cases, the person was found unfit for custody. These cases concerned mainly persons with psychological symptoms and advanced alcohol or drug withdrawal syndromes. We were able to show that the recent introduction of new police custody regulations in Halle/S had a significant influence on the medical decision on fitness for custody. Our detailed assessment has provided us with the basis to develop solutions for the improvement of medical care in police custody. The focus lies here on the organisation and legal regulation of the medical aspects of custody but also on policing and medical work.     

A guide to parents' participation in pediatric imaging

Family-centered care requires collaboration between the caregivers and the care-seekers at all levels of healthcare. Even the JCAHO Handbook outlines what families can expect from those providing care. Managers of pediatric imaging departments need to evaluate how far to incorporate these Joint Commission requirements into their own hospitals regulations. The house rules of the radiology department at Children's Hospital in Omaha, Neb., where this author is manager, are discussed. State radiation regulations, radiologists' preferences and staff experience in promoting patient cooperation must all be considered when a hospital is preparing to define its own regulations. The Children's Hospital radiology department surveyed 40 children's hospitals across the United States. Although 54% of the responding hospitals allow both parents to accompany a child into the examining room, Children's Hospital elected not to change its practice of allowing only one parent in the room. Although it may not fully meet the needs of parents and children, the hospital believes its practice meets the best interests of its patients.     

Unintended consequences of health care legislation

Unintended consequences of health care legislation threaten the financial and social well-being of the United States. Examples of major legislation resulting in unintended and unforeseen consequences include the Social Security Amendments Acts of 1989 and 1993 (the Stark laws), the Balanced Budget Act of 1997, and the Social Security Amendments Act of 1965 (Medicare and Medicaid). Each of these has had unintended financial and social outcomes. Spending for Medicare and Medicaid now equals an unsustainable 23% of the federal budget. Major reasons for unintended consequences include failure to appreciate the complexity of the issues, the open-ended nature of medical advances with attendant increases in costs, the inducement of change in behaviors in response to legislation, and the moral hazard of people spending other people's money. Actions that should be considered to avoid unintended consequences include more involvement of health professionals in the design of legislation, the inclusion of triggers to target review of legislatively defined programs, and the setting of time limits for sun-setting legislation. The ACR has played an important advocacy role and should continue to offer input to legislators, federal policymakers, and other stakeholders. Many opportunities exist to address the current financial situation by reducing the amount of unnecessary care delivered. Both major US political parties need to find the political will to compromise to chart the way forward. Some level of sacrifice is likely to be necessary from patients and providers and other stakeholders.