... an undesired pregnancy. The medicine helps remove the fetus and placenta from the mother's womb (uterus). There are different types of medical abortions: Therapeutic medical abortion is done because the woman ...
Trussell, J; Ellertson, C
Comparisons of the efficacy of different regimens of medical abortion are difficult because of the widely varying protocols (even for testing identical regimens), divergent definitions of success and failure, and lack of a standard method of analysis. In this article we review the current efficacy literature on medical abortion, highlighting some of the most important differences in the way that efficacy has been analyzed. We then propose a standard conceptual approach and the accompanying statistical methods for analyzing clinical trials of medical abortion and to explain how clinical investigators can implement this approach. Our review reveals that research on the efficacy of medical abortion has closely followed the conceptual model used for analysis of surgical abortion. The problem, however, is that, whereas surgical abortion is a discrete event occurring in the space of a few minutes or less, medical abortion is a process typically lasting from several days to several weeks. In this process, two events may occur that are not possible with surgical abortion. First, the woman can opt out of the process before a fair determination of efficacy can be made. Second, the process of medical abortion allows time for surgical interventions that may be convenient for the clinician but not strictly necessary from a medical perspective. Another difference from surgical abortions is that, for medical abortions, different medical abortion protocols specify different waiting periods, giving the drugs less time to work in some studies than in others before a determination of efficacy is made. We argue that, when analyzing efficacy of medical abortion, researchers should abandon their close reliance on the analogy to surgical abortion. In fact, medical abortion is more appropriately analyzed by life table procedures developed for the study of another fertility regulation technology; contraception. As with medical abortion, a woman initiating use of a contraceptive method can
Rosenblatt, R A; Robinson, K B; Larson, E H; Dobie, S A
This paper investigated the attitude toward abortion and other reproductive health services of first- and second-year medical students at the Seattle campus of the University of Washington, a large regional primary care-oriented medical school, in 1996-97. A total of 219 (76.6%) students responded. The majority of the students support the availability of a broad range of reproductive health services including abortion; 58.1% felt that first-trimester abortions should be available to patients under most circumstances. Of the 43.4% of students who anticipated a career in family practice, most expected to provide abortions in their future practices. Moreover, older students and women were more likely to support the provision of abortion services. This study concludes that despite the continuing pressure on abortion providers, most first- and second-year medical students at a fairly state-supported medical school intend to incorporate this procedure into their future practices.
While the medical abortion (MA) drugs, mifepristone and misoprostol, have radically altered reproductive health practices around the world, there has been little field research on the sales and use of these drugs, especially in developing countries. This leaves the family planning community with many unanswered questions. While good profiles of contraceptive use are available for many countries and we have good technical data on the MA drugs' efficacy, dosages and regimens such as home dosage of misoprostol versus clinic dosage, we have very little information about the quantities of MA drugs sold, how they are used, where they are used, and, in the case of misoprostol, for what purposes. Sales data are available from one excellent commercial survey and from social marketing sales of mifepristone and misoprostol and these are presented. Acknowledging the sensitivity of the issue, especially in countries where abortion is severely restricted, the author makes a plea for careful additional research to shed light on an important and growing part of the international reproductive health picture.
Surgical abortion has been provided liberally in Australia since the early 1970s, mainly in privately owned specialist clinics. The introduction of medical abortion, however, was deliberately obstructed and consequently significantly delayed when compared to similar countries. Mifepristone was approved for commercial import only in 2012 and listed as a government subsidised medicine in 2013. Despite optimism from those who seek to improve women's access to abortion, the increased availability of medical abortion has not yet addressed the disadvantage experienced by poor and non-metropolitan women. After telling the story of medical abortion in Australia, this paper considers the context through which it has become available since 2013. It argues that the integration of medical abortion into primary health care, which would locate abortion provision in new settings and expand women's access, has been constrained by the stigma attached to abortion, overly cautious institutionalised frameworks, and the lack of public health responsibility for abortion services. The paper draws on documentary sources and oral history interviews conducted in 2013 and 2015.
Radu, A; Capra, G
In the course of the evolution of human society the problem or idea of interrupting a pregnancy has been faced many times. Romania has adopted a mixed solution to the termination of pregnancy allowing abortions for medical, eugenic, and social reasons. The 1936 penal code allowed only medical abortion, but recent regulations have offered differing solutions. The old regulation not allowing termination of pregnancy or restricting it was in force with minor modifications until 1957. In 1966 a decree was issued that allowed women with 4 children an abortion for special reasons as determined by an abortion committee, but still therapeutic and strictly medical causes predominated. In 1985 a new regulation of medical law prohibited termination of normal pregnancy up to 28 weeks of gestation and infractions were punishable by law. Illegal induced abortion represents an antisocial manifestation that jeopardizes human relationships in society. Induced abortion occurs often in disintegrated family situations. The social implications of the phenomenon of birth are manyfold. Medical intervention is difficult because of the mutilating effect of abortion. The motives are a matter of reflection for physicians and jurists alike.
An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or ... personal. If you are thinking of having an abortion, most healthcare providers advise counseling.
Mihciokur, Sare; Akin, Ayse; Dogan, Bahar Guciz; Ozvaris, Sevkat Bahar
Abortion has been legal and safe in Turkey since 1983, but the unmet need for safe abortion services remains high. Many medical practitioners believe that the introduction of medical abortion would address this. However, since 2012 there has been political opposition to the provision of abortion services. The government has been threatening to restrict the law, and following an administrative change in booking of appointments, some hospital clinics that provided family planning and abortion services had to stop providing abortions. Thus, the availability of safe abortion depends not only on permissive legislation but also political support and the ability of health professionals to provide it. We conducted a study among university medical school students in three provinces on their knowledge of abortion and abortion methods, to try to understand their future practice intentions. Pre-tested, structured, self-administered questionnaires were answered by 209 final-year medical students. The students' level of knowledge of abortion and abortion methods was very low. More than three-quarters had heard of surgical abortion, but only 56% mentioned medical abortion. Although nearly 90% supported making abortion services available in Turkey, their willingness to provide surgical abortion (16%) or medical abortion (15%) was low, due to lack of knowledge. Abortion care, including medical abortion, needs to be included in the medical school curriculum in order to safeguard this women's health service.
Landy, U; Lewit, S
A survey of members of the National Abortion Federation (NAF), most of them non-hospital facilities, responsible for performing almost half of the abortions in the United States, was carried out by the NAF in 1981. Among the principal findings were the following: Fifty-three percent of the NAF facilities are freestanding clinics operated for profit. Fifty-one percent are open more than 50 hours per week, and 77 percent are open six days a week; 86 percent are open on Saturdays. Seventy-five percent of the physicians performing abortions in these facilities are gynecologists. Counseling provided by specially trained abortion counselors is a unique contribution of abortion facilities to health-care delivery. Virtually all facilities employ counselors who are neither doctors nor nurses. Most NAF facilities have more counselors than nurses and more nurses than doctors. Counseling in virtually all facilities includes providing written as well as verbal information about the nature of the procedure and its medical risks; such information is given to the patient so that she can give informed consent for the abortion. Almost all facilities include information about contraception and about the options available to a woman with a problem pregnancy. Most offer counseling to the male, as well as the female partner, on the patient's request. Twenty-eight percent of facilities generally provide both individual and group counseling. Where only one type of counseling is provided, it is usually individual counseling.(ABSTRACT TRUNCATED AT 250 WORDS)
Mckenas, David K.; Jennings, Richard T.
NASA and DOD studies of medical-planning and logistical problems are reviewed as applicable to providing emergency medical care at remote transoceanic abort landing (TAL) sites. Two options are analyzed including a modified surgical response team and a combination physician/medical technician team. The two concepts are examined in terms of cost-effectiveness, specific types of medical support such as blood procurement, and search-and-rescue requirements. It is found that the physician/technician team is more economically efficient, and the description of the concept permits the development of an effective TAL-site astronaut medical-support system. A balance is struck between the competing problems of cost and medical capability by planning for on-scene medical stabilization and air evacuation to DOD tertiary medical centers.
Tey, Nai-peng; Yew, Siew-yong; Low, Wah-yun; Su’ut, Lela; Renjhen, Prachi; Huang, M. S. L.; Tong, Wen-ting; Lai, Siow-li
Background Abortion is a serious public health issue, and it poses high risks to the health and life of women. Yet safe abortion services are not readily available because few doctors are trained to provide such services. Many doctors are unaware of laws pertaining to abortion. This article reports survey findings on Malaysian medical students’ attitudes toward abortion education and presents a case for including abortion education in medical schools. Methods and Results A survey on knowledge of and attitudes toward abortion among medical students was conducted in two public universities and a private university in Malaysia in 2011. A total of 1,060 students returned the completed questionnaires. The survey covered about 90% of medical students in Years 1, 3, and 5 in the three universities. About 90% of the students wanted more training on the general knowledge and legal aspects of abortion, and pre-and post-abortion counseling. Overall, 75.9% and 81.0% of the students were in favor of including in medical education the training on surgical abortion techniques and medical abortion, respectively. Only 2.4% and 1.7% were opposed to the inclusion of training of these two methods in the curriculum. The remaining respondents were neutral in their stand. Desire for more abortion education was associated with students’ pro-choice index, their intention to provide abortion services in future practice, and year of study. However, students’ attitudes toward abortion were not significantly associated with gender, type of university, or ethnicity. Conclusions Most students wanted more training on abortion. Some students also expressed their intention to provide abortion counseling and services in their future practice. Their desire for more training on abortion should be taken into account in the new curriculum. Abortion education is an important step towards making available safe abortion services to enable women to exercise their reproductive rights. PMID:23300600
Petersen, Kerry A
Mifepristone is a safe, effective and relatively cheap drug that plays an important role in women's health care and is widely used for early medical abortion in many countries. The Therapeutic Goods Administration (TGA) can authorise mifepristone to be imported into and marketed in Australia. To date, no pharmaceutical company has applied to register mifepristone in Australia. The TGA can also permit medical practitioners to prescribe medicine that is not approved for marketing in Australia under the Authorised Prescribers scheme. The number of approvals for mifepristone has gradually increased, in spite of a complicated and protracted application process. Approval under the Authorised Prescribers scheme requires medical practitioners to comply with state or territory legislation. Abortion laws in Australia vary between jurisdictions, and in some states the law is unclear and confusing. The decriminalisation of abortion in all Australian jurisdictions would protect medical practitioners from criminal liability, promote the health interests of Australian women, and discourage the illegal importation of abortifacients that are being used without quality controls or medical supervision. The Victorian Abortion Law Reform Act 2008 is one legislative model for this.
payments prohibited for drugs or devices to prevent implantation of the fertilized ovum , or for medical procedures necessary for the termination of an...fertilized ovum , or for medical procedures necessary for the termination of an ectopic pregnancy: Provided, however, That the several States are and
are payments prohibited for drugs or devices to prevent implantation of the fertilized ovum , or for medical procedures necessary for the termination...the fertilized ovum , or for medical procedures necessary for the termination of an ectopic pregnancy: Provided, however, That the several States are
Rodriguez, Maria Isabel; Mendoza, Willis Simancas; Guerra-Palacio, Camilo; Guzman, Nelson Alvis; Tolosa, Jorge E
The majority of abortions in Colombia continue to take place outside the formal health system under a range of conditions, with the majority of women obtaining misoprostol from a thriving black market for the drug and self-administering the medication. We conducted a cost analysis to compare the costs to the health system of three approaches to the provision of abortion care in Colombia: post-abortion care for complications of unsafe abortions, and for legal abortions in a health facility, misoprostol-only medical abortion and vacuum aspiration abortion. Hospital billing records from three institutions, two large maternity hospitals and one specialist reproductive health clinic, were analysed for procedure and complication rates, and costs by diagnosis. The majority of visits (94%) were to the two hospitals for post-abortion care; the other 6% were for legal abortions. Only one minor complication was found among the women having legal abortions, a complication rate of less than 1%. Among the women presenting for post-abortion care, 5% had complications during their treatment, mainly from infection or haemorrhage. Legal abortions were associated not only with far fewer complications for women, but also lower costs for the health system than for post-abortion care. We calculated based on our findings that for every 1,000 women receiving post-abortion care instead of a legal abortion within the health system, 16 women experienced avoidable complications, and the health system spent US $48,000 managing them. Increasing women's access to safe abortion care would not only reduce complications for women, but would also be a cost-saving strategy for the health system.
Powell-Jackson, Timothy; Acharya, Rajib; Filippi, Veronique; Ronsmans, Carine
Background Medical abortion (mifepristone and misoprostol) has the potential to contribute to reduced maternal mortality but little is known about the provision or quality of advice for medical abortion through the private retail sector. We examined the availability of medical abortion and the practices of pharmacists in India, where abortion has been legal since 1972. Methods We interviewed 591 pharmacists in 60 local markets in city, town and rural areas of Madhya Pradesh. One month later, we returned to 359 pharmacists with undercover patients who presented themselves unannounced as genuine customers seeking a medical abortion. Results Medical abortion was offered to undercover patients by 256 (71.3%) pharmacists and 24 different brands were identified. Two thirds (68.5%) of pharmacists stated that abortion was illegal in India. Only 106 (38.5%) pharmacists asked clients the timing of the last menstrual period and 38 (13.8%) requested to see a doctor’s prescription – a legal requirement in India. Only 59 (21.5%) pharmacists correctly advised patients on the gestational limit for medical abortion, 97 (35.3%) provided correct information on how many and when to take the tablets in a combination pack, and 78 (28.4%) gave accurate advice on where to seek care in case of complications. Advice on post-abortion family planning was almost nonexistent. Conclusions The retail market for medical abortion is extensive, but the quality of advice given to patients is poor. Although the contribution of medical abortion to women’s health in India is poorly understood, there is an urgent need to improve the practices of pharmacists selling medical abortion. PMID:25822656
Dourlen-rollier, A M
The historical and current (1969) abortion laws in France as well as those in other Western countries are analyzed. France has had a series of punitive abortion codes since the Napoleonic Code of 1810 prescribing solitary confinement for the woman. The reforms of 1920 and 1923 made provocation of abortion or contraceptional propaganda a "crime" (felony), later a "delit" (misdemeanor), called for trial before magistr ate instead of jury, but resulted in only about 200 convictions a year. The decree of 1939 extended the misdemeanor to women who aborted even if they were not pregnant, and provided for professional licenses such as that of surgeon or pharmacist to be suspended. The law of 1942 made abortion a social crime and increased the maximum penalty to capital punishment, which was exercised in 2 cases. About 4000 per year were convicted from 1942-1944. Now the law still applies to all who intend to abort, whether or not pregnant or successful, but punishemnt is limited to 1-5 years imprisonment, and 72,000 francs fine, or suspension of medical practice for 5 years. About 500 have been convicted per year. Since 1955 legal abortion has been available (to about 130 women over 4 years) if it is the only means to save the woman's life. Although pregnancy tests are controlled, the population desregards the law by resorting to clandestine abortion. The wealthy travel to Switzerland (where 68% of legal abortions are done on French women) or to England. Numbers are estimated by the French government at 250,000-300,000 per year, or 1 for every 2 live births, but by hospital statistics at 400,000-1,000,000 per year. The rest of the review covers abortion laws in Scandinavian, Central European, and individual US states as of 1969.
The Belgian law relative to euthanasia has been published in 2002. A physician is allowed to help a patient with intractable suffering (physical or psychological). Legal conditions are clear. However, nothing is said about medical procedures or medications to be used. The present paper will present specific clinical situations at the end of life, practical procedures and medications. A special focus is made on psychological impact of euthanasia.
Zamberlin, Nina; Romero, Mariana; Ramos, Silvina
Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe. Medical abortion (MA) refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In settings where mifepristone is not available, misoprostol alone is used.Medical abortion has radically changed abortion practices worldwide, and particularly in legally restricted contexts. In Latin America women have been using misoprostol for self-induced home abortions for over two decades.This article summarizes the findings of a literature review on women's experiences with medical abortion in Latin American countries where voluntary abortion is illegal.Women's personal experiences with medical abortion are diverse and vary according to context, age, reproductive history, social and educational level, knowledge about medical abortion, and the physical, emotional, and social circumstances linked to the pregnancy. But most importantly, experiences are determined by whether or not women have the chance to access: 1) a medically supervised abortion in a clandestine clinic or 2) complete and accurate information on medical abortion. Other key factors are access to economic resources and emotional support.Women value the safety and effectiveness of MA as well as the privacy that it allows and the possibility of having their partner, a friend or a person of their choice nearby during the process. Women perceive MA as less painful, easier, safer, more practical, less expensive, more natural and less traumatic than other abortion methods. The fact that it is self-induced and that it avoids surgery are also pointed out as advantages. Main disadvantages identified by women are that MA is painful and takes time to complete. Other negatively evaluated aspects have to do with side effects, prolonged bleeding, the possibility that it might not be effective, and the
Abortion is legally restricted in most of Latin America where 95% of the 4.4 million abortions performed annually are unsafe. Medical abortion (MA) refers to the use of a drug or a combination of drugs to terminate pregnancy. Mifepristone followed by misoprostol is the most effective and recommended regime. In settings where mifepristone is not available, misoprostol alone is used. Medical abortion has radically changed abortion practices worldwide, and particularly in legally restricted contexts. In Latin America women have been using misoprostol for self-induced home abortions for over two decades. This article summarizes the findings of a literature review on women’s experiences with medical abortion in Latin American countries where voluntary abortion is illegal. Women’s personal experiences with medical abortion are diverse and vary according to context, age, reproductive history, social and educational level, knowledge about medical abortion, and the physical, emotional, and social circumstances linked to the pregnancy. But most importantly, experiences are determined by whether or not women have the chance to access: 1) a medically supervised abortion in a clandestine clinic or 2) complete and accurate information on medical abortion. Other key factors are access to economic resources and emotional support. Women value the safety and effectiveness of MA as well as the privacy that it allows and the possibility of having their partner, a friend or a person of their choice nearby during the process. Women perceive MA as less painful, easier, safer, more practical, less expensive, more natural and less traumatic than other abortion methods. The fact that it is self-induced and that it avoids surgery are also pointed out as advantages. Main disadvantages identified by women are that MA is painful and takes time to complete. Other negatively evaluated aspects have to do with side effects, prolonged bleeding, the possibility that it might not be effective, and
The three articles by Dr. Gans Epner, Drs. Sprang and Neerhof, and Dr. Grimes centered around the issue that criminal laws against so-called partial-birth abortion go beyond banning any one abortion procedure or just "late-term" procedures. It is noted that even the authors gave different definitions of "late term". In addition, neither the phrase "late term" nor "intact dilation" and evacuation is present or defined in any of the partial-birth abortion laws passed in 27 states or in the federal bill. Evidence shows that 17 courts across the US have blocked partial-birth abortion laws as unconstitutional, finding such laws could, at any point in a pregnancy, outlaw an abortion performed using the most common and safest procedures. In these terms, the endorsement of the federal partial-birth abortion law by the American Medical Association gave credibility to the deception that partial-birth abortion legislation is a ban on the intact dilation and extraction procedure. Moreover, it has endorsed government intrusion in a private medical decision and sanctioned a law that subjects physicians to criminal prosecution for providing necessary health care.
Raymond, Elin; Kaczorowski, Janusz; Smith, Pat; Sellors, John; Walsh, Allyn
OBJECTIVE: To determine the knowledge, attitudes, and interest in providing medical abortion reported by family physicians and residents in rural and urban settings. DESIGN: A self-administered mailed survey using the modified Dillman method. SETTING: Hamilton and Thunder Bay County in Ontario. PARTICIPANTS: Family medicine residents (n = 93) and physicians (n = 234) in predominantly urban (Hamilton) and rural (Thunder Bay) settings. All faculty family physicians at McMaster University practising general family medicine and all family physicians in Thunder Bay County were surveyed. MAIN OUTCOME MEASURES: Knowledge of, attitudes toward, and interest in providing medical abortion. RESULTS: Overall response rate to the survey was 62.7% (n = 327); 74.2% (69/93) of residents responded; 58.1% (136/234) of physicians responded. Physicians and residents rated their knowledge about medical abortion as poor, but most were interested in receiving more information and training in this area. Many (83.1%, 157/189) reported that medical abortion was an acceptable procedure for family physicians to perform, and 52.0% (64/123) of the physicians would consider providing medical abortions for their patients. Residents training in the more rural Thunder Bay program were less likely to support first-trimester abortions for both medical and nonmedical reasons than those training in Hamilton (P < .05). Male respondents were significantly less supportive of abortion for nonmedical reasons and were less likely to consider providing medical abortions for their patients (P < .05). CONCLUSION: Most family physicians and residents showed interest in receiving more information about and training in medical abortion. PMID:11935718
Louie, Karmen S; Chong, Erica; Tsereteli, Tamar; Avagyan, Gayane; Vardanyan, Susanna; Winikoff, Beverly
In Armenia, abortion is the main means of fertility regulation; however, before research activities were initiated only surgical methods were available and the quality of services was low in some areas. Our clinical study from 2008-2011 aimed to show that early medical abortion is an acceptable and feasible option. A total of 700 eligible women with pregnancies up to 63 days LMP presenting for abortion were recruited for the study in five locations. Participants took 200 mg mifepristone and 800 μg buccal misoprostol 24-48 hours later. They returned for a follow-up visit two weeks after mifepristone administration. 95% of the women had successful abortions and 95% were satisfied with the method. In 2012-2013, we conducted a follow-up assessment to examine the ongoing provision and quality of medical abortion services at the former research sites. Medical record reviews, interviews and observations were carried out three times approximately six months apart. The assessment found that all five sites had continued providing medical abortion, with about half of eligible women choosing the medical method. Four of the five sites were achieving high success rates. Staff turnover and the lack of trained providers likely contributed to the higher failure rate at the fifth site. These findings provide evidence that first trimester medical abortion is an acceptable and feasible option for Armenian women and providers, and that high quality services are being delivered.
Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu
Introduction The termination of unwanted pregnancies up to 12 weeks’ gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse‐midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS‐11). Results By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary‐level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary‐level health facilities. Post‐training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. PMID:26860072
Nayak, Prasanta Kumar; Mitra, Subarna; Padma, Alaganandam; Agrawal, Sarita
A majority of the unsafe abortions are performed by untrained birth attendants or quacks leading to complications in a large proportion of these cases. Complications like bowel injury, bladder injury, uterine perforation, and septic abortion are mostly caused by unskilled hands and are detected immediately or within few days of the procedure, owing to the need for tertiary level care. Here we present a very interesting case of unsafe abortion induced by a Ryle's tube in a 32-year-old lady, which was diagnosed five years after the procedure. Considering its atypical presentation, it is the first case of its kind in the literature. The details of the case and its management are described along with appropriate pictures. PMID:24649386
Guilbert, Edith R.; Hayden, Althea S.; Jones, Heidi E.; White, Katharine O’Connell; Steven Lichtenberg, E.; Paul, Maureen; Norman, Wendy V.
Abstract Objective To understand the current availability and practice of first-trimester medical abortion (MA) in Canada. Design Using public sources and professional networks, abortion facilities across Canada were identified for a cross-sectional survey on medical and surgical abortion. English and French surveys were distributed by surface or electronic mail between July and November 2013. Setting Canada. Participants A total of 94 abortion facilities were identified. Main outcome measures Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using χ2 and t tests. Results A total of 78 of 94 (83.0%) facilities responded. Medical abortion represented 3.8% of first-trimester abortions reported (2706 of 70 860) in 2012. Among the facilities offering MA, 45.0% performed fewer than 500 first-trimester abortions a year, while 35.0% performed more than 1000. More MAs were performed in private offices or ambulatory health centres than in hospitals. Sixty-two physicians from 28 of 78 facilities reported providing first-trimester MA; 87.1% also provided surgical abortion. More than three-quarters of MA physicians were female and 56.5% were family physicians. A preponderance (85.2%) of providers offered methotrexate with misoprostol. Nearly all physicians (90.3%) required patients to have an ultrasound before MA, and 72.6% assessed the completion of the abortion with ultrasonography. Most physicians (74.2%) offered MA through 49 days after the onset of the last menstrual period, and 21.0% offered MA through 50 to 56 days; 37.1% reported providing MA to patients who lived more than 2 hours away. Four physicians from 1 site provided MA via telemedicine. Conclusion In Canada, MA provision using methotrexate and misoprostol is consistent with best-practice guidelines, but MA is rare and its availability is unevenly distributed. PMID:28192275
... Education & Events Advocacy For Patients About ACOG Induced Abortion Home For Patients Search FAQs Induced Abortion Page ... Induced Abortion FAQ043, May 2015 PDF Format Induced Abortion Special Procedures What is an induced abortion? What ...
Henshaw, R C; Naji, S A; Russell, I T; Templeton, A A
A total of 363 women undergoing legal abortion at < 63 days of amenorrhoea were allocated by a patient-centered, partially randomized study design to undergo medical abortion (using mifepristone 600 mg followed 48 h later by gemeprost 1 mg vaginal pessary) or vacuum aspiration (performed under general anaesthesia). The aim of the study was to compare the efficacy and complications of the two procedures. Main outcome measures included efficacy rates, medical complications within 21 days of abortion and unplanned family doctor consultation rates within 8 weeks following abortion. Sequelae such as pain, vaginal bleeding and recovery time were assessed by the change in haemoglobin level, the time taken to return to work or normal activity and the analgesic use. Results were gestation-related; at 50 days of amenorrhoea there was little to choose between the two procedures. At 50-63 days of amenorrhoea medical abortion becomes more painful and less effective, whereas vacuum aspiration retains high tolerance and efficacy. Women who are unsure which method to use are likely to find vacuum aspiration more acceptable at longer gestations.
Piras, Mauro; Delbon, Paola; Bin, Paola; Casella, Claudia; Capasso, Emanuele; Conti, Adelaide
Abstract In Italy, Law 194 of 22 May 1978 provides for and regulates the voluntary termination of pregnancy (VTP). Medical abortion became popular nationwide after Mifepristone (RU-486) was authorized for the market by AIFA (Italian Drug Agency) in July 2009. We searched articles in medical literature database with these terms: “medical abortion”, “RU486”, “surgical abortion”. We also searched laws and judgments concerning abortion in national legal databases. Ministerial guidelines were searched on official website of Italian Ministry of Health. We found many medical studies about medical and surgical abortion. We found also ministerial and regional guidelines, which were analyzed. From the point of view of legal medicine, the issues related to abortion with the pharmacological method consist in verifying compatibility and consistency with the safety principles and the parameters imposed by Law n. 194 of 1978, using off-label Misoprostol, what inpatient care should be used and informed consent. The doctor’s job is to provide the patient with comprehensive and clear information about how the procedure will be performed, any complications and the time period needed for both procedures. PMID:28352815
Powell, R. W.; Eide, D. G.
An investigation has been made of abort procedures for space shuttle-type vehicles using a point mass trajectory optimization program known as POST. This study determined the minimum time gap between immediate and once-around safe return to the launch site from a baseline due-East launch trajectory for an alternate space shuttle concept which experiences an instantaneous loss of 25 percent of the total main engine thrust.
Gilmartin, Mary; White, Allen
Medical tourism in Ireland, like in many Western states, is built around assumptions about individual agency, choice, possibility, and mobility. One specific form of medical tourism—the flow of women from Ireland traveling in order to secure an abortion—disrupts and contradicts these assumptions. One legacy of the bitter, contentious political and legal battles surrounding abortion in Ireland in the 1980s and 1990s has been securing the right of mobility for all pregnant Irish citizens to cross international borders to secure an abortion. However, these mobility rights are contingent upon nationality, social class, and race, and they have enabled successive Irish governments to avoid any responsibility for providing safe, legal, and affordable abortion services in Ireland. Nearly twenty years after the X case discussed here, the pregnant female body moving over international borders—entering and leaving the state—is still interpreted as problematic and threatening to the Irish state.
Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily
Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…
Park, Min Hae; Nguyen, Thang Huu; Dang, Anh Thi Ngoc; Ngo, Thoai Dinh
Objective To describe medical abortion (MA) practices among private providers in Vietnam. Methods The study subjects were women (n = 258) undergoing early MA through 12 private providers in Hanoi during February–June 2012. The women were interviewed on the day of their procedure and were followed up by telephone 14 days after mifepristone administration. Results Of the 258 women in the study, 97% used a regimen of mifepristone plus misoprostol; 80% were instructed to administer misoprostol at home. MA resulted in a complete termination in 90.8% of cases. All women were provided with information on potential complications and were instructed to return for a follow-up visit. We successfully followed up 77.5% (n = 200) of participants by telephone, while nearly two-thirds of women returned to the clinic for a follow-up visit. At follow-up, 39.5% of women reported having used a Help line service, while 7% had sought help from a health provider. A high unmet need for postabortion family planning was identified. Conclusion Follow-up of women, postabortion care, and the provision of family planning have been identified as important areas to address for strengthening MA services in the private sector in Vietnam. PMID:24082795
Beckman, Linda J; Harvey, S Marie; Satre, Sarah J
This study examined beliefs about the delivery of medical abortion services and current roles of 76 providers of methotrexate-induced abortion. The sample included physicians, midlevel professionals, administrators, and counselors/other medical staff. Over 75% of participants believed that, given proper training and emergency backup, physicians and midlevel clinicians alike could provide medical abortions. Over 85% agreed that methotrexate-induced abortions could be provided in any physician's office or medical facility. There were no differences in perceptions by participant group. Involvement of midlevel providers in provision of medical abortion could potentially increase access and options for women seeking to terminate an early pregnancy.
Devjee, Jaymala; Moodley, Jack
Background Despite a liberal abortion law, access to safe abortion services in South Africa is challenging for many women. Medication abortion was introduced in 2013, but its reach remains limited. We aimed to estimate the costs and cost effectiveness of providing first-trimester medication abortion and manual vacuum aspiration (MVA) services to inform planning for first-trimester service provision in South Africa and similar settings. Methods We obtained data on service provision and outcomes from an operations research study where medication abortion was introduced alongside existing MVA services in public hospitals in KwaZulu-Natal province. Clinical data were collected through interviews with first-trimester abortion clients and summaries completed by nurses performing the procedures. In parallel, we performed micro-costing at three of the study hospitals. Using a model built in Excel, we estimated the average cost per medical and surgical procedure and determined the cost per complete abortion performed. Results are presented in 2015 US dollars. Results A total of 1,129 women were eligible for a first trimester abortion at the three study sites. The majority (886, 78.5%) were eligible to choose their abortion procedure; 94.1% (n = 834) chose medication abortion. The total average cost per medication abortion was $63.91 (52.32–75.51). The total average cost per MVA was higher at $69.60 (52.62–86.57); though the cost ranges for the two procedures overlapped. Given average costs, the cost per complete medication abortion was lower than the cost per complete MVA despite three (0.4%) medication abortion women being hospitalized and two (0.3%) having ongoing pregnancies at study exit. Personnel costs were the largest component of the total average cost of both abortion methods. Conclusion This analysis supports the scale-up of medication abortion alongside existing MVA services in South Africa. Women can be offered a choice of methods, including medication
The Alan Guttmacher Institute's State Reproductive Health Monitor "Legislative Proposals and Actions" provides US legislative information on abortion. The listing contains information on pending bills: the state, the identifying legislative number, the sponsor, the committee, the date the bill was introduced, a description of the bill, and when available the bill's status. The bills cover: 1) clinic licensing, e.g., requiring outpatient health care facilities in which abortions are performed, to have malpractice liability insurance; 2) comprehensive statues, which require parental notification before minor may obtain abortions, mandate abortion counseling to all women 24 hours before the abortion can be performed and prohibit disciplining or discharging a state employee for refusing to provide abortion counseling; 3) fetal personhood and rights, e.g. providing that life is vested in each person at fertilization; 4) fetal research and remains; 5) gender of fetus, which regulate abortions relative to sex selection in pregnancies; 6) harassment regulation; 7) informed consent and waiting periods detailing the risks and alternatives to abortion, and the 24-hour waiting period; 8) insurance coverage, e.g., eliminating language banning the coverage of abortions for state workers, and prohibiting disclosure by a health insurance carrier to the employer of a claimant that the claimant had a surgical abortion; 9) legality of abortion, urging Congress to reject he Freedom of Choice Act; 10) parental consent and notification; 11) postviability requirements; 12) public funding; 13) reporting requirements; 14) reproductive rights, and 15) spousal and paternal consent and notification.
Ferris, L E; Basinski, A S
Dr. Ellen R. Wiebe's study of the use of methotrexate and misoprostol in combination for early termination of intrauterine pregnancy (see pages 165 to 170 of this issue) is the first Canadian study of the use of this drug combination for medical abortion. The authors compare Wiebe's findings with those of earlier studies on methotrexate and misoprostol, as well as with European findings on the use of mifepristone with prostaglandins. The authors argue that although the methotrexate-misoprostol combination appears to be reasonably safe for the woman, the failure rate and the teratogenicity of methotrexate and misoprosol give cause for concern. The authors conclude that medical abortions ought to be offered only where there is adequate access to laboratory and surgical facilities and where losses to follow-up are systematically minimized to reduce the potential for continued pregnancy resulting in congenital abnormality. PMID:8548707
Anderson, K; Anderson, R
This discussion examines the claim by conservatives that abortion does not count as health care and provides a more adequate liberal response which views the abortion as an argument over moral beliefs. The conservative claim is not without attractive features. It does seem plausible to say that health care is the care required to treat and prevent disease and injury--"the disease and injury view." As a definition, it is attractive because it emphasizes the seemingly central issue, i.e., the maintenance of one's body as an instrument to do what one wants. Second, this definition is attractive because it embodies a general principle of priority in health care. Some diseases and their treatments are more resoure-consuming than others. Thus, some treatments and preventions have a higher priority than others. These 2 features make the disease and injury definition attractive to either liberal or conservative. Yet, the conservative then produces a further and more controversial implication. Contraception and abortion aim at preventing or eliminating the condition of pregnancy, and thus, they fail to fall under the definition of health care as stated, unless one is willing to regard pregnancy as a disease or injury. As both the conservative view and liberal response are equally distressing, it is necessary to look for another liberal response by reconsidering the fundamental propositions of the definition of health care in a world of limited medical resources. The simple fact is that pregnancy, abortion, and contraception all have enormous implications for oneself and one's body. Even in this resource-rich society, what a person wants for and from one's body is the essential element in defining health care. Pregnancy and the treatmets of contraception and abortion meet the requirement of health care because of the enormous impact of having a child.
Puri, Mahesh; Tamang, Anand; Shrestha, Prabhakar; Joshi, Deepak
Medical abortion was introduced in Nepal in 2009, but rural women's access to medical abortion services remained limited. We conducted a district-level operations research study to assess the effectiveness of training 13 auxiliary nurse-midwives as medical abortion providers, and 120 female community health volunteers as communicators and referral agents for expanding access to medical abortion for rural women. Interviews with service providers and women who received medical abortion were undertaken and service statistics were analysed. Compared to a neighbouring district with no intervention, there was a significant increase in the intervention area in community health volunteers' knowledge of the legal conditions for abortion, the advantages and disadvantages of medical abortion, safe places for an abortion, medical abortion drugs, correct gestational age for home use of medical abortion, and carrying out a urine pregnancy test. In a one-year period in 2011-12, the community health volunteers did pregnancy tests for 584 women and referred 114 women to the auxiliary nurse-midwives for abortion; 307 women in the intervention area received medical abortion services from auxiliary nurse-midwives. There were no complications that required referral to a higher-level facility except for one incomplete abortion. Almost all women who opted for medical abortion were happy with the services provided. The study demonstrated that auxiliary nurse-midwives can independently and confidently provide medical abortion safely and effectively at the sub-health post level, and community health volunteers are effective change agents in informing women about medical abortion.
Dans, Peter E.
Surveys of first- and fourth-year Johns Hopkins University (Maryland) medical students found little change in attitudes about abortion over four years. Attitudes correlated most strongly with personal beliefs about when a fetus is considered human life and somewhat with student gender. Results are used in a medical ethics course to illuminate…
Somerville, A C
A survey of 886 adults over 16 was conducted regarding abortion in Papanui, New Zealand. Only 7.79% thought a person should never have an abortion under any circumstances, 16.70% thought the decision to have an abortion should be decided by a panel of two doctors, a social worker, and a statutory committee set up by the government. 44.4% thought the decision should be between a woman and the doctor of her choice. 20.54% thought the decision should be made solely by the woman concerned. The respondants had thought about the question. Other surveys in different electorates reflected similar views. It is hoped that people's opinions will influence legislators to enact more liberal abortion laws.
Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal’s national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in nearly 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion
Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal's national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in approximately 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating
Teklehaimanot, K I; Smith, C Hord
A number of countries adopt abortion laws recognizing rape as a legal ground for access to safe abortion service. As rape is a crime, these abortion laws carry with them criminal and health care elements that in turn result in the involvement of legal and medical expertise. The most common objective of the laws should be providing safe abortion services to women survivors of rape. Depending on purposes of a given abortion law, the laws usually require women to undergo a medical examination to qualify for a legal abortion. Some abortion laws are so vague as to result in uncertainties regarding the steps health personnel must follow in conducting medical examination. Another group of abortion laws do not leave room for regulation and remain too rigid to respond to changing socio-economic circumstances. Still others require medical examination as a prerequisite for abortion. As a result, a number of abortion laws remain on the books. The paper attempts to analyze legal and practical issues related to medical examination in rape cases.
Nunes, J P
Abortion is the interruption of a dynamic process in a final and irreversible form. The legalization of abortion is applied to human ontogenesis, that is, the development of the human being. However, the embryo that is growing in the uterus is not a human being because a human being is a complex organism with differentiated systems, its own identity and intrinsic autonomy in its process of development. There are basically four levels of the analysis of the problem of abortion: 1) fundamental emotional arguments; 2) profound ignorance of technical and scientific facts; 3) rational positions obfuscated by the dramatic intensity of everyday situations; and 4) the conjunction of deliberated position where culpability is avoided with solidarity for all subjects of the process with a socially oriented view. The phenomenon of abortion from an epidemiological point of view summons the facts with which it is associated: poverty, illiteracy, shortage or lack of community health resources, absence of centers for adolescents, degradation of the environment, and precariousness of employment.
The purpose of the manual is to provide the medical assisting student a text which presents the common laboratory procedures in use today in physician's offices. The procedures for performing a complete urinalysis are outlined, along with those for carrying out various hematological tests. Information is also presented to help the student learn to…
Electronic procedures are replacing text-based documents for recording the steps in performing medical operations aboard the International Space Station. S&K Aerospace, LLC, has developed a content-based electronic system-based on the Extensible Markup Language (XML) standard-that separates text from formatting standards and tags items contained in procedures so they can be recognized by other electronic systems. For example, to change a standard format, electronic procedures are changed in a single batch process, and the entire body of procedures will have the new format. Procedures can be quickly searched to determine which are affected by software and hardware changes. Similarly, procedures are easily shared with other electronic systems. The system also enables real-time data capture and automatic bookmarking of current procedure steps. In Phase II of the project, S&K Aerospace developed a Procedure Representation Language (PRL) and tools to support the creation and maintenance of electronic procedures for medical operations. The goal is to develop these tools in such a way that new advances can be inserted easily, leading to an eventual medical decision support system.
Abortion on medical and eugenic grounds has been legal in most European countries for several years. In Austria, abortions are performed following obligatory counseling, and physicians can abstain conscientiously from performing them. In Denmark, first trimester abortion is performed on request for women over age 17. Abortion has been legal in Finland since 1950; the abortion rate reached its peak in 1973, and has been declining since then. First trimester abortion is legal in France, but a woman seeking admission to a hospital must present a physician's certificate, a counselor's certificate, and her own written consent. Delays in the processing of the application are not unusual and the whole procedure can be lengthy and discouraging. First trimester abortion was legalized in the German Democratic Republic in 1972, and in 1973 in the Federal Republic of Germany, where 79% of abortions are requested on grave social grounds. Applications for abortions are seldom refused in Hungary, where the abortion rate reached 81.1/1000 women in 1971. Abortion on request is expected to be legalized shortly in Norway, while it prevails in Poland, where 98% of abortions are performed for social indications. In Sweden, abortion is performed only in public hospitals, and contraceptive advice and fitting is free. The availability of abortion in the United Kingdom is limited by the restrictive attitude of some National Health Service physicians, and nearly all abortions on nonresidents (32% in 1973) are performed on private premises. In Yugoslavia, abortion is the constitutional right of every woman, but only the Republic of Slovenia has, so far, legislated fertility regulation as a whole, and termination of pregnancy can be performed only with the approval of a special committee.
Lemkau, Jeanne Parr
Summarizes literature on normative reactions to abortion and factors that increase risk of negative emotional sequelae. Discusses characteristics of woman, social support and cultural milieu around the abortion, the medical environment and abortion procedure itself, and events subsequent to abortion which may cause conflict. Discusses implications…
Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth
To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) < or = 63 days receiving either a medical (600 mg mifepristone and 1 mg gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p < .01] and also with a higher risk of antibiotic treatment than medical abortion [7.8% (37/467) vs. 3.7% (13/356), p < .05]. The median leave of absence was shorter in women choosing a medical (1 day) than a surgical termination (2 days), p < .05. On average, one third of all the women requested at least one extra unscheduled consultation apart from a routine follow-up visit. We conclude that the chance of a primary successful termination at GA < or = 63 days is higher after a surgical abortion in general anesthesia compared to a medical abortion induced with 600 mg mifepristone and 1 mg gemeprost. A surgical abortion is associated with an increased risk of antibiotic treatment compared to medical abortion. The women's need for follow-up might be higher than we expect.
Erdman, Joanna N
The Irish Protection of Life During Pregnancy Act seeks to clarify the legal ground for abortion in cases of risk to life, and to create procedures to regulate women's access to services under it. This article explores the new law as the outcome of an international human rights litigation strategy premised on state duties to implement abortion laws through clear standards and procedural safeguards. It focuses specifically on the Irish law reform and the jurisprudence of the European Court of Human Rights, including A. B. and C. v. Ireland (2010). The article examines how procedural rights at the international level can engender domestic law reform that limits or expands women's access to lawful abortion services, serving conservative or progressive ends.
Yang, Y Tony; Kozhimannil, Katy B
In summer 2015, the Iowa Supreme Court unanimously struck down a restriction that would have prevented physicians from administering a medication abortion remotely through video teleconferencing. In its ruling, the Iowa Supreme Court stated that the restriction would have placed an undue burden on a woman's right to access abortion services. It is crucially important for clinicians--especially primary care clinicians, obstetrician-gynecologists (ob-gyns), and all health care providers of telemedicine services--to understand the implications of this recent ruling, especially in rural settings. The Court's decision has potential ramifications across the country, for both women's access to abortion and the field of telemedicine. Today telemedicine abortion is available only in Iowa and Minnesota; 18 states have adopted bans on it. If telemedicine abortions are indeed being unconstitutionally restricted as the Iowa Supreme Court determined, court decisions reversing these bans could improve access to abortion services for the 21 million reproductive-age women living in these 18 states, which have a limited supply of ob-gyns, mostly concentrated in urban, metropolitan areas. Beyond the potential effects on abortion access, we argue that the Court's decision also has broader implications for telemedicine, by limiting the role of state boards of medicine regarding the restriction of politically controversial medical services when provided through telemedicine. The interplay between telemedicine policy, abortion politics, and the science of medicine is at the heart of the Court's decision and has meaning beyond Iowa's borders for reproductive-age women across the United States.
Pazol, Karen; Creanga, Andreea A.; Zane, Suzanne B.
Background With changing patterns and increasing use of medical abortion in the United States, it is important to have accurate statistics on the use of this method regularly available. This study assesses the accuracy of medical abortion data reported annually to the Centers for Disease Control and Prevention (CDC) and describes trends over time in the use of medical abortion relative to other methods. Study Design This analysis included data reported to CDC for 2001–2008. Year-specific analyses included all states that monitored medical abortion for a given year, while trend analyses were restricted to states that monitored medical abortion continuously from 2001 to 2008. Data quality and completeness were assessed by (a) examining abortions reported with an unspecified method type within the gestational age limit for medical abortion (med-eligible abortions) and (b) comparing the percentage of all abortions and med-eligible abortions reported to CDC as medical abortions with estimates based on published mifepristone sales data for the United States from 2001 to 2007. Results During 2001–2008, the percentage of med-eligible abortions reported to CDC with an unspecified method type remained low (1.0%–2.2%); CDC data and mifepristone sales estimates for 2001–2007 demonstrated strong agreement [all abortions: intraclass correlation coefficient (ICC)=0.983; med-eligible abortions: ICC=0.988]. During 2001–2008, the percentage of abortions reported to CDC as medical abortions increased (p<.001 for all abortions and for med-eligible abortions). Among states that reported medical abortions for 2008, 15% of all abortions and 23% of med-eligible abortions were reported as medical abortions. Conclusion CDC’s Abortion Surveillance System provides an important annual data source that accurately describes the use of medical abortion relative to other methods in the United States. PMID:22770796
Dixon, Darrin P
Many women are unprepared to make prenatal decisions about fetuses diagnosed with Down Syndrome because of societal pressures to have "normal" children, a negative view of persons with disabilities by many in society, a fear of legal liability by those in the medical community, the lack of genuine informed consent before undergoing genetic testing and abortion, and the failure of non-directive pre-abortion counseling in the medical community. Moreover, medical professionals fail to communicate correct and unbiased information before and during the genetic screening, diagnostic testing, and abortion decision-making process. This article addresses the contributing factors and causes that ultimately lead to a lack of informed consent and a very high abortion rate for fetuses diagnosed with Down Syndrome.
Lüleci, Nimet Emel; Kaya, Eda; Aslan, Ece; Şenkal, Ece Söylem; Çiçek, Zehra Nadide
Background: Historically, sexual assault is a common issue in Turkey. As doctors are one of the steps to help sexually assaulted women, medical students should have basic knowledge of and sensitivity regarding this subject. Another common women’s public health issue is induced abortion. In countries where access to abortion is restricted, there is a tendency towards unhealthy abortion. Aims: The aims of this study are: (1) to determine the attitudes and opinions of Marmara University Medical Faculty students about sexual assault against women and induced abortion and (2) to propose an educational program for medical students about sexual assault and abortion. Study Design: Cross-sectional study. Methods: The questionnaires were self-administered and the data were analyzed using SPSS v.15.0. First, the descriptive statistics were analyzed, followed by Chi-square for contingency tests assessing differences in attitudes toward sexual assault and induced abortion by factors such as gender and educational term. Differences were considered statistically significant at p<0.05. Results: About 89.6% of the participants (n=266) reported that they had never been sexually assaulted and about 11.5% of the women (n=19) had been sexually assaulted. There was no significant relationship between previous sexual assault and gender (p>0.05). Although there was no significant difference regarding the extent of punishment by victim’s status as a virgin, 21.3% (n=63) agreed that punishment should be more severe when the victim was a virgin. About 40.7% (n=120) agreed that the legal period of abortion in Turkey (10 weeks) should be longer. The majority (86.1%, n=255) agreed that legally prohibiting abortions causes an increase in unhealthy abortions. Conclusion: An educational program on these issues should be developed for medical students. PMID:27403386
An engineering analysis and computer code (AERSEP) for predicting Space Shuttle Orbiter - HO Tank longitudinal aerodynamic characteristics during abort separation has been developed. Computed results are applicable at Mach numbers above 2 for angle-of-attack between plus or minus 10 degrees. No practical restrictions on orbiter-tank relative positioning are indicated for tank-under-orbiter configurations. Input data requirements and computer running times are minimal facilitating program use for parametric studies, test planning, and trajectory analysis. In a majority of cases AERSEP Orbiter-Tank interference predictions are as accurate as state-of-the-art estimates for interference-free or isolated-vehicle configurations. AERSEP isolated-orbiter predictions also show excellent correlation with data.
Sneeringer, Robyn K; Billings, Deborah L; Ganatra, Bela; Baird, Traci L
Unsafe abortion continues to be a major contributor to maternal mortality and morbidity around the world. This article examines the role of pharmacists in expanding women's access to safe medical abortion in Latin America, Africa, and Asia. Available research shows that although pharmacists and pharmacy workers often sell abortion medications to women, accurate information about how to use the medications safely and effectively is rarely offered. No publication covered effective interventions by pharmacists to expand access to medical abortion, but lessons can be learned from successful interventions with other reproductive health services. To better serve women, increasing awareness and improving training for pharmacists and pharmacy workers about unsafe abortion – and medications that can safely induce abortion – are needed. PMID:22402571
Gemzell-Danielsson, Kristina; Lalitkumar, Sujata
Second trimester abortions constitute 10-15% of all induced abortions worldwide but are responsible for two-thirds of major abortion-related complications. During the last decade, medical methods for second trimester induced abortion have been considerably improved and become safe and more accessible. Today, in most cases, safe and efficient medical abortion services can be offered or improved by minor changes in existing health care facilities. Second trimester medical abortion can be provided by a nurse-midwife with the back-up of a gynaecologist. Because of the potential for heavy vaginal bleeding and serious complications, it is advisable that second trimester terminations take place in a health care facility where blood transfusion and emergency surgery (including laparotomy) are available. This article provides basic information on regimens recommended for second trimester medical abortion. The combination of mifepristone and misoprostol is now an established and highly effective method for second trimester abortion. Where mifepristone is not available or affordable, misoprostol alone has also been shown to be effective, although a higher total dose is needed and efficacy is lower than for the combined regimen. Therefore, whenever possible, the combined regimen should be used. Efforts should be made to reduce unnecessary surgical evacuation of the uterus after expulsion of the fetus. Future studies should focus on improving pain management, the treatment of women with failed medical abortion after 24 hours, and the safety of medical abortion regimens in women with a previous caesarean section or uterine scar.
Abortion is common. Data on abortion rates are inexact but can be used to explore trends. Globally, the estimated rate in the period 2010-2014 was 35 abortions per 1000 women (aged 15-44 years), five points less than the rate of 40 for the period 1990-1994. Abortion laws vary around the world but are generally more restrictive in developing countries. Restrictive laws do not necessarily deter women from seeking abortion but often lead to unsafe practice with significant mortality and morbidity. While a legal framework for abortion is a prerequisite for availability, many laws, which are not evidence based, restrict availability and delay access. Abortion should be available in the interests of public health and any legal framework should be as permissive as possible in order to promote access. In the absence of legal access, harm reduction strategies are needed to reduce abortion-related mortality and morbidity. Abortion can be performed surgically (in the first trimester, by manual or electric vacuum aspiration) or with medication: both are safe and effective. Cervical priming facilitates surgery and reduces the risk of incomplete abortion. Diagnosis of incomplete abortion should be made on clinical grounds, not by ultrasound. Septic abortion is a common cause of maternal death almost always following unsafe abortion and thus largely preventable. While routine follow-up after abortion is unnecessary, all women should be offered a contraceptive method immediately after the abortion. This, together with improved education and other interventions, may succeed in reducing unintended pregnancy.
Yang, Y. Tony; Kozhimannil, Katy B.
In summer 2015, the Iowa Supreme Court unanimously struck down a restriction that would have prevented physicians from administering a medication abortion remotely through video teleconferencing. In its ruling, the Iowa Supreme Court stated that the restriction would have placed an undue burden on a woman's right to access abortion services. It is crucially important for clinicians – especially primary care clinicians, obstetrician–gynecologists, and all health care providers of telemedicine services –to understand the implications of this recent ruling, especially in rural settings. The Court’s decision has potential ramifications across the country, both for women’s access to abortion, and for the field of telemedicine. Today telemedicine abortion is only available in Iowa and Minnesota, and 18 states have adopted bans on it. If telemedicine abortions are indeed being unconstitutionally restricted as the Iowa Supreme Court determined, court decisions reversing these bans could improve access to abortion services for the 21 million reproductive-age women living in these 18 states, which have a limited supply of obstetrician–gynecologists, mostly concentrated in urban, metropolitan areas. Beyond the potential effects on abortion access, we argue that the Court’s decision also has broader implications for telemedicine, by limiting state boards of medicine’s role regarding the restriction of politically controversial medical services when provided through telemedicine. The interplay between telemedicine policy, abortion politics, and the science of medicine is at the heart of the Court’s decision, and has meaning beyond Iowa’s boarders, for reproductive-age women across the United States. PMID:26942359
González De León Aguirre D; Salinas Urbina AA
This research project explores doctors' views regarding induced abortion. Abortion's penalization in Mexico greatly conditions its relevance as a social and public health problem. Physicians constitute a professional sector that can play an important role in reforming current laws on abortion. As a professional group, they have taken a conservative stance towards abortion. Their attitudes are to a great extent influenced by the medical training they receive. In this article we present results from a survey of 96 medical students from the Universidad Autónoma Metropolitana Xochimilco, in Mexico City. Data were processed with the SPSS program. Simple frequencies show that students have limited knowledge concerning the legal status of abortion and that they tolerate it with restrictions and in limited situations. Women students apparently take a more conservative stance, but statistical analysis with the c-square test did not show significant differences by gender. The article poses the need to modify doctors' training in the reproductive health field, allowing future doctors to acquire a broader view of health problems related to sexuality and reproduction. In the long run, this should also promote a kind of comprehensive health care practice in medical services, thus responding more satisfactorily to women's needs.
Foster, Angel M.; Wynn, L. L.; Trussell, James
Introduction The worldwide expansion of the Internet offers an important modality of disseminating medically accurate information about medication abortion. We chronicle the story of www.medicationabortion.com, an English-, Spanish-, Arabic-, and French-language website dedicated to three early abortion regimens. Methods We evaluated the website use patterns from 2005 through 2009. We also conducted a content and thematic analysis of 1,910 emails submitted during this period. Results The website experienced steady growth in use. In 2009, it received 35,000 visits each month from more than 20,000 unique visitors and was accessed by users in 208 countries and territories. More than half of all users accessed the website from a country in which abortion is legally restricted. Users from more than 40 countries sent emails with individual questions. Women often wrote in extraordinary detail about the circumstances of their pregnancies and attempts to obtain an abortion. These emails also reflect considerable demand for information about the use of misoprostol for self-induction. Conclusion The use patterns of www.medicationabortion.com indicate that there is significant demand for online information about abortion, and the findings suggest future priorities for research, collaboration, and educational outreach. PMID:24360644
Klausen, Susanne M
After its formation in 1910 as a self-governing dominion within the British empire, the Union of South Africa followed a combination of English and Roman-Dutch common laws on abortion that decreed the procedure permissible only when necessary to save a woman's life. The government continued doing so after South Africa withdrew from the Commonwealth and became a republic in 1961. In 1972 a sensational trial took place in the South African Supreme Court that for weeks placed clandestine abortion on the front pages of the country's newspapers. Two men, one an eminent doctor and the other a self-taught abortionist, were charged with conspiring to perform illegal abortions on twenty-six white teenagers and young unmarried women. The prosecution of Dr Derk Crichton and James Watts occurred while the National Party government was in the process of drafting abortion legislation and was perceived by legal experts as another test of the judiciary's stance on the common law on abortion. The trial was mainly intended to regulate the medical profession and ensure doctors ceased helping young white women evade their 'duty' to procreate within marriage. Ultimately, the event encapsulated a great deal about elites' attempt to buttress apartheid culture and is significant for, among other reasons, contributing to the production of South Africa's extremely restrictive Abortion and Sterilisation Act (1975).
Caro-Bruce, Emily; Schoenfeld, Elizabeth; Nothnagle, Melissa; Taylor, Julie
Medical school curricula frequently contain gaps in the areas of abortion and sexual health. A group of first- and second-year medical students at the authors' institution organized a collaborative, multidisciplinary elective course to address such omissions in the preclinical curriculum. This paper describes the process of creating and implementing the elective. Medical students identified curricular gaps in the areas of abortion, sexual assault, lesbian/gay/bisexual/transgender health, and HIV counseling. Clinical faculty and community-based professionals were invited to address these topics in a weekly lecture series organized by students. The course also included a half-day experience shadowing at a local abortion clinic. Collaboration with several student groups helped broaden student interest in and increase financial support for the elective. Some 37% of all first- and second-year students enrolled in the elective and received institutional credit for the course. Written and verbal evaluations confirmed student satisfaction with the lectures and the clinical experience. Dynamic and well-prepared speakers who presented interesting medical content received the highest ratings from students. Student leaders identified several challenges in implementing the elective. Ultimately the elective proved to be a successful collaboration among students, faculty, and healthcare providers, and resulted in permanent changes in the standard medical school curriculum. Challenges for student-initiated electives include difficulty in finding administrative support, securing funding and ensuring sustainability. This paper aims to make this process accessible and applicable to other students and faculty interested in addressing curricular gaps at their respective medical schools.
Combellick, Sarah L.; Kohn, Julia E.; Roberts, Sarah C. M.
Background In February 2011, an Ohio law took effect mandating use of the United States Food and Drug Administration (FDA)-approved protocol for mifepristone, which is used with misoprostol for medication abortion. Other state legislatures have passed or enacted similar laws requiring use of the FDA-approved protocol for medication abortion. The objective of this study is to examine the association of this legal change with medication abortion outcomes and utilization. Methods and Findings We used a retrospective cohort design, comparing outcomes of medication abortion patients in the prelaw period to those in the postlaw period. Sociodemographic and clinical chart data were abstracted from all medication abortion patients from 1 y prior to the law’s implementation (January 2010–January 2011) to 3 y post implementation (February 2011–October 2014) at four abortion-providing health care facilities in Ohio. Outcome data were analyzed for all women undergoing abortion at ≤49 d gestation during the study period. The main outcomes were as follows: need for additional intervention following medication abortion (such as aspiration, repeat misoprostol, and blood transfusion), frequency of continuing pregnancy, reports of side effects, and the proportion of abortions that were medication abortions (versus other abortion procedures). Among the 2,783 medication abortions ≤49 d gestation, 4.9% (95% CI: 3.7%–6.2%) in the prelaw and 14.3% (95% CI: 12.6%–16.0%) in the postlaw period required one or more additional interventions. Women obtaining a medication abortion in the postlaw period had three times the odds of requiring an additional intervention as women in the prelaw period (adjusted odds ratio [AOR] = 3.11, 95% CI: 2.27–4.27). In a mixed effects multivariable model that uses facility-months as the unit of analysis to account for lack of independence by site, we found that the law change was associated with a 9.4% (95% CI: 4.0%–18.4%) absolute increase in
Kottow Lang, Miguel Hugo
Voluntarily induced abortion has been under permanent dispute and legal regulations, because societies invariably condemn extramarital pregnancies. In recent decades, a measure of societal tolerance has led to decriminalize and legalize abortion in accordance with one of two models: a more restricted and conservative model known as therapeutic abortion, and the model that accepts voluntary abortion within the first trimester of pregnancy. Liberalization of abortion aims at ending clandestine abortions and decriminalizes the practice in order to increase reproductive education and accessibility of contraceptive methods, dissuade women from interrupting their pregnancy and, ultimately, make abortion a medically safe procedure within the boundaries of the law, inspired by efforts to reduce the incidence of this practice. The current legal initiative to decriminalize abortion in Chile proposes a notably rigid set of indications which would not resolve the three main objectives that need to be considered: 1) Establish the legal framework of abortion; 2) Contribute to reduce social unrest; 3) Solve the public health issue of clandestine, illegal abortions. Debate must urgently be opened to include alternatives in line with the general tendency to respect women's decision within the first trimester of pregnancy.
Clinical language applied to early pregnancy loss changed in late twentieth century Britain when doctors consciously began using the term 'miscarriage' instead of 'abortion' to refer to this subject. Medical professionals at the time and since have claimed this change as an intuitive empathic response to women's experiences. However, a reading of medical journals and textbooks from the era reveals how the change in clinical language reflected legal, technological, professional and social developments. The shift in language is better understood in the context of these historical developments, rather than as the consequence of more empathic medical care for women who experience miscarriage.
Sri, Subha B; Ravindran, T K Sundari
Women's control over their own bodies and reproduction is a fundamental prerequisite to the achievement of sexual and reproductive health and rights. A woman's ability to terminate an unwanted pregnancy has been seen as the exercise of her reproductive rights. This study reports on interviews with 15 women in rural South India who had a medical abortion. It examines the circumstances under which they chose to have an abortion and their perspectives on medical abortion. Women in this study decided to have an abortion when multiple factors like lack of spousal support for child care or contraception, hostile in-laws, economic hardship, poor health of the woman herself, spousal violence, lack of access to suitable contraceptive methods, and societal norms regarding reproduction and sexuality converged to oppress them. The availability of an easy and affordable method like medical abortion pills helped the women get out of a difficult situation, albeit temporarily. Medical abortion also fulfilled their special needs by ensuring confidentiality, causing least disruption of their domestic schedule, and dispensing with the need for rest or a caregiver. The study concludes that medical abortion can help women in oppressive situations. However, this will not deliver gender equality or women's empowerment; social conditions need to change for that.
Dresser, R S
The current shortage of US physicians willing to perform induced abortions has created a conflict between women's legal right to access to pregnancy termination and physicians' right to refuse participation in a procedure they regard as morally objectionable. According to a 1993 survey, 84% of US counties (housing 30% of women of reproductive age) had no abortion provider. This situation has been exacerbated by a trend to isolate abortion from other medical procedures; in 1992, only 12% of residency programs in obstetrics and gynecology routinely offered training on first-trimester abortion. Also contributing to physician reluctance to become abortion providers have been the violence, death threats, property damage, and harassment of abortion seekers perpetrated by anti-abortion groups. To ameliorate the abortion access crisis, without intruding on the religious convictions of individual physicians, there must be greater collaboration between professional and community groups. Local community officials and pro-choice supporters are urged to use their influence to protect abortion providers from harassment. Professional organizations should provide both symbolic and practical support, e.g. increased status and remuneration, to physicians who commit to the hardship of abortion provision. Older physicians, most aware of the threat to women's health posed by any erosion of abortion rights, should educate their younger colleagues about the importance of safe abortion. Finally, training on abortion techniques should be integrated into the medical school curriculum and rotations should be established at local abortion clinics.
Paul, Mandira; Iyengar, Kirti; Essén, Birgitta; Gemzell-Danielsson, Kristina; Iyengar, Sharad D.; Bring, Johan; Soni, Sunita; Klingberg-Allvin, Marie
Background Studies evaluating acceptability of simplified follow-up after medical abortion have focused on high-resource or urban settings where telephones, road connections, and modes of transport are available and where women have formal education. Objective To investigate women’s acceptability of home-assessment of abortion and whether acceptability of medical abortion differs by in-clinic or home-assessment of abortion outcome in a low-resource setting in India. Design Secondary outcome of a randomised, controlled, non-inferiority trial. Setting Outpatient primary health care clinics in rural and urban Rajasthan, India. Population Women were eligible if they sought abortion with a gestation up to 9 weeks, lived within defined study area and agreed to follow-up. Women were ineligible if they had known contraindications to medical abortion, haemoglobin < 85mg/l and were below 18 years. Methods Abortion outcome assessment through routine clinic follow-up by a doctor was compared with home-assessment using a low-sensitivity pregnancy test and a pictorial instruction sheet. A computerized random number generator generated the randomisation sequence (1:1) in blocks of six. Research assistants randomly allocated eligible women who opted for medical abortion (mifepristone and misoprostol), using opaque sealed envelopes. Blinding during outcome assessment was not possible. Main Outcome Measures Women’s acceptability of home-assessment was measured as future preference of follow-up. Overall satisfaction, expectations, and comparison with previous abortion experiences were compared between study groups. Results 731 women were randomized to the clinic follow-up group (n = 353) or home-assessment group (n = 378). 623 (85%) women were successfully followed up, of those 597 (96%) were satisfied and 592 (95%) found the abortion better or as expected, with no difference between study groups. The majority, 355 (57%) women, preferred home-assessment in the event of a future
Stubblefield, P G; Grimes, D A
Abortion-related deaths, which account for 47% of total maternal mortality in the world, result primarily from sepsis and are widespread in developing countries where abortion is illegal or inaccessible. Septic abortion offers opportunities for prevention on the primary, secondary, and tertiary level of medial care. Primary prevention of septic abortion encompasses the provision of effective contraception, provision of safe and legal abortion in cases of contraceptive failure, and appropriate medical management of abortion. Secondary prevention involves the prompt diagnosis of endometriosis and effective treatment to avert more serious infection. The diagnosis of septic abortion should be considered when women of reproductive age present to health facilities with vaginal bleeding, lower abdominal pain, and fever. Tertiary prevention is aimed at avoiding the serious complications of postabortal infection, including hysterectomy and death. Women with high fever, pelvic peritonitis, and tachycardia should undergo uterine evacuation and parental antibiotic therapy. Supportive care for cardiovascular system and other organs may be essential. The medical technology needed to avert serious complications and deaths from septic abortion is available. Lacking is a political commitment on the part of many governments and health care agencies to address this avoidable contributor to maternal morbidity and mortality.
Hooper, T I; Smith, R G; Pion, R J
induction-abortion interval determine the length of hospitalization and consequently the cost of the procedure. Early abortion procedures reduce both cost and risk of complications.
Ramos, Silvina; Romero, Mariana; Aizenberg, Lila
This article presents the findings of a qualitative study exploring the experiences of women living in Buenos Aires Metropolitan Area, Argentina, with the use of misoprostol for inducing an abortion. We asked women about the range of decisions they had to make, their emotions, the physical experience, strategies they needed to use, including seeking health care advice and in dealing with a clandestine medical abortion, and their overall evaluation of the experience. An in-depth interview schedule was used. The women had either used misoprostol and sought counselling or care at a public hospital (n=24) or had used misoprostol based on the advice of a local hotline, information from the internet or from other women (n=21). Four stages in the women's experiences were identified: how the decision to terminate the pregnancy was taken, how the medication was obtained, how the tablets were used, and reflections on the outcome whether or not they sought medical advice. Safety and privacy were key in deciding to use medical abortion. Access to the medication was the main obstacle, requiring a prescription or a friendly drugstore. Correct information about the number of pills to use and dosage intervals was the least easy to obtain and caused concerns. The possibility of choosing a time of privacy and having the company of a close one was highlighted as a unique advantage of medical abortion. Efforts to improve abortion law, policy and service provision in Argentina in order to ensure the best possible conditions for use of medical abortion by women should be redoubled.
A proposal is presented for a Community College of Philadelphia course, entitled "Medical Office Laboratory Procedures," which provides a laboratory introduction to microscopic and chemical analysis of blood and urine as performed in the physician's office. Following a standard cover form, a statement of the purpose of the course discusses course…
Marshburn, Tom; Goode, Julie
The Health Maintenance System (HMS) hardware will be used to support a medical contingency for the International Space Station (ISS). During two test flights, the procedures for performing Advanced Cardiac Life Support (ACLS) were evaluated to determine the required level of detail, assess the logic of the steps and division of tasks among crew members.
A new publication of the World Health Organization, "Abortion in the Developing World," reports that 40% of the 50 million abortions performed each year are unsafe, and 90% of these medically perilous procedures occur in developing countries. Although the 30 million abortions performed annually in developing countries represent 60% of the global total, they account for 95% of abortion-related deaths. Abortion was illegal in 94% of the developing countries included in the WHO study. Unexpectedly, the proportion of women who were using contraception when they experienced an unintended pregnancy was similar in countries with strong family planning programs and those with weak or nonexistent programs.
Acharya, Rajib; Kalyanwala, Shveta
There is only limited evidence on whether certified and uncertified health care providers in India support reforming the Medical Termination of Pregnancy (MTP) Act to expand the abortion provider base to allow trained nurses and AYUSH physicians (who are trained in Indian systems of medicine) to provide medical abortion. To explore their views, we conducted a survey of 1,200 physicians and other health care providers in Maharashtra and Bihar states and in-depth interviews with 34 of them who had used medical abortion in their practices. Findings indicate that obstetrician-gynaecologists and other allopathic physicians were less supportive than non-physicians of nurses and AYUSH physicians providing early medical abortion. The physicians did not think that these providers would be able to assess women's eligibility for medical abortion correctly. In contrast, the majority of non-physicians found task shifting of medical abortion provision to trained nurses and AYUSH physicians acceptable, and they were confident that these providers would be able to provide medical abortion as safely and effectively as trained physicians. Assuming the reforms are passed, efforts will need to be made by government and medical professional bodies to train these new providers to undertake this role, prepare the health infrastructure to include them, and create an environment, including among physicians, that is conducive to enabling non-physicians to provide medical abortion.
Webb, B W
Family physicians are often consulted to evaluate medically a patient for various dental procedures. The majority of the referrals are for diseases of the cardiovascular system. General guidelines have been established at the University of Maryland Family Health Center for the evaluation of these patients. These guidelines pertain to the use of local anesthetics and prophylaxis for endocarditis, as well as to the evaluation of patients with cardiac disease, hypertension, pulmonary disease, endocrine disease, neurological disease, hepatic disease, pregnancy, and anticoagulant therapy.
A post-independence (1992-93) decree issued by the Estonian Ministry of Social Affairs permits abortion on request up to 12 weeks of gestation and, on medical grounds, up to 20 weeks. According to reports received by the Estonian Medical Statistical Bureau, the 1994 abortion rate was 53.8/1000 women of reproductive age. Among women under 20 years of age, the abortion rate declined from 55.5/1000 in 1992 to 41.5/1000 in 1994. Only mini-abortions and abortions performed for medical reasons are free of charge; women with health insurance pay 50% of the cost of most procedures. Funds from abortion fees are used to subsidize contraception for full-time students, women in the first postpartum year, and women who had an induced abortion in the past three months. All other women must pay the full price of contraception. In 1994, only 234 out of every 1000 fertile women were using effective forms of contraception (IUDs and hormonal methods). However, the birth rate has been declining rapidly since 1990 and the rate of natural increase became negative in 1993 (-4.0). The fact that abortion but not contraception is subsidized has facilitated reliance on abortion as a family planning method. Recommended, to reduce the abortion rate and improve the family planning situation in Estonia, are improved contraceptive counseling, including pre- and post-abortion services, and school-based sex education.
Klausen, Susanne M.
After its formation in 1910 as a self-governing dominion within the British empire, the Union of South Africa followed a combination of English and Roman-Dutch common laws on abortion that decreed the procedure permissible only when necessary to save a woman’s life. The government continued doing so after South Africa withdrew from the Commonwealth and became a republic in 1961. In 1972 a sensational trial took place in the South African Supreme Court that for weeks placed clandestine abortion on the front pages of the country’s newspapers. Two men, one an eminent doctor and the other a self-taught abortionist, were charged with conspiring to perform illegal abortions on twenty-six white teenagers and young unmarried women. The prosecution of Dr Derk Crichton and James Watts occurred while the National Party government was in the process of drafting abortion legislation and was perceived by legal experts as another test of the judiciary’s stance on the common law on abortion. The trial was mainly intended to regulate the medical profession and ensure doctors ceased helping young white women evade their ‘duty’ to procreate within marriage. Ultimately, the event encapsulated a great deal about elites’ attempt to buttress apartheid culture and is significant for, among other reasons, contributing to the production of South Africa’s extremely restrictive Abortion and Sterilisation Act (1975). PMID:24775430
Assessment of completion of early medical abortion using a text questionnaire on mobile phones compared to a self-administered paper questionnaire among women attending four clinics, Cape Town, South Africa.
Constant, Deborah; de Tolly, Katherine; Harries, Jane; Myer, Landon
In-clinic follow-up to assess completion of medical abortion is no longer a requirement according to World Health Organization guidance, provided adequate counselling is given. However, timely recognition of ongoing pregnancy, complications or incomplete abortion, which require treatment, is important. As part of a larger trial, this study aimed to establish whether women having a medical abortion could self-assess whether their abortion was complete using an automated, interactive questionnaire on their mobile phones. All 469 participants received standard abortion care and all returnees filled in a self-assessment on paper at clinic follow-up 2-3 weeks later. The 234 women allocated to receive the phone messages were also asked to do a mobile phone assessment at home ten days post-misoprostol. Completion of the mobile assessment was tracked by computer and all completed assessments, paper and mobile, were compared to providers' assessments at clinic follow-up. Of the 226 women able to access the mobile phone assessment, 176 (78%) completed it; 161 of them (93%) reported it was easy to do so. Neither mobile nor paper self-assessments predicted all cases needing additional treatment at follow-up. Prediction of complete procedures was good; 71% of mobile assessments and 91% of paper assessments were accurate. We conclude that an interactive questionnaire assessing completion of medical abortion on mobile phones is feasible in the South African setting; however, it should be done later than day 10 and combined with an appropriate pregnancy test to accurately detect incomplete procedures.
Yang, Zhiyong; Yi, Bin
Painless abortion is an outpatient surgical procedure performed under general anesthesia, which requires an appropriate anesthetic reagent that must be safe, comfortable for the patient, and highly controllable. At present, fentanyl and propofol are first-choice anesthetic reagents in clinical applications. However, both have various side effects, including the inhibition of respiration and circulation and the occurrence of postoperative sexual fantasies and amorous behavior. In this report, we will demonstrate three cases of allegations of assault and violence caused by sexual hallucinations in patients who were anesthetized with propofol and fentanyl during painless abortion surgery.
... 11 Federal Elections 1 2010-01-01 2010-01-01 false Special procedure: Medical records. 1.6 Section 1.6 Federal Elections FEDERAL ELECTION COMMISSION PRIVACY ACT § 1.6 Special procedure: Medical records....
Fetters, Tamara; Raisanen, Keris; Mupeta, Stephen; Malisikwanda, Isikanda; Vwalika, Bellington; Osur, Joachim; Dijkerman, Sally
Despite broad grounds for legal abortion in Zambia, access to abortion services remains limited. Pharmacy workers, a primary source of health care for communities, present an opportunity to bridge the gap between policy and practice. As part of a larger operations study, 80 pharmacy workers, both registered pharmacists and their assistants, participated in a training on medical abortion in 2009 and 2010. Fifty-five of the 80 pharmacy workers completed an anonymous, structured training pre-test, treated as a baseline questionnaire; 53 of the 80 trainees were interviewed 12-24 months post-training in face-to-face interviews to measure the retention of information and training effectiveness. Survey questions were selected to illustrate the principles of a harm reduction approach to unsafe abortion. Bivariate analysis was used to examine pharmacy worker knowledge, attitudes and dispensing behaviours pre-training and at follow-up. A higher percentage of pharmacy workers reported referring women to a health care facility between surveys (47% to 68%, p = 0.03). The number of pharmacy workers who reported dispensing ineffective abortifacients decreased from baseline to end-line (30% to 25%) but the difference was non-significant. However, study results demonstrate that Zambian pharmacy workers have a role to play in safe abortion services and some are willing to play that role.
Stotland, Nada L
The subject of abortion is fraught with politics, emotions, and misinformation. A widespread practice reaching far back in history, abortion is again in the news. Psychiatry sits at the intersection of the religious, ethical, psychological, sociological, medical, and legal facets of the abortion issue. Although the religions that forbid abortion are more prominent in the media, many religions have more liberal approaches. While the basic right to abortion has been upheld by the U.S. Supreme Court, several limitations have been permitted, including parental notification or consent (with the possibility of judicial bypass) for minors, waiting periods, and mandatory provision of certain, sometimes biased, information. Before the Roe v. Wade decision legalizing abortion in 1973, many women were maimed or killed by illegal abortions, and psychiatrists were sometimes asked to certify that abortions were justified on psychiatric grounds. Currently, there are active attempts to convince the public and women considering abortion that abortion frequently has negative psychiatric consequences. This assertion is not borne out by the literature: the vast majority of women tolerate abortion without psychiatric sequelae. The psychiatric outcome of abortion is best when patients are able to make autonomous, supported decisions. Psychiatrists need to know the medical and psychiatric facts about abortion. Psychiatrists can then help patients prevent unwanted pregnancies, make informed decisions consonant with their own values and circumstances when they become pregnant, and find appropriate social and medical resources whatever their decisions may be.
... PRIVACY ACT REGULATIONS § 310.6 Special procedures: Medical records. Medical records shall be disclosed on... information to a medical doctor named by the requesting individual for release of the patient. ... 12 Banks and Banking 4 2011-01-01 2011-01-01 false Special procedures: Medical records....
... PRIVACY ACT REGULATIONS § 310.6 Special procedures: Medical records. Medical records shall be disclosed on... information to a medical doctor named by the requesting individual for release of the patient. ... 12 Banks and Banking 5 2012-01-01 2012-01-01 false Special procedures: Medical records....
... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Special procedures: Medical records. 310.6... PRIVACY ACT REGULATIONS § 310.6 Special procedures: Medical records. Medical records shall be disclosed on... transmission of the medical information directly to the requesting individual could have an adverse effect...
Marinov, B; Andreeva, A
There are still too many unsafe abortions performed worldwide. Together with the efforts to reduce the abortion by choice, we note a rise in the need for mid trimester pregnancy termination for medical reasons. The article looks at the past present and future perspective of the abortion as a procedure in Bulgaria. States the fact that medical abortion is officially not widely performed. We reckon that with the existing guidelines by WHO and with Mifepriston and Misoprostol recently registered in Bulgaria, it is time for the medical abortion to become part of the clinical practice in Bulgaria. We believe that early medical abortion as well as mid trimester induced abortion is and adequate if not better alternative to the existing in Bulgaria procedures.
Background Patients undergoing medically induced second-trimester abortions feel insufficiently informed and use the Web for supplemental information. However, it is still unclear how people who have experience with pregnancy termination appraise the quality of patient information websites about medically induced second-trimester abortions, whether they consider the websites suitable for patients, and what issues they experience with the websites. Objective Our objective was to investigate the quality of, suitability of, and issues with patient information websites about medically induced second-trimester abortions and potential differences between websites affiliated with the health care system and private organizations. Methods We set out to answer the objective by using 4 laypeople who had experience with pregnancy termination as quality assessors. The first 50 hits of 26 systematic searches were screened (N=1300 hits) using search terms reported by the assessors. Of these hits, 48% (628/1300) were irrelevant and 51% (667/1300) led to websites about medically induced second-trimester abortions. After correcting for duplicate hits, 42 patient information websites were included, 18 of which were affiliated with the health care system and 24 with private organizations. The 4 assessors systematically assessed the websites with the DISCERN instrument (total score range 16-80), the Ensuring Quality Information for Patients (EQIP) tool (total score range 0-100), as well as questions concerning website suitability and perceived issues. Results The interrater reliability was 0.8 for DISCERN and EQIP, indicating substantial agreement between the assessors. The total mean score was 36 for DISCERN and 40 for EQIP, indicating poor overall quality. Websites from the health care system had greater total EQIP (45 vs 37, P>.05) and reliability scores (22 vs 20, P>.05). Only 1 website was recommended by all assessors and 57% (24/42) were rated as very unsuitable by at least one
Cook, R J; Erdman, J N; Dickens, B M
National and international courts and tribunals are increasingly ruling that although states may aim to deter unlawful abortion by criminal penalties, they bear a parallel duty to inform physicians and patients of when abortion is lawful. The fear is that women are unjustly denied safe medical procedures to which they are legally entitled, because without such information physicians are deterred from involvement. With particular attention to the European Court of Human Rights, the UN Human Rights Committee, the Constitutional Court of Colombia, the Northern Ireland Court of Appeal, and the US Supreme Court, decisions are explained that show the responsibility of states to make rights to legal abortion transparent. Litigants are persuading judges to apply rights to reproductive health and human rights to require states' explanations of when abortion is lawful, and governments are increasingly inspired to publicize regulations or guidelines on when abortion will attract neither police nor prosecutors' scrutiny.
Background Medical abortion is legal in South Africa but access and acceptability are hampered by the current protocol requiring a follow-up visit to assess abortion completion. Objective To assess the feasibility and efficacy of information and follow-up provided via mobile phone after medical abortion in a randomized controlled trial (RCT). Methods Mobile phones were used in three ways in the study: (1) coaching women through medical abortion using short message service (SMS; text messages); (2) a questionnaire to assess abortion completion via unstructured supplementary service data (USSD, a protocol used by GSM mobile telephones that allows the user to interact with a server via text-based menus) and the South African mobile instant message and social networking application Mxit; and (3) family planning information via SMS, mobisite and Mxit. A needs and context assessment was done to learn about women’s experiences undergoing medical abortion and their use of mobile phones. After development, the mobile interventions were piloted. Recruitment was done by field workers at the clinics. In the RCT, women were interviewed at baseline and exit. Computer logs were also analyzed. All study participants received standard of care at the clinics. Results In the RCT, 234 women were randomized to the intervention group. Eight did not receive the intervention due to invalid numbers, mis-registration, system failure, or opt-out, leaving 226 participants receiving the full intervention. Of the 226, 190 returned and were interviewed at their clinic follow-up visit. The SMSs were highly acceptable, with 97.9% (186/190) saying that the SMSs helped them through the medical abortion. In terms of mobile phone privacy, 86.3% (202/234) said that it was not likely or possible that someone would see SMSs on their phone, although at exit, 20% (38/190) indicated that they had worried about phone privacy. Having been given training at baseline and subsequently asked via SMS to complete
Loewenau, Aleksandra; Weindling, Paul J
Issues relating to the euthanasia killings of the mentally ill, the medical research conducted on collected body parts, and the clinical investigations on living victims under National Socialism are among the best-known abuses in medical history. But to date, there have been no statistics compiled regarding the extent and number of the victims and perpetrators, or regarding their identities in terms of age, nationality, and gender. "Victims of Unethical Human Experiments and Coerced Research under National Socialism," a research project based at Oxford Brookes University, has established an evidence-based documentation of the overall numbers of victims and perpetrators through specific record linkages of the evidence from the period of National Socialism, as well as from post-WWII trials and other records. This article examines the level and extent of these unethical medical procedures as they relate to the field of neuroscience. It presents statistical information regarding the victims, as well as detailing the involvement of the perpetrators and Nazi physicians with respect to their post-war activities and subsequent court trials.
Von Baross, J
The commentary on West German abortion law, particularly in illegal abortion in the Netherlands, finds the law restrictive and in violation of the dignity and rights of women. The Max-Planck Institute in 1990 published a study that found that a main point of prosecution between 1976 and 1986, as reported by Der Spiegal, was in border crossings from the Netherlands. It is estimated that 10,000 annually have abortions abroad, and 6,000 to 7,000 in the Netherlands. The procedure was for an official to stop a young person and query about drugs; later the woman would admit to an abortion, and be forced into a medical examination. The German Penal Code Section 218 stipulates abortion only for certain reasons testified to by a doctor other than the one performing the abortion. Counseling on available social assistance must be completed 3 days prior to the abortion. Many counseling offices are church related and opposed to abortions. Many doctors refuse legally to certify, and access to abortion is limited. The required hospital stay is 3-4 nights with no day care facilities. Penal Code Section 5 No. 9 allows prosecution for uncounseled illegal abortion. Abortion law reform is anticipated by the end of 1992 in the Bundestag due to the Treaty or the Unification of Germany. The Treaty states that the rights of the unborn child must be protected and that pregnant women relieve their distress in a way compatible with the Constitution, but improved over legal regulations from either West or East Germany, which permits abortion on request within 12 weeks of conception without counseling. It is hoped that the law will be liberalized and Penal Code Section 5 No. 9 will be abolished.
Baum, Sarah E.; White, Kari; Hopkins, Kristine; Potter, Joseph E.; Grossman, Daniel
Background In November 2013, Texas implemented three abortion restrictions included in House Bill 2 (HB 2). Within six months, the number of facilities providing abortion decreased by almost half, and the remaining facilities were concentrated in large urban centers. The number of medication abortions decreased by 70% compared to the same period one year prior due to restrictions on this method imposed by HB 2. The purpose of this study was to explore qualitatively the experiences of women who were most affected by the law: those who had to travel farther to reach a facility and those desiring medication abortion. Methods In August and September 2014, we conducted 20 in-depth interviews with women recruited from ten abortion clinics across Texas. The purposive sample included women who obtained or strongly preferred medication abortion or traveled ≥50 miles one way to the clinic. The interview guide focused on women’s experiences with obtaining services following implementation of HB 2, and a thematic analysis was performed. Results Women faced informational, cost and logistical barriers seeking abortion services, and these obstacles were often compounded by poverty. Two women found the process of finding or getting to a clinic so onerous that they considered not having the procedure, although they ultimately had an abortion; another woman decided to continue her pregnancy, in part because of challenges in getting to the clinic. For two women, arranging travel required disclosure to more people than desired. Women who strongly preferred medication abortion were frustrated by the difficulty or inability to obtain their desired method, especially among those who were near or just beyond the gestational age limit. The restricted eligibility criteria for medication abortion and difficulty finding clinics offering the method created substantial access barriers. Conclusions Medication abortion restrictions and clinic closures following HB 2 created substantial
Polish laws specify the parties responsible for lawful medical care in the availability of abortion differently than the Resolution of the Council of Europe. According to Polish regulations they include all Polish doctors while according to the Resolution, the state. Polish rules should not discriminate against anyone in connection with his religion or belief, even more so because the issue of abortion is an example of an unresolved ethical dispute. The number of lawful abortion in Poland does not exceed 1000 per year and can be carried out by only a few specialists contracted by the National Health Fund. Sufficient information and assistance should be provided to all pregnant women by the National Health Fund. The participation of all physicians in the informing process is not necessary, as evidenced by the lack of complaints to provide information on where in vitro fertilization treatment can be found - until recently only available when paid for by the individual and performed in much larger numbers than abortion. Entities performing this paid procedure made sure to provide information on their own. The rejection of the right to the conscientious objection clause by negating the right to refuse information may lead some to give up the profession or cause the termination of certain professionals on the basis of the professed worldview. Meanwhile, doctors are not allowed to be discriminated against on the basis of their conscience or religion.
Data on unsafe abortions, defined as those provided by persons lacking the necessary skills in an environment failing to meet medical standards, are scarce given the legal and ethical implications of reporting such procedures. However, the World Health Organization estimates that 20 million unsafe abortions occur each year, 90% of them in developing countries under conditions of illegality. The rate is 8/1000 women of reproductive age in more developed countries compared with 17/1000 in less developed countries; the highest rate (47/1000) exists in Latin America. Worldwide, there are an estimated 70,000 unsafe abortion-related deaths each year; again, the risk of mortality is at least 15 times higher in developing than developed countries. In addition, about 20-30% of unsafe abortions result in reproductive tract infections, many of which produce infertility. Of concern is the increase in unsafe abortion among unmarried adolescents who lack access to fertility control services. Urged is a reframing of the abortion issue on the basis of a commitment to women's reproductive health and well-being.
Nguyen, My Huong; Habib, Ndema; Afework, Mesganaw Fantahun; Harries, Jane; Iyengar, Kirti; Moodley, Jennifer; Constant, Deborah; Sen, Swapnaleen
Objective To assess the accuracy of assessment of eligibility for early medical abortion by community health workers using a simple checklist toolkit. Design Diagnostic accuracy study. Setting Ethiopia, India and South Africa. Methods Two hundred seventeen women in Ethiopia, 258 in India and 236 in South Africa were enrolled into the study. A checklist toolkit to determine eligibility for early medical abortion was validated by comparing results of clinician and community health worker assessment of eligibility using the checklist toolkit with the reference standard exam. Results Accuracy was over 90% and the negative likelihood ratio <0.1 at all three sites when used by clinician assessors. Positive likelihood ratios were 4.3 in Ethiopia, 5.8 in India and 6.3 in South Africa. When used by community health workers the overall accuracy of the toolkit was 92% in Ethiopia, 80% in India and 77% in South Africa negative likelihood ratios were 0.08 in Ethiopia, 0.25 in India and 0.22 in South Africa and positive likelihood ratios were 5.9 in Ethiopia and 2.0 in India and South Africa. Conclusion The checklist toolkit, as used by clinicians, was excellent at ruling out participants who were not eligible, and moderately effective at ruling in participants who were eligible for medical abortion. Results were promising when used by community health workers particularly in Ethiopia where they had more prior experience with use of diagnostic aids and longer professional training. The checklist toolkit assessments resulted in some participants being wrongly assessed as eligible for medical abortion which is an area of concern. Further research is needed to streamline the components of the tool, explore optimal duration and content of training for community health workers, and test feasibility and acceptability. PMID:26731176
... 19 Customs Duties 3 2011-04-01 2011-04-01 false Special procedures: Medical records. 201.27... APPLICATION Safeguarding Individual Privacy Pursuant to 5 U.S.C. 552a § 201.27 Special procedures: Medical... maintained by the Commission which pertain to him or her, medical and psychological records merit...
... 29 Labor 4 2011-07-01 2011-07-01 false Special procedures: Medical records. 1410.5 Section 1410.5 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE PRIVACY § 1410.5 Special procedures: Medical records. (a) If medical records are requested for inspection...
... 29 Labor 4 2011-07-01 2011-07-01 false Special procedures: Medical records. 1611.6 Section 1611.6... REGULATIONS § 1611.6 Special procedures: Medical records. In the event the Commission receives a request pursuant to § 1611.3 for access to medical records (including psychological records) whose disclosure...
... 19 Customs Duties 3 2010-04-01 2010-04-01 false Special procedures: Medical records. 201.27... APPLICATION Safeguarding Individual Privacy Pursuant to 5 U.S.C. 552a § 201.27 Special procedures: Medical... maintained by the Commission which pertain to him or her, medical and psychological records merit...
... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Special procedures; medical records. 2412.7 Section 2412.7 Administrative Personnel FEDERAL LABOR RELATIONS AUTHORITY, GENERAL COUNSEL OF THE... Special procedures; medical records. (a) If medical records are requested for inspection which, in...
... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Special procedures: Medical Records. 16... PRIVACY ACT OF 1974 § 16.8 Special procedures: Medical Records. Should EPA receive a request for access to medical records (including psychological records) disclosure of which the system manager decides would...
... 29 Labor 4 2010-07-01 2010-07-01 false Special procedures: Medical records. 1410.5 Section 1410.5 Labor Regulations Relating to Labor (Continued) FEDERAL MEDIATION AND CONCILIATION SERVICE PRIVACY § 1410.5 Special procedures: Medical records. (a) If medical records are requested for inspection...
... 29 Labor 4 2010-07-01 2010-07-01 false Special procedures: Medical records. 1611.6 Section 1611.6... REGULATIONS § 1611.6 Special procedures: Medical records. In the event the Commission receives a request pursuant to § 1611.3 for access to medical records (including psychological records) whose disclosure...
... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Special procedures for medical records... PRESIDENT PRIVACY ACT REGULATIONS § 2504.6 Special procedures for medical records. (a) When the Privacy Act Officer receives a request from an individual for access to those official medical records which belong...
... 7 Agriculture 1 2010-01-01 2010-01-01 false Special procedures: Medical records. 1.115 Section 1... Regulations § 1.115 Special procedures: Medical records. In the event an agency receives a request pursuant to § 1.112 for access to medical records (including psychological records) whose disclosure it...
... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Special procedures for medical records. 1403.6 Section 1403.6 Banks and Banking FARM CREDIT SYSTEM INSURANCE CORPORATION PRIVACY ACT REGULATIONS § 1403.6 Special procedures for medical records. Medical records in the custody of the Farm Credit System...
... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Special procedures: Medical records. 4... GOVERNMENT INFORMATION Privacy Act § 4.26 Special procedures: Medical records. (a) No response to any request for access to medical records from an individual will be issued by the Privacy Officer for a period...
... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Special procedures for medical records. 603.325 Section 603.325 Banks and Banking FARM CREDIT ADMINISTRATION ADMINISTRATIVE PROVISIONS PRIVACY ACT REGULATIONS § 603.325 Special procedures for medical records. Medical records in the custody of the...
... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Special procedures for medical records. 261a.7... Requests by Individual to Whom Record Pertains § 261a.7 Special procedures for medical records. Medical or psychological records requested pursuant to § 261a.5 of this part shall be disclosed directly to the...
Gemzell-Danielsson, Kristina; Kopp, Helena Kallner
A safe induced abortion has no impact on future fertility. Ovulation may resume as early as 8 days after the abortion. There is no difference in return to fertility after medical or surgical abortion. Most women resume sexual activity soon after an abortion. Contraceptive counseling and provision should therefore be an integrated part of the abortion services to help women avoid another unintended pregnancy and risk, in many cases an unsafe, abortion. Long-acting reversible contraceptive methods that includes implants and intrauterine contraception have been shown to be the most effective contraceptive methods to help women prevent unintended pregnancy following an abortion. However, starting any method is better than starting no method at all. This Special Report will give a short guide to available methods and when they can be started after an induced abortion.
Kumar, Anuradha; Hessini, Leila; Mitchell, Ellen M H
Abortion stigma is widely acknowledged in many countries, but poorly theorised. Although media accounts often evoke abortion stigma as a universal social fact, we suggest that the social production of abortion stigma is profoundly local. Abortion stigma is neither natural nor 'essential' and relies upon power disparities and inequalities for its formation. In this paper, we identify social and political processes that favour the emergence, perpetuation and normalisation of abortion stigma. We hypothesise that abortion transgresses three cherished 'feminine' ideals: perpetual fecundity; the inevitability of motherhood; and instinctive nurturing. We offer examples of how abortion stigma is generated through popular and medical discourses, government and political structures, institutions, communities and via personal interactions. Finally, we propose a research agenda to reveal, measure and map the diverse manifestations of abortion stigma and its impact on women's health.
In the US, violence against abortion clinics is escalating. In July 1994, a doctor who performed abortions and one of his escorts was gunned down outside of an abortion clinic. In March of 1993, another doctor was killed outside of a clinic. That killing prompted passage of a federal law designed to protect abortion providers and clinics from violence. In addition to the individuals murdered, the number of violent incidents against abortion clinics increased four-fold to 250 in 1993. Some elderly physicians feel compelled to continue to perform the procedure instead of retiring because there are no young practitioners to replace them. These physicians note that the young practitioners have no experience with the deaths and illness which resulted from illegal abortions and have not been properly trained by their medical schools. The US Attorney General has dispatched federal marshalls to guard abortion clinics, and local police are increasing their protection of clinics. Abortion protestors say that the new federal law will cause some formerly peaceful protestors to resort to violence.
Drife, James Owen
Abortion is mentioned in ancient medical texts but the effectiveness of the methods described is doubtful. Attitudes varied from apparent disapproval by Hippocrates to open approval in Ancient Rome. In mediaeval times abortion was practised by women in secret and this continued during the 19th and early 20th centuries. Despite being illegal in England induced abortion became more common in Victorian times as the population grew. At the same time the link between criminal abortion and maternal mortality became increasingly clear, and if a woman died after a procedure the abortionist (sometimes a midwife) could be sentenced to death. The law was more tolerant of abortions performed by registered doctors. In the 20th century pressure grew for its legalisation. At the time of the 1967 Abortion Act, abortion was the leading cause of maternal death in the UK but within fifteen years death from illegal abortion had been abolished.
Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...
Purcell, Carrie; Cameron, Sharon; Lawton, Julia; Glasier, Anna; Harden, Jeni
Objective To examine experiences of contraceptive care from the perspective of health professionals and women seeking abortion, in the contexts of hospital gynaecology departments and a specialist sexual and reproductive health centre (SRHC). Materials and methods We conducted in-depth semistructured interviews with 46 women who had received contraceptive care at the time of medical abortion (gestation≤9 weeks) from one SRHC and two hospital gynaecology-department-based abortion clinics in Scotland. We also interviewed 25 health professionals (nurses and doctors) involved in abortion and contraceptive care at the same research sites. We analysed interview data thematically using an approach informed by the Framework method, and comparison was made between the two clinical contexts. Results Most women and health professionals felt that contraceptive counselling at abortion was acceptable and appropriate, if provided in a sensitive, nonjudgemental way. Participants framed contraceptive provision at abortion as significant primarily as a means of preventing subsequent unintended conceptions. Accounts of contraceptive decision making also presented tensions between the priorities of women and health professionals, around ‘manoeuvring’ women towards contraceptive uptake. Comparison between clinical contexts suggests that women's experiences may have been more positive in the SRHC setting. Conclusions Whilst abortion may be a theoretically and practically convenient time to address contraception, it is by no means an easy time to do so and requires considerable effort and expertise to be managed effectively. Training for those providing contraceptive care at abortion should explicitly address potential conflicts between the priorities of health professionals and women seeking abortion. Implications This paper offers unique insight into the detail of women and health professionals' experiences of addressing contraception at the time of medical abortion. The
Department of the Army, Washington, DC.
This manual presents laboratory procedures for the differentiation and identification of disease agents from clinical materials. Included are procedures for the collection of specimens, preparation of culture media, pure culture methods, cultivation of the microorganisms in natural and simulated natural environments, and procedures in…
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Special procedures: Medical records. 215.6... PRIVACY ACT OF 1974 § 215.6 Special procedures: Medical records. If the Assistant Director for Administration or the Privacy Liaison Officer, determines that the release directly to the individual of...
... 18 Conservation of Power and Water Resources 2 2012-04-01 2012-04-01 false Special procedures-medical records. 1301.16 Section 1301.16 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY PROCEDURES Privacy Act § 1301.16 Special procedures—medical records. If, in the judgment of...
... 18 Conservation of Power and Water Resources 2 2013-04-01 2012-04-01 true Special procedures-medical records. 1301.16 Section 1301.16 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY PROCEDURES Privacy Act § 1301.16 Special procedures—medical records. If, in the judgment of...
... 18 Conservation of Power and Water Resources 2 2014-04-01 2014-04-01 false Special procedures-medical records. 1301.16 Section 1301.16 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY PROCEDURES Privacy Act § 1301.16 Special procedures—medical records. If, in the judgment of...
... 18 Conservation of Power and Water Resources 2 2011-04-01 2011-04-01 false Special procedures-medical records. 1301.16 Section 1301.16 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY PROCEDURES Privacy Act § 1301.16 Special procedures—medical records. If, in the judgment of...
Globally, abortion mortality accounts for at least 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high mortality and morbidity from abortion tend to occur together. Preventing mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. This article examines the changes in policy and health service provision required to make abortions safe. It is based on a wide-ranging review of published and unpublished sources. In order to be effective, public health measures must take into account the reasons why women have abortions, the kind of abortion services required and at what stages of pregnancy, the types of abortion service providers needed, and training, cost and counselling issues. The transition from unsafe to safe abortions demands the following: changes at national policy level; abortion training for service providers and the provision of services at the appropriate primary level health service delivery points; and ensuring that women access these services instead of those of untrained providers. Public awareness that abortion services are available is a crucial element of this transition, particularly among adolescent and single women, who tend to have less access to reproductive health services generally. PMID:10859852
Replies to the request by the Journal of Nursing on readers' positions against induced abortion indicate there is a definite personal position against induced abortion and the assistance in this procedure. Some writers expressed an emotional "no" against induced abortion. Many quoted arguments from the literature, such as a medical dictionary definition as "a premeditated criminally induced abortion." The largest group of writers quoted from the Bible, the tenor always being: "God made man, he made us with his hands; we have no right to make the decision." People with other philosophies also objected. Theosophical viewpoint considers reincarnation and the law of cause and effect (karma). This philosophy holds that induced abortion impedes the appearance of a reincarnated being. The fundamental question in the abortion problem is, "can the fetus be considered a human life?" The German anatomist Professor E. Bleckschmidt points out that from conception there is human life, hence the fertilized cell can only develop into a human being and is not merely a piece of tissue. Professional nursing interpretation is that nursing action directed towards killing of a human being (unborn child) is against the nature and the essence of the nursing profession. A different opinion states that a nurse cares for patients who have decided for the operation. The nurse doesn't judge but respects the individual's decision. Some proabortion viewpoints considered the endangering of the mother's life by the unborn child, and the case of rape. With the arguments against abortion the question arises how to help the woman with unwanted pregnancy. Psychological counseling is emphasized as well as responsible and careful assistance. Referral to the Society for Protection of the Unborn Child (VBOK) is considered as well as other agencies. Further reader comments on this subject are solicited.
Legal abortions are authorized medical procedures, and as such, they are or can be recorded at the health facility where they are performed. The incidence of illegal, often unsafe, induced abortion has to be estimated, however. In the literature, no fewer than eight methods have been used to estimate the frequency of induced abortion: the "illegal abortion provider survey," the "complications statistics" approach, the "mortality statistics" approach, self-reporting techniques, prospective studies, the "residual" method, anonymous third party reports, and experts' estimates. This article describes the methodological requirements of each of these methods and discusses their biases. Empirical records for each method are reviewed, with particular attention paid to the contexts in which the method has been employed successfully. Finally, the choice of an appropriate method of estimation is discussed, depending on the context in which it is to be applied and on the goal of the estimation effort.
...-medical records. 1301.16 Section 1301.16 Conservation of Power and Water Resources TENNESSEE VALLEY AUTHORITY PROCEDURES Privacy Act § 1301.16 Special procedures—medical records. If, in the judgment of TVA, the transmission of medical records, including psychological records, directly to a...
...: Medical records. 701.306 Section 701.306 Conservation of Power and Water Resources WATER RESOURCES COUNCIL COUNCIL ORGANIZATION Protection of Privacy § 701.306 Special procedure: Medical records. (a) An individual requesting disclosure of a record which contains medical or psychological information may name a...
Sedgh, Gilda; Ball, Haley
Each year in Indonesia, millions of women become pregnant unintentionally, and many choose to end their pregnancies, despite the fact that abortion is generally illegal. Like their counterparts in many developing countries where abortion is stigmatized and highly restricted, Indonesian women often seek clandestine procedures performed by untrained providers, and resort to methods that include ingesting unsafe substances and undergoing harmful abortive massage. Though reliable evidence does not exist, researchers estimate that about two million induced abortions occur each year in the country and that deaths from unsafe abortion represent 14-16% of all maternal deaths in Southeast Asia. Preventing unsafe abortion is imperative if Indonesia is to achieve the fifth Millennium Development Goal of improving maternal health and reducing maternal mortality. Current Indonesian abortion law is based on a national health bill passed in 1992. Though the language on abortion was vague, it is generally accepted that the law allows abortion only if the woman provides confirmation from a doctor that her pregnancy is life-threatening, a letter of consent from her husband or a family member, a positive pregnancy test result and a statement guaranteeing that she will practice contraception afterwards. This report presents what is currently known about abortion in Indonesia. The findings are derived primarily from small-scale, urban, clinic-based studies of women's experiences with abortion. Some studies included women in rural areas and those who sought abortions outside of clinics, but none were nationally representative. Although these studies do not give a full picture of who is obtaining abortions in Indonesia or what their experiences are, the evidence suggests that abortion is a common occurrence in the country and that the conditions under which abortion takes place are often unsafe.
Wohlert, M; Larsen, F M
Sociomedical factors were compared for a group for 531 women seeking abortion and 285 pregnant women, in order to give a differentiated picture of the social conditions which may motivate a woman to seek abortion and the stress which bearing a child can cause. Married women tended to want to carry the pregnancy to term in all age groups. Among the abortion seekers there was a significant overrepresentation of unskilled workers and students. The abortion frequency increased with the number of children. Each woman was classified according to whether her situation was characterized by a chronic social stress, an imminent social stress, or no social stress. The group designated by imminent social stress was significantly predominated by single women, the other two by married women. This group also had a significantly higher representation of students and unskilled workers. (p .0005) The chronic social stress group more often lived in apartments and had more children living at home. Among the abortion seekers, those with chronic situations most often gave as a reason for applying for abortion that they had enough children, that they were alone or had marital problems. Among the imminent stress group the reasons most often given were that the woman was too young or still pursuing her education. Among the group with no social stress, the most frequent reasons for seeking abortion were that the woman was too old or had enough children. It was concluded that bearing a child would cause actual social stress among ca. 50% of the women studied.
Sanhueza Smith, Patricio; Peña, Melanie; Dzuba, Ilana G; García Martinez, María Laura; Aranguré Peraza, Ana Gabriela; Bousiéguez, Manuel; Shochet, Tara; Winikoff, Beverly
Extensive evidence exists regarding the efficacy and acceptability of medical abortion through 63 days since last menstrual period (LMP). In Mexico City's Secretariat of Health (SSDF) outpatient facilities, mifepristone-misoprostol medical abortion is the first-line approach for abortion care in this pregnancy range. Recent research demonstrates continued high rates of complete abortion through 70 days LMP. To expand access to legal abortion services in Mexico City (where abortion is legal through 12 weeks LMP), this study sought to assess the efficacy and acceptability of the standard outpatient approach through 70 days in two SSDF points of service. One thousand and one women seeking pregnancy termination were enrolled and given 200 mg mifepristone followed by 800 μg misoprostol 24-48 hours later. Women were asked to return to the clinic one week later for evaluation. The great majority of women (93.3%; 95% CI: 91.6-94.8) had complete abortions. Women with pregnancies ≤ 8 weeks LMP had significantly higher success rates than women in the 9th or 10th weeks (94.9% vs. 90.5%; p = 0.01). The difference in success rates between the 9th and 10th weeks was not significant (90.0% vs. 91.2%; p = 0.71). The majority of women found the side effects (82.9%) and the use of misoprostol (84.4%) to be very acceptable or acceptable. This study provides additional evidence supporting an extended outpatient medical abortion regimen through 10 weeks LMP.
Zamanian, Maryam; Baneshi, Mohammad Reza; Haghdoost, AliAkbar; Zolala, Farzaneh
Objectives Abortion is a sensitive issue; many cultures disapprove of it, which leads to under-reporting. This study sought to estimate the rate of abortion visibility in the city of Kerman, Iran—that is, the percentage of acquaintances who knew about a particular abortion. For estimating the visibility rate, it is crucial to use the network scale-up method, which is a new, indirect method of estimating sensitive behaviours more accurately. Materials and methods This cross-sectional study was conducted in Kerman, Iran using various methods to ensure the cooperation of clinicians and women. A total of 222 women who had had an abortion within the previous year (74 elective, 74 medical and 74 spontaneous abortions) were recruited. Participants were asked how many of their acquaintances were aware of their abortion. Abortion visibility was estimated by abortion type. 95% CIs were calculated by a bootstrap procedure. A zero-inflated negative binomial regression analysis was conducted to assess the variables related to visibility. Results The visibility (95% CI) of elective, medical and spontaneous abortion was 8% (6% to 10%), 60% (54% to 66%) and 50% (43% to 57%), respectively. Women and consanguineal family were more likely to be aware of the abortion than men and affinal family. Non-family members had a low probability of knowing about the abortion, except in elective cases. Abortion type, marital status, sex of the acquaintance and closeness of the relationship were the most important determinants of abortion visibility in the final multifactorial model. Conclusions This study shows the visibility rate to be low, but it does differ among social network members and by the type of abortion in question. This difference might be explained through social and cultural norms as well as stigma surrounding abortion. The low visibility rate might explain the low estimates of abortion rates found in other studies. PMID:27737886
LIU, HAIYANG; MA, WEI; LIU, QI; WANG, FASHAN; CAO, LING; LI, TIENAN; ZHANG, NING; GENG, FANG
The Wujia Shenghua capsule (WSC) is derived from Sheng-Hua-Tang, a well-known traditional Chinese medicine compound prescription that has been widely applied during the postpartum period in Chinese communities for a number of years. The aim of the present study was to investigate the effect of WSC on uterine bleeding following medically-induced incomplete abortion in rats during early pregnancy. Incomplete abortions were induced in Wistar rats during early pregnancy using mifepristone combined with misoprostol. The effects of WSC treatment were investigated in terms of the duration and volume of uterine bleeding, the uterine index and shape, and various hemodynamic indexes. In addition, blood samples were collected to measure the levels of estradiol (E2), fibronectin (FN) and laminin (LM) via a radioimmunoassay or enzyme-linked immunosorbent assay, while the expression levels of FN, estrogen receptor (ER) and progesterone receptor (PR) in the uterine tissues were determined by immunohistochemistry. The in vivo results demonstrated that WSC treatment markedly shortened the duration and reduced the volume of uterine bleeding when compared with the model group. Furthermore, WSC treatment significantly elevated the E2 level in the serum and the expression of the ER and PR in the uterine tissues, while notably decreasing the FN and LM levels in the serum and uterine tissues. In addition, the hemodynamic indexes were shown to improve with WSC treatment. These results demonstrated that WSC exerted an inhibitory effect on the bleeding caused by medical abortion, possibly through modulating the E2, ER, PR, FN and LM levels. PMID:26622367
Cohen, R I; Chopra, P; Upshur, C
For patients without a specific diagnosis, treatment of low back pain begins with strategies to avoid re-injury and exacerbation. Most patients benefit from some form of medical therapy, guided by the three-step World Health Organization analgesic ladder. Opioid therapy is appropriate when needed for low back pain, especially in the acute period. Adjuvant medication (eg, an anticonvulsant or antidepressant) may help reduce or eliminate the need for opioid therapy. Side effects are common with opioid medications, although many resolve with time. Patient education in exercise, back protection, nutrition, and sexual concerns is an important component of treatment. Some patients may benefit from referral to a pain center for multidisciplinary management. Those with a structural or mechanical cause of pain may do well with surgery.
Autoimmune progesterone dermatitis (APD) is a rare autoimmune response to raised endogenous progesterone levels that occur during the luteal phase of the menstrual cycle. Cutaneous, mucosal lesions and other systemic manifestations develop cyclically during the luteal phase of the menstrual cycle when progesterone levels are elevated. APD symptoms usually start 3 - 10 days before menstruation and resolve 1 - 2 days after menstruation ceases. A 30-year-old woman presented with urticaria, petechiae and palpable pinpoint purpura lesions of the legs, forearms, neck and buttocks 1 week prior to her menses starting and 2 months after a medical abortion. She was diagnosed with allergic contact dermatitis and topical steroids were prescribed. Her skin conditions did not improve and were associated with her menstrual cycle. We performed an intradermal test using progesterone, which was positive. She was treated with oral contraceptive pills and the symptoms were resolved. This is a typical case of APD triggered by increased sensitivity to endogenous progesterone induced a few months after medical abortion.
Carlson, Jestin N; Karns, Christopher; Mann, N Clay; E Jacobson, Karen; Dai, Mengtao; Colleran, Caroline; Wang, Henry E
Emergency medical services (EMS) must provide a wide range of care for patients in the out-of-hospital setting. Although previous work has detailed that EMS providers rarely perform certain procedures, (e.g., endotracheal intubation) there are limited data detailing the frequency of procedures across the breadth of EMS providers' scope of practice. We sought to characterize procedures performed by EMS in the United States. We conducted an analysis of the 2011 National Emergency Medical Services Information System (NEMSIS) research data set, encompassing EMS emergency response data from 40 states and two territories. From these data, we report the number and incidence of EMS procedures. We also characterize procedures performed. There were 14,371,941 submitted EMS responses, of which 7,680,559 had complete information on procedures performed on adults. Of these, 4,206,360 EMS responses had procedures performed totaling 11,407,396 procedures. The most common procedures performed were peripheral venous access (28.4%), cardiac monitoring (16.1%) pulse oximetry (13.5%), and blood glucose analysis (10.4%). Procedures were performed most often in patients with traumatic injury (20.0%) followed by chest pain/discomfort (14.0%). Critical procedures (cardioversion, defibrillation, endotracheal intubation, etc.) were infrequently performed (n = 277,785, 2.4%). These data highlight the frequency with which EMS providers perform procedures across the United States. This may help to guide future EMS training and education efforts by highlighting the relative frequency and infrequency of specific procedures.
Informed consent mandates for abortion providers may infringe the First Amendment's freedom of speech. On the other hand, they may reinforce the physician's duty to obtain informed consent. Courts can promote both doctrines by ensuring that compelled physician speech pertains to medical facts about abortion rather than abortion ideology and that compelled speech is truthful and not misleading.
Tamang, Anand; Puri, Mahesh; Lama, Kalyan; Shrestha, Prabhakar
In Nepal, despite policy restrictions, both registered and unregistered brands of mifepristone and misoprostol can easily be obtained at pharmacies. Since many women visit pharmacies for abortion information, ensuring that they receive effective care from pharmacy workers remains an important challenge. We conducted an operations research study to examine whether trained pharmacy workers can correctly provide information on safe use of mifepristone and misoprostol for early first trimester medical abortion. Pharmacy workers in one district were given orientation and training using a harm-reduction approach, and compared with a non-equivalent comparison group in the second district. Overall, trained pharmacy workers' knowledge increased substantially, but no increase was found in the comparison group. Compared to the baseline (65%), 97% of trained pharmacy workers knew up to what stage of pregnancy and how women should use mifepristone and misoprostol. A higher percentage of pharmacy workers in the intervention group (77%) compared to the comparison group (49%) were knowledgeable at follow-up about determining whether an abortion was successful, implying a need for improving this aspect of training. As many mid-level health providers run their own pharmacies and offer medical abortion pills, it is important for the government to consider training these providers and registering their pharmacies as safe medical abortion service outlets.
The American Association of Pro-Life Obstetricians and Gynecologists is an 18 year old coalition of 960 doctors who refuse to perform abortions. In addition, they are committed to aggressively counseling women with unintended pregnancies to continue to full term. Today there are so many pressures on doctors not to perform abortions that they are turning away from the procedure. Financial, peer, an activist pressure all contribute to this change. A 1986 study found that 66% of gynecologists would not perform abortions. A National Abortion Federation study found that only 50% of training programs in medical schools offer abortion training. Further, the majority of these are optional so a great many doctors are leaving medical school with no training in abortion. Currently in 83% of the counties in the US there are no abortion providers. Utah has only 2, North and South Dakota each have 1. Women may still have the right to have abortions, but there is no Constitutional provision to ensure their doctor will be willing to perform one.
Abortion is illegal in Thailand, except in cases when it is considered necessary for a woman's health or in the case of rape. Yet abortions remain common and an important public health issue for women in Thailand. Based upon eight months' ethnographic research carried out in Northeast Thailand, this paper presents findings from a survey of 164 women of reproductive age in rural villages and from interviews with 19 women who have had illegal abortions. A range of techniques to induce abortions are used, including the consumption of abortifacients, massage, and uterine injections by untrained practitioners, and procedures carried out by trained medical personnel. This paper examines the effects of the current laws through the experiences of women who have undergone illegal abortions. Within the restrictive legal context, risk is stratified along economic lines. Poorer women have little choice but to resort to abortions by untrained practitioners. There is evidence of wide public support for the reform of the abortion laws to widen the circumstances under which abortion is legal. An ongoing movement, led by women's groups, medical and legal professionals, seeks to reform the law.
Rao, Kamini A; Faúndes, Anibal
The World Health Organization defines unsafe abortion as a procedure for terminating an unintended pregnancy carried out by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both. The Programme of Action of the International Conference on Population and Development recommends that 'In circumstances where abortion is not against the law, such abortion should be safe'. However, millions of women still risk their lives by undergoing unsafe abortion even if they comply with the law. This is a serious violation of women's human rights, and obstetricians and gynaecologists have a fundamental role in breaking the administrative and procedural barriers to safe abortion. This chapter reviews the magnitude of the problem, its consequences for women's health, the barriers to access to safe abortion, including its legal status, the effect of the law on the rate and the consequences of abortion, the human rights implications and the current evidence on methods to perform safe abortion. This chapter concludes with an analysis of what can be done to change the current situation.
Mahdi, Sundus; Ghannam, Obadah; Watson, Sydeaka; Padela, Aasim I
Physician religiosity can influence their ethical attitude toward medical procedures and can thereby impact healthcare delivery. Using a national survey of American Muslim physicians, we explored the association between physician recommendation of three controversial medical procedures--tubal ligation, abortion, and porcine-based vaccine--and their (1) religiosity, (2) utilization of bioethics resources, and (3) perception of whether the procedure was a medical necessity and if the scenario represented a life threat. Generally, multivariate models found that physicians who read the Qur'an more often as well as those who perceived medical necessity and/or life threat had a higher odds recommending the procedures, whereas those who sought Islamic bioethical guidance from Islamic jurists (or juridical councils) more often had a lower odds. These associations suggest that the bioethical framework of Muslim physicians is influenced by their reading of scripture, and the opinions of Islamic jurists and that these influences may, paradoxically, be interpreted to be in opposition over some medical procedures.
Fein, Lydia; Ketterer, Em; Young, Emily; Backus, Lois
The US Supreme Court’s 1973 Roe v Wade decision had clear implications for American women’s reproductive rights and physician ability to carry out patient choices. Its effect on physician abortion training was less apparent. In an effort to increase patient access to abortions after Roe, provision shifted from hospitals to nonhospital clinics. However, these procedures and patients were taken out of the medical education realm, and physicians became vulnerable to intimidation. The consequent provider shortage created an unexpected barrier to abortion access. Medical Students for Choice was founded in 1993 to increase abortion-training opportunities for medical students and residents. Its mission ensures that motivated medical students will learn and a growing number of physicians will commit to comprehensive abortion provision. PMID:23327239
... 32 National Defense 2 2014-07-01 2014-07-01 false Special procedures: Medical records. 319.7 Section 319.7 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) PRIVACY PROGRAM DEFENSE INTELLIGENCE AGENCY PRIVACY PROGRAM § 319.7 Special procedures:...
... 32 National Defense 2 2012-07-01 2012-07-01 false Special procedures: Medical records. 319.7 Section 319.7 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) PRIVACY PROGRAM DEFENSE INTELLIGENCE AGENCY PRIVACY PROGRAM § 319.7 Special procedures:...
... 32 National Defense 2 2010-07-01 2010-07-01 false Special procedures: Medical records. 319.7 Section 319.7 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) PRIVACY PROGRAM DEFENSE INTELLIGENCE AGENCY PRIVACY PROGRAM § 319.7 Special procedures:...
Winkler, H. E. (Inventor)
A bio-medical flow sensor including a packageable unit of a bottle, tubing and hypodermic needle which can be pre-sterilized and is disposable. The tubing has spaced apart tubular metal segments. The temperature of the metal segments and fluid flow therein is sensed by thermistors and at a downstream location heat is input by a resistor to the metal segment by a control electronics. The fluids flow and the electrical power required for the resisto to maintain a constant temperature differential between the tubular metal segments is a measurable function of fluid flow through the tubing. The differential temperature measurement is made in a control electronics and also can be used to control a flow control valve or pump on the tubing to maintain a constant flow in the tubing and to shut off the tubing when air is present in the tubing.
Lemkau, J P
Without ambivalence, psychotherapy would be unnecessary; however there is a great deal of ambivalence about abortion so it is a therapy issue. In our society abortion decision are made in an ambivalent environment. Even when a woman makes a free decision to have a legal abortion, an emotional sequelae can ensue. This article reviews literature and relates professional experience about the psychological problems and treatment of women before and after having an abortion. A feeling of relief is the typical reaction to an abortion for the woman. The issues involved in the decision process are the woman's own health and happiness as well as that of her future family. The issues include medical and interpersonal ones and often present a moral crisis. Issues such as education, occupation, and relationships must be considered. Three major types of reactions seem to follow an abortion. The 1st is a positive feeling of happiness and relief. The 2nd and 3rd are negative, one being socially based guilt and the other being individually based guilt. Identifying abortion related issues in psychotherapy is not always easy, since they are no usually directly presented to the therapist. They often manifest themselves as symptoms of other problems. Research suggests that unmarried young women without children have a harder time resolving all the issues involved in making an abortion decision. One effective method of discovering emotional problems is to determine the reasons for delaying an abortion. If a woman is having problems making the decision is must be for an important reason. Just as important is the aftermath of the abortion. Attempts should be made to discover as much information about the procedure itself, the recovery time and any repercussions of the procedure. Neither research nor clinical experience has shown that abortion related psychotherapy is different than other forms of treatment. Griefwork, educational approaches, reviews of the decision making process and
A summary of an article which describes how persons form attitudes toward abortion is presented. 3 parameters play roles in the formation of attitudes toward abortion. One such parameter is the decision for which cases abortion is to be allowed. A second parameter is the person's conception of when life commences. A third parameter is formed by unconscious or non-reasoned attitudes which relate to abortion. A model depicts the interaction of these parameters to form opinions about abortion ranging from "abortion is murder" to "liberalize abortion." This leads to the consideration of more general ethical problems. Arguments for and against abortion are listed, as well as improtant statistics concerning abortion from 1975.
Greydanus, D E; Railsback, L D
This article reviews the difficult but complex subject of abortion in adolescents. Methods of abortion are outlined and additional aspects are presented: psychological effects, counseling issues, and legal parameters. It is our conclusion that intense efforts should be aimed at education of youth about sexuality and prevention of pregnancy, utilizing appropriate contraceptive services. When confronted with a youth having an unwanted pregnancy, all legal options need to be carefully explored: delivery, adoption, or abortion. The decision belongs to the youth and important individuals in her environment. Understanding developmental aspects of adolescence will help the clinician deal with the pregnant teenagers. If abortion is selected, a first trimester procedure is best. Finally, physicians are urged to be aware of the specific, ever changing legal dynamics concerning this subject which are present in their states. Abortion is a phenomenon which has become an emotional but undeniably important aspect of adolescent sexuality and adolescent health care, in this country and around the world.
In the US, 10.2% of legal abortions are performed at 13-20 weeks and an additional 1% occur at 21 weeks gestation or beyond. These second-trimester abortions account for about 140,000 procedures per year. Dilatation and evacuation; instillation of saline, urea, or medication into the amniotic cavity; and intravenous prostaglandin administration are the approaches available for these procedures. At present, intravaginal prostaglandin E is the most commonly used mid-trimester abortion method; new research suggests that intravaginal misoprostol may confer advantages. Since teenagers are the population group most likely to delay abortion until the second trimester, priority should be given to making abortion services more accessible and removing requirements such as parental consent. Most beneficial would be a preventive approach that decreases the number of unintended pregnancies among adolescents through school-based sex education programs and access to free, effective contraceptive methods. Problematic is the reluctance on the part of many obstetricians and gynecologists to perform abortions due to a lack of technical training or moral objections. These practitioners should be mandated to fulfill their obligation to meet the needs of their patients, regardless of their personal views on the abortion issues.
Mabry, H P
3 papers giving the Hindu, Catholic and Protestant views on abortion, presented at a seminar for physicians at the Christian Medical College, Vellore, India, January 1972, are summarized. S. THANDAVESWARA stated that the traditional Hindu position, based on the ethical code, Dharma Shastras, prohibits abortion because the practice could prevent rebirth of a specific human life that is in the process of becoming liberated (moksa). Yet an institution, the Parishads, exists to reconsider such matters, and if its membership were not committed to conservative priorities, it could conceivably approve of abortion for the mothers' physical or mental health if she freely chose an abortion. O. DIJKSTRA stated the traditional Catholic view that "direct" abortion is always murder, but "indirect" abortion may be allowed as in removing a cancerous pregnant uterus. He expanded on the phenomenologic interpretation of some liberal theologians, whose views are not yet accepted officially, that the human self emerges irreversibily at nidation, before which abortion could be permitted. The author gave a Protestant position based on Biblical and sociologic sources. He disputed the Catholic's view that human life begins at nidation, and maintained that mere life is only one value to be weighed against love and justice for the fetus, mother, family and society. Love and justice require a choice of contraceptives, safe abortion for all economic classes, safe gestation for future pregnancies, and a resonable hope for a good life for the fetus, its family and society.
Kinaro, Joyce; Ali, Tag Elsir Mohamed; Schlangen, Rhonda; Mack, Jessica
Unsafe abortion in Sudan results in significant morbidity and mortality. This study of treatment for complications of unsafe abortion in five hospitals in Khartoum, Sudan, included a review of hospital records and a survey of 726 patients seeking abortion-related care from 27 October 2007 to 31 January 2008, an interview of a provider of post-abortion care and focus group discussions with community leaders. Findings demonstrate enormous unmet need for safe abortion services. Abortion is legally restricted in Sudan to circumstances where the woman's life is at risk or in cases of rape. Post-abortion care is not easily accessible. In a country struggling with poverty, internal displacement, rural dwelling, and a dearth of trained doctors, mid-level providers are not allowed to provide post-abortion care or prescribe contraception. The vast majority of the 726 abortion patients in the five hospitals were treated with dilatation and curettage (D&C), and only 12.3% were discharged with a contraceptive method. Some women waited long hours before treatment was provided; 14.5% of them had to wait for 5-8 hours and 7.3% for 9-12 hours. Mid-level providers should be trained in safe abortion care and post-abortion care to make these services accessible to a wider community in Sudan. Guidelines should be developed on quality of care and should mandate the use of manual vacuum aspiration or misoprostol for medical abortion instead of D&C.
Spitz, A M; Oberle, M; Zaro, S M
According to data reported to the Georgia Department of Human Resources (DHR), the number of induced abortions performedin Georgia in 1980 decreased for the 1st time since 1968 when the state legalized abortion. To verify this reported decrease, the DHR data were compared with statistics obtained by the Alan Guttmacher Institute in a 1980 survey of abortion providers in Georgia. Since the AGI contacts providers directly, its statistics are considered a more accurate reflection of abortions performed. According to the DHR, the number of abortions dropped from 36,579 in 1979 to 33,288 in 1980, a 9% decrease, and the abortion rate fell from 26.6/1000 women ages 15-44 years to 23.9/1000. AGI data indicated a drop from 38,760 abortions in 1979 to 37,890 in 1980, a 2% decrease. Since both sources noted a similar trend despite differences in data collection methods, the 1980 decline in abortion procedures in Georgia is considered to represent a true decline rather than s statistical artifact. The sociodemographic characteristics of women obtaining abortions in Georgia in 1980 were also analyzed on the basis of DHR data. Although the number of abortions in Georgia performed on Georgia residents increased 2.5% from 1979-80 to 90.7%, the abortion ratio for residents decreased from 367.7 to 327.4 abortions/1000 live births. There was little change in the age, race, or marital status distribution of women receiving abortions. The ratio for white women was 317 abortions/1000 live births and that for blacks was 342/1000. The abortion ratio for unmarried women (1166/1000) was 13 times that for married women (88/1000). The number of repeat abortions decreased form 34% in 1979 to 29% in 1980. Moreover, 93% of women obtaining abortions did so in the 1st 12 weeks of gestation compared with 89% in 1979. The percentage of abortions performed in clinics increased from 66.5% in 1979 to 75.3% in 1980, with suction curettage accounting for 85% of all abortions in the 1st 12 weeks of
Williams, Carolyn L.; Kendall, Philip C.
Summarizes many of the issues relevant to patient education programs concerning psychological preparation for stressful medical procedures. Individual differences among patients and their differential responses to types of intervention are emphasized, and descriptions of information provision, skills training, relaxation training/desensitization,…
... Subcommittee § 1102.104 Special procedure: Medical records. (a) Statement of physician or mental health... or a mental health professional indicating that, in his or her opinion, disclosure of the requested...) Designation of physician or mental health professional to receive records. If the ASC believes, in good...
... Subcommittee § 1102.104 Special procedure: Medical records. (a) Statement of physician or mental health... or a mental health professional indicating that, in his or her opinion, disclosure of the requested...) Designation of physician or mental health professional to receive records. If the ASC believes, in good...
... Subcommittee § 1102.104 Special procedure: Medical records. (a) Statement of physician or mental health... or a mental health professional indicating that, in his or her opinion, disclosure of the requested...) Designation of physician or mental health professional to receive records. If the ASC believes, in good...
Cheseaux, Nicole; de Saint Lager, Alix Juillet; Walder, Bernhard
The aim of this systematic review was to estimate the efficiency of hypnosis prior to medical procedures. Different databases were analyzed to identify randomized controlled trials (RCTs) comparing hypnosis to control interventions. All RCTs had to report pain or anxiety. Eighteen RCTs with a total of 968 patients were included; study size was from 20 to 200 patients (14 RCTs ≤ 60 patients). Fourteen RCTs included 830 adults and 4 RCTs included 138 children. Twelve of 18 RCTs had major quality limitations related to unclear allocation concealments, provider's experience in hypnosis, patient's adherence to hypnotic procedures, and intention-to-treat design. This systematic review observed major methodological limitations in RCTs on hypnosis prior to medical procedures.
The rising costs of medical treatment in the United States are fueling a movement to outsource medical treatment. Estimates of the number of Americans traveling overseas for treatment range from 50,000 to 500,000. Charges for common procedures such as heart bypass can be $11,000 in Thailand compared to $130,000 in the United States. Knee…
a "seamless garment" representing a consistent ethic of life. The current Pope recognizes that the moment of ensoulment is unknown but condemns abortion in all cases (except as the unintentional byproduct of another medical procedure).
Fawcus, Susan R
Unsafe abortions refer to terminations of unintended pregnancies by persons lacking the necessary skills, or in an environment lacking the minimum medical standards, or both. Globally, unsafe abortions account for 67,900 maternal deaths annually (13% of total maternal mortality) and contribute to significant morbidity among women, especially in under-resourced settings. The determinants of unsafe abortion include restrictive abortion legislation, lack of female empowerment, poor social support, inadequate contraceptive services and poor health-service infrastructure. Deaths from unsafe abortion are preventable by addressing the above determinants and by the provision of safe, accessible abortion care. This includes safe medical or surgical methods for termination of pregnancy and management of incomplete abortion by skilled personnel. The service must also include provision of emergency medical or surgical care in women with severe abortion complications. Developing appropriate services at the primary level of care with a functioning referral system and the inclusion of post abortion contraceptive care with counseling are essential facets of abortion care.
Benson, J; Nicholson, L A; Gaffikin, L; Kinoti, S N
medications and procedures; and case studies on the provision of safe abortion services where legally allowed.
Savulescu, Julian; Schuklenk, Udo
In an article in this journal, Christopher Cowley argues that we have 'misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors'. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors' personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: (1) removing a right to conscientious objection; (2) selecting candidates into relevant medical specialities or general practice who do not have objections; (3) demonopolizing the provision of these services away from the medical profession.
Abstract In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’.1 We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors' personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: (1) removing a right to conscientious objection; (2) selecting candidates into relevant medical specialities or general practice who do not have objections; (3) demonopolizing the provision of these services away from the medical profession. PMID:27716989
Diedrich, Justin; Drey, Eleanor
For decades, the induction of fetal demise has been used before both surgical and medical second-trimester abortion. Intracardiac potassium chloride and intrafetal or intra-amniotic digoxin injections are the pharmacologic agents used most often to induce fetal demise. In the last several years, induction of fetal demise has become more common before second-trimester abortion. The only randomized, placebo-controlled trial of induced fetal demise before surgical abortion used a 1 mg injection of intra-amniotic digoxin before surgical abortion at 20-23 weeks' gestation and found no difference in procedure duration, difficulty, estimated blood loss, pain scores or complications between groups. Inducing demise before induction terminations at near viable gestational ages to avoid signs of life at delivery is practiced widely. The role of inducing demise before dilation and evacuation (D&E) remains unclear, except for legal considerations in the United States when an intact delivery is intended. There is a discrepancy between the one published randomized trial that used 1 mg intra-amniotic digoxin that showed no improvement in D&E outcomes and observational studies using different routes, doses and pre-abortion intervals that have made claims for its use. Additional randomized trials might provide clearer evidence upon which to make further recommendations about any role of inducing demise before surgical abortion. At the current time, the Society of Family Planning recommends that pharmacokinetic studies followed by randomized controlled trials be conducted to assess the safety and efficacy of feticidal agents to improve abortion safety.
"Individual and social attitudes toward abortion are unstable," the author notes, as he reviews the history of such attitudes in the United States and Britain. In both countries abortion was legal in 1800, but had become illegal by 1900, largely due to changing attitudes within the medical profession, including the desire to protect the profession against the activities of non-physicians. In the U.S., religious groups took little interset in the issue until late in the 19th century. Today, years after the legalization of abortion in Britain (1967) and the U.S. (1974), there is a chance that public attitudes will be influenced for a second time by a vocal few, again restricting legal access to abortion. The commercial success of MDs who specialize in abortions is a complicating factor, making it easier for opposition groups to recruit supporters. The abortion debate concerns unprovable interpretations of observable facts; it is an exercise in religious toleration. The most important role of physicians is to help establish a liberal and civilized framework within which colleagues of different persuasions can make free and objective choices regarding the delivery of abortion services.
The aim of this paper is to present current controversies concerning the safety of medical devices and procedures under pressure in a hyperbaric chamber including: defibrillation in a multiplace chamber; implantable devices during hyperbaric oxygen treatment (HBOT) and the results of a recent European questionnaire on medical devices used inside hyperbaric chambers. Early electrical defibrillation is the only effective therapy for cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia. The procedure of defibrillation under hyperbaric conditions is inherently dangerous owing to the risk of fire, but it can be conducted safely if certain precautions are taken. Recently, new defibrillators have been introduced for hyperbaric medicine, which makes the procedure easier technically, but it must be noted that sparks and fire have been observed during defibrillation, even under normobaric conditions. Therefore, delivery of defibrillation shock in a hyperbaric environment must still be perceived as a hazardous procedure. Implantable devices are being seen with increasing frequency in patients referred for HBOT. These devices create a risk of malfunction when exposed to hyperbaric conditions. Some manufacturers support patients and medical practitioners with information on how their devices behave under increased pressure, but in some cases an individual risk-benefit analysis should be conducted on the patient and the specific implanted device, taking into consideration the patient's clinical condition, the indication for HBOT and the capability of the HBOT facility for monitoring and intervention in the chamber. The results of the recent survey on use of medical devices inside European hyperbaric chambers are also presented. A wide range of non-CE-certified equipment is used in European chambers.
ten Cate, T J; Hendrix, H L
Admittance to a medical school in the Netherlands has for decades been based on a grade point average weighted lottery system of secondary school leavers. Since 2000, the Dutch Higher Education and Scientific Research Act has given medical schools the option of selecting candidates. In 2000, two of the eight Dutch medical schools started selection experiments for 10 percent of their places. Leiden University Medical Center invited school leavers who had studied a more varied range of extra subjects to attend a 10-day summer school. All 54 candidates were ranked on the basis of assessments and tests; 24 of them were admitted. Utrecht University invited students with a higher education degree to a selection day. An application form, a structured interview and a questionnaire determined the ranking of 53 candidates; 24 of them were admitted. Both schools were satisfied with the manner in which the selection procedure worked. However, it is not yet possible to draw any definite conclusions about the effectiveness of the selection procedure.
Harries, Jane; Malaba, Thokozile; Myer, Landon; Patel, Malika; Petro, Gregory; Grossman, Daniel
Objective To document clinical outcomes and women’s experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. Methods Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2–4 weeks after discharge for the 2014 cohort. Results The 2014 cohort received 200 mg mifepristone, which was self-administered 24–48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3–4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels
Access to safe abortion hinges upon the availability of trained abortion providers. The American College of Obstetricians and Gynecologists supports education for students in health care fields as well as clinical training for residents and advanced practice clinicians in abortion care in order to increase the availability of trained abortion providers. The American College of Obstetricians and Gynecologists supports the expansion of abortion education and an increase in the number and types of trained abortion providers in order to ensure women's access to safe abortions. Integrated medical education and universal opt-out training policies help to lessen the stigma of abortion provision and improve access by increasing the number of abortion providers. This Committee Opinion reviews the current status of abortion education, describes initiatives to ensure the availability of appropriate and up-to-date abortion training, and recommends efforts for integrating and improving abortion education in medical schools, residency programs, and advanced practice clinician training programs.
Randall, Amy E
This article examines Soviet reproductive politics after the Communist regime legalized abortion in 1955. The regime's new abortion policy did not result in an end to the condemnation of abortion in official discourse. The government instead launched an extensive campaign against abortion. Why did authorities bother legalizing the procedure if they still disapproved of it so strongly? Using archival sources, public health materials, and medical as well as popular journals to investigate the antiabortion campaign, this article argues that the Soviet government sought to regulate gender and sexuality through medical intervention and health "education" rather than prohibition and force in the post-Stalin era. It also explores how the antiabortion public health campaign produced "knowledge" not only about the procedure and its effects, but also about gender and sexuality, subjecting both women and men to new pressures and regulatory norms.
Arilha, Margareth Martha
The scope of this article is to discuss the commercialization and use of misoprostol for abortion purposes in the illegal contexts that still persist in Brazil. The information presented was collected through case studies conducted with two young women who aborted using medication - one successfully and one unsuccessfully - and two adult women who have close ties with women who used misoprostol. The study confirms the hypothesis that the diffusion and expansion of the use of misoprostol outside the hospital context is associated with the decision of women who seek lower costs, lower risks to their health and privacy. It also permits examination of the interpretation that this increase in consumption is linked to the inclusion of the medication in a set of goods that are illegally traded in Brazil, in different ways and in different contexts. As a result, women are exposed to different degrees of vulnerability depending directly on the steps taken, types of mediation used and social networks they belong to. These are the ways in which women and men obtain access to the use of misoprostol for abortion, the outcome of which may be successful or not.
Gold, Marji; Chong, Erica
Given the highly political nature of abortion in the United States, the provision of medical abortion with mifepristone (Mifeprex®) and misoprostol has always occurred under a unique set of circumstances. The Food and Drug Administration-approved regimen requires clinicians to administer the mifepristone in the office and also requires women to return to the office for the misoprostol. In the US, where off-label drug use is an accepted practice when supportive evidence exists, most clinicians give women the misoprostol at the initial visit for her to take at home, eliminating an unnecessary visit to the office. This commentary suggests that, based on current studies, there is also enough evidence to offer women the option to self-administer mifepristone out of the office and that this is just another feature of off-label use. Six studies, enrolling over 1800 women, found that the option of taking mifepristone out of the office was popular and acceptable among women and providers. Given that it is safe, highly acceptable and not burdensome on providers, outside-office-use of mifepristone should be offered to all women as part of routine medical abortion services.
Across four decades of political and social action, Nepal changed from a country strongly enforcing oppressive abortion restrictions, causing many poor women's long imprisonment and high rates of abortion-related maternal mortality, into a modern democracy with a liberal abortion law. The medical and public health communities supported women's rights activists in invoking legal principles of equality and non-discrimination as a basis for change. Legislative reform of the criminal ban in 2002 and the adoption of an Interim Constitution recognizing women's reproductive rights as fundamental rights in 2007 inspired the Supreme Court in 2009 to rule that denial of women's access to abortion services because of poverty violated their constitutional rights. The government must now provide services under criteria for access without charge, and services must be decentralized to promote equitable access. A strong legal foundation now exists for progress in social justice to broaden abortion access and reduce abortion stigma.
Suls, Jerry; Wan, Choi K.
A meta-analysis of studies on preparation for medical procedures and pain examined the relative effects of sensory, procedural, and combined sensory-procedural preoperational information on coping outcomes. Results indicated that, in contrast to sensory information, procedural information provided no significant benefits over control group…
McAvoy, P A; McCrorie, P; Jolly, B; Ayers, A B; Cox, J; Howes, A D; Macdonald, E B; Slimmon, D J; Southgate, L
From July 1997, the General Medical Council (GMC) has had the power to investigate doctors whose performance is considered to be seriously deficient. Assessment procedures have been developed for all medical specialties to include peer review of performance in practice and tests of competence. Peer review is conducted by teams of at least two medical assessors and one lay assessor. A comprehensive training programme for assessors has been developed that simulates the context of a typical practice-based assessment and has been tailored for 12 medical specialties. The training includes the principles of assessment, familiarization with the assessment instruments and supervised practice in assessment methods used during the peer review visit. High fidelity is achieved through the use of actors who simulate third party interviewees and trained doctors who role play the assessee. A subgroup of assessors, selected to lead the assessment teams, undergo training in handling group dynamics, report writing and in defending the assessment report against legal challenge. Debriefing of assessors following real assessments has been strongly positive with regard to their preparedness and confidence in undertaking the assessment.
Young, Alma T.; And Others
When New York State's abortion laws were liberalized in 1970, there was a sharp rise in the number of clinic patients who requested abortions. Because social workers at Mount Sinai Medical Center believed that abortion still is an emotional risk for many women, a study was conducted to determine which patients needed intensive counseling. (Author)
The rising costs of medical treatment in the United States are fueling a movement to outsource medical treatment. Estimates of the number of Americans traveling overseas for treatment range from 50,000 to 500,000. Charges for common procedures such as heart bypass can be $11,000 in Thailand compared to $130,000 in the United States. Knee replacement in the United States can cost $40,000 compared to $13,000 in Singapore.A new industry, medical tourism, has been created to advise patients on the appropriate facility in the right country for their condition, handle all travel arrangements, teleconference with physicians, and send medical records. To respond to the growth in medical travel, the Joint Commission (formerly the Joint Commission on Accreditation of Health Care Organizations) initiated the Joint Commission International (JCI) to accredit hospitals worldwide. Although outcome statistics from hospitals outside the United States are rare, first-person reports on quality are numerous. Making surgery possible for uninsured and underinsured individuals or self-insured state, municipal, and private entities is a major benefit of medical tourism. Mitigating against medical travel are the lack of legal remedies in place for malpractice and the possibility that travel itself can impose risk to patients. For example, lengthy air flights where the patient is in a fixed position for hours at a time can cause embolisms. If the trend toward medical tourism continues, continuing education, credentialing, and certification services may be required to help assure patient safety.
Cook, R J; Dickens, B M; Horga, M
In 2003, the World Health Organization published its well referenced handbook Safe Abortion: Technical and Policy Guidance for Health Systems to address the estimated almost 20 million induced abortions each year that are unsafe, imposing a burden of approximately 67 thousand deaths annually. It is a global injustice that 95% of unsafe abortions occur in developing countries. The focus of guidance is on abortion procedures that are lawful within the countries in which they occur, noting that in almost all countries, the law permits abortion to save a woman's life. The guidance treats unsafe abortion as a public health challenge, and responds to the problem through strategies concerning improved clinical care for women undergoing procedures, and the appropriate placement of necessary services. Legal and policy considerations are explored, and annexes present guidance to further reading, international consensus documents on safe abortion, and on manual vacuum aspiration and post-abortion contraception.
On February 15, (1995) the Accreditation Council for Graduate Medical Education announced that it will now require medical schools seeking accreditation to provide abortion training for all residents in obstetrics and gynecology. The new "Program Requirements for Residency Education in Obstetrics and Gynecology," approved unanimously, will take effect on January 1, 1996. According to the Council, the newly issued standards are the first to refer specifically to abortion. The language states, "Experience with induced abortion must be part of residency training, except for residents with moral or religious objections .... Experience with management of complications of abortion must be provided to all residents." The Council also mandates that if a medical school itself has "a religious, moral or legal" objection to teaching the procedure, it must "ensure that residents ... who do not have a religious or moral objection receive education and experience in performing abortion at another institution." Other revisions provide for expanded resident education in "primary and preventive care," due to the fact that many women rely on their obstetricians and gynecologists as their primary care physicians, as well as additional training experience in family planning, including "all reversible methods of contraception" and sterilization. In order to be certified by the American Board of Obstetrics and Gynecology, ob/gyns must graduate from an accredited residency program. In addition, teaching hospitals must be accredited to secure federal reimbursements for the medical services patients receive from residents. The Accreditation Council for Graduate Medical Education operates under the aegis of the American Medical Association, the American Board of Medical Specialties, the American Hospital Association, the Association of American Medical Colleges, and the Council of Medical Specialty Societies. Both the American Board of Obstetrics and Gynecology and the American College of
Juratli, Mazen A.; Sarimollaoglu, Mustafa; Nedosekin, Dmitry A.; Galanzha, Ekaterina; Suen, James Y.; Zharov, Vladimir P.
Many cancer deaths are related to metastasis to distant organs due to dissemination of circulating tumor cells (CTCs) shed from the primary tumor. For many years, oncologists believed some medical procedures may provoke metastasis; however, no direct evidence has been reported. We have developed a new, noninvasive technology called in vivo photoacoustic (PA) flow cytometry (PAFC), which provides ultrasensitive detection of CTCs. When CTCs with strongly light-absorbing intrinsic melanin pass through a laser beam aimed at a peripheral blood vessel, laser-induced acoustic waves from CTCs were detected using an ultrasound transducer. We focused on melanoma as it is one of the most metastatically aggressive malignancies. The goal of this research was to determine whether melanoma manipulation, like compression, incisional biopsy, or tumor excision, could enhance penetration of cancer cells from the primary tumor into the circulatory system. The ears of nude mice were inoculated with melanoma cells. Blood vessels were monitored for the presence of CTCs using in vivo PAFC. We discovered some medical procedures, like compression of the tumor, biopsy, and surgery may either initiate CTC release in the blood which previously contained no CTCs, or dramatically increased (10-30-fold) CTC counts above the initial level. Our results warn oncologists to use caution during physical examination, and surgery. A preventive anti-CTC therapy during or immediately after surgery, by intravenous drug administration could serve as an option to treat the resulting release of CTCs.
Annas, G J
In the US, a new antiabortion strategy of using legislative and judicial forums to change the rhetoric of abortion rather than using abortion rhetoric to change the law arose out of disappointment when the 1992 Casey decision failed to overturn Roe. This new approach is crystallized by the 1995 introduction of federal legislation (vetoed by the President) to ban so-called "partial-birth" abortions. Opponents to this late-term procedure undertaken to preserve a women's life or health distinguish intact dilatation and extraction from induced labor to terminate a nonviable pregnancy (failing to recognize the lack of ethical difference) and make inaccurate political statements linking the abortion procedure to infanticide. When the ban was reintroduced to Congress in 1997, the previously silent American Medical Association agreed to support the bill if two "physician-friendly" amendments were added, but the American College of Obstetricians and Gynecologists made it clear that it is "inappropriate, ill advised, and dangerous" for legislative bodies to intervene into medical decision-making. The new version of the bill shifted the focus to all abortions after viability unless they are necessary to protect the mother from grievous harm to her physical (not mental) health, thus limiting the reach of the Roe decision. Clinton vetoed this bill also. Such legislation would be unlikely to prevent even one abortion, and its importance rests in its view of the proper role of government in regulating health care. This follows previous efforts to reframe the abortion debate by creating a dichotomy that marginalizes either women or fetuses and shifts the focus to another issue.
Of all the religious injunctions against abortion, the most effective one over time has been the belief that God is the giver of life and that therefore abortion constitutes an attack on Divine Will. The question of when the soul enters the embryo is, under that view, of secondary importance. 2 schools of thought, each with a large body of supporting literature, have developed on the subject, however; 1 is that life is created complete and by Divine impulse, and the other that the soul enters the body after its creation as a continuing act of Divine creation. Writers supporting the latter view tend to agree that only God knows or can know the moment of the soul's entrance, and furthermore that it probably occurs quite soon after conception. In any case, a doctor can respect his own religious principles with regard to abortion but does not have the right to condemn those of his colleagues who hold different views.
This paper examines how death is managed in a larger regional hospital within the Norwegian health-care. The central focus of my paper concerns variations in how healthcare personnel enact death and handle the dead patient. Over several decades, modern standardised hospital death has come under critique in the western world. Such critique has resulted in changes in the standardisation of hospital deaths within Norwegian health-care. In the wake of the hospice movement and with greater focus on palliative care, doors have gradually been opened and relatives of the deceased are now more often invited to participate. I explore how the medical practice around death along with the procedure manual of post-mortem care at Trondheim University Hospital has changed. I argue that in the late-modern context, standardisation of hospital death is a multidimensional affair, embedded in a far more comprehensive framework than the depersonalized medico-legal. In the late-modern Norwegian hospital, interdisciplinary negotiation and co-operation has allowed a number of different agendas to co-exist, without any ensuing loss of the medical power holder's authority to broker death. I follow Mol's notion of praxiographic orientation of the actor-network approach while exploring this medical practice.
Tunc, Tanfer Emin
In 1971, lay California abortion provider Harvey Karman set out to revolutionize second trimester abortion just as he had done for first trimester abortion with his eponymous suction curette, the Karman cannula. An ardent critic of hypertonic saline instillation and surgical procedures such as hysterotomy, his plan was to introduce a new abortion procedure he had developed--the super coil technique--which, he believed, would finally replace all other methods to become the one and only undisputed second trimester abortion technology. What resulted, however, was a medical fiasco that prompted investigations by American federal agencies, such as the CDC and the FDA. These investigations had the net effect of increasing regulations on the development, testing and implementation of reproductive technologies in the United States.
Wallin Lundell, Inger; Öhman, Susanne Georgsson; Sundström Poromaa, Inger; Högberg, Ulf; Sydsjö, Gunilla; Skoog Svanberg, Agneta
Objectives To identify perceived deficiencies in the quality of abortion care among healthy women and those with mental stress. Methods This multi-centre cohort study included six obstetrics and gynaecology departments in Sweden. Posttraumatic stress (PTSD/PTSS) was assessed using the Screen Questionnaire-Posttraumatic Stress Disorder; anxiety and depressive symptoms, using the Hospital Anxiety Depression Scale; and abortion quality perceptions, using a modified version of the Quality from the Patient's Perspective questionnaire. Pain during medical abortion was assessed in a subsample using a visual analogue scale. Results Overall, 16% of the participants assessed the abortion care as being deficient, and 22% experienced intense pain during medical abortion. Women with PTSD/PTSS more often perceived the abortion care as deficient overall and differed from healthy women in reports of deficiencies in support, respectful treatment, opportunities for privacy and rest, and availability of support from a significant person during the procedure. There was a marginally significant difference between PTSD/PTSS and the comparison group for insufficient pain alleviation. Conclusions Women with PTSD/PTSS perceived abortion care to be deficient more often than did healthy women. These women do require extra support, relatively simple efforts to provide adequate pain alleviation, support and privacy during abortion may improve abortion care.
Seller, M J
The technique of amniocentesis, by which an abnormal fetus can be detected in utero, has brought a technological advance in medical science but attendant medical and moral problems. Dr Seller describes those congenital disabilities which can be detected in the fetus before birth, for which the "remedy" is selective abortion. She then discusses the arguments for and against selective abortion, for the issue is not simple, even in the strictly genetic sense of attempting to ensure a population free of congenital abnormality.
Stotland, N L
US anti-abortion groups have used misinformation on the long-term psychological impact of induced abortion to advance their position. This article reviews the available research evidence on the definition, history, cultural context, and emotional and psychiatric sequelae of induced abortion. Notable has been a confusion of normative, transient reactions to unintended pregnancy and abortion (e.g., guilt, depression, anxiety) with serious mental disorders. Studies of the psychiatric aspects of abortion have been limited by methodological problems such as the impossibility of randomly assigning women to study and control groups, resistance to follow-up, and confounding variables. Among the factors that may impact on an unintended pregnancy and the decision to abort are ongoing or past psychiatric illness, poverty, social chaos, youth and immaturity, abandonment issues, ongoing domestic responsibilities, rape and incest, domestic violence, religion, and contraceptive failure. Among the risk factors for postabortion psychosocial difficulties are previous or concurrent psychiatric illness, coercion to abort, genetic or medical indications, lack of social supports, ambivalence, and increasing length of gestation. Overall, the literature indicates that serious psychiatric illness is at least 8 times more common among postpartum than among postabortion women. Abortion center staff should acknowledge that the termination of a pregnancy may be experienced as a loss even when it is a voluntary choice. Referrals should be offered to women who show great emotional distress, have had several previous abortions, or request psychiatric consultation.
Kurstak, Edouard; Tijssen, Peter; Kurstak, Christine; Morisset, Richard
This review article describes several applications of the widely used enzyme immunoassay (EIA) procedure. EIA methods have been adapted to solve problems in diagnostic virology where sensitivity, specificity, or practicability is required. Concurrent developments in hybridoma and conjugation methods have increased significantly the use of these assays. A general overview of EIA methods is given together with typical examples of their use in diagnostic medical virology; attention is drawn to possible pitfalls. Recent advances in recombinant DNA technology have made it possible to produce highly specific nucleic acid probes that have a sensitivity approximately 100 times greater than that of EIA. Some applications of these probes are described. Although the non-labelled nucleic acid probes for use in the field are not as refined as non-labelled immunoassays, their range of applications is expected to expand rapidly in the near future. ImagesFig. 4 PMID:3533302
Court Decision: 353 Federal Reporter, 3d Series 436; 2003 Dec 17 (date of decision). The U.S. Court of Appeals for the Sixth Circuit reversed a lower court decision and held that Ohio's partial-birth abortion law was constitutional because the law permitted the procedure in the event of significant maternal health risk and did not prohibit dilation and evacuation (a lawful abortion procedure). Women's Medical Professional Corporation challenged the constitutionality of Ohio's ban on partial-birth abortion, claiming that the law did not contain an adequate exception for maternal health and that it unduly burdened a woman's right to abort a nonviable fetus by dilation and evacuation (D&E). The Sixth Circuit held that the law's maternal health exception was valid under the Fourteenth Amendment because it allowed partial-birth abortion when there is significant maternal health risk. The court rejected the plaintiff's assertion that partial-birth abortion should be allowed at any physician's discretion and noted that precedent allows states to "restrict an abortion procedure except when the procedure is necessary to prevent a significant health risk." The court also held that the law did not ban D&E, the most common second-trimester abortion procedure, because the law explicitly tracked the medical differences between D&E and partial-birth abortion, it provided an exception for D&E, and it focused on other distinctions between D&E and partial-birth abortion. For these reasons, Ohio's partial-birth abortion ban did not unduly burden a woman's right to terminate a pregnancy and was therefore constitutional.
Gbagbo, Fred Yao; Amo-Adjei, Joshua; Laar, Amos
Decision-making for induced abortion can be influenced by various circumstances including those surrounding onset of a pregnancy. There are various dimensions to induced abortion decision-making among women who had an elective induced abortion in a cosmopolitan urban setting in Ghana, which this paper examined. A cross-sectional mixed method study was conducted between January and December 2011 with 401 women who had undergone an abortion procedure in the preceding 12 months. Whereas the quantitative data were analysed with descriptive statistics, thematic analysis was applied to the qualitative data. The study found that women of various profiles have different reasons for undergoing abortion. Women considered the circumstances surrounding onset of pregnancy, person responsible for the pregnancy, gestational age at decision to terminate, and social, economic and medical considerations. Pressures from partners, career progression and reproductive intentions of women reinforced these reasons. First time pregnancies were mostly aborted regardless of gestational ages and partners' consent. Policies and programmes targeted at safe abortion care are needed to guide informed decisions on induced abortions.
Abortion is illegal in Nigeria except to save a woman's life. It is also common, and most procedures are performed under unsafe, clandestine conditions. In 1996, an estimated 610,000 abortions occurred (25 per 1,000 women of childbearing age), of which 142,000 resulted in complications severe enough to require hospitalization. The number of abortions is estimated to have risen to 760,000 in 2006. Unsafe abortions are a major reason Nigeria's maternal mortality rate--1,100 deaths per 100,000 live births--is one the world's highest. According to conservative estimates, more than 3,000 women die annually in Nigeria as a result of unsafe abortion.
Background Internet surveys that draw from traditionally generated samples provide the unique conditions to engage adolescents in exploration of sensitive health topics. Methods We examined awareness of unwanted pregnancy, abortion behaviour, methods, and attitudes toward specific legal indications for abortion via a school-based internet survey among 378 adolescents aged 12–21 years in three Rio de Janeiro public schools. Results Forty-five percent knew peers who had undergone an abortion. Most students (66.0%) did not disclose abortion method knowledge. However, girls (aOR 4.2, 95% CI 2.4-7.2), those who had experienced their sexual debut (aOR1.76, 95% CI 1.1-3.0), and those attending a prestigious magnet school (aOR 2.7 95% CI 1.4-6.3) were more likely to report methods. Most abortion methods (79.3%) reported were ineffective, obsolete, and/or unsafe. Herbs (e.g. marijuana tea), over-the-counter medications, surgical procedures, foreign objects and blunt trauma were reported. Most techniques (85.2%) were perceived to be dangerous, including methods recommended by the World Health Organization. A majority (61.4%) supported Brazil’s existing law permitting abortion in the case of rape. There was no association between gender, age, sexual debut, parental education or socioeconomic status and attitudes toward legal abortion. However, students at the magnet school supported twice as many legal indications (2.7, SE.27) suggesting a likely role of peers and/or educators in shaping abortion views. Conclusions Abortion knowledge and attitudes are not driven simply by age, religion or class, but rather a complex interplay that includes both social spaces and gender. Prevention of abortion morbidity and mortality among adolescents requires comprehensive sexuality and reproductive health education that includes factual distinctions between safe and unsafe abortion methods. PMID:24521075
... 29 Labor 9 2010-07-01 2010-07-01 false Special procedures for requesting medical records. 2400.7... COMMISSION REGULATIONS IMPLEMENTING THE PRIVACY ACT § 2400.7 Special procedures for requesting medical records. (a) Upon an individual's request for access to his medical records, including...
... Special procedures for medical and psychological records. (a) In general. When a request for access or amendment involves medical or psychological records and when the originator determines that such records are... 32 National Defense 6 2010-07-01 2010-07-01 false Special procedures for medical and...
... 32 National Defense 6 2012-07-01 2012-07-01 false Special procedures for medical/psychiatric... procedures for medical/psychiatric/psychological records. Current and former ODNI employees, including... access to their medical, psychiatric or psychological testing records by writing to: Information...
... 32 National Defense 6 2014-07-01 2014-07-01 false Special procedures for medical/psychiatric... procedures for medical/psychiatric/psychological records. Current and former ODNI employees, including... access to their medical, psychiatric or psychological testing records by writing to: Information...
... 32 National Defense 6 2013-07-01 2013-07-01 false Special procedures for medical/psychiatric... procedures for medical/psychiatric/psychological records. Current and former ODNI employees, including... access to their medical, psychiatric or psychological testing records by writing to: Information...
Che, Yan; Liu, Xiaoting; Zhang, Bin; Cheng, Linan
Abstract Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. However, limited data exist supporting the effective use of OCs postabortion. We conducted this systematic review and meta-analysis in the present study reported immediate administration of OCs or combined OCs postabortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, increase endometrial thickness 2 to 3 weeks after abortion, and reduce the risk of complications and unintended pregnancies. A total of 8 major authorized Chinese and English databases were screened from January 1960 to November 2014. Randomized controlled trials in which patients had undergone medical or surgical abortions were included. Chinese studies that met the inclusion criteria were divided into 3 groups: administration of OC postmedical abortion (group I; n = 1712), administration of OC postsurgical abortion (group II; n = 8788), and administration of OC in combination with traditional Chinese medicine postsurgical abortion (group III; n = 19,707). In total, 119 of 6160 publications were included in this analysis. Significant difference was observed in group I for vaginal bleeding time (P = 0.0001), the amount of vaginal bleeding (P = 0.03), and menstruation recovery period (P < 0.00001) compared with the control groups. Group II demonstrated a significant difference in vaginal bleeding time (P < 0.00001), the amount of vaginal bleeding (P = 0.0002), menstruation recovery period (P < 0.00001), and endometrial thickness at 2 (P = 0.003) and 3 (P < 0.00001) weeks postabortion compared with the control group. Similarly, a significant difference was observed in group III for reducing vaginal bleeding time (P < 0.00001) and the amount of vaginal bleeding (P < 0.00001), shortening the menstruation recovery period (P < 0.00001), and increasing endometrial thickness 2 and 3 weeks after surgical abortion (P < 0
Harries, J; Lince, N; Constant, D; Hargey, A; Grossman, D
Around 25% of abortions in South Africa are performed in the second trimester. This study aimed to better understand what doctors, nurses and hospital managers involved in second trimester abortion care thought about these services and how they could be improved. Nineteen in-depth interviews with abortion-related service providers and managers in the Western Cape Province, South Africa, were undertaken. Data were analysed using a thematic analysis approach. Participants expressed resistance to the dilation and evacuation (D&E) procedure, as this required more active provider involvement. Medical abortion was preferred as it required less provider involvement in the abortion process. A shortage of providers willing to perform D&E resulted in most public sector services being outsourced to private sector doctors. Respondents noted an increased demand for services and a concomitant lack of infrastructure, physical space and personnel to respond to these demands, sometimes resulting in fragmented or poor quality care. At medical induction sites, most thought introducing the combined mifepristone-misoprostol regimen would improve service capacity, although they were concerned about cost. Improving contraceptive services was also seen as a much-needed intervention to improve care and prevent abortion. Ongoing training, including values clarification, as well as emotional support and team-building for providers are needed to ensure sustainable, high-quality second trimester abortion services.
Jovic, Olga S
The content of this work is conceived on the research of the consequences of surrogate motherhood as a process of assisted procreation, which represent a way of parenthood in cases when it is not possible to realize parenthood through a natural way. Surrogate motherhood is a process in which a woman (surrogate mother) agrees to carry a pregnancy with the intent to give the child to the couple with whom she has made a contract on surrogate maternity after the birth. This process of conception and birth makes the determination of the child's origin on its mother's side hard to determine, because of the distinction of the genetic and gestation phases of the two women. The concept of surrogate motherhood is to appear in two forms, depending on the existence or the non-existence of the genetic link between the surrogate mother and the child she gives birth to. There are gestation (full) and genetic (partial) surrogates each with different modalities and legal and ethical implications. In Serbia, Infertility Treatment and the Bio-medically Assisted Procreation Act from 2009 explicitly forbids surrogate motherhood, despite the fact that an infertile couple decides to use it, as a rule, after having tried all other treatment procedures, in cases when there is a diagnosis but the conventional treatment applied has not produced the desired results. Given the fact that no one has the right to ignore the sufferings of people who cannot procreate naturally, the medical practice and legal science in our country plead for a formulation of a legal framework in which to apply surrogate motherhood as an infertility treatment, under particular conditions.
López Ortiz, E; Sandoval Sevilla, S; Arteaga, V M; Rosas Arceo, J; Ortíz Arroyo, R
268 cases of septic abortion which occurred between 1964-72 in a large metropolitan hospital in Mexico were analyzed retrospecively. There cases represented 0.88% of all cases of abortion during the same time. Most patients were between 21-30, and 48% with parity 2-5; 63% were at their first abortion; only 16 patients declared to have attempted abortion, and most cases were first trimester abortion. Pre- and postoperative procedures and vital signs were carefully taken, and time elapsed from medical treatment to surgery was 4-12 hours. There were 237 curettages, and 28 hysterectomies. Complication from surgery were 4.1%; there were 19 deaths, i.e. 7.5% of patients, of which 10 only 24 hours after hospitalization. Protocol of treatment of septic abortion is discussed, and surgical treatment highly recommended.
Van Look, Paul F A; Cottingham, Jane C
An estimated 60 000-70 000 women die annually from complications of unsafe abortion and hundreds of thousands more suffer long-term consequences which include chronic pelvic pain and infertility. The reasons for the continuing high incidence of unwanted pregnancy leading to unsafe abortion include lack of access to, or misuse of and misinformation about, effective contraceptive methods, coerced sex which prohibits women from protecting themselves, and contraceptive failure. Unsafe abortion is closely associated with restrictive legal environments and administrative and policy barriers hampering access to existing services. Vacuum aspiration and medical methods combining mifepristone and a prostaglandin for early abortion are simple and safe. For second trimester abortion, the main choices are repeat doses of prostaglandin with or without prior mifepristone, and dilatation and evacuation by experienced providers. Strategies for preventing unsafe abortion include: upgrading providers' skills; further development of medical methods for pregnancy termination and their introduction into national programmes; improving the quality of contraceptive and abortion services; and improving partner communication.
Fromer, M J
Nurses have opinions about abortion, but because they are health professionals and their opinions are sought as such, they are obligated to understand why they hold certain views. Nurses need to be clear about why they believe as they do, and they must arrive at a point of view in a rational and logical manner. To assist nurses in this task, the ethical issues surrounding abortion are enumerated and clarified. To do this, some of the philosophic and historic approaches to abortion and how a position can be logically argued are examined. At the outset some emotion-laden terms are defined. Abortion is defined as the expulsion of a fetus from the uterus before 28 weeks' gestation, the arbitrarily established time of viability. This discussion is concerned only with induced abortion. Since the beginning of recorded history women have chosen to have abortions. Early Jews and Christians forbade abortion on practical and religious grounds. A human life was viewed as valuable, and there was also the practical consideration of the addition of another person to the population, i.e., more brute strength to do the necessary physical work, defend against enemies, and ensure the continuation of the people. These kinds of pragmatic reasons favoring or opposing abortion have little to do with the Western concept of abortion in genaeral and what is going on in the U.S. today in particular. Discussion of the ethics of abortion must rest on 1 or more of several foundations: whether or not the fetus is a human being; the rights of the pregnant woman as opposed to those of the fetus, and circumstances of horror and hardship that might surround a pregnancy. Viability is relative. Because viability is not a specific descriptive entity, value judgments become part of the determination, both of viability and the actions that might be taken based on that determination. The fetus does not become a full human being at viability. That occurs only at conception or birth, depending on one's view
Asa, Isaac; de Costa, Caroline; Mola, Glen
Induced abortion on demand or for socio-economic indications is illegal in Papua New Guinea under the 1974 Criminal Code. Nevertheless, the procedure is known to be widely practised. This prospective study examines the demographic and medical features of women presenting with complications of induced abortion to Goroka Hospital in a 6-month period. It was noted that abortion was most commonly induced using the synthetic prostaglandin analogue misoprostol. Although illegal induced abortion cannot be condoned, it appears that misoprostol, much safer in this context than mechanical or traditional herbal methods, is now being widely used for the purpose of induced abortion in Papua New Guinea, as it is in other developing countries.
Samal, Sunita; Ghose, Seetesh
Unsafe abortion is one of the causes of maternal mortality and morbidity in developing countries. The complications mostly results following unsafe abortion procedure done by unskilled provider with or without minimal medical knowledge in rural part of developing countries. These complications can endanger the life of mother if proper medical or surgical interventions are not offered in time. A majority of these complications remains confidential. The uterine perforation is one of the serious but preventable complications of surgical abortion. A 21-year-old woman G4P2L2A1, presented in the emergency ward with complaints of lower abdominal pain for four days after attempting twice surgical termination of pregnancy at 19 weeks of gestation for an unwanted pregnancy. Transabdominal sonography and MRI revealed uterine rent with pelvic extrusion of fetal head. Emergency laparotomy with removal of fetal head and uterine rent repair was done. This case illustrates the importance of maintaining a high index of suspicion by the gynaecologist for uterine perforation in patient presenting with abdominal pain a few days after undergoing surgical abortion, also shows the complementary role of sonography and MRI in evaluation of the similar patient and this case also highlights the rampant illegal unsafe abortion procedure in rural India despite of legalization of abortion act. PMID:26675988
Begum, Jasmina; Samal, Sunita; Ghose, Seetesh
Unsafe abortion is one of the causes of maternal mortality and morbidity in developing countries. The complications mostly results following unsafe abortion procedure done by unskilled provider with or without minimal medical knowledge in rural part of developing countries. These complications can endanger the life of mother if proper medical or surgical interventions are not offered in time. A majority of these complications remains confidential. The uterine perforation is one of the serious but preventable complications of surgical abortion. A 21-year-old woman G4P2L2A1, presented in the emergency ward with complaints of lower abdominal pain for four days after attempting twice surgical termination of pregnancy at 19 weeks of gestation for an unwanted pregnancy. Transabdominal sonography and MRI revealed uterine rent with pelvic extrusion of fetal head. Emergency laparotomy with removal of fetal head and uterine rent repair was done. This case illustrates the importance of maintaining a high index of suspicion by the gynaecologist for uterine perforation in patient presenting with abdominal pain a few days after undergoing surgical abortion, also shows the complementary role of sonography and MRI in evaluation of the similar patient and this case also highlights the rampant illegal unsafe abortion procedure in rural India despite of legalization of abortion act.
Achilles, Sharon L; Reeves, Matthew F
One known complication of induced abortion is upper genital tract infection, which is relatively uncommon in the current era of safe, legal abortion. Currently, rates of upper genital tract infection in the setting of legal induced abortion in the United States are generally less than 1%. Randomized controlled trials support the use of prophylactic antibiotics for surgical abortion in the first trimester. For medical abortion, treatment-dose antibiotics may lower the risk of serious infection. However, the number-needed-to-treat is high. Consequently, the balance of risk and benefits warrants further investigation. Perioperative oral doxycycline given up to 12 h before a surgical abortion appears to effectively reduce infectious risk. Antibiotics that are continued after the procedure for extended durations meet the definition for a treatment regimen rather than a prophylactic regimen. Prophylactic efficacy of antibiotics begun after abortion has not been demonstrated in controlled trials. Thus, the current evidence supports pre-procedure but not post-procedure antibiotics for the purpose of prophylaxis. No controlled studies have examined the efficacy of antibiotic prophylaxis for induced surgical abortion beyond 15 weeks of gestation. The risk of infection is not altered when an intrauterine device is inserted immediately post-procedure. The presence of Chlamydia trachomatis, Neisseria gonorrhoeae or acute cervicitis carries a significant risk of upper genital tract infection; this risk is significantly reduced with antibiotic prophylaxis. Women with bacterial vaginosis (BV) also have an elevated risk of post-procedural infection as compared with women without BV; however, additional prophylactic antibiotics for women with known BV has not been shown to reduce their risk further than with use of typical pre-procedure antibiotic prophylaxis. Accordingly, evidence to support pre-procedure screening for BV is lacking. Neither povidone-iodine nor chlorhexidine have
... doctor or other person to act as his agent as described in § 701.310(a). Records containing medical or... request. (b) If the individual has not named a medical doctor as agent, the Council may determine, after consultation with a medical doctor, that disclosure of the information would have an adverse effect on...
... doctor or other person to act as his agent as described in § 701.310(a). Records containing medical or... request. (b) If the individual has not named a medical doctor as agent, the Council may determine, after consultation with a medical doctor, that disclosure of the information would have an adverse effect on...
... doctor or other person to act as his agent as described in § 701.310(a). Records containing medical or... request. (b) If the individual has not named a medical doctor as agent, the Council may determine, after consultation with a medical doctor, that disclosure of the information would have an adverse effect on...
Henshaw, S K
where the procedure is illegal. On the basis of hospital reports and other fragmentary information, the true rate appears to be relatively high in Latin America and the Far East. The abortion rate for Latin America in the mid-1970s was estimated at 65/1000 fertile aged women, and rates were believed to be higher in urban areas. Sub-Saharan Africa, where women desire very large families, apparently had the lowest rates. Up to 68% of pregnancies in the USSR, 57% in Rumania, and 55% in Japan may end in abortion. The proportion in developing countries ranged from 8% in Vietnam to 43% in China. Women undergoing abortion in developed countries tend to be young, childless, and single, while those in developing countries tend to be older, high parity, and married. Abortion mortality is still high in countries where large numbers of illegal abortions are performed by unqualified personnel, as in many parts of Latin America.
A pastor comments on the recent ruling by the Swedish Department of Health and Social Affairs that the remains of an abortion should be "treated respectfully"--cremated or buried in a cemetery. This decision results from recognition on the part of the government and the medical establishment that a growing segment of public opinion agrees that the fetus is a human being. The new rules mean, though, that a fetus becomes human only upon its death. Logically, an abortion that is respectfully performed ought not to be performed at all. This is the fundamental problem with abortion, and no amount of arbitrary boundary drawing at various levels of supposed capability for survival at the 12th, the 18th, or the 24th week of pregnancy will alter the fact. It is necessary to face the problem with complete intellectual honesty and say that a fetus is a human being no matter what its age, but that voluntary abortion is also a social necessity. Only then can society find another abortion policy, one that recognizes that late abortions are hard to distinguish from births. The Swedish abortion policy must reflect honest facts, rather than etiological legends, preconceived ideas for which arguments must be found afterward.
... 45 Public Welfare 1 2010-10-01 2010-10-01 false Special procedures for notification of or access to medical records. 5b.6 Section 5b.6 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PRIVACY ACT REGULATIONS § 5b.6 Special procedures for notification of or access to medical records. (a) General. An individual...
... maintained by the Commission which pertain to him or her, medical and psychological records merit special treatment because of the possibility that disclosure will have an adverse physical or psychological effect... medical and/or psychological records which pertain to him or her, he or she shall, in his or her...
... maintained by the Commission which pertain to him or her, medical and psychological records merit special treatment because of the possibility that disclosure will have an adverse physical or psychological effect... medical and/or psychological records which pertain to him or her, he or she shall, in his or her...
... maintained by the Commission which pertain to him or her, medical and psychological records merit special treatment because of the possibility that disclosure will have an adverse physical or psychological effect... medical and/or psychological records which pertain to him or her, he or she shall, in his or her...
... facilities utilized: Estimated cost and duration of treatment: Summary of incident: (32 U.S.C. 318-320 and... benefits. (b) Authorization for care in civilian facility. (1) An individual who desires medical or dental care in civilian medical treatment facilities at Federal expense is not authorized such care...
... facilities utilized: Estimated cost and duration of treatment: Summary of incident: (32 U.S.C. 318-320 and... benefits. (b) Authorization for care in civilian facility. (1) An individual who desires medical or dental care in civilian medical treatment facilities at Federal expense is not authorized such care...
... facilities utilized: Estimated cost and duration of treatment: Summary of incident: (32 U.S.C. 318-320 and... benefits. (b) Authorization for care in civilian facility. (1) An individual who desires medical or dental care in civilian medical treatment facilities at Federal expense is not authorized such care...
... routine use, for all systems of records containing medical records, consultations with an individual's... them; (3) Obtain specific, written consent for USPTO to consult the individual's physician and/or... be warranted, USPTO's medical expert shall so consult or transmit. Whether or not such a...
... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Fees for medical services; unresolved... ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.415 Fees for medical services; unresolved... seek a hearing pursuant to section 556 of title 5, United States Code. Upon written request for such...
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Fees for medical services; unresolved... ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.415 Fees for medical services; unresolved... seek a hearing pursuant to section 556 of title 5, United States Code. Upon written request for such...
... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Fees for medical services; unresolved... ADMINISTRATION AND PROCEDURE Medical Care and Supervision § 702.415 Fees for medical services; unresolved... seek a hearing pursuant to section 556 of title 5, United States Code. Upon written request for such...
Danzer, D; Czerny, M; Widmer, M K
Treatment of dialysis access-related hand ischaemia with preservation of the access remains an issue. We report the case of a patient presenting critical hand ischaemia 2 years after proximalisation of a distal radio-cephalic fistula with preservation of the original access. After valvulotomy, the distal cephalic vein was used as in situ bypass and directly anastomosed to the distal brachial artery, providing a direct flow to the hand. This procedure relieved the hand ischaemia without sacrificing the functioning fistula. Six months later, the fistula and bypass were still patent, showing that flow reversal of a previous fistula can be an efficient strategy to correct dialysis access-related hand ischaemia in selected cases.
Gugerty, Leo; Halgren, Shannon; Gosbee, John; Rudisill, Marianne
This study investigated two methods to improve organization and presentation of computer-based medical procedures. A literature review suggested that the GOMS (goals, operators, methods, and selecton rules) model can assist in rigorous task analysis, which can then help generate initial design ideas for the human-computer interface. GOMS model are hierarchical in nature, so this study also investigated the effect of hierarchical, hypertext interfaces. We used a 2 x 2 between subjects design, including the following independent variables: procedure organization - GOMS model based vs. medical-textbook based; navigation type - hierarchical vs. linear (booklike). After naive subjects studies the online procedures, measures were taken of their memory for the content and the organization of the procedures. This design was repeated for two medical procedures. For one procedure, subjects who studied GOMS-based and hierarchical procedures remembered more about the procedures than other subjects. The results for the other procedure were less clear. However, data for both procedures showed a 'GOMSification effect'. That is, when asked to do a free recall of a procedure, subjects who had studies a textbook procedure often recalled key information in a location inconsistent with the procedure they actually studied, but consistent with the GOMS-based procedure.
Westley, S B
In Korea, China, and Taiwan--countries where son preference persists--the availability of prenatal screening techniques and induced abortion has produced an imbalance in the naturally occurring sex ratios of 104-107 male births for every 100 female births. Policy responses to sex-selective abortion were the focus of a 1994 International Symposium on Sex Preference for Children in the Rapidly Changing Demographic Dynamics in Asia sponsored by the United Nations Population Fund and the Government of the Republic of Korea. Modern technology (i.e., amniocentesis, ultrasound, and chorionic villi sampling) enables couples to control both family size and sex selection. According to data from the 1990 Korean Census, 80,000 female fetuses were aborted from 1986-90 as a result of son preference. In the late 1980s, the Governments of Korea, China, and India imposed bans on the use of medical technology for prenatal sex determination, but many observers maintain that regulations have served only to make the procedures clandestine and more expensive. To remedy the problems underlying sex-selective abortion, the Symposium recommended the following government actions: 1) implement policies and programs to diminish gender discrimination; 2) establish guidelines for the monitoring and regulation of prenatal testing; 3) utilize mass and folk media, interpersonal channels, and school curricula to promote gender equality; 4) strengthen the ethics curriculum of medical schools to address son preference; and 5) increase the capability of statistical and research organizations to collect gender-disaggregated data.
Hudson Rosen, R A et
The attitudes toward abortion of students and faculty in 3 health related fields--nursing, medicine, and social work--are examined and compared with the views of the population at large. The relation of religious affiliation to attitude toward abortion is also examined. The data was obtained via questionnaire in 47 nursing, 11 medical, and 15 social work schools in the fall and winter of 1971. 7 attitudinal items provided the focus of attention. 5 dealt with conditions under which an abortion should be performed; 2 dealt with the willingness of the respondent to help a client get an abortion. Nursing students and faculty had the most conservative attitude, followed by medical personnel and social workers. The nursing faculty's opinions were most like those of the general public; the medical and social work students and faculty generally mirrored respondents with some college education. Catholic health professionals were even less in favor of abortion than Catholics at large, even those with only a grade-school education. Catholic students, however, were more favorably disposed than Catholic faculty, indicating a more liberal trend in the Catholic Church.
Jilozian, Ann; Agadjanian, Victor
As in other post-Soviet settings, induced abortion has been widely used in Armenia. However, recent national survey data point to a substantial drop in abortion rates with no commensurate increase in modern contraceptive prevalence and no change in fertility levels. We use data from in-depth interviews with women of reproductive age and health providers in rural Armenia to explore possible underreporting of both contraceptive use and abortion. While we find no evidence that women understate their use of modern contraception, the analysis suggests that induced abortion might indeed be underreported. The potential for underreporting is particularly high for sex-selective abortions, for which there is growing public backlash, and medical abortion, a practice that is typically self-administered outside any professional supervision. Possible underreporting of induced abortion calls for refinement of both abortion registration and relevant survey instruments. Better measurement of abortion dynamics is necessary for successful promotion of effective modern contraceptive methods and reduction of unsafe abortion practices.
Williams, Gigi; Greene, Siobhan
The Royal Children's Hospital (RCH) in Melbourne has launched a world-first app for children that will help reduce anxiety and the need for anesthesia during medical imaging procedures. The free, game-based app, "Okee in Medical Imaging", helps children aged from four to eight years to prepare for all medical imaging procedures--X-ray, CT, MRI, ultrasound, nuclear medicine, and fluoroscopy. The app is designed to reduce anticipatory fear of imaging procedures, while helping to ensure that children attend imaging appointments equipped with the skills required for efficient and effective scans to be performed. This paper describes how the app was developed.
In Latin American countries abortion on demand is legal only in Cuba and must be performed there in hospitals within the 1st 12 weeks of pregnancy. After the 1st trimester, it can be performed only for medical reasons. With regard to the other 18 Latin American countries, abortion is illegal in 2 of them even for saving the life of the pregnant women. In 9 countries therapeutic abortion is permitted only to save the woman's life. It is allowed in 4 countries in the case of severe disease that will be aggravated if the pregnancy continues. In the 3 remaining countries, in addition to medical reasons, it is legal if pregnancy is the consequence of incest or rape. Despite the law, induced abortion is often performed. The complications of illegal abortion are reviewed along with mortality and morbidity and abortions in adolescents. In Colombia in 1974, 58,717 women were hospitalized for complications of abortion. 42,160 women were hospitalized in Chile in 1974 with the same diagnosis. As Colombia and Chile both have family planning programs and effecive contraceptives are easily obtained, the rate could be even higher in those countries without programs or contraceptive availability. From surveys conducted in these 2 countries, it may be concluded that only 1 out of 3 induced abortions is complicated and requires hospitalization. The hospitalization for complications of abortion/1000 women of fertile age in Colombia and Chile suggests that there is an annual average of 15 hospitalized cases/1000 women of fertile age throughout Latin America. Presuming reasonable accuracy for these surveys, the rate of induced abortion in the entire continent can be estimated to be at least 45/1000 women of fertile age. From this, without considering Cuba, a conservative estimate of 3.4 million illegal induced abortions are performed annually in Latin America. It seems that illegal abortions are performed at an even higher rate than that observed in countries where abortion is legal and
Cameron, I T; Baird, D T
Three different regimens for termination of early pregnancy by medical means were compared to vacuum aspiration. Women seeking therapeutic abortion of pregnancy (less than or equal to 56 days amenorrhoea) were allocated to one of four treatment groups: (1) vacuum aspiration (n = 28); (2) 1 mg vaginal pessary of a prostaglandin analogue (gemeprost) every 3 h for up to 5 pessaries (n = 30); (3) the antigestogen (RU 486--mefipristone) 150 mg per day for 4 days by mouth (n = 20); (4) RU 486 in the same dose as group 3 together with 1 mg gemeprost on day 3 (n = 19). Complete abortion occurred more often in women treated with vacuum aspiration (96%), gemeprost alone (97%) and RU 486 plus gemeprost (95%) than in those treated with RU 486 alone (60%). In women receiving up to five gemeprost pessaries alone vomiting occurred in 7 (23%) and diarrhoea in 10 (33%); 16 (53%) required parenteral opiates for relief of pain. Side-effects and analgesic requirements were much reduced in the women who received RU 486 alone or in combination with a single gemeprost pessary. There was no difference in the number of days of vaginal bleeding after abortion between the four groups although there was wide individual variation (mean 10 days, range 1-34). These results confirm that medical induction of abortion in early pregnancy with prostaglandin vaginal pessaries is as effective as vacuum aspiration and that the dose can be reduced five-fold without loss of efficacy when used in combination with RU 486.
Clinical language applied to early pregnancy loss changed in late twentieth century Britain when doctors consciously began using the term ‘miscarriage’ instead of ‘abortion’ to refer to this subject. Medical professionals at the time and since have claimed this change as an intuitive empathic response to women's experiences. However, a reading of medical journals and textbooks from the era reveals how the change in clinical language reflected legal, technological, professional and social developments. The shift in language is better understood in the context of these historical developments, rather than as the consequence of more empathic medical care for women who experience miscarriage. PMID:23429567
Ng, Jia Hui; Yeak, Seth; Phoon, Natalie; Lo, Stephen
INTRODUCTION Although cosmetic procedures have become increasingly popular among the younger population in recent years, limited research on this subject has been done in the Asian context. We aimed to explore the views and knowledge regarding cosmetic procedures among junior college (JC) and medical students in Singapore. METHODS In the first phase of the study, a cross-sectional, self-administered survey of 1,500 JC students aged 16–21 years from six JCs was conducted in 2010. The same survey was then conducted on a random sample of Year 2–5 medical students from an undergraduate medical school in 2011. RESULTS In total, 1,164 JC and 241 medical students responded to the surveys. There was an overall female to male ratio of 1.3:1. Of all the respondents, 2.5% of the JC students and 3.0% of the medical students admitted to having undergone cosmetic procedures. Among those who claimed to have never had cosmetic procedures done, 9.0% and 44.0% of the JC and medical students, respectively, responded that they would consider such procedures in the future. Those who disapproved of their peers undergoing cosmetic surgery comprised 35.0% of JC students and 56.8% of medical students. Among the JC and medical students, 52.0% and 36.1%, respectively, were unaware of any risks associated with cosmetic procedures. CONCLUSION The younger population is increasingly accepting of cosmetic procedures. However, there is a general lack of understanding of the risks associated with such procedures. Education of both the general public and medical students may help prevent potential medicolegal issues. PMID:25189303
Counseling abortion seekers can be a very difficult task. Some patients can be very knowledgeable about contraception and abortion techniques, and only need reassurance. Most patients, however, need not only explanation about the abortion procedure, but total information about the various contraceptive methods. Attitude, patience, understanding and sympathy of the counseling personnel are just as important as their professional training.
Katz, Ernest R.
Improving prognosis for many forms of childhood cancer has resulted in increased attention on the quality-of-life experience. Conditioned anxiety and pain associated with recurrent diagnostic and treatment procedures have been identified as major sources of distress in children with malignant disease. To evaluate the efficacy of various…
Bica, Ioan; Bunoiu, Madalin; Chirigiu, Liviu; Spunei, Marius; Juganaru, Iulius
The paper presents the experimental installation for the production, in argon plasma, of cavitational iron microparticles (pore microspheres, microtubes and octopus-shaped microparticles). Experimental results are presented and discussed and it is shown that absorbant particles with a minimum iron content are obtained by the plasma procedures
Agarwal, Swapnil S; Kumar, Lavlesh; Mestri, S C
Some sections in Criminal Procedure Code and Indian Penal Code have a direct binding on medical practitioner. With changing times, few of them have been revised and these changes are presented in this article.
Dunlap, Hester; Brazeau, Paulette; Stermac, Lana; Addison, Mary
Despite the negative physical and mental health outcomes of sexual assault, a minority of sexually assaulted women seek immediate post-assault medical and legal services. This study identified the number and types of acute forensic medical procedures used by women presenting at a hospital-based urgent care centre between 1997 and 2001 within 72 hours following a reported sexual assault. The study also examined assault and non-assault factors associated with the use of procedures. It was hypothesized that assault characteristics resembling the stereotype of rape would be associated with the use of more procedures. The multiple regression indicated that injury severity, coercion severity, homelessness, and delay in presentation were significantly associated with the number of procedures received. Findings provide partial support for the hypothesis that post-assault procedures would be associated with the stereotype of rape, and highlight homeless women as a group particularly at risk for not receiving adequate medical treatment following a sexual assault.
Mavroforou, Anna; Giannoukas, Athanasios; Michalodimitrakis, Emmanuel
As medical abortion becomes more widely used and available in Greece, several issues are emerging and require clarification. Health care providers often face a dilemma when dealing with an adolescent requesting abortion. Parents' consent is mandatory before delivering any kind of treatment to minors. However, as it appears in the case presented here, the circumstances are not always straightforward. A critical review of the Greek legal framework in relation to the current social context is attempted through an interesting case aiming to elicit potential defects of the law that should be addressed by the legislator.
... access to their medical, psychiatric or psychological testing records by writing to: Information and.../psychological records. 1701.13 Section 1701.13 National Defense Other Regulations Relating to National Defense... procedures for medical/psychiatric/psychological records. Current and former ODNI employees,...
... psychological records. 326.11 Section 326.11 National Defense Department of Defense (Continued) OFFICE OF THE... Special procedures for disclosure of medical and psychological records. When requested medical and psychological records are not exempt from disclosure, the PA Coordinator may determine which non-exempt...
.../psychological records. 1701.13 Section 1701.13 National Defense Other Regulations Relating to National Defense... procedures for medical/psychiatric/psychological records. Current and former ODNI employees, including... access to their medical, psychiatric or psychological testing records by writing to: Information...
... 49 Transportation 5 2012-10-01 2012-10-01 false Procedure for removal from the National Registry... MOTOR CARRIER SAFETY REGULATIONS FEDERAL MOTOR CARRIER SAFETY REGULATIONS; GENERAL National Registry of Certified Medical Examiners § 390.115 Procedure for removal from the National Registry of Certified...
... 49 Transportation 5 2014-10-01 2014-10-01 false Procedure for removal from the National Registry... MOTOR CARRIER SAFETY REGULATIONS FEDERAL MOTOR CARRIER SAFETY REGULATIONS; GENERAL National Registry of Certified Medical Examiners § 390.115 Procedure for removal from the National Registry of Certified...
... 49 Transportation 5 2013-10-01 2013-10-01 false Procedure for removal from the National Registry... MOTOR CARRIER SAFETY REGULATIONS FEDERAL MOTOR CARRIER SAFETY REGULATIONS; GENERAL National Registry of Certified Medical Examiners § 390.115 Procedure for removal from the National Registry of Certified...
Daniels, Cynthia R; Ferguson, Janna; Howard, Grace; Roberti, Amanda
Since 2010, the United States has witnessed a dramatic expansion of state-based restrictions on abortion. The most common of these are informed consent statutes, which require that a woman seeking an abortion receive a state-authored informational packet before the abortion procedure can be performed. These laws, in addition to requiring the provision of information about alternatives to and risks of abortion, all also require details of embryological and fetal development. This article presents the findings of a comprehensive study of state-authored informed consent materials regarding embryological and fetal development. To conduct this study, we recruited a panel of experts in human anatomy to assess the accuracy of these materials in the context of the constitutional standard established inPlanned Parenthood of Southeastern Pennsylvania et al. v. Robert P. Casey et al.(505 U.S. 833 (1992)): that such information must be "truthful" and "nonmisleading." We find that nearly one-third of the informed consent information is medically inaccurate, that inaccurate information is concentrated primarily in the earlier weeks of pregnancy and is clustered around particular body systems. We discuss the implications of our findings for the question of the constitutionality of informed consent laws as they have been implemented in practice.
This brief summary presents information on the epidemiology of abortion requested by IPPF. In 1975, 8% of the world's population lived in areas where the law prohibits abortion completely, and 27% lived in areas where abortions are severely restricted. Over 2 years, 40,000 hospitalizations for abortion complications were reported in such countries, with 168 deaths. 21% of women hospitalized for a diagnosis related to abortion died. In Latin America, hospitalization and death because of illegal abortion led to epidemiological studies. In Chile, surveys indicate that 1/4 women has had an abortion. Colombia data state that 10 women die/week from abortion complications. Bangladesh identified 31 abortion deaths. When related to live births occurring in the area from which the deaths were reported, the abortion mortality ratio was 19/1000,000 live births. Data from Romania showed that before 1966, when abortion was legal, there were fewer than 100 reported deaths. After 1966, when abortion was restricted, crude birth rate increased from 15-40/1000 total population. During the following 4 years, the birth rate dropped until it was below 25, but concomitant deaths due to abortion increased. In 1965, 64 abortion-related deaths occurred, whereas by 1971, abortion-related deaths increased to 364. In North America abortion deaths and number of illegal abortions decreased dramatically after 1973, when abortion became legal in the U.S. In 1972, illegal abortions led to the deaths of 41 women, but in 1974 only 5 such deaths occurred. If women with unplanned or unwanted pregnancies all underwent abortion within the 1st 8 weeks of pregnancy, 90% of the deaths due to legal abortion could be prevented.
Though pregnancy termination is highly restricted in Kenya, induced abortion remains common. Illegal abortion is often unsafe, putting women at risk of death or severe complications. In eastern Africa as a whole, an estimated 14% of all pregnancies end in abortion, and nearly one in five maternal deaths are due to unsafe abortion.
Johansson, A; Nga, N T; Huy, T Q; Dat, D D; Holmgren, K
This study analyzes the involvement of men in abortion in Vietnam, where induced abortion is legal and abortion rates are among the highest in the world. Twenty men were interviewed in 1996 about the role they played in their wives' abortions and about their feelings and ethical views concerning the procedure. The results showed that both husbands and wives considered the husband to be the main decisionmaker regarding family size, which included the decision to have an abortion, but that, in fact, some women had undergone an abortion without consulting their husbands in advance. Parents and in-laws were usually not consulted; the couples thought they might object to the decision on moral grounds. Respondents' ethical perspectives on abortion are discussed. When faced with an unwanted pregnancy, the husbands adopted an ethics of care and responsibility toward family and children, although some felt that abortion was immoral. The study highlights the importance of understanding husbands' perspectives on their responsibilities and rights in reproductive decisionmaking and their ethical and other concerns related to abortion.
Iyengar, M S; Carruth, T N; Florez-Arango, J; Dunn, K
Currently, paper-based and/or electronic together with telecommunications links to Earth-based physicians are used to assist astronaut crews perform diagnosis and treatment of medical conditions during space travel. However, these have limitations, especially during long duration missions in which telecommunications to earth-based physicians can be delayed. We describe an experimental technology called GuideView in which clinical guidelines are presented in a structured, interactive, multi-modal format and, in each step, clinical instructions are provided simultaneously in voice, text, pictures video or animations. An example application of the system to diagnosis and treatment of space Decompression Sickness is presented. Astronauts performing space walks from the International Space Station are at risk for decompression sickness because the atmospheric pressure of the Extra-vehicular Activity space- suit is significantly less that that of the interior of the Station. PMID:19048089
Parker, Nigel; OQuinn, Veronica
Several technological enhancements have been made to METI's commercial Emergency Care Simulator (ECS) with regard to how microgravity affects human physiology. The ECS uses both a software-only lung simulation, and an integrated mannequin lung that uses a physical lung bag for creating chest excursions, and a digital simulation of lung mechanics and gas exchange. METI's patient simulators incorporate models of human physiology that simulate lung and chest wall mechanics, as well as pulmonary gas exchange. Microgravity affects how O2 and CO2 are exchanged in the lungs. Procedures were also developed to take into affect the Glasgow Coma Scale for determining levels of consciousness by varying the ECS eye-blinking function to partially indicate the level of consciousness of the patient. In addition, the ECS was modified to provide various levels of pulses from weak and thready to hyper-dynamic to assist in assessing patient conditions from the femoral, carotid, brachial, and pedal pulse locations.
Parker, Nigel; O'Quinn, Veronica
Several technological enhancements have been made to METI's commercial Emergency Care Simulator (ECS) with regard to how microgravity affects human physiology. The ECS uses both a software-only lung simulation, and an integrated mannequin lung that uses a physical lung bag for creating chest excursions, and a digital simulation of lung mechanics and gas exchange. METI s patient simulators incorporate models of human physiology that simulate lung and chest wall mechanics, as well as pulmonary gas exchange. Microgravity affects how O2 and CO2 are exchanged in the lungs. Procedures were also developed to take into affect the Glasgow Coma Scale for determining levels of consciousness by varying the ECS eye-blinking function to partially indicate the level of consciousness of the patient. In addition, the ECS was modified to provide various levels of pulses from weak and thready to hyper-dynamic to assist in assessing patient conditions from the femoral, carotid, brachial, and pedal pulse locations.
Ibrahim, Rami B; Balogun, Rasheed Abiodun
Therapeutic apheresis refers to a group of extracorporeal therapies commonly used in the treatment of a variety of neurological, renal, hematological, and other systemic diseases caused by circulating "toxic agents" that cannot be cleared by other means. This article presents an overview of the concepts underlying the effect of therapeutic apheresis procedures on prescription drugs taken by patients and describes key drug-related and procedure-related factors that may impact drug disposition during therapeutic apheresis. Therapeutic apheresis, and specifically therapeutic plasma exchange (TPE), is the process involving the extracorporeal separation of plasma from the cellular components of blood, discarding the plasma and exchanging it with replacement physiologic fluids such as albumin or fresh frozen plasma to maintain oncotic pressure and blood volume, and then returning this and the original cellular components of blood back to the patient's circulatory system (Ibrahim and Balogun, Semin Dial 2012;25:176-189). Over the last 4 decades, modern therapeutic apheresis has been used clinically for the treatment of a host of renal, hematological, and neurological diseases such as Goodpasture's syndrome, thrombotic thrombocytopenic purpura, and myasthenia gravis to name a few (Ibrahim et al., Pharmacotherapy 2007;27:1529-1549). Because of its ability to remove plasma, TPE can extract circulating drugs residing in this compartment, thereby affecting their disposition and potentially their therapeutic action (Ibrahim and Balogun, Semin Dial 2012;25:176-189; Ibrahim et al., Pharmacotherapy 2007;27:1529-1549; Kale-Pradhan and Woo, Pharmacotherapy 1997;17:684-695; Kintzel et al., J Clin Apher 2003;18:194-205). The aim of this article is to shed light on drug-related and TPE-related factors that may influence drug removal by TPE. Emphasis is put on areas needing improvement in the way of assessing drug removal by TPE. In addition, a call for an expanded investigation of TPEs
Bradley, J; Sikazwe, N; Healy, J
In this commentary, the impact of the introduction of manual vacuum aspiration (MVA) for incomplete abortion patients and for early uterine evacuation is discussed for the University Teaching Hospital in Lusaka, Zambia. This 3-year training and service delivery program was begun in 1988 after it was clear that 15% of maternal deaths were due to illegally induced abortion. The prior procedure of dilation and curettage (D and C) required use of the main operating room and general anesthesia, which resulted in severe congestion and treatment delays. As a result of the new MVA procedure, congestion has decreased substantially, treatment is safer and more timely, and the staff's ability to provide abortions has increased. Family planning counseling is provided to postabortion patients in a more thorough fashion, and the savings in time has improved the quality of patient-staff interactions. Specifically, the patient flow has improved from a 12-hour wait to a 4-6 hour wait and rarely requires overnight hospitalization. The demand for the main operating room had decreased which frees space, time, and commodities for other gynecological treatment. The shorter procedure and release time means a minimal loss of earnings and productivity, and allows for greater privacy in explaining absences to families, schools, or employers. The improved quality of are is reflected in the figures for number treated, i.e., in 1989, 74% were treated with MVA for incomplete abortion 12 weeks and pregnancy termination 8 weeks compared with 26% treated with D and C. In 1990, the figures were 86% with MVA and 14% with D and C. The likelihood of complications from hemorrhage and sepsis have also been reduced. The MVA procedure is also less traumatic for the patient. The increased access to safe legal abortion services is reflected in the ratio of induced to incomplete abortions between 1988-1990 (1:25 to 1:5). Family planning counseling is provided by a full-time counselor who counsels preabortion
The United States District Court for the District of Rhode Island, on 30 August 1999, enjoined enforcement of Rhode Island's partial-birth abortion ban act. The act defined partial-birth abortion as "an abortion in which the person performing the abortion vaginally delivers a living human fetus before killing the infant and completing the delivery." The act also provided that a physician could perform an aborton on a viable fetus if necessary to save the mother's life only if "no other medical procedure would suffice for that purpose." The United States District Court found Rhode Island's statute to be constitutionally flawed in four respects. First, the court ruled that the definition of partial-birth abortion was unconstitutionally vague within the meaning of the Fourteenth Amendment to the United States Constitution since it implicitly banned the legally protected D & E procedure along with the impermissible D & X procedure. Secondly, following the United States Supreme Court precedent, the court invalidated the statute because it lacked a provision that would permit a partial-birth abortion to preserve the mother's health. Thirdly, the court concluded that the section of the statute permitting a partial-birth abortion to save the mother's life was inadequate. Finally, the court found that the statute placed an undue burden on a woman's right to an abortion within the meaning of the Fourteenth Amendment. Its provision for a civil action against an abortion provider by the father of a fetus or by a minor's parents could involve third parties in the abortion decision against a woman's will.
Cuperus-Bosma, J M; van der Wal, G; Kostense, P J; van der Maas, P J
The objective of the study was to provide an insight into the role of the medical examiner in the euthanasia notification procedure in The Netherlands. At the beginning of 1996 a representative group of 116 medical examiners was interviewed. The study found that there was a considerable variation in the way in which the medical examiners fulfilled their tasks. In all cases, after the physician-assisted death had taken place, the medical examiner investigated whether the attending physician had met the requirements for prudent practice, and in approximately 75% of the cases he reported his findings to the Public Prosecutor. In 78% of cases the attending physician was well known to the medical examiners, who were general practitioners, and in a third of the cases this influenced their assessment. Seventy-six per cent of the medical examiners, 61% of the members of the public prosecution and 47% of the physicians thought that it is the task to the medical examiner to review whether the requirements for prudent practice have been met by the attending physician. In conclusion further specification of the task of the medical examiner would appear to be beneficial to increase uniformity in the procedure. In particular, it should be determined whether it is the medical examiner's responsibility to review whether the requirements for prudent practice have been met. It should also be taken into consideration whether the position of the general practitioner medical examiner is sufficiently independent to make an objective report.
Stanhope, Kaitlyn; Rochat, Roger; Fink, Lauren; Richardson, Kalie; Brack, Chelsey; Comeau, Dawn
Since the decriminalisation of abortion in 2006, women in Colombia have continued to seek clandestine abortions, endangering their health and contributing to maternal mortality and morbidity. The goal of this study was to explore physicians' opinions towards and knowledge about legal abortion in Bogotá, Colombia, and key barriers to the legal abortion access. We conducted 13 key informant interviews followed by a survey with a probability sample of 49 doctors working in public hospitals in Bogotá. Interview and survey data showed lack of technical experience in the provision of abortion and nuanced opinions towards its practice. Key informants described ignorance and lack of abortion training in medical schools as key barriers to provision. In the survey, 16/49 respondents had performed an abortion, 24/49 had referred a woman for an abortion and only 33/49 showed correct knowledge of the law.
Johnson-Troop; Pettys, Marianne; Hurst, Victor, IV; Smaka, Todd; Paul, Bonnie; Rosenquist, Kevin; Gast, Karin; Gillis, David; McCulley, Phyllis
International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task
Cook, R J; Dickens, B M
During the period between 1977 and the first quarter of 1988, 35 countries liberalized their abortion laws and four countries limited grounds for the procedure. Most legislation has extended abortion eligibility through traditional indications such as danger to maternal health or fetal handicap, but a number of other indications have been created such as adolescence, advanced maternal age, family circumstances, and AIDS or HIV infection. A number of countries have redesigned their abortion laws as part of a comprehensive package to facilitate access to and delivery of contraception, voluntary sterilization, and abortion services. Abortion litigation has increased and stimulated the liberalization of abortion provisions and the support of women's autonomous choice within the law. In Canada, the entire criminal prohibition of abortion was held unconstitutional for violating women's integrity and security. In contrast, Latin American and other constitutional developments may limit legal abortion to instances of danger to women's lives. PMID:3048126
Lamina, Mustafa Adelaja
Background. Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of availability of contraceptive services. The aim of this study is to determine the rate of abortion and contraceptive use among women seeking repeat induced abortion in Western Nigeria. Method. A prospective cross-sectional study utilizing self-administered questionnaires was administered to women seeking abortion in private hospitals/clinics in four geopolitical areas of Ogun State, Western Nigeria, from January 1 to December 31 2012. Data were analyzed using SPSS 17.0. Results. The age range for those seeking repeat induced abortion was 15 to 51 years while the median age was 25 years. Of 2934 women seeking an abortion, 23% reported having had one or more previous abortions. Of those who had had more than one abortion, the level of awareness of contraceptives was 91.7% while only 21.5% used a contraceptive at their first intercourse after the procedure; 78.5% of the pregnancies were associated with non-contraceptive use while 17.5% were associated with contraceptive failure. The major reason for non-contraceptive use was fear of side effects. Conclusion. The rate of women seeking repeat abortions is high in Nigeria. The rate of contraceptive use is low while contraceptive failure rate is high. PMID:26078881
Hu, Howard; Straube, Tim; Madsen, Jennifer; Ricard, Mike
One of the most demanding tasks that must be performed by the Space Shuttle flight crew is the process of determining whether, when and where to abort the vehicle should engine or system failures occur during ascent or entry. Current Shuttle abort procedures involve paging through complicated paper checklists to decide on the type of abort and where to abort. Additional checklists then lead the crew through a series of actions to execute the desired abort. This process is even more difficult and time consuming in the absence of ground communications since the ground flight controllers have the analysis tools and information that is currently not available in the Shuttle cockpit. Crew workload specifically abort procedures will be greatly simplified with the implementation of the Space Shuttle Cockpit Avionics Upgrade (CAU) project. The intent of CAU is to maximize crew situational awareness and reduce flight workload thru enhanced controls and displays, and onboard abort assessment and determination capability. SAFM was developed to help satisfy the CAU objectives by providing the crew with dynamic information about the capability of the vehicle to perform a variety of abort options during ascent and entry. This paper- presents an overview of the SAFM application. As shown in Figure 1, SAFM processes the vehicle navigation state and other guidance information to provide the CAU displays with evaluations of abort options, as well as landing site recommendations. This is accomplished by three main SAFM components: the Sequencer Executive, the Powered Flight Function, and the Glided Flight Function, The Sequencer Executive dispatches the Powered and Glided Flight Functions to evaluate the vehicle's capability to execute the current mission (or current abort), as well as more than IS hypothetical abort options or scenarios. Scenarios are sequenced and evaluated throughout powered and glided flight. Abort scenarios evaluated include Abort to Orbit (ATO), Transatlantic
McMurtrie, Stephanie M; García, Sandra G; Wilson, Kate S; Diaz-Olavarrieta, Claudia; Fawcett, Gillian M
A nationally representative survey was conducted among 3000 Catholics in Mexico during 2009 and 2010. Respondents were presented with a hypothetical situation about a young woman who decided to have an abortion and were asked their personal opinion of her. On the basis of a stigma index, it was found that the majority (61%) had stigmatizing attitudes about abortion; however, 81% believed that abortion should be legal in at least some circumstances. Respondents were significantly more likely to stigmatize abortion if they disagreed with the Mexico City law legalizing the procedure (odds ratio 1.66; 95% CI, 1.30-2.11) and believed that abortion should be prohibited in all cases (odds ratio 3.13; 95% CI, 2.28-4.30). Such stigma can lead women to seek unsafe abortions to avoid judgment by society.
Pheterson, Gail; Azize, Yamila
Small island exigencies and a legacy of colonial jurisprudence set the stage for this three-year study in 2001-2003 of abortion practice on several islands of the northeast Caribbean: St. Martin, St. Maarten, Anguilla, Antigua and St Kitts. Based on in-depth interviews with 26 physicians, 16 of whom were performing abortions, it found that licensed physicians are routinely providing abortions in contravention of the law, and that those services, tolerated by governments and legitimised by European norms, are clearly the mainstay of abortion care on these islands. Medical abortion was being used both under medical supervision and through self-medication. Women travelled to find anonymous services, and also to access a particular method, provider or facility. Sometimes they settled for a less acceptable method if they could not afford a more comfortable one. Significantly, legality was not the main determinant of choice. Most abortion providers accepted the current situation as satisfactory. However, our findings suggest that restrictive laws were hindering access to services and compromising quality of care. Whereas doctors may have the liberty and knowledge to practise illegal abortions, women have no legal right to these services. Interviews suggest that an increasing number of women are self-inducing misoprostol abortions to avoid doctors, high fees and public stigma. The Caribbean Initiative on Abortion and Contraception is organising meetings, training providers and creating a public forum to advocate decriminalisation of abortion and enhance abortion care.
Dennis, Amanda; Blanchard, Kelly
Objective To evaluate the implementation of state Medicaid abortion policies and the impact of these policies on abortion clients and abortion providers. Data Source From 2007 to 2010, in-depth interviews were conducted with representatives of 70 abortion-providing facilities in 15 states. Study Design In-depth interviews focused on abortion providers' perceptions regarding Medicaid and their experiences working with Medicaid and securing reimbursement in cases that should receive federal funding: rape, incest, and life endangerment. Data Extraction Data were transcribed verbatim before being coded. Principal Findings In two study states, abortion providers reported that 97 percent of submitted claims for qualifying cases were funded. Success receiving reimbursement was attributed to streamlined electronic billing procedures, timely claims processing, and responsive Medicaid staff. Abortion providers in the other 13 states reported reimbursement for 36 percent of qualifying cases. Providers reported difficulties obtaining reimbursement due to unclear rejections of qualifying claims, complex billing procedures, lack of knowledgeable Medicaid staff with whom billing problems could be discussed, and low and slow reimbursement rates. Conclusions Poor state-level implementation of Medicaid coverage of abortion policies creates barriers for women seeking abortion. Efforts to ensure policies are implemented appropriately would improve women's health. PMID:22742741
This article answers several questions relating to the moral issue of abortion, the value of life, and the rights of women. Women all over the world have been having abortions, legal or illegal, since time immemorial for reasons which are difficult to document. While legal and safe abortions do not compromise the physical and psychological health of the woman, more than ten thousand women suffer and die from complications of illegal abortions especially in countries where women are denied of their reproductive rights. Though abortion remained illegal in many countries such as Brazil and Latin America, legal restrictions do little to reduce the incidence of abortion. Meanwhile, the question on when the fetus has life is viewed differently by the scientific, medical, legal and religious communities. But even with the conviction that abortion involves taking the life of a person, it is indeed a responsibility to respect the views of other religions. Finally, although the decision to have abortion should belong to the couple, the last word should belong to the woman.
Cagiano De Azevedo, R
The adoption of a recent law on abortion (1978) makes available in Italy new statistics at both the national and regional levels. Following the official source of ISTAT, the abortion rate/100 livebirths in 1979 was about 28%, about 40% in the northern part of Italy, and only 16% in Mezzogiorno. This abortion rate, as an average data at the national level, corresponds to a normal position among similar rates in western countries; closer to EEC member states. But the regional variability seems a very interesting new aspect of the Italian tryptic (north, center, south) largely presented in many demographic indicators. 3 factors are presented as a possible explication of this variability: a real different attitude of women and couples towards abortion from cultural, religious, and political points of view; the coexistence of legal and illegal abortion despite the adoption of a new liberal law; and the very important disequilibrium in the distribution of structures and medical services available to assure abortions in different parts of the country. Some other demographic points related to abortion are also presented here, particularly in connection with age structure of women and their marital status. Future trends in abortion with subsequent effects on fertility are also discussed at the end of this article. The arguments follow 2 alternatives presented in Italy by the National Committee on Population and the Committee of Demographic Studies. (author's modified)
Fallah, Razieh; Ferdosian, Farzad; Shajari, Ahmad
Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist.
FALLAH, Razieh; FERDOSIAN, Farzad; SHAJARI, Ahmad
Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist. PMID:26401146
Banks, Matthew L; Hutsell, Blake A; Schwienteck, Kathryn L; Negus, S Stevens
Drug addiction is a disease that manifests as an inappropriate allocation of behavior towards the procurement and use of the abused substance and away from other behaviors that produce more adaptive reinforcers (e.g. exercise, work, family and social relationships). The goal of treating drug addiction is not only to decrease drug-maintained behaviors, but also to promote a reallocation of behavior towards alternative, nondrug reinforcers. Experimental procedures that offer concurrent access to both a drug reinforcer and an alternative, nondrug reinforcer provide a research tool for assessment of medication effects on drug choice and behavioral allocation. Choice procedures are currently the standard in human laboratory research on medications development. Preclinical choice procedures have been utilized in biomedical research since the early 1940's, and during the last 10-15 years, their use for evaluation of medications to treat drug addiction has increased. We propose here that parallel use of choice procedures in preclinical and clinical studies will facilitate translational research on development of medications to treat cocaine addiction. In support of this proposition, a review of the literature suggests strong concordance between preclinical effectiveness of candidate medications to modify cocaine choice in nonhuman primates and rodents and clinical effectiveness of these medications to modify either cocaine choice in human laboratory studies or metrics of cocaine abuse in patients with cocaine use disorder. The strongest evidence for medication effectiveness in preclinical choice studies has been obtained with maintenance on the monoamine releaser d-amphetamine, a candidate agonist medication for cocaine use analogous to use of methadone to treat heroin abuse or nicotine formulations to treat tobacco dependence.
Banks, Matthew L; Hutsell, Blake A; Schwienteck, Kathryn L; Negus, S. Stevens
Opinion Statement Drug addiction is a disease that manifests as an inappropriate allocation of behavior towards the procurement and use of the abused substance and away from other behaviors that produce more adaptive reinforcers (e.g. exercise, work, family and social relationships). The goal of treating drug addiction is not only to decrease drug-maintained behaviors, but also to promote a reallocation of behavior towards alternative, nondrug reinforcers. Experimental procedures that offer concurrent access to both a drug reinforcer and an alternative, nondrug reinforcer provide a research tool for assessment of medication effects on drug choice and behavioral allocation. Choice procedures are currently the standard in human laboratory research on medications development. Preclinical choice procedures have been utilized in biomedical research since the early 1940’s, and during the last 10–15 years, their use for evaluation of medications to treat drug addiction has increased. We propose here that parallel use of choice procedures in preclinical and clinical studies will facilitate translational research on development of medications to treat cocaine addiction. In support of this proposition, a review of the literature suggests strong concordance between preclinical effectiveness of candidate medications to modify cocaine choice in nonhuman primates and rodents and clinical effectiveness of these medications to modify either cocaine choice in human laboratory studies or metrics of cocaine abuse in patients with cocaine use disorder. The strongest evidence for medication effectiveness in preclinical choice studies has been obtained with maintenance on the monoamine releaser d-amphetamine, a candidate agonist medication for cocaine use analogous to use of methadone to treat heroin abuse or nicotine formulations to treat tobacco dependence. PMID:26009706
du Jardin, J
The author specifies the rules and the vocabulary of the civil and penal procedures. He points out the characteristics of the medical act and the failures that a medical practitioner can be blamed for. He defines the notions of the duty of best efforts and the duty to achieve a specific result. The role of the expert is touched upon. The article is supplemented by significant case-law decisions and a list of recent textbooks.
ten Cate, T J; Kooij, L R
On December 1, 2005 in the Netherlands, a new procedure was introduced to assess international medical graduates (IMGs) with a diploma acquired outside the European Economic Area (EEA). This procedure includes (a) general tests on the active and passive use of Dutch medical language, English reading proficiency, basic IT skills and knowledge of the Dutch health care system, and (b) a specific set of tests of medical competence, including knowledge of basic sciences, clinical knowledge and clinical skills. IMGs who wish to get their diploma acknowledged and be registered as a physician are required to complete this assessment. With the introduction of this procedure, the Netherlands have joined a minority of countries inside and outside Europe with setting high standards for intake procedures. It is advocated that all European countries should devise such procedures, as a European Directive (2005/36/EC) on the recognition of professional qualifications prohibits the assessment of medical graduates with a diploma that is recognised in another EEA country.
Paulsen, James A.
Discusses general attitudes towards unwanted pregnancies and abortions, the methods that students have resorted to in order to abort themselves, and the mental state of college women, who become pregnant with children they don't want. (RK)
Byrne, V. E.; Hudy, C.; Smith, D.; Whitmore, M.
As part of the Space Human Factors Engineering Critical Questions Roadmap, a three year Technology Development Project (TDP) was funded by NASA Headquarters to examine emergency medical procedures on ISS. The overall aim of the emergency medical procedures project was to determine the human factors issues in the procedures, training, communications and equipment, and to recommend solutions that will improve the survival rate of crewmembers in the event of a medical emergency. Currently, each ISS crew remains on orbit for six month intervals. As there is not standing requirement for a physician crewmember, during such time, the maintenance of crew health is dependant on individual crewmembers. Further, in the event of an emergency, crew will need to provide prolonged maintenance care, as well as emergency treatment, to an injured crewmember while awaiting transport to Earth. In addition to the isolation of the crew, medical procedures must be carried out within the further limitations imposed by the physical environment of the space station. For example, in order to administer care on ISS without the benefit of gravity, the Crew Medical Officers (CMOs) must restrain the equipment required to perform the task, restrain the injured crewmember, and finally, restrain themselves. Both the physical environment and the physical space available further limit the technology that can be used onboard. Equipment must be compact, yet able to withstand high levels of radiation and function without gravity. The focus here is to highlight the human factors impacts from our three year project involving the procedures and equipment areas that have been investigated and provided valuable to ISS and provide groundwork for human factors requirements for medical applications for exploration missions.
Faramarzalian, Ali; Armitage, Keith B.; Kapoor, Baljendra; Kalva, Sanjeeva P.
The rapid expansion of minimally invasive image-guided procedures has led to their extensive use in the interdisciplinary management of patients with vascular, hepatobiliary, genitourinary, and oncologic diseases. Given the increased availability and breadth of these procedures, it is important for physicians to be aware of common complications and their management. In this article, the authors describe management of select common complications from interventional radiology procedures including tumor lysis syndrome, acute on chronic postprocedural pain, and venous thromboembolism. These complications are discussed in detail and their medical management is outlined according to generally accepted practice and evidence from the literature. PMID:26038627
Hiersche, H D
On February 2, 1975 the Federal Constitutional Court gave the indications for abortion. But the regulations are often misunderstood and are often contravened by mistake. Hence the following explanations are for the assistance of physicians. The sections discussed are sec. 218 (abortion), 218a (indications for abortion), 218b (abortion without advising the woman), 219 (abortion without a physician's order), 219a (wrongful physician's order), 219b (soliciting abortion), 219c (transporting the instruments used for abortion), and 219d (definition). The law recognizes only medical indications for abortion: the purely medical indication, the indication of damage to the fetus, the criminological indication, and the indication from extreme emergency. The law states clearly that no one is compelled to perform an abortion, whatever the consequences for the mother and fetus might be. The law provides for stages of notification: 1) the personal physician must provide in writing a well-grounded indication for abortion; 2) in the absence of a purely medical indication, the woman must at least 3 days before rupture request assistance from a social service agency or a physician with appropriate knowledge and skill; 3) the woman must have explained to her all aspects of abortion, not only the purely medical, but also the arguments of various kinds against it; and 4) the physician who undertakes to do the abortion is responsible for ensuring that all provisions of the law have been satisfied. The law provides that abortion may be done only in a hospital, i.e., a place where special arrangements for it may be made; it cannot be done on an outpatient basis.
Adler, Nancy E.; Ozer, Emily J.; Tschann, Jeanne
Reviews the current status of abortion laws pertaining to adolescents worldwide, examining questions raised by parental consent laws in the United States and by the relevant psychological research (risk of harm from abortion, informed consent, consequences of parental involvement in the abortion decision, and current debate). Discusses issues…
... 32 National Defense 6 2012-07-01 2012-07-01 false Special procedures for medical and psychological records. 1801.31 Section 1801.31 National Defense Other Regulations Relating to National Defense NATIONAL COUNTERINTELLIGENCE CENTER PUBLIC RIGHTS UNDER THE PRIVACY ACT OF 1974 Additional Administrative Matters §...
... 32 National Defense 6 2013-07-01 2013-07-01 false Special procedures for medical and psychological records. 1801.31 Section 1801.31 National Defense Other Regulations Relating to National Defense NATIONAL COUNTERINTELLIGENCE CENTER PUBLIC RIGHTS UNDER THE PRIVACY ACT OF 1974 Additional Administrative Matters §...
... 32 National Defense 6 2014-07-01 2014-07-01 false Special procedures for medical and psychological records. 1801.31 Section 1801.31 National Defense Other Regulations Relating to National Defense NATIONAL COUNTERINTELLIGENCE CENTER PUBLIC RIGHTS UNDER THE PRIVACY ACT OF 1974 Additional Administrative Matters §...
... 32 National Defense 6 2010-07-01 2010-07-01 false Special procedures for medical and psychological records. 1801.31 Section 1801.31 National Defense Other Regulations Relating to National Defense NATIONAL COUNTERINTELLIGENCE CENTER PUBLIC RIGHTS UNDER THE PRIVACY ACT OF 1974 Additional Administrative Matters §...
... 32 National Defense 6 2011-07-01 2011-07-01 false Special procedures for medical and psychological records. 1801.31 Section 1801.31 National Defense Other Regulations Relating to National Defense NATIONAL COUNTERINTELLIGENCE CENTER PUBLIC RIGHTS UNDER THE PRIVACY ACT OF 1974 Additional Administrative Matters §...
Jay, Susan M.; Elliott, Charles H.
Compared program efficacy in helping parents cope with children's painful medical procedures. Parents (n=72) of pediatric leukemia patients participated in either stress inoculation program or observed child participating in cognitive behavior therapy. Found parents in stress inoculation program reported lower anxiety scores and higher positive…
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Procedure for requesting medical care; employee's duty to notify employer. 702.418 Section 702.418 Employees' Benefits EMPLOYMENT STANDARDS... exercise of reasonable diligence should be aware, of the relationship between an injury or disease and...
... 32 National Defense 6 2011-07-01 2011-07-01 false Special procedures for medical and psychological records. 1901.31 Section 1901.31 National Defense Other Regulations Relating to National Defense CENTRAL INTELLIGENCE AGENCY PUBLIC RIGHTS UNDER THE PRIVACY ACT OF 1974 Additional Administrative Matters §...
... 32 National Defense 6 2013-07-01 2013-07-01 false Special procedures for medical and psychological records. 1901.31 Section 1901.31 National Defense Other Regulations Relating to National Defense CENTRAL INTELLIGENCE AGENCY PUBLIC RIGHTS UNDER THE PRIVACY ACT OF 1974 Additional Administrative Matters §...
Morgenthau, J E
The issue of abortion, except when it is rendered moot because the fetus endangers the life of the mother, is not really a medical issue. The physician's role is to help patients achieve and maintain their maximum potential for physical, mental, and social well-being. To accomplish this, the physician must acquire a constantly evolving database of scientific knowledge, must evaluate this information in a critical and ethical manner, and must be prepared to apply what is learned. In the realm of applied ethics, no particular religion, profession, culture, class, or sex should be thought of as having all the answers in the realm of applied ethics. This physician's actions are predicated on the belief that, to a large extent, ethical precepts reflect the broader social and economic issues of the period in which they are articulated. If this is the case, then in today's world the population explosion, the postindustrial society, the women's rights movement, inequality of access, and the ability to perform prenatal diagnosis are all factors which have molded the approach to the issue of abortion. Only the last 3 of these can in any way be considered as medical. When considering the role of a physician in dealing with the issue of abortion in the adolescent, this individual relies on the concept articulated by the World Health Association (WHA): promoting the physical, emotional, and social well-being of one's patients. Each year in the US over 1 million 15-19 year olds become pregnant, resulting in over 600,000 births. Most of these pregnancies are unintentional, yet approximately 90% of the infants are kept in the home by mothers who are ill prepared to be parents. What is most disturbing is that the pregnancy rate for the younger mother, 16 years or under, is accounting for an ever increasing percentage of the total. Studies at the Adolescent Health Center of the Mount Sinai Hospital in New York City as well as national studies suggest that the younger teens are more
Leone, Tiziana; Coast, Ernestina; Parmar, Divya; Vwalika, Bellington
Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g. hospital fees). This article estimates the individual-level economic burden of safe and unsafe abortion care-seeking in Zambia, incorporating all indirect and direct costs. It uses data collected in 2013 from a tertiary hospital in Lusaka, (n = 112) with women who had an abortion. Three treatment routes are identified: (1) safe abortion at the hospital, (2) unsafe clandestine medical abortion initiated elsewhere with post-abortion care at the hospital and (3) unsafe abortion initiated elsewhere with post-abortion care at the hospital. Based on these three typologies, we use descriptive analysis and linear regression to estimate the costs for women of seeking safe and unsafe abortion and to establish whether the burden of abortion care-seeking costs is equally distributed across the sample. Around 39% of women had an unsafe abortion, incurring substantial economic costs before seeking post-abortion care. Adolescents and poorer women are more likely to use unsafe abortion. Unsafe abortion requiring post-abortion care costs women 27% more than a safe abortion. When accounting for uncertainty this figure increases dramatically. For safe and unsafe abortions, unofficial provider payments represent a major cost to women.This study demonstrates that despite a liberal legislation, Zambia still needs better dissemination of the law to women and providers and resources to ensure abortion service access. The policy implications of this study include: the role of pharmacists and mid-level providers in the provision of medical abortion services; increased access to contraception, especially for adolescents; and elimination of demands for unofficial provider
Sedgh, Gilda; Rossier, Clémentine; Kaboré, Idrissa; Bankole, Akinrinola; Mikulich, Meridith
Abortion is illegal in Burkina Faso except in cases of incest, rape, fetal defect, or when the woman's life or physical health is endangered. As a result, abortion procedures are often conducted illegally and unsafely and measuring incidence proves difficult. We estimate incidence of abortion and associated morbidity using two methodologies. The first is the Abortion Incidence Complications Method (AICM), which uses information on women hospitalized for abortion-related complications as well as health professionals' assessments of the proportion of women who seek treatment for complications from unsafe abortions. The second is the Anonymous Third Party Reporting (ATPR) method, which entails surveying women about their confidantes' abortions. We conclude that the AICM yields a more accurate result. We estimate that 87,200 abortion procedures were carried out in 2008, representing 25 for every 1,000 women aged 15-49. More than one in four procedures resulted in complications treated at a health facility. The abortion rate estimated using the ATPR approach was 72 percent of that estimated with the AICM. The ATPR method yields information on the characteristics of the women who have abortions as well as the providers and methods they use.
Hess, Rosanna F
The purpose of this study was to explore the reasons women in rural, southern Gabon, Africa, chose to terminate their pregnancies, the methods used to induce abortions, and postabortion effects experienced by these women. Abortion is illegal in this country. A descriptive qualitative design guided the methodology for this study. Five women with a history of induced abortion were interviewed in-depth for their abortion story. Reasons cited for an abortion included lack of financial and partner support. Abortion methods included oral, rectal, and vaginal concoctions of leaves, bark, and water and over-the-counter medications, including misoprostol. Affects were physical, spiritual, and relational. Health care professionals need to provide women with guidance for appropriate contraceptive usage. Abortion after-care of women with physical and spiritual needs is important. Future research is suggested on the use of misoprostol in Gabon to understand its affects on women's reproductive health.
DREES,A.; AHRENS,L.; III FLILLER,R.; GASSNER,D.; MCINTYRE,G.T.; MICHNOFF,R.; TRBOJEVIC,D.
During the RHIC Au-run in 2001 the 200 MHz storage cavity system was used for the first time. The rebucketing procedure caused significant beam debunching in addition to amplifying debunching due to other mechanisms. At the end of a four hour store, debunched beam could account for approximately 30%-40% of the total beam intensity. Some of it will be in the abort gap. In order to minimize the risk of magnet quenching due to uncontrolled beam losses at the time of a beam dump, a combination of a fast transverse kicker and copper collimators were used to clean the abort gap. This report gives an overview of the gap cleaning procedure and the achieved performance.
Deutsch, E; Füllmich, R; Poppe, H
The increasing employment of gene technological procedures in medical diagnostics and criminal procedure has forced both the medical and the legal professions to focus their attention on the complex question of liability of physicians, lab technicians, and other personnel involved in applying these measures. This article gives an outline, by citing practical cases, of the major aspects of liability for malpractice that are relevant under German law. Bearing in mind that this article will be read predominantly by members of the Anglo-American common-law legal system, the legal aspects - even though they are German legal aspects - are viewed in the light of the common law. The article examines three major issues: (a) liability for diagnoses employing gene technological procedures: (b) liability for wrong testimony based on 'genetic finger-printing': and (c) the donor's rights concerning his or her DNA-probe.
Gilard, Martine; Debroucker, Frederique; Dubray, Claude; Allioux, Yves; Aper, Eliane; Barat-Leonhardt, Valérie; Brami, Michèle; Carbonneil, Cédric; Chartier-Kastler, Emmanuel; Coqueblin, Claire; Fare, Sandrine; Giri, Isabelle; Goehrs, Jean-Marie; Levesque, Karine; Maugendre, Philippe; Parquin, François; Sales, Jean-Patrick; Szwarcensztein, Karine
Medical devices are many and various, ranging from tongue spatulas to implantable or invasive devices and imaging machines; their lifetimes are short, between 18 months and 5 years, due to incessant incremental innovation; and they are operator-dependent: in general, the clinical user performs a fitting procedure (hip implant or pacemaker), a therapeutic procedure using a non-implantable invasive device (arrhythmic site ablation probe, angioplasty balloon, extension spondyloplasty system, etc.) or follow-up of an active implanted device (long-term follow-up of an implanted cardiac defibrillator or of a deep brain stimulator in Parkinson's patients). A round-table held during the XXVIII(th) Giens Workshops meeting focused on the methodology of scientific evaluation of medical devices and the associated procedures with a view to their pricing and financing by the French National Health Insurance system. The working hypothesis was that the available data-set was sufficient for and compatible with scientific evaluation with clinical benefit. Post-registration studies, although contributing to the continuity of assessment, were not dealt with. Moreover, the focus was restricted to devices used in health establishments, where the association between devices and technical medical procedures is optimally representative. An update of the multiple regulatory protocols governing medical devices and procedures is provided. Issues more specifically related to procedures as such, to non-implantable devices and to innovative devices are then dealt with, and the proposals and discussion points raised at the round-table for each of these three areas are presented.
Globally, abortion mortality accounts for approximately 13% of all maternal mortality. Unsafe abortion procedures, untrained abortion providers, restrictive abortion laws and high maternal mortality and morbidity from abortion tend to occur together. Unplanned and unwanted pregnancies constitute a serious public health responsibility. While fertility has declined by half in developing countries, the motivation to control and space births has risen faster than the rate of contraceptive use. Preventing maternal mortality and morbidity from abortion in countries where these remain high is a matter of good public health policy and medical practice, and constitutes an important part of safe motherhood initiatives. A range of positive steps has been taken to reduce deaths and morbidity from abortion in a growing number of countries over the past 15 years. Making abortion legal is an essential prerequisite in making it safe. In this respect, changing the law does matter and assertions to the contrary are ill conceived and unsupported in practice. Although, in many countries, trends towards safer abortion have often occurred prior to or in the absence of changes in the law, legal changes need to take place if safety is to be sustained for all women. Religious laws may also require attention when legal change is being contemplated. There are three main ways of approaching this problem: liberalizing the existing law within the penal or criminal code; partially or fully legalizing abortion through a positive law or a court ruling; and decriminalising abortion by taking it out of the law. Women's health groups and other advocates, parliamentarians and health professionals, can work together to support the right of women not to die from unsafe abortions and to ensure they receive treatment for complications. Committed doctors can make a difference by providing treatment for abortion complications, interpreting the law in a liberal way and providing safe services where these are
Diniz, Debora; Medeiros, Marcelo
This study presents the first results of the National Abortion Survey (PNA, Pesquisa Nacional de Aborto), a household random sample survey fielded in 2010 covering urban women in Brazil aged 18 to 39 years. The PNA combined two techniques, interviewer-administered questionnaires and self-administered ballot box questionnaires. The results of PNA show that at the end of their reproductive health one in five women has performed an abortion, with abortions being more frequent in the main reproductive ages, that is, from 18 to 29 years old. No relevant differentiation was observed in the practice of abortion among religious groups, but abortion was found to be more common among people with lower education. The use of medical drugs to induce abortion occurred in half of the abortions, and post-abortion hospitalization was observed among approximately half of the women who aborted. Such results lead to conclude that abortion is a priority in the Brazilian public health agenda.
Benkirane, A; Jabli, N; Rodolakis, A
A survey was carried out on 23 sheep flocks to estimate the frequency of abortion as well as the prevalence of antibodies against abortive infections. During the visit of each farm, a questionnaire was completed with the collaboration of the owner and blood samples were collected from all aborted ewes and some of those with normal lambing. A rate of 7% abortion was reached in both aborted and normally lambed ewes. Anti-Chlamydia psittaci antibodies were the most frequently detected (14 flocks). Anti-Coxiella burnetii and anti-Toxoplasma gondii antibodies were found in 9 flocks, whereas anti-Brucella and anti-Salmonella abortus ovis were present in only 1 flock each. None of the 5 infections was detected in 2 flocks. Mixed infections were prevalent: 13 flocks were simultaneously infected by at least 2 abortive pathogens. The procedure used does not allow the cause of abortion to be identified in all cases.
Izugbara, Chimaraoke O; Egesa, Carolyne; Okelo, Rispah
Public health discourses on safe abortion assume the term to be unambiguous. However, qualitative evidence elicited from Kenyan women treated for complications of unsafe abortion contrasted sharply with public health views of abortion safety. For these women, safe abortion implied pregnancy termination procedures and services that concealed their abortions, shielded them from the law, were cheap and identified through dependable social networks. Participants contested the notion that poor quality abortion procedures and providers are inherently dangerous, asserting them as key to women's preservation of a good self, management of stigma, and protection of their reputation, respect, social relationships, and livelihoods. Greater public health attention to the social dimensions of abortion safety is urgent.
Burkman, R T; King, T M; Burnett, L S; Atienza, M F
A survey of 86 university abortion programs was carried out in December 1973, a year after the Supreme Court decision on abortion. In comparing the results of the questionnaires used in the survey, California, Colorado, Hawaii, Maryland, and New York are considered separately as established states because of their prior liberalized abortion laws, and the other states are referred to as new states. At least 52% of all centers where abortions are performed have less than 500 procedures annually. 31.6% of the new states and 50% of the established states perform menstrual extraction. 65% of all centers providing abortion services have investigative programs. No significant differences exist between the centers of new and established states. It appears that significant numbers of physicians are not exposed to the management of abortions. Less than 1/3 of university programs provide educational experience for outside physicians. It was made evident by the survey that many university departments have not made elective abortion an integral part of the service and educational responsibilities of obstetrics and gynecology.
Misoprostol, a WHO essential medicine indicated for labour induction, management of miscarriage and post-partum haemorrhage, as well as for induced abortion and treatment of post-abortion complications, came up for registration in Sri Lanka in December 2010. The decision on registration was postponed, indefinitely. This has wide-ranging implications, as misoprostol is widely available and used, including by health professionals in Sri Lanka, without guidance or training in its use. This paper attempts to situate the failure to register misoprostol within the broader context of unsafe abortion, drawing on data from interviews with physicians and health policymakers in Sri Lanka. It demonstrates how personal opposition to abortion infiltrates policy decisions and prevents the issue of unsafe abortion being resolved. Any move to reform abortion law and policy in Sri Lanka will require a concerted effort, spearheaded by civil society. Women and communities affected by the consequences of unsafe abortion need to be involved in these efforts. Regardless of the law, women will access abortion services if they need them, and providers will provide them. Decriminalizing abortion and registering abortion medications will make provision of abortion services safer, less expensive and more equitable.
Ferris, L E; McMain-Klein, M; Colodny, N; Fellows, G F; Lamont, J
OBJECTIVE: To identify factors associated with increased risk of immediate complications from induced abortion. DESIGN: Retrospective analysis of a provincial database. SETTING: All Ontario general hospitals in which abortions are performed and all free-standing abortion clinics in Ontario. POPULATION: Women in Ontario aged 15 to 44 years who underwent an induced abortion in the province (without concurrent sterilization) between Jan. 1, 1992, and Dec. 31, 1993. OUTCOME MEASURES: Recording of complications at the time of the procedure, gestational age, type of procedure, place of abortion (hospital or clinic), and patient's age, parity and history of previous abortion (spontaneous or induced). RESULTS: During the study period 83 469 abortions were performed that met our inclusion criteria. Immediate complications were reported in 571 cases (0.7%). Multivariate logistic regression analysis revealed that, after other variables were controlled for, the patient's age, parity and history of previous abortions (spontaneous or induced) were not significant risk factors for immediate complications; however, gestational age, method of abortion and place of abortion were significant risk factors (p < 0.001). The odds ratio (OR) for having a complication from abortion was 1.3 (95% confidence interval [CI] 1.02 to 1.63) between 9 and 12 weeks, compared with having one after abortion at 9 weeks or earlier, and increased to 3.3 (95% CI 2.23 to 5.00) after abortion between 17 and 20 weeks. Compared with surgical dilatation and curettage (D&C), instillation of saline and instillation of prostaglandins were more likely to be associated with immediate complications (OR 24.0, 95% CI 13.22 to 43.70, and OR 11.7, 95% CI 6.43 to 21.18, respectively), whereas both suction D&C and insertion of a laminaria tent were less likely to be associated with immediate complications (OR 0.4, 95% CI 0.26 to 0.67, and OR 0.3, 95% CI 0.19 to 0.52, respectively). Compared with women who had an abortion
Stone, R; Waszak, C
A focus-group study of adolescents from cities across the United States revealed that they lacked accurate knowledge about abortion and the laws governing it. Most expressed erroneous beliefs about abortion, describing it as medically dangerous, emotionally damaging and widely illegal. The study also revealed that antiabortion views, conservative morality and religious beliefs were the primary sources of these adolescents' attitudes toward abortion. In general, the participants in the study said they were personally opposed to abortion, but supported its continued legality as a woman's choice. Although most of the teenagers expressed positive feelings toward parents, they did not feel that mandatory parental involvement would be helpful, and in some cases could cause harm.
In early 1991 the abortion debate in Poland entered its new stage. The prolife and prochoice options had already clashed in the early 1930s over a new penal code and backstreet abortions. According to the code of 1932, induced abortion was allowed in cases of rape, incest, or for medical indications. Abortion was legalized in 1956, but subsequently it came under attack from Catholic circles, and by 1989 the Unborn Child Protection Bill was drafted which criminalized abortion. Only 11% of Polish women use modern contraceptives. The less efficient methods are the most prevalent: the natural method (Ogino-Knaus calendar), 35% of couples; coitus interruptus, 34%; condoms, 15%; oral contraceptives 7%; chemical spermicides, 2.5%; and the IUD 2%. According to size of Catholic Church estimate there are 600,000 abortions yearly. In contrast, official statistics indicate that the number of abortions is decreasing: 137,950 in 1980; 105,300 in 1988; 80,100 in 1989; 59,400 in 1990. In January 1991 the Constitutional Tribunal dismissed the motion of the Polish Feminist Association against the restrictive regulations of the Ministry of Health concerning abortion. After a parliamentary stalemate on the Unborn Child Protection Bill a commission consisting of 46 persona (1.2 of them women, 20 persons from the prochoice and 24 from the prolife lobby) continued the debate on the bill. Public opinion polls conducted by independent groups in November 1990 showed that about 60% of citizens were against the Senate's draft. Since then interest in the abortion issue has dwindled, and only 200 women and men took part in a prochoice demonstration in front of the parliament on January 25, 1991. In the spring of 1989 and in September 1990 thousands had participated in similar demonstrations. The prevailing attitude is that if the antiabortion bill is passed nothing can be done.
Peterson, Leif E.; Nachtwey, D. Stuart
Radiation protection standards for space activities differ substantially from those applied to terrestrial working situations. The levels of radiation and subsequent hazards to which space workers are exposed are quite unlike anything found on Earth. The new more highly refined system of risk management involves assessing the risk to each space worker from all sources of radiation (occupational and non-occupational) at the organ level. The risk coefficients were applied to previous space and medical exposures (diagnostic x ray and nuclear medicine procedures) in order to estimate the radiation-induced lifetime cancer incidence and mortality risk. At present, the risk from medical procedures when compared to space activities is 14 times higher for cancer incidence and 13 times higher for cancer mortality; however, this will change as the per capita dose during Space Station Freedom and interplanetary missions increases and more is known about the risks from exposure to high-LET radiation.
Approaches relying on fair procedures rather than substantive principles have been proposed for answering dilemmas in medical ethics and health policy. These dilemmas generally involve two questions: the epistemological (factual) question of which benefits an intervention will have, and the ethical (value) question of how to distribute those benefits. This article focuses on the potential of fair procedures to help address epistemological and factual questions in medicine, using the debate over antidepressant efficacy as a test case. In doing so, it employs concepts from social epistemology such as testimonial injustice (bias resulting from the exclusion of evidence) and hermeneutical injustice (bias resulting from a prevailing discussion framework's conceptual limitations). This article also explores the relevance of scientific consensus to determinations regarding medical evidence.
Paterson, L.E.; Nachtwey, D.S.
Radiation protection standards for space activities differ substantially from those applied to terrestrial working situations. The levels of radiation and subsequent hazards to which space workers are exposed are quite unlike anything found on Earth. The new more highly refined system of risk management involves assessing the risk to each space worker from all sources of radiation (occupational and non-occupational) at the organ level. The risk coefficients were applied to previous space and medical exposures (diagnostic x ray and nuclear medicine procedures) in order to estimate the radiation-induced lifetime cancer incidence and mortality risk. At present, the risk from medical procedures when compared to space activities is 14 times higher for cancer incidence and 13 times higher for cancer mortality; however, this will change as the per capita dose during Space Station Freedom and interplanetary missions increases and more is known about the risks from exposure to high-LET radiation.
Wertlake, Paul T; Henson, Michael D
Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. This study concerns the use of the clinical laboratory as a resource for physicians recommending cannabidiol (CBD) to patients, or for patients using medical marijuana. Marijuana containing delta-9-tetrahydrocannabinol (THC) is psychoactive. CBD is not psychoactive. CBD is reported to have medical benefit for seizure control, neurologic disorders including multiple sclerosis, neuropathic pain and pain associated with cancer. Use of opiates leads to increasing dosage over time that may cause respiratory depression. The Medical Board of California has termed this a serious public health crisis of addiction, overdose, and death. Is it feasible that CBD might alleviate persistent, severe pain and therefore diminished opiate use? Further study is needed to determine medical effectiveness of CBD including the effect on concurrent opiate therapy due to competition for receptor sites. This study is the application of a gas chromatography mass spectrometry procedure adapted for use in our laboratory, to detect CBD in urine. The intended use is as a tool for physicians to assess that marijuana being used by a patient is of a composition likely to be medically effective. A law ensuring physicians freedom from federal prosecution would provide confidence essential to formal study of medical uses of marijuana and treatment of clinical problems. Detection of CBD in a urine sample would be a convenient test for such confirmation. PMID:26929665
Wertlake, Paul T; Henson, Michael D
Marijuana is classified by the Drug Enforcement Agency (DEA) as Schedule I, drugs having no accepted medical value. Twenty-three states and the District of Columbia have legalized medical marijuana. This conflict inhibits physicians from prescribing marijuana and the systematic study of marijuana in medical care. This study concerns the use of the clinical laboratory as a resource for physicians recommending cannabidiol (CBD) to patients, or for patients using medical marijuana. Marijuana containing delta-9-tetrahydrocannabinol (THC) is psychoactive. CBD is not psychoactive. CBD is reported to have medical benefit for seizure control, neurologic disorders including multiple sclerosis, neuropathic pain and pain associated with cancer. Use of opiates leads to increasing dosage over time that may cause respiratory depression. The Medical Board of California has termed this a serious public health crisis of addiction, overdose, and death. Is it feasible that CBD might alleviate persistent, severe pain and therefore diminished opiate use? Further study is needed to determine medical effectiveness of CBD including the effect on concurrent opiate therapy due to competition for receptor sites. This study is the application of a gas chromatography mass spectrometry procedure adapted for use in our laboratory, to detect CBD in urine. The intended use is as a tool for physicians to assess that marijuana being used by a patient is of a composition likely to be medically effective. A law ensuring physicians freedom from federal prosecution would provide confidence essential to formal study of medical uses of marijuana and treatment of clinical problems. Detection of CBD in a urine sample would be a convenient test for such confirmation.
Legislators or regulators in Mississippi, South Carolina, and Missouri have imposed burdensome and unnecessary clinic requirements on abortion providers. In each case, the legislators or regulators designed the requirements to make abortions more difficult to obtain. Mississippi, a state with only two licensed abortion clinics, already had restrictive abortion laws. In August 1996, it implemented stringent regulations on private physicians who provide abortion services in their offices. Some requirements include purchasing specific equipment, widening hallways, and hiring more staff. Several physicians have filed a lawsuit to stop enforcement of the regulations because they make the provision of abortion services so cumbersome and expensive as to discourage physicians from offering abortions. Antiabortion groups testified before the legislature that the Department of Health had been negligent in monitoring private practices for compliance with Mississippi's many abortion laws, particularly counseling requirements. The Republican governor signed the legislation in March 1996. In July 1996, a federal judge prohibited the South Carolina Department of Health from enforcing a new regulation making physicians who perform as few as five abortions a month to meet strict specifications for their office (e.g., disclosure of patient records and medical agreements). The regulation was a response to a 1995 law targeting private physicians who perform abortions in their offices. The judge held that the substantial changes in terms of privacy and expense could bring an undue burden on women seeking abortions. The state denied that the regulation would close clinics or would increase costs so much as to make abortions inaccessible. In September 1996, the House did not override the Democratic governor's veto of a bill that would have required all facilities where abortions are done to be licensed and undergo annual inspections and that would have required all physicians to have
showed that nurses were among the last people they would consider consulting about personal difficulties. Although fewer than 10% of women have serious psychiatric problems following an abortion, it is a stressful event for all who undergo it, and nurses can offer several types of assistance, including offering support and helping the patient to explore her feelings and reactions and to make firm decisions. Nurses should provide patients with all needed information on the procedure and subsequent contraception, and they should make themselves available after the procedure.
This piece describes abortion practices in use from the 1600s to the 19th century among the inhabitants of North America. The abortive techniques of women from different ethnic and racial groups as found in historical literature are revealed. Thus, the point is made that abortion is not simply a "now issue" that effects select women. Instead, it is demonstrated that it is a widespread practice as solidly rooted in our past as it is in the present.
Comer, S D; Ashworth, J B; Foltin, R W; Johanson, C E; Zacny, J P; Walsh, S L
The purpose of this review is to illustrate the utility and value of employing human self-administration procedures in medication development, including abuse liability assessments of novel medications and evaluation of potential pharmacotherapies for substance use disorders. Traditionally, human abuse liability testing has relied primarily on subjective reports describing drug action by use of questionnaires; similarly, drug interactions between putative treatment agents and the drugs of abuse have relied on these measures. Subjective reports are highly valued because they provide qualitative and quantitative information about the characteristics of central and peripheral pharmacodynamic effects as well as safety and tolerability. However, self-administration procedures directly examine the behavior of interest-that is, drug taking. The present paper (1) reviews the most commonly used human self-administration procedures, (2) discusses the concordance of subjective reports and self-administration within the context of medications development for substance use disorders, focusing primarily on illustrative examples from development efforts with opioid and cocaine dependence, and (3) explores the utility of applying self-administration procedures to assess the abuse liability of novel compounds, including "abuse-deterrent" formulations (ADFs). The review will focus on opioid and cocaine dependence because a rich database from both clinical laboratory and clinical trial research exists for these two drug classes. The data reviewed suggest that drug-induced changes in self-administration and subjective effects are not always concordant. Therefore, assessment of self-administration in combination with subjective effects provides a more comprehensive picture that may have improved predictive validity for translating to the clinical setting.
Comer, SD; Ashworth, JB; Foltin, RW; Johanson, CE; Zacny, JP; Walsh, SL
The purpose of this review is to illustrate the utility and value of employing human self-administration procedures in medication development, including abuse liability assessments of novel medications and evaluation of potential pharmacotherapies for substance use disorders. Traditionally, human abuse liability testing has relied primarily on subjective reports describing drug action by use of questionnaires; similarly, drug interactions between putative treatment agents and the drugs of abuse have relied on these measures. Subjective reports are highly valued because they provide qualitative and quantitative information about the characteristics of central and peripheral pharmacodynamic effects as well as safety and tolerability. However, self-administration procedures directly examine the behavior of interest – that is, drug taking. The present paper 1) reviews the most commonly used human self-administration procedures, 2) discusses the concordance of subjective reports and self-administration within the context of medications development for substance use disorders, focusing primarily on illustrative examples from development efforts with opioid and cocaine dependence, and 3) explores the utility of applying self-administration procedures to assess the abuse liability of novel compounds, including “abuse deterrent” formulations (ADFs). The review will focus on opioid and cocaine dependence because a rich database from both clinical laboratory and clinical trial research exists for these two drug classes. The data reviewed suggest that drug-induced changes in self-administration and subjective effects are not always concordant. Therefore, assessment of self-administration in combination with subjective effects provides a more comprehensive picture that may have improved predictive validity for translating to the clinical setting. PMID:18436394
Medical abortion using methotrexate and misoprostol and manual vacuum aspiration are two new methods for pregnancy termination during the first 8 weeks of gestation. Compared to the regimen of mifepristone (RU 486) and misoprostol, both methods offer high rates of complete abortion and acceptability to users. Limitations of the new two-drug regimen compared with mifepristone include a longer time to effect abortion, transient gastrointestinal side effects, and risk of potential teratogenicity from methotrexate's cytotoxicity. Compared to standard surgical abortion, both methods allow women to avoid surgery, are more privately performed, and may be more easily accessible. The safety of first-trimester abortion provided by nurse practitioners and physician assistants has been established. Whether midwives and either new method to their practices depends on several factors. These include obtaining appropriate training, overcoming legal restrictions, and meeting professional and personal challenges inherent in providing early abortion care.
Devine, P E
The introduction to this essay, which presents and defends the "conservative" position on abortion, explains that this position holds that 1) abortion is wrong because it destroys the fetus; 2) the fetus has full personhood from conception (or very near conception); 3) abortion is only justified under special circumstances, such as when the pregnancy poses a threat to the woman's life; and 4) these conclusions should be reflected in law and public policy. Part 2 sets forth the moral foundations for this position. The third part considers the status of the fetus and reviews the various arguments that have been forwarded to resolve the question, such as the species principle, the potentiality principle, the sentience principle, and the conventionalist principle. Part 4 applies the conservative position to problems posed by hard cases, determines that abortion is a form of homicide from two weeks after fertilization (at the latest), reviews circumstances in which various legal definitions of homicide are applicable, argues for the denial of abortion funding by the state, and notes that violent militancy is not the appropriate response to a belief that abortion should be illegal. Section 5 refutes objections to the conservative position based on the fact that some opponents of abortion also oppose contraception, based on feminist ideals, and based on calls for religious freedom in a pluralistic society. In conclusion, the labels applied to the abortion debate are examined, and it is suggested that "communitarian" is the best term for the conservative position.
Responses to the question as to whether abortions should be performed at the woman's request during the first trimester of pregnancy were evenly divided. There was support for abortion on socioeconomic grounds, during the first trimester, from 61.5% of the respondents. Termination of pregnancy beyond the first trimester was supported by a majority of the respondents only in cases in which the woman's life is in danger (73.9%) or in which there is evidence of a severe physical abnormality in the fetus (70.6%) or in cases in which the woman's physical health is in danger (55.5%). Those who said they would not support abortion under any circumstances constitute, at most, 5.1% of the respondents. Support for the maintenance or the elimination of therapeutic abortion committees was addressed in two questions and in both cases the respondents were evenly divided. The responses to these two questions were compared and found to be logically consistent. Only physicians should perform abortions, and they should be performed in hospitals with the woman either as an inpatient or, during the first trimester, as an outpatient. The performance of first-trimester abortions in provincially approved abortion clinics was supported by 47.3% of the respondents. Of the 885 respondents who wished to see some amendment to the Criminal Code, 409 stated that the term "health" as used in the Criminal Code relative to the legal grounds for therapeutic abortion should be defined. PMID:6861064
South Africa's National Assembly voted 209 to 87 for passage of the "Choice on Termination of Pregnancy Act" on October 30; it was passed in the Senate, 49 to 21 (20 abstentions), on November 5. The African National Congress strongly supported the Act, while the National Party opposed it. Under the law, abortions during the first 12 weeks of pregnancy may to be performed by physicians or trained midwives. From week 13 through week 20, a physician, in consultation with the mother, may terminate the pregnancy after determining that continuing the pregnancy would threaten the woman's health (physical or mental) or circumstances (social or economic), or that the fetus is at substantial risk of suffering severe physical or mental abnormalities. Abortion is permitted after 20 weeks if two doctors (or midwives) decide continuing the pregnancy would endanger the mother's life or result in injury or severe malformation of the fetus. Only the pregnant woman's consent is required. Although an abortion provider must advise a young client to consult with parents, guardian, family members, or friends before the procedure, she is not required to comply. All women are to be informed of their rights under the Act; criminal penalties (up to 10 years) are mandated for unauthorized abortion providers, for persons who prevent a lawful abortion, or for those who obstruct access to an abortion facility. The new statute repeals the more restrictive Abortion and Sterilization Act of 1975, which permitted abortion only in cases of maternal life or health endangerment, severe fetal abnormality, rape, incest, or mental incapacity.
Jain, J K; Mishell, D R
The authors conducted a study to determine whether the intracervical placement of laminaria tents would improve the effectiveness of the prostaglandin analog misoprostol for the elective termination of pregnancies in the second trimester. 68 women at 12-22 weeks of gestation with either an intrauterine fetal death or medical or genetic indications for pregnancy termination were randomized to receive 200 mcg of misoprostol administered vaginally every 12 hours with or without the intracervical placement of laminaria concurrently with the first dose of misoprostol. There was a 69.7% rate of abortion 24 hours after the initiation of treatment in the 33 women who received misoprostol alone and 68.6% in the 35 women treated with both misoprostol and laminaria. Abortion rates 48 hours after the initiation of treatment were 84.8% and 91.4%, respectively, an insignificant difference. The complete abortion rate was 39.3% among women who received misoprostol alone and 37.5% among women who received both misoprostol and laminaria. There were no significant differences between the two groups in the incidence of fever, vomiting, diarrhea, or pain. The mean interval from the initiation of treatment to abortion was 15.7 hours among women who received misoprostol alone and 17.4 hours among women who received both misoprostol and laminaria. In both groups, women who had live fetuses at the start of the procedure had a higher failure rate of abortion and a longer time interval to abortion than women whose fetus was dead. These findings indicate that the insertion of laminaria tents concurrent with the first dose of misoprostol does not significantly improve the abortifacient effect of vaginal misoprostol during the second trimester of pregnancy.
Between February 2012 and March 2015, the claim that sex selection abortion was taking place in Britain and that action needed to be taken to stop it dominated debate in Britain about abortion. Situating an analysis in sociological and social psychological approaches to the construction of social problems, particularly those considering “feminised” re-framings of anti-abortion arguments, this paper presents an account of this debate. Based on analysis of media coverage, Parliamentary debate and official documents, we focus on claims about grounds (evidence) made to sustain the case that sex selection abortion is a British social problem and highlight how abortion was problematised in new ways. Perhaps most notable, we argue, was the level of largely unchallenged vilification of abortion doctors and providers, on the grounds that they are both law violators and participants in acts of discrimination and violence against women, especially those of Asian heritage. We draw attention to the role of claims made by feminists in the media and in Parliament about “gendercide” as part of this process and argue that those supportive of access to abortion need to critically assess both this aspect of the events and also consider arguments about the problems of “medical power” in the light of what took place. PMID:28367000
Maternowska, M Catherine; Mashu, Alexio; Moyo, Precious; Withers, Mellissa; Chipato, Tsungai
In Zimbabwe, abortions are legally restricted and complications from unsafe abortions are a major public health concern. This study in 2012 explored women's and providers' perspectives in Zimbabwe on the acceptability of the use of misoprostol as a form of treatment for complications of abortion in post-abortion care. In-depth interviews were conducted with 115 participants at seven post-abortion care facilities. Participants included 73 women of reproductive age who received services for incomplete abortion and 42 providers, including physicians, nurses, midwives, general practitioners and casualty staff. Only 29 providers had previously used misoprostol with their own patients, and only 21 had received any formal training in its use. Nearly all women and providers preferred misoprostol to surgical abortion methods because it was perceived as less invasive, safer and more affordable. Women also generally preferred the non-surgical method, when given the option, as fears around surgery and risk were high. Most providers favoured removing legal restrictions on abortion, particularly medical abortion. Approving use of misoprostol for post-abortion care in Zimbabwe is important in order to reduce unsafe abortion and its related sequelae. Legal, policy and practice reforms must be accompanied by effective reproductive health curricula updates in medical, nursing and midwifery schools, as well as through updated training for current and potential providers of post-abortion care services nationwide. Our findings support the use of misoprostol in national post-abortion care programmes, as it is an acceptable and potentially life-saving treatment option.
Porto, Thaisy Mendes; Machado, Daniele Caferatti; Martins, Rafael Olívio; Galato, Dayani; Piovezan, Anna Paula
Background Locus of pain control (LPC) is characterized by the behavior of people coping with their health problems, as a result of their own actions (internal control) or external factors or other people (external control). This parameter can be associated with medication adherence, in addition to other psychosocial factors that may also influence this behavior. This study was performed to investigate the influence of the LPC on medication adherence in patients undergoing an orthopedic procedure. Subjects and methods We conducted a prospective cohort study on patients who attended an orthopedic clinic for arthroscopy treatment. The patients’ LPC and pain intensity data were obtained on the day of admission through the use of the LPC scale and the visual analog scale (VAS), respectively, both being validated tools. After arthroscopic surgery, the patients received drug prescriptions and were reassessed after 15 days regarding treatment adherence, using the Morisky test. A P-value <0.05 was considered statistically significant. Results We assessed 79 individuals from both the internal LPC group (n=35) and external LPC group (n=44) and found that there were no group differences in sex, affected limb, cause of injury, repetitive strain injury, duration of pain, or pain intensity. However, there was a higher proportion of patients in the external LPC group that adhered to the prescribed medication compared with the internal LPC group (P<0.01). Conclusion The results showed that among patients who underwent an orthopedic procedure, there was a higher adherence rate to prescribed medication in the external LPC group compared with the internal LPC group. PMID:25075178
Cook, R J; Dickens, B M
Modern thinking on abortion, reflected in recent legal developments around the world, has turned from concentration upon criminality in favor of female and family well-being. New laws enacted during the last decade are coming to focus upon conditions of health and social welfare of women and their existing families as indications for lawful termination of pregnancy. Regulations governing the delivery of services may be restrictive, however, so as to limit in practice access to means of safe, legal abortion made available in theory. Requirements may be imposed that only medical personnel with unduly high qualifications perform procedures, or that they be undertaken only in institutions meeting standards higher than similar health care requires. Approval procedures may be established involving second medical opinions or committees to monitor observance of the law, which may delay abortions and therefore increase their hazards. Parental and spousal consent requirements may exist in addition with the same effects, or to veto a pregnant female's request. Regulations may be employed more positively, however, to encourage contraceptive practice. A disappointment with legislative reform is that it may fail to improve circumstances if public resources are not applied to achieve the supply of services newly rendered legitimate, and illegal practice may persist. PMID:665881
Pillai Riddell, Rebecca R.; Khan, Maria; Calic, Masa; Taddio, Anna; Tablon, Paula
Objective To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children. Methods A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0–18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review. Results 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented. Conclusions Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factors. PMID:26338981
Nathanson, Bernard; Lawrence, George
Two physicians debate whether abortions should be available on request regardless of medical indications. The crux of the issue is whether the fetus should be considered body tissue over which the woman has complete control or whether society has an interest in the embryo and should protect it. (Author/BY)
Fuentes, Liza; Grossman, Daniel; White, Kari; Keefe-Oates, Brianna; Baum, Sarah E.; Hopkins, Kristine; Stolp, Chandler W.; Potter, Joseph E.
Objectives. To evaluate the additional burdens experienced by Texas abortion patients whose nearest in-state clinic was one of more than half of facilities providing abortion that had closed after the introduction of House Bill 2 in 2013. Methods. In mid-2014, we surveyed Texas-resident women seeking abortions in 10 Texas facilities (n = 398), including both Planned Parenthood–affiliated clinics and independent providers that performed more than 1500 abortions in 2013 and provided procedures up to a gestational age of at least 14 weeks from last menstrual period. We compared indicators of burden for women whose nearest clinic in 2013 closed and those whose nearest clinic remained open. Results. For women whose nearest clinic closed (38%), the mean one-way distance traveled was 85 miles, compared with 22 miles for women whose nearest clinic remained open (P ≤ .001). After adjustment, more women whose nearest clinic closed traveled more than 50 miles (44% vs 10%), had out-of-pocket expenses greater than $100 (32% vs 20%), had a frustrated demand for medication abortion (37% vs 22%), and reported that it was somewhat or very hard to get to the clinic (36% vs 18%; P < .05). Conclusions. Clinic closures after House Bill 2 resulted in significant burdens for women able to obtain care. PMID:26985603
... Kasich signed a bill banning abortions after 20 weeks. The ban is similar to what 15 states ... in their pregnancy that was within the two weeks of a facility's cutoff for doing the procedure ( ...
José Barzelatto first distinguished himself as a leader with a vision in his years as a medical student. Later, principally as Director of the Reproductive Health Program at the World Health Organization and of the Ford Foundation program for women's sexual and reproductive rights, he contributed immensely toward the recognition of women's sexual and reproductive rights as part of their basic human rights. José Barzelatto's vision on abortion reflects his drive to promote social justice and respect individual rights, respect diversity, and promote a social consensus for a peaceful society. He believed that the fetus has moral value and did not accept abortion as a method of fertility control, but understood that abortion is a social phenomenon that cannot be changed with legal or moral condemnation. He accepted that condemning women who abort does not prevent abortion, is unfair, and causes great human suffering at a high social cost. José proposed nine points to form the basis for an overlapping consensus on abortion, on which to base a practical consensus that would allow societies to reduce the number of abortions and minimize their consequences. If we can agree on all or most of those points we would achieve the common objectives of: fewer women confronting the dilemma of how to deal with an unwanted pregnancy; fewer induced abortions; and fewer women suffering the consequences of unsafe abortion.
Vučemilo, Luka; Borovečki, Ana
Background High quality of informed consent form is essential for adequate information transfer between physicians and patients. Current status of medical procedure consent forms in clinical practice in Croatia specifically in terms of the readability and the content is unknown. The aim of this study was to assess the readability and the content of informed consent forms for diagnostic and therapeutic procedures used with patients in Croatia. Methods 52 informed consent forms from six Croatian hospitals on the secondary and tertiary health-care level were tested for reading difficulty using Simple Measure of Gobbledygook (SMOG) formula adjusted for Croatian language and for qualitative analysis of the content. Results The averaged SMOG grade of analyzed informed consent forms was 13.25 (SD 1.59, range 10–19). Content analysis revealed that informed consent forms included description of risks in 96% of the cases, benefits in 81%, description of procedures in 78%, alternatives in 52%, risks and benefits of alternatives in 17% and risks and benefits of not receiving treatment or undergoing procedures in 13%. Conclusions Readability of evaluated informed consent forms is not appropriate for the general population in Croatia. The content of the forms failed to include in high proportion of the cases description of alternatives, risks and benefits of alternatives, as well as risks and benefits of not receiving treatments or undergoing procedures. Data obtained from this research could help in development and improvement of informed consent forms in Croatia especially now when Croatian hospitals are undergoing the process of accreditation. PMID:26376183
Martins, I R; Costa, S H; Freitas, S R; Pinto, C S
This paper examines the practice of abortion, especially induced abortion among low income women. The discussion is based on survey data collected between 1984 and 1985 in seven slum communities (favelas) situated in the metropolitan area of Rio de Janeiro, Brazil. Despite restrictive law, induced abortion is extremely frequent. Among married women 21.4 per cent reported experience of induced abortion. Most abortions were performed by physicians, however the quality of care of these procedures can be questioned since almost all induced abortions are illegal there is no possible supervision by health authorities. The incidence of post-abortion complication is very high, especially for those performed by traditional midwifes or by the woman herself. More than 60 per cent of the women were not using contraception at the time of pregnancy. About, 21 per cent reported that they were using the pill. Such a high pill failure rate is inacceptable, and probably was related to incorrect use. This points to the need for a better access to family planning care within the health services. The consequences of the restrictive abortion laws in Brazil are also discussed. Restrictions that in practice prove to have little impact on the practice of induced abortion, appear to be very effective in brooding even more the social-economic inequalities.
Teles, Pedro; Carmen de Sousa, M; Paulo, Graciano; Santos, Joana; Pascoal, Ana; Cardoso, Gabriela; Lança, Isabel; Matela, Nuno; Janeiro, Luís; Sousa, Patrick; Carvoeiras, Pedro; Parafita, Rui; Santos, Ana Isabel; Simãozinho, Paula; Vaz, Pedro
In a wide range of medical fields, technological advancements have led to an increase in the average collective dose in national populations worldwide. Periodic estimations of the average collective population dose due to medical exposure is, therefore of utmost importance, and is now mandatory in countries within the European Union (article 12 of EURATOM directive 97/43). Presented in this work is a report on the estimation of the collective dose in the Portuguese population due to nuclear medicine diagnostic procedures and the Top 20 diagnostic radiology examinations, which represent the 20 exams that contribute the most to the total collective dose in diagnostic radiology and interventional procedures in Europe. This work involved the collaboration of a multidisciplinary taskforce comprising representatives of all major Portuguese stakeholders (universities, research institutions, public and private healthcare providers, administrative services of the National Healthcare System, scientific and professional associations and private service providers). This allowed us to gather a comprehensive amount of data necessary for a robust estimation of the collective effective dose to the Portuguese population. The methodology used for data collection and dose estimation was based on European Commission recommendations, as this work was performed in the framework of the European wide Dose Datamed II project. This is the first study estimating the collective dose for the population in Portugal, considering such a wide national coverage and range of procedures and consisting of important baseline reference data. The taskforce intends to continue developing periodic collective dose estimations in the future. The estimated annual average effective dose for the Portuguese population was of 0.080±0.017 mSv caput(-1) for nuclear medicine exams and of 0.96±0.68 mSv caput(-1) for the Top 20 diagnostic radiology exams.
Faúndes, Aníbal; Duarte, Graciana Alves; de Sousa, Maria Helena; Soares Camargo, Rodrigo Paupério; Pacagnella, Rodolfo Carvalho
Unsafe abortions remain a major public health problem in countries with very restrictive abortion laws. In Brazil, parliamentarians - who have the power to change the law - are influenced by "public opinion", often obtained through surveys and opinion polls. This paper presents the findings from two studies. One was carried out in February-December 2010 among 1,660 public servants and the other in February-July 2011 with 874 medical students from three medical schools, both in São Paulo State, Brazil. Both groups of respondents were asked two sets of questions to obtain their opinion about abortion: 1) under which circumstances abortion should be permitted by law, and 2) whether or not women in general and women they knew who had had an abortion should be punished with prison, as Brazilian law mandates. The differences in their answers were enormous: the majority of respondents were against putting women who have had abortions in prison. Almost 60% of civil servants and 25% of medical students knew at least one woman who had had an illegal abortion; 85% of medical students and 83% of civil servants thought this person(s) should not be jailed. Brazilian parliamentarians who are currently reviewing a reform in the Penal Code need to have this information urgently.
Hanada, Eisuke; Takano, Kyoko; Antoku, Yasuaki; Matsumura, Kouji; Watanabe, Yoshiaki; Nose, Yoshiaki
Problems involving electromagnetic interference (EMI) with electronic medical equipment are well-documented. However, no systematic investigation of EMI has been done. We have systematically investigated the causes of EMI. The factors involved in EMI were determined as follows: 1) Electric-field intensity induced by invasive radio waves from outside a hospital. 2) Residual magnetic-flux density at welding points in a building. 3) Electric-field intensity induced by conveyance systems with a linear motor. 4) The shielding capacity of hospital walls. 5) The shielding capacity of commercial shields against a wide range frequency radio waves. 6) The immunity of electronic medical equipment. 7) EMI by cellular telephone and personal handy-phone system handsets. From the results of our investigation, we developed a following practical procedure to prevent EMI. 1) Measurement of electric-field intensity induced by invasive radio waves from outside the hospital and industrial systems in the hospital. 2) Measurement of residual magnetic-flux density at electric welding points of hospital buildings with steel frame structures. 3) Control of the electromagnetic environment by utilizing the shielding capacity of walls. 4) Measurement of the immunity of electronic medical equipment. And 5) Installation of electronic gate equipment at the building entrance to screen for handsets.
Burgun, Anita; Denier, Patrick; Bodenreider, Olivier; Botti, Geneviève; Delamarre, Denis; Pouliquen, Bruno; Oberlin, Philippe; Lévéque, Jean M.; Lukacs, Bertrand; Kohler, François; Fieschi, Marius; Le Beux, Pierre
Abstract The Model for Assistance in the Orientation of a User within Coding Systems (MAOUSSC) project has been designed to provide a representation for medical and surgical procedures that allows several applications to be developed from several viewpoints. It is based on a conceptual model, a controlled set of terms, and Web server development. The design includes the UMLS knowledge sources associated with additional knowledge about medico-surgical procedures. The model was implemented using a relational database. The authors developed a complete interface for the Web presentation, with the intermediary layer being written in PERL. The server has been used for the representation of medico-surgical procedures that occur in the discharge summaries of the national survey of hospital activities that is performed by the French Health Statistics Agency in order to produce inpatient profiles. The authors describe the current status of the MAOUSSC server and discuss their interest in using such a server to assist in the coordination of terminology tasks and in the sharing of controlled terminologies. PMID:9292841
An argument is made for applying the principles of evolutionary biology to abortion behavior, based on the idea that long-lasting behavior (including ethical behavior) has a positive selective value which theoretically can be translated into population numbers. The approach verges on utilitarianism; it is argued that such an approach could reduce or avoid the emotionality and subjectivity of arguments for and against induced abortion. Actual application of evolutionary biology principles is limited by the rudimentary present state of behavioral science.
Statistics on legal abortion in Britain between 1968-1974 are presented. There was a mortality rate of 10+ or -2 per 100,000 abortions: 27+ or -11 in 1968-1969, 12+ or -4 in 1970-1972, and 6+ or -3 in 1973-1974. Legal abortion mortality increased from 4+ or -3 when performed at gestation under 9 weeks to 5+ or -2 at 9-12 weeks, 13+ or -7 at 13-16 weeks, and 62+ or -33 at 17 weeks and over. The ratio was 11+ or -6 for women under 20 years of age, increasing to 5+ or -3 at age 20-29, 10+ or -6 at age 30-39, and 23+ or -19 at age 40 and over. The parity had little influence on abortion mortality, but the technique used had a great influence. Hysterotomy, hypertonic saline, and abortifacient paste were the most dangerous, in increasing order, with mortality rates of 39+ or -30, 106+ or -75, and 152+ or -89, respectively. The rates for aspiration and curretage were 4+ or -2 and 4+ or -3, respectively. There was a higher mortality risk with abortion with sterilization. The main causes of legal abortion mortality were infection, pulmonary embolism, and complications of general anesthesia. The high incidence of mortality associated with legal abortion in Britain is partially caused by: 1) high incidence of concurrent sterilization, 2) former use of dangerous techniques, 3) significant incidence of second trimester abortion, 4) routine use of general anesthesia, and 5) previous ill health of some of the women.
Based on available evidence, this review article posits that contemporary use of abortion in sub-Saharan Africa often substitutes for and sometimes surpasses modern contraceptive practice. Some studies and some data sets indicate that this occurs not only among adolescents but also within older age groups. In several sub-Saharan cities, particularly where contraceptive use is low and access to clinical abortion is high (though largely illegal), abortion appears to be the method of choice for limiting or spacing births. Even in rural areas, women may regularly resort to abortion, often using extremely unsafe procedures, instead of contraception. Available data seem to indicate that relatively high levels of abortion correlate with low access to modern contraception, low status of women, strong sanctions against out-of-wedlock pregnancy, traditional tolerance of abortion, and availability of modern abortion practices. Abortion has been and will likely continue to be used to plan families within much of sub-Saharan Africa.
Guedes, A C
Abortion is illegal in Brazil except when performed to save the woman's life or in cases of rape. This paper gives a brief history of parliamentary and extra-parliamentary efforts to change abortion-related legislation in Brazil in the past 60 years, the contents of some of the 53 bills that have been tabled in that time, the non-governmental stakeholders involved and the debate itself in recent decades. The authorities in Brazil have never assumed full public responsibility for reproductive health care or family planning, let alone legal abortion; the ambivalence of the medical profession is an important obstacle. Most politicians avoid getting involved in the abortion debate, but the majority of bills in the 1990s have favoured less restrictive legislation. Incremental legislative and health service changes could help to improve the situation for women. Advocacy is probably the most important action, to promote an environment conducive to change. Clandestine abortion is a serious public health problem in Brazil, and the inadequacy of family planning services is one of the causes of this problem. The solutions should be made a priority for the Brazilian public health system.
Wiebe, E.; Janssen, P.
OBJECTIVE: To describe women's experiences with expectant management of spontaneous abortions. DESIGN: Descriptive survey using questionnaires with fixed-choice and open-ended questions. The latter were analyzed for themes, using qualitative methods. SETTING: Urban and suburban private primary care family practices. PARTICIPANTS: A convenience sample of family practice patients (59 of 80 eligible) pregnant for less than 12 weeks who had spontaneous abortions without surgery. Response rate was 84.7%; 50 questionnaires were received from the 59 women. METHOD: Women were asked about their physical experiences, including amount of pain and bleeding; emotional effects; their satisfaction with medical care; and their suggestions for improving care. MAIN FINDINGS: The mean worst pain experienced during a spontaneous abortion on an 11-point scale was 5.9. Bleeding varied, but was often very heavy. Satisfaction rate was 92.9% with family physician care and 84.6% with hospital care. Women described the emotional effect of "natural" spontaneous abortions and made recommendations for improving care. CONCLUSIONS: A better understanding of the physical and emotional experiences of the women in this study might help physicians better prepare and support patients coping with expectant management of spontaneous abortions. PMID:10540695
Sumner, L W
This essay offers a moderate view of abortion that imposes a time limit for unrestricted abortion and specific indications for later abortions. The introduction notes that the discussion will provide a defense for this policy based on a moral analysis but that other options for moderates, especially options provided by freestanding views (the defense of which does not rest on any prior commitment about the morality of abortion), will also be considered. The next section considers the moral status of the fetus grounded in a criterion of moral standing that stipulates the necessary characteristics to achieve moral standing. This discussion concludes that a fetus acquires moral standing only when it becomes sentient. Section 3 moves the argument from ethics to politics to prove that a moderate policy must place no limitations on abortion before the time the fetus becomes sentient because before that time the fetus has no interest for the state to protect. The final section notes that some pro-choice advocates may be happier with the moderate policy proposed than with its controversial defense based on the moral status of the fetus and that another defense of a moderate policy could be based on a finding that the ethical issue can not be decided and that no view about abortion ethics is more reasonable than any other. The essay concludes that the ethical debate is ultimately unavoidable.
Shepard, Bonnie L; Casas Becerra, Lidia
Abortion is not legal in Chile even to save the woman's life or health. This situation creates serious dilemmas and vulnerabilities for both women and medical practitioners. Abortion incidence has probably decreased since 1990, when data were last studied, due to increased use of contraception and lower fertility, and deaths and complication rates have fallen as well. Misoprostol is available, but Chilean hospitals are still using D&C for incomplete abortions. Although Chilean medical professionals should by law report illegal abortions to the authorities, less than 1% of women in hospital with abortion complications are reported. There are two loopholes, one legal, one clinical. "Interruption of pregnancy" after 22 weeks of pregnancy is legal for medical reasons; this may save some women's lives but can also force prolongation of health-threatening pregnancies. Catholic clinical guidelines define interventions solely aimed at saving the woman's life, even if the fetus dies, not as abortion but "indirect abortion" and permissible. Since 1989, three bills to liberalise the law on therapeutic grounds have been unsuccessful. The political climate is not favourable to changing the law. Conservatives have also not succeeded in making the law more punitive, while the governing centre-left coalition is divided and the associated political risks are considerable.
In both the Republic of Ireland and the North of Ireland, it is impossible to obtain a legal abortion unless the life of the mother would otherwise be lost. Thus, an estimated 10-12,000 women travel from Ireland to England each year to have an abortion. These women can receive support from the Irish Women's Abortion Support Group (IWASG) which is made up of volunteer women who are Irish or of Irish descent. The IWASG provides accommodations, emotional and practical support, and information about how to obtain an abortion in the UK. It makes appointments, negotiates fees, and monitors services offered. The group can also provide financial assistance to women in need. IWASG liaises with pro-choice groups in Ireland, such as the underground Women's Information Network (WIN), which has branches in Dublin, Galway, and Cork. WIN provides confidential, nondirective counseling to women in need. Abortion is a very difficult choice for Irish women because of the legal strictures and because of the guilt which often results from government and religious propaganda. The prospect of finding their way around London is often as daunting to the Irish women as the procedure itself, and many of the women travel to England absolutely alone with no one at home even aware of what they are doing. IWASG is seeking new members to help them support these women. For information, write IWASG, 52 Featherstone Street, London ECIY 8RT.
This paper characterizes the Mexican abortion laws using the case of a girl aged 14 years, Paulina Ramirez Jacinta, who was raped, became pregnant, and chose to terminate the unwanted pregnancy, yet was denied an abortion. This case clearly showed that Mexican abortion law, despite its legality, is highly restrictive in nature and, in a way, violated the human rights of Paulina. Even though it permits first-trimester abortion procedures for rape victims or women whose lives are endangered by the pregnancy, many pregnant women still resort to illegal abortion. To further aggravate the restrictive nature of the law, Baja California state Rep. Martin Dominguez Rocha made a proposal to eliminate the rape exception in the state's penal code. The case of Paulina will be handled by the lawyers at the Center for Reproductive Law and Policy in order to arrive at a settlement favorable to Paulina.
Carinou, E; Ferrari, P; Koukorava, C; Krim, S; Struelens, L
There are many factors that can influence the extremity and eye lens doses of the medical staff during interventional radiology and cardiology procedures. Numerical simulations can play an important role in evaluating extremity and eye lens doses in correlation with many different parameters. In the present study, the first results of the ORAMED (Optimisation of Radiation protection of MEDical staff) simulation campaign are presented. The parameters investigated for their influence on eye lens, hand, wrist and leg doses are: tube voltage, filtration, beam projection, field size and irradiated part of the patient's body. The tube voltage ranged from 60 to 110 kV(p), filtration from 3 to 6 mm Al and from 0 to 0.9 mm Cu. For all projections, the results showed that doses received by the operator decreased with increasing tube voltage and filtration. The magnitude of the influence of the tube voltage and the filtration on the doses depends on the beam projection and the irradiated part of the patient's body. Finally, the influence of the field size is significant in decreasing the doses.
Cook, R J; Dickens, B M
International developments in abortion laws have been diverse, but the general thrust of legislation and court decisions has been towards decriminalization and liberalization of laws and the reduction of legal barriers to access to therapuetic abortion services presented by spousal and parental authorization requirements. Most legislation has extended abortion eligibility through traditional indications such as danger to maternal health or fetal handicap, but other indications have also been created, such as adolescence, advanced maternal age, family circumstances and Acquired Immunodeficiency Syndrome or Human Immunodeficiency Virus infection. Several jurisdictions established stages of early gestation within which abortion could be undertaken with minimal legal scrutiny. In Canada, the entire prohibition of abortion was held unconstitutional for violating women's integrity and security. Under medical and public health guidance, several countries have amended their constitutions to recognize and protect human life from contraception. Cyprus, Italy, and Taiwan have created an indication for abortion of welfare of the women's family, while France and the Netherlands recognize the women's distress and Hungary cites cases where the women is single or separated for 6 months, where appropriate housing is lacking or where she is 35 years or older and has had 3 deliveries. National health services and insurance schemes vary in their coverage of abortion costs, but generally tend to fund the major park of lawful services. In Britain, France, Israel, the US and Yugoslavia husband's claims to veto abortions have been rejected. Courts have also established that mature adolescents, although legally minors, may give autonomous consent to abortion and are entitled to confidentiality. Few countries' laws define when criminal abortion liability commences or when conception occurs, but the law has moved to restrict abortion in Israel, Honduras, Romania and Finland.
Karlsson, Katarina; Englund, Ann-Charlotte Dalheim; Enskär, Karin; Rydström, Ingela
When children endure needle-related medical procedures (NRMPs), different emotions arise for the child and his/her parents. Despite the parents’ own feelings, they have a key role in supporting their child through these procedures. The aim of this study is to describe the meanings of supporting children during NRMPs from the perspective of the parents. Twenty-one parents participated in this study. A reflective lifeworld research (RLR) approach was used and phenomenological analysis was applied. The essential meaning of the phenomenon—supporting children during an NRMP—is characterized as “keeping the child under the protection of one’s wings,” sometimes very close and sometimes a little further out under the wingtips. The essential meaning is additionally described through its constituents: paying attention to the child’s way of expressing itself, striving to maintain control, facilitating the child’s understanding, focusing the child’s attention, seeking additional support, and rewarding the child. The conclusion is that parents’ ability to be supportive can be affected when seeing their child undergo an NRMP. To regain the role as the child’s protector and to be able to keep the child “under the protection of one’s wings,” parents need support from the staff. PMID:25008196
Karlsson, Katarina; Englund, Ann-Charlotte Dalheim; Enskär, Karin; Rydström, Ingela
When children endure needle-related medical procedures (NRMPs), different emotions arise for the child and his/her parents. Despite the parents' own feelings, they have a key role in supporting their child through these procedures. The aim of this study is to describe the meanings of supporting children during NRMPs from the perspective of the parents. Twenty-one parents participated in this study. A reflective lifeworld research (RLR) approach was used and phenomenological analysis was applied. The essential meaning of the phenomenon-supporting children during an NRMP-is characterized as "keeping the child under the protection of one's wings," sometimes very close and sometimes a little further out under the wingtips. The essential meaning is additionally described through its constituents: paying attention to the child's way of expressing itself, striving to maintain control, facilitating the child's understanding, focusing the child's attention, seeking additional support, and rewarding the child. The conclusion is that parents' ability to be supportive can be affected when seeing their child undergo an NRMP. To regain the role as the child's protector and to be able to keep the child "under the protection of one's wings," parents need support from the staff.
Consedine, Nathan S; Windsor, John A
Mismatches between the needs of public health systems and student interests have led to renewed study on the factors predicting career specializations among medical students. While most work examines career and lifestyle values, emotional proclivities may be important; disgust sensitivity may help explain preferences for careers with greater and lesser degrees of procedural content. In the study, 294 students completed measures assessing: (1) demographics, (2) career interest or intention regarding emergency medicine, internal medicine, obstetrics/gynecology, and pediatric medicine, (3) traditional determinants of career intention/interest, and (4) core/bodily product, animal reminder, contamination, and sexual/moral disgust sensitivity. As predicted, logistic regressions controlling for demographics and traditional career predictors, showed that greater animal reminder disgust predicted reduced interest in emergency medicine but greater interest in pediatric medicine. Conversely, greater core/bodily product disgust predicted lower interest in obstetrics/gynecology and pediatric medicine; greater contamination and sexual/moral disgust both predicted increased odds of interest in internal medicine. Overall, specific disgust sensitivities were the best predictors of specialization intention in multivariate models. Specific disgust sensitivities appear to differentially deter and/or predispose self-selection into specific trajectories varying in procedural content. Such findings may permit the early identification of specialty fit and provide guidance in career counseling.
Jensen, Brock; Burkart, Rebecca; Levis, Malorie
Objective This investigation was performed to determine how students in a health sciences program utilize and explain techniques within blood pressure measurement using a novel assessment, and changes associated with greater curricular exposure. Methods An exploratory, qualitative and quantitative study was conducted using a ‘Think Aloud’ design with protocol analysis. Following familiarization, participants performed the task of measuring blood pressure on a reference subject while stating their thought processes. A trained practitioner recorded each participant’s procedural proficiency using a standardized rubric. There were 112 participants in the study with varying levels of curricular exposure to blood pressure measurement. Results Four trends are noted. Specifically, a trend was observed wherein a marked increase in procedural proficiency with a plateau occurred (e.g. released cuff pressure 2-4 mmHg, 10%, 60%, 83%, 82%). Secondly, a trend was observed with improvement across groups (e.g. cuff placed snugly/smoothly on upper arm, 20%, 60%, 81%, and 91%). Other trends included a marked improvement with subsequent decrease, and an improvement without achieving proficiency (e.g. palpation of the brachial pulse, 5%, 90%, 81%, 68%, appropriate size cuff, 17%, 40%, 33%, 41%, respectively). Qualitatively, transcript interpretation resulted in a need for clarification in the way blood pressure procedure is instructed in the curriculum. Conclusions The current investigation provides a snapshot of proficiency in blood pressure assessment across a curriculum and highlights considerations for best instructional practices, including the use of Think Aloud. Consequently, medical educators should use qualitative and quantitative assessments concurrently to determine achievement of blood pressure skill proficiency. PMID:27864919
Resnic, Frederic S.; Gross, Thomas P.; Marinac-Dabic, Danica; Loyo-Berrios, Nilsa; Donnelly, Sharon; Normand, Sharon-Lise T.; Matheny, Michael E.
Context Assuring the safety of medical devices challenges current surveillance approaches which rely heavily on voluntary reporting of adverse events. Automated surveillance of clinical registries may provide early warnings in the post-market evaluation of medical device safety. Objective To determine whether automated safety surveillance of clinical registries using a computerized tool can provide early warnings regarding the safety of new cardiovascular devices. Design Prospective propensity matched cohort analysis of seven newly introduced cardiovascular devices, utilizing data from patients undergoing percutaneous coronary intervention (PCI) in Massachusetts between April 2003 and October 2007. Setting and Patients All adults undergoing PCI in Massachusetts licensed hospitals utilizing clinical data captured in the Massachusetts implementation of the National Cardiovascular Data Repository CathPCI Registry. Main Outcome Measure The presence of any safety alert, triggered if the cumulative observed risk for a given device exceeded the upper 95% confidence interval (CI) of comparator control device. Predefined sensitivity analyses assessed robustness of alerts when triggered. Results We evaluated 74,427 consecutive interventional coronary procedures. Three of 21 safety analyses triggered sustained alerts in two implantable devices. Patients receiving Taxus Express2® drug eluting stents (DES) experienced a 1.28 fold (2.87% versus 2.25%, absolute risk increase of 0.62%, CI: 0.25-0.99%) increased risk of post-procedural myocardial infarction and a 1.21 fold increase major adverse cardiac events relative to alternative DES (4.24% vs. 3.50%, absolute increase of 0.74%, CI: 0.29-1.19%). Patients receiving the Angio-Seal STS® vascular closure device (VCD) experienced a 1.51 fold increased risk (1.09% vs. 0.72%, absolute increased risk 0.37%, CI: 0.03-0.71%) increased risk of major vascular complications compared with alternative VCD. Sensitivity analyses confirmed
Rymer, T A
A federal appellate court for Massachusetts has ruled that regulations prohibiting counseling or referrals for abortion services violate the constitutional right to reproductive choice. The regulations in question were promulgated under Title X of the US Public Health Service Act. The regulations required pregnant women to be furnished with a list of providers who supported the welfare of the mother and the fetus, thus making the decision to abort more difficult and intruding upon pre- existing physician-patient relationships. The regulations further imposed substantial costs and delays on women who chose to abort through their endorsement of the withholding of requested information. In finding these regulations unconstitutional, the Court noted that they went beyond a mere refusal to fund abortion and interfered with the decision making process by dictating the information a woman was entitled to receive. On the basis of general principles that govern the provision of health services and the physician-patient relationship, the American Medical Association supported the position that the Title X regulations were unconstitutional. The Association noted in its brief that physicians must be free to reveal to their patients all the relevant facts patients need to make an informed decision about medical treatment, even if the physician does not personally plan to provide such treatment.
McGuinness, Sheelagh; Thomson, Michael
The complicated intra-professional rivalries that have contributed to the current contours of abortion law and service provision have been subject to limited academic engagement. In this article, we address this gap. We examine how the competing interests of different specialisms played out in abortion law reform from the early twentieth-century, through to the enactment of the Abortion Act 1967, and the formation of the structures of abortion provision in the early 1970s. We demonstrate how professional interests significantly shaped the landscape of abortion law in England, Scotland, and Wales. Our analysis addresses two distinct and yet related fields where professional interests were negotiated or asserted in the journey to law reform. Both debates align with earlier analysis that has linked abortion law reform with the market development of the medical profession. We argue that these two axes of debate, both dominated by professional interests, interacted to help shape law's treatment of abortion, and continue to influence the provision of abortion services today.
Costa, S H
In Brazil, abortion is only permitted to save the woman's life or in cases of rape. The principal effect of legal restrictions is not to make induced abortion practice less prevalent but to force poor women to resort to abortions performed under unhygienic conditions or attempt self-induced abortion. Within this context, misoprostol, a synthetic analogue of prostaglandin E1, was introduced in the country in 1986. Purchased over the counter in pharmacies, misoprostol has became a popular abortifacient method among Brazilian women. By 1990, about 70% of women hospitalized with abortion-related diagnoses reported use of the drug. In 1991, the Ministry of Health restricted the sale of misoprostol, and in some states its use was totally banned. While the proportion of abortions induced with misoprostol has decreased, the drug continues to be sold on the black market at an inflated value. Research indicates that women have acquired more experience with the drug over time, resulting in lower doses and more effective administration. Several studies show that the rate and severity of complications are significantly less among women who used misoprostol compared with women who used invasive methods. Research also suggests that about half of the women have complete abortion with misoprostol, but seek medical care as soon as they have vaginal bleeding. The experience of Brazilian women with misoprostol is an example of how women when faced with unwanted pregnancy will resort to illegal abortion whatever the costs are to their health.
Lassiter, Dragana; Mercier, Rebecca; Bryant, Amy; Lyerly, Anne Drapkin
BACKGROUND Laws governing abortion provision are proliferating throughout the United States, yet little is known about how these laws affect providers. We investigated the experiences of abortion providers in North Carolina practicing under the 2011 Women’s Right to Know Act, which mandates that women receive counseling with specific, state-prescribed information at least 24 hours prior to an abortion. We focus here on a subset of the data to examine one strategy by which providers worked to minimize moral conflicts generated by the counseling procedure. Drawing on Erving Goffman’s work on language and social interaction, we highlight how providers communicated moral objections and layered meanings through a practice that we call prefacing the script. METHODS We conducted semi-structured interviews with 31 physicians, nurses, physician assistants, and clinic managers who provide abortion care in North Carolina. Audio-recorded interviews were transcribed verbatim and analyzed using an inductive, iterative analytic approach, which included reading for context, interpretive memo-writing, and focused coding. RESULTS Roughly half of the participants (14/31) reported that they or the clinicians who performed the counseling in their institution routinely prefaced the counseling script with qualifiers, disclaimers, and apologies that clarified their relationship to the state-mandated content. We identified three performative functions of this practice: 1) enacting a frame shift from a medical to a legal interaction, 2) distancing the speaker from the authorial voice of the counseling script, and 3) creating emotional alignment. CONCLUSIONS Prefacing state-mandated abortion counseling scripts constitutes a practical strategy providers use to balance the obligation to comply with state law with personal and professional responsibilities to provide tailored care, emotional support, and serve the patient’s best interests. Our findings suggest that language constitutes a
Drogendijk, A C
Various ethical and practical aspects concerning induced abortion are discussed. Arguments against abortion can be enumerated on many levels. The unborn fetus has a worth of its own, but it also has a value for the parents and the society as a whole. Guilt feelings can occur in women who undergo induced abortion, and the possibility of complications of the operation must be taken into consideration. Abortion can also cause stress in the physician who performs it and in the partner of the abortion patient. The costs of abortion are paid by society through insurance costs. Abortion can damage the ethical conscience of the abortion patient, the physician who performs the operation, and in the society which allows it. Ethical considerations involved with abortion are also expounded. Induced abortion is a process whereby life is weighed against other considerations. Ethical conscience involves the ability to differentiate between degrees of possible communication, which would differentiate the life of the embryo from that of a retarded child, for example. Guilt feelings are rooted in ethical considerations. The capability for independent existence is the principle ethical boundary involved in determining when abortion is to be permitted. Eugenic abortion is a separate ethical consideration. A schema of practical guidelines for considerations and indications for performing abortions is presented.
Michael, M; Buckle, S
This paper examines a proposal to make use of IVF techniques to provide an alternative to therapeutic abortion of fetuses with genetic abnormalities. We begin by describing the proposed procedure, and then show that, considered in itself, it is morally on a par with therapeutic abortion. However, once the wider practical implications are brought into view, the proposed new procedure loses its initial appeal. The pros and cons are not sufficiently clear-cut entirely to rule out the IVF procedure, so the paper concludes by indicating some further complications which may follow, should the procedure come to be adopted.
In India, the 1971 Medical Termination of Pregnancy Act, while allowing abortions under a broad range of circumstances, can be considered a conservative law from a feminist perspective. The Act allows healthcare providers rather than women seeking abortion to have the final say on abortion, and creates an environment within which women are made dependent on their healthcare providers. On October 29, 2014, the Ministry of Health and Family Welfare released a draft of the MTP (Amendment) Bill 2014, which proposes changes that could initiate a shift in the focus of the Indian abortion discourse from healthcare providers to women. Such a shift would decrease the vulnerability of women within the clinical setting and free them from subjective interpretations of the law. The Bill also expands the base of healthcare providers by including mid-level and non-allopathic healthcare providers. While the medical community has resisted this inclusion, the author is in favour of it, arguing that in the face of the high rates of unsafe abortion, such a step is both ethical and necessary. Additionally, the clause extending the gestational limit could trigger ethical debates on eugenic abortions and sex-selective abortions. This paper argues that neither of these should be used to limit access to late-trimester termination, and should, instead, be dealt with separately and in a way that enquires into why such pregnancies are considered unwanted.
Medoff, Marshall H.
This study uses pooled cross-section time-series data, over the years 1982, 1992 and 2000, to estimate the impact of various restrictive abortion laws on the demand for abortion. This study complements and extends prior research by explicitly including the price of obtaining an abortion in the estimation. The empirical results show that the real…
Boyle, Elizabeth H; Kim, Minzee; Longhofer, Wesley
Controversy sets abortion apart from other issues studied by world society theorists, who consider the tendency for policies institutionalized at the global level to diffuse across very different countries. The authors conduct an event history analysis of the spread (however limited) of abortion liberalization policies from 1960 to 2009. After identifying three dominant frames (a women's rights frame, a medical frame, and a religious, natural family frame), the authors find that indicators of a scientific, medical frame show consistent association with liberalization of policies specifying acceptable grounds for abortion. Women's leadership roles have a stronger and more consistent liberalizing effect than do countries' links to a global women's rights discourse. Somewhat different patterns emerge around the likelihood of adopting an additional policy, controlling for first policy adoption. Even as support for women's autonomy has grown globally, with respect to abortion liberalization, persistent, powerful frames compete at the global level, preventing robust policy diffusion.
Boyle, Elizabeth H.; Kim, Minzee; Longhofer, Wesley
Controversy sets abortion apart from other issues studied by world society theorists, who consider the tendency for policies institutionalized at the global level to diffuse across very different countries. We conduct an event history analysis of the spread (however limited) of abortion liberalization policies from 1960 to 2009. After identifying three dominant frames (a women's rights frame, a medical frame, and a religious, natural family frame), we find that indicators of a scientific, medical frame show consistent association with liberalization of policies specifying acceptable grounds for abortion. Women's leadership roleshave a stronger and more consistent liberalizing effect than do countries' links to a global women's rights discourse. Somewhat different patterns emerge around the likelihood of adopting an additional policy, controlling for first policy adoption. Even as support for women's autonomy has grown globally, with respect to abortion liberalization, persistent, powerful frames compete at the global level, preventing robust policy diffusion. PMID:26900619
Abortion has been a reality in women's lives since the beginning of recorded history, typically with a high risk of fatal consequences, until the last century when evolutions in the field of medicine, including techniques of safe abortion and effective methods of family planning, could have ended the need to seek unsafe abortion. The context of women's lives globally is an important but often ignored variable, increasingly recognised in evolving human rights especially related to gender and reproduction. International and regional human rights instruments are being invoked where national laws result in violations of human rights such as health and life. The individual right to conscientious objection must be respected and better understood, and is not absolute. Health professional organisations have a role to play in clarifying responsibilities consistent with national laws and respecting reproductive rights. Seeking common ground using evidence rather than polarised opinion can assist the future focus.
Hsu, Lilian M.
Abortive initiation, when first discovered, was an enigmatic phenomenon, but fully three decades hence, it has been shown to be an integral step in the transcript initiation process intimately tied to the promoter escape reaction undergone by RNA polymerase at the initiation-elongation transition. A detailed understanding of abortive initiation-promoter escape has brought within reach a full description of the transcription initiation mechanism. This enormous progress was the result of convergent biochemical, genetic, and biophysical investigations propelled by parallel advances in quantitation technology. This chapter discusses the knowledge gained through the biochemical approach and a high-resolution method that yields quantitative and qualitative information regarding abortive initiation-promoter escape at a promoter. PMID:18948204
In this article we address the issue, with a tentative empirical application to the Italian data, of the relationship, very debated mainly in north America, between abortion legalization and reduction of crime rates of youth. The rationale of this relationship is that there is a causal factor at work: the more unwanted pregnancies aborted, the less unwanted children breeding their criminal attitude in an hostile/deprived family environment. Many methodological and empirical criticisms have been raised against the proof of the existence of such a relationship: our attempt to test if this link is valid for Italy cannot endorse its existence. The data we used made necessary some assumptions and the reliability of official estimates of crime rates was debatable (probably downward biased). We conclude that, at least for Italy, the suggested relationship is unproven: other reasons for the need of legal abortion have been and should be put forward.
van Lith, D A; Wittman, R; Keith, L G
This chapter provides a detailed description of 1st and 2nd trimester abortion techniques. In general, low morbidity is facilitated by preoperative diagnosis and evaluation, operator skill, sterile technique, avoidance of trauma, completeness of evacuation, and postoperative care. The 1st trimester technique used by the authors involves predilatation with laminaria, paracervical and intracervical blocks (anesthetic solution, 1% lignocaine with adrenaline), dilatation with either the Hawkin Ambler type or half-sized Pratt dilator, and evacuation with the van Lith or Karman type suction cannula. For 2nd trimester pregnancy termination, the authors use aspirotomy, a technique that combines the classic dilatation and evacuation method with suction curettage. An ergometrine maleate preparation is administered at the start of the procedure to produce sustained contraction of the uterine wall, decrease the chance of perforation, and accelerate the emptying process. Adrenaline in 1% lignocaine is used as a local anesthetic solution. A specially designed crushing forceps decreases the cervical dilatation required. Also presented is a technique for late 2nd trimester (16-20 weeks gestation) abortion that involves prostaglandins or the Finks dilatation and evacuation technique. The complication rate in the authors' unit for 3500 2nd trimester terminations was less than 0.5% but rose after 17 weeks of gestation.
Goldman, Lisa A; García, Sandra G; Díaz, Juan; Yam, Eileen A
Background Abortion laws are extremely restrictive in Brazil. The knowledge, opinions of abortion laws, and abortion practices of obstetrician-gynecologists can have a significant impact on women's access to safe abortion. Methods We conducted a mail-in survey with a 10% random sample of obstetrician-gynecologists affiliated with the Brazilian Federation of Obstetricians and Gynecologists. We documented participants' experiences performing abortion under a range of legal and illegal circumstances, and asked about which abortion techniques they had experience with. We used chi-square tests and crude logistic regression models to determine which sociodemographic, knowledge-related, or practice-related variables were associated with physician opinion. Results Of the 1,500 questionnaires that we mailed out, we received responses from 572 (38%). Less than half (48%) of the respondents reported accurate knowledge about abortion law and 77% thought that the law should be more liberal. One-third of respondents reported having previous experience performing an abortion, and very few of these physicians reported having experience with manual vacuum aspiration (MVA) or with misoprostol with either mifepristone or methotrexate. Physicians that favored liberalization of the law were more likely to have correct knowledge about abortion law, and to be in favor of public funding for abortion services. Conclusion Brazilian obstetrician-gynecologists need more information on abortion laws and on safe, effective abortion procedures. PMID:16288647
Henderson, Edward M.; Nguyen, Tri X.
This paper documents some of the evolutionary steps in developing a rigorous Space Shuttle launch abort capability. The paper addresses the abort strategy during the design and development and how it evolved during Shuttle flight operations. The Space Shuttle Program made numerous adjustments in both the flight hardware and software as the knowledge of the actual flight environment grew. When failures occurred, corrections and improvements were made to avoid a reoccurrence and to provide added capability for crew survival. Finally some lessons learned are summarized for future human launch vehicle designers to consider.
Hayes, Peggy Sue
The purpose of NASA's Constellation project is to create the new generation of spacecraft for human flight to the International Space Station in low-earth orbit, the lunar surface, as well as for use in future deep-space exploration. One portion of the Constellation program was the development of the Orion crew exploration vehicle (CEV) to be used in spaceflight. The Orion spacecraft consists of a crew module, service module, space adapter and launch abort system. The crew module was designed to hold as many as six crew members. The Orion crew exploration vehicle is similar in design to the Apollo space capsules, although larger and more massive. The Flight Test Office is the responsible flight test organization for the launch abort system on the Orion crew exploration vehicle. The Flight Test Office originally proposed six tests that would demonstrate the use of the launch abort system. These flight tests were to be performed at the White Sands Missile Range in New Mexico and were similar in nature to the Apollo Little Joe II tests performed in the 1960s. The first flight test of the launch abort system was a pad abort (PA-1), that took place on 6 May 2010 at the White Sands Missile Range in New Mexico. Primary flight test objectives were to demonstrate the capability of the launch abort system to propel the crew module a safe distance away from a launch vehicle during a pad abort, to demonstrate the stability and control characteristics of the vehicle, and to determine the performance of the motors contained within the launch abort system. The focus of the PA-1 flight test was engineering development and data acquisition, not certification. In this presentation, a high level overview of the PA-1 vehicle is given, along with an overview of the Mobile Operations Facility and information on the White Sands tracking sites for radar & optics. Several lessons learned are presented, including detailed information on the lessons learned in the development of wind
Chen, Szi-Wen; Chen, Yuan-Ho
In this paper, a discrete wavelet transform (DWT) based de-noising with its applications into the noise reduction for medical signal preprocessing is introduced. This work focuses on the hardware realization of a real-time wavelet de-noising procedure. The proposed de-noising circuit mainly consists of three modules: a DWT, a thresholding, and an inverse DWT (IDWT) modular circuits. We also proposed a novel adaptive thresholding scheme and incorporated it into our wavelet de-noising procedure. Performance was then evaluated on both the architectural designs of the software and. In addition, the de-noising circuit was also implemented by downloading the Verilog codes to a field programmable gate array (FPGA) based platform so that its ability in noise reduction may be further validated in actual practice. Simulation experiment results produced by applying a set of simulated noise-contaminated electrocardiogram (ECG) signals into the de-noising circuit showed that the circuit could not only desirably meet the requirement of real-time processing, but also achieve satisfactory performance for noise reduction, while the sharp features of the ECG signals can be well preserved. The proposed de-noising circuit was further synthesized using the Synopsys Design Compiler with an Artisan Taiwan Semiconductor Manufacturing Company (TSMC, Hsinchu, Taiwan) 40 nm standard cell library. The integrated circuit (IC) synthesis simulation results showed that the proposed design can achieve a clock frequency of 200 MHz and the power consumption was only 17.4 mW, when operated at 200 MHz. PMID:26501290
Karlsson, Katarina; Rydström, Ingela; Enskär, Karin; Englund, Ann-Charlotte Dalheim
Children state that among their worst fears during hospitalization are those related to various nursing procedures and to injections and needles. Nurses thus have a responsibility to help children cope with needle-related medical procedures (NRMP) and the potentially negative effects of these. The aim of the study is to describe the lived experience of supporting children during NRMP, from the perspective of nurses. Fourteen nurses took part in the study, six of whom participated on two occasions thus resulting in 20 interviews. A reflective lifeworld research approach was used, and phenomenological analysis was applied. The result shows that supporting children during NRMP is characterized by a desire to meet the child in his/her own world and by an effort to reach the child's horizon of understanding regarding these actions, based on the given conditions. The essential meaning of the phenomenon is founded on the following constituents: developing relationships through conversation, being sensitive to embodied responses, balancing between tact and use of restraint, being the child's advocate, adjusting time, and maintaining belief. The discussion focuses on how nurses can support children through various types of conversation and by receiving help from the parents’ ability to be supportive, and on whether restraint can be supportive or not for children during NRMP. Our conclusion is that nurses have to see each individual child, meet him/her in their own world, and decide on supportive actions while at the same time balancing their responsibility for the completion of the NRMP. This work can be described as “balancing on a tightrope” in an unpredictable situation. PMID:24646473
Chen, Szi-Wen; Chen, Yuan-Ho
In this paper, a discrete wavelet transform (DWT) based de-noising with its applications into the noise reduction for medical signal preprocessing is introduced. This work focuses on the hardware realization of a real-time wavelet de-noising procedure. The proposed de-noising circuit mainly consists of three modules: a DWT, a thresholding, and an inverse DWT (IDWT) modular circuits. We also proposed a novel adaptive thresholding scheme and incorporated it into our wavelet de-noising procedure. Performance was then evaluated on both the architectural designs of the software and. In addition, the de-noising circuit was also implemented by downloading the Verilog codes to a field programmable gate array (FPGA) based platform so that its ability in noise reduction may be further validated in actual practice. Simulation experiment results produced by applying a set of simulated noise-contaminated electrocardiogram (ECG) signals into the de-noising circuit showed that the circuit could not only desirably meet the requirement of real-time processing, but also achieve satisfactory performance for noise reduction, while the sharp features of the ECG signals can be well preserved. The proposed de-noising circuit was further synthesized using the Synopsys Design Compiler with an Artisan Taiwan Semiconductor Manufacturing Company (TSMC, Hsinchu, Taiwan) 40 nm standard cell library. The integrated circuit (IC) synthesis simulation results showed that the proposed design can achieve a clock frequency of 200 MHz and the power consumption was only 17.4 mW, when operated at 200 MHz.
Changes in homicide and arrest rates were compared among cohorts born before and after legalization of abortion and those who were unexposed to legalized abortion. It was found that legalized abortion improved the lives of many women as they could avoid unwanted births.
... or an emergency room. Getting Ready for a Medical Abortion The health care provider will: Do a physical exam and ultrasound Go ... vaginal intercourse for about a week after a medical abortion. You can ... care provider about what birth control to use. You should ...
In 2008, the Victorian Parliament enacted the Abortion Law Reform Act 2008 (Vic) and amended the Crimes Act 1958 (Vic) to decriminalise terminations of pregnancy while making it a criminal offence for unqualified persons to carry out such procedures. The reform legislation has imposed a civil regulatory regime on the management of abortions, and has stipulated particular statutory duties of care for registered qualified health care practitioners who have conscientious objections to terminations of pregnancy. The background to, and the structure of, this novel statutory regime is examined, with a focus on conscientious objection clauses and liability in the tort of negligence and the tort of breach of statutory duty.
Bloche, M Gregg
In this article, I explore this failure [of the therapeutic exception as a compromise device in federal abortion counseling regulations] with an eye toward its broader lessons about the social uses of medical discretion and the difficulty of achieving an abortion compromise in America. I begin by examining the legal underpinning beneath the widespread belief that the "gag rule" imposed a near-absolute ban on discussion of the abortion option. This conventional wisdom, I conclude, collapses on careful inspection. It fails utterly to account for the strong support to be found in the Title X regulations and their larger legal context for a therapeutic exception unconstrained by administrative or judicial definition. Next, I observe that this legal unboundedness would have empowered Title X clinic physicians (and perhaps others who do counseling) to exercise broad discretion over abortion access, under the rubric of medical indication.... By so doing, however, physicians would have become abortion gatekeepers. This would have raised difficult ethical and clinical questions about the extent to which medical judgment should be allowed to incorporate (and shield) socially-disputed moral choices. I briefly consider some of these questions, along with the countervailing appeal of preserving a measure of intimate freedom under medical cover. I then conclude by positing some connections between the moral infirmities of medical gatekeeping and the political failure of the therapeutic exception. I suggest, in essence, that this failure was ensured by a strong resonance between the exception's moral infirmities and the fears of the medical leaders, pro-choice activists, and abortion opponents who framed the public debate over the "gag rule." The potential breadth of the therapeutic exception went unrecognized and unexplored because professional and popular understanding of the abortion counseling regulations was molded by the activists who framed the debate...
"Heidelberg standard examination" and "Heidelberg standard procedures" - Development of faculty-wide standards for physical examination techniques and clinical procedures in undergraduate medical education.
Nikendei, C; Ganschow, P; Groener, J B; Huwendiek, S; Köchel, A; Köhl-Hackert, N; Pjontek, R; Rodrian, J; Scheibe, F; Stadler, A-K; Steiner, T; Stiepak, J; Tabatabai, J; Utz, A; Kadmon, M
The competent physical examination of patients and the safe and professional implementation of clinical procedures constitute essential components of medical practice in nearly all areas of medicine. The central objective of the projects "Heidelberg standard examination" and "Heidelberg standard procedures", which were initiated by students, was to establish uniform interdisciplinary standards for physical examination and clinical procedures, and to distribute them in coordination with all clinical disciplines at the Heidelberg University Hospital. The presented project report illuminates the background of the initiative and its methodological implementation. Moreover, it describes the multimedia documentation in the form of pocketbooks and a multimedia internet-based platform, as well as the integration into the curriculum. The project presentation aims to provide orientation and action guidelines to facilitate similar processes in other faculties.
Thompson, Laura; Exline, Matthew; Leung, Cynthia G; Way, David P; Clinchot, Daniel; Bahner, David P; Khandelwal, Sorabh
Background Procedural skills training is a critical component of medical education, but is often lacking in standard clinical curricula. We describe a unique immersive procedural skills curriculum for medical students, designed and taught primarily by emergency medicine faculty at The Ohio State University College of Medicine. Objectives The primary educational objective of this program was to formally introduce medical students to clinical procedures thought to be important for success in residency. The immersion strategy (teaching numerous procedures over a 7-day period) was intended to complement the student's education on third-year core clinical clerkships. Program design The course introduced 27 skills over 7 days. Teaching and learning methods included lecture, prereading, videos, task trainers, peer teaching, and procedures practice on cadavers. In year 4 of the program, a peer-team teaching model was adopted. We analyzed program evaluation data over time. Impact Students valued the selection of procedures covered by the course and felt that it helped prepare them for residency (97%). The highest rated activities were the cadaver lab and the advanced cardiac life support (97 and 93% positive endorsement, respectively). Lectures were less well received (73% positive endorsement), but improved over time. The transition to peer-team teaching resulted in improved student ratings of course activities (p<0.001). Conclusion A dedicated procedural skills curriculum successfully supplemented the training medical students received in the clinical setting. Students appreciated hands-on activities and practice. The peer-teaching model improved course evaluations by students, which implies that this was an effective teaching method for adult learners. This course was recently expanded and restructured to place the learning closer to the clinical settings in which skills are applied.
Thompson, Laura; Exline, Matthew; Leung, Cynthia G.; Way, David P.; Clinchot, Daniel; Bahner, David P.; Khandelwal, Sorabh
Background Procedural skills training is a critical component of medical education, but is often lacking in standard clinical curricula. We describe a unique immersive procedural skills curriculum for medical students, designed and taught primarily by emergency medicine faculty at The Ohio State University College of Medicine. Objectives The primary educational objective of this program was to formally introduce medical students to clinical procedures thought to be important for success in residency. The immersion strategy (teaching numerous procedures over a 7-day period) was intended to complement the student's education on third-year core clinical clerkships. Program design The course introduced 27 skills over 7 days. Teaching and learning methods included lecture, prereading, videos, task trainers, peer teaching, and procedures practice on cadavers. In year 4 of the program, a peer-team teaching model was adopted. We analyzed program evaluation data over time. Impact Students valued the selection of procedures covered by the course and felt that it helped prepare them for residency (97%). The highest rated activities were the cadaver lab and the advanced cardiac life support (97 and 93% positive endorsement, respectively). Lectures were less well received (73% positive endorsement), but improved over time. The transition to peer-team teaching resulted in improved student ratings of course activities (p<0.001). Conclusion A dedicated procedural skills curriculum successfully supplemented the training medical students received in the clinical setting. Students appreciated hands-on activities and practice. The peer-teaching model improved course evaluations by students, which implies that this was an effective teaching method for adult learners. This course was recently expanded and restructured to place the learning closer to the clinical settings in which skills are applied. PMID:27222103
Albar, Mohammed A.
Background: Induced Abortion for social reasons is spreading all over the world. It is estimated that globally 50 million unborn babies are killed annually, resulting in the deaths of 200,000 pregnant women and the suffering of millions. The complications of illegal abortion are very serious. Abortion is still used in many countries as a means of family planning. The medical reasons for abortion are limited and con-sti-tute a small proportion of all abortion cases. This paper discusses the different views on abortion, its history, its evolution over time, and the present legal circumstances. The emphasis is on the situation in Islamic countries and the effect of Islamic Fatwas on abortion. PMID:23008648
...) of this section, the “medical benefits package” does not include the following: (1) Abortions and abortion counseling. (2) In vitro fertilization. (3) Drugs, biologicals, and medical devices not...
Medical students acquire and enhance their clinical skills using various available techniques and resources. As the health care profession has move towards team-based practice, students and trainees need to practice team-based procedures that involve timely management of clinical tasks and adequate communication with other members of the team.…
Guttmacher, Alan F.; And Others
A roundtable discussion on legal abortion includes Dr. Alan F. Guttmacher, President of The Planned Parenthood Federation of America, Robert Hall, Associate Professor of Obstetrics and Gynecology at Columbia University College of Physicians and Surgeons, Christopher Tietze, a diretor of The Population Council, and Harriet Pilpel, a lawyer.…
Persona, marketed by Unipath, is a new method of natural family planning which has been on the market since 1996. It works by measuring the hormone levels in a woman's urine and letting her know when she is not fertile and may have sex without using a barrier method of contraception. The British Pregnancy Advisory Service (BPAS) found that their surveyed clients who reported using Persona had 188 abortions in 3 months and concluded that there was a need for better information and more advice for couples who plan to use the method. The other major non-NHS abortion provider, Marie Stopes International, reported similar findings, with about 60 women per month visiting their clinics for abortions after having used the method. The BPAS survey also showed that 43% of the women who had an abortion after using Persona were aged 24 years or younger even though Persona is intended for use by women aged 25-40 years in stable relationships. A similar proportion also reported having sex on days when the method told them that they were most fertile. These latter women were not asked if they used another method of contraception on fertile days. An additional 13% reported ignoring the instructions to wait for 3 natural periods after terminating pill use before beginning to use Persona.
Adams, Adrien; Patlach, Bob; Duchense, Ted; Chandler, Mike; Stepaniak, Philip C.
This poster paper outlines the operational and medical procedures for a shuttle mission that has a failure that precludes a safe return to Earth. Information about the assumptions, procedures and limiting consumables is included.
Törnbom, M; Ingelhammar, E; Lilja, H; Möller, A; Svanberg, B
In a study of 404 women (simple random sample), 20-29 years of age, 201 (group A) applying for abortion and 203 (group B) continuing their pregnancies, the women were given a questionnaire and in addition were interviewed. The aim of the study was to evaluate the spontaneous personal motives of women for abortion at a time when age is not supposed to be a common reason. The results showed that more than half of the women expressed that a bad relationship with the partner in one way or another was a motive for the abortion. Other important motives included characteristics of the women and their partners, mainly immaturity, work/studies and unsuitable life situation for having a child. Less common motives seemed to be economy, dwelling and medical and health factors. It is obvious that women in this study wanted to have a stable relationship to the child's father before they dared or wanted to have a child. Social networks in modern society seem to be too weak. The women do not want to face social and emotional problems as lonely mothers. Political decisions in the society, for example with parental benefit according to your income discourage women from continuing their pregnancies during their studies. It also seems important for the woman to feel mature enough to have a child. The provision and encouragement of methods for safer sex may be a possible way by which to reduce the number of abortions.
Nations, M K; Misago, C; Fonseca, W; Correia, L L; Campbell, O M
Two folk medical conditions, "delayed" (atrasada) and "suspended" (suspendida) menstruation, are described as perceived by poor Brazilian women in Northeast Brazil. Culturally prescribed methods to "regulate" these conditions and provoke menstrual bleeding are also described, including ingesting herbal remedies, patent drugs, and modern pharmaceuticals. The ingestion of such self-administered remedies is facilitated by the cognitive ambiguity, euphemisms, folklore, etc., which surround conception and gestation. The authors argue that the ethnomedical conditions of "delayed" and "suspended" menstruation and subsequent menstrual regulation are part of the "hidden reproductive transcript" of poor and powerless Brazilian women. Through popular culture, they voice their collective dissent to the official, public opinion about the illegality and immorality of induced abortion and the chronic lack of family planning services in Northeast Brazil. While many health professionals consider women's explanations of menstrual regulation as a "cover-up" for self-induced abortions, such popular justifications may represent either an unconscious or artful manipulation of hegemonic, anti-abortion ideology expressed in prudent, unobtrusive and veiled ways. The development of safer abortion alternatives should consider women's hidden reproductive transcripts.
Geary, Cynthia Waszak; Gebreselassie, Hailemichael; Awah, Paschal; Pearson, Erin
Despite Zambia's relatively progressive abortion law, women continue to seek unsafe, illegal abortions. Four domains of abortion attitudes - support for legalization, immorality, rights, and access to services - were measured in 4 communities. A total of 668 people were interviewed. Associations among the 4 domains were inconsistent with expectations. The belief that abortion is immoral was widespread, but was not associated with lack of support for legalization. Instead, it was associated with belief that women need access to safe services. These findings suggest that increasing awareness about abortion law in Zambia may be important for encouraging more favorable attitudes.
Notably absent from the public debate on abortion in Ireland have been the voices of women who have experienced induced abortion. Interviews with six acquaintances of the author who underwent abortion identified four themes underlying women's post-abortion silence. First, women fear public condemnation and personal rejection. Second, women are concerned that any emotional ambivalence they express about the abortion experience will be misconstrued as anti-abortion sentiment. Third, women worry that speaking out about their experience would be upsetting to friends and family. Fourth, women report frustration about the lack of a suitable public forum for voicing the complexities inherent in the abortion issue. The women's perception that their experience did not fit neatly with the rhetoric of either pro- or anti-abortion groups caused them to feel alienated from a political discourse that tends to depersonalize abortion. Although none of the women regretted the abortion decision, they continued to struggle with unresolved conflicts over taking responsibility for ending some form of life. A cycle has been created in which women do not feel safe to discuss their personal experiences until a more favorable political climate exists, yet the public perception of abortion is unlikely to change until more women's voices are heard. Feminist leaders are urged to address this dilemma.
Lindell, M E; Olsson, H M
The Swedish abortion legislation of 1975 gave women the right to make a decision about abortion before the end of the 18th week of pregnancy. The number of abortions is rising in Sweden as a chosen method of birth control. The attitudes of students toward abortion were studied in 1986-1987. A questionnaire containing items on how sex education is taught, the anatomy and physiology of reproduction, contraceptives, sexually transmitted diseases, and legal abortion was answered by 421 high school students. Results pertaining to the students' attitudes toward abortion are reported. Two thirds of the students believed that the decision about an abortion should be made by the man and woman together. Nearly all respondents believed that abortion should not be considered a method of birth control. These results may be considered a guide for interventions to prevent the need for abortion. One fourth of all pregnancies in Sweden terminate in abortion. The students in the present study thought of abortion as a solution. Authors studying samples with different cultural backgrounds have reported similar attitudes.
Pfeiffer, Yvonne; Taxis, Katja
Background Double-checking is widely recommended as an essential method to prevent medication errors. However, prior research has shown that the concept of double-checking is not clearly defined, and that little is known about actual practice in oncology, for example, what kind of checking procedures are applied. Objective To study the practice of different double-checking procedures in chemotherapy administration and to explore nurses' experiences, for example, how often they actually find errors using a certain procedure. General evaluations regarding double-checking, for example, frequency of interruptions during and caused by a check, or what is regarded as its essential feature was assessed. Methods In a cross-sectional survey, qualified nurses working in oncology departments of 3 hospitals were asked to rate 5 different scenarios of double-checking procedures regarding dimensions such as frequency of use in practice and appropriateness to prevent medication errors; they were also asked general questions about double-checking. Results Overall, 274 nurses (70% response rate) participated in the survey. The procedure of jointly double-checking (read-read back) was most commonly used (69% of respondents) and rated as very appropriate to prevent medication errors. Jointly checking medication was seen as the essential characteristic of double-checking—more frequently than ‘carrying out checks independently’ (54% vs 24%). Most nurses (78%) found the frequency of double-checking in their department appropriate. Being interrupted in one's own current activity for supporting a double-check was reported to occur frequently. Regression analysis revealed a strong preference towards checks that are currently implemented at the responders' workplace. Conclusions Double-checking is well regarded by oncology nurses as a procedure to help prevent errors, with jointly checking being used most frequently. Our results show that the notion of independent checking needs to be
Sommer, Matthew H
In late imperial China, a number of purported methods of abortion were known; but who actually attempted abortion and under what circumstances? Some historians have suggested that abortion was used for routine birth control, which presupposes that known methods were safe, reliable, and readily available. This paper challenges the qualitative evidence on which those historians have relied, and presents new evidence from Qing legal sources and modern medical reports to argue that traditional methods of abortion (the most common being abortifacient drugs) were dangerous, unreliable, and often cost a great deal of money. Therefore, abortion in practice was an emergency intervention in a crisis: either a medical crisis, in which pregnancy threatened a woman's health, or a social crisis, in which pregnancy threatened to expose a woman's extramarital sexual relations. Moreover, abortion was not necessarily available even to women who wanted one.
Coast, Ernestina; Murray, Susan F
Unsafe abortion is a significant but preventable cause of global maternal mortality and morbidity. Zambia has among the most liberal abortion laws in sub-Saharan Africa, however this alone does not guarantee access to safe abortion, and 30% of maternal mortality is attributable to unsafe procedures. Too little is known about the pathways women take to reach abortion services in such resource-poor settings, or what informs care-seeking behaviours, barriers and delays. In-depth qualitative interviews were conducted in 2013 with 112 women who accessed abortion-related care in a Lusaka tertiary government hospital at some point in their pathway. The sample included women seeking safe abortion and also those receiving hospital care following unsafe abortion. We identified a typology of three care-seeking trajectories that ended in the use of hospital services: clinical abortion induced in hospital; clinical abortion initiated elsewhere, with post-abortion care in hospital; and non-clinical abortion initiated elsewhere, with post-abortion care in hospital. Framework analyses of 70 transcripts showed that trajectories to a termination of an unwanted pregnancy can be complex and iterative. Individuals may navigate private and public formal healthcare systems and consult unqualified providers, often trying multiple strategies. We found four major influences on which trajectory a woman followed, as well as the complexity and timing of her trajectory: i) the advice of trusted others ii) perceptions of risk iii) delays in care-seeking and receipt of services and iv) economic cost. Even though abortion is legal in Zambia, girls and women still take significant risks to terminate unwanted pregnancies. Levels of awareness about the legality of abortion and its provision remain low even in urban Zambia, especially among adolescents. Unofficial payments required by some providers can be a major barrier to safe care. Timely access to safe abortion services depends on chance rather
Smit, I; Bitzer, E M; Boshoff, E L D; Steyn, D W
The high morbidity and mortality rate due to illegal abortions in South Africa necessitated the implementation of abortion legislation in February 1997. Abortion legislation stipulates that registered nurses who had undergone the proposed abortion care training--certified nurses--may carry out abortions within the first 12 weeks of pregnancy. Currently it seems that an inadequate number of nurses are being trained in the Western Cape to provide pregnant women with counselling, to perform abortions and/or refer problem cases. No real attempts have since been made by higher education institutions in the Western Cape to offer abortion care training for nurses. This case study explores the situation of certified nurses and the context in which they provide abortion care in different regions of the Western Cape. The sampling included a random, stratified (non-proportional) number of designated state health care facilities in the Western Cape, a non-probability purposive sampling of nurses who provided abortion care, a non-probability convenience sample of women who had received abortion care, and a non-probability purposive sampling of final-year pre-registration nursing students. Data was generated by means of questionnaires, a checklist and semi-structured interviews. The main findings of this study indicate that the necessary infrastructure required for legal abortion is in place. However, the ongoing shortage of trained health care practitioners hampers abortion care services. Deficiencies were identified in the existing provincial protocol as some of the guidelines were either not in use or had become obsolete. Certified midwives who had been trained by the regional offices of the Department of Health: Western Cape were skilled in carrying out the abortion procedure, but other aspects of abortion care mainly carried out by other categories of nurses required more attention. This article suggests a training framework that should provide focus for the development of
Andaya, Elise; Mishtal, Joanna
Women's rights to legal abortion in the United States are now facing their greatest social and legislative challenges since its 1973 legalization. Legislation restricting rights and access to abortion care has been passed at state and federal levels at an unprecedented rate. Given the renewed vigor of anti-abortion movements, we call on anthropologists to engage with this shifting landscape of reproductive politics. This article examines recent legislation that has severely limited abortion access and maps possible directions for future anthropological analysis. We argue that anthropology can provide unique contributions to broader abortion research. The study of abortion politics in the United States today is not only a rich opportunity for applied and policy-oriented ethnographic research. It also provides a sharply focused lens onto broader theoretical concerns in anthropology and new social formations across moral, medical, political, and scientific fields in 21st-century America.
In 1978 the abortion law was liberalised in Norway. It permits abortion on request up to 12 weeks of pregnancy, and after that with the agreement of a medical commission, taking the woman's own views into consideration. In 2003, 96% of abortions took place before 12 weeks of pregnancy. There is considerable support among the population for the current law, and the right to abortion does not seem to be under threat, yet opponents of abortion attack the law frequently. Debates on recent biotechnology laws and difficulties introducing the abortion pill, on the spurious grounds that it would make abortion too easy, imply continuing moral qualms about abortion. While abortion among young, unmarried women is more accepted, many married women feel they have to justify their decision. Women are expected to feel sorrow, shame and guilt because of their sexual conduct for many reasons, but especially if the result is an unwanted pregnancy. It is easier to protect the law when there is recognition of the moral right to choose abortion. The legal battle has been won, but winning the moral battle is important in Norway now. I believe that until having an abortion is considered as acceptable morally as using contraception, women will not have gained their full reproductive rights.
This paper provides an overview of legal, religious, medical and social factors that serve to support or hinder women's access to safe abortion services in the 21 predominantly Muslim countries of the Middle East and North Africa (MENA) region, where one in ten pregnancies ends in abortion. Reform efforts, including progressive interpretations of Islam, have resulted in laws allowing for early abortion on request in two countries; six others permit abortion on health grounds and three more also allow abortion in cases of rape or fetal impairment. However, medical and social factors limit access to safe abortion services in all but Turkey and Tunisia. To address this situation, efforts are increasing in a few countries to introduce post-abortion care, document the magnitude of unsafe abortion and understand women's experience of unplanned pregnancy. Religious fatāwa have been issued allowing abortions in certain circumstances. An understanding of variations in Muslim beliefs and practices, and the interplay between politics, religion, history and reproductive rights is key to understanding abortion in different Muslim societies. More needs to be done to build on efforts to increase women's rights, engage community leaders, support progressive religious leaders and government officials and promote advocacy among health professionals.
Hajri, Selma; Raifman, Sarah; Gerdts, Caitlin; Baum, Sarah; Foster, Diana Greene
Barriers to accessing legal abortion services in Tunisia are increasing, despite a liberal abortion law, and women are often denied wanted legal abortion services. In this paper, we seek to explore the reasons for abortion denial and whether these reasons had a legal or medical basis. We also identify barriers women faced in accessing abortion and make recommendations for improved access to quality abortion care. We recruited women immediately after they had been turned away from legal abortion services at two facilities in Tunis, Tunisia. Thirteen women consented to participate in qualitative interviews two months after they were turned away from the facility. Women were denied abortion care on the day they were recruited due to three main reasons: gestational age, health conditions, and logistical barriers. Nine women ultimately terminated their pregnancies at another facility, and four women carried to term. None of the women attempted illegal abortion services or self-induction. Further research is needed in order to assess abortion denial from the perspective of providers and medical staff. PMID:26684189
Hajri, Selma; Raifman, Sarah; Gerdts, Caitlin; Baum, Sarah; Foster, Diana Greene
Barriers to accessing legal abortion services in Tunisia are increasing, despite a liberal abortion law, and women are often denied wanted legal abortion services. In this paper, we seek to explore the reasons for abortion denial and whether these reasons had a legal or medical basis. We also identify barriers women faced in accessing abortion and make recommendations for improved access to quality abortion care. We recruited women immediately after they had been turned away from legal abortion services at two facilities in Tunis, Tunisia. Thirteen women consented to participate in qualitative interviews two months after they were turned away from the facility. Women were denied abortion care on the day they were recruited due to three main reasons: gestational age, health conditions, and logistical barriers. Nine women ultimately terminated their pregnancies at another facility, and four women carried to term. None of the women attempted illegal abortion services or self-induction. Further research is needed in order to assess abortion denial from the perspective of providers and medical staff.
Anderson, Mark T.; Vu, Chau; Derby, K. Mark; Goris, Mary; McLaughlin, T. F.
Functional analysis methods were used to monitor medication used to reduce vocal and physical tics of a child with Tourettes Syndrome. Post-medication results demonstrated a reduced level of tics by the participant. Although preliminary, the findings suggest that functional analysis methods can be used to monitor the effects of medication in…
Gibbs, Victoria; Lim, Chung Sim
Objectives Competency in practical skills is an important aspect of training for medical doctors. This questionnaire survey aimed to investigate if the current Foundation Year trainees have performed several practical procedures of importance and their level of confidence in carrying them out unsupervised. Design Questionnaire study. Setting Five National Health Service hospitals in England. Participants A total of 103 Foundation Year trainees responded to the survey (73 FY1s; 30 FY2s). Main outcome measures Percentage of trainees who have performed these skills and their average level of confidence. Results The percentage of trainees who have performed these skills and their average level of confidence (scale of 1 to 5) are as follows: intubation (32%, 1); chest drain (33%, 1); central line (26%, 1); femoral line (23%, 1); peripheral line (28%, 1); lumbar puncture (64%, 3); ascitic tap (57%, 3). Only 25% of the trainees have attended certified training courses on these skills during their Foundation Year training. More than half of these trainees (73%) found the courses very useful. Ninety-two per cent of trainees who did not attend practical skill courses are very interested to attend them. All the trainees agreed that these courses should be available for all the Foundation Year doctors, and 92% believe that these courses are most beneficial during the Foundation Year 1 training. Conclusion Most Foundation Year trainees have low confidence and exposure to these important practical skills. Certified practical skills courses should be made available to the Foundation Year doctors for the benefit of their training. This will also increase the quality of patient care. PMID:25057395
Lee, Young- Ah
This paper tried to collect, classify and analyse the discourse about abortion in 1920~1930. In Korea, modern medical abortion operation started in 1920~30s. At that time abortion was prohibited by the Japanese Government-General of Korea, because the Japanese Government-General of Korea needed large population which was used for labor and exploitation. Hence, the Empire of Japan de-penalized Japanese criminal law related to birth control but Korean law was not revised between 1910~1945. Nevertheless, there were quite a few women who wanted abortion when they had children born in sin or they were too poor to raise their children, so they had abortion secretly. At that time the women generally had abortion through toxic drugs or foods and violence (dropping from a high place or beating their stomach). But high class women did it by medical operation. In 1920s, there was few Korean (modern) medical doctors who could operate for abortion, instead Japanese immigrant medical doctors did it--as the newspaper of that time showed(there were many pieces of news that Japanese doctor who helped abortion was arrested by the police). As time went by Korean doctors got their say about the technique and various knowledge of abortion in newspapers, magazines, and academic Journals; this was especially the case starting in 1930. It is worth noting that they were sometimes arrested for illegal abortion operations. Furthermore, from the late 1920s the insist that abortion should be permitted for women and poor people, appeared. This insist was affected by Japan, the Soviet Union and other countries which was generous with abortion.
Christian, W; Grillmaier, G
The study is an attempt to elucidate the official number of abortions on German women from the Federal Bureau of Statistics (FBS) in the Federal Republic of Germany (BRD). These numbers are derived from the General Medical Council up to mid-1976; after this date, from the FBS; also from registered and nonregistered cases in neighboring countries. There are "hidden numbers" in these data. Fetal deaths are reliably included in the abortion statistics. Abortions performed in Holland and Great Britain are fairly reliably registered. Abortions performed elsewhere (e.g. Austria) are not reliably registered but probably not quantitatively important. Miscarriages, a non-notifiable occurrence, are included insofar as numbers were ascertainable from hospital statistics. Data from the General Medical Council show an increase of 300% in 5 years--from 1970 to 1975. The first year of liberalized legislation, 1977, 54,309 abortions are registered, increasing to 82,788 in 1979 (50%). During those latter years there is a diminishing abortion rate on German women done abroad. Hard-to-estimate figures stem from: 1) legal, but not reported abortions, 2) nonsubstantiated abortions abroad, and 3) illegal abortions. Total number of abortions in 1979 is set at 135,600 which gives the BRD the lowest abortion rate of the European countries. However, the number of illegal abortions is set by independent experts at 75,000-300,000/year. With such divergent numbers it is difficult to accurately quantify the abortion rate. It can only be measured against the number of abortions no longer performed by quacks. The abortion rate (number of abortions/1000 women of childbearing age) and abortion ratio (number of abortions/1000 live births) are compared between various European countries for the year 1977. It shows the BDR with the 2nd lowest rate after the Netherlands and 3rd lowest rate after the Netherlands and Scotland. Hungary has both the highest rate (39.2/1000) and ratio (502/1000) in this
The debate over abortion is still controversial as ever. As one of every four people in the world is of the Muslim religion, it is important to learn more about the Islamic point of view toward this dilemma in medical ethics. The first part of this paper gives a general view of the sources of Islamic law and discusses modern developments in Islamic medical ethics regarding abortion. The second part focuses on the legal aspects of abortion in different Islamic states, dealing with the need to supply solutions to women who for different reasons wish to abort and at the same time enact laws that would not contradict Islamic principles. A study of three Muslim states (Egypt, Kuwait and Tunisia) demonstrates three different approaches toward legalizing abortion--a conservative approach, a more lenient approach, and a liberal one--all within Islamic oriented states. This leads to a conclusion that a more liberal attitude regarding abortion is possible in Islamic states, as long as traditional principles are taken into account.
Klausen, Susanne M
This article examines the struggle over abortion law reform that preceded the enactment in 1975 of the first statutory law on abortion in South Africa. The ruling National Party government produced legislation intended to eliminate access to doctors willing to procure abortions in an attempt to prevent young, unmarried white women from engaging in premarital (hetero) sexual activity. It was also aimed at strictly regulating the medical profession’s actions with regards to abortion. The production of the abortion legislation was directly influenced by international struggles for accessible abortion and, more broadly, sexual liberation. The regime believed South Africa was being infiltrated by Western "immorality" and the abortion law was an attempt to buttress racist heteropatriarchal apartheid culture. Examining the abortion controversy highlights the global circulation of ideas about reproduction in the twentieth century and foregrounds a neglected dimension of the history of sexual regulation in apartheid South Africa: the disciplining and regulation of white female reproductive sexuality.
Most of the recent public and scholarly interest in Italy concerning bioethical issues has centered on abortion, general reform of the health care system, and deinstitutionalization of the mentally ill. Medical decisions are thought to concern technical rather than moral issues, and are generally left to physicians. Although ethics is a formal part of the medical curriculum only in Catholic universities, physicians have recently shown more of an interest in bioethical issues, as have philosophers. At present, however, the author is aware of only one non-Catholic institution that is devoted to the study of ethical questions in medicine.
Ogland, Curtis P; Verona, Ana Paula
This study examines the association between religion and attitudes toward the practice of abortion and abortion policy in Brazil. Drawing upon data from the 2002 Brazilian Social Research Survey (BSRS), we test a number of hypotheses with regard to the role of religion on opposition to the practice of abortion and its legalization. Findings indicate that frequently attending Pentecostals demonstrate the strongest opposition to the practice of abortion and both frequently attending Pentecostals and Catholics demonstrate the strongest opposition to its legalization. Additional religious factors, such as a commitment to biblical literalism, were also found to be significantly associated with opposition to both abortion issues. Ultimately, the findings have implications for the future of public policy on abortion and other contentious social issues in Brazil.
The field of abortion counseling originated in the abortion rights movement of the 1970s. During its evolution to the present day, it has faced significant challenges, primarily arising from the increasing politicization and stigmatization of abortion since legalization. Abortion counseling has been affected not only by the imposition of antiabortion statutes, but also by the changing needs of patients who have come of age in a very different era than when this occupation was first developed. One major innovation--head and heart counseling--departs in significant ways from previous conventions of the field and illustrates the complex and changing political meanings of abortion and therefore the challenges to abortion providers in the years following Roe v Wade.
The murders of two abortion clinic workers in Brookline, Massachusetts, on December 30, 1994, have raised public awareness about the increasing violence against abortion clinics, their clients, and their employees. The US Justice Department immediately launched an investigation, while clinics have started to install metal detectors and bulletproof glass. Boston Archbishop Bernard Cardinal Law called for a moratorium on abortion protests in front of clinics in the wake of this incident and urged activists to take their vigils to churches to avoid any violence. In contrast, New York Archbishop John Cardinal O'Connor called for the protests to continue. The Brookline tragedy brings to five the number of abortion clinic workers killed in the previous 22 months, and it had prompted a national debate over inflammatory language inciting violence and whether mainstream anti-abortion groups are willing to assume the moral responsibility for such acts. To be sure at the annual anti-abortion march on Washington, DC, 45,000 protesters gathered peacefully, but they did not condemn violent tactics. After the March 1993 murder of Dr. David Gunn, President Clinton had established a task force to investigate these violent attacks and possible conspiracy implications. At the same time, the Attorney General pointed out that round-the-clock protection of all clinics would be prohibitively expensive for the US Marshall Service. In the House and Senate, measures were introduced calling for full enforcement of the Freedom of Access to Clinics Entrances Law (FACE). The Justice Department also brought several suits against anti-abortion protesters who blocked clinic entrances and stalked employees. All reproductive health clinics are grappling with these threats as well as the associated crisis of a decline in the number of physicians willing to provide abortion services. Medical education associations that set standards for residency programs are also under pressure whether to approve
McLachlan, H V
The issue of abortion is discussed with reference to the claim that people have a right of control over their own bodies. Do people "own" their own bodies? If so, what would be entailed? These questions are discussed in commonsense terms and also in relation to the jurisprudence of Hohfeld, Honore, Munzer and Waldron. It is argued that whether or not women are morally and/or should be legally entitled to have abortions, such entitlements cannot be derived from a general moral entitlement to do what we will with our own bodies since there is no such entitlement. Whether or not we "own" them, we can have rights duties, liabilities, restrictions and disadvantages as well as rights concerning our own bodies.
Pshenichnaya, Natalia Yurievna; Nenadskaya, Svetlana Alexeevna
We report here a fatal case of laboratory confirmed Crimean-Congo hemorrhagic fever (CCHF), which caused nosocomial infection in eight health care workers (HCWs), who had provided medical care for the patient. All the HCWs survived. The report demonstrates that airborne transmission of CCHF is a real risk, at least when the CCHF patient is in a ventilator. During performance of any aerosol-generating medical procedures for any CCHF patient airborne precautions should always be added to standard precautions, in particular, airway protective N95 mask or equivalent standard, eye protection, single airborne precaution room, or a well-ventilated setting.
... by the Military Medical Departments to DoDDS Students on IEPs C Appendix C to Part 57 National... Appendix C to Part 57—Procedures for the Provision of Related Services by the Military Medical Departments to DoDDS Students on IEPs A. Evaluation Procedures (1) Upon request by a DoDDS CSC, the...
... by the Military Medical Departments to DoDDS Students on IEPs C Appendix C to Part 57 National... Appendix C to Part 57—Procedures for the Provision of Related Services by the Military Medical Departments to DoDDS Students on IEPs A. Evaluation Procedures (1) Upon request by a DoDDS CSC, the...
Oizerovich, Silvia; Stray-Pedersen, Babill
Objectives We assessed healthcare students’ knowledge and opinions on Argentinian abortion law and identified differences between first- and final-year healthcare students. Methods In this cross-sectional study, self-administered anonymous questionnaires were administered to 760 first- and 695 final-year students from different fields of study (medicine, midwifery, nursing, radiology, nutrition, speech therapy, and physiotherapy) of the School of Medicine at the University of Buenos Aires, in 2011-2013. Results Compared to first-year students, a higher percentage of final-year students knew that abortion is legally restricted in Argentina (p < 0.001). A significantly higher percentage of final-year students could correctly identify the circumstances in which abortion is legal: woman´s life risk (87.4% last vs. 79.1% first year), rape of a woman with developmental disability (66.2% first vs. 85.4% last-year; p < 0.001). More final-year students chose severe foetal malformations (37.3% first year vs. 57.3% final year) despite its being illegal. Conclusions Although most final-year students knew that abortion is legally restricted in Argentina, misconceptions regarding circumstances of legal abortion were observed; this may be due to the fact that abortion is inadequately covered in the medical curricula. Medical schools should ensure that sexual and reproductive health topics are an integral part of their curricula. Healthcare providers who are aware of the legality of abortion are more likely to provide the public with sound information and ensure abortions are appropriately performed. PMID:27018552
Processing and Paying Medical Claims in the Philippines Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden for the...ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Additional Copies To obtain additional...Eligibility Reporting System DFAS Defense Finance and Accounting Service EFT Electronic Funds Transfer PhilHealth Philippine Health Insurance
Edwards, R B
This essay seeks to reveal the weakness in arguments against public funding of abortions and abortion counseling in the US based on economic, ethico-religious, anti-racist, and logical-consistency objections and to show that public funding of abortion is strongly supported by appeals to basic human rights, to freedom of speech, to informed consent, to protection from great harm, to justice, and to equal protection under the law. The first part of the article presents the case against public funding with detailed considerations of the economic argument, the ethico/religious argument, the argument that such funding supports racist genocide or eugenic quality control, and arguments that a logical inconsistency exists between the principles used to justify the legalization of abortions and arguments for public funding. The second part of the article presents the case for public funding by discussing the spending of public funds on morally offensive programs, arguments for public funding of abortion counseling for the poor, and arguments for public funding of abortions for the poor. It is concluded that it is morally unacceptable and rationally unjustifiable to refuse to expend public funds for abortions for low income women, because after all most money for legal abortions for the poor comes from welfare payments made to women. If conservative forces want to insure that no public funds pay for abortions, they must stop all welfare payments to pregnant women.
Since the RHIC Au-Au run in the year 2001 the 200 MHz cavity system was used at storage and a 28 MHz system during injection and acceleration. The rebucketing procedure potentially causes a higher debunching rate of heavy ion beams in addition to amplifying debunching due to other mechanisms. At the end of a four hour store, debunched beam can easily account for more than 50% of the total beam intensity. This effect is even stronger with the achieved high intensities of the RHIC Au-Au run in 2004. A beam abort at the presence of a lot of debunched beam bears the risk of magnet quenching and experimental detector damage due to uncontrolled beam losses. Thus it is desirable to avoid any accumulation of debunched beam from the beginning of each store, in particular to anticipate cases of unscheduled beam aborts due to a system failure. A combination of a fast transverse kickers and the new 2-stage copper collimator system are used to clean the abort gap continuously throughout the store with a repetition rate of 1 Hz. This report gives. an overview of the new gap cleaning procedure and the achieved performance.
Pacheco, Julianna; Kreitzer, Rebecca
The stability of abortion opinions suggests that pre-adult factors influence these attitudes more than contemporaneous political events. Surprisingly, however, we know little about the origins of abortion opinions, no doubt because the majority of research focuses on cross-sectional analyses of patterns across cohorts. We use a developmental model that links familial and contextual factors during adolescence to abortion attitudes years later when respondents are between 21 and 38 years old. Findings show that religious adherence and maternal gender role values are significant predictors of adult abortion opinions, even after controlling for contemporaneous religious adherence and the respondents’ own views on gender roles. Adolescent religious adherence matters more than religious denomination for adult abortion attitudes. The results have important implications for future trends in abortion attitudes in light of declining religiosity among Americans. PMID:27257307
Read, Christine Margaret
I recently watched a fascinating documentary about the crusade of Dr Bertram Wainer in the 1960s to bring the practice of illegal abortion in Victoria to an end. It documented the profound horror of the backyard abortion that so often ended in infection, sterility or death, and served as a potent reminder of a practice to which we must never return. Of course that cant happen again, abortion is legal now, isnt it? In Victoria in 1969 a Supreme Court judge ruled that an abortion is not unlawful if a doctor believed that: the abortion is necessary to preserve the woman from serious danger to her life or physical or mental health (Menhennit ruling). In Australia today however, abortion law remains conditional, unclear and inconsistent and, except in the ACT, is still part of criminal statutes.
the headache allowing a return to normal function. Despite availability of effective abortive medication, several problems with this treatment have...Working Title: MIGRAINE PREVENTIVE TREATMENT AND ITS INFLUENCE ON THE CHANGE IN THERAPEUTIC INTENSITY WITH DISEASE-SPECIFIC ABORTIVE AGENTS ABSTRACT...Objective: To (1) examine prescribing patterns of migraine-specific abortive medication among new users and non-users of migraine preventive therapy
Mumford, S D
The national security implications of abortion have not been addressed in a public forum but could come to be the single most important facet of the abortion debate. Abortion has been and will continue to be an essential variable in fertility control. Any serious effort at population growth control in the next few decades will have to recognize the role abortion has in birth rate decline. At this time an estimated 40-50 million abortions are performed worldwide each year; 1/2 of them are illegal. In the absence of abortion, annual growth would approach approximately 120 million. Growth of this magnitude would probably place intolerable strains on the economics and environments of some nations. To recognize the role of abortion in fertility control is to emphasize the inescapable need for abortion as 1 element in any comprehensive family planning service. Excessive population growth leads to chronic unemployment and the frustration of the goals of hundreds of millions of people. While this new threat to the security of individual nations and ultimately to global security has not been widely acknowledged, it is beginning to gain the attention of people of different professions and distinctive political persuasions. In many ways, rampant population growth is an even more dangerous and subtle threat to the world than thermonuclear war, for it is intrinsically less subject to rational safeguards and less amenable to organized control. Possibly the greatest and most pervasive problem is the declining ability to meet human needs in the areas of food, raw material, and resources, counterpoised against what are clearly rising expectations of growing populations. The following facts cannot be disputed: world population is a threat to the security of all nations, including the U.S.; abortion is essential to any effective population growth control effort; abortion is a national security issue; and as the availability of legal abortion in the U.S. goes, so goes the availability
Hunt, M E
A female Catholic theologian imagines a just society that does not judge women who decide to undergo an abortion. The Church, practitioners, and the courts must trust that women do make person-enhancing choices about the quality of life. In the last 15 years most progress in securing a woman's right to abortion has been limited to white, well-educated, and middle or upper middle class women. A just society would consider reproductive options a human right. Abortion providers are examples of a move to a just society; they are committed to women's well-being. There are some facts that make one pessimistic about achieving abortion in a just society. The US Supreme Court plans to review important decisions establishing abortion as a civil right. Further, some men insist on suing women who want to make their own reproductive decisions--an anti-choice tactic to wear away women's right to reproductive choice. Bombings of abortion clinics and harassment campaigns by anti-choice groups are common. These behaviors strain pro-choice proponents emotionally, psychically, and spiritually. Their tactics often lead to theologians practicing self-censorship because they fear backlash. Abortion providers also do this. Further, the reaction to AIDS is that sex is bad. Anti-abortion groups use AIDS to further their campaigns, claiming that AIDS is a punishment for sex. Strategies working towards abortion in a just society should be education and persuasion of policymakers and citizens about women's right to choose, since they are the ones most affected by abortion. Moreover, only women can secure their rights to abortion. In a just society, every health maintenance organization, insurance company, and group practice would consider abortion a normal service. A just society provides for the survival needs of the most marginalized.
One of the main objectives of pharmaceutical policies in developing countries is to ensure accessibility and affordability of good quality medicines for the population. The Essential Medicines and Generic Drugs Purchasing Central (French acronym, CAMEG-Togo) is a not-for-profit association established in 1998 to ensure procurement for public and not-for-profit private public health facilities within the framework of recovery of costs. Although attention has been focused mainly on medicines, medical devices account for a growing part of the pharmaceutical products purchased by central stores, hospitals and health programs. Recognizing this need in 2002, CAMEG-Togo in collaboration with the French cooperation agency decided to upgrade its competency in evaluating the quality of medical devices. For that purpose the information sheet used to preselect suppliers for international tenders and the technical specifications sheet for medical devices was revised and pharmacists responsible for processing these files were given specific training. European directive N 93/42/CEE of 14 June 1993 is currently used by CAMEG-Togo as the regulatory basis for preselection of medical device suppliers. Referencing based on American regulatory requirements is now under way to widen the scope of suppliers eligible for preselection. The purpose of this article is first to describe the main guidelines of the European directive used by medical device manufacturers to obtain EC certification and second to present the procedures used by the CAMEG-Togo to preselect medical device suppliers, with special focus on the technical specifications sheet.
... other agencies; medical records. 792.57 Section 792.57 Banks and Banking NATIONAL CREDIT UNION...; medical records. (a) When a request for records or information from NCUA includes information furnished by... whether to disclose the record shall be made in the first instance by the system manager. (b)...
An attempt is made to identify and document the problems of comparative evaluation of the more recent studies of psychiatric morbidity after abortion and to determine the current consensus so that when the results of the joint RCGP/RCOG study of the sequelae of induced abortion become available they can be viewed in a more informed context. The legalization of abortion has provided more opportunities for studies of subsequent morbidity. New laws have contributed to the changing attitudes of society, and the increasing acceptability of the operation has probably influenced the occurrence of psychiatric sequelae. The complexity of measuring psychiatric sequelae is evident from the many terms used to describe symptomatology and behavioral patterns and from the number of assessment techniques involved. Numerous techniques have been used to quantify psychiatric sequelae. Several authors conclude that few psychiatric problems follow an induced abortion, but many studies were deficient in methodology, material, or length of follow-up. A British study in 1975 reported a favorable outcome for a "representative sample" of 50 National Health Service patients: 68% of these patients had an absence of or only mild feelings of guilt, loss, or self reproach and considered abortion as the best solution to their problem. The 32% who had an adverse outcome reported moderate to severe feelings of guilt, regret, loss, and self reproach, and there was evidence of mental illness. In most of these cases the adverse outcome was related to the patient's environment since the abortion. A follow-up study of 126 women, which compared the overall reaction to therapeutic abortion between women with a history of previous mild psychiatric illness and those without reported that a significantly different emotional reaction could not be demonstrated between the 2 groups. In a survey among women seeking an abortion 271 who were referred for a psychiatric opinion regarding terminations of pregnancy
De Bruijn-Geraets, Daisy P; Van Eijk-Hustings, Yvonne JL; Vrijhoef, Hubertus JM
Aim The study protocol is designed to evaluate the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Background Recent (temporarily) enacted legislation in Dutch health care authorizes nurse practitioners and physician assistants to indicate and perform specified medical procedures, i.e. catheterization, cardioversion, defibrillation, endoscopy, injection, puncture, prescribing and simple surgical procedures, independently. Formerly, these procedures were exclusively reserved to physicians, dentists and midwives. Design A triangulation mixed method design is used to collect quantitative (surveys) and qualitative (interviews) data. Methods Outcomes are selected from evidence-based frameworks and models for assessing the impact of advanced nursing on quality of health care. Data are collected in various manners. Surveys are structured around the domains: (i) quality of care; (ii) costs; (iii) healthcare resource use; and (iv) patient centredness. Focus group and expert interviews aim to ascertain facilitators and barriers to the implementation process. Data are collected before the amendment of the law, 1 and 2·5 years thereafter. Groups of patients, nurse practitioners, physician assistants, supervising physicians and policy makers all participate in this national study. The study is supported by a grant from the Dutch Ministry of Health, Welfare and Sport in March 2011. Research Ethics Committee approval was obtained in July 2011. Conclusion This study will provide information about the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Study findings aim to support policy makers and other stakeholders in making related decisions. The study design enables a cross-national comparative analysis. PMID:24684631
Poulakou-Rebelakou, E; Lascaratos, J; Marketos, S G
The legislation and the texts of the most important medical writers of Byzantine times have been studied with reference to abortions, the ethical aspect of this social and medico-legal problem, the theological and the scientific approach. The theoretical basis of the permanent and absolute condemnation of all kinds of abortions except those permitted for medical reasons, is greatly influenced by the spirit of Christianity. In fact, religion supported the view that the reception of the seed in the uterus and the conception of the embryo means the beginning of life and accepted that the foetus is already a living creature. All legislation of Byzantium from the earliest times also condemned abortions. Consequently, foeticide was considered equal to murder and infanticide and the result was severe punishments for all persons who participated in an abortive technique reliant on drugs or other methods. The punishments could extend to exile, confiscation of property and death. The physicians followed the tradition of Ancient Greece, incorporated in the Hippocratic Oath, representative of the ideas of previous philosophers. According to this famous document, it is forbidden them to give a woman "an abortive suppository". The Orthodox faith reinforced this attitute, protective of every human life. On the other hand, the Church and the State accepted selective abortion based on medical data, such as prevention of dangerous conditions in pregnancy or anatomical difficulties involved. In conclusion, science, church and legislation had a common attitude to matters concerning abortion and this fact reveals an effort to apply a fair policy for the rights of the embryo and the protection of human life in Byzantine society.
This article traces the establishment of abortion clinics following Roe v Wade. Abortion clinics followed one of two models: (1) a medical model in which physicians emphasized the delivery of high quality medical services, contrasting their clinics with the back-alley abortion services that had sent many women to hospital emergency rooms prior to legalization, or (2) a feminist model in which clinics emphasized education and the dissemination of information to empower women patients and change the structure of women’s health care. Male physicians and feminists came together in the newly established abortion services and argued over the priorities and characteristics of health care delivery. A broad range of clinics emerged, from feminist clinics to medical offices run by traditional male physicians to for-profit clinics. The establishment of the National Abortion Federation in the mid-1970s created a national forum of health professionals and contributed to the broadening of the discussion and the adoption of compromises as both feminists and physicians influenced each other's practices. PMID:23327251
Raab, G Gregory; Parr, David H
This paper, the last of 3 that discuss the reimbursement challenges facing new medical device technology in various issues of this journal, addresses the structural diversity of Medicare's various payment systems. These systems vary widely in how they establish prices, how they incorporate new technologies and procedures, and the means by which they are updated and maintained. Their importance extends beyond Medicare because other payers use these payment rates as a basis for setting rates of their own. Device manufacturers and medical practitioners must often navigate several of these payment systems concurrently to ensure that technologies and procedures (that are already coded properly and covered) receive a fair payment rate. It is important to recognize that coverage can be undermined without adequate payment and that this situation will dampen further product innovation. The 3 papers, taken together, document the challenges posed by insurer reimbursement policies and show that a close working relationship between the manufacturers that develop new medical technologies and physician practitioners is needed if reimbursement hurdles are to be managed and medical innovation is to continue.
Erdmann, Detlev; Pradka, Sarah P; Similie, Ernest; Marcus, Jeffrey R; Moyer, Kurtis E; Shelburne, John D; Tyler, Douglas S; Levin, Scott L
Many plastic surgery procedures span the divide between aesthetic ("cosmetic") and reconstructive surgery. However, definitions and guidelines may be inconsistent, which may decrease patients' access to legitimate procedures. The article aims to assist Veterans' Health Administration-affiliated plastic surgeons in continuing to provide optimal care to the Nation's Veterans and family members, and should be regarded as an open discussion.
... of Breast & Gynecologic Cancers Breast Cancer Screening Research Abortion, Miscarriage, and Breast Cancer Risk: 2003 Workshop In ... cancer risk, including studies of induced and spontaneous abortions. They concluded that having an abortion or miscarriage ...
A primiparous ewe aborted in mid-gestation. Toxoplasma gondii was suspected as the cause of abortion and a presumptive diagnosis of T. gondii abortion was based on histological lesions of the placenta. PMID:12715986
Hedayat, K M; Shooshtarizadeh, P; Raza, M
Abortion is forbidden under normal circumstances by nearly all the major world religions. Traditionally, abortion was not deemed permissible by Muslim scholars. Shiite scholars considered it forbidden after implantation of the fertilised ovum. However, Sunni scholars have held various opinions on the matter, but all agreed that after 4 months gestation abortion was not permitted. In addition, classical Islamic scholarship had only considered threats to maternal health as a reason for therapeutic abortion. Recently, scholars have begun to consider the effect of severe fetal deformities on the mother, the families and society. This has led some scholars to reconsider the prohibition on abortion in limited circumstances. This article reviews the Islamic basis for the prohibition of abortion and the reasons for its justification. Contemporary rulings from leading Shiite scholars and from the Sunni school of thought are presented and reviewed. The status of abortion in Muslim countries is reviewed, with special emphasis on the therapeutic abortion law passed by the Iranian Parliament in 2003. This law approved therapeutic abortion before 16 weeks of gestation under limited circumstances, including medical conditions related to fetal and maternal health. Recent measures in Iran provide an opportunity for the Muslim scholars in other countries to review their traditional stance on abortion.
Warakamin, Suwanna; Boonthai, Nongluk; Tangcharoensathien, Viroj
Abortion is illegal in Thailand unless the woman's health is at risk or pregnancy is due to rape. This study, carried out in 1999 in 787 government hospitals, examined the magnitude and profile of abortion in Thailand, using data collected prospectively through a review of 45,990 case records (of which 28.5% were classified as induced and 71.5% as spontaneous abortions) and face-to-face interviews with a sub-set of 1854 women patients. The estimated induced abortion ratio was 19.5 per 1000 live births. Almost half the induced abortions were in young women under 25 years of age, many of whom had little or no access to contraception. Socio-economic reasons accounted for 60.2% of abortions. Serious complications were observed in almost a third of cases, especially following abortions performed by non-health personnel. Government physicians' current provision of induced abortion went beyond the provisions of the law in almost half of cases, most commonly for intrauterine death and for congenital anomalies. The paper proposes a framework for policy discussions of the grey areas of maternal and fetal indications leading to legal reform, in order to facilitate safe abortion. A recommendation to amend the abortion law has been proposed to the Ministry of Public Health and the Thai Medical Council.
Medoff, Marshall H; Dennis, Christopher
Targeted Regulation of Abortion Providers (or TRAP) laws impose medically unnecessary and burdensome regulations solely on abortion providers in order to make abortion services more expensive and difficult to obtain. Using event history analysis, this article examines the determinants of the enactment of a TRAP law by states over the period 1974–2008. The empirical results find that Republican institutional control of a state's legislative/executive branches is positively associated with a state enacting a TRAP law, while Democratic institutional control is negatively associated with a state enacting a TRAP law. The percentage of a state's population that is Catholic, public anti-abortion attitudes, state political ideology, and the abortion rate in a state are statistically insignificant predictors of a state enacting a TRAP law. The empirical results are consistent with the hypothesis that abortion is a redistributive issue and not a morality issue.
Borges, Ana Luiza Vilela
Contraceptive counseling and the supply of contraceptive methods are part of post-abortion care and positively influence the subsequent use of contraceptive methods. Studies showing such evidence have been conducted predominantly in countries with no legal restrictions on abortion and with adequate care for women that terminate a pregnancy. However, little is known about contraceptive practices in contexts where abortion is illegal, as in Brazil, in which post-abortion contraceptive care is inadequate. The objective of this study was to analyze the effect of contraceptive care on male condom use and oral and injectable contraceptives in the six months post-abortion, considering reproductive intention. The results showed that contraceptive care only has a positive effect on the use of oral contraceptives in the first six months post-abortion, as long as the woman had a medical consultation in the same month in which she received information on contraception. One or the other intervention alone had no significant impact.
Before 2000, Mexico City's criminal laws prohibited induced abortion to maintain public morality. The Criminal Code considered abortion by accident or in cases of rape not criminal, and criminal but excusable-and therefore not punishable-in certain cases not endangering public morality, such as medical necessity to save the woman's life. In 2000, the Criminal Code was reformed expanding exceptions from criminal liability, particularly in cases of danger to a woman's health or where fetal survival was at risk. In 2004, Mexico City enacted its own law, effectively decriminalizing consensual abortion in cases of rape, fetal malformation, and risk to the woman's health. A 2007 reform further decriminalized all consensual abortion within the first 12 weeks of pregnancy, and required public hospitals to provide abortion and family planning services. In August 2008, the Supreme Court of Mexico ruled Mexico City's 2007 liberalization of abortion law constitutional.
Purcell, Carrie; Hilton, Shona; McDaid, Lisa
The media play a significant part in shaping public perceptions of health issues, and abortion attracts continued media interest. Detailed examination of media constructions of abortion may help to identify emerging public discourse. Qualitative content analysis was used to examine if and how the print media in contributes to the stigmatisation of abortion. Articles from seven British and five Scottish national newspapers from 2010 were analysed for overall framings of abortion and emergent themes, including potentially stigmatising discursive constructs and language. Abortion was found to be presented using predominantly negative language and discursive associations as ‘risky’, and in association with other ‘discredited’ social practices. Key perspectives were found to be absent or marginalised, including those of women who have sought abortion. Few articles framed abortion as a positive and legitimate choice. Negative media representations of abortion contribute to the stigmatisation of the procedure and of women who have it, and reflect a discrediting of women's reproductive decision-making. There is a need to challenge the notion that abortion stigma is inevitable, and to encourage positive framings of abortion in the media and other public discourse. PMID:25115952
Purcell, Carrie; Hilton, Shona; McDaid, Lisa
The media play a significant part in shaping public perceptions of health issues, and abortion attracts continued media interest. Detailed examination of media constructions of abortion may help to identify emerging public discourse. Qualitative content analysis was used to examine if and how the print media in contributes to the stigmatisation of abortion. Articles from seven British and five Scottish national newspapers from 2010 were analysed for overall framings of abortion and emergent themes, including potentially stigmatising discursive constructs and language. Abortion was found to be presented using predominantly negative language and discursive associations as 'risky', and in association with other 'discredited' social practices. Key perspectives were found to be absent or marginalised, including those of women who have sought abortion. Few articles framed abortion as a positive and legitimate choice. Negative media representations of abortion contribute to the stigmatisation of the procedure and of women who have it, and reflect a discrediting of women's reproductive decision-making. There is a need to challenge the notion that abortion stigma is inevitable, and to encourage positive framings of abortion in the media and other public discourse.
Logsdon, Melissa B; Handler, Arden; Godfrey, Emily M
Between July and December 2006, 209 women at a university-based primary care center and a freestanding abortion clinic completed a verbally administered questionnaire in which they were asked their preference for the location of early abortion services. Sixty women seeking primary care services at the university-based clinic and 149 women seeking first-trimester abortion services at an abortion clinic completed the questionnaire. Sixty-seven percent (67%) of women surveyed at the university-based primary care facility and 69% at the abortion clinic indicated a preference for abortion services from their regular health care provider. A statistically significant association (P = 0.002) was found between comfort speaking with a regular health care provider about pregnancy prevention and preference for the provision of abortion services from a regular health care provider. Women may feel more comfortable undergoing an early abortion procedure with a provider with whom they have an established relationship. The integration of early abortion services into primary care practice may increase continuity of care among women seeking an abortion.
Smith, Stephanie S
The complications of unsafe, illegal abortions are a significant cause of maternal mortality in Botswana. The stigma attached to abortion leads some women to seek clandestine procedures, or alternatively, to carry the fetus to term and abandon the infant at birth. I conducted research into perceptions of abortion in urban Botswana in order to understand the social and cultural obstacles to women's reproductive autonomy, focusing particularly on attitudes to terminating a pregnancy. I carried out 21 interviews with female and male urban adult Batswana. This article constitutes a review of the abortion issue in Botswana based on my research. Restrictive laws must eventually be abolished to allow women access to safe, timely abortions. My findings however, suggest that socio-cultural factors, not punitive laws, present the greatest barriers to women seeking to terminate an unwanted pregnancy. These factors must be addressed so that effective local solutions to unsafe abortion can be generated.
Kageyama, Kyoko; Jimba, Koichi; Hashimoto, Satoru
Code of civil procedure is started when a plaintiff appeals to the law. Conversely, if a suit is not appealed, it is not started. We explain the essential principles of the code of civil procedure, and present systems associated with expediting trials (a brief, preliminary oral arguments, preparatory proceedings, inquiry to opponent, organized proceedings, technical adviser system, etc.). Amendment of law is repeated for the purpose of aiming suitably expediting trials. We should utilize the present code of civil procedure suitably, and expect the quick conclusion of trials.
Aguirre Zozaya, F; Iglesias, M; Reyes, R M; Iturralde, G; Martínez, M; Pineda Hernández, C
The history of abortion is a very long one. Every people and nation used different and widely varied methods during the centuries to get rid of unwanted pregnancies. Unfortunately, in most instances, the great majority of these methods was equivalent to zero effectiveness, or, too often, to suicide. Legal aspects of induced abortion have changed considerably with the passing of time and according to countries; these days 36% of the world countries admit abortion on request, 24% for specific reasons only, 16% for medical reasons only, and 8% still consider it an illegal practice. In Mexico abortion is legal only when pregnancy would imply death of the mother, when it is the result of rape of minors, or when it is done on women with very serious mental pathology. Obviously abortion is not the solution to unwanted pregnancies; an improvement in the socioeconomic condition and in the quality of life of many people would be a much better, and more difficult, approach to the solution. Psychosocial factors of abortion involve concepts which are difficult to define, such as those of the wanted or of the unwanted child, and can cause problems which are very difficult to handle. Health education, and sex education in particular, should not only teach the fundamentals of reproduction, but respect and consideration for the phenomenon of procreation, and a strong sense of personal and social responsibility toward family planning.
In Thailand abortion is against the law except in cases of risk to a woman's health or if the pregnancy is the result of rape or other sexual crimes. This paper presents an overview of the history of the abortion debate in Thailand based upon research conducted from 1997-2001 for an ethnographic and historical study. Information was taken from media reports from 1950 in the Thai and English language press, a review of parliamentary records and interviews with 10 key informants. The debate over legal reform started in 1973. A reform bill was passed in 1981 in the House of Representatives but defeated in the Senate, primarily due to the lobbying efforts of Chamlong Srimuang, the leader of a broad-based religious coalition, who has been central in the anti-reform movement since then. The current democratically elected government in Thailand offers the best hope yet for reform, though abortion remains a politically sensitive issue, sensationalized in the press to counter reform efforts. A new advocacy network has recently been formed, including a range of women's organisations, public health advocates, academics and journalists. Current proposals from governmental and medical profession bodies may make abortions available to some women, but most, who seek abortions due to socio-economic and family planning reasons, will continue to have to find abortions by whatever means they can.
Gerdts, Caitlin; DePiñeres, Teresa; Hajri, Selma; Harries, Jane; Hossain, Altaf; Puri, Mahesh; Vohra, Divya; Foster, Diana Greene
Background Factors such as poverty, stigma, lack of knowledge about the legal status of abortion, and geographical distance from a provider may prevent women from accessing safe abortion services, even where abortion is legal. Data on the consequences of abortion denial outside of the US, however, are scarce. Methods In this article we present data from studies among women seeking legal abortion services in four countries (Colombia, Nepal, South Africa and Tunisia) to assess sociodemographic characteristics of legal abortion seekers, as well as the frequency and reasons that women are denied abortion care. Results The proportion of women denied abortion services and the reasons for which they were denied varied widely by country. In Colombia, 2% of women surveyed did not receive the abortions they were seeking; in South Africa, 45% of women did not receive abortions on the day they were seeking abortion services. In both Tunisia and Nepal, 26% of women were denied their wanted abortions. Conclusions The denial of legal abortion services may have serious consequences for women's health and wellbeing. Additional evidence on the risk factors for presenting later in pregnancy, predictors of seeking unsafe illegal abortion, and the health consequences of illegal abortion and childbirth after an unwanted pregnancy is needed. Such data would assist the development of programmes and policies aimed at increasing access to and utilisation of safe abortion services where abortion is legal, and harm reduction models for women who are unable to access legal abortion services. PMID:25511805
Khitamy, Badawy A B
A Muslim woman in her sixteenth week of pregnancy was informed that her ultrasound scan showed spina bifida, and laboratory results confirmed the diagnosis. The child would have various complications and, most probably, would need medical care for life. With the consent of her husband she decided to terminate the pregnancy. Her decision sparked controversy among Muslim clerics in her community, sparking debate between those who would allow abortion for medical reasons and those who oppose abortion for any reason. This paper will review the philosophical and theological arguments of the pro-life and pro-choice groups as well as the Islamic perspective concerning a woman's autonomy over her reproductive system, the sanctity of the fetus and the embryo, therapeutic abortion, and ensoulment.
Khitamy, Badawy A. B.
A Muslim woman in her sixteenth week of pregnancy was informed that her ultrasound scan showed spina bifida, and laboratory results confirmed the diagnosis. The child would have various complications and, most probably, would need medical care for life. With the consent of her husband she decided to terminate the pregnancy. Her decision sparked controversy among Muslim clerics in her community, sparking debate between those who would allow abortion for medical reasons and those who oppose abortion for any reason. This paper will review the philosophical and theological arguments of the pro-life and pro-choice groups as well as the Islamic perspective concerning a woman’s autonomy over her reproductive system, the sanctity of the fetus and the embryo, therapeutic abortion, and ensoulment. PMID:23573379
Background Bowel perforation though rarely reported is a serious complication of induced abortion, which is often performed illegally by persons without any medical training in developing countries. A sudden increase in the number of patients in our centre in recent years prompted the authors to analyze this problem. The study was conducted to describe our own experiences in the surgical management of these patients. Methods This was a retrospective study involving patients who were jointly managed by the surgical and gynecological teams at Bugando Medical Centre (BMC) for bowel perforation secondary to illegally induced abortion from January 2002 to December 2011. The statistical analysis was performed using SPSS version 17.0. Results A total of 68 patients (representing 4.2% of cases) were enrolled in the study. Their ages ranged from 14 to 45 years with a median age of 21 years. Majority of patients were, secondary school students/leavers (70.6%), unmarried (88.2%), nulliparous (80.9%), unemployed (82.4%) and most of them were dependent member of the family. Previous history of contraceptive use was reported in only 14.7% of cases. The majority of patients (79.4%) had procured the abortion in the 2nd trimester. Dilatation and curettage (82.4%) was the most common reported method used in procuring abortion. The interval from termination of pregnancy to presentation in hospital ranged from 1 to 14 days (median 6 days ). The ileum (51.5%) and sigmoid colon (22.1%) was the most common portions of the bowel affected. Resection and anastomosis with uterine repair was the most common (86.8%) surgical procedure performed. Complication and mortality rates were 47.1% and 10.3% respectively. According to multivariate logistic regression analysis, gestational age at termination of pregnancy, delayed presentation, delayed surgical treatment and presence of complications were significantly associated with mortality (P<0.001). The overall median length of hospital stay (LOS
Wardle, L D
They only certain outcomes of the Webster decision is that state legislatures will be stimulated to enact more legislation regulating abortion. However it is unlikely that the worst prochoice fears will be realized. A return to the 19th century abortion prohibition era is very unlikely because of trends in Western societal attitudes and laws. Since 1973 and the Roe decision there have been more than 300 bills or acts enacted by state legislatures that regulate abortion. Whether it is criminal prohibitions, licensing requirements, zoning restrictions, parental participation, spousal participation, informed consent, health and sanitation regulations, post viability regulations, laws protecting the right of health care workers not to participate in abortion, public funding restrictions, or regulations of fetal experimentation, abortion regulations have definitely been wide spread. The democratic process is going to produce a moderate position on abortion as a result of the Webster decision for 7 reasons: (1) the period before Roe was a time when abortion legislation was in a trend towards moderation. In 1962 abortion prohibitions were in place in all states. In 1967 4 states adopted an abortion reform position that allowed for abortion in the hard cases: (1) maternal health, (2) fetal defect, (3) rape/incest. Over the next 5 years 9 more states followed and 3 others went even farther by allowing unrestricted abortion during early pregnancy. (2) public opinion is consistent and strong in favoring abortion restrictions except for the hard cases. (3) the trend towards moderation in abortion regulations is closely related to other legal trends toward moderation. No fault divorce was a move towards moderation. The abortion experience in Western Europe was towards moderation. (5) Medical technological developments are putting the power of abortion in the hands of women. Abortificant drugs that can be used without medical assistance give women greater freedom. (6) The
open surgery, laparoscopy ), the technology that was used to complete the procedure (e.g., laparoscope, endoscope), and the device that was...distinct procedures such as open coronary angioplasty (code 3603), percutaneous angioplasty (code 3606), and intercoronary thrombosis infusion (code 3604...code, code 3606, “insertion of coronary artery stent,” would also have to be reported. For payment or research purposes, to know how many vessels
Wolleat, Patricia L.
A number of questions relating to providing abortion information to teenagers can be raised from legal, ethical and philosophical standpoints. The purpose of this article is to examine abortion information-giving from the perspective of counseling and guidance theory and practice. (Author)
Handy, J A
The literature concerning psychosocial aspects of induced abortion is reviewed. Key areas discussed are: the legal context of abortion in Britain, psychological characteristics of abortion-seekers, pre- and post-abortion contraceptive use, pre- and post-abortion counselling, the actual abortion and the effects of termination versus refused abortion. Women seeking termination are found to demonstrate more psychological disturbance than other women, however this is probably temporary and related to the short-term stresses of abortion. Inadequate contraception is frequent prior to abortion but improves afterwards. Few women find the decision to terminate easy and most welcome opportunities for non-judgemental counselling. Although some women experience adverse psychological sequelae after abortion the great majority do not. In contrast, refused abortion often results in psychological distress for the mother and an impoverished environment for the ensuing offspring.
In 1987, 20,830 legal abortions were performed in Denmark. 2,845 involved women below the age of 20, and 532 involved women terminating pregnancy after the 12th week. Danish law permits all of its female citizens to have an abortion free-of-charge before the 12th week of pregnancy. After the 12th week, the abortion must be applied for through a committee of 3 members, and all counties in Denmark have a committee. It is felt in Denmark that a woman has a right to an abortion if she decides to have one. It she makes that choice, doctors and nurses are supportive. Since 1970, sex education has been mandatory in Danish schools. Teachers often collaborate closely with school doctors and nurses in this education. All counties are required to have at least 1 clinic that provides contraceptive counselling. It was recently found that the lowest number of pregnancies among teenaged girls was found in a county in Jutland where all 9th grade students visit the county clinic to learn about contraceptives, pregnancy, and abortion. Within 1 year after Copenhagen had adopted this practice, the number of abortions among teenagers declined by 20%. One fourth of all pharmacies also collaborate with schools to promote sex education, instructing students about contraceptives and pregnancy tests. The Danish Family Planning Association has produced a film on abortion, and plans to produce videos on abortion for use in schools. The organization also holds training programs for health care personnel on contraception, pregnancy, and abortion. By means of the practices described above, it is hoped that the number of abortions and unwanted pregnancies in Denmark will be reduced.
Jukic, Marko; Kvolik, Slavica; Kardum, Goran; Kozina, Slavica; Tomic Juraga, Ana
AIM. To assess physicians' knowledge and practices for obtaining patients' informed consent to medical procedures. METHODS. An anonymous and voluntary survey of knowledge and practices for obtaining informed consent was conducted among 470 physicians (63% response rate) working in 6 hospitals: 93 specialists in anesthesiology, 166 in internal medicine, and 211 in surgery. RESULTS. Only 54% physicians were acquainted with the fact that the procedure for obtaining consent was regulated by the law. Internists and surgeons were better informed than anesthesiologists (P=0.024). More than a half of respondents (66%) were familiar with the fact that a law on patient rights was passed in Croatia; there were no differences among different specialties (P=0.638). Only 38% of the physicians were fully informed about the procedure of obtaining consent. Internists and surgeons provided detailed information to the patient in 33% of the cases and anesthesiologists in 16% of the cases (P<0.050). Internists reported spending more time on informing the patient than anesthesiologists and surgeons (P<0.001). There were no differences in knowledge and practices for obtaining informed consent between physicians working in university and those working in community hospitals (P> or =0.05 for all questions). CONCLUSION. Physicians in Croatia have no formal education on informed consent and implement the informed consent process in a rather formal manner, regardless of the type of hospital or medical specialty. Systemic approach at education and training at the national level is needed to improve the informed consent process.
Stolar, M H
The following concepts are discussed: (1) quality assurance programs, (2) drug usage review, (3) utilization review, (4) peer review, (5) medical audit, (6) patient care audit and (7) medical care evaluation studies. A framework within which all types of hospital quality assurance mechanisms can be constructed is proposed and their interrelationships are described. The pharmacist's particpiation in the hospital's overall quality assurance program is stressed in two main areas-drug usage review, performed jointly with the medical staff, and quality assurance of pharmaceutical services, a peer review function of the pharmacy profession. These services are primarily drug distribution and control, drug information, clinical pharmacy, continuing education, and other pharmacy and pharmacist functions. Both functions may be viewed as parts of the pharmacy audit, one of several patient care audits within the facility. Pharmacists in skilled nursing facilities have quality assurance responsibilities similar to those of hospital-based pharmacists.
Penbegul, Necmettin; Atar, Murat; Kendirci, Muammer; Bozkurt, Yasar; Hatipoglu, Namık Kemal; Verit, Ayhan; Kadıoglu, Ates
In recent years, day by day, robotic surgery applications have increase their role in our medical life. In this article, we reported the discovery of the first primitive robotic applications as automatic machines for the sensitive calculation of liquids such as blood in the literature. Al-Jazari who wrote the book "Elcâmi 'Beyne'l - 'ilm ve'l - 'amel en-nâfi 'fi es-sınaâ 'ti'l - hiyel", lived in Anatolian territory between 1136 and 1206. In this book that was written in the twelfth century, Al-Jazari described nearly fifty graphics of robotic machines and six of them that were designed for medical purposes. We found that some of the robots mentioned in this book are related to medical applications. This book reviews approximately 50 devices, including water clocks, candle clocks, ewers, various automata used for amusement in drink assemblies, automata used for ablution, blood collection tanks, fountains, music devices, devices for water lifting, locks, a protractor, a boat-shaped water clock, and the gate of Diyarbakir City in south-east of Turkey, actually in northern Mesopotamia. We found that automata used for ablution and blood collection tanks were related with medical applications; therefore, we will describe these robots.
Consedine, Nathan S.; Windsor, John A.
Mismatches between the needs of public health systems and student interests have led to renewed study on the factors predicting career specializations among medical students. While most work examines career and lifestyle values, emotional proclivities may be important; disgust sensitivity may help explain preferences for careers with greater and…
Potdar, Pritam; Barua, Alka; Dalvie, Suchitra; Pawar, Anand
In India, safe abortion services are sought mainly in the private sector for reasons of privacy, confidentiality, and the absence of delays and coercion to use contraception. In recent years, the declining sex ratio has received much attention, and implementation of the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act (2003) has become stringent. However, rather than targeting sex determination, many inspection visits target abortion services. This has led to many private medical practitioners facing negative media publicity, defamation and criminal charges. As a result, they have started turning women away not only in the second trimester but also in the first. Samyak, a Pune-based, non-governmental organization, came across a number of cases of refusal of abortion services during its work and decided to explore the experiences of private medical practitioners with the regulatory mechanisms and what happened to the women. The study showed that as a fallout from the manner of implementation of the PCPNDT Act, safe abortion services were either difficult for women to access or outright denied to them. There is an urgent need to recognize this impact of the current regulatory environment, which is forcing women towards illegal and unsafe abortions.
Katz, Ernest R.; And Others
The amount of anxiety suggested the need for clinical intervention to reduce procedure-related distress in children with cancer. Younger children exhibited consistently higher levels of distress than older children and displayed a greater variety of anxious responses over a longer time span. (Author/BEF)
Lang, Elvira V; Berbaum, Kevin S; Faintuch, Salomao; Hatsiopoulou, Olga; Halsey, Noami; Li, Xinyu; Berbaum, Michael L; Laser, Eleanor; Baum, Janet
Medical procedures in outpatient settings have limited options of managing pain and anxiety pharmacologically. We therefore assessed whether this can be achieved by adjunct self-hypnotic relaxation in a common and particularly anxiety provoking procedure. Two hundred and thirty-six women referred for large core needle breast biopsy to an urban tertiary university-affiliated medical center were prospectively randomized to receive standard care (n=76), structured empathic attention (n=82), or self-hypnotic relaxation (n=78) during their procedures. Patients' self-ratings at 1 min-intervals of pain and anxiety on 0-10 verbal analog scales with 0=no pain/anxiety at all, 10=worst pain/anxiety possible, were compared in an ordinal logistic regression model. Women's anxiety increased significantly in the standard group (logit slope=0.18, p<0.001), did not change in the empathy group (slope=-0.04, p=0.45), and decreased significantly in the hypnosis group (slope=-0.27, p<0.001). Pain increased significantly in all three groups (logit slopes: standard care=0.53, empathy=0.37, hypnosis=0.34; all p<0.001) though less steeply with hypnosis and empathy than standard care (p=0.024 and p=0.018, respectively). Room time and cost were not significantly different in an univariate ANOVA despite hypnosis and empathy requiring an additional professional: 46 min/161 dollars for standard care, 43 min/163 dollars for empathy, and 39 min/152 dollars for hypnosis. We conclude that, while both structured empathy and hypnosis decrease procedural pain and anxiety, hypnosis provides more powerful anxiety relief without undue cost and thus appears attractive for outpatient pain management.
Moslin, Trisha A; Rochat, Roger W
Little is known about women's contraceptive use and sexual activity in the immediate post-abortion period although effective contraceptive use is paramount during this time because fertility returns almost immediately. This study sought to learn more about women's contraceptive use and sexual behaviors to inform abortion providers and help them serve their clients better, potentially leading to a decline in the rates of unintended pregnancy and repeat abortion. Abortion clients of an Atlanta, GA clinic were surveyed over the telephone 3-5 weeks post-abortion. Background information was collected from clinic medical charts. Simple and stratified frequencies and logistic regression were used to describe women's sexual activity and contraceptive use in the immediate post-abortion period and to determine if variables known at the time of the abortion could predict contraceptive use 3-5 weeks post-abortion. 54.2% (n = 39) of women had engaged in sexual intercourse in the immediate post-abortion period. Of these, 30.8% (n = 12) were not using a contraceptive method or were not using it effectively. Women who said they did not want or need information about birth control on their medical history form were less likely to be using contraception 3-5 weeks post abortion. Emphasizing the rapid return of fertility and risk of conception in pre-abortion counseling sessions could prevent future unintended pregnancies among abortion clients. Further research could explore the interaction between a willingness to talk about contraceptive methods at the time of abortion and method use post-abortion.
Nicholson, R H
Europe is experiencing the same conflict over abortion that the US is having. In Germany the unification has resulted in not 1, but 2 abortion laws. Each law apples to the old borders, but a new law is to be formulated by 1992. The most restrictive abortion laws are in Ireland where there is total prohibition. The most permissive laws are in the Netherlands where it is available on demand until the 24th week. France, Belgium, Spain, Italy have all relaxed their laws to some degree; however, there is no common European position on abortion. Eastern European countries have seen abortion banned, to increase the population to survive a war with the West, to having it become the primary form of birth control decades later. In Poland, as well as many other Eastern European countries, abortion is beginning to become illegal again as independence allows the freedom of the citizens to choose their own laws and rights. The development of new drugs, such as RU486 or mifepristone, has also influenced a change in abortion policy. Currently it is legal in France and Great Britain.
Joffe, C E; Weitz, T A; Stacey, C L
Abortion represents a particularly interesting subject for a social movements analysis of healthcare issues because of the involvement of both feminist pro-choice activists and a segment of the medical profession. Although both groups have long shared the same general goal of legal abortion, the alliance has over time been an uneasy one, and in many ways a contradictory one. This paper traces points of convergence as well as points of contention between the two groups, specifically: highlighting the tensions between the feminist view of abortion as a women-centred service, with a limited, 'technical' role for the physicians, and the abortion-providing physicians' logic of further medicalization/professional upgrading of abortion services as a response to the longstanding marginality and stigmatisation of abortion providers. Only by noting the evolving relationships between these two crucial sets of actors can one fully understand the contemporary abortion rights movement. We conclude by speculating about similar patterns in medical/lay relationships in other health social movements where 'dissident doctors' and lay activists are similarly seeking recognition for medical services that are controversial.
... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...
... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...
... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...
... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Abortion. 551.23 Section 551.23 Judicial..., Pregnancy, Child Placement, and Abortion § 551.23 Abortion. (a) The inmate has the responsibility to decide either to have an abortion or to bear the child. (b) The Warden shall offer to provide each...
Di Nucci, Ezio
I argue that it is possible for prospective mothers to wrong prospective fathers by bearing their child; and that lifting paternal liability for child support does not correct the wrong inflicted to fathers. It is therefore sometimes wrong for prospective mothers to bear a child, or so I argue here. I show that my argument for considering the legitimate interests of prospective fathers is not a unique exception to an obvious right to procreate. It is, rather, part of a growing consensus that procreation can be morally problematic and that generally talking of rights in this context might not be warranted. Finally, I argue that giving up a right to procreate does not imply nor suggest giving up on women's absolute right to abort, which I defend.
The Cardinal of Milan and the linguist and writer Umberto Eco maintained a correspondence in the mid-1990s in connection with the Italian magazine ¿Liberal¿. One of the issues discussed was the conflict between belief in the value of human life and existing abortion legislation. Umberto Eco stated that he would do all in his power to dissuade a woman pregnant with his child from having an abortion, regardless of the personal cost to the parents, because the birth of a child is a miracle. He would not, however, feel capable of imposing his ethical position on anyone else. Terrible moments occur in which women have a right to make autonomous decisions concerning their bodies, their feelings, their futures. Those who disagree cite the right to life, a rather vague concept about which even atheists can be enthusiastic. The moment at which a new human being is formed has been brought to the center of Catholic theology, despite its uncertainty; the beginning of a new life may always need to be understood as a process whose end result is the newborn. Only the mother should decide at what moment the process may be interrupted. The cardinal¿s response distinguished between psychic and physical life, on the one hand, and life participating in the life of God on the other. The threshold is the moment of conception, reflecting a continuity of identity. The new being is worthy of respect. Any violation of the affection and care owed to the being can only be experienced as a profound suffering and painful laceration that may never heal. The response of Eco is unknown.
An active opponent of abortion was the primary investigator of a new statistical meta-analysis of existing research on the possibility of an association between induced abortion and breast cancer. Based on the findings, he and his colleagues concluded that an induced abortion does increase the risk of breast cancer. There are several factors that the meta-analysis did not take into consideration, however. The studies considered induced abortion separate from other categories of breast cancer risk (i.e., never having given birth and having first child after age 30). They did not examine the effects of miscarriages, since they assumed that spontaneous abortions are not associated with sufficient levels of estrogen. Many of the 23 studies in the meta-analysis did not distinguish between spontaneous and induced abortions. All but seven studies did not include a control group of women who had never had children. The cancer research community looks upon the conclusions of the authors with skepticism. In February 1996, the National Cancer Institute (NCI) reported that no evidence of a direct relationship between breast cancer and either induced or spontaneous abortion exists. In September 1995, the American College of Obstetricians and Gynecologists (ACOG) and the California Medical Association independently reviewed the literature. They jointly concluded that the evidence is insufficient to support claims that induced abortion increases the risk of breast cancer. ACOG and NCI are concerned that some women, especially healthy controls, did not answer truthfully about having had had an abortion, particularly those who may have had one when it was illegal in the US. A Swedish study supports this concern. It found significant discrepancies between what patients said and their medical records. Some anti-choice state legislators are using the conclusions of the meta-analysis to discourage abortion. Mississippi and Montana have enacted legislation that requires notification of
Belton, Suzanne; Whittaker, Andrea; Fonseca, Zulmira; Wells-Brown, Tanya; Pais, Patricia
The new Penal Code in 2009 was an opportunity for Timor-Leste to allow some legal grounds for abortion, which was highly restricted under Indonesian rule. Public debate was contentious before ratification of the new code, which allowed abortion to save a woman's life and health. A month later, 13 amendments to the code were passed, highly restricting abortion again. This paper describes the socio-legal context of unsafe abortion in Timor-Leste, based on research in 2006-08 on national laws and policies and interviews with legal professionals, police, doctors and midwives, and community-based focus group discussions. Data on unsafe abortions in Timor-Leste are rarely recorded. A small number of cases of abortion and infanticide are reported but are rarely prosecuted, due to deficiencies in evidence and procedure. While there are voices supporting law reform, the Roman Catholic church heavily influences public policy and opinion. Professional views on when abortion should be legal varied, but in the community people believed that saving women's lives was paramount and came before the law. The revised Penal Code is insufficient to reduce unsafe abortion and maternal mortality. Change will be slow, but access to safe abortion and modern contraception are crucial to women's ability to participate fully as citizens in Timor-Leste.
Savage, W; Francome, C
In 2008, we investigated the attitudes and practice of British consultant gynaecologists towards induced abortion, and made comparisons with our similar survey in 1989. A random sample of one in six (217) was selected from the register of the Royal College of Obstetricians and Gynaecologists (RCOG). The response to the postal questionnaire was 70% (152). Satisfaction with the way the 1967 Abortion Act is operating was expressed by 59% (76% in 1989) and an upper limit of 24 weeks was supported by 50% (77% in 1989). Abortion after 20 weeks was approved to protect health by 92%; after rape by 60% and for serious fetal handicap by 87%. A change in the regulations to require the signature of only one doctor (rather than two) to certify the need for abortion was supported by 65%. Only a minority (41%) provided 2nd trimester abortion in person; 61% would separate abortion provision from general gynaecology; 57% suggested there should be separate abortion units for gestations over 13 weeks and 56% felt that fertility control should become be a sub-specialty. Satisfaction with the Abortion Act 1967 has decreased during the last 20 years. Gynaecologists' attitudes to the indications for 2nd trimester abortion remain wide, with clear implications for women seeking abortion. The service to women would be improved if abortion on request was permitted in the 1st trimester and after only one medical signature in the 2nd trimester. Our view is that the decision to end a pregnancy should be made by the woman and that abortion should be decriminalised.
Bankole, Akinrinola; Sedgh, Gilda; Oye-Adeniran, Boniface A; Adewole, Isaac F; Hussain, Rubina; Singh, Susheela
This study used data from a community-based survey to examine women's experiences of abortion in Nigeria. Fourteen percent of respondents reported that they had ever tried to terminate a pregnancy, and 10% had obtained an abortion. The majority of women who sought an abortion did so early in the pregnancy. Forty-two percent of women who obtained an abortion used the services of a non-professional provider, a quarter experienced complications and 9% sought treatment for complications from their abortions. Roughly half of the women who obtained an abortion used a method other than D&C or MVA. The abortion prevalence and conditions under which women sought abortions varied by women's socio-demographic characteristics. Because abortion is illegal in Nigeria except to save the woman's life, many women take significant risks to terminate unwanted pregnancies. Reducing the incidence of unwanted pregnancy and unsafe abortion can significantly impact the reproductive health of women in Nigeria.
Cheng, Chris-Tin; Deitch, Jessica M; Haines, Ian E; Porter, David J; Kilbreath, Sharon L
Lymphoedema of the arm is a potentially serious consequence of any axillary procedure performed during the management of breast cancer. In an attempt to reduce its incidence and severity, patients are instructed to avoid venepunctures and blood pressure measurements on the treated arm. These precautions are not possible in some patients and attempts to adhere to them can cause discomfort, anxiety and stress for both patients and their health-care workers. The strength with which these recommendations are made is in contrast to the level of evidence underpinning them. This paper reviews this evidence regarding the safety, or lack thereof, of blood pressure monitoring and intravenous puncture in women who have had axillary surgery. With this evidence generally being anecdotal in nature, there appears to be no rigorous evidence-based support for the risk-reduction behaviours of avoiding blood pressure monitoring and venepuncture in the affected arm in the prevention of lymphoedema after axillary procedure. A clinical trial was proposed to investigate whether such avoidance measures were valuable, but failed during its inception. There remains a need for research from prospective trials on this controversial topic to determine the most appropriate patient recommendations that should be provided after axillary procedure regarding the risks for development of lymphoedema.
Jones, Rachel K.; Jerman, Jenna
Objective To determine which characteristics and circumstances were associated with very early and second-trimester abortion. Methods Paper and pencil surveys were collected from a national sample of 8,380 non-hospital U.S. abortion patients in 2014 and 2015. We used self-reported LMP to calculate weeks gestation; when LMP was not provided we used self-reported weeks pregnant. We constructed two dependent variables: obtaining a very early abortion, defined as six weeks gestation or earlier, and obtaining second-trimester abortion, defined as occurring at 13 weeks gestation or later. We examined associations between the two measures of gestation and a range of characteristics and circumstances, including type of abortion waiting period in the patients’ state of residence. Results Among first-trimester abortion patients, characteristics that decreased the likelihood of obtaining a very early abortion include being under the age of 20, relying on financial assistance to pay for the procedure, recent exposure to two or more disruptive events and living in a state that requires in-person counseling 24–72 hours prior to the procedure. Having a college degree and early recognition of pregnancy increased the likelihood of obtaining a very early abortion. Characteristics that increased the likelihood of obtaining a second-trimester abortion include being Black, having less than a high school degree, relying on financial assistance to pay for the procedure, living 25 or more miles from the facility and late recognition of pregnancy. Conclusions While the availability of financial assistance may allow women to obtain abortions they would otherwise be unable to have, it may also result in delays in accessing care. If poor women had health insurance that covered abortion services, these delays could be alleviated. Since the study period, four additional states have started requiring that women obtain in-person counseling prior to obtaining an abortion, and the increase in
Joffe, Carole; Yanow, Susan
A hopeful note in the contemporary abortion environment in the United States is the expanding role of advanced practice clinicians--nurse practitioners, physician assistants and nurse-midwives--in first trimester abortion provision. A large percentage of primary health care in the U.S. is currently provided by these non-physicians but their involvement in abortion care is promising, especially in light of the shortage of physician providers. Two national symposia in 1990 and 1996 approved the expansion of early abortion care to non-physicians. As of January 2004, trained advanced practice clinicians were providing medical, and in some cases, early surgical abortion in 14 states. This has required not only medical training but also political organising to achieve the necessary legal and regulatory changes, state by state, by groups such as Clinicians for Choice and the Abortion Access Project, described here in examples in two states and the reflections of three advanced practice clinicians. Recent surveys in three states show a substantial interest among advanced practice clinicians in abortion training, leading to cautious optimism about the possibility of increased abortion access for women. Most encouraging, advanced practice clinicians, like their physician counterparts, show a level of passionate commitment to the work that is rare elsewhere in health care in the U.S. today.
Chor, Julie; Hill, Brandon; Martins, Summer; Mistretta, Stephanie; Patel, Ashlesha; Gilliam, Melissa
Objectives To evaluate the impact of doula support on first trimester abortion care. Study Design Women were randomized to receive doula support or routine care during first trimester surgical abortion. We examined the effect of doula support on pain during abortion using a 100-mm visual analog scale. The study had statistical power to detect 20% difference in mean pain scores. Secondary measures included satisfaction, procedure duration, and patient recommendations regarding doula support. Results Two hundred and fourteen women completed the study: 106 received doula support, 108 received routine care. The groups did not differ regarding demographics, gestational age, or medical history. Pain scores in the doula and control groups did not differ at speculum insertion (38.6mm [±26.3mm] vs. 43.6mm [±25.9mm], p=0.18) or procedure completion (68.2mm [±28.0mm] vs. 70.6mm [±23.5mm], p=0.52). Procedure duration (3.39min [±2.83min] vs. 3.18min [±2.36min], p=0.55) and patient satisfaction (75.2mm [±28.6mm] vs. 74.6mm [±27.4mm], p=0.89) did not differ between doula and control groups. Among women who received doula support, 96.2% recommended routine doula support for abortion and 60.4% indicated interest in training as doulas. Among women who did not receive doula support, 71.6% of women would have wanted it. Additional clinical staff was needed to provide support for 2.9% of women in the doula group and 14.7% of controls (p<0.01). Conclusions Although doula support did not have a measurable effect on pain or satisfaction, women overwhelmingly recommended it for routine care. Women receiving doula support were less likely to require additional clinic support resources. Doula support, therefore, may address patient psychosocial needs. PMID:24983679
Howard, E; Kharibian, G
To test the hypothesis that a standard library system could be designed for hospital departmental libraries, a system was developed and partially tested for four departmental libraries in the Washington University School of Medicine and Associated Hospitals. The system from determination of needs through design and evaluation, is described. The system was limited by specific constraints to control of the monograph collection. Products of control include catalog cards, accessions list, new book list, location list, fund list, missing book list, and discard book list. Sample data form and pages from a procedure manual are given, and conversion from a manual to an automated system is outlined. The question of standardization of library records and procedures is discussed, with indications of the way in which modular design, as utilized in this system, could contribute to greater flexibility in design of future systems. Reference is made to anticipating needs for organizing departmental libraries in developing regional medical library programs and to exploring the role of the departmental library in a medical library network.
Giard, R W M; Overbeke, A J P M
In The Netherlands the threat of terrorist attacks also exist. Both doctors and hospitals alike should be prepared for such attacks both on the logistical as well as the medical level. Most terrorist attacks are carried out with explosives. This results in many victims and in cases of explosions in closed or semi-closed areas, often results in complex medical problems in many of the victims. An explosion that occurs as the result ofa bomb detonating can result in 4 patterns of injury: the primary explosion injury caused by the pressure of the blast, the secondary injuries caused by flying debris, the tertiary injuries caused by the explosion wind, and the quaternary caused by heat and fire. Common injuries seen following an explosion include: lung damage, neurological damage, abdominal injuries, bone fractures and skeletal damage and crush-syndrome. The triage occurs at the site of the explosion as well as on arrival in hospital. One especially important aspect of this is the sorting and selecting between victims who are likely to develop complex problems and who therefore need to receive aggressive treatment in a specially equipped centre and those patients for whom the nearest emergency department will suffice their needs. The triage should be repeated considering the possibility that initial estimates on these points may have been wrong. Epidemiological research should be carried out for each attack in order to make an inventory of the number of victims, the injuries incurred, the assessment of the effects of the medical help received and an assessment of the effectiveness of the total aid received.
Abortion coverage under various health care reform proposals has dominated the political reproductive rights debate, while poor women's access to abortion under Medicaid presents a current practical concern. Under the Clinton administration's proposed Health Security Act, abortion would be covered under "services for pregnant women," and Medicaid would eventually be incorporated into the national health plan. A final version is a long way off. For now, the Hyde amendment, limiting Medicaid coverage of abortion, controls the issue. Congress has made only negligible progress in freeing federal funds for Medicaid abortions: only in situations of life endangerment, rape, or incest. States are required to cover abortions that are medically necessary under the new guidelines, which now include pregnancy arising from rape and incest. The federal policy defers to state law on the definition of rape and incest, allowing for reasonable reporting or documentation requirements, while disallowing unduly burdensome regulations by allowing the treating physician reimbursement when the physician certifies that the patient was unable for physical or psychological reasons to comply with the requirement. States disagreeing with the new abortion policy immediately registered their opposition. Utah's health department, which has a "life only" law, has pledged not to implement the new federal policy until there is further clarification. The Health Care Financing Administrator responded by writing that "the decision to implement this policy nationwide was not discretionary." Congress chose not to add statutory language deferring to the states, and under U.S. Constitutional law, where state law or policy conflicts with federal law, federal law takes precedence. The next battle will certainly center on attempts to amend the Hyde amendment itself as well as health care legislation along the "states' option" lines.
Cabridain, M O
In anesthésie-réanimation, a discipline that brings together anaesthesiology and emergency as well as intensive care, the managerial methods of evaluation and control of needs in personnel, were not adequate for describing medical practices. Around four managerial standards that were used by the Paris public hospital administration, new situations have crystalized. The historical analysis of how these standards have been put into use, used and put in question throws light upon the way organizations function. The present day situation in this speciality seems to be mainly determined by the strategies of specialists for obtaining professional recognition of their discipline and for advancing their careers.
Putintsev, V A; Bogomolov, D V; Fedulova, M V; Gribunov, Iu P; Kul'bitskiĭ, B N
This paper is devoted to the novel computer technologies employed in the studies of histological preparations. These technologies allow to visualize digital images, structurize the data obtained and store the results in computer memory. The authors emphasize the necessity to properly document digital images obtained during forensic-histological studies and propose the procedure for the formulation of electronic documents in conformity with the relevant technical and legal requirements. It is concluded that the use of digital images as a new study object permits to obviate the drawbacks inherent in the work with the traditional preparations and pass from descriptive microscopy to their quantitative analysis.
Kramer, Mark; Ly, Amy; Li, Jun
The phenotype HNPP (hereditary neuropathy with liability to pressure palsies) is caused by heterozygous deletion of the PMP22 gene. HNPP is clinically characterized by asymmetric focal sensory loss and muscle weakness. Reports of HNPP have been rare. In this article, we report the case of an asymptomatic woman with the HNPP mutation. After undergoing total knee arthroplasty, she developed a footdrop with prolonged recovery. We concluded (a) that the HNPP mutation may carry a high risk for certain surgical procedures not expected to cause neurologic deficits in normal patients and (b) that humans with the HNPP mutation can be asymptomatic. Lack of symptoms can contribute to underrecognition of the disease.
Kramer, Mark; Ly, Amy; Li, Jun
The phenotype HNPP (hereditary neuropathy with liability to pressure palsies) is caused by heterozygous deletion of the PMP22 gene. HNPP is clinically characterized by asymmetric focal sensory loss and muscle weakness. Reports of HNPP have been rare. In this article, we report the case of an asymptomatic woman with the HNPP mutation. After undergoing total knee arthroplasty, she developed a footdrop with prolonged recovery. We concluded (a) that the HNPP mutation may carry a high risk for certain surgical procedures not expected to cause neurologic deficits in normal patients and (b) that humans with the HNPP mutation can be asymptomatic. Lack of symptoms can contribute to underrecognition of the disease. PMID:26761923
The Orion Launch Abort System, or LAS, pathfinder returned home to NASA Langley on Oct. 18 on its way to NASA's Kennedy Space Center. The hardware was built at Langley and was used in preparation f...
I discuss three topics. First, there is a philosophical connecting thread between several recent trends in the abortion discussion, namely, the issue of our animal nature, and physical embodiment. The philosophical name given to the position that you and I are essentially human animals is "animalism." In Section II of this paper, I argue that animalism provides a unifying theme to recent discussions of abortion. In Section III, I discuss what we do not find among recent trends in the abortion discussion, namely "the right to privacy." I suggest some reasons why the right to privacy is conspicuous by its absence. Finally, I address Patrick Lee's claim that the evil of abortion involves "the moral deterioration that the act brings to those who are complicit in it, and to the culture that fosters it."
The World Health Organization estimates that almost half a million women in developing countries die in pregnancy and childbirth every year. Unsafe induced abortion is responsible for perhaps one-quarter of these deaths. In this article, the author reviews the legal, medical, and social contexts in which women in developing countries resort to clandestine abortion. Despite intensified international concern with reducing high rates of maternal mortality and morbidity, national policy makers and participants at international conferences on maternal health--with a few important exceptions--have not recommended that safe, legal services for terminating unwanted pregnancies be offered as an essential element of basic reproductive health care. United States international policy on funding abortion-related activities in maternal health and family planning programs is especially restrictive. A new policy approach is clearly needed if unacceptably high rates of maternal morbidity and mortality in many countries are to be reduced.
Dispersion analysis was used in research on the regluation of the size of families. The total number of applications for abortion to the Central District Hospital of Pinsk in 1970-1971 was analyzed. Figures are given on the age of applicants, marital status, their history of birth and contraception, the last pregnancy and abortion undergone, and the size of their present family. The data, compiled into a table showing the age factors involved in the reason for abortion, proved to be useful in making recommendations for the improvement of the medical service of these people. Dispersion analysis allowed an evaluation of the level of reliability and proportion of influence of determining factors of a phenomenon.
This study developed an abortion attitude scale and abortion knowledge inventory that may be utilized by health educators, counselors, and researchers for assessing attitudes toward abortion and knowledge about it. (SK)
Jukić, Marko; Kvolik, Slavica; Kardum, Goran; Kozina, Slavica; Tomić, Ana; Juraga
Aim To assess physicians’ knowledge and practices for obtaining patients’ informed consent to medical procedures. Methods An anonymous and voluntary survey of knowledge and practices for obtaining informed consent was conducted among 470 physicians (63% response rate) working in 6 hospitals: 93 specialists in anesthesiology, 166 in internal medicine, and 211 in surgery. Results Only 54% physicians were acquainted with the fact that the procedure for obtaining consent was regulated by the law. Internists and surgeons were better informed than anesthesiologists (P = 0.024). More than a half of respondents (66%) were familiar with the fact that a law on patient rights was passed in Croatia; there were no differences among different specialties (P = 0.638). Only 38% of the physicians were fully informed about the procedure of obtaining consent. Internists and surgeons provided detailed information to the patient in 33% of the cases and anesthesiologists in 16% of the cases (P < 0.050). Internists reported spending more time on informing the patient than anesthesiologists and surgeons (P < 0.001). There were no differences in knowledge and practices for obtaining informed consent between physicians working in university and those working in community hospitals (P ≥ 0.05 for all questions). Conclusion Physicians in Croatia have no formal education on informed consent and implement the informed consent process in a rather formal manner, regardless of the type of hospital or medical specialty. Systemic approach at education and training at the national level is needed to improve the informed consent process. PMID:20017225
Jackson, E. Bruce; Rivers, Robert A.; Chowdhry, Rajiv S.; Ragsdale, W. A.; Geyer, David W.
The capability of the HL-20 lifting-body spacecraft to perform an abort maneuver from the launch pad to a horizontal landing was studied. This study involved both piloted and batch simulation models of the vehicle. A point-mass model of the vehicle was used for trajectory optimization studies. The piloted simulation was performed in a fixed-base simulator. A candidate maneuver was developed and refined for the worst-case launch-pad-to-landing-site geometry using an iterative procedure of off-line maneuver analysis followed by piloted evaluations and heuristic improvements to the candidate maneuver. The resulting maneuver demonstrates the launch site abort capability of the HL-20 and dictates requirements for nominal abort motor performance. The sensitivity of the maneuver to variations in several design parameters was documented.
Stillwater, Ryan Allanque
The National Aeronautics and Space Administration created the Constellation program to develop the next generation of manned space vehicles and launch vehicles. The Orion abort system is initiated in the event of an unsafe condition during launch. The system has a controller gains schedule that can be tuned to reduce the attitude errors between the simulated Orion abort trajectories and the guidance trajectory. A program was created that uses the method of steepest descent to tune the pitch gains schedule by an automated procedure. The gains schedule optimization was applied to three potential abort scenarios; each scenario tested using the optimized gains schedule resulted in reduced attitude errors when compared to the Orion production gains schedule.
Johnson, B R; Horga, M; Andronache, L
After the downfall of the Ceausescu regime in December, 1989, the new Government of Romania abolished the law that prohibited abortions on request. Subsequently, the rate of legally induced abortions increased significantly while the rate of maternal mortality declined dramatically. Despite the large number of women who request induced abortions, most women and gynaecologists say that they would prefer to prevent unwanted pregnancies through the use of modern contraception. In this paper we examine factors that contribute to the disparity between women's desire to use modern contraception to prevent unwanted pregnancies and their practice of having induced abortions to prevent unwanted births. The results show that women (and suggest that men) need a wide choice of dependably available high-quality contraceptives; they need to be able to obtain information, counselling, and methods from a wide range of sources/health-care providers; both women's and men's perceptions about, and use of, modern contraception could be positively affected through sexual education started in secondary school; and, to reduce repeat abortions, women's post-abortion family-planning needs must not be neglected.
Moore, Ann M; Jagwe-Wadda, Gabriel; Bankole, Akinrinola
Abortion is illegal in Uganda except to save the life of the woman. Nevertheless, the practice is quite common: about 300,000 induced abortions occur annually among Ugandan women aged 15-49 (Singh et al., 2005) and a large proportion of these women require treatment for post-abortion complications. In the male-dominant culture of Uganda, where men control most of the financial resources, men play a critical part in determining whether women receive a safe abortion, or appropriate treatment if they experience abortion complications. This study examines men's roles in determining women's access to a safer abortion and post-abortion care. It draws on in-depth interviews carried out in 2003 with 61 women aged 18-60 and 21 men aged 20-50 from Kampala and Mbarara, Uganda. Respondents' descriptions of men's involvement in women's abortion care agreed that men's stated attitudes about abortion often prevented women from involving them in either the abortion or post-abortion care. Most men believe that if a woman is having an abortion, it must be because she is pregnant with another man's child, although this does not correspond with women's reasons for having an abortion--a critical disjuncture revealed by the data between men's perceptions of, and women's realities regarding, reasons for seeking an abortion. If the woman does experience post-abortion complications, the prevailing attitude among men in the sample was that they cannot support a woman in such a situation seeking care because if it had been his child, she would not have had a covert abortion. Since money is critical to accessing appropriate care, without men's support, women seeking an abortion may not be able to access safer abortion options and if they experience complications, they may delay care-seeking or may not obtain care at all. Barriers to involving men in abortion decision-making endanger women's health and possibly their lives.