Abortion, Induced

堕胎,诱导
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    文章类型: Journal Article
    终止妊娠现在在澳大利亚所有司法管辖区都是合法的,虽然在不同的基础上。虽然堕胎在澳大利亚没有像在其他地方一样受到激烈的辩论,过去,在堕胎服务提供者之外发生了旨在说服妇女不要终止妊娠的抗议活动。在过去的十年里,这导致引入了法律,在提供商场所周围设置了所谓的安全访问区。禁止在距离堕胎服务特定距离内进行反堕胎抗议,侵权行为应承担刑事责任。由于安全进入区法律阻止抗议者在某些空间表达他们的观点,问题是法律“遵守抗议者”的人权。本文根据昆士兰州的人权立法,通过考虑昆士兰州禁令的人权合规性来对此进行分析。结论是,在堕胎诊所附近强制禁止反堕胎抗议符合人权。
    Terminating a pregnancy is now lawful in all Australian jurisdictions, although on diverse bases. While abortions have not been subject to the same degree of heated debate in Australia as elsewhere, protests aimed at persuading women not to have a termination of their pregnancy have occurred outside abortion service providers in the past. Over the last decade, this has led to the introduction of laws setting out so-called safe access zones around provider premises. Anti-abortion protests are prohibited within a specific distance from abortion services and infringements attract criminal liability. As safe access zone laws prevent protesters from expressing their views in certain spaces, the question arises as to the laws\' compliance with protesters\' human rights. This article analyses this by considering the human rights compliance of the Queensland ban in light of Queensland human rights legislation. It concludes that the imposed prohibition of anti-abortion protests near abortion clinics is compatible with human rights.
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    背景:与其他高收入国家相比,澳大利亚长效可逆避孕(LARC)的摄入量较低,早期药物流产(EMA)的获取是可变的,只有11%的全科医生(GP)提供EMA。AusCAPPS(澳大利亚避孕和堕胎初级保健从业者支持)网络是为支持全科医生而建立的虚拟实践社区,护士和药剂师在初级保健中提供LARC和EMA。通过AusCAPPS评估参与者的参与为了解与LARC和EMA护理相关的临床医生需求提供了机会。
    方法:数据收集时间为2021年7月至2023年7月。对有关AusCAPPS的在线资源视图的数量进行了描述性分析,并对参与者帖子的文本进行了定性内容分析。
    结果:在2023年中期,AusCAPPS拥有1911名成员:1133(59%)GP,439名(23%)药剂师和272名(14%)护士。简明即时文档是最常查看的资源类型。在655个职位中,大多数是由全科医生创建的(532,81.2%),其次是护士(88,13.4%),然后是药剂师(16,2.4%)。全科医生最常发布有关临床问题的信息(263,占全科医生职位的49%)。护士最常发布有关服务实施的信息(占护士职位的24,27%)。药剂师发布的内容最多涉及卫生系统和监管问题(占药剂师职位的7,44%)。
    结论:GP,护士和药剂师都有专业的同伴支持和资源,以启动或继续LARC和EMA护理,全科医生特别寻求进一步的临床教育和提高技能。开发资源,培训和实施支持可能会改善澳大利亚初级保健中的LARC和EMA供应。
    BACKGROUND: Uptake of long-acting reversible contraception (LARC) is lower in Australia compared with other high-income countries, and access to early medical abortion (EMA) is variable with only 11% of general practitioners (GPs) providing EMA. The AusCAPPS (Australian Contraception and Abortion Primary Care Practitioner Support) Network is a virtual community of practice established to support GPs, nurses and pharmacists to provide LARC and EMA in primary care. Evaluating participant engagement with AusCAPPS presents an opportunity to understand clinician needs in relation to LARC and EMA care.
    METHODS: Data were collected from July 2021 until July 2023. Numbers of online resource views on AusCAPPS were analysed descriptively and text from participant posts underwent qualitative content analysis.
    RESULTS: In mid-2023 AusCAPPS had 1911 members: 1133 (59%) GPs, 439 (23%) pharmacists and 272 (14%) nurses. Concise point-of-care documents were the most frequently viewed resource type. Of the 655 posts, most were created by GPs (532, 81.2%), followed by nurses (88, 13.4%) then pharmacists (16, 2.4%). GPs most commonly posted about clinical issues (263, 49% of GP posts). Nurses posted most frequently about service implementation (24, 27% of nurse posts). Pharmacists posted most about health system and regulatory issues (7, 44% of pharmacist posts).
    CONCLUSIONS: GPs, nurses and pharmacists each have professional needs for peer support and resources to initiate or continue LARC and EMA care, with GPs in particular seeking further clinical education and upskilling. Development of resources, training and implementation support may improve LARC and EMA provision in Australian primary care.
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  • 文章类型: Journal Article
    罗伊诉韦德案的推翻导致许多州颁布了新的堕胎限制。然而,关于这些禁令对心理健康的一般影响,存在有限的经验证据。利用全国家庭脉搏调查,我们使用差异方法评估了2021年7月至2023年6月期间紧急妊娠限制和彻底禁止对自我报告的心理健康状况的影响.回应表明,在实施此类限制后,精神困扰的报告显着增加。这些影响似乎在禁令后至少持续了4个月,并且受到家庭收入和教育的影响,而不是性别的影响。种族,年龄,婚姻状况,或者性取向.与较富裕的人相比,受教育程度较低,富裕程度较低的人报告的心理健康困扰更大,受过更多教育的群体。这些结果表明,堕胎限制制度对生活在美国的人们的心理健康产生了广泛的负面影响。特别是那些受教育程度和个人财富较低的人。
    The overturning of Roe v. Wade has led to numerous states enacting new abortion restrictions. However, limited empirical evidence exists regarding the general mental health impact of these bans. Leveraging the nationwide Household Pulse Survey, we evaluate the impact of emergent gestational limits and outright bans on self-reported mental health status between July 2021 and June 2023 using a difference in difference approach. Responses indicate a significant increase in reports of mental distress after the institution of such restrictions. These effects appear to persist at least 4 months following a ban and are moderated by household income and education but not by sex, race, age, marital status, or sexual orientation. Less educated and less wealthy subjects reported greater mental health distress compared to wealthier, more educated groups. These results suggest that the institution of abortion restrictions has had broad negative implications for the mental health of people living in the US, particularly those of lower education and personal wealth.
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  • 文章类型: Journal Article
    背景:这项定性研究旨在评估临床医生和临床工作人员对邮购药房分配药物流产的看法。
    方法:作为前瞻性队列研究的一部分,参与者包括参与在7个州的11个诊所实施药物流产邮购配药模式的临床医生和工作人员。始于2020年1月(在FDA取消了米非司酮的当面配药要求之前)。从2021年6月到2022年7月,我们邀请了参与诊所的参与者,包括六个初级保健和五个堕胎诊所,完成关于他们经历的半结构化视频采访。然后,我们对访谈数据进行了定性主题分析,总结与感知到的好处和对邮购模式的关注相关的主题,感知到的患者兴趣,以及大规模实施的潜在障碍。
    结果:我们总共对临床医生(13名医生和一名执业护士)和诊所工作人员(n=10)进行了24次访谈。与会者强调了邮购模式的感知好处,包括将堕胎服务扩展到初级保健的潜力,增加患者的自主权和隐私,并使堕胎服务正常化。他们还强调了关键的后勤,临床,以及对邮购模式的可行性担忧,以及将堕胎纳入初级保健的具体挑战。
    结论:初级保健和流产诊所的临床医生和诊所工作人员乐观地认为,邮购药物流产分配可以提高一些提供者提供流产的能力,并使更多的患者获得服务。根据最高法院多布斯的裁决,邮购药房分配药物流产的可行性有待确定。
    背景:注册表:Clinicaltrials.gov.
    背景:NCT03913104。注册日期:2019年4月3日首次提交,2019年4月12日首次发布。
    BACKGROUND: This qualitative study aims to assess perspectives of clinicians and clinic staff on mail-order pharmacy dispensing for medication abortion.
    METHODS: Participants included clinicians and staff involved in implementing a mail-order dispensing model for medication abortion at eleven clinics in seven states as part of a prospective cohort study, which began in January 2020 (before the FDA removed the in-person dispensing requirement for mifepristone). From June 2021 to July 2022, we invited participants at the participating clinics, including six primary care and five abortion clinics, to complete a semi-structured video interview about their experiences. We then conducted qualitative thematic analysis of interview data, summarizing themes related to perceived benefits and concerns about the mail-order model, perceived patient interest, and potential barriers to larger-scale implementation.
    RESULTS: We conducted 24 interviews in total with clinicians (13 physicians and one nurse practitioner) and clinic staff (n = 10). Participants highlighted perceived benefits of the mail-order model, including its potential to expand abortion services into primary care, increase patient autonomy and privacy, and to normalize abortion services. They also highlighted key logistical, clinical, and feasibility concerns about the mail-order model, and specific challenges related to integrating abortion into primary care.
    CONCLUSIONS: Clinicians and clinic staff working in primary care and abortion clinics were optimistic that mail-order dispensing of medication abortion can improve the ability of some providers to provide abortion and enable more patients to access services. The feasibility of mail-order pharmacy dispensing of medication abortion following the Supreme Court Dobbs decision is to be determined.
    BACKGROUND: Registry: Clinicaltrials.gov.
    BACKGROUND: NCT03913104. Date of registration: first submitted on April 3, 2019 and first posted on April 12, 2019.
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  • 文章类型: Journal Article
    胎儿心脏病的产前诊断可能会影响父母终止妊娠的决策。现有文献表明,严重性,无论是复杂性还是杀伤力,显著影响父母关于堕胎的决定。然而,关于胎儿心脏病严重程度如何影响父母决定的问题仍然存在,鉴于近期在术后结局方面的进展。因此,我们调查了胎儿心脏病产前诊断后与父母决定流产相关的危险因素.我们的分析包括妊娠22周前诊断为胎儿心脏病的73例(终止:n=37;续:n=36)妊娠。诊断时胎龄的增加降低了父母决定终止妊娠的可能性(模型1:调整后的比值比,0.94;95%置信区间0.89-0.99;模型2:0.950.90-0.997)。危重病(5.25;1.09-25.19)和并发心外或遗传异常(模型1:4.19,1.21-14.53;模型2:5.47,1.50-19.96)增加了选择流产的可能性。值得注意的是,复杂疾病对父母决定没有显著影响(0.56;0.14-2.20).这些结果表明,父母关于流产的决策可能会受到诊断时早期胎龄的影响。心脏病的致命性,心外或遗传异常,但如果产前诊断和父母咨询是在心血管专业机构提供的,则不是其复杂性。
    The prenatal diagnosis of fetal heart disease potentially influences parental decision-making regarding pregnancy termination. Existing literature indicates that the severity, whether in complexity or lethality, significantly influences parental decisions concerning abortion. However, questions remain as to how fetal heart disease severity impacts parental decisions, given recent advancements in postsurgical outcomes. Therefore, we investigated risk factors associated with parents\' decision-making regarding abortion following a prenatal diagnosis of fetal heart disease. Our analysis included 73 (terminated: n = 37; continued: n = 36) pregnancies with a fetal heart disease diagnosed before 22 weeks of gestation. Increased gestational age at diagnosis reduced the likelihood of parents\' decision on termination (Model 1: adjusted odds ratio, 0.94; 95% confidence interval 0.89-0.99; Model 2: 0.95 0.90-0.997). Critical disease (5.25; 1.09-25.19) and concurrent extracardiac or genetic abnormalities (Model 1: 4.19, 1.21-14.53; Model 2: 5.47, 1.50-19.96) increased the likelihood of choosing abortion. Notably, complex disease did not significantly influence parental decisions (0.56; 0.14-2.20). These results suggest that parental decision-making regarding abortion may be influenced by earlier gestational age at diagnosis, the lethality of heart disease, and extracardiac or genetic abnormalities, but not its complexity if prenatal diagnosis and parental counseling are provided at a cardiovascular-specialized facility.
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  • 文章类型: Journal Article
    背景:人工流产是世界上最常见的妇科手术之一,每十个怀孕中就有三个以堕胎告终。It,然而,仍然有争议。这项范围审查的目的是探索和绘制有关提供堕胎护理的人的经验的现有文献。
    结果:这项探索性综述遵循了Levac等人。指南,并根据PRISMA-ScR清单报告。CINAHL,科克伦,EMBASE,PsycInfo,PubMed,和WebofScience被用来识别同行评审,发表关于提供者堕胎经验的原创研究文章。我们确定了106项相关研究,其中包括来自28个国家和六大洲的4,250家提供商的样本。大多数研究是定性的(n=83),虽然定量(n=15)和混合方法(n=8)研究也包括在内。我们确定了两个主要主题:(1)提供者“堕胎耻辱的经历”和(2)提供者对堕胎工作的反思。我们的发现表明,来自世界各地的提供者在社会及其社区和工作场所中都面临挑战,这些挑战加剧了堕胎的污名化和边缘化,并对这项工作的道德提出了质疑。大多数,然而,为他们的工作感到骄傲,相信堕胎护理是社会重要和必要的,并继续致力于提供护理。
    结论:本综述的结果提供了提供堕胎护理的已知经验的全面概述。对于国际供应商来说,这是一个关键的参考点,研究人员,并主张在自己的领土上进一步研究或讨论这一领域。这项审查的结果将为今后如何支持提供者反对污名化的工作提供信息,并将为提供者提供反思自己经历的机会。
    BACKGROUND: Induced abortion is one of the most common gynecological procedures in the world, with as many as three in every ten pregnancies ending in abortion. It, however, remains controversial. The objective of this scoping review was to explore and map existing literature on the experiences of those who provide abortion care.
    RESULTS: This exploratory review followed the Levac et al. guidelines and was reported in accordance with the PRISMA-ScR checklist. CINAHL, Cochrane, EMBASE, PsycInfo, PubMed, and Web of Science were used to identify peer-reviewed, original research articles published on providers\' experience of abortion. We identified 106 relevant studies, which include a total sample of 4,250 providers from 28 countries and six continents. Most of the studies were qualitative (n = 83), though quantitative (n = 15) and mixed methods (n = 8) studies were also included. We identified two overarching themes: (1) Providers\' experiences with abortion stigma and (2) Providers\' reflections on their abortion work. Our findings suggest that providers from around the world experience challenges within society and their communities and workplaces which reinforce the stigmatization and marginalization of abortion and pose questions about the morality of this work. Most, however, are proud of their work, believe abortion care to be socially important and necessary, and remain committed to the provision of care.
    CONCLUSIONS: The findings of this review provide a comprehensive overview on the known experiences of providing abortion care. It is a key point of reference for international providers, researchers, and advocates to further this area of research or discussion in their own territories. The findings of this review will inform future work on how to support providers against stigmatization and will offer providers the chance to reflect on their own experiences.
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  • 文章类型: News
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  • 文章类型: Journal Article
    生殖健康问题,包括不安全的终止妊娠,仍然是发展中国家妇女的重大关切。这项研究的重点是通过采用混合机器学习方法来调查和预测孟加拉国的妊娠终止。该分析使用了2011年、2014年和2017年至2018年孟加拉国人口和健康调查的数据。十个独立变量,包括年龄等因素,residence,司,财富指数,工作状态,BMI,出生的孩子总数,最近出生,和活着的孩子的数量,我们检查了它们与终止妊娠的潜在关联。数据集经过预处理,解决缺失的值和平衡类分布。为了预测终止妊娠,本研究使用了8种经典机器学习模型和混合模型。模型性能是根据曲线下的面积进行评估的,精度,召回,F1得分。结果突出了混合模型的有效性,特别是投票混合模型(曲线下面积:91.97;精度:84.14;召回率:83.87;F1得分:83.84),准确预测终止妊娠。值得注意的预测因素包括年龄,司,财富指数。这些发现对旨在降低终止妊娠率的政策干预具有重要意义。强调考虑区域差异和社会经济因素的量身定制方法的必要性。总的来说,这项研究证明了混合机器学习模型在理解和预测终止妊娠方面的有效性,为孟加拉国和类似情况下的生殖健康举措提供有价值的见解。
    Reproductive health issues, including unsafe pregnancy termination, remain a significant concern for women in developing nations. This study focused on investigating and predicting pregnancy termination in Bangladesh by employing a hybrid machine learning approach. The analysis used data from the Bangladesh Demographic and Health Surveys conducted in 2011, 2014, and 2017 to 2018. Ten independent variables, encompassing factors such as age, residence, division, wealth index, working status, BMI, total number of children ever born, recent births, and number of living children, were examined for their potential associations with pregnancy termination. The dataset undergoes preprocessing, addressing missing values and balancing class distributions. To predict pregnancy termination, 8 classical machine learning models and hybrid models were used in this study. The models\' performance was evaluated based on the area under the curve, precision, recall, and F1 score. The results highlighted the effectiveness of the hybrid models, particularly the Voting hybrid model (area under the curve: 91.97; precision: 84.14; recall: 83.87; F1 score: 83.84), in accurately predicting pregnancy termination. Notable predictors include age, division, and wealth index. These findings hold significance for policy interventions aiming to reduce pregnancy termination rates, emphasizing the necessity for tailored approaches that consider regional disparities and socioeconomic factors. Overall, the study demonstrates the efficacy of hybrid machine learning models in comprehending and forecasting pregnancy termination, offering valuable insights for reproductive health initiatives in Bangladesh and similar contexts.
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