This study analyzed data from a 30-year longitudinal study of over 500 women in New Zealand to examine the association between pregnancy outcomes and later mental health issues. The study found that after adjusting for potential confounding factors, women who had an abortion had rates of mental health disorders that were about 30% higher than those who did not have an abortion. No consistent associations were found between other pregnancy outcomes like miscarriage or live birth and increased risk of mental health problems. The authors concluded that the evidence suggests abortion may be associated with a small increase in risk of mental disorders.
- Dr. Chang informs 37-year-old patient Niki about declining fertility with age and recommends an AMH test to evaluate her ovarian reserve since Niki wants to have children.
- Niki's test results show very low AMH levels. Dr. Goldstein, who is covering for Dr. Chang, is upset that Dr. Chang informed Niki without considering her lack of a partner and career focus.
- The commentary argues that physicians have a responsibility to provide patients information relevant to their reproductive goals and futures to allow for informed decision making, even if the news is unexpected or unwelcome.
2016 modifiers of stress related to timing of diagnosis in parents of childre...gisa_legal
This study examined differences in parental stress levels between parents who received a prenatal versus postnatal diagnosis of complex congenital heart disease in their child that required surgery before newborn discharge. The study found that after adjusting for factors like disease severity, parents who received a prenatal diagnosis had lower levels of anxiety and global stress at the time of diagnosis and birth compared to parents receiving a postnatal diagnosis, though there was no difference at follow-up. The differences were primarily seen in fathers. For parents receiving a prenatal diagnosis, mothers had higher stress scores than fathers, and a later gestational age at diagnosis was linked to higher anxiety and stress.
The main purpose of the present study was to determine the effect of regular home visits on the developmental indices of low birth weight infants. The present study was an on-site clinical investigation. 90 infants ranging between 1500 to 2500g born in Razi Hospital of Marand town having the entrance criteria to the present study were taken into consideration through the available sampling method and then they were divided into two intervention and control groups. The intervention group has received the whole routine cares since the first to fourth week and then they were visited at home for 45 minutes a week. The control group received the routine cares. The evolutionary indices of both groups were also completed monthly for three months by referring homes. The related data gathering tool was also subjected to the demographic information through registration list and the Persian version of the Low Weight Infant Inventory (LWII) (2 months) that have been completed by the researcher on the birthday, first, second and third months of the birth through the interview. SPSS-15 software and the application of the inferential and descriptive statistical tests (K2 and T-tests) were also applied in order to analyze the related data in this study. The significance level was considered as p<0.05.
More than half of these related research units of both groups had experience (61.5%) and control (55.8%) regarding all women in this study; the mean score of the low weight infants on the first month had not shown any statistical significant difference; but on the second months (p=0.04) and the third months (p=0.001), they had shown statistical significant difference progressively. The healthcare based on home-visit had influence on the recovery indices of the low weight infants. Hence, nurses and other health monitors of the infants should apply for the healthcare programs based on home-visit particularly in caring infants.
1) This study compared the IQ of 100 children with treated congenital hypothyroidism to 100 healthy children in Kurdistan Province, Iran, where congenital hypothyroidism prevalence is high.
2) The average IQ scores of the patient group treated for 42 months with thyroxine and the healthy group were 103.4 (±16.9) and 103.4 (±15.4) respectively, with no statistically significant difference.
3) The only factor found to significantly impact IQ was the mother's level of education, not whether the child had congenital hypothyroidism or not.
This document discusses issues surrounding the diagnosis and treatment of illnesses as idiopathic or of unknown origin. It argues that many conditions labeled as idiopathic may actually be iatrogenic, or caused by medical treatment. It notes that a high percentage of medical interventions and clinical practice guidelines are not evidence-based, and many medications' safety and efficacy have not been adequately tested, especially for women and children. As a result, so-called idiopathic conditions may in fact be adverse effects that were never studied or recognized. The document critiques overreliance on medication and lack of research into environmental or lifestyle causes of disease. It calls for more rigorous testing of treatments, especially for vulnerable groups.
Infertility is considered as a basic health issue in human
reproductive care. It is clinically defined as a failure to achieve natural pregnancy aft er twelve or more months of regular unprotected sexual intercourse
This presentation outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women’s preferences, cultural and religious beliefs as well as any co-existing medical issues.
- Dr. Chang informs 37-year-old patient Niki about declining fertility with age and recommends an AMH test to evaluate her ovarian reserve since Niki wants to have children.
- Niki's test results show very low AMH levels. Dr. Goldstein, who is covering for Dr. Chang, is upset that Dr. Chang informed Niki without considering her lack of a partner and career focus.
- The commentary argues that physicians have a responsibility to provide patients information relevant to their reproductive goals and futures to allow for informed decision making, even if the news is unexpected or unwelcome.
2016 modifiers of stress related to timing of diagnosis in parents of childre...gisa_legal
This study examined differences in parental stress levels between parents who received a prenatal versus postnatal diagnosis of complex congenital heart disease in their child that required surgery before newborn discharge. The study found that after adjusting for factors like disease severity, parents who received a prenatal diagnosis had lower levels of anxiety and global stress at the time of diagnosis and birth compared to parents receiving a postnatal diagnosis, though there was no difference at follow-up. The differences were primarily seen in fathers. For parents receiving a prenatal diagnosis, mothers had higher stress scores than fathers, and a later gestational age at diagnosis was linked to higher anxiety and stress.
The main purpose of the present study was to determine the effect of regular home visits on the developmental indices of low birth weight infants. The present study was an on-site clinical investigation. 90 infants ranging between 1500 to 2500g born in Razi Hospital of Marand town having the entrance criteria to the present study were taken into consideration through the available sampling method and then they were divided into two intervention and control groups. The intervention group has received the whole routine cares since the first to fourth week and then they were visited at home for 45 minutes a week. The control group received the routine cares. The evolutionary indices of both groups were also completed monthly for three months by referring homes. The related data gathering tool was also subjected to the demographic information through registration list and the Persian version of the Low Weight Infant Inventory (LWII) (2 months) that have been completed by the researcher on the birthday, first, second and third months of the birth through the interview. SPSS-15 software and the application of the inferential and descriptive statistical tests (K2 and T-tests) were also applied in order to analyze the related data in this study. The significance level was considered as p<0.05.
More than half of these related research units of both groups had experience (61.5%) and control (55.8%) regarding all women in this study; the mean score of the low weight infants on the first month had not shown any statistical significant difference; but on the second months (p=0.04) and the third months (p=0.001), they had shown statistical significant difference progressively. The healthcare based on home-visit had influence on the recovery indices of the low weight infants. Hence, nurses and other health monitors of the infants should apply for the healthcare programs based on home-visit particularly in caring infants.
1) This study compared the IQ of 100 children with treated congenital hypothyroidism to 100 healthy children in Kurdistan Province, Iran, where congenital hypothyroidism prevalence is high.
2) The average IQ scores of the patient group treated for 42 months with thyroxine and the healthy group were 103.4 (±16.9) and 103.4 (±15.4) respectively, with no statistically significant difference.
3) The only factor found to significantly impact IQ was the mother's level of education, not whether the child had congenital hypothyroidism or not.
This document discusses issues surrounding the diagnosis and treatment of illnesses as idiopathic or of unknown origin. It argues that many conditions labeled as idiopathic may actually be iatrogenic, or caused by medical treatment. It notes that a high percentage of medical interventions and clinical practice guidelines are not evidence-based, and many medications' safety and efficacy have not been adequately tested, especially for women and children. As a result, so-called idiopathic conditions may in fact be adverse effects that were never studied or recognized. The document critiques overreliance on medication and lack of research into environmental or lifestyle causes of disease. It calls for more rigorous testing of treatments, especially for vulnerable groups.
Infertility is considered as a basic health issue in human
reproductive care. It is clinically defined as a failure to achieve natural pregnancy aft er twelve or more months of regular unprotected sexual intercourse
This presentation outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women’s preferences, cultural and religious beliefs as well as any co-existing medical issues.
Violence against women by their husband and postpartum depression finalChetkant Bhusal
The study aimed to determine the prevalence of violence against women by their husbands, postpartum depression, and the relationship between violence and depression in Nepal. The study found the incidence of postpartum depression was 19.4-22.2% and violence was 13.9-20.8%. No significant relationship was found between violence and depression, possibly due to small sample size. The study highlighted the need for further large-scale research on this topic in Nepal.
This study evaluated the clinical and perinatal outcomes of 100 teenage pregnancies at a tertiary referral center in South India. The study found that teenage pregnancies had higher rates of complications like anemia (43%), preeclampsia (21%), preterm labor (21%), and emergency c-sections (33%) compared to adult pregnancies. Neonatal outcomes were also worse, with 38% of babies being low birth weight (<2.5 kg) and 21% being preterm. The study concluded that teenage pregnancy poses significant health risks to both mother and baby due to the biological immaturity of teenage mothers.
This research proposal aims to study the effect of Jacobson's progressive muscle relaxation technique on anxiety among primigravida women. The study will assess anxiety levels among 60 primigravida women split into experimental and control groups. The experimental group will receive the relaxation technique while the control will not receive any intervention. Anxiety levels will be measured before and after the intervention using the Spielberger anxiety inventory. The study hypothesizes that the relaxation technique will significantly reduce anxiety levels compared to the control group. Findings could help provide relief from anxiety during pregnancy.
New debate on link between stress infertilityrinku987
A ton of individuals worry that their stress, anxiety, tension, and worry may scale back their probabilities of maternity with a particular treatment cycle, however there's no proof of that," says investigator Jacky Boivin, PhD, a health man of science at capital University in Wales.
Clinical, ethical and legal considerations in the treatment of newborns 2008Dominique Gross
Non-ketotic hyperglycinaemia (NKH) is a devastating neurometabolic disorder leading, in its classical form, to early death or severe disability and poor quality of life in survivors. Affected neonates may need ventilatory support during a short period of respiratory depression. The transient dependence on ventilation dictates urgency in decision-making regarding withdrawal of therapy.
The occurrence of patients with apparent transient forms of the disease, albeit rare, adds uncertainty to the prediction of clinical outcome and dictates that the current practice of withholding or withdrawing therapy in these neonates be reviewed. Both bioethics and law take the view that treatment decisions should be based on the best interests of the patient.
The medical-ethics approach is based on the principles of non-maleficence, beneficence, autonomy and justice. The law relating to withholding or withdrawing life-sustaining treatment is complex and varies between jurisdictions. Physicians treating newborns with NKH need to provide families with accurate and complete information regarding the disease and the relative probability of possible outcomes of the neonatal presentation and to explore the extent to which family members are willing to take part in the decision making process. Cultural and religious attitudes, which may potentially clash with bioethical and juridical principles, need to be considered.
2008 Elsevier Inc
This document discusses genetic testing, including its definition, various types, reasons for testing, results, risks and limitations. It provides information on several genetic testing methods like newborn screening, diagnostic testing, carrier testing, prenatal testing, and preimplantation testing. The document outlines the role of nurses in ensuring informed consent, counseling, confidentiality, and addressing psychological impacts of genetic testing. In summary, the document provides a comprehensive overview of genetic testing, its various applications and the ethical considerations involved.
This document is an informed consent form for a clinical trial studying a new drug called NewCure for the treatment of a rare disease in children. The study involves 100 children across 10 medical centers who will receive either NewCure or a placebo over 3 months with 5 clinic visits. Study procedures include medical history interviews, physical exams, blood tests, taking the study drug twice daily for 4 weeks, and completing questionnaires about symptoms before and after treatment. The purpose is to determine if NewCure is safe and effective for treating the rare disease.
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data
V. Berghella, M. Palacio, A. Ness, Z. Alfirevic, K. H. Nicolaides and G. Saccone
Volume 49, Issue 3, Date: March (pages 322–329)
Slides prepared by Dr Shireen Meher (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17388/full
Increased nuchal translucency thickness and risk of neurodevelopmental disorders
S. G. Hellmuth, L. H. Pedersen, C. B. Miltoft, O. B. Petersen, S. Kjærgaard, C. Ekelund, A. Tabor
Volume 49, Issue 5; Date: May (pages 592–598)
Slides prepared by Dr Maddalena Morlando (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15961/full
Austin Public Health is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Public Health.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Public Health. Austin Public Health accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of public health.
Austin Public Health strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
This document summarizes a study on household decision-making and contraceptive use in Zambia. The study found that unmet need for family planning remains high in Zambia, despite available services. It investigated how a husband's role in decisions influences a wife's contraceptive use. Women were given vouchers for free contraception either with their husbands (couples treatment) or privately (individual treatment). The couples treatment led to 25% fewer women using concealable contraception compared to the individual treatment. The study suggests spousal disagreement can impact contraceptive use and fertility outcomes.
Perinatal and long-term outcomes in fetuses diagnosed with isolated unilateral ventriculomegaly: systemic review and meta-analysis
C. Scala, A. Familiari, A. Pinas, A.T. Papageorghiou, A. Bhide, B. Thilaganathan, A. Khalil
Volume 49, Issue 4, Date: April (pages 450–459)
Slides prepared by Dr Yael Raz (UOG Editor-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15943/full
Sex dimorphic effects of prenatal treatment withHiya Boro
1) The study assessed the long-term cognitive functions and scholastic performance of 34 children aged 7-17 years who were treated with dexamethasone in the first trimester of pregnancy for risk of congenital adrenal hyperplasia, compared to 66 healthy controls.
2) Neuropsychological tests assessed intelligence, executive functions, processing speed, memory, and scholastic competence. No significant differences were found between the dexamethasone-treated and control groups on any measures.
3) This study suggests that short-term prenatal dexamethasone treatment in the first trimester does not adversely impact long-term cognitive functions or scholastic performance during childhood and adolescence.
This document discusses the ethical issues surrounding treatment decisions for preterm infants. It notes that while infant mortality has declined, preterm infants often face lifelong disabilities. Treatment approaches vary globally, with some guidelines recommending only palliative care below certain gestational ages. There is no consensus on interventions for extremely preterm infants, who have high mortality rates. The document argues for comprehensive, multidisciplinary discussions involving medical staff and families to determine the approach that best serves the infant's interests.
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...CrimsonpublishersNTNF
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hypertension Stress and Anxiety in African Americans by Taunjah P Bell Neasman* in Investigations in Gynecology Research & Women’s Health
1. The document reviews the implications of rheumatoid arthritis (RA) on fertility and infertility. It finds that RA women tend to have smaller families and longer times to conception compared to healthy women.
2. Several factors may contribute to decreased fertility in RA women, including inflammatory processes, suppressed sexual function due to pain/fatigue, effects of drug treatments like NSAIDs on ovulation, and advanced maternal age. However, the mechanisms involved are still unclear.
3. The review examines the impact of RA on ovarian function, pregnancy loss, and risks like preeclampsia. It also discusses how inflammation may interact with the reproductive system, though more research is still needed to understand these relationships fully.
Infertility, recent and advanced in management 02.12.2020Shazia Iqbal
(1) Infertility is defined as the inability to become pregnant after one year of unprotected sex. It can be caused by problems in either the male or female partner or both.
(2) Management of infertility involves counseling for lifestyle changes like diet, exercise, avoiding smoking and alcohol, as well as medical treatments.
(3) Recent advances include assisted reproduction techniques like intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) which can help couples conceive but are often costly with rates of success dependent on multiple factors.
1) Women whose pregnancies were complicated by fetal anomalies that require surgery had significantly higher levels of state anxiety than women without such complications. Older maternal age was also correlated with higher state anxiety.
2) Those with histories of mental health issues had higher trait anxiety scores. Most women reported that knowing about the nurse care coordinator at the fetal care center decreased their anxiety.
3) Participants expressed interest in speaking with families who had similar experiences as a form of emotional support. The study provides insight into risk factors for higher maternal anxiety and potential support services.
The document summarizes a qualitative study on women's experiences with abortion. It analyzed responses from 987 women who had contacted crisis pregnancy centers for post-abortion care. Many women expressed no benefits from their abortions. Commonly voiced positives included spiritual growth, involvement in pro-life efforts, and helping other women considering abortion. Common negatives included feelings of loss, existential concerns, declines in quality of life, feelings about terminating a life, regret, shame, guilt, depression, anxiety, and self-destructive behaviors. The study provides insight into developing more sophisticated pre-and post-abortion counseling protocols for women at risk of adverse psychological outcomes.
1) The study examined the effects of a digital prenatal program called the Baby Care Program (BCP) on 512 first-time mothers. The BCP included mindfulness activities like meditation, yoga, music, and baby bonding exercises.
2) Results showed statistically significant benefits for mothers who used the BCP, including lower stress, better sleep, fewer preterm births and higher birth weights, compared to mothers who did not participate.
3) The BCP was found to help mothers develop a stronger bond with their babies, better manage nutrition and pregnancy symptoms, and have an overall healthier pregnancy experience.
Violence against women by their husband and postpartum depression finalChetkant Bhusal
The study aimed to determine the prevalence of violence against women by their husbands, postpartum depression, and the relationship between violence and depression in Nepal. The study found the incidence of postpartum depression was 19.4-22.2% and violence was 13.9-20.8%. No significant relationship was found between violence and depression, possibly due to small sample size. The study highlighted the need for further large-scale research on this topic in Nepal.
This study evaluated the clinical and perinatal outcomes of 100 teenage pregnancies at a tertiary referral center in South India. The study found that teenage pregnancies had higher rates of complications like anemia (43%), preeclampsia (21%), preterm labor (21%), and emergency c-sections (33%) compared to adult pregnancies. Neonatal outcomes were also worse, with 38% of babies being low birth weight (<2.5 kg) and 21% being preterm. The study concluded that teenage pregnancy poses significant health risks to both mother and baby due to the biological immaturity of teenage mothers.
This research proposal aims to study the effect of Jacobson's progressive muscle relaxation technique on anxiety among primigravida women. The study will assess anxiety levels among 60 primigravida women split into experimental and control groups. The experimental group will receive the relaxation technique while the control will not receive any intervention. Anxiety levels will be measured before and after the intervention using the Spielberger anxiety inventory. The study hypothesizes that the relaxation technique will significantly reduce anxiety levels compared to the control group. Findings could help provide relief from anxiety during pregnancy.
New debate on link between stress infertilityrinku987
A ton of individuals worry that their stress, anxiety, tension, and worry may scale back their probabilities of maternity with a particular treatment cycle, however there's no proof of that," says investigator Jacky Boivin, PhD, a health man of science at capital University in Wales.
Clinical, ethical and legal considerations in the treatment of newborns 2008Dominique Gross
Non-ketotic hyperglycinaemia (NKH) is a devastating neurometabolic disorder leading, in its classical form, to early death or severe disability and poor quality of life in survivors. Affected neonates may need ventilatory support during a short period of respiratory depression. The transient dependence on ventilation dictates urgency in decision-making regarding withdrawal of therapy.
The occurrence of patients with apparent transient forms of the disease, albeit rare, adds uncertainty to the prediction of clinical outcome and dictates that the current practice of withholding or withdrawing therapy in these neonates be reviewed. Both bioethics and law take the view that treatment decisions should be based on the best interests of the patient.
The medical-ethics approach is based on the principles of non-maleficence, beneficence, autonomy and justice. The law relating to withholding or withdrawing life-sustaining treatment is complex and varies between jurisdictions. Physicians treating newborns with NKH need to provide families with accurate and complete information regarding the disease and the relative probability of possible outcomes of the neonatal presentation and to explore the extent to which family members are willing to take part in the decision making process. Cultural and religious attitudes, which may potentially clash with bioethical and juridical principles, need to be considered.
2008 Elsevier Inc
This document discusses genetic testing, including its definition, various types, reasons for testing, results, risks and limitations. It provides information on several genetic testing methods like newborn screening, diagnostic testing, carrier testing, prenatal testing, and preimplantation testing. The document outlines the role of nurses in ensuring informed consent, counseling, confidentiality, and addressing psychological impacts of genetic testing. In summary, the document provides a comprehensive overview of genetic testing, its various applications and the ethical considerations involved.
This document is an informed consent form for a clinical trial studying a new drug called NewCure for the treatment of a rare disease in children. The study involves 100 children across 10 medical centers who will receive either NewCure or a placebo over 3 months with 5 clinic visits. Study procedures include medical history interviews, physical exams, blood tests, taking the study drug twice daily for 4 weeks, and completing questionnaires about symptoms before and after treatment. The purpose is to determine if NewCure is safe and effective for treating the rare disease.
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data
V. Berghella, M. Palacio, A. Ness, Z. Alfirevic, K. H. Nicolaides and G. Saccone
Volume 49, Issue 3, Date: March (pages 322–329)
Slides prepared by Dr Shireen Meher (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17388/full
Increased nuchal translucency thickness and risk of neurodevelopmental disorders
S. G. Hellmuth, L. H. Pedersen, C. B. Miltoft, O. B. Petersen, S. Kjærgaard, C. Ekelund, A. Tabor
Volume 49, Issue 5; Date: May (pages 592–598)
Slides prepared by Dr Maddalena Morlando (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15961/full
Austin Public Health is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Public Health.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Public Health. Austin Public Health accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of public health.
Austin Public Health strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
This document summarizes a study on household decision-making and contraceptive use in Zambia. The study found that unmet need for family planning remains high in Zambia, despite available services. It investigated how a husband's role in decisions influences a wife's contraceptive use. Women were given vouchers for free contraception either with their husbands (couples treatment) or privately (individual treatment). The couples treatment led to 25% fewer women using concealable contraception compared to the individual treatment. The study suggests spousal disagreement can impact contraceptive use and fertility outcomes.
Perinatal and long-term outcomes in fetuses diagnosed with isolated unilateral ventriculomegaly: systemic review and meta-analysis
C. Scala, A. Familiari, A. Pinas, A.T. Papageorghiou, A. Bhide, B. Thilaganathan, A. Khalil
Volume 49, Issue 4, Date: April (pages 450–459)
Slides prepared by Dr Yael Raz (UOG Editor-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.15943/full
Sex dimorphic effects of prenatal treatment withHiya Boro
1) The study assessed the long-term cognitive functions and scholastic performance of 34 children aged 7-17 years who were treated with dexamethasone in the first trimester of pregnancy for risk of congenital adrenal hyperplasia, compared to 66 healthy controls.
2) Neuropsychological tests assessed intelligence, executive functions, processing speed, memory, and scholastic competence. No significant differences were found between the dexamethasone-treated and control groups on any measures.
3) This study suggests that short-term prenatal dexamethasone treatment in the first trimester does not adversely impact long-term cognitive functions or scholastic performance during childhood and adolescence.
This document discusses the ethical issues surrounding treatment decisions for preterm infants. It notes that while infant mortality has declined, preterm infants often face lifelong disabilities. Treatment approaches vary globally, with some guidelines recommending only palliative care below certain gestational ages. There is no consensus on interventions for extremely preterm infants, who have high mortality rates. The document argues for comprehensive, multidisciplinary discussions involving medical staff and families to determine the approach that best serves the infant's interests.
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hype...CrimsonpublishersNTNF
Proposed Beneficial Effects of Cardiac Coherence Training on Gestational Hypertension Stress and Anxiety in African Americans by Taunjah P Bell Neasman* in Investigations in Gynecology Research & Women’s Health
1. The document reviews the implications of rheumatoid arthritis (RA) on fertility and infertility. It finds that RA women tend to have smaller families and longer times to conception compared to healthy women.
2. Several factors may contribute to decreased fertility in RA women, including inflammatory processes, suppressed sexual function due to pain/fatigue, effects of drug treatments like NSAIDs on ovulation, and advanced maternal age. However, the mechanisms involved are still unclear.
3. The review examines the impact of RA on ovarian function, pregnancy loss, and risks like preeclampsia. It also discusses how inflammation may interact with the reproductive system, though more research is still needed to understand these relationships fully.
Infertility, recent and advanced in management 02.12.2020Shazia Iqbal
(1) Infertility is defined as the inability to become pregnant after one year of unprotected sex. It can be caused by problems in either the male or female partner or both.
(2) Management of infertility involves counseling for lifestyle changes like diet, exercise, avoiding smoking and alcohol, as well as medical treatments.
(3) Recent advances include assisted reproduction techniques like intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) which can help couples conceive but are often costly with rates of success dependent on multiple factors.
1) Women whose pregnancies were complicated by fetal anomalies that require surgery had significantly higher levels of state anxiety than women without such complications. Older maternal age was also correlated with higher state anxiety.
2) Those with histories of mental health issues had higher trait anxiety scores. Most women reported that knowing about the nurse care coordinator at the fetal care center decreased their anxiety.
3) Participants expressed interest in speaking with families who had similar experiences as a form of emotional support. The study provides insight into risk factors for higher maternal anxiety and potential support services.
The document summarizes a qualitative study on women's experiences with abortion. It analyzed responses from 987 women who had contacted crisis pregnancy centers for post-abortion care. Many women expressed no benefits from their abortions. Commonly voiced positives included spiritual growth, involvement in pro-life efforts, and helping other women considering abortion. Common negatives included feelings of loss, existential concerns, declines in quality of life, feelings about terminating a life, regret, shame, guilt, depression, anxiety, and self-destructive behaviors. The study provides insight into developing more sophisticated pre-and post-abortion counseling protocols for women at risk of adverse psychological outcomes.
1) The study examined the effects of a digital prenatal program called the Baby Care Program (BCP) on 512 first-time mothers. The BCP included mindfulness activities like meditation, yoga, music, and baby bonding exercises.
2) Results showed statistically significant benefits for mothers who used the BCP, including lower stress, better sleep, fewer preterm births and higher birth weights, compared to mothers who did not participate.
3) The BCP was found to help mothers develop a stronger bond with their babies, better manage nutrition and pregnancy symptoms, and have an overall healthier pregnancy experience.
cepat hamil adalah hal yang paling harapkan untuk pasangan yang lansung ingin menimang buah hati, berikut adalah ebook panduan cara cepat hamil, dapatkan informasi lebih lengkap dengan megunjungi http://www.wishingbaby.com/
This document summarizes a study that explored factors influencing decision-making around pregnancy for women with bipolar disorder. Through interviews with 21 women and online forum posts from 50 women, researchers identified four main themes: 1) the central importance of motherhood to women's identities and life goals, 2) contextual social and economic factors like cultural/religious beliefs, physical/mental readiness, and time pressures, 3) experiences of stigma regarding their bipolar disorder, and 4) fears relating to risks of relapse or postpartum episodes associated with pregnancy. The study highlights information needs of these women to help with complex healthcare decisions and reduce stigma from health professionals.
Randomized, Controlled Trial Of A Prenatal And Postnatal Lactation ConsultantBiblioteca Virtual
This randomized controlled trial evaluated the effectiveness of a prenatal and postnatal lactation consultant intervention on the duration and intensity of breastfeeding up to 12 months. Over 300 low-income women receiving prenatal care at two community health centers were randomly assigned to an intervention or control group. The intervention group received individualized support from lactation consultants including prenatal meetings, a postpartum hospital visit, and home visits/phone calls. The trial found the intervention group was more likely to breastfeed through 20 weeks and had higher breastfeeding intensity scores at 13 and 52 weeks compared to the control group. US-born women in the control group had the lowest breastfeeding intensity. The study concluded the "best-practices" lactation
This document summarizes a study that explored whether early sexual intercourse could impact women's reproductive health in middle adulthood. The study followed 522 females from age 14 to 43, asking about the timing of their first sexual experience and later reproductive health. It found that women who had early intercourse were more likely to have lower education, leave home earlier, have more abortions and miscarriages, and report more menstrual symptoms than those who had later first intercourse. The results suggest early sexual activity can predict certain reproductive health issues later in life.
Running Head The Study of Effects of Smoking in Pregnant Women1.docxtodd521
Running Head: The Study of Effects of Smoking in Pregnant Women 1
The Study of Effects of Smoking in Pregnant Women 21
The Study of Effects of Smoking in Pregnant Women
Smoking during pregnancy carries considerable dangers to both mother and the unborn baby. Prenatal exposure to maternal cigarette smoking (PEMCS) is linked, therefore, with many different obstetric complications such as an augmented danger of ectopic pregnancy, fetal development limitation, placental previa and abruption, preterm premature rip apart of the membranes, preterm delivery, unexpected newborn death syndrome, and oral facial clefts among others. Despite these risks, women still smoke during pregnancy. There is, therefore, a great need to develop policies and interventions such as discovering what can help the women to cease smoking, in order to reduce these risks. As such, alternatives such as the use of electronic cigarettes can be introduced to the pregnant smokers. Treatment for smoking can also be offered to women during pregnancy.
Background
The following section will discuss the background of the topic. Smoking during pregnancy exposes the mother and unborn child to great risks. Prenatal exposure to maternal cigarette smoking (PEMCS) is linked, therefore, with many different obstetric complications. According to Bauld (2017), the complications could range from an augmented danger of ectopic pregnancy, fetal development limitation, placental previa and abruption, preterm premature rip apart of the membranes, preterm delivery, unexpected newborn death syndrome, and oral facial clefts. Anblagan et al., (2013) includes more risks such as the development of respiratory diseases, gestational bleeding, obesity and obesity associated disorders like cardiovascular as well as diabetes results that start when the child reaches puberty. However, intrauterine growth restriction is the most common of them all. Considering all these risks and the fact that women who smoke carry on with this habit during pregnancy, there is a great need to develop policies and interventions that would address this matter. As such, there is need to discover what can be given to these women to help in cessation. General Problem Statement
The general problem is that there are limited researches that detail about smoking patterns in pregnant women. A research by Eiden et al., (2013) indicates a shifting trajectory in pregnant smokers and major changes in due course within each trajectory. This element is important as it has the prospective to notify timing of smoking cessation intervention. Specific Problem Statement
The specific problem is that there is little information about the stability of cessation efforts on the elements that distinguish women who effectively minimize smoking during their pregnancy in comparison to the persistent smokers who stop later in pregnancy. For example, little is known about low-income expectant smokers’ demographic factors such as monetary challenges, p.
Factors influencing initiation of breast feeding among postAlexander Decker
This document summarizes a study that examined factors influencing initiation of breastfeeding among postpartum mothers in Nigeria. 317 mothers were surveyed about socio-demographic factors like age, education, employment status, and psychological state. Results showed that only maternal age significantly influenced breastfeeding initiation. The majority of mothers displayed good knowledge about breastfeeding initiation but lacked understanding of key predictive factors. It was concluded that providing mothers with more information on influencing factors could help increase initiation rates.
Fetal screening and selection medical dogma or parental preferenceKatharine Perry
This document discusses fetal screening and selection, and whether women's decisions to terminate pregnancies based on fetal abnormalities are truly autonomous. It notes that medical practitioners have significantly more positive views of terminating pregnancies for disabilities compared to patients. This difference in views threatens patients' autonomy during genetic counseling. The document examines discrepancies between medical and patient attitudes, how prenatal testing has advanced, and abortion rates after diagnoses. It argues that the medical community's tendency to over-medicalize and view disabilities as defining traits influences their support for fetal screening and selection in a way that can undermine patient consent.
Prospective study of infertility in humans due to life style changesAsma Afreen
This study assessed infertility treatment in humans in Kerala, India. It compared infertility prevalence in northern and southern Kerala and examined the impact of environmental factors. The study reviewed charts and interviewed patients aged 20-50 at three hospitals over three months. It found infertility was more common in males, increased with age and urban living, and was influenced by alcohol consumption and smoking. Long term treatment and patient education can improve infertility treatment outcomes.
Do Anxiety Scores of Pregnant Women Correlate with Doppler Indices of Uterine...semualkaira
In The Diagnostic and Statistical Manual of Mental Disorders
(DSM-V), a stressor is defined as any emotional, physical, social,
economic, or otherwise unclassified factor that disrupts the normal
physiological, cognitive, emotional, or behavioural balance of an
individual [1]. Thus, as pregnancy alters the normal physiological
balance of pregnant women, it can be regarded as a stress factor
or stressor for all individuals who experience it
Why Do Women Stop Breastfeeding Findings From The Pregnancy RiskBiblioteca Virtual
This study examined breastfeeding behaviors using data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) from 2000-2001. The authors found that 32% of women did not initiate breastfeeding, 4% stopped within the first week, 13% stopped within the first month, and 51% continued for over 4 weeks. Younger women and those with limited socioeconomic resources were more likely to stop breastfeeding early. Common reasons for stopping included sore nipples, perceived inadequate milk supply, and difficulties with breastfeeding. Women's predelivery intentions impacted their likelihood of initiating and continuing breastfeeding.
Running head The study of effects of smoking in pregnant women .docxtodd521
Running head: The study of effects of smoking in pregnant women 1
THE STUDY OF EFFECTS OF SMOKING IN PREGNANT WOMEN 6
Method
Introduction
Use of tobacco products which includes smoking cigarettes, smokeless tobacco and electronic cigarettes during pregnancy is considered to be the biggest cause of harm to young infants and their mothers. Smoking is considered to be a risk factor associated with adverse outcomes including pregnancy related effects, unhealthy and physical problems, cognitive deficits, behavioral and social problems. Statistics show that up to 13% of the women in the United Kingdom smoke during pregnancy although pregnancy motivates around 49% of the women to stop smoking. Ultimately, intervention and screening for smoking during pregnancy can be imperative in achieving smoking cessation, educating women’s partners and family members on the merits of smoking cessation during pregnancy. This section is an overview of the Methodologies used in my research assignment. The section focuses on the population used, sampling frame and the analyzed data and some of the recommended practices which result from the methodologies in regard to effects of smoking in pregnant women.Research Method and Design Appropriateness
Experts acknowledge that it is essential to know the difference between quantitative and qualitative research methods although there are misconceptions between the two. On the contrary both methods serve vastly diversified purposes. Quantitative research methods are used when it comes to quantifying the problem through generation of numerical data which is transformed into useable statistics. This method uses measureable data in formulation of facts and includes surveys, observations and reviews of records. Qualitative research method is used in gaining a clear understanding of underlying opinions, motivations and reasons. This method uses a small selected size sample and helps to develop ideas or hypotheses and gives insights into the problem. Qualitative research methods include focus groups, individual interviews, document reviews and in-depth interviews. This research study was designed to use qualitative approach in the form of in-depth interviews with women in the core group that was targeted. This method was more appropriate for my study because the fundamental goal of the research was to carry out face-to-face in-depth interviews at a well-known location. Due to the interests of including the views of a variety of women, an approach that was flexible to the actual location was adopted including local cafes, in-home, meeting rooms and in multiple special cases by telephone. This allowed the researching process many women in the client group.
Population
The study population on the effects of smoking in pregnant women involved an inclusion criterion of both white and black women pregnant smokers and pregnant non-smokers between 17 years and 36 years of age specifically in the state of Alabama Unit.
Running Head The Study of Effects of Smoking in Pregnant Women.docxtodd521
Running Head: The Study of Effects of Smoking in Pregnant Women
1
The Study of Effects of Smoking in Pregnant Women
4
The Study of Effects of Smoking in Pregnant Women
A Capstone Proposal Presented in Partial Fulfillment
of the Requirements for the Degree
Master of Healthcare Administration
Purdue Global University
A Study of Effects of Smoking in Pregnant Women
Smoking during pregnancy carries considerable dangers to both mother and the unborn baby. Prenatal exposure to maternal cigarette smoking (PEMCS) is linked, therefore, with many different obstetric complications such as an augmented danger of ectopic pregnancy, fetal development limitation, placental previa and abruption, preterm premature rip apart of the membranes, preterm delivery, unexpected newborn death syndrome, and oral facial clefts among others. Despite these risks, women still smoke during pregnancy. There is, therefore, a great need to develop policies and interventions such as discovering what can help the women to cease smoking, in order to reduce these risks. As such, alternatives such as the use of electronic cigarettes can be introduced to the pregnant smokers. Treatment for smoking can also be offered to women during pregnancy.
Background
The following section will discuss the background of the topic. Smoking during pregnancy exposes the mother and unborn child to great risks. Prenatal exposure to maternal cigarette smoking (PEMCS) is linked, therefore, with many different obstetric complications. According to Bauld (2017), the complications could range from an augmented danger of ectopic pregnancy, fetal development limitation, placental previa and abruption, preterm premature rip apart of the membranes, preterm delivery, unexpected newborn death syndrome, and oral facial clefts. Anblagan et al., (2013) includes more risks such as the development of respiratory diseases, gestational bleeding, obesity and obesity associated disorders like cardiovascular as well as diabetes results that start when the child reaches puberty. However, intrauterine growth restriction is the most common of them all. Considering all these risks and the fact that women who smoke carry on with this habit during pregnancy, there is a great need to develop policies and interventions that would address this matter. As such, there is need to discover what can be given to these women to help in cessation.
General Problem Statement
The general problem is that there are limited researches that detail about smoking patterns in pregnant women. A research by Eiden et al., (2013) indicates a shifting trajectory in pregnant smokers and major changes in due course within each trajectory. This element is important as it has the prospective to notify timing of smoking cessation intervention. Specific Problem Statement
The specific problem is that there is little information about the stability of cessation efforts on the elements that distinguish women who effectively minimize smoking during.
Rai, D., Lee, B. K., Dalman, C., Golding, J., Lewis, G., & Magnuss.docxmakdul
Rai, D., Lee, B. K., Dalman, C., Golding, J., Lewis, G., & Magnusson, C. (2013). Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: Population based case-control study. BMJ : British Medical Journal (Online), 346 doi:http://dx.doi.org.saintleo.idm.oclc.org/10.1136/bmj.f2059
Parental depression, maternal antidepressant use
during pregnancy, and risk of autism spectrum
disorders: population based case-control study
OPEN ACCESS
Dheeraj Rai clinical lecturer 1 2 3, Brian K Lee assistant professor 4, Christina Dalman associate
professor2, Jean Golding professor emeritus5, Glyn Lewis professor1, Cecilia Magnusson professor2
1Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK;
2Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 3Avon and Wiltshire
Partnership Mental Health NHS Trust, Bristol, UK; 4Department of Epidemiology and Biostatistics, Drexel University School of Public Health,
Philadelphia, PA, USA; 5Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
Abstract
Objective To study the association between parental depression and
maternal antidepressant use during pregnancy with autism spectrum
disorders in offspring.
Design Population based nested case-control study.
Setting Stockholm County, Sweden, 2001-07.
Participants 4429 cases of autism spectrum disorder (1828 with and
2601 without intellectual disability) and 43 277 age and sex matched
controls in the full sample (1679 cases of autism spectrum disorder and
16 845 controls with data on maternal antidepressant use nested within
a cohort (n=589 114) of young people aged 0-17 years.
Main outcome measure A diagnosis of autism spectrum disorder, with
or without intellectual disability.
Exposures Parental depression and other characteristics prospectively
recorded in administrative registers before the birth of the child. Maternal
antidepressant use, recorded at the first antenatal interview, was
available for children born from 1995 onwards.
Results A history of maternal (adjusted odds ratio 1.49, 95% confidence
interval 1.08 to 2.08) but not paternal depression was associated with
an increased risk of autism spectrum disorders in offspring. In the
subsample with available data on drugs, this association was confined
to women reporting antidepressant use during pregnancy (3.34, 1.50 to
7.47, P=0.003), irrespective of whether selective serotonin reuptake
inhibitors (SSRIs) or non-selective monoamine reuptake inhibitors were
reported. All associations were higher in cases of autism without
intellectual disability, there being no evidence of an increased risk of
autism with intellectual disability. Assuming an unconfounded, causal
association, antidepressant use during pregnancy explained 0.6% of
the cases of autism sp ...
Gaudium IVF is now the most successful and advanced IVF institute of North India, (New Delhi, Punjab, Jammu Srinagar & Haryana). It was setup by renowned and awarded Dr. Manika Khanna (Delhi Ratan 2008, Recognized by The President of India, Mrs. Pratibha Patil, 2009) with the aim of delivering the joy of parenthood to childless couples. It has achieved more than 6000 IVF pregnancies in last 6 years. Gaudium has been recognized as the Best IVF Institute of India 2012 by the IVF India Magazine. And, Best IVF centre of the year 2014 by State Govt. It was also awarded the Best brand in IVF Surrogacy by the Brands Academy 2012. Gaudium is proud to have healthy babies in many cities across India and Overseas.
This randomized controlled trial tested the effects of docosahexaenoic acid (DHA) supplementation on perceived stress and cortisol response to stress among 64 pregnant African American women living in low-income environments. Women were randomly assigned to receive either 450 mg of DHA per day or a placebo from 16-21 weeks of gestation through the end of pregnancy. Women who received DHA reported lower levels of perceived stress at 30 weeks of gestation and had a lower cortisol response to a stress test, indicating that DHA supplementation may reduce the effects of maternal stress during late pregnancy.
Smoking Cessation and Relapse Among PregnantAfrican-American.docxrosemariebrayshaw
Smoking Cessation and Relapse Among Pregnant
African-American Smokers in Washington, DC
Ayman A. E. El-Mohandes • M. Nabil El-Khorazaty •
Michele Kiely • Marie G. Gantz
Published online: 8 June 2011
� Springer Science+Business Media, LLC (outside the USA) 2011
Abstract Smoking is the single most preventable cause
of perinatal morbidity. This study examines smoking
behaviors during pregnancy in a high risk population of
African Americans. The study also examines risk factors
associated with smoking behaviors and cessation in
response to a cognitive behavioral therapy (CBT) inter-
vention. This study is a secondary analysis of data from a
randomized controlled trial addressing multiple risks dur-
ing pregnancy. Five hundred African-American Washing-
ton, DC residents who reported smoking in the 6 months
preceding pregnancy were randomized to a CBT inter-
vention. Psycho-social and behavioral data were collected.
Self-reported smoking and salivary cotinine levels were
measured prenatally and postpartum to assess changes in
smoking behavior. Comparisons were made between active
smokers and those abstaining at baseline and follow-up in
pregnancy and postpartum. Sixty percent of participants
reported quitting spontaneously during pregnancy. In
regression models, smoking at baseline was associated with
older age,\a high school education and illicit drug use. At
follow-up closest to delivery, smoking was associated with
lower education, smoking and cotinine level at baseline
and depression. At postpartum, there was a relapse of 34%.
Smokers postpartum were significantly more likely to
smoke at baseline and use illicit drugs in pregnancy.
Mothers in the CBT intervention were less likely to
relapse. African-American women had a high spontaneous
quit rate and no response to a CBT intervention during
pregnancy. Postpartum mothers’ resolve to maintain a quit
status seems to wane despite their prolonged period of
cessation. CBT reduced postpartum relapse rates.
Keywords Smoking � Pregnancy � African-Americans �
Washington, DC
Introduction
Smoking during pregnancy is associated with problems of
placentation [1], low birthweight [2–8], prematurity [3, 9,
10], sudden infant death [10–12], infant mortality [12],
and later physical [13], developmental [13] and behav-
ioral [10, 14, 15] problems. A significant percentage of
smokers continue to smoke during pregnancy and are
unable to quit on their own despite their knowledge of the
risks involved. Existing behavioral interventions are only
modestly successful, having an attributable benefit of no
more than 10% above spontaneous quit rates among
pregnant women [16].
M. Nabil El-Khorazaty: Deceased.
Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov,
NCT00381823.
A. A. E. El-Mohandes
College of Public Health, University of Nebraska Medical
Center, Omaha, NE, USA
M. N. El-Khorazaty � M. G. Gantz
RTI International (RTI International is a trad.
Selection Bias in the Link Between Child Wantednessand Child.docxtcarolyn
1. The document examines potential selection bias in the link between unwanted births and child mortality using data from 7,942 women in Matlab, Bangladesh who declared birth intentions in 1990.
2. It explores two opposing reasons for bias - biological processes may make unwanted births appear healthier, while social privileges may make them appear less healthy by facilitating avoidance of births.
3. The analysis finds no overall effect of unwantedness on child survival, no evidence biological factors make unwanted births appear healthier, and some evidence higher education makes unwanted births appear less healthy by enabling avoidance. The results suggest selection bias may impact attempts to link unwantedness and child health.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
1. Abortion and mental health disorders: evidence from a 30-year
longitudinal study
David M. Fergusson, L. John Horwood and Joseph M. Boden
BJP 2008, 193:444-451.
Access the most recent version at doi: 10.1192/bjp.bp.108.056499
Reprints/ To obtain reprints or permission to reproduce material from this paper, please
permissions write to permissions@rcpsych.ac.uk
You can respond http://bjp.rcpsych.org/cgi/eletter-submit/193/6/444
to this article at
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from Published by The Royal College of Psychiatrists
To subscribe to The British Journal of Psychiatry go to:
http://bjp.rcpsych.org/site/subscriptions/
2. The British Journal of Psychiatry (2008)
193, 444–451. doi: 10.1192/bjp.bp.108.056499
Abortion and mental health disorders:
evidence from a 30-year longitudinal study{
David M. Fergusson, L. John Horwood and Joseph M. Boden
Background
Research on the links between abortion and mental health who had had abortions had rates of mental disorder that
has been limited by design problems and relatively weak were about 30% higher. There were no consistent
evidence. associations between other pregnancy outcomes and mental
health. Estimates of attributable risk indicated that exposure
Aims to abortion accounted for 1.5% to 5.5% of the overall rate of
To examine the links between pregnancy outcomes and mental disorders.
mental health outcomes.
Method Conclusions
Data were gathered on the pregnancy and mental health The evidence is consistent with the view that abortion may
history of a birth cohort of over 500 women studied to the be associated with a small increase in risk of mental
age of 30. disorders. Other pregnancy outcomes were not related to
increased risk of mental health problems.
Results
After adjustment for confounding, abortion was associated Declaration of interest
with a small increase in the risk of mental disorders; women None. Funding detailed in Acknowledgements.
Over the past two decades there has been increasing research into alcohol dependence and illicit drug dependence). This analysis is
mental health outcomes associated with induced abortion. These an extension of an earlier study8 that examined the links between
outcomes include depression,1–10 anxiety,6,8,11,12 substance abortion and mental health in the same birth cohort.
use,8,13 and suicidal behaviour and self-harm.8,14 The findings
from this research have been both controversial and inconsistent, Method
with a number of studies reporting adverse effects associated with
abortion3,6,8,10,13 but others finding no association.1,2,4,5,12 Research The data used in this analysis were gathered over the course of the
in this area has faced a number of complications that have Christchurch Health and Development Study (CHDS). The CHDS
prevented clear conclusions about whether or not exposure to is a longitudinal study of a birth cohort of 1265 children born in
induced abortion is associated with increased (or decreased) risks the Christchurch urban region in New Zealand who have been
of mental health problems in women having unwanted studied at birth, 4 months, 1 year and annual intervals to age 16
pregnancies. First, studies in this area have been subject to a years, and again at ages 18, 21, 25 and 30. The present analysis
number of threats to validity that include inadequate ascertain- is based on the cohort of 534 women for whom information on
ment of exposure to abortion, limited assessment of mental health pregnancy history and mental health outcomes was available.
outcomes and failure to control confounding.8,15–18 These threats However, since not all women were assessed on all occasions,
to validity are pervasive and no existing study has been able to the sample sizes used in the analysis range between 507 and
overcome all of them.15 These technical problems of research 524, depending on the timing of assessment of pregnancy history
design have been exacerbated by the fact that the issue of mental and mental health. These samples represent between 80% and
health effects of abortion has been hotly contested by pro-life and 83% of the original cohort of 630 women. All data were collected
pro-choice advocates, resulting in a situation in which weak only on the basis of signed consent from participants. The study
research evidence has been used to support strongly stated had ethical approval from the Canterbury ethics committee.
opinions on the harms or benefits associated with abortion.15,16
Finally, there has been an unfortunate tendency in the literature
on this topic for study findings to coincide with the ideological Pregnancy and abortion (15–30 years)
views of authors about the desirability of abortion.15,19 This At each assessment from age 15 to 30 years participants were
combination of limited evidence, controversy and strongly stated questioned about any pregnancies occurring since the previous
opinion has made research into the mental health effects of assessment, and the timing and outcome of each reported
abortion a contested area and there has been wide variation in pregnancy was recorded. Participants were also questioned about
scientific views of the matter.3,20–22 their reaction to each pregnancy and the extent to which this had
In this paper we report an analysis of data from a 30-year caused them to be upset or distressed. At age 30, as a check on the
longitudinal study in which we seek to examine the extent to accuracy of the prospectively gathered pregnancy data, all
which variations in pregnancy outcomes, including induced participants were asked to provide a summary of their full
abortion, live birth and pregnancy loss, are associated with pregnancy history. As well as information on timing and outcome,
increased (or decreased) risks of a range of common mental health participants were also questioned about whether the pregnancy
problems (major depression, anxiety disorders, suicidal ideation, was wanted or unwanted, and their initial reaction to the
pregnancy at the time. Initial reactions were coded on a 5-point
{
See invited commentaries, pp. 452–454 this issue. scale from very happy to very unhappy/distressed. Comparison
444
3. Abortion and mental health disorders
of the prospective and retrospective reports of pregnancy history obtained of the family’s gross annual income for the past 12
showed that for just under 90% of women the two reports were months.
in agreement.
For the purposes of the present analysis the measures of Measures of parental adjustment/family functioning
pregnancy history were defined using a combination of both
prospective and retrospective reports. Using the information on Using detailed information on patterns of family change gathered
timing and outcome for each reported pregnancy, the woman’s over the interval from birth to 15 years, a measure of family
pregnancy history for any given period of interest was classified instability was constructed on the basis of a count of the number
using four dichotomous measures of pregnancy outcomes. of changes of parents experienced by the child by age 15. At age 18,
participants were questioned using items from the Conflict Tactics
(a) Whether the woman reported having an elective abortion Scale27 concerning incidents of inter-parental violence that they
during the interval. may have witnessed during childhood ( 516 years). These items
(b) Whether the women experienced a pregnancy loss during the were combined to provide an overall measure of the extent of
interval. Pregnancy loss was defined to include miscarriage, inter-parental violence.28 The reliability of this scale was a=0.88.
stillbirth and termination of ectopic pregnancy. When participants were aged 11 years, parents were
questioned about their own history of illicit drug use. When
(c) Whether the woman had a live birth during the interval for participants were aged 15 years, parents were further questioned
which she reported an adverse reaction to the pregnancy. An about their history of mental health problems, problems with
adverse reaction was defined to include where the woman alcohol, and involvement in criminal offending. These reports
reported that the pregnancy was unwanted or that she had were used to classify participants on four dichotomous measures
been distressed or very distressed on learning of the pregnancy. reflecting whether any parent had a reported history of illicit drug
(d) Whether the woman had a live birth during the interval with use, mental health problems, alcohol problems or criminality
no adverse reaction to the pregnancy. respectively. The quality of parental–child attachment in
adolescence was assessed at age 15 years using the Armsden &
Based on the combined report data, 284 women (53% of the Greenberg29 scale of parental attachment (a=0.87).
cohort) reported a total of 686 pregnancies before age 30. These
pregnancies included a total of 153 abortions (occurring to 117
Measures of exposure to child abuse
women), 138 pregnancy losses (n=95), 66 live births (n=52) that
resulted from an unwanted pregnancy or one that provoked an At age 18 and 21 years, participants were questioned about their
adverse reaction, and 329 live births (n=197) resulting from a experience of sexual abuse in childhood ( 516 years).30
pregnancy for which there was no reported adverse reaction. Individuals were classified as having experienced childhood sexual
abuse if they reported at either age 18 or 21 any episode of abuse
involving physical contact with a perpetrator. Participants were
Mental health (15–30 years)
also questioned at age 18 and 21 years about the extent, on a
At each assessment from age 16 to 30 years, participants were 5-point scale,31 to which their parents used physical punishment
questioned about mental health issues since the previous assess- during childhood ( 516 years). Individuals were classified as hav-
ment using structured questionnaires based on the Diagnostic ing experienced physical child abuse if they reported at either age
Interview Schedule for Children (DISC)23 at age 16 years and 18 or 21 that at least one parent had regularly used physical
the Composite International Diagnostic Interview24 at ages 18– punishment, had used physical punishment too often or too
30 years, supplemented by additional measures. From this severely, or had treated them in a harsh and abusive manner.
questioning it was possible to ascertain the proportion of young
women who met DSM–IV25 diagnostic criteria for the following
Measures of individual characteristics and educational
disorders during the intervals 15–18, 18–21, 21–25 and 25–30
years: major depression, anxiety disorders (including generalised achievement
anxiety, panic disorder, agoraphobia, social phobia and specific Child neuroticism was assessed at age 14 years using a short-form
phobia), alcohol dependence and illicit drug dependence. In version of the neuroticism scale of the Eysenck Personality
addition, measures of DSM–IV disorders were supplemented by Inventory.32 The reliability of this scale was a=0.80. Child
measures of self-reported suicidal ideation. Finally, to provide self-esteem was assessed at age 15 years using the Coopersmith
an overall measure of the burden of mental disorder, the Self-Esteem Inventory.33 The reliability of this scale was a=0.87.
individual measures were summed to obtain a count of the Child novelty-seeking was assessed at age 16 years using the
number of mental health problems reported for each interval. novelty-seeking scale of the Tridimensional Personality Inventory.34
The reliability of this scale was a=0.76. At age 7, 8 and 9 years, the
Covariate factors extent to which participants exhibited tendencies to conduct
disordered and oppositional behaviours was assessed using a scale
Measures of childhood socio-economic circumstances that combined items from the Rutter35 and Conners36,37 child
Maternal and paternal education levels were assessed at the time of behaviour rating scales. Separate ratings were obtained from the
the cohort member’s birth using a 3-point scale (no formal child’s parent and class teacher. Parent and teacher ratings were
qualifications, secondary qualifications, tertiary qualifications). summed for each year and then averaged over the interval from
Family socio-economic status was assessed at birth using the 7 to 9 years to provide a robust measure of the child’s tendencies
Elley–Irving revised index of socio-economic status for New to conduct problems. The reliability of the resulting scale was
Zealand.26 Family living standards were assessed on the basis of a=0.97. Child IQ was assessed at age 8 years using the revised
an interviewer rating at each interview from birth to age 10 years. Wechsler Intelligence Scale for Children.38 The split half reliability
Ratings were made on a 5-point scale from very good to very poor. of this scale was 0.93.
These ratings were averaged over the 10-year period to provide an At each assessment from age 11 to 13 years, the child’s class
overall measure of the family’s average living standard during this teacher was asked to rate the child’s performance in each of the
period. At each assessment from age 1 to 10 years, estimates were five areas of the curriculum (reading, handwriting, written
445
4. Fergusson et al
expression, spelling, mathematics) using a 5-point scale ranging G(Yit) was the log odds of Y for the i-th individual in the t-th
from 1=very good to 5=very poor. To provide a global measure time interval for dichotomous outcomes or the log rate of
of the child’s educational achievement over the interval from 11 problems for the i-th individual in the t-th time interval for the
to 13 years, the teacher ratings were summed across years and cur- count of the number of mental health problems; Xit was a time-
riculum areas and then averaged to provide a teacher-rating grade dynamic dichotomous variable reflecting the pregnancy history
point average for each child. The reliability of this measure was outcome (abortion, pregnancy loss, live birth with adverse
a=0.96. reaction, or other live birth) for the i-th individual up to the
t-th interval; ui was an individual specific random effect assumed
to be uncorrelated with Xit ; and eit was the disturbance term for
Measures of adolescent adjustment the model. The intercept B0 was permitted to vary with time t
At age 18, participants were questioned about their sexual to allow for changes in the base rate of each outcome over time.
behaviours, including the age of first intercourse. Young women In each case, an estimate of the pooled risk ratio of disorder (odds
who reported that they had first had sex before age 16 were ratios for dichotomous outcomes, incidence rate ratio for the
classified as having early sexual onset. problem count) and corresponding 95% confidence interval was
At age 15, participants were questioned about their use of obtained from the fitted coefficient B1 and its standard error in
tobacco, alcohol and cannabis. Tobacco use was assessed on the the usual way eB1+1.96s.e.(B1). To avoid problems associated with
basis of a 5-point scale reflecting the current frequency of cigarette repeated significance testing of multiple correlated outcomes, tests
smoking at age 15. This scale ranged from ‘non-smoker’ through of significance of the pooled associations were restricted to the
to ‘daily smoker’. The frequency of alcohol use in the past 12 models for the count of number of mental health problems.
months was assessed using a 6-point scale that ranged from ‘never’ Risk ratio estimates for each measure of pregnancy history
to ‘almost every day’. In addition, a dichotomous measure of adjusted for other pregnancy outcomes (Table 1) were obtained
cannabis use was created based on the young person’s report of by extending the models in the above equation to include all four
use in the past 12 months. measures of pregnancy history. Thus:
At age 15, young people were administered a mental health
interview that combined components of DISC23 and other G(Yit) = B0t + B1X1it + B2X2it + B3X3it + B4X4it + ui + eit
measures to assess a range of DSM–III–R39 disorders in the cohort
over the previous 12 months. This information was used to X1it , X2it , X3it , X4it were time-dynamic dichotomous measures
construct DSM–III–R diagnoses of major depression and anxiety reflecting exposure of the i-th participant to abortion, pregnancy
disorders, including overanxious disorder, generalised anxiety loss, live birth with adverse reaction, or other live birth respec-
disorder, social phobia and simple phobia. In addition, individuals tively. Two models were fitted for each mental health outcome:
were also questioned about the frequency of suicidal thoughts in (a) a model in which the pregnancy history measures (X1it, X2it,
the previous 12 months. X3it , X4it) were assessed up to and concurrently with the
observation interval for mental health outcomes; (b) a model in
which the pregnancy history outcomes were assessed as lagged
Time-dynamic lifestyle and other factors measures in the 5 years prior to the beginning of the interval in
At each assessment from age 18 onwards, participants were which the mental health outcome was assessed. The random-
questioned about aspects of their living arrangements since the effects models were then further extended to obtain risk ratio
previous assessment including: (a) living with parents and age estimates adjusted for the series of fixed and time-dynamic
of leaving the family home; and (b) entry into cohabiting covariate factors described previously (Table 2). In fitting the
relationships. In addition, participants were questioned about covariate adjusted models, all covariates were initially considered
other adverse life events occurring in each year since the previous for inclusion in each model. The covariate set was then refined
assessment using a life-event checklist based on the Feeling Bad using methods of forwards and backwards variable elimination
Scale.40 This information was used to classify participants on four to identify a stable set of covariates that were significant in at least
measures reflecting the extent of exposure to employment one of the models fitted. The final analyses were conducted using
problems, partner relationship problems, serious illness or death only these covariates.
in the family, and sexual or physical violence victimisation within All models were fitted using Stata version 8 for Windows.
any given interval. Finally, to control for the changing history of Estimates of the attributable fraction of mental health problems
prior mental health, a lagged measure of the number of mental owing to abortion were derived from the adjusted rate ratio
health problems observed in the previous assessment period was measures using the methods described by Bruzzi et al.41
also considered.
Sample bias
Statistical analysis As noted previously the sample sizes available for analysis
The associations (risk ratios) between pregnancy history and represented 80–83% of the initial sample of 630 women who
mental health at ages 15–18, 18–21, 21–25 and 25–30 years (online entered the study at birth. To test for selection bias arising from
Table DS1) were estimated by fitting random-effects models to the the processes of sample attrition, the sample of women included
repeated-measures data for each outcome and each measure of in the analysis was compared with the remaining cohort on a
pregnancy history (abortion, pregnancy loss, live birth with series of measures collected at the time of birth. These comparisons
adverse reaction, other live birth). For dichotomous outcomes suggested evidence of small but statistically significant (P50.05)
(depression, anxiety, suicidal ideation, substance dependence) tendencies for women from socio-economically disadvantaged
logistic regression models were fitted, whereas for the count of backgrounds (low parental education, low socio-economic status
number of mental health problems Poisson regression was used. family, single-parent family) to be under-represented in the
For each outcome (Y) the general model fitted was of the form: analysis sample. To examine the extent to which the study findings
may have been influenced by these small biases, the analyses were
G(Yit) = B0t + B1Xit + u1 + eit repeated using the data weighting methods described by Carlin
446
5. Abortion and mental health disorders
Table 1 Estimated risk ratios (95% CI) between mental health outcomes and each pregnancy outcome adjusted for other
pregnancy outcomes
Live birth, RR (95% CI)
Abortion Pregnancy loss Unwanted/adverse No adverse
Measure RR (95% CI) RR (95% CI) reaction reaction
Concurrent models
Major depression 2.04 (1.36–3.07) 1.99 (1.21–3.28) 1.97 (1.11–3.48) 0.69 (0.46–1.04)
Anxiety disorder 2.10 (1.38–3.19) 2.12 (1.28–3.49) 1.46 (0.80–2.66) 1.05 (0.70–1.58)
Suicidal ideation 2.07 (1.19–3.57) 3.08 (1.62–5.86) 1.37 (0.63–3.00) 0.99 (0.57–1.73)
Alcohol dependence 1.89 (0.86–4.17) 3.30 (1.33–8.21) 0.44 (0.10–1.83) 0.74 (0.31–1.81)
Illicit drug dependence 6.64 (2.83–15.61) 1.68 (0.55–5.14) 1.36 (0.40–4.63) 0.53 (0.19–1.46)
Number of mental health problems 1.49 (1.24–1.80) 1.48 (1.19–1.83) 1.18 (0.91–1.53) 0.91 (0.75–1.09)
5-year lagged models
Major depression 1.54 (0.92–2.59) 1.29 (0.67–2.50) 1.72 (0.82–3.61) 1.51 (0.90–2.52)
Anxiety disorder 2.72 (1.59–4.66) 2.45 (1.23–4.91) 1.17 (0.51–2.67) 1.75 (1.02–3.00)
Suicidal ideation 2.26 (1.17–4.38) 2.15 (0.96–4.83) 1.46 (0.52–4.09) 2.42 (1.24–4.71)
Alcohol dependence 5.33 (1.90–14.97) 2.29 (0.62–8.39) 0.37 (0.03–4.12) 1.15 (0.34–3.87)
Illicit drug dependence 4.82 (1.91–12.18) 3.85 (1.05–14.09) 0.37 (0.05–2.80) 0.36 (0.08–1.58)
Number of mental health problems 1.48 (1.18–1.85) 1.26 (0.96–1.67) 1.05 (0.74–1.49) 1.27 (1.00–1.61)
Table 2 Estimated risk ratios (95% CI) between measures of pregnancy history and mental health outcomes after adjustment
for covariates
Live birth, RR (95% CI)
Abortion Pregnancy loss Unwanted/ No adverse Significant
Measure RR (95% CI) RR (95% CI) adverse reaction reaction covariatesa
Concurrent models
Major depression 1.58 (1.08–2.32) 1.14 (0.70–1.85) 1.60 (0.94–2.72) 0.71 (0.47–1.05) 3–5,7,12–17
Anxiety disorder 1.55 (1.03–2.32) 1.41 (0.86–2.32) 1.22 (0.69–2.15) 1.12 (0.75–1.68) 5, 8,14–17
Suicidal ideation 1.35 (0.77–2.38) 1.96 (1.00–3.83) 0.93 (0.41–2.13) 1.02 (0.57–1.83) 3–5,9,12,14–16
Alcohol dependence 1.19 (0.56–2.55) 2.23 (0.92–5.41) 0.48 (0.12–1.89) 0.68 (0.28–1.64) 4,12–14,17
Illicit drug dependence 3.56 (1.59–7.98) 0.87 (0.29–2.56) 1.12 (0.35–3.63) 0.58 (0.22–1.50) 2,3,10,11,14,16,17
Number of mental health problems 1.37 (1.16–1.62) 1.25 (1.01–1.53) 1.11 (0.88–1.41) 0.93 (0.78–1.11) 3-7,12,14–17
5-year lagged models
Major depression 1.31 (0.77–2.22) 0.76 (0.39–1.50) 1.66 (0.80–3.45) 1.15 (0.68–1.96) 3-5,7,15,16
Anxiety disorder 2.13 (1.24–3.64) 2.10 (1.05–4.20) 1.17 (0.51–2.65) 1.44 (0.84–2.46) 5,6,15
Suicidal ideation 1.61 (0.82–3.18) 1.47 (0.63–3.39) 1.02 (0.35–3.00) 1.85 (0.94–3.65) 3,4,9
Alcohol dependence 2.88 (1.01–8.18) 1.33 (0.36–4.96) 0.41 (0.04–4.28) 1.19 (0.36–4.00) 1,4,9,16
Illicit drug dependence 2.85 (1.09–7.44) 1.30 (0.33–5.19) 0.22 (0.02–2.77) 0.30 (0.07–1.35) 2,3,7,10
Number of mental health problems 1.32 (1.05–1.67) 1.06 (0.79–1.43) 1.05 (0.73–1.50) 1.22 (0.96–1.55) 3-7,15,16
a. 1=maternal education; 2=family socio-economic status; 3=childhood sexual abuse; 4=childhood physical abuse; 5=child neuroticism (14 years); 6=self-esteem (15 years);
7=teacher-rated grade point average (11–13 years); 8=depression/anxiety disorder (15 years); 9=suicidal ideation (15 years); 10=adolescent alcohol use (16 years); 11=living
with parents; 12=cohabiting partner; 13=employment problems; 14=partner relationship problems; 15=serious illness or death in family; 16=sexual or physical violence victimisation;
17=lagged history of mental health problems. Covariates not significant in any analysis: family living standards (0–10 years); family income (0–10 years); changes of parents
(0–15 years);inter-parental violence (0–16 years); parental mental health problems; parental alcohol problems; parental criminality; parental illicit drug use; parental attachment;
novelty-seeking; child IQ; child conduct problems; early sexual onset; early tobacco use and early cannabis use.
et al.42 These analyses produced almost identical conclusions to reaction to becoming pregnant; and a live birth with no adverse
the results reported here, suggesting that the findings were reaction to the pregnancy. Online Table DS1 reports associations
unlikely to have been influenced by selection bias. (risk ratios (RRs)) between each measure of pregnancy history
and each mental health outcome (see Method). For the measure
of total number of mental health problems the RR is estimated
Results by the incidence rate ratio (IRR), and for other outcomes by the
odds ratio (OR). Online Table DS1 leads to the following
Associations between pregnancy outcomes and conclusions.
mental health (15–30 years)
(a) Exposure to induced abortion was consistently associated with
Online Table DS1 shows the relationships between a series of
increased rates of mental disorders, with ORs for individual
mental health outcomes during the intervals 15–18, 18–21, 21–
disorders ranging from 1.86 to 7.08. These trends are reflected
25 and 25–30 years and the women’s pregnancy history to ages
in the fact that those exposed to abortion between ages 15–30
18, 21, 25 and 30 years respectively. Mental health outcomes
had overall rates of mental health problems that were 1.54
include measures of major depression, anxiety disorder, suicidal
(95% CI 1.28–1.85) times higher than those not exposed to
ideation, alcohol dependence, illicit drug dependence and a count
abortion (P50.001).
of the total number of mental health problems. Pregnancy history
is summarised by four dichotomous measures representing (b) Exposure to pregnancy loss was also associated with modest
whether the women had experienced any of the following out- but consistent increases in risks of mental health problems,
comes by a given age: an abortion; a pregnancy loss (miscarriage, with ORs for individual disorders ranging from 1.76 to 3.30.
stillbirth, ectopic pregnancy); a live birth from a pregnancy that These trends are reflected in the fact that, overall, those who
either was unwanted or caused the woman to have an adverse had experienced pregnancy loss had rates of mental disorder
447
6. Fergusson et al
that were 1.49 (95% CI 1.21–1.84) times higher than those had such losses having overall rates of mental health problems that
who had not (P50.001). were 1.26 (95% CI 0.96–1.67) times higher than those who had
not become pregnant (P=0.10). Having a live birth with an
(c) Having a live birth that was associated with an unwanted/ unwanted/adverse reaction was associated with a modest increase
adverse reaction to pregnancy was associated with modest in rates of internalising disorders (depression, anxiety) and
increases in risks of all individual outcomes except for suicidal ideation, but a reduction in the risks of substance use dis-
alcohol dependence. For alcohol dependence the OR was orders, with an overall RR of disorder of 1.05 (95% CI 0.74–1.49)
0.54, and for other disorders it ranged from 1.77 to 2.25. that was no higher than for those who had not become pregnant
The overall rate of disorder for those who reported an (P40.75). However, in contrast to the concurrent model, those
unwanted/adverse reaction was 1.31 (95% CI 1.01–1.69) who had had a live birth without an adverse reaction appeared
times higher than for those who did not (P50.05). to have elevated risks of subsequent disorder for most mental
(d) Associations between mental health outcomes and having a health outcomes (particularly for anxiety disorder and suicidal
live birth with no reported adverse reaction were generally ideation). Overall, having an other live birth was associated with
weak and inconsistent, with ORs ranging from 0.72 to 1.41. a 1.27 (95% CI 1.00–1.61) times increase in rates of mental
This trend is reflected in an overall rate of mental disorder disorder (P=0.05).
that was only 1.03 (95% CI 0.86–1.22) times higher than for
those who had not experienced a live birth with no adverse Covariate adjusted results
reaction (P40.75). A limitation of the analysis in Table 1 is that the associations
between pregnancy outcomes and mental health do not take into
Adjustment for associations between pregnancy account potential confounding factors that might be associated
outcomes with increased risks of various pregnancy outcomes and/or mental
The results in online Table DS1 do not take account of the inter- health outcomes. To address this issue the associations in Table 1
relationships between various pregnancy outcomes, reporting just were adjusted for a series of confounding covariates (see Method).
on the contemporaneous relationships between pregnancy out- These covariates included measures of: childhood socio-economic
comes and mental health. These issues are addressed in Table 1, circumstances; childhood family functioning; parental adjust-
which shows estimates of the RRs between rates of mental health ment; exposure to abuse in childhood; individual characteristics;
problems and each pregnancy outcome adjusted for other educational achievement; adolescent adjustment; and time-
pregnancy outcomes. These estimates were obtained by fitting dynamic lifestyle and related factors.
the random-effects model described in the Method. The associa- Table 2 shows the estimated covariate adjusted RR and 95%
tions are reported for two different models: (a) a model in which CIs for each mental health outcome estimated by the concurrent
pregnancy outcomes were assessed concurrently with mental and lagged models. After adjustment, both sets of models yielded
health (as in online Table DS1); and (b) a lagged model in which a similar set of conclusions.
exposure to the pregnancy outcome occurred in the 5 years prior (a) For both models there was consistent evidence that even after
to the interval in which mental health was assessed. Table 1 leads extensive covariate adjustment, exposure to abortion was
to the following general conclusions. associated with a modest but detectable increase in rates of
mental disorder. The concurrent data suggested that after
Concurrent model adjustment for confounding those exposed to abortion had
rates of mental health problems that were 1.37 (95% CI
In all cases, RR estimates for exposure to abortion and exposure to
1.16–1.62) times higher than for those who had not become
pregnancy loss were greater than 1, implying that exposure to
pregnant (P50.001). The lagged model produced a slightly
these conditions was associated with increased risks of concurrent
lower estimate of 1.32 (95% CI 1.05–1.67, P50.05).
mental health problems. Overall, those exposed to induced
abortion had rates of mental health problems that were 1.49 (b) Pregnancy loss was associated with a modest increase in the
(95% CI 1.24–1.80) times higher than the rates for those who rate of problems using the concurrent measures of pregnancy
did not become pregnant (P50.001), whereas exposure to outcome, with those who experienced a pregnancy loss having
pregnancy loss was associated with a 1.48 (95% CI 1.19–1.82) a rate of mental health problems that was 1.25 (95% CI 1.01–
times increase (P50.001). Risk ratios for live birth with an 1.53) times the rate for those who were never pregnant
unwanted/adverse reaction tended to be more modest, with an (P50.05). However, under the lagged model, pregnancy loss
overall rate of mental health problems that was only 1.18 (95% was not associated with later outcomes, with an adjusted RR
CI 0.91–1.53) times the rate for those who did not become of 1.06 (95% CI 0.79–1.43, P40.70).
pregnant (P40.20). In contrast, other live birth was associated (c) For both models, having a live birth, whether with or without
with reduced risks of most disorders, with an overall RR of an unwanted/adverse reaction, was not associated with signif-
disorder of 0.91 (95% CI 0.75–1.09) compared with women icant increases in the overall rate of mental health problems
who did not become pregnant (P40.30). when due allowance was made for confounding variables.
Inspection of the results in Table 2 suggests that the reasons
The 5-year lagged model for the higher rates of mental disorder among women exposed
The results of the 5-year lagged model were in most respects very to induced abortion were owing to small but consistent tendencies
similar to the findings from the concurrent model. Exposure to for those exposed to abortion to be at increased risks of a range of
induced abortion was associated with consistently increased risks adverse mental health outcomes, with these trends being most
of mental health problems, with women who had had abortions marked for illicit drug dependence in the concurrent model,
having overall rates of mental health problems that were 1.48 and anxiety disorders, alcohol dependence and illicit drug
(95% CI 1.18–1.85) times the rates for those who had not become dependence in the lagged model. Odds ratios for specific disorders
pregnant (P50.001). Pregnancy loss was also associated with ranged from 1.19 to 3.56 for the concurrent model and from 1.31
increased risks of mental health problems, with women who had to 2.88 for the lagged model.
448
7. Abortion and mental health disorders
Sensitivity analysis abortions had rates of mental health problems that were about
The models in Tables 1 and 2 are a subset of the models that could 30% higher than rates of disorder in other women. Although rates
be fitted to these data. In particular, there are two key decisions of all forms of disorder were higher in women exposed to
that could affect the outcomes of the modelling process. The first abortion, the conditions most associated with abortion included
was the data-set used to analyse the results. As explained in the anxiety disorders and substance use disorders. In contrast, none
Method, pregnancy data were available from both prospective of the other pregnancy outcomes (pregnancy loss, live birth
and retrospective reports and the present analysis is based on a following unwanted pregnancy or a pregnancy having an initial
data-set that combined both retrospective and prospective adverse reaction, and other live birth) was consistently related to
report data. A second way in which the analysis could vary was significantly increased risks of mental health problems.
with the choice of the lag between the measures of pregnancy his- Although exposure to abortion was associated with significant
tory and the assessment of mental health outcomes. To explore the increases in risks of mental health problems, the overall effects of
consequences of these decisions, a sensitivity analysis was abortion on mental health proved to be small. Estimates of the
conducted by replicating the analysis of the effect of abortion attributable fraction suggested that exposure to abortion
on the total number of mental health problems using three accounted for 1.5–5.5% of the overall rates of mental disorder
different strategies to define pregnancy history (combined data, in this cohort.
prospective data, retrospective data) and using four lag rules
(concurrent, lagged 5 years, 4 years and 3 years). Evidence of causality
The results of this analysis are shown in Table 3, which gives These findings are consistent with the view that exposure to abor-
IRR estimates and 95% CIs for the effects of abortion on overall tion has a small causal effect on the mental health of women. The
rates of mental health outcomes for the different models. Table following lines of evidence support a causal conclusion.
3 shows that the results of the analyses were highly consistent:
(a) Consistency of associations: In this study data gathered at
(a) the combined-data models yielded a range of IRRs that varied
different ages and on different mental health outcomes
from 1.37 to 1.24 with a median value of 1.34.
showed generally consistent tendencies for women exposed
(b) the prospective-data models yielded a range from 1.45 to 1.29 to abortion to be at increased risks of mental health problems
with a median value of 1.33. (online Table DS1).
(c) the retrospective-data models yielded a range from 1.30 to
(b) Resiliency to control for confounding: Associations between
1.23 with a median value of 1.26.
exposure to abortion and mental health proved to be resilient
Among the lagged models there was a tendency for RR to extensive controls for confounding factors. Over 30
estimates to reduce with shorter lags, with the IRRs for the 5-year confounding variables were considered in the analyses
lagged model ranging from 1.34 to 1.26 compared with 1.29 to reported. These variables included measures of childhood
1.23 for the 3-year lagged model. socio-economic background, family functioning, exposure to
All results are consistent with the conclusion that even child abuse, individual factors, prior mental health disorders,
following extensive covariate adjustment, exposure to induced and exposure to stressful life events in adulthood (including
abortion was associated with a small but consistent increase in violence victimisation). This list of covariates appears to
rates of mental health problems. However, although there was cover all of the major sources of confounding suggested in
evidence of significant associations between exposure to induced the literature.4,12,20
abortion and rates of mental health problems, the contribution
of induced abortion to population rates of disorder was small. (c) Temporal sequence: Associations between abortion and
The estimated attributable fractions for the analyses summarised mental health outcomes were present for lagged models in
in Table 3 ranged from 1.5% to 5.5%. which exposure to abortion was assessed 3–5 years prior to
the period during which mental health outcomes were
assessed (Tables 2 and 3).
Discussion
(d) Availability of comparison groups: A frequent criticism of
In this paper we have used extensive data gathered over the course research into abortion and mental health is that studies have
of a 30-year longitudinal study to examine the links between a failed to include appropriate comparison groups.43 In this
series of pregnancy outcomes (abortion, pregnancy loss, unwanted study we have included results for three comparison groups:
pregnancy leading to live birth, and other live birth) and common pregnancy loss, live birth following an adverse reaction to
mental health outcomes, including depression, anxiety, suicidal pregnancy, and other live birth. After extensive adjustment
behaviours and substance use disorders. The major finding of this for confounding, abortion was the only pregnancy outcome
analysis is that even following extensive control for prospectively that was associated with consistent increases in risks of
and concurrently measured confounders, women who had had mental health problems. The specificity of the association
Table 3 Adjusted risk ratios (95% CI) for the effect of abortion on number of mental health problems by alternative strategies for
defining pregnancy history and alternative lag rules
Pregnancy history, RR (95% CI)
Combined prospective and
Lag rule retrospective data Prospective data only Retrospective data only
Concurrent 1.37 (1.16–1.62) 1.45 (1.21–1.73) 1.30 (1.10–1.55)
Lagged 5 years 1.32 (1.05–1.67) 1.34 (1.04–1.73) 1.26 (0.99–1.61)
Lagged 4 years 1.35 (1.07–1.70) 1.33 (1.03–1.73) 1.26 (0.99–1.62)
Lagged 3 years 1.24 (0.96–1.61) 1.29 (0.99–1.69) 1.23 (0.93–1.64)
449
8. Fergusson et al
between abortion and increased mental health risks further the woman’s health before termination of pregnancy can be
reinforces the view that the association is causal. authorised.
(e) Robustness of results: The same general conclusions were
David M. Fergusson, PhD, L. John Horwood, MSc, Joseph M. Boden, PhD,
reached using a series of models that varied in the basis for Christchurch Health and Development Study, University of Otago, Christchurch School
assessing pregnancy history (prospective, retrospective and of Medicine and Health Sciences, New Zealand
combined) and the lag between exposure and outcome Correspondence: Professor David M. Fergusson, Christchurch Health nd
(Table 3). Development Study, University of Otago, Christchurch School of Medicine
and Health Sciences, PO Box 4345, Christchurch, New Zealand. Email:
(f) Theoretical plausibility of results: The finding of a small dm.fergusson@otago.ac.nz
adjusted association between exposure to abortion and First received 23 Jun 2008, final revision 11 Aug 2008, accepted 14 Aug 2008
mental health is consistent with evidence which suggests
that for a minority of women abortion is a highly stressful
life event which evokes distress, guilt and other negative feel-
Acknowledgements
ings that may last for many years.3,6,8,13
Although the weight of the evidence favours the view that This research was funded by grants from the Health Research Council of New Zealand, the
National Child Health Research Foundation, the Canterbury Medical Research Foundation
abortion has a small causal effect on mental health problems, and the New Zealand Lottery Grants Board.
other explanations remain possible. In particular it could be sug-
gested that the small association between abortion and mental
References
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