Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States

Objectives. We set out to assess the occurrence of new depression and anxiety diagnoses in women 3 years after they sought an abortion.Methods. We conducted semiannual telephone interviews of 956 women who sought abortions from 30 US facilities. Adjusted multivariable discrete-time logistic survival models examined whether the study group (women who obtained abortions just under a facility’s gestational age limit, who were denied abortions and carried to term, who were denied abortions and did not carry to term, and who received first-trimester abortions) predicted depression or anxiety onset during seven 6-month time intervals.Results. The 3-year cumulative probability of professionally diagnosed depression was 9% to 14%; for anxiety it was 10% to 15%, with no study group differences. Women in the first-trimester group and women denied abortions who did not give birth had greater odds of new self-diagnosed anxiety than did women who obtained abortions just under facility gestational limits.Conclusions. Among women seeking abortions near facility gestational limits, those who obtained abortions were at no greater mental health risk than were women who carried an unwanted pregnancy to term.There has been much interest in understanding the effects of abortion, one of the most commonly performed surgical procedures,1,2 on women’s mental health outcomes. Leading reviews on this topic have found no evidence of mental health harm from an abortion,3–6 with the exception of 1 review7 which has been critically refuted.5,8–11 These reviews have called for more research of women seeking abortion beyond the first trimester, longitudinal studies, studies that control for preexisting mental health conditions, and studies that compare women who have had an abortion to women who want an abortion but are unable to get one.3–5Most of the few longitudinal studies available have been conducted outside of the United States. A Danish population-based cohort study assessed the onset of a first psychiatric event before and up to 12 months after a first-trimester abortion and found no increased risk of mental disorders after abortion.12 A Norwegian study followed 120 women for 5 years and compared the psychological response of women who had first-trimester abortions to women who had miscarriages,13 finding no differences in depression or anxiety between the 2 groups.13 Fergusson et al. published a series of articles based on a longitudinal study conducted in New Zealand that suggested that abortion is associated with an increased risk of mental health problems.14,15 These studies, however, have a number of shortcomings that have been discussed elsewhere and may not be generalizable to the US setting.4 One of the few longitudinal US studies is a secondary analysis of the National Comorbidity Survey that compared the mental health outcomes of women who obtained abortions to women who gave birth.16 In this study, the predictive effect of abortion on mental health conditions disappeared when analyses controlled for mental health history.16In this article, we report on the first 3 years of a 5-year longitudinal study, the Turnaway Study, which was specifically designed to examine the psychological consequences of undergoing or being denied an abortion in the United States. Previous findings from the Turnaway Study have demonstrated that most women seeking abortions for financial-, timing-, or partner-related reasons17 commonly express feelings of relief after the abortion and feel that abortion was the right decision.18 The mental health symptom trajectories of women who sought an abortion differed little from those who were denied one; however, both improved over time.19 Our previous analysis19 assessed self-reported mental health symptoms at 5 discrete points in time over 2 years (potentially missing symptoms of anxiety and depression that may have occurred in between interview dates or after 2 years), and it did not assess women’s severity of symptoms or other circumstances that may have led to a clinical diagnosis of depression or anxiety. This study further contributes to the literature by assessing diagnoses of new depression and anxiety disorders that may have occurred in women at any point up to 3 years after having sought an abortion.     

A survey of case studies on the use of forensic three-dimensional printing in England and Wales

3D printing has rapidly developed and been applied in forensic science due to its use in creating demonstrations for courts of law. Much of the literature on this specific topic has focused on the use of 3D printed models in academia, the potential influence on a jury, and its use as a long-term documentation process, but with few actual forensic case examples. This paper offers an insight into the development of 3D printing in forensic practice and how 3D printing is currently being used in the criminal justice system in England and Wales.

A series of case reports were gathered from multiple police forces and forensic practitioners in the UK to identify how 3D printing was being used. These discussions established who was requesting 3D printed exhibits, what type of technologies were being utilised, what type of exhibits were being printed, and resulting feedback for the use of 3D printed material within a criminal case. As a result, this research demonstrates the current use of 3D printing in England and Wales, discussing the associated cases that have been known to incorporate 3D prints. Likewise, this work explores the limitations that have been encountered by forensic practitioners and identifies a series of research questions that should be considered in future investigations.

     

Composition and function of peripheral blood stem and progenitor cell harvests from patients with severe active rheumatoid arthritis

High-dose chemotherapy with autologous stem cell rescue has been proposed as an intensive therapy for severe rheumatoid arthritis (RA). In view of previous observations of abnormal haemopoiesis in RA patients, the composition and function of peripheral blood stem cell harvests (PBSCH) was investigated. Compared with PBSCH from healthy allogeneic donors mobilized with the same dose of G-CSF (filgrastim; 10 μg/kg/d, n = 14), RA PBSCH (n = 9) contained significantly fewer mononuclear cells (375 v 569 × 10⁶/kg, P = 0.03) and CD34⁺ cells (2.7 v 5.8 × 10⁶/kg, P = 0.003). However, there were increased proportions of CD14⁺ cells (P = 0.006) and CD14⁺CD15⁺ cells (the phenotype of previously described ‘abnormal’ myeloid cells, P = 0.002) in the RA PBSCH which translated into 3.5- and 7-fold increases respectively on a per CD34⁺ cell basis. There were no differences in T-cell activation status as judged by proportions of CD4⁺ and CD8⁺ expressing CD45RA, CD45RO, HLA-DR and CD28 (RA PBSCH, n = 7, donor PBSCH, n = 5, P = 0.2–0.7). Phytohaemagglutinin responses determined fluorocytometrically with induction of CD69 expression were reduced in CD4⁺ and CD8⁺ cells following filgrastim administration in 3/3 RA patients tested. Compared with bone marrow as a potential source of CD34⁺ cells, PBSCH contained 11-fold more T cells (P < 0.0005), 8-fold more B cells (P < 0.0005) and 4-fold more monocytes (P = 0.02). In short-term methylcellulose culture there were no differences in colony counts (CFU-GM, CFU-GEMM, BFU-E) per CD34⁺ cell from PBSCH from RA patients (n = 11) and healthy donors (n = 10). Long-term culture initiator cells were cultured successfully from cryopreserved PBSCH from RA patients (n = 9). In conclusion, PBSCH from RA patients differed significantly in composition from normal individuals, but in vitro studies support normal stem and progenitor cell function. Changes in T-cell function occur during mobilization in RA patients. This work provides reassurance for the use of PBSCH as haematological rescue and baseline data for clinical trials of graft manipulation strategies in patients with RA.     

Comparison of isometric and anatomical graft placement in synthetic ACL reconstructions: A pilot study

Correct graft placement is critical to the success of anterior cruciate ligament reconstructions (ACLR). Whilst current trend is to insert the graft in an anatomical location, synthetic grafts have shown to better perform when they are located in an isometric position. Placement, however, is largely dependent on the surgeon and no consensus has been reached for synthetic grafts.Kinematic flexion-extension data of four separate cadaveric knees was obtained using an optical tracking system. Knees were CT-scanned and computer models were developed for each specimen. Three different graft insertion techniques were simulated in each of the computer models. Kinematic data obtained from the optical tracking was applied to the 3D computer models to simulate knee flexion-extension, and virtual change in ACL graft length was measured over the cycle for each insertion technique. Length changes were plotted onto the Radiological-Quadrant.The isometric region on the femur was found to be a band spreading from the mid to deep end of the Blumensaat's line down to the shallow-inferior end of the femoral condyle. The JP Laboureau isometric point technique was consistently located in the isometric zone, with the following coordinates on the Radiographic-Quadrant: t=0.375 (SD 0.0066), h=0.227 (SD 0.0266). The Bernard–Hertel and Charlie Brown anatomical placement methods were located (13%, ?6%) and (8%, ?15%) away, from the JP Laboureau isometric point, respectively, based on t- and h- coordinates of the Radiographic-Quadrant.This study has determined the isometric region using three-dimensional analysis relative to the Radiographic-Quadrant. The JP Laboureau method best finds the isometric point. This information is useful for synthetic graft placement.