No-Test Medication Abortion: A Systematic Review

The use of medication abortion has increased significantly in the past several years, in part due to the increased adoption of telemedicine during the COVID-19 pandemic. Several leading organizations have established recommendations for the practice of providing a medication abortion without a prior pelvic examination or ultrasonogram (no-test medication abortion). Evidence demonstrates that gestational age can be accurately measured with patient screening questions and the risk of ectopic pregnancy among women seeking medication abortion is very low. Given this paradigm shift in abortion access, increasing numbers of health care professionals worldwide have adopted these practices and published their results. This systematic review aimed to summarize the efficacy and safety outcomes of medication abortion performed without prior pelvic examination or ultrasound. Ongoing and published clinical trials were identified, and randomized control trials and comparative cohort trials discussing the provision of no-test medication abortion were eligible. The primary study outcome was successful medication abortion, defined as complete abortion without the need for surgical management. Failure was thus defined as the need for surgical intervention to complete the abortion. Medication regimens, efficacy rates, complication rates, and adverse events were ed from eligible studies. A total of 21 studies were included in this review, including cases performed in over 24 countries. Ultimately, 15 studies were sufficiently homogenous in terms of design and comparator to create aggregate data with summary statistics for the primary outcome. The overall efficacy rate of no-test medication abortion was found to be 96.4% (95% confidence interval [CI], 96.096.7) in the 10,693 patients included in this review. Among pregnancies at less than 70 days' gestation (n = 8166), the efficacy rate was 95.2% (95% CI, 94.795.7). The rate of surgical intervention was 4.4% (95% CI, 4.04.9), and at less than 70 days' gestation was 3.8% (95% CI, 3.34.3). The ectopic pregnancy rate was 0.06% (95% CI, 0.020.15), blood transfusion rate ranged from 0% to 0.7%, and there were no deaths reported. The results of this systematic review encompassing data on 10,693 patients showed demonstrate that no-test medication abortion is likely effective and safe. The rates of surgical evacuation and complication were comparable with the rate among those undergoing medication abortion with pretreatment ultrasound, and significantly lower than the rates seen with unsafe methods of abortion.

Reassessing social trust: gossip, self-policing, and Covid-19 risk communication in Norway

This article analyses patterns of compliance with COVID-19 regulations in Southwest Norway. Based on ethnographic fieldwork and a series of interviews, we contrast grassroots discourses with the Norwegian government's own emphasis on 'trust' in its risk communication strategies. As opposed to the official claim that Norwegians complied with COVID-19 emergency regulations because they trusted the authorities, the evidence suggests that citizens complied more due to the informal pressure of their peers. Affective reciprocity and moral judgement, including the dynamics of kinship sociability in which they are expressed, here acquire a critical analytical dimension. In dialogue with dominant theories of trust in risk studies, we argue that such relational aspects of everyday life should be taken into consideration as essential factors for any health risk mitigation strategy.Copyright © 2023 Informa UK Limited, trading as Taylor & Francis Group.

An Implementation Project to Expand Access to Teledoulas for Abortion Patients

INTRODUCTION: The purpose of this study was to describe the implementation and results of a patient outreach project to offer teledoula services to patients choosing medication abortion in Hawai'i during the COVID-19 pandemic. METHODS: We trained medical student volunteers at John A. Burns School of Medicine (JABSOM) as abortion teledoulas to remotely provide emotional support, education, pain management, and selfadvocacy. We offered teledoula services to pregnant patients presenting for medication abortion either in person or via telemedicine appointment at a university-based, outpatient family planning clinic. The teledoulas were notified by the abortion provider when a patient was interested in the service and the assigned teledoula contacted the patient by phone or text message. We conducted initial training and outreach in February 2021 and recorded completed pairings of teledoulas and patients through July 2021. Institutional review board (IRB) committee approval was waived for the study. RESULTS: Of the 15 medical students who attended the teledoula training, 12 (80%) were interested in participating. Of the interested medical students, 100% successfully paired with patients for support. Of the 194 patients who had a medication abortion in the 5 months that this service was offered, 37 (19.1%) were interested in participating in the program and all were contacted by a teledoula via text message. Thirty-three (89%) patients responded to the text message and successfully connected with a teledoula for support during their medication abortion. CONCLUSION: A teledoula service staffed by medical student volunteers can be successfully implemented and provide remote support for patients choosing medication abortion during the COVID-19 pandemic.

The Risks of the Mask

In this article we go beyond epidemiological models to make a case for a more holistic approach to the use of face masks as a risk mitigation factor in the context of the Covid-19 pandemic. We argue that while masking offers a measure of protection from infection, its moral, political, and affective implications produce two main collateral risks. These are: (1) the heightening of social boundaries, which thus increase the potential of conflict between different social groups;and (2) the impairment of normative interaction rituals followed by a dynamic of distancing, insulation, and social alienation. While we stop short from constructing a hierarchy of risks, we do argue that policy makers should consider these collateral risks as part of any large-scale Covid-19 risk mitigation and communication strategy. We thus provide some principled guidance on how that might be done. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

VIOLATING FOOD SYSTEM WORKERS' RIGHTS IN THE TIME OF COVID-19: THE QUEST FOR STATE ACCOUNTABILITY

Food system workers, accounting for nearly one-third of the global workforce, are vital to the universal realization of the right to food, yet face formidable barriers to the realization of their own rights. Despite state obligations to protect, respect, and fulfil the rights of workers under international human rights law, gaps in legal frameworks and lack of political will have left food system workers exposed to discrimination and abuse at the hands of private actors. Migrant workers, as well as racial and ethnic minorities, in particular, face targeted exploitation without redress. Case studies demonstrate the extent of this harm, even as governments designate workers as "essential" during the COVID-19 pandemic. The authors of this article argue that deliberate inaction by states to extend meaningful protections to workers or indict exploitative actors demonstrates the need for a new state crime-one that holds accountable governments that are complicit in the grave violations of workers' fundamental rights.

Hemorrhagic stroke in the setting of COVID-19 is associated with anticoagulation use

Introduction: While the thrombotic complications of COVID-19 have been described, there are limited data on its implications in hemorrhagic stroke. The clinical characteristics, underlying stroke mechanism, and outcomes in this group of patients are especially salient as empiric therapeutic anticoagulation becomes increasingly common in the treatment and prevention of thrombotic complications of COVID-19. Methods: We conducted a retrospective cohort study of patients with hemorrhagic stroke (both nontraumatic intracerebral hemorrhage and spontaneous non-aneurysmal subarachnoid hemorrhage) who were hospitalized between 3/1/20-5/15/20 at a NYC hospital system, during the coronavirus pandemic. We compared the demographic and clinical characteristics of patients with hemorrhagic stroke and COVID-19 to those without COVID-19 admitted to our hospital between 3/1/20-5/15/20 (contemporary controls) and 3/1/19-5/15/19 (historical controls), using Fischer's exact test and nonparametric testing. We adjusted for multiple comparisons using the Bonferroni method. Results: During the study period, 19 out of 4071 (0.5%) patients who were hospitalized with COVID-19 had hemorrhagic stroke on imaging. Of all COVID-19 with hemorrhagic stroke, only 3 had non-aneurysmal SAH without intraparenchymal hemorrhage. Among hemorrhagic stroke and COVID-19 patients, coagulopathy was the most common etiology (73.7%);empiric anticoagulation was started in 89.5% vs 4.2% of contemporary and 10.0% of historical controls (both with p = <0.001). Compared to contemporary and historical controls, COVID-19 patients had higher initial NIHSS scores, INR, PTT and fibrinogen levels. These patients also had higher rates of in-hospital mortality [84.6% vs. 4.6%, p =<0.001]. Sensitivity analyses excluding patients with strictly subarachnoid hemorrhage yielded similar results. Conclusion: We observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in COVID-19 patients occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in COVID-19 patients.

Cerebral Venous Thrombosis Associated with COVID-19.

Despite the severity of coronavirus disease 2019 (COVID-19) being more frequently related to acute respiratory distress syndrome and acute cardiac and renal injuries, thromboembolic events have been increasingly reported. We report a unique series of young patients with COVID-19 presenting with cerebral venous system thrombosis. Three patients younger than 41 years of age with confirmed Severe Acute Respiratory Syndrome coronavirus 2 (SARS-Cov-2) infection had neurologic findings related to cerebral venous thrombosis. They were admitted during the short period of 10 days between March and April 2020 and were managed in an academic institution in a large city. One patient had thrombosis in both the superficial and deep systems; another had involvement of the straight sinus, vein of Galen, and internal cerebral veins; and a third patient had thrombosis of the deep medullary veins. Two patients presented with hemorrhagic venous infarcts. The median time from COVID-19 symptoms to a thrombotic event was 7 days (range, 2-7 days). One patient was diagnosed with new-onset diabetic ketoacidosis, and another one used oral contraceptive pills. Two patients were managed with both hydroxychloroquine and azithromycin; one was treated with lopinavir-ritonavir. All patients had a fatal outcome. Severe and potentially fatal deep cerebral thrombosis may complicate the initial clinical presentation of COVID-19. We urge awareness of this atypical manifestation.

Characteristics of Adult Outpatients and Inpatients with COVID-19 — 11 Academic Medical Centers, United States, March–May 2020

This report describes survey findings of adult inpatients and outpatients who tested positive for SARS-CoV-2 infection.