History and Politics of Medication Abortion in the United States and the Rise of Telemedicine and Self-Managed Abortion.

This article examines the decades-long campaign to increase access to abortion pills in the United States, including advocates' work to win US Food and Drug Administration approval of mifepristone and misoprostol for abortion, the continuing restrictions on mifepristone, and the multiple strategies advocates have pursued to challenge these restrictions, including lobbying the FDA to remove the restrictions, obtaining a limited research exemption from FDA restrictions, and suing the FDA during the COVID-19 pandemic. The article pays particular attention to the influence of research conducted on the safety and efficacy of medication abortion as well as research on the impact of increased availability of abortion pills through telemedicine during the pandemic. The article also addresses self-managed abortion, wherein people obtain and use mifepristone and/or misoprostol outside the formal health care system, and it documents the growing network of organizations providing logistical, medical, and legal support to people self-managing abortion. The article concludes with reflections on the role abortion pills might play in the post-Roe era amid increasingly divergent abortion access trends across different regions of the United States.

Impact of Initial Therapy on Readmissions in Minority Versus White Populations With Heart Failure.

Background: Minority populations are often underrepresented in landmark trials for the management of heart failure with reduced ejection fraction (HFrEF). Major trials shaping the guidelines sometimes include as few as 5% black patients. Objective: The purpose of this pilot study was to evaluate the initiation of guideline-directed medical therapy (GDMT) for HFrEF on hospital discharge for minority vs white populations and its impact on all-cause 30-day readmission rates to identify areas for larger future research studies and opportunities for pharmacist intervention. Methods: A retrospective analysis was conducted on patients with HFrEF patients discharged over a 3-month period. The primary objective was to compare all-cause 30-day readmissions in minority vs white patients with HFrEF who were discharged on initial GDMT. Results: 300 patients were included in this study, with 188 patients in the minority group and 112 patients in the white group. The minority group was predominantly African American (92%). The primary endpoint demonstrated significantly higher 30-day all-cause readmissions in minority patients compared to white patients who received initial GDMT (20.5 vs 7.7%, P = .0144), despite similar rates of GDMT therapy between groups. Conclusion: Initial GDMT in minority patients may not reduce readmissions to the same extent seen in white patients. Special emphasis should be placed on evaluating minority patients with HFrEF for additional therapeutic interventions.

Reduced-Dose Apixaban in the Treatment of Left Ventricular Thrombus: A Report of 2 Cases.

According to the American College of Cardiology and the American Heart Association, warfarin has historically been the standard of care anticoagulant for the treatment of left ventricular thrombus. The use of direct oral anticoagulants (DOACs) has become more prevalent, as they require less frequent laboratory monitoring, offer fixed-dose regimens, are associated with fewer drug-drug and drug-food interactions, and provide more favorable safety profiles when compared to warfarin. However, DOACs are not currently FDA-indicated in the treatment of left ventricular (LV) thrombus. Numerous recent studies have reported and evaluated the use of DOACs for treatment of LV thrombus. Recently, a prospective, open-label, multicenter study evaluated warfarin compared to DOACs for LV thrombus treatment. The AHA recently published a scientific statement regarding the management of patients at risk for and with left ventricular thrombus, which included DOACs as a reasonable alternative to warfarin. This report describes two patients treated with DOACs following LV thrombus diagnosis. The first case is a 71-year-old male admitted for cerebrovascular accident and non-ST-elevation myocardial infarction complicated by a LV thrombus. The second case is an 83-year-old female admitted for acute myocardial infarction complicated with an LV thrombus. Both patients were prescribed apixaban 2.5 mg twice daily. Neither patient has experienced LV thrombus or DOAC treatment related complications. This case series serves as evidence for reduced-dose DOACs as an alternative to warfarin in the treatment of LV thrombus.

Evaluating the Effects of Social Capital, Self-Stigma, and Social Identity in Predicting Behavioral Intentions of Agricultural Producers to Seek Mental Health Assistance.

Mental illness significantly impacts agricultural producers, whose occupation puts them at increased risk for compromised mental health and related disorders. Help-seeking intention, which can be mediated by variables such as social identity, social capital, and self-stigma, can lead to improved mental health outcomes. This cross-sectional study aimed to describe the intention of agricultural producers to seek mental health assistance and determine whether these three variables are associated with help-seeking intention. Researchers administered a cross-sectional survey of agricultural producers from two regions in 32 Texas counties. Researchers surveyed a sample of Texas agricultural producers (n = 429) to understand their social identity, social capital, and degree of self-stigma, and their intent to seek help for personal or emotional problems and for suicide ideation. Researchers identified a relationship between social identity and social capital, which indicated that social identity is moderately associated with greater levels of social capital. The multiple linear regression analyses confirmed that social capital and self-stigma are significant predictors of producers' help-seeking intention for both help-seeking types. These results signify the importance of efforts to increase social capital, increase mental health literacy and tailor training to address self-stigma and enhance positive help-seeking behavior among agricultural producers.

Barriers to medication abortion among Massachusetts public university students.

OBJECTIVE: Proposed legislation in Massachusetts would require public university health centers to provide medication abortion services on campus. This study assesses need for these services by investigating current travel time, costs, wait times and insurance acceptance at off-campus, abortion-providing facilities nearest to public universities in Massachusetts. STUDY DESIGN: This investigation projected the total number of students obtaining medication abortions each year at the 13 Massachusetts public universities based on campus enrollment figures and age- and state-adjusted medication abortion rates. Using a cross-sectional study design, the research calculated the distance and public transit time from campuses to the nearest abortion-providing facilities. Researchers contacted facilities to determine costs, wait times and insurance acceptance. RESULTS: We estimate 50 to 115 of Massachusetts public university students obtain medication abortion services each month, or 600 to 1,380 each year. Students have to travel between 2 and 42 miles to reach the nearest abortion-providing facility, with a population-weighted average distance of 19 miles each way. Travel time on public transportation to reach the nearest abortion-providing facility takes between 18 and 400 hundred minutes, with a population-weighted average of 103 minutes each way. Average cost of medication abortion was $680, and average wait time to the first available appointment was 8 days. Eight of 13 abortion-providing facilities did not have weekend appointments. All of the nearest abortion-providing facilities in Massachusetts accepted Mass Health, but one nearest facility was out of state and did not. All accepted multiple private insurance plans. CONCLUSIONS: College students face cost, scheduling, and travel barriers to abortion care. Offering medication abortion on campus would reduce these barriers. IMPLICATIONS: The barriers to medication abortion experienced by students attending public universities in Massachusetts fall particularly hard on female and low-income students, who are disproportionately students of color. Offering medication abortion on campus would reduce these barriers and enhance gender and racial equity on campus.

Challenging Narratives of the Anti-Rape Movement's Decline.

A recent trend in scholarship characterizes the anti-rape movement as founded with radical goals and achieving success at reforming rape laws, but then declining because of co-optation by the state. This article challenges narratives of decline in light of the history of the anti-rape movement and current anti-rape activism. By focusing their critique on criminal justice and therapeutic approaches to sexual violence, and failing to account for the diversity of the anti-rape movement, advocates for narratives of decline ignore parts of the movement that challenge the state and other parts that use broader cultural and community-based strategies to end rape.