State For Health Research Articles

Pharmaceutical company ranks best, worst states to live in for MH

In an analysis published last month, the online pharmacy company, Universal Drugstore, ranked the best and worst states to live in for mental health after evaluating various data points, including the prevalence of mental illness and the cost of care, FortuneWell, reported on April 8. Montana topped the list of best places to live for mental health, scoring 8.06 out of 10. The state had the lowest number by population of “mentally unhealthy adults” who cannot afford care, and residents took the second‐fewest mental health sick days in 2022. By contrast, Nevada ranked as the worst state for mental health, with a score of 2.06 out of 10. The Silver State placed in the top five for several measurements, including the highest number of mental health sick days taken and the most youth reporting depressive episodes. Nevada also had one of the lowest ratios of psychologists to residents across the nation. Breaking the data down further, South Dakota, ranked fourth as the best state for mental health with the fewest reported mental health sick days (three), while West Virginia and Louisiana, ranked 34th and 44th, reported the most (six). Adults in New Jersey, ranked 16th, had the lowest rates of mental illness diagnoses (16%), while adults residing in Utah, ranked 25th, had the highest rates of mental illness (27%). Oregon, in 50th place, ranked as the second‐worst state for mental health with a score of 2.89 out of 10, tied with New Mexico, ranked 42nd, for the nation's highest percentage of youth experiencing depressive episodes (19%); the lowest is in Washington, D.C. (11%). The nation's capital, which ranked 13th, is also home to the highest proportion of psychologists compared to Alabama, Maine, Georgia, and Louisiana. Researchers used data from the U.S. Bureau of Labor Statistics, the Kaiser Family Foundation, Mental Health America, the U.S. Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration to compile the rankings. They compared each state's ratio of psychologists to residents, the average number of mental health sick days taken, the prevalence of mental illness for adults and youth, the number of beds available in mental health facilities and the cost of prescription drugs.

AGING MODULATION WITH EXERCISE AND MIMETICS

Abstract Understanding the molecular and cellular processes of the Longevity Pathway AMPK-SIRT1, and its activation by exercise and mimetics, plays a vital role in a series of molecular and cellular processes which stimulates optimal healthy cellular efficiency and functioning, ending with improved exercise tolerance. Knowledge of the role of exercise induced activation of the AMPK-SIRT1 pathway, and altering it towards dysfunctional processes and drivers of aging and disease propagation is important to understand to also understand. Cellular dysfunction unfortunately is the norm. This leads to molecular increase of P53 in a binding state not of DNA repair, but upregulation of gene transcription of NF-kB, which increases inflammatory cytokines, over activation of MTOR, and cellular senescence with secretion of the SASP. All these dysfunctions create feedback loops, which makes the process self propagating, resulting in progressive aging, and disease states. The most optimal state is regulation of the optimal molecular and cellular environment, via exercise or a mimetic stimulator of AMPK-SIRT1. Knowledge of the optimal body state for health, and enhancing this AMPK-SIRT process, is low body fat releasing beneficial adiponectin, and no inflammatory cytokines or adipokines. Training muscle releases positive myokines. Various mimetics can stimulate AMPK-SIRT1, such as Metformin, the mitochondrial derived peptide MOTS-C, AICAR, and other compounds intended for people with medical issues that prevents exercise. Some display a synergistic effect with exercise. Understanding, the benefits of exercise and modulation of aging, by encouraging healthy processes, and reducing the deleterious patterns is important to understand.

The Independent Medicines and Medical Devices Safety Review: Regulatory Reform and Remedies

For years, groups of patients and their families in the United Kingdom raised their concerns about three medical interventions. The first was a possible link between hormone pregnancy tests and fetal malformations and deaths; the second was the physical and neurodevelopmental impacts of in utero valproate exposure; and the third was life-changing adverse events caused by pelvic mesh implants for pelvic organ prolapse repair and stress urinary incontinence management. In response to their tireless campaigning, the Independent Medicines and Medical Devices Safety (IMMDS) Review was commissioned by the Secretary of State for Health and Social Care in 2018. The review, chaired by Baroness Cumberlege, found a catalogue of institutional, systems and structural failures within both the medical establishment and healthcare system more broadly. Drawing on the IMMDS Review findings on pelvic mesh, in this article, I consider the dire consequences when medical devices go wrong. Drawing on firsthand experience as lead researcher for the IMMDS Review, I examine some of the background, outline some key findings and reflect on the strategic changes recommended to medical device regulation and the redress prompted by the pelvic mesh scandal. In so doing, I contextualise and consider the relevant regulatory frameworks, the fundamental systems failures and the other issues identified. Three years on, this article also provides an opportunity to assess the extent to which the IMMDS Review recommendations have been successfully operationalised, as well as to take stock of the improvements that still need to be made.

Discrimination in Abortion Law and the Message the Law is Sending: R (Crowter) v Secretary of State for Health and Social Care

R (Crowter) v Secretary of State for Health and Social Care involved a legal challenge to the law on abortion under the Abortion Act 1967, on the basis that the disability ground ‘expresses’ a negative message about disabled people, based on negative stereotyping, and that this expression is incompatible with Articles 8 and 14 of the European Convention on Human Rights. The case is significant because of the way that rights‐based arguments about abortion were framed; they were not centred on the interests or rights of the pregnant woman or the fetus, but on the rights of disabled people. This framing reflects the well‐known expressivist argument in the disability and bioethics literature. The arguments raised about a potential violation of rights due to ‘the message’ the law is sending could have far‐reaching implications, well beyond the law on abortion.

Rationing of resources in the National Health Service.

The National Health Service was set up to provide healthcare to every citizen, based not on the ability to pay, but on need. However, the Secretary of State for Health's duty under section 1 of the National Health Service Act 2006 to promote a comprehensive health service is to provide services that can be provided within the resources available. As those resources are not unlimited, it is necessary to ration them. The issue of rationing of resources in the NHS came up again in R (Wallpott) v Welsh Health Specialised Services Committee and Aneurin Bevan University Health Board [2021] EWHC 3291 (Admin). This paper reviews that case and comments on it, looking at why there is rationing of NHS resources and at the approach of the courts to the issue. It concludes that, although rationing of NHS resources is controversial, it is lawful and necessary.

Obesity as pleiotropic risk state for metabolic and mental health throughout life

Obesity, a highly prevalent disorder and central diagnosis of the metabolic syndrome, is linked to mental health by clinical observations and biological pathways. Patients with a diagnosis of obesity may show long-lasting increases in risk for receiving psychiatric co-diagnoses. Austrian national registry data of inpatient services from 1997 to 2014 were analyzed to detect associations between a hospital diagnosis of obesity (ICD-10: E66) and disorders grouped by level-3 ICD-10 codes. Data were stratified by age decades and associations between each pair of diagnoses were computed with the Cochran-Mantel-Haenszel method, providing odds ratios (OR) and p values corrected for multiple testing. Further, directions of the associations were assessed by calculating time-order-ratios. Receiving a diagnosis of obesity significantly increased the odds for a large spectrum of psychiatric disorders across all age groups, including depression, psychosis-spectrum, anxiety, eating and personality disorders (all pcorr < 0.01, all OR > 1.5). For all co-diagnoses except for psychosis-spectrum, obesity was significantly more often the diagnosis received first. Further, significant sex differences were found for most disorders, with women showing increased risk for all disorders except schizophrenia and nicotine addiction. In addition to the well-recognized role in promoting disorders related to the metabolic syndrome and severe cardiometabolic sequalae, obesity commonly precedes severe mental health disorders. Risk is most pronounced in young age groups and particularly increased in female patients. Consequently, thorough screening for mental health problems in patients with obesity is urgently called for to allow prevention and facilitate adequate treatment.

Real-Time PCR based Rapid and Culture-Independent Detection of Citrobacter: 'An Alarming State for Environment and Human Health'.

Real-Time PCR based Rapid and Culture-Independent Detection of Citrobacter: 'An Alarming State for Environment and Human Health'.

Real-Time PCR based Rapid and Culture-Independent Detection of Citrobacter: ‘An Alarming State for Environment and Human Health’

The changing global scenario of environmental conditions and altered microbial community has severely deteriorated the quality of water which enforced an elevated health risks on human beings due to unavailability of safe and pristine water. Citrobacter is one of the fecal coliform bacteria of family Enterobacteriaceae. It is an opportunistic pathogen formerly used as an indicator bacterium along with other fecal coliforms namely Escherichia coli, Klebsiella and Enterobacter, but is now known to cause several diseases in human beings. In present study we collected 135 samples from potable water and riverine-systems and confirmed the existence of Citrobacter using the conserved sequence of gnd (6-phosphogluconate dehydrogenate) gene with the application of SYBR green real-time PCR, which demonstrated extremely high specificity, fidelity and stringency in detection strategy. The Citrobacter counts in potable water were in the range of zero to 1.54 x104 ± 572.88 cfu/100ml. The Citrobacter levels in surface water were 2.18 x104 ±848, 1.54 x104 ±462, 3.53 x104 ±1299, 2.57 x104 ±912, 8.78 x103 ±201, 1.28 x104 ±370, CFU/100ml; associated with hydrophytes were 6.24 x104 ±1535, 8.42 x104 ±2711, 1.19 x105 ±4792, 1.12 x105 ±4177, 8.32 x104 ±2329, 8.08 x104 ±2149 CFU/10g and in the sediments the counts were 2.50 x104 ±647, 5.02 x104 ±1852, 3.26 x104 ±1186, 7.65 x104 ±2884, 1.50 x104 ±355, and 2.56 x104 ±737 CFU/10g at sampling site # 1, site # 2, site # 3, site # 4, site # 5 and site # 6, respectively. The present assay could be applied in the detection and regular monitoring of potable water and other environmental samples to check waterborne diseases and outbreaks caused by Citrobacter.

A major conditions strategy cannot replace a national cancer plan—patient advocates voice their concerns

The UK Secretary of State for Health and Social Care, Stephen Barclay, has set out plans for an alternative approach to cancer service provision based on a major conditions strategy. 1 Barclay S Major conditions and diseases announcement. Jan 24, 2023. Hansard, Commons. https://hansard.parliament.uk/Commons/2023-01-24/debates/23012433000010/MajorConditionsAndDiseasesDate accessed: February 24, 2023 Google Scholar The six areas for inclusion in the strategy are cancer, cardiovascular disease, respiratory disease, dementia, mental health, and musculoskeletal disorders. All these areas are priorities for a national health strategy but is lumping them all together an effective route to success in treating them? As patients and patient advocates, we do not consider that this approach is wise, either for people with these diseases or for the National Health Service (NHS). A holistic approach to patient care can be helpful and there are many scenarios when “integrated, whole-person care”, as promised by this new strategy, 1 Barclay S Major conditions and diseases announcement. Jan 24, 2023. Hansard, Commons. https://hansard.parliament.uk/Commons/2023-01-24/debates/23012433000010/MajorConditionsAndDiseasesDate accessed: February 24, 2023 Google Scholar is appropriate and beneficial; however, understanding comorbidities is vital to treatment outcomes and experiences and a key part of clinical decision making for individual patients, and is very different to merging diseases in a national strategy that will dilute attention to specific areas.

Human rights and foetal impairment grounds for abortion: Crowter v Secretary of State for Health and Social Care [2022] EWCA Civ 1559

This commentary discusses the Court of Appeal’s decision in Crowter v Secretary of State for Health and Social Care handed down on 25 November 2022. The appellants argued that s.1(1)(d) of the Abortion Act 1967, the foetal impairment ground for abortion, was incompatible with Articles 8 and 14 of the European Convention on Human Rights for perpetuating discriminatory attitudes towards people with disabilities. The appeal was unsuccessful. In rejecting their argument, the Court of Appeal considered European and international human rights standards on discrimination, and distinguished between the direct and social impacts of discrimination. This commentary will engage with these arguments, and situate the decision within the broader context of recent changes to abortion laws in the United Kingdom and worldwide.

Policy Gains and Ongoing Collaboration in the House of Medicine

Back to table of contents Previous article Next article From the PresidentFull AccessPolicy Gains and Ongoing Collaboration in the House of MedicineRebecca Brendel, M.D., J.D.Rebecca BrendelSearch for more papers by this author, M.D., J.D.Published Online:25 Jan 2023https://doi.org/10.1176/appi.pn.2023.02.2.17As I write this column in the first month of 2023, the year is already turning out to be as busy and auspicious for mental health as in 2022! We began the new year against the backdrop of the latest findings of the APA Healthy Minds Poll, which showed that more Americans rated their mental health as fair or poor in 2022 than in 2021 (37% versus 31%) and that a significant number of Americans were making New Year’s resolutions about their mental health in anticipation of more stress ahead in 2023. As mental health remains front and center in our private lives, Congress ended 2022 with bipartisan legislation that funded key policy measures to improve access to mental health care (“Congress Passes Spending Bill With Several APA Priorities”). These policy gains addressed key issues and priorities for psychiatry and APA, including legislation proposed and championed by our policy and government relations teams and on which APA members testified in the House and the Senate over the past year, myself included.These are among the highlights of gains made during the final days of the 117th Congress: the addition of 200 graduate medical education slots, including 100 dedicated specifically to psychiatry and its subspecialties; extension of pandemic-era telehealth flexibilities under Medicare; and new grants to support implementation of the Collaborative Care Model in primary care practices. While these are important wins for advancing psychiatry and mental health, they are nonetheless just a start in what is needed to address the current and ongoing mental health needs of Americans post-pandemic. We have our work cut out for us in 2023, including continued advocacy for measures to bolster the effectiveness of the 988 mental health crisis hotline with community resources and investments; addressing ongoing workforce shortages; achieving mental health parity in practice; leveraging telehealth and other innovative technology to advance access to high-quality, evidence-based mental health care; and championing patient safety.While we continue to advance our policy initiatives in Washington, we cannot do this work alone. Collaboration with other medical organizations and professional societies is a key element of boosting our effectiveness in advancing health, including mental health, and gaining momentum and support for key legislation on the state and federal levels. One critical partnership is with the AMA—our psychiatry delegation to the policymaking House of Delegates is growing in influence and size with participation of psychiatry’s subspecialty organizations. Recent contributions of our psychiatry delegation include championing 988 to obtain critical AMA support, advocating for the end of discriminatory medical licensing questions related to mental health that are more restrictive and probing than questions about physical health, and recognizing the need for additional investments in the physician workforce.As we go to press, members of the AMA delegation and APA government relations staff have just returned from the annual AMA State Advocacy Summit, which met in person for the first time since 2019. Summit participants addressed challenges facing medicine at the state level—where the majority of medical practice and private insurance is regulated—and opportunities for action and change. Many of the featured topics had key relevance to APA and our members, including addressing physician wellness through the creation of confidential resources for physicians to address well-being and burnout, eliminating discriminatory medical licensing questions about mental health, and collaboration with state medical boards. Another central issue for both APA and the AMA is patient safety related to prescriptive authority and nonphysician practice parameters; one of the topics discussed at the meeting was the emerging evidence about gaps in quality and higher spending when nonphysician professionals serve in independent roles in primary care and emergency settings. Other important areas on the advocacy agenda included insurance priorities, discriminatory prior authorization requests, continued focus on effective measures to combat the opioid epidemic, and considerations in delivering comprehensive reproductive health care following the U.S. Supreme Court 2022 Dobbs decision.Our collaboration with the AMA is continuing at this year’s AMA National Advocacy Conference in Washington, D.C., to provide a critical assessment and call to action on federal law and policy influencing health and the practice of medicine.There is no question that in 2023 state and federal advocacy for health and mental health will continue to be front and center in APA’s work on behalf of our profession, members, and those whom we serve. You can follow my efforts in real time on Twitter @Pres_APA, and, as always, I look forward to hearing from you, especially about your advocacy adventures and successes! ■ ISSUES NewArchived

Vascular calcification: Molecular mechanisms and therapeutic interventions.

Vascular calcification (VC) is recognized as a pathological vascular disorder associated with various diseases, such as atherosclerosis, hypertension, aortic valve stenosis, coronary artery disease, diabetes mellitus, as well as chronic kidney disease. Therefore, it is a life-threatening state for human health. There were several studies targeting mechanisms of VC that revealed the importance of vascular smooth muscle cells transdifferentiating, phosphorous and calcium milieu, as well as matrix vesicles on the progress of VC. However, the underlying molecular mechanisms of VC need to be elucidated. Though there is no acknowledged effective therapeutic strategy to reverse or cure VC clinically, recent evidence has proved that VC is not a passive irreversible comorbidity but an active process regulated by many factors. Some available approaches targeting the underlying molecular mechanism provide promising prospects for the therapy of VC. This review aims to summarize the novel findings on molecular mechanisms and therapeutic interventions of VC, including the role of inflammatory responses, endoplasmic reticulum stress, mitochondrial dysfunction, iron homeostasis, metabolic imbalance, and some related signaling pathways on VC progression. We also conclude some recent studies on controversial interventions in the clinical practice of VC, such as calcium channel blockers, renin-angiotensin system inhibitions, statins, bisphosphonates, denosumab, vitamins, and ion conditioning agents.

Health inequalities and diabetes

AbstractInequalities in health care exist in many countries in the world. In 2008 the then UK Secretary of State for Health commissioned the Marmot review, ‘Fair Society, Healthy Lives’, to propose strategies to address health inequalities in the UK. Most of Marmot's proposals were not acted upon and in 2020, 10 years after the initial recommendations were published, Marmot found that there had been no improvement and some things were worse.In diabetes care inequalities are widespread, impacting on prevention, treatment, access to technology, screening for complications, risk of complications, morbidity and mortality. Ethnicity is a major risk factor, starkly demonstrated by the increased COVID‐19 related mortality in people from minority ethnic groups with diabetes. Disadvantaged groups include, but are not limited to, those with social deprivation, intellectual and physical disabilities and severe mental illness.The decision to shelve the long‐awaited white paper on tackling health inequalities, taken recently by the last Secretary of State for Health amid protests from a coalition of medical organisations, makes it unlikely that the government will take the actions proposed by Marmot. In the absence of a national strategy, responsibility to recognise and address inequalities in diabetes care falls on health care professionals, in teams and as individuals. Copyright © 2023 John Wiley &amp; Sons.

COVID-19 Stay at Home Restrictions and the Interpretation of Emergency Powers: A Comparative Analysis

Abstract The COVID-19 pandemic has created immense challenges for governments in their management of the public health response and tested the limits of public law. This article undertakes a comparative analysis of the common law jurisdictions of the United Kingdom, New Zealand, and Australia. It discusses the imposition of ‘stay at home’ restrictions pursuant to public health legislative frameworks, focusing on judicial scrutiny in the context of statutory interpretation. It examines the appellate cases of R (Dolan) v Secretary of State for Health and Social Care [2021] 1 WLR 2326, Borrowdale v Director-General of Health [2022] 2 NZLR 356, and Kassam v Hazzard (2021) 106 NSWLR 520. Using these case studies, this article seeks to reveal key themes and implications for public law. What approaches have the courts adopted to construe public health emergency powers? How have the courts treated ‘rights-based’ principles of statutory interpretation? Have the courts approached interpretation in the usual manner or displayed an unorthodox level of deference to other branches of government? The article concludes on what implications the judicial approaches have for the interpretation of emergency powers in the future.

R (Gardner and Harris) v Secretary of State for Health and Social care and Others [2022] EWHC 967: Scant regard for Covid-19 risk to care homes.

R (Gardner and Harris) v Secretary of State for Health and Social care and Others [2022] EWHC 967: Scant regard for Covid-19 risk to care homes.

“Love Doesn’t Count Chromosomes”: Reflections on Disability, Law and Religious Ethics

In July 2021 Heidi Crowter took the UK Secretary of State for Health and Social Care to court with the aim of challenging the aspects of the Abortion Act that in her view discriminate against people with Down's Syndrome. The case ignited the civic debate on disability, law and public ethics, re-exposing the shaky grounds and inherent contradictions of human rights discourse and legislation and revealing the acute dangers of utilitarian logic that sustains the status quo. In this paper I argue that if we are to safeguard the dignity and rights of those among us who might not satisfy the utilitarian criteria of “worthiness of existence”, the values that underlie human rights legislation need to be firmly situated in the realm of the absolute and the unconditional. This is an area where religious ethics can offer invaluable contribution. The transcendental grounding of faith-based morality endows the notion of human dignity with universality that is not conditional on any “worldly” category of worth (the concept of “ability” being one such category). Also, it provides a radical and counter-cultural redefinition of the notion of what it means to be a “contributor” to the social sphere, a redefinition that does not exclude those among us living with a disability.

선내안전보건 및 사고 예방에 관한 입법론적 연구

According to Korea Seafarer’s Statistical Yearbook, as of 2020, seafarers’ occupational accident rate of 9.49% was 19.4 times higher than shore workers’ occupational accident rate of 0.49% according to the Analysis of the Status of Industrial Accident in 2020 published by the Ministry of Employment and Labor, the accident rate related to safety and health on board ships is in a very serious level. In addition, the accident rate of Korean seafarers of 11.24% (as of 2019) is 6.8 times higher than the accident rate of Japanese seafarers of 1.66% (as of 2019). This suggests that it is urgent to improve legislation related to seafarers’ accidents to reduce the accident rate of seafarers in the Republic of Korea. To raise the level of safety and health on board ships for the prevention of occupational accidents of seafarers, it is preferentially necessary to improve related legislation. Legislation for the protection of shore workers has been completed through the full revision of “Occupation Safety and Health Acts” while there are institutional gaps, like the lack of standards for safety and health on board ships for seafarers. Thus, it is necessary to seek institutional legal measures for reducing the high accident rate of seafarers. However, in order to improve standards for safety and health on board ships for the prevention of occupational accidents of seafarers, not only the improvement of related legislation is important but also the roles of shipowners and seafarers who comply with them are important. In particular, to prevent the occupational accident of seafarers, shipowners shall comply with the obligations relating to the safety and health on board a ship and it is also essential for seafarers to work together with shipowner in taking such preventive measures. Thus, as for measures for reducing the accident rate of seafarers, this study aims to examine the present legislation on the state, shipowners, and seafarers for safety and health on board ships and then derive measures for the improvement relating thereto. As a result of this study, the following improvements were proposed. First, as measures for improving safety and health on board ships from the prospective of the state, the following points were derived: ➀ measures for improving the survey of occupational accidents, injuries, and diseases of seafarers (the definition of an occupational accident, the improvement of reporting standards, contents, and procedures, and the improvement of investigating range, and contents), ➁ measures for improving statistics on the occupational accidents, injuries and diseases of seafarers (the clarification of the contents of statistics), and ➂ measures for improving the safety and health of seafarers of fishing vessels with gross tonnage of less than 20 tons (measures for the integration of legislation and competent department through legislating an independent Act). Second, as measures for improving safety and health on board ships from the prospective of shipowners, this study clearly stated that shipowners are the ones complying with the duty of care for safety in seafarers’ employment contract on the safety and health on board ships and derived the necessity of the improvement of shipowners’ role to raise the level of safety and health on board ships by actively participating in reviews for revising standards for safety and health on board ships. Third, as measures for improving safety and health on board ships from the prospective of seafarers, this study suggested that seafarers’ duties (safe care for a third party, duty of reporting hazards, and duty to take caution, etc.) should be expanded so that seafarers could independently and actively participate in the prevention of the occupational accident of seafarers, the duty of care for safety should be explicitly introduced in the Seafarers’ Act for seafarers to enable them to play positive and key roles in observing and implementing the safety and health standards, and seafarer claims should also be admitted for the case of breaching the duty of care for safety by shipowners. Last, despite improvements by the implementation agent to increase the level of safety and health on board ships, this study found that it would be necessary to have a special law (Laws for safety and health on board ships and accident prevention) to prepare more comprehensive legislation on the safety and health on board ships for the prevention of the occupational accident of seafarers, and derive the concept, role and main content of the special law.

The Khan review: the UK Government must act now for a smokefree future

The UK Government set out its smokefree 2030 goal (defined as less than 5% smoking prevalence) for England in 2019. However, it has not introduced policy measures to achieve this target, which on current trends will not be reached for the poorest in society until 2044.1 But Javed Khan's independent 2022 review, The Khan Review: Making Smoking Obsolete,2 gives cause for hope. Commissioned by a previous UK Secretary of State for Health and Social Care, the Khan review sets out a plan to achieve smokefree 2030 and to address the substantial health and economic disparities caused by smoking.

The duty to provide after-care under section 117 of the Mental Health Act 1983 again.

In December 2021 the Court of Appeal (Civil Division) published its ruling in Worcestershire County Council, R (On the Application Of) v Secretary of State for Health and Social Care [2021] EWCA Civ 1957, a case about a dispute between two local authorities regarding which of them should bear the duty to provide after-care for a patient (service user) following her discharge from her second detention under section 3 of the Mental Health Act 1983. The primary issue in the case was where she was ordinarily resident at the time of her second detention under s 3 of the Mental Health Act 1983. This paper reviews the case, surveys the evolution of the duty to provide after-care and comments on specific aspects of the Court of Appeal's decision.

Preserving women’s reproductive autonomy while promoting the rights of people with disabilities?: the case of Heidi Crowter and Maire Lea-Wilson in the light of NIPT debates in England, France and Germany

On July 2021, the UK High Court of Justice heard the Case CO/2066/2020 on the application of Heidi Crowter who lives with Down’s syndrome, and Máire Lea-Wilson whose son Aidan...