This selective report notes recent events relating to pregnancy termination in the U.S., France, England, Italy, East and West Germany, Norway, Sweden, and the Netherlands. Due to the Supreme Court decision in January 1973, abortion is now legal in the U.S. Although abortions is illegal in France, an estimated 400,000-1,000,000 clandestine abortions occur each year. Although abortions are legal in Britain, the ease with which they can be obtained varies regionally. As of March 1973, contraceptives are part of Britain's National Health Service. In Italy, a bill to legalize abortion has been introduced in Parliament, though there is little likelihood of its passing. In East Germany, abortion can be granted for medical or social reasons, while in West Germany, the governmental policies are more conservative, resulting in an abundance of illegal abortions performed by physicians. There is a trend toward easier abortion laws in Norway and Sweden. Little is happening in the Netherlands as far as liberalizing the abortion laws. Rather liberal grounds for pregnancy termination exist in China (though emphasis is on contraception), India, Russia, and Eastern Europe (with the exception of Romania). Abortion is frowned upon in Africa, Latin America, and the Middle East resulting in a large number of illegal abortions. It is concluded that there is liberalized abortion in communist bloc countries, there is trend toward liberalizing abortion in a large group of western countries, and tradition and religion are responsible for conservative abortion laws in a third group of countries.
Data from 12 different European countries show a rapid increase in HIV antibody positivity among drug users or a high degree of contamination already reached wherever studies have been made. Until 31 December 1986, 698 (18%) of AIDS cases were among drug users, of which 600 (15%) of AIDS cases were solely drug users, and 98 (3%) were in addition homosexual or bisexual. A further increase is expected. Because of the epidemiological importance for transmission to the heterosexual population, this problem has become a focus of attention. Drug abusing prostitutes constitute a major source of infection for the heterosexual population and newborns. The increase in the number of AIDS cases in 1986 among male drug abusers was 98 - that is up 61% compared to previous years; among women, the increase was 56%. The 3 main approaches to solution of this problem, i.e. interdiction of the drug trade, availability of sterile needles, and an education program have not proven as successful as anticipated. Relevant indications of the progress of infection in society can only be obtained by systematic observation of conversion rates in differential subgroups, i.e. drug abusers, newly incarcerated drug abusers, male and female prostitutes who use drugs, and individuals newly reporting for treatment. Separation of HIV antibody positives and negatives in therapeutic communities which are not drug free is recommended for epidemiological purposes in view of the developments to date. Nor should forced segregation of the infected from noninfected be dismissed out of hand.
We present data on patients' experiences with access to and cost and quality of health services in the United States, Canada, and Germany. In general, patients report favorably about their care. U.S. respondents report more problems with access to care, even controlling for the severe problems of the uninsured. Differences in managed care versus fee-for-service plans in the United States mirror some of the problems observed in international comparisons--access to specialists and tests and waiting times for and quality of some services. Different cost containment strategies have measurable effects on patients' perspectives, particularly among patients who are sicker.
54 patients in five centres participated in a study of the relationship between steady-state plasma-levels of amitriptyline (AT) and its active metabolite nortriptyline (NT) and therapeutic response. The participants were inpatients who, after a 7-12 day period of assessment, were rated greater than or equal to 16 on the Hamilton rating scale for depression. They were given 75 mg of amitriptyline for 3 days and then 150 mg daily for an active-treatment period of 6 weeks. Clinical ratings and plasma-samples were obtained at baseline then at 2, 4, and 6 weeks after starting therapy. Contrary to the findings of three previous trials, no important correlations were found between steady-state plasma-levels and therapeutic outcome or corrected side-effects. Corrected side-effects correlated negatively with therapeutic outcome. There seems little advantage in routine monitoring of AT and NT, since variations in plasma-levels do not account for the considerable variation in therapeutic outcome.
The risk of non-melanoma skin cancer in northern Europeans who indulge in sunbathing or use a UVA solarium was estimated using a mathematical model of skin cancer incidence that makes allowance for childhood, occupational and recreational sun exposure. This model demonstrates that the cumulative incidence of skin cancer in indoor workers is about 2-3% by the age of 70, yet this risk can increase 5-fold if they indulge in a two-week sunbathing vacation each summer. The use of a UVA solarium is also shown to increase the risk of skin cancer. Because risk increases with the approximate square of annual solarium exposure, it is not possible to define a 'safe' level of exposure. Instead, it is shown that weekly use of a UVA solarium from age 20 until middle age (40-50) gives a relative cumulative incidence of 1.3 compared with non-users of sun beds and sun canopies. The risk begins to increase rapidly for more frequent use, particularly when solaria are used in combination with sunbathing.