The various countries of Europe have similar conditions of access to contraceptive methods. In eastern Europe, however, the supply of contraceptive pills, coils, spermicidal products, and condoms is less than the demand (except for Hungary and the Czech and Slovak republics), particularly in Poland, in the former Soviet Union, and in Romania. Sweden and Turkey have authorized midwives to prescribe contraceptive pills or to insert coils. In Turkey, Bulgaria, Romania, and in the former Soviet Union, the dispensing of pills without prescription is tolerated. Spermicidal products can generally be dispensed in pharmacies without a prescription. Condoms are sold even in Ireland. France dose not allow the advertising of contraceptives in nonmedical journals, while Denmark encourages such advertising. Today a number of European countries regulate contraceptive surgery. In Finland, a minimum of 3 children is the prerequisite and age conditions are set (over 18 years in Turkey, over 25 years in Austria, Denmark, Iceland, Norway, Portugal, and Sweden, over 30 years in Finland, and over 35 years in Croatia and Slovenia). Sterilization for contraceptive purposes constitutes a statutory offense of mutilation in France, Ireland, Austria, Greece, Malta, and Poland. Sterilization is carried out in Spain and Italy, less so in Ireland and Malta, and there is slow progress in this regard in Belgium and France. Voluntary sterilization is legally allowed in Hungary and Romania, practiced on a small scale in Albania, and prohibited in Bulgaria. The Netherlands has the highest number of couples protected by sterilization. Most often the public family planning services are integrated in other services, such as community clinics, hospitals, and pre- and postnatal clinics. In Europe as compared with the developing countries, a very large number of private practitioners have the responsibility of informing and prescribing.
Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Quebec, Canada. sasha.bernatsky@mail.mcgill.ca
To examine the validity of case definitions for systemic autoimmune rheumatic diseases [SARD; systemic lupus erythematosus (SLE), systemic sclerosis (SSc), myositis, Sjögren's syndrome, vasculitis, and polymyalgia rheumatica] based on administrative data, compared to rheumatology records.
A list of rheumatic disease diagnoses was generated from population-based administrative billing and hospitalization databases. Subjects who had been seen by an arthritis center rheumatologist were identified, and the medical records reviewed.
We found that 844 Nova Scotia residents had a diagnosis of one of the rheumatic diseases of interest, based on administrative data, and had had = 1 rheumatology assessment at a provincial arthritis center. Charts were available on 824 subjects, some of whom had been identified in the administrative database with > 1 diagnosis. Thus a total of 1136 diagnoses were available for verification against clinical records. Of the 824 subjects, 680 (83%) had their administrative database diagnoses confirmed on chart review. The majority of subjects who were "false-positive" for a given rheumatic disease on administrative data had a true diagnosis of a similar rheumatic disease. Most sensitivity estimates for specific administrative data-based case definitions were > 90%, although for SSc, the sensitivity was 80.5%. The specificity estimates were also > 90%, except for SLE, where the specificity was 72.5%.
Although health administrative data may be a valid resource, there are potential problems regarding the specificity and sensitivity of case definitions, which should be kept in mind for future studies.
Family planning associations (FPAs) in the Scandinavian countries know the importance of addressing the needs of male adolescents and young men. Even though sex education is part of school curricula in Denmark, many young men lack good and confident counsellors to give them advice about sexuality and reproduction. In Denmark, almost half of men aged 16-20 years never talk to their parents about sexuality. It should therefore not be surprising that more than two-thirds of callers to the Danish FPA's, and other European FPAs', anonymous sex counseling telephone line are male. Many of the questions asked by young men indicate insecurity about sexual activity and what is perceived to be sexually normal. FPAs can play a vital role in providing counselling to boys and young men. Male discussion groups can help identify the needs of boys and young. Involving adolescents and the importance of the male perspective are discussed.
A comparative study of adolescent reproductive behavior in the 1980s examined difference in pregnancy, birth, and abortion levels among teenagers in developed countries especially in the US, Canada, the UK, France, the Netherlands, and Sweden. Only 6 of 37 countries with total fertility rates 3.5 and per capita income US$2000/year, and at least 1 million people had adolescent birth rates higher than the US (Bulgaria, Cuba, Puerto Rico, Romania, Hungary, and Chile). The US had the highest abortion rate (42/1000) followed by Hungary (27/1000). Thus the US had the highest adolescent pregnancy rate (96/1000) as well as Hungary (96/1000). The 6 country analysis showed that reducing the level of sexual activity among teenagers is not necessarily needed to achieve lower pregnancy rates. For example, Sweden had the highest levels of sexual activity but its pregnancy rate were 33% as high as those of the US. The rates of sexual activity among teenagers in the Netherlands equaled those of the US, but its pregnancy rates were 14% as high as those of the US. All countries had earlier, more extensive, and better contraceptive use among sexually active teenagers than the US which accounted for their lower pregnancy rates. The more realistic acceptance of sexual activity among teenagers and provision of contraceptives in all the countries except the US differed from the societal ambivalence in the US. Thus ambivalence about sexuality and the appropriateness of contraceptive use results in lower contraceptive use and greater adolescent pregnancy rates. US adolescents constantly receive conflicting messages that sex is romantic, thrilling, and arousing but it is also immoral to have premarital sex. Thus adults need to be more candid about sexuality so they can clearly convey to adolescents their expectations for responsible behavior and to provide the information and services needed to make effective use of contraceptives when sexually active.
In the Scandinavian countries there is no age limit for adolescents' access to contraceptive advice. Denmark deems it important to avoid barriers which prevent young girls from seeking contraceptive advice. Offering easy access to counseling is preferable to adolescent girls having unwanted pregnancies. In Denmark there is no age limit for adolescent girls to see their general practitioner (GP) for instruction in the use contraceptive methods. Without parental consent all can receive such counseling. In addition, the GP is obliged to observe professional secrecy at counseling, hence parents cannot request any information from the GP. There must be exceptionally serious reasons for breaking this professional secrecy. Thus a young woman should not refrain from seeking advice out of fear that her parents will know about her intimate life, and that she protects herself against unwanted pregnancy. It is not desirable to fix any age limit for adolescents' right to seek this advice because it concerns the adolescents' actual sex life. After the introduction of free abortion, many quite young girls sought abortion. The objective is to bolster the development that all children receive the requisite sex education at school, as well as to ensure that there is easy access to information on contraceptive methods. The GP's counseling is provided free of charge. A number of contraceptive clinics are available all over the country to provide alternative contraceptive counseling in case a young woman does not want to consult her GP because perchance the GP is her family doctor. Denmark as well as the other Scandinavian countries characteristically give high priority to promoting and improving the access to information and counseling on contraceptive methods by avoiding all economical, geographical, ethical, or emotional barriers.
To study the prevalence of adverse events (AEs) associated with neonatal transport, and to categorize, classify and assess the risk estimation of these events.
Written comments in 1082 transport records during the period 1999-2011 were reviewed. Comments related to events that infringed on patient and staff safety were included as AEs, and categorized and further classified as complaint, imminent risk of incident/negative event, actual incident or actual negative event. AEs were also grouped into emergency or planned transports, and risk estimation was calculated according to a risk assessment tool and defined as low, intermediate, high or extreme risk.
AEs (N = 883) were divided into five categories: logistics (n = 337), organization (n = 177), equipment (n = 165), vehicle (n = 129) and medical/nursing care (n = 75). Eighty-five percent of AEs were classified as incidents or negative events. The majority of AEs were estimated to be of low or intermediate risk in both planned and emergency transports. AEs estimated to be of high or extreme risk were significantly more frequent in emergency transports (OR = 10.1; 95% CI: 5.0-20.9; p
