PurposeTo examine pregnancy rates and outcomes (births and abortions) among 15- to 19-year olds and 10- to 14-year olds in all countries for which recent information could be obtained and to examine trends since the mid-1990s.MethodsInformation was obtained from countries’ vital statistics reports and the United Nations Statistics Division for most countries in this study. Alternate sources of information were used if needed and available. We present estimates primarily for 2011 and compare them to estimates published for the mid-1990s.ResultsAmong the 21 countries with complete statistics, the pregnancy rate among 15- to 19-year olds was the highest in the United States (57 pregnancies per 1,000 females) and the lowest rate was in Switzerland (8). Rates were higher in some former Soviet countries with incomplete statistics; they were the highest in Mexico and Sub-Saharan African countries with available information. Among countries with reliable evidence, the highest rate among 10- to 14-year olds was in Hungary. The proportion of teen pregnancies that ended in abortion ranged from 17% in Slovakia to 69% in Sweden. The proportion of pregnancies that ended in live births tended to be higher in countries with high teen pregnancy rates (p =.02). The pregnancy rate has declined since the mid-1990s in the majority of the 16 countries where trends could be assessed.ConclusionsDespite recent declines, teen pregnancy rates remain high in many countries. Research on the planning status of these pregnancies and on factors that determine how teens resolve their pregnancies could further inform programs and policies.

Higher abortion rates in particular age-groups probably reflect higher-than-average levels of unmet need for contraception or difficulty using methods consistently and effectively, and a stronger desire to avoid childbearing. Each of the patterns observed has implications for service and information needs within countries.

Objective: This study examines intergenerational continuities in relationship instability, general relationship quality, and intimate partner violence (IPV) between mothers and adolescents.Background: A growing body of literature has observed similarities in relationship quality between parents and their adult offspring. Less attention has focused on whether intergenerational continuities are present in adolescent relationships.

Shortly afterward, an expanding 18 × 15-cm erythematous rash appeared below his left shoulder. The rash resolved but malaise and fatigue recurred. Two additional doxycycline courses provided only transient improvement. Five months after his initial diagnosis, the patient was referred to an infectious disease specialist for presumed chronic Lyme disease. The results of the physical examination and laboratory evaluation were normal except for a slightly elevated white blood cell count. Results of serologic testing for Lyme disease were consistent with previous infection (Table). The patient had a remote 18 pack-year history of smoking. The chest radiograph revealed a 1.1-cm nodular mass in the right upper lobe confirmed by computed tomographic scan (Figure). Further evaluation demonstrated stage I non-small cell adenocarcinoma, which was successfully resected. Discussion | Patients 1 and 2 had no evidence of ever having Lyme disease. Patient 3 likely had true Borrelia burgdorferi infection for which antibiotic therapy was appropriate; however, subsequent symptoms were incorrectly attributed to persistent infection. Chronic Lyme disease is a misleading term that should be avoided. 2 Posttreatment Lyme disease syndrome is the proper term for patients with a verified previous B burgdorferi infection who experience fatigue, arthralgias, or other symptoms 6 months or more after antibiotic treatment when all other conditions have been ruled out. 1,2,5 We are not suggesting that every patient with nonspecific symptoms, such as fatigue, joint pain, or abdominal pain, should be aggressively evaluated for cancer. Rather, we present these cases to demonstrate delays in diagnosis that come from assuming that patients have chronic Lyme disease.

Worldwide, the incidence of induced abortion has remained steady in recent years after declining in the 1990s and early 2000s. 1 The same is not true, however, for each individual country for which information on abortion trends is available: In many, the incidence of abortion has continued to decline, and in a few, it has risen. 2Abortion levels and trends can also vary within countries, across subgroups of women.3 Documentation of abortion incidence is unavailable in most countries with highly restrictive abortion laws, and quantitative information on the characteristics of women who have abortions in such countries-including their age, marital status and parity-is even more scarce. However, abortion data collection systems are in place in most countries with liberal abortion laws. The information obtained about women having abortions differs across these countries; age is perhaps the most commonly recorded characteristic. Groups of women with disproportionately high abortion rates likely have an exceptionally difficult time avoiding unintended pregnancies or a greater motivation to terminate such pregnancies. In many societies, young unmarried women who are sexually active might have a particularly difficult time avoiding unintended pregnancies, because fear of the stigma attached to nonmarital sexual activity can inhibit them from obtaining contraceptive services and from using methods correctly and consistently. In addition, young women may find it difficult to negotiate contraceptive use with their partners. Unplanned births among adolescents and young adults can carry high opportunity costs-sometimes forcing them to curtail their schooling and, thus, adversely affecting their future employment prospects and sometimes compromising their ability to establish stable partnerships. 4,5 On the other hand, sexual activity is less prevalent among adolescents than among women in their 20s; in settings where sexual activity is low among adolescents, abortion rates might also be low. 6Other factors that could influence the age patterns of abortion include age at marriage, desired fertility and fecundity. The average age at marriage has been increasing in many countries, 7,8 and the risk of unintended pregnancy and abortion among sexually active women in their 20s may also be increasing. Women who are reaching the end of their reproductive years, are sexually active and fecund, and have completed their desired family size are also at risk of unintended pregnancy and abortion. The most recent prior assessments of abortion incidence across age-groups of women are for the mid-1990s and for 2003; 3,9 however, patterns in age-specific abortion levels in many countries may have changed since then.