Mitchell S. Karlan

Manganese in gasoline

This report responds to a resolution that asked the American Medical Association (AMA) to take action to reduce potential health risks from the use of methylcyclopentadienyl manganese tricarbonyl (MMT) in gasoline. Information for this report was derived from a search of the MEDLINE database and references listed in pertinent articles, as well as through communications with medical and public health experts. Based on this information, the AMA Council on Scientific Affairs determined that there is insufficient scientific evidence to assess the public health impact of MMT use. While limited evidence indicates that general-population exposures to manganese from the use of MMT in gasoline are low, more research is needed to determine possible health effects from long-term, low-dose exposures to MMT and its combustion products. Until such data are available, educational and informational strategies should be developed to improve public awareness of the health and environmental issues surrounding MMT use.

Adolescents as victims of family violence

Adolescents as victims of family violence Cable Y.D. Jr.; Estes E.H. Jr.; Head C.A.; Karlan M.S.; Kennedy W.R.; Numann P.J.: Scheider K.A.; Scott W.C.; Skelton W.D.; Steinhilber R.M.; Strong J.P.; Wagner H.N. Jr.; Loeb J.M.; Rinaldi R.C.; Stewart B.; Voegtle K. USA J AM MED ASSOC 1993 270/15(1850-1856) Adolescents experience maltreatment at rates equal to or exceeding those of younger children. Recent increases in reported cases of maltreatment have occurred disproportionately among older children and adolescents. However, adolescents are less likely to be reported to child protective services and are more likely to be perceived as responsible for their maltreatment. Adolescent girls are reported as victims more often than boys, especially in sexual abuse. However, boys may be less likely to be identified or reported and often are abused by nonfamily members. Parents of adolescent victims have higher average income and educational levels and are less likely to have a parental history of abuse than parents of younger children. A wide range of serious adolescent risk behaviors is associated with maltreatment. These include increased risk of premature sexual activity, unintended pregnancy, emotional disorders, suicide attempts, eating disorders, alcohol and other drug abuse, and delinquent behavior. Incarcerated youth, homeless or runaway youth. and youth who victimize siblings or assault parents have been shown to have high rates of prior maltreatment. Signs of maltreatment are often ambiguous for adolescents. Screening questions have been effective in prompting self-disclosure of abuse. Adolescents also experience problems in the child welfare system that offers fewer and less appropriate services for this age group. Recommendations are made regarding screening of adolescents for maltreatment. the development of better services for adolescents, research on parenting to prevent maltreatment, and training of school staff to identify and refer victims of maltreatment.

Induced termination of pregnancy before and after Roe v Wade: Trends in the mortality and morbidity of women

The mortality and morbidity of women who terminated their pregnancy before the 1973 Supreme Court decision in Roe v Wade are compared with post-Roe v Wade mortality and morbidity. Mortality data before 1973 are from the National Center for Health Statistics; data from 1973 through 1985 are from the Centers for Disease Control and The Alan Guttmacher Institute. Trends in serious abortion-related complications between 1970 and 1990 are based on data from the Joint Program for the Study of Abortion and from the National Abortion Federation. Deaths from illegally induced abortion declined between 1940 and 1972 in part because of the introduction of antibiotics to manage sepsis and the widespread use of effective contraceptives. Deaths from legal abortion declined fivefold between 1973 and 1985 (from 3.3 deaths to 0.4 death per 100,000 procedures), reflecting increased physician education and skills, improvements in medical technology, and, notably, the earlier termination of pregnancy. The risk of death from legal abortion is higher among minority women and women over the age of 35 years, and increases with gestational age. Legal-abortion mortality between 1979 and 1985 was 0.6 death per 100,000 procedures, more than 10 times lower than the 9.1 maternal deaths per 100,000 live births between 1979 and 1986. Serious complications from legal abortion are rare. Most women who have a single abortion with vacuum aspiration experience few if any subsequent problems getting pregnant or having healthy children. Less is known about the effects of multiple abortions on future fecundity. Adverse emotional reactions to abortion are rare; most women experience relief and reduced depression and distress.