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Biomedical subjects

J A Paulson

Publications and source records attributed to J A Paulson.

17 recordsLinked to original sources
PubMed2001

Pediatric advocacy.

Advocacy is part of the job description of a pediatrician. There is a long history of pediatrician involvement in civil society. Like other skills in pediatrics, the skills required for advocacy activities are learnable. Anyone who can learn the Krebs cycle can learn how to be a child advocate. Being a child advocate is not always easy, but it is rewarding. The 1995 Nobel Prize in Chemistry was awarded to Rowland et al for their work in the description of the destruction of stratospheric ozone by chlorofluorocarbons. Having done the groundbreaking research, Rowland and Molina spent much time working to ban chlorofluorocarbons. When asked why they, as bench scientists, ventured out of the laboratory as advocates, Rowland stated, "If not me, who? If not now, when?" (personal communication, December 7, 2000).

Adult↗
PubMed1999

Expanding the physician's role in pediatric environmental health.

In rural Georgia, a nurse and an environmental health specialist from the local health department visit the home of a young nursing mother to evaluate her home for the presence of lead hazards. The mother's older child, a 3-year old girl, has a blood lead level of 22 micrograms per deciliter, which was discovered through routine (EPSTD) health department screening. In examining the home, the specialist finds classic environmental risks; peeling and chipping lead-based paint on windows and door frames, lead dust on window wells and floors, and a backyard that serves as a burial ground for defunct car parts and dead batteries. In the course of talking with the mother about the lead hazards he has found, he notices that she and her 8-week-old infant seem quite listless, so he asks the mother how she's coping with her new baby. Eventually, the mother discloses that during her pregnancy she craved dirt and that she had eaten bowels of it scooped from her backyard. Once she had the baby, she says, she lost her craving. The nurse immediately contacts the physician involved in this case, who arranges for the mother and infant to be admitted to a nearby medical center for chelation therapy. Testing reveals the mother's lead level at 90 micrograms per deciliter; the infant's level is staggering 85 micrograms per deciliter. Once lead levels are reduced,the physician and public health nurse arrange for a host of social services, including psychological and nutritional counseling for the mother and periodic retesting of the children. The family moves from the dilapidated rental home. However, the mother misses her appointments, and despite repeated attempts to locate her, the family is lost to follow-up.

Adolescent↗
PubMed1994

Evaluation and comparison of histopathologic grading systems of epithelial carcinoma of the uterine cervix: Gynecologic Oncology Group studies.

The subjects of this study are 445 patients with advanced cervical cancer treated by standardized radiation therapy. Upon entry into one of two Gynecologic Oncology Group (GOG) protocols, original pathologic diagnoses and histologic tumor descriptions for each patient were compared with separate evaluations made by a consensus opinion of two GOG pathologists. A review diagnosis using grade, cell type, and the Stendahl scoring system was then made by the first author (R.J.S.) without knowledge of the prior diagnoses. Of the original pathologists' diagnoses, 21% did not include grade or cell type. There was little agreement among the different pathologists as to the use of either specific grade or cell type. Histologic grade, irrespective of the pathologists making the diagnosis, had no correlation to prognosis. The Reagan and Wentz large-cell keratinizing (LCK) cell type, when applied by the author to tumors with any form of squamous keratinization present, identified a group of patients with a poorer prognosis, although not independently of other prognostic factors. The Stendahl scoring system identified a number of patients with both a poorer and better prognosis. This was statistically significant and independent of other risk factors. A major limitation, however, was the number of patients evaluable because of inadequate biopsy material in 23.6% of the study group.

Adult↗
PubMed1992

Standard definitions for childhood injury research: excerpts of a conference report.

As awareness of the huge human and other costs of injury has grown, research has expanded. There has not been any standard set of terminology for use in this research. As a result, research and surveillance data are too often difficult to interpret and compare. To overcome this impediment to gains in needed knowledge about childhood injuries, a conference was held in 1989 by the National Institute of Child Health and Human Development to develop a set of standard definitions. The full conference report is available from the US Government Printing Office. This report presents excerpts, emphasizing those--core--variables likely to be of use to the largest number of investigators. The conference recommendations presented address cross-cutting factors (age, race/ethnicity, location, socioeconomic status, and biopsychosocial development), effect modifiers (exposure, medical risk factors, substance abuse, time, injury severity, and social risk factors), and specific injuries (motor vehicle injuries, central nervous system injuries, falls, fire/burns, drowning, and violence). It is expected that childhood injury investigators will strive to meet the recommendations of this conference and that use of these definitions will lead to improvements in research and, ultimately, to revision of the definitions.

Child↗
PubMed1991

Mesonephric rest hyperplasia. A potential diagnostic pitfall.

A case of mesonephric rest hyperplasia, an incidental finding in the hysterectomy specimen of a 48-year-old woman, was initially misdiagnosed as a well-differentiated cervical adenocarcinoma. We highlight the histologic, histochemical, and immunohistochemical features of this potential diagnostic pitfall and review the relevant literature.

Adenocarcinoma↗
PubMed1989

Richter's transformation of lymphoma complicating Gaucher's disease.

A case of lymphoma in a middle-aged woman with Gaucher's disease, a mu-kappa monoclonal gammopathy, peripheral lymphocytosis, and massive splenomegaly is described. There was no evidence of Gaucher's disease in the splenectomy specimen. Instead, the splenic architecture was effaced by a small lymphocytic lymphoma (SLL), with a few foci of large cell lymphoma (LCL). Immunoperoxidase studies showed that both lymphomatous components had a mu-kappa immunophenotype. Flow cytometric analysis of peripheral blood and spleen lymphocyte surface markers confirmed monoclonality. The intensity of surface immunoglobulin expression and the results of other cell marker studies in the SLL component were consistent with a stage of differentiation beyond that typical of chronic lymphocytic leukemia (CLL). The presence of abundant cytoplasmic immunoglobulin in the SLL and the association with monoclonal gammopathy were more consistent with Waldenström's macroglobulinemia or plasmacytoid lymphocytic lymphoma. The immunohistochemical and flow cytometric findings suggest that the SLL component evolved clonally or underwent Richter's transformation to LCL. Although Gaucher's disease has been associated with a variety of B-cell disorders, the subsequent transformation to a high-grade lymphoma has not been previously reported.

B-Lymphocytes↗
PubMed1988

The epidemiology of injuries in adolescents.

Injuries are the major health problem of adolescents. Injuries are the leading cause of death in the adolescent age group and the leading cause of potentially productive years of life lost in the nation. Nonfatal injuries are also very common, generating frequent physician visits, hospital admission, and high medical care costs. The road is the most dangerous environment for teens where motor vehicle occupants, motorcyclists, pedestrians, and bicyclists all sustain frequent injuries. Alcohol and other drugs are often contributing factors to these injuries. Head and spinal cord injury result in many permanent disabilities. At school, children usually sustain nonfatal injuries in sports activities. Injuries at home are less common among adolescents than among younger children. The farm environment is an understudied, but dangerous environment. There is a need for standardization of data sets and age grouping within data sets to better understand the epidemiology of injuries in adolescents.

Accidents, Traffic↗
PubMed1986

Seat restraint contamination and cleaning.

This study was undertaken to demonstrate that seat restraints are unlikely vehicles for the transmission of pathogenic bacteria from infant to infant in seat restraint loaner programs. Simple surface cleaning with antibacterial solutions is sufficient to prepare seats for reloaning.

Antisepsis↗
PubMed1986

Farm accidents.

Explore the source record for details and available documents.

Accidents↗
PubMed1986

Violent death in children in a metropolitan county: changing patterns of homicide, 1958 to 1982.

Death rates from homicide in children younger than 15 years of age in the United States have increased during the last 30 years. Previous studies have suggested a typology consisting of fatal child abuse in young children and community violence in older children. We reviewed the data from the Cuyahoga County, Ohio, coroner's office pertaining to homicides in children less than 15 years of age between 1958 and 1982 and obtained similar findings. The homicide rates for city children increased from 1.1 to 6.7/100,000 in the first 20 years and then stabilized. Nonwhite boys had the highest death rates except in one period. Assailants were usually adolescent and young adult men of the same race; however, 43% of children less than 5 years of age were killed by women. The older the child, the more likely the homicide was to have been committed by a nonrelative, outside of the home, and with a firearm. Overall, firearms are the leading cause of homicide (36.2%). The temporal characteristics of child homicides are also described.

Adolescent↗
PubMed1984

Baby walker-related injuries.

A retrospective review of charts of patients with baby walker-related injuries presenting to a large urban emergency room over a 23-month period was undertaken. Ninety-seven percent of the children sustained injuries to their head or face. Sixty-eight percent of the injuries were the result of falling down steps. Twenty-two percent of the injuries required surgical or dental evaluation in addition to pediatric evaluation.

Accidents, Home↗
PubMed1981

The case of mandatory seat restraint laws.

Motor vehicle accidents are the leading cause of death and injury to children over one year of age in the United States. About 800 motor vehicle occupants less than four years old are killed each year and tens of thousands are injured severely enough to require emergency room treatment. Studies have demonstrated that the vast majority of children ride unprotected in motor vehicles. Restrained children are likely to have milder injuries or no injuries at all. One study intimates that seat belts or restraints could reduce injuries up to 70 per cent and deaths up to 90 per cent. Various educational efforts have been attempted to increase restraint and belt use. Most have not worked. Seat belts laws in other countries have been effective in increasing belt use by adults when the laws are enforced. In Tennessee, where a mandatory seat restraint law has been part of a large-scale educational effort, restraint use has increased from an average of 9 per cent prior to the law, to an average of 18.7 per cent in the fall of 1979. Because the problem of motor vehicle-related deaths and injuries is widespread and because legislation holds some promise for amelioration of this problem, pediatricians and public health professionals should work toward the passage of such laws.

Accidents, Traffic↗
PubMed1981

Patient education.

Explore the source record for details and available documents.

Evaluation Studies as Topic↗