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Biomedical subjects

S Ludwig

Publications and source records attributed to S Ludwig.

At least 109 records · Page 6Linked to original sources
PubMed1991

Night people: utilization of a pediatric emergency department during the late night.

This study was undertaken to define the factors that enter into the decision to seek care in a pediatric emergency department (ED) during the late evening hours. A questionnaire was administered which sought responses regarding demographic, social/familial, medical, and visit-related information. The questionnaire was completed by 170 nighttime utilizers (11:00 PM to 7:00 AM) and 202 daytime controls. Nighttime users were more likely to have private physicians, were ill for shorter periods of time, were more likely to attempt treatment at home prior to arriving at the ED, tended to use the ED more often, and spent their days outside of the home (in school or daycare), as compared with the daytime controls (P less than 0.05). The average waiting time was longer during the night than during the day (7:00 AM to 5:00 PM). The prime reasons for presenting for care during the night (as well as during the day), according to the caretaker, were illness concerns and not those of convenience.

Adolescent↗
PubMed1991

Pediatric emergency transport and the private practitioner.

A mail survey of 182 pediatricians and 92 family practitioners in Pennsylvania was conducted to determine their methods of transport of seriously ill children from their offices to referral centers and their involvement with professional transport services. Although most physicians (93.1%) stated that they had professional services available to them (at their office location), more than half (53.8%) indicated that the patient's family automobile was their most commonly used method of transport of ill children to tertiary care centers. This was true regardless of the disease entity involved, including suspected epiglottitis. Practice setting had little influence on transport method. However, in general, younger children were judged to need ambulance transport more often than older children. Reasons cited for not using professional transport from the office included a perceived better efficiency of the family car (61.8%), the prohibitively high expense of professional transport (9.8%), and failure to consider professional transport (6.5%). Further study of this component of office preparedness is suggested.

Child↗
PubMed1990

Derivation of the nucleoproteins (NP) of influenza A viruses isolated from marine mammals.

The nucleoprotein (NP) genes of influenza viruses were sequenced from a variety of virus isolates derived from marine mammals: whales from the Pacific and Atlantic oceans, seal and gull from the Western Atlantic, and a tern from the Caspian Sea. In comparison to published NP sequences, we found pairs of NPs derived from avian and marine mammal isolates to be closely related, e.g., the gull-whale and mallard-seal pairs from the Atlantic Coast of the USA and the tern-Pacific Ocean whale pair of the Eastern Hemisphere. Our analysis suggests that influenza viruses have been independently introduced into marine mammals from avian sources for each of our three examples. Furthermore, the closeness of the relationship in these avian-mammalian NP pairs indicates that the introductions are relatively recent. The sequences of these marine mammal NPs are avian-like and can be clearly distinguished from human NPs. Our results provide further support of interspecies transmission of influenza A viruses from the avian host reservoir directly to mammalian hosts.

Amino Acid Sequence↗
PubMed1990

A child-oriented emergency medical services system.

Although the principles of emergency care may be relatively easy to state, it is their promulgation that is so difficult. The development of EMS-C is the challenge. How do we take these principles of preserving children's lives and translate them into services for everyone who needs them? How do we organize a large, diverse health care system which will be responsive to this group of patients in need? How do we prioritize pediatric emergency care among the many other funding needs, both medical and nonmedical? The answer lies with the initiative and advocacy of each of us as child advocates. Providing all the aforementioned elements of the EMS-C will save children's lives. These are lives which are usually responsive to therapy, uncomplicated by interlocking disease states, and filled with potential for future achievement. The challenge is ours.

Child↗
PubMed1988

Major blunt abdominal trauma due to child abuse.

We reviewed 15 years' experience with childhood trauma at two hospitals in different cities, one a city hospital, the other a children's hospital, to learn the extent, circumstances, presentations, and consequences of major blunt abdominal trauma due to child abuse. Some 10,000 children admitted to these hospitals for treatment of injuries from 1972 through 1986 provided the basis for the study; the incidence and severity of pediatric trauma at the two hospitals was similar, in that 13% of the visits to both hospitals' emergency rooms were for trauma, of which 5% resulted in admission. Major blunt abdominal trauma due to child abuse accounted for 22 of these cases, six at the former, 16 at the latter, and represented less than 0.50% of all abused children seen at both institutions. The average age was 24 mo; 14 were boys and eight were girls. In only two instances was the family unit intact; in both, the child was abused by the babysitter. Otherwise, the father, or the mother's "boyfriend," was responsible. Overall mortality was 45%, and was related both to type of injury and presenting signs. Of one who presented with an epigastric mass due to a pancreatic hematoma, none died; the pseudocyst which subsequently developed resolved on bowel rest and TPN. Of three who presented with bilious vomiting due to duodenal hematoma, none died; one required operative evacuation. Of five who presented with peritonitis due to duodenojejunal rupture, one died; this child presented greater than 24 hr following injury in profound septic shock. Of three who presented with hypovolemia due to moderate hemorrhage, none died; the former two were managed conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1988

The insulin receptor gene and its expression in insulin-resistant mice.

Defects of insulin receptor binding and tyrosine kinase activity have been described in genetically diabetic (db/db) and obese (ob/ob) mice. To determine if these changes were related to an abnormality in insulin receptor mRNA expression or structure of the receptor gene, we quantitated receptor mRNA from db/db and ob/ob homozygous, heterozygous (db/x, ob/x) and unaffected [db(x/x), ob(x/x)] mice and also analyzed restriction fragment length patterns of genomic DNA. Northern blot analysis of insulin receptor mRNA in livers from each of the genotypes revealed two major species of 7.5 and 9.5 kilobases. In contrast to known decreased receptor number in various tissues of ob/ob and db/db mice, quantitation of liver insulin receptor mRNA revealed that both homozygous affected strains had 2-fold or more increased levels of both major mRNA species compared to unaffected control groups. (P less than 0.05). Restriction fragment length analysis revealed no major insertion or deletion mutations in either the db/db or ob/ob insulin receptor gene. From the number and size of the fragments generated by this analysis, the minimal size of the mouse insulin receptor gene was calculated to be 97 kilobases, and the minimal number of exons was 16. These data indicate that the insulin receptor gene in ob/ob and db/db mice exhibits no major structural abnormality. Decreases in insulin receptor binding and/or kinase activity in affected mice appear to be due to a defect at the posttranscriptional level and occur despite increased levels of receptor mRNA.

Animals↗
PubMed1988

Stairway injuries in children.

Children frequently injure themselves falling down stairways, but the characteristics of these injuries are not well described. A total of 363 consecutive patients seen in a pediatric emergency department were studied. The majority of patients had minor superficial injuries. Bony injuries occurred in 7% of patients. Head and neck injuries occurred in 73% of patients, extremity injuries, which were predominantly distal, in 28%, and truncal injuries in 2%. Children younger than 4 years of age were more likely to sustain head trauma than children older than 4 years of age (P less than .005). Injury to more than one body part occurred in only 2.7% of patients. Children who fell down more than four steps had no greater number or severity of injury than those who fell down less than four steps (P = .67). Patients were admitted to hospitals in 3% of cases. No patient had life-threatening injuries and no patients required intensive care. When multiple, severe, truncal, or proximal extremity injuries are noted in a patient who reportedly fell down stairs, a different mechanism of injury should be suspected.

Accidental Falls↗
PubMed1987

Minor head trauma in children: an intervention to decrease functional morbidity.

Minor head trauma is common among children and evokes strong parental reaction. Parents often rush the child to an emergency department or consult their pediatrician by telephone despite the minor nature of the injury. In a previous report we showed that children with minor head trauma appear to have limitations in their usual daily activities and a high rate of school absenteeism. This study was a prospective, randomized trial of an intervention designed to reduce this functional morbidity after head trauma. Parents in the control group (n = 168) received routine discharge instructions. Parents in the intervention group (n = 153) received a discharge interview during which the nurse gave more explicit and behaviorally oriented instructions. The nurse also called intervention parents the next day to reassure them and to urge that the children return to their usual routine. One month after the injury a questionnaire was administered by telephone to assess physical health status, social or functional limitations, and behavior problems. The majority of parents (85%) were anxious, and this was not alleviated by previous experience with head trauma. Triage nurses incorrectly rated one third of the parents as not anxious. Physical health status, role activity indices, and behavior problems, were similar for the intervention and control groups 1 month after the head injury. Subsequent morbidity was highly correlated with parental anxiety. In managing children with minor head trauma, pediatricians and emergency department physicians must focus their discharge instructions on the parent's anxiety, emphasize the minor severity of the injury, and urge that the children return to their usual routine.

Adolescent↗
PubMed1986

Factors influencing outcome of cardiopulmonary resuscitation in children.

We evaluated 47 pediatric patients after cardiopulmonary arrest. Patients entered the study with the onset of advanced life support. We followed them until death, or discharge from the hospital, occurred. We identified three groups of patients: long-term survivors, who survived to discharge, short-term survivors, who survived longer than 24 hours after CPR but not until discharge, and nonsurvivors, who died within 24 hours of their arrest. All of the long-term surviving patients were discharged from the hospital without gross neurologic deficit attributable to the arrest or resuscitation effort. Twenty-seven (57%) children were successfully resuscitated. Eighteen (38%) were long term-survivors, while nine (19%) were short-term survivors. Favorable outcome is associated with the following factors: inhospital arrest, extreme bradycardia as the presenting arrhythmia, successful resuscitation with only ventilation, oxygen and closed chest massage, and a duration of CPR of less than 15 minutes. Age, sex, and race, as well as pupillary reaction and motor response at the onset of advanced life support, did not correlate with long-term survival.

Age Factors↗
PubMed1986

Morbidity following minor head trauma in children.

Head trauma, the most common form of accidental injury among children, is a source of concern for parents and pediatricians. Parents worry about a child's loss of intellectual function. Pediatricians often see the well-documented sequelae of severe head trauma as a basis for parental instructions on observation of a child after minor head injury. A prospective study of 321 children, 6 months to 14 years of age, who had sustained minor head injury within the previous 24 hours was conducted in the emergency department of the Children's Hospital of Philadelphia. Parents of all children completed a ten-minute triage questionnaire and received discharge instructions after their child had received standard medical management. One month after the injury, a questionnaire was administered in a telephone interview to assess the child's physical health status, social or functional limitations, and behavior problems. Physical morbidity was rare, and headache, the most frequent complaint, occurred in only 7% of the children. However, parents reported substantial functional morbidity, and there were significantly more behavioral problems in the 2- to 14-year-old head trauma patients than reported for the standard normal population. Therefore, children who have sustained minor head trauma manifest substantial functional morbidity despite the rarity of physical sequelae. This functional morbidity probably reflects parental overreaction and possibly family dysfunction. It is recommended that pediatricians who have determined that a child's head injury is mild should focus parental education on the rarity of physical sequelae and the importance of the child's returning to a normal routine.

Absenteeism↗
PubMed1985

Increased lead absorption in children with accidental ingestions.

Children with accidental ingestions exhibit excessive hand-to-mouth behavior. In a lead-burdened environment, hand-to-mouth behavior contributes to increased lead absorption. To test the hypothesis that accidental-ingestion patients experience greater lead absorption than other urban children, 95 children under 6 years of age with recent ingestions of nonlead-containing materials and a matched control group were compared. Ingestors had higher mean blood lead levels than controls (25.0 micrograms/dl versus 22.2 micrograms/dl, P = 0.036) and higher mean erythrocyte protoporphyrin levels (40.6 micrograms/dl versus 28.6 micrograms/dl, P = 0.006). Ingestion victims were more than three times as likely as controls to be classified as having increased lead absorption. Thumb-sucking was twice as common among ingestors as controls (37% versus 19%). These findings indicate that children with accidental ingestions are at greater risk of increased lead absorption than other urban children.

Child, Preschool↗
PubMed1985

Temperature response to antipyretic therapy in children: relationship to occult bacteremia.

The response of rectal temperature to antipyretic therapy was studied in an attempt to identify a clinical characteristic that would distinguish children with occult bacteremia from those with sterile cultures of blood. Children 3-24 months of age with initial temperature recordings of 38.9 degrees C or greater had a blood culture drawn and received a standard dose (10mg/kg) of either aspirin or acetaminophen. Temperature was again recorded 60-120 minutes later. During the period of investigation, 255 patients were studied; 16 had bacteremia, and 239 had sterile blood cultures. There was no difference in the response to antipyretic therapy between the two groups. The mean decrease in temperature for each was similar (1.3 versus 1.05 degrees C, P = 0.14). The authors conclude that response to antipyretic therapy does not distinguish children who are bacteremic from those who are not.

Acetaminophen↗