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PubMed2000

Is epilepsy a progressive disease? The neurobiological consequences of epilepsy.

While primary, or idiopathic, epilepsies may exist, in the vast majority of cases epilepsy is a symptom of an underlying brain disease or injury. In these cases, it is difficult if not impossible to dissociate the consequences of epilepsy from the consequences of the underlying disease, the treatment of either the disease or the epilepsy, or the actual seizures themselves. Several cases of apparent complications of epilepsy are presented to illustrate the range of consequences encountered in clinical practice and the difficulty in assigning blame for progressive symptomatology in individual cases. Because of the difficulty in interpreting clinical material, many investigators have turned to epilepsy models in order to address the potential progressive consequences of recurrent seizures. The authors review experimental data, mainly from animal models, that illustrate short-, medium-, and long-term morphological and biochemical changes in the brain occurring after seizures, and attempt to relate these observations to the human condition.

Adult↗

PubMed1990

Learned tolerance to alcohol: mental rehearsal with imagined consequences.

Two experiments tested the hypothesis that the acquisition of a new response is enhanced by mental rehearsal which includes the imagined consequence of mental performance. A total of 48 males participated in the research. Experiment 1 tested drug-free learning of a motor skill task. Experiment 2 used the same task to test the acquisition of a drug-compensatory response (i.e., tolerance) under alcohol. Subjects in each experiment were randomly assigned to one of three treatments: mental rehearsal with imagined consequences (C), mental rehearsal with no imagined consequences (N), and rest (R). Both experiments confirmed the hypothesis. C treatment yielded superior drug-free performance, and a greater tolerance. The effect of N treatment was intermediate, and R treatment was least effective. It was concluded that incorporating an imagined consequence of mental performance enhances the learning of alcohol tolerance and the acquisition of a motor skill. Factors that may have contributed to the marginal efficacy of N treatment were discussed, and research implications were considered.

Adult↗

PubMed1998

Elder abuse in the community: prevalence and consequences.

OBJECTIVES: (1) To assess the prevalence and the consequences of chronic verbal aggression, physical aggression, financial mistreatment, and neglect in a community-based sample; (2) to investigate the circumstances that led to the abuse and the ways in which the victims handled the problem. DESIGN: Prevalence was assessed in a population-based sample of 1797 older people living independently in Amsterdam, the Netherlands. In a follow-up study 1 year later, the victims were questioned again about the background and consequences of the abuse. RESULTS: The 1-year prevalence of elder abuse was 5.6%. The prevalence of the various types of elder abuse was: verbal aggression 3.2%, physical aggression 1.2%, financial mistreatment 1.4%, and neglect 0.2%. Most victims reported emotional reactions immediately after the abuse. Seven of 36 victims experienced physical or financial damage as a consequence of the abuse. More than 70% of the victims were able to stop the abuse, either by themselves or with the help of others. CONCLUSION: The rate of occurrence and the consequences of elder abuse in the Netherlands was established. Elder abuse is more widely spread if not only close relatives or people with whom the older person lives are considered as possible perpetrators but other familiar and trusted people are considered as well. Intervention should be focused on the roughly 40% of victims who were not able to stop the abuse.

Aged↗

PubMed1993

Consequence of epileptic activity in vitro.

Hippocampal sclerosis: a cause or consequence of epileptic activity? This question has concerned neurologists and pathologists for over 150 years. This paper reviews data from an in vitro model system regarding the consequences of epileptic activity of known origin. Exposure of organotypic hippocampal slice cultures to convulsants, such as bicuculline or picrotoxin for three days leads to pronounced neuronal degeneration and a reversible loss of dendritic spines. A similar pathology has been described in hippocampal tissue removed from patients suffering from severe, drug refractory epilepsy. The consequences of such pathological changes are not self-sustaining epileptic activity, as might be expected if such sclerosis caused epilepsy, but rather a selective decrease in synaptic excitation. Inhibitory synaptic transmission and GABAergic interneurons, in contrast, are preserved. At least two mechanisms contribute to the depression of synaptic excitation: morphological changes in dendritic spines and a decrease in the expression of genes for some glutamatergic receptors. It is hoped that this model will allow the characterization of the mechanisms underlying the pathological consequences of epileptic activity, and lead to useful therapeutic strategies.

Animals↗

PubMed2000

Violence and its injury consequences in American movies: a public health perspective.

OBJECTIVES: To evaluate the seriousness and frequency of violence and the degree of associated injury depicted in the 100 top-grossing American films of 1994. METHODS: Each scene in each film was examined for the presentation of violent actions on persons and coded by a systematic context-sensitive analytic scheme. Specific degrees of violence and indices of injury severity were abstracted. Only actually depicted, not implied, actions were coded, although both explicit and implied consequences were examined. RESULTS: The median number of violent actions per film was 16 (range, 0-110). Intentional violence outnumbered unintentional violence by a factor of 10. Almost 90% of violent actions showed no consequences to the recipient's body, although more than 80% of the violent actions were executed with lethal or moderate force. Fewer than 1% of violent actions were accompanied by injuries that were then medically attended. CONCLUSIONS: Violent force in American films of 1994 was overwhelmingly intentional and in 4 of 5 cases was executed at levels likely to cause significant bodily injury. Not only action films but movies of all genres contained scenes in which the intensity of the action was not matched by correspondingly severe injury consequences. Many American films, regardless of genre, tend to minimize the consequences of violence to human beings.

Humans↗

PubMed2000

Violence and its injury consequences in American movies: a public health perspective.

OBJECTIVES: The purpose of this study was to evaluate the seriousness and frequency of violence and the degree of associated injury depicted in the 100 top grossing American films of 1994. METHODS: Each scene in each film was examined for the presentation of violent actions upon persons and coded by means of a systematic context sensitive analytic scheme. Specific degrees of violence and indices of injury severity were abstracted. Only actually depicted, not implied, actions were coded, although both explicit and implied consequences were examined. RESULTS: The median number of violent actions per film was 16, with a range from 1 to 110. Intentional violence outnumbered unintentional violence by a factor of 10. Almost 90% of violent actions showed no consequences to the recipient's body, although more than 80% of the violent actions were executed with lethal or moderate force. Fewer than 1% of violent actions were accompanied by injuries that were then medically attended. CONCLUSIONS: Violent force in American films of 1994 was overwhelmingly intentional and in four of five cases was executed at levels likely to cause significant bodily injury. Not only action films but movies of all genres contained scenes in which the intensity of the action was not matched by correspondingly severe injury consequences. Many American films, regardless of genre, tend to minimize the consequences of violence to human beings.

Americas↗

PubMed1985

Coping, stress, stressors and health consequences.

The conventional sequence of stressful event (stressor) causing stress (biochemical and physiological changes) which, in turn, causes pathological consequences (diseases) is examined. A number of experiments are described which show that biochemical, physiological and/or pathological changes in an organism do not seem to be caused by the aversive or noxious nature of the stressor but by the ability or inability of the organism to deal with this stressor. If an individual can cope successfully with the environmental challenge, little or no stress is experienced, the challenge is viewed as only minimal stressful and no major health consequences seem to arise. If an individual cannot cope or needs a great deal of effort to cope, stress is experienced, the environmental event becomes stressful and major health consequences seem to arise. Thus, coping strategies available to and employed by an individual will determine whether or not stress is experienced, whether or not an event becomes stressful and whether or not pathological consequences will occur.

Adaptation, Psychological↗

PubMed1997

Immunologic consequences of blood transfusion and their clinical manifestations.

Aspects of clinical immunology, in the context of transfusion medicine, became highlighted in the last decade as a consequence of the accelerating expansion of basic immunology, immunogenetics and molecular biology. In addition sophisticated new technologies, which were capable of producing pure and safe blood products, attracted more attention to research and monitor the consequences of transfusion. These technologies also had obvious effects on supportive hematological therapy. The transfusion of blood components follows the rules of organ transplantation: when there is a mismatch between the donor and the recipient, the transfusion has the potential to induce various kinds of immune response against alloantigens. Antigen-compatible transfusions that involve major and rare blood groups are in almost all cases mismatched with respect to various polymorphic systems expressed on the cellular blood components. These include histocompatibility leukocyte antigens (HLA), tissue-specific and differentiation alloantigens, and, in the case of plasma, immunoglobulins, complement components, heat shock proteins, and shedded soluble membrane alloantigens. Clinical manifestations of alloimmune responses are typically deleterious. For example, immediate antigen-antibody binding and its consequences as secondary activations are paralleled by the nonhaemolytic febrile reaction, HLA sensitization can lead to a state of platelet refractoriness and inconvenient clinical symptoms. In certain immunogenetic situations and in immunodeficient patients graft-versus-host disease can be induced by blood products that contain live lymphocytes. Leukocyte filtration techniques are widely used to avoid most but not all of these harmful side effects of blood component therapy. In contrast to these harmful side effects in certain immunogenetic conditions, alloantigens that are expressed on various blood products can elicit an advantageous suppression of the immune response in the recipient. In the context of kidney transplantation this is termed the 'beneficial transfusion effect', and typically results in the prolongation of the graft's survival. In cases of recurrent habitual abortion and IgG therapy associated with certain autoimmune diseases, immunization with leukocytes specifically takes advantage of this phenomenon. To date the beneficial transfusion effect is not fully understood. In certain cases of malignancies or gastrointestinal surgeries this suppression of immune regulation that is induced by transfusion can worsen the clinical state either by permitting the spread of the tumor or by allowing severe infections to proceed unchecked. In conclusion it is imperative to monitor the immunological consequences of transfusion in order to deter the disadvantageous side effects. Taking advantage of the 'beneficial transfusion effect' may also provide a new means for immune therapy using the various blood products.

Blood Cells↗

PubMed2006

The "ripple effect": cultural differences in perceptions of the consequences of events.

Previous research has demonstrated that people from East Asian cultural backgrounds make broader, more complex causal attributions than do people from Western cultural backgrounds. In the current research, the authors hypothesized that East Asians also would be aware of a broader, more complex distribution of consequences of events. Four studies assessed cultural differences in perceptions of the consequences of (a) a shot in a game of pool, (b) an area being converted into a national park, (c) a chief executive officer firing employees, and (d) a car accident. Across all four studies, compared to participants from Western cultural backgrounds, participants from East Asian cultural backgrounds were more aware of the indirect, distal consequences of events. This pattern occurred on a variety of measures, including spontaneously generated consequences, estimations of an event's impact on subsequent events, perceived responsibility, and predicted affective reactions. Implications for our understanding of cross-cultural psychology and social perception are discussed.

Adolescent↗

PubMed1994

Psychological consequences of screening mammography.

OBJECTIVE: To examine the psychological consequences at a number of stages in the screening process for women attending a screening mammography programme. SETTING: A pilot mammographic screening programme in Melbourne, Australia. METHOD: The psychological consequences questionnaire (PCQ; a reliable and valid measure of the psychological consequences of screening mammography) was used to measure the emotional, social, and physical functioning of women in a mammographic screening programme and a control community sample. A screening group (in whom no abnormality was detected at initial screen; n = 142) had four measurements: at screening clinic; before results were received; one week after all-clear results were received; and eight months after initial visit. The recall group (who were recalled for further investigation which showed the detected abnormality to be benign; n = 58) had measurements at the same points as the screening group and an additional measurement while waiting at the recall assessment clinic. A randomly selected community control group (n = 52) had measurements one week, two weeks, three weeks, and eight months after consenting to participate. RESULTS: Emotional, social, and physical functioning of women in the screening group did not change over time and at no point differed significantly from that of community controls. The profiles of emotional and physical dysfunction of women in the recall group differed significantly from those of the screening and control groups. The level of emotional and physical dysfunction in the recall group was highest while waiting at recall assessment clinic, and scores were still significantly higher than scores obtained at comparable times from screening and control groups one week after obtaining notification that there was no sign of cancer (emotional P < 0.001; physical P < 0.05). This difference had disappeared eight months after the screening visit, when the level of emotional and physical functioning was similar to that of the screening and control groups. Social dysfunction scores did not change significantly over time and were similar for all three groups. CONCLUSIONS: Given that up to 10% of women are recalled for further investigations on first round screening, significant numbers of women may have psychological consequences. This speaks for the necessity for accurate reading of mammograms to minimise the false positive recall rate, and for counselling services to be available at recall assessment centres.

Attitude to Health↗

PubMed1998

Social consequences of substance abuse: the impact of comorbid psychiatric disorders. A prospective study of a nation-wide sample of treatment-seeking patients.

This is both a retrospective and a 16 and 28 months prospective study of the association between psychiatric comorbidity and social consequences (accidents, fights, broken relationships, drunken driving arrest, and reduced employment) related to alcohol in a nation-wide sample (n = 351) of substance abusers seeking inpatient treatment. Psychiatric comorbidity was evaluated with the Diagnostic Interview Schedule, while drinking history and social consequences were assessed with a structured questionnaire. The social consequences had a high rate of re-occurrence. Controlled for alcohol consumption, polysubstance abuse predicted accidents (OR = 2.9) and fights (OR = 3.9) among men, while among pure alcoholics of both sexes phobia (OR = 4.3) and antisocial personality disorder (OR = 3.0) predicted fights. Only level of abuse predicted broken relationships. Antisocials had most drunken driving arrests. Attempts to reduce these social consequences should aim at treating polysubstance abuse, phobia, and antisocial personality disorder. However, the overriding aim should be the promotion of abstinence.

Adult↗

PubMed2007

Measuring the psychosocial consequences of screening.

The last three decades have seen a dramatic rise in the implementation of screening programmes for cancer in industrialised countries. However, in contrast to screening for infectious diseases, most cancer screening programmes only have the potential to reduce mortality; they cannot lower the incidence of cancer in a population. In fact, most cancer screening programmes have been shown to increase the incidence of the disease as a consequence of over-diagnosis. A further dilemma of cancer screening programmes is that they do not distinguish between healthy people and those with disease. Rather, they identify a continuum of disease severity. Consequently, many healthy people who have abnormal screening tests are wrongly diagnosed. Indeed, studies have demonstrated that for each screening-prevented death from cancer, at least 200 false-positive results are given. Therefore, screening has the potential to be harmful as well as beneficial. The psychosocial consequences of false-positive screening results cannot be determined by diagnostic tests or by other technical means. Instead, patient reported outcome measures must be employed. To measure the outcomes of screening accurately and comprehensively patient reported outcome measures have to capture; the nature and extent of the psychosocial consequences and how these change over time. The outcome measures used must have high content validity and their psychometric properties should be determined prior to their use in the specific population. In particular it is important to establish unidimensionality, additivity and item ordering through the application of Item Response Theory.

Diagnostic Errors↗

PubMed2006

The chernobyl accident 20 years on: an assessment of the health consequences and the international response.

BACKGROUND: The Chernobyl accident in 1986 caused widespread radioactive contamination and enormous concern. Twenty years later, the World Health Organization and the International Atomic Energy Authority issued a generally reassuring statement about the consequences. Accurate assessment of the consequences is important to the current debate on nuclear power. OBJECTIVES: Our objectives in this study were to evaluate the health impact of the Chernobyl accident, assess the international response to the accident, and consider how to improve responses to future accidents. DISCUSSION: So far, radiation to the thyroid from radioisotopes of iodine has caused several thousand cases of thyroid cancer but very few deaths ; exposed children were most susceptible. The focus on thyroid cancer has diverted attention from possible nonthyroid effects, such as mini-satellite instability, which is potentially important. The international response to the accident was inadequate and uncoordinated, and has been unjustifiably reassuring. Accurate assessment of Chernobyl's future health effects is not currently possible in the light of dose uncertainties, current debates over radiation actions, and the lessons from the late consequences of atomic bomb exposure. CONCLUSIONS: Because of the uncertainties over the dose from and the consequences of the Chernobyl accident, it is essential that investigations of its effects should be broadened and supported for the long term. Because of the problems with the international response to Chernobyl, the United Nations should initiate an independent review of the actions and assignments of the agencies concerned, with recommendations for dealing with future international-scale accidents. These should involve independent scientists and ensure cooperation rather than rivalry.

Chernobyl Nuclear Accident↗

PubMed1999

Localization of relevant consequences in anti-drinking and driving PSAs (public service announcements): a new approach to targeting underage college students?

Drinking and driving is prevalent among college students, particularly among underage college students. Although most of these students know that drunk driving is a potentially harmful behavior, many of them still make the decision to do so. The purpose of this study was to determine why underage students drink and drive and what consequences, if any, these students fear when they engage in this behavior. Focus groups and in-depth interviews were conducted, using the Health Belief Model as a guide for discussion topics. Participants revealed that PSAs focusing on relevant, localized consequences would have more meaning to underage college students than the more general campaigns that they reported seeing. In addition, they revealed that the consequence that they fear most is being charged with a DUI, yet current anti-drinking and driving PSAs never portray this as a possible negative consequence.

Adolescent↗

PubMed1996

A path analysis of gender differences in adolescent onset of alcohol, tobacco and other drug use (ATOD), reported ATOD use and adverse consequences of ATOD use.

Gender differences in the ways a risk factor approach explains onset of using alcohol, tobacco and other drugs (ATOD), reported use of ATOD and adverse consequences from ATOD use were investigated by means of separate path analyses for male and female adolescents. A fully recursive model was specified in which alienation, trait anger, interaction anxiety and cognitive motivation for ATOD use comprised the first column variables which were used to predict earliness of onset. For the second step, column one variables plus onset were used to predict ATOD use. In the final step, column one variables plus onset and ATOD use were used to predict adverse consequences of ATOD use. An ex post facto design was used in surveying 796 high school students in a single Midwestern community. The data from this sample supported the predictive validity of the theoretical model. In addition to the expected indirect or mediated effects of the risk factors via onset of ATOD use on ATOD use and via onset and ATOD use on adverse consequences of ATOD use, there were direct effects of column on risk factors on both ATOD use and on adverse consequences of ATOD use for both males and females, lending support to the concept of multiple pathway risk factors. The three gender differences that emerged in the separate path analyses were entirely consistent with the gendered deviance model.

Adolescent↗

PubMed1985

Consequences of decriminalization of homosexuality: a study of two Australian states.

A comparison between homosexual males in two Australian states, Victoria (prior to decriminalization of homosexuality) and South Australia (eight years after decriminalization), indicated that the consequences of decriminalization did not include an increase in the negative aspects of homosexuality, such as public solicitation or sexually transmitted disease. Findings suggest that as a consequence of decriminalization, the psychological adjustment of homosexual men will increase and sexually transmitted diseases and public solicitation will decrease. These data are tentatively interpreted as indicating that there are few if any negative consequences of decriminalizing homosexuality, and a number of positive consequences.

Adult↗

PubMed2004

College student protective strategies and drinking consequences.

OBJECTIVE: This study explored the relationships between college student gender, alcohol use, protective strategies and harmful drinking consequences. METHOD: A derivation sample (N = 3,851; 54% women) and a replication sample (N = 4,151; 55% women) of undergraduate students completed the Campus Alcohol Survey (CAS) in classroom settings. RESULTS: Although women drank less than men and were less likely to experience harmful consequences, they were more likely to use protective strategies. Hierarchical regression analyses revealed that students who consumed at least six drinks when they partied--especially men-were less likely to experience more common consequences (e.g., poor academic performance, property damage, unconsciousness, riding in a vehicle with others who have been drinking) if they engaged in self-protective strategies. Such strategies also helped students who exceeded the median number of drinks to moderate the effect of drinking on less common consequences (e.g., vehicular accidents, class failure, conflicts with authorities). CONCLUSIONS: These findings add to the growing literature on contextual events that protect students from harm while drinking.

Adolescent↗

PubMed2004

Parental substance use consequences and adolescent psychopathology.

OBJECTIVE: This study examines the relationship between parental substance use consequences and adolescent psychological problems by gender of the adolescent and gender of the parent. METHOD: The data in this study were collected between 1989 and 1994 from 173 (116 proband and 57 control) families participating in the Collaborative Study on the Genetics of Alcoholism (COGA) project. All 173 adolescents (89 [51%] boys) completed the Structured Assessment Record of Alcoholic Homes (SARAH) to assess parental substance use consequences. In addition, the Semi-Structured Assessment for the Genetics of Alcoholism for Adolescents (C-SSAGA-A) was administered to all adolescents to obtain clinical psychiatric diagnoses. RESULTS: Concern about mother's substance use was significantly associated with adolescent alcohol dependence and major depressive disorder. In addition, concern about father's substance use was significantly related to adolescent alcohol dependence. Avoidance of mother when she was drinking or using drugs and maternal anger when drinking or using drugs also was significantly associated with adolescent alcohol dependence, conduct disorder and major depressive disorder. In contrast, avoidance of father and paternal anger when drinking or using drugs was not related to any of the adolescent diagnoses. CONCLUSIONS: These results suggest that maternal substance use consequences may be more closely linked to adolescent psychological adjustment than are paternal substance use consequences.

Adolescent↗