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PubMed2000

Postmenopausal osteoporosis: fracture consequences and treatment efficacy vary by skeletal site.

At least half of all postmenopausal women will experience fractures during their lifetime, and the consequences are often serious, but most women at risk are not receiving adequate treatment. The objective of this paper is to summarize the literature concerning the consequences of osteoporotic fractures, and the effectiveness of pharmacologic agents for preventing fractures and their consequences, emphasizing a systematic, evidence-based summary of treatment results from randomized, controlled trials that were published previously. Osteoporosis is associated with increased risk of fractures at most skeletal sites. Hip fractures have much greater prognostic significance in terms of health than any other single type of fracture. However, symptomatic vertebral fractures and other non-hip fractures also represent enormous morbidity and economic burdens, and signal increased risk of future fractures of all types, including the hip. There is convincing evidence that two bisphosphonates (alendronate and risedronate) reduce the risk of both spine and non-spine fractures. The evidence for reducing hip fracture risk is greater for alendronate, with a consistent approximately 50% reduction in hip fractures across studies. Alendronate has also been demonstrated to maintain quality of life by reducing outcomes such as hospitalization and bed rest related to back pain. Among other agents, raloxifene reduces the risk of vertebral fractures by approximately 30%; the published evidence for most other agents is inconclusive. Osteoporosis should be regarded as seriously as other important chronic disorders such as hypertension and hyperlipidemia. Postmenopausal patients with a high risk of fractures--such as those with prior fractures or osteoporosis as measured by BMD--need to be treated. Although other therapeutic modalities are available, the evidence is most convincing for the bisphosphonates, alendronate and risedronate.

Fractures, Bone↗

PubMed2006

The subjective consequences of suffering a first episode psychosis: trauma and suicide behaviour.

BACKGROUND: The subjective impact of a psychotic breakdown can be profound, potentially resulting in loss of social roles, hopes and aspirations and leading to stigmatisation, trauma and elevated suicide risk. This study aimed to assess the subjective effect and consequences of suffering a first episode of psychosis. It was hypothesised that suicide behaviour would be associated with the negative consequences of psychosis and co-morbid symptomatic-PTSD. METHODS: Patients were assessed by means of a semi-structured interview on their reactions and experience of their psychotic episode and its treatment and by means of standardised methods for psychotic (PANSS) and trauma-related (CAPS) symptoms. RESULTS: A total of 35 patients suffering their first episode of psychosis were interviewed. As a result of the onset of their illness, 77% indicated they had suffered loss or disruption to their life, 60% had thwarted future aspirations, 38% had suffered violence or harassment, 53% had suffered stigma and 50% social exclusion. Totally, 80% felt they had been traumatised by their treatment and 38% were cases for symptomatic-PTSD. Symptomatic-PTSD was significantly associated with involuntary hospitalisation but not psychotic symptoms. Positive psychotic symptoms were associated with harassment, stigma and social exclusion. Suicidal ideation was reported by 40% and 31% reported attempting suicide. Suicidal behaviour was greater in those suffering symptomatic-PTSD but this was not significant, suicidal behaviour was significantly associated with the experience of trauma, but not the severity of that trauma, prior to the onset of their psychosis. CONCLUSIONS: The negative consequences of a psychotic episode are significant. The potential iatrogenic effect of psychiatric care needs to be considered. Interventions need to be developed to reduce traumatisation and suicide risk.

Adult↗

PubMed2000

[Selective kidney angiography within the scope of heart catheterization: pathological findings and therapeutic consequences].

BACKGROUND: The importance of renal artery stenosis as a cause of refractory hypertension, recurrent pulmonary edema and renal failure is being increasingly recognized. The prevalence and clinical consequences of renovascular and macroscopic renal parenchymal pathology in patients undergoing coronary angiography is assessed prospectively. PATIENTS AND METHODS: Selective renal artery angiography was performed in 190 consecutive patients following coronary angiography and prior to PTCA if indicated. Diagnostic yield, therapeutic consequences, complications and fluoroscopy time were noted. RESULTS: Mean age as 63 (+/- 11) years, 74% of patients were males. Mean fluoroscopy time (including PTCA or PTA) was 8 (+/- 11) minutes. The pathological renal and renovascular findings included critical atherosclerotic renal artery stenosis in four patients (2%), non critical (angiographically < 60%) stenosis in 22 patients (12%), double arterial supply on one side in 26 patients (14%), on both sides in seven patients (4%), fibromuscular dysplasia in two patients (1%) and large renal cyst, renal artery aneurysm and aberrant blood supply of an ectopic pelvic kidney in one patient (0.5%). The four patients with critical renal artery stenosis underwent primarily successful PTA and stenting. CONCLUSIONS: Selective renal angiography in the wake of coronary angiography is safe and inexpensive. Furthermore, it can be performed easily in the majority of cases. The diagnostic yield of renal angiography ist not negligible; 2% of patients had critical renal artery stenosis with an unequivocal indication for an interventional procedure. Progression of (as yet) nonsignificant renal artery stenosis is reported in a large number of cases, meaning that early diagnosis may have later therapeutic consequences. Ad hoc PTA and stenting is the treatment of choice for significant renal artery stenosis.

Aged↗

PubMed1998

Psychological consequences of road traffic accidents in children.

Questionnaire information about possible psychological changes in the months following their accident was obtained for 45 school age children who had attended an Accident and Emergency Department because of their involvement in road traffic accidents. Central nervous system involvement was rare in this group. Short-term psychological consequences were common, but even after 4-7 months 33% were considered by their parents to still have a moderate reaction and a further 11% were considered to be severely affected. The children had high levels of post-traumatic stress symptoms, particularly avoidance in over 50%. Travel anxiety was described in 39%, 23% were depressed and 14% highly anxious--features which were considered by parents to have appeared following the accident, often with increasing disturbance over time. Other apparent repercussions were nightmares and other sleep difficulties in 17%, accident related fears, irritability, anger and emotionally regressed behaviour. As head injury was very uncommon in this series, such psychological consequences were attributable to non-neurological factors. Parents had become more protective of their children and placed greater restrictions on their travel, causing conflict. Younger children, those who had not fully recovered from their accident injuries, and children who also had a parent involved in the same accident, were most at risk. Greater awareness of these psychological consequences of road traffic accidents is required on the part of parents and professionals. Prospective studies are also needed to delineate more precisely those at greatest risk and to assess the effectiveness of treatment approaches.

Accidents, Traffic↗

PubMed2005

ALDH2 and CYP2E1 genotypes, urinary acetaldehyde excretion and the health consequences in moderate alcohol consumers.

Deficiencies in mitochondrial low-Km aldehyde dehydrogenase (ALDH2) activity, and consequently high blood acetaldehyde levels, have been suggested to relate to various diseases in Japanese, including esophageal cancer. In the present study, 200 men aged 35-59 years randomly selected from an occupational population were analyzed for the association of ALDH2 genotypes and cytochrome P450-2E1 (CYP2E1) genotypes with the urinary excretion of acetaldehyde (which is bound to some chemicals in the urine) and with common alcohol-related health consequences. Urinary acetaldehyde excretion was increased, reflecting increased alcohol consumption even in this moderate alcohol-consuming population. Neither the ALDH2 nor the CYP2E1 genotypes showed significant influence on the elevation of urinary acetaldehyde excretion. Neither these genotypes nor urinary acetaldehyde concentration significantly affected blood pressure, serum aspartate aminotransferase and gamma-glutamyl transferase activities, or serum HDL-cholesterol and lipid peroxide concentrations. It was concluded that acetaldehyde accumulates in moderate alcohol consumers irrespective of ALDH2 and CYP2E1 genotype, and that the implications of these genotypes and acetaldehyde accumulation in terms of common alcohol-related health consequences were obscure. The results also suggest that the carcinogenicity of acetaldehyde on esophageal mucosa depends greatly upon repeated exposure to high blood acetaldehyde, even through transient rather than chronic exposure.

Acetaldehyde↗

PubMed1985

Evaluations and consequences of assertive behavior.

Male and female high assertive and low assertive subjects observed videotaped scenes of actors exhibiting assertive, empathic-assertive, and nonassertive behavior in response to unreasonable requests made by acquaintances. Subjects provided evaluative ratings of actors in the different scenes and rated the likelihood of various consequences that might follow from the actors' behaviors. Generally, empathic-assertive behavior was more positively received than assertive behavior. Empathic assertion received high ratings on dimensions of competence and likeability and was associated with expectations of positive consequences of a social (i.e. requestor's reactions to the actor's behavior) or personal (i.e. the actor's own feelings) nature. In contrast, both empathic-assertion and assertion were believed to result in more negative long-term consequences (i.e. the effect the actor's responses will have on the relationship in the long run) than nonassertive behavior. These effects were modified by the sex of the requestor and the sex and assertiveness of the subject, but unaffected by the sex of the actor. Implications of these findings for research and training of assertive behavior are discussed.

Assertiveness↗

PubMed1996

The expression of anger and its consequences.

Cluster analysis, using TRYSYS key cluster variable analyses, on 59 anger expression items replicated Spielberger's Anger-In and Anger-Control dimensions and revealed seven additional forms of anger expression: Noisy Arguing, Verbal Assault, Physical Assault-People, Physical Assault-Objects, Reciprocal Communication, Time Out, and Direct Expression. Aggressive dimensions (Noisy Arguing, Verbal Assault, Physical Assault-People and -Objects) correlated positively with each other and with trait anger and negatively with non-aggressive forms of expression (Control, Reciprocal Communication, and Time Out). The latter were positively correlated with each other and negatively with trait anger. Forms of expression correlated logically with the frequency of eight types of anger consequences, and there was evidence of distinct relationships between anger expression and anger consequences; e.g. Physical Assault-People correlated most with frequency of physical altercations, and Noisy Arguing and Verbal Assault with the frequency of verbal fights. Males were more likely to utilize aggressive forms of expression and to suffer consequences involving physical and verbal fights and property damage. Results are discussed in terms of convergent and discriminant validity, and in terms of their implications for assessment, treatment, and future research.

Adaptation, Psychological↗

PubMed1992

Some consequences of stimulus variability on speech processing by 2-month-old infants.

The present study explores how stimulus variability in speech production influences the 2-month-old infant's perception and memory for speech sounds. Experiment 1 focuses on the consequences of talker variability for the infant's ability to detect differences between speech sounds. When tested with high-amplitude sucking (HAS) procedure, infants who listened to versions of a syllable, such as [symbol: see text], produced by 6 male and 6 female talkers, detected a change to another syllable, such as [symbol: see text], uttered by the same group of talkers. In fact, infants exposed to multiple talkers performed as well as other infants who heard utterances produced by only a single talker. Moreover, other results showed that infants discriminate the voices of the individual talkers, although discriminating one mixed group of talkers (3 males and 3 females) from another is too difficult for them. Experiment 2 explored the consequences of talker variability on infants' memory for speech sounds. The HAS procedure was modified by introducing a 2-min delay period between the familiarization and test phases of the experiment. Talker variability impeded infants' encoding of speech sounds. Infants who heard versions of the same syllable produced by 12 different talkers did not detect a change to a new syllable produced by the same talkers after the delay period. However, infants who heard the same syllable produced by a single talker were able to detect the phonetic change after the delay. Finally, although infants who heard productions from a single talker retained information about the phonetic structure of the syllable during the delay, they apparently did not retain information about the identity of the talker. Experiment 3 reduced the range of variability across talkers and investigated whether variability interferes with retention of all speech information. Although reducing the range of variability did not lead to retention of phonetic details, infants did recognize a change in the gender of the talkers' voices (from male to female or vice versa) after a 2-min delay. Two additional experiments explored the consequences of limiting the variability to a single talker. In Experiment 4, with an immediate testing procedure, infants exposed to 12 different tokens of one syllable produced by the same talker discriminated these from 12 tokens of another syllable.(ABSTRACT TRUNCATED AT 400 WORDS)

Arousal↗

PubMed1993

Ulceration, unsteadiness, and uncertainty: the biomechanical consequences of diabetes mellitus.

Diabetes mellitus, which results from a failure of the endocrine system to control blood glucose levels within normal limits, affects approximately 15% of the population over the age of 65 in developed countries. Between 20-50% of people with diabetes for more than 10 years will experience symmetrical distal sensory neuropathy resulting in a progressive, distal to proximal, loss of sensation in the lower extremities. The most common consequence is plantar ulceration that too often results in partial or total amputation of the foot. While neuropathy is a major permissive factor, plantar ulcers occur at locations of high plantar pressures. The measurement of pressure using tools developed and refined in the field of biomechanics has been shown to be a valuable asset to the management of the foot at risk for ulceration. In particular, the use of in-shoe measuring techniques has the potential to revolutionize the prescription of therapeutic footwear. Biomechanical techniques have also helped to evaluate other consequences of diabetic neuropathy on the foot such as callus formation, foot deformity, limited joint mobility and bony abnormalities. The reduction of afferent information from the lower extremities implies a lack of active feedback thought to be necessary for the control of human movements such as posture and gait. Our results show that diabetic neuropathy results in a significant increase in sway during standing that is not compensated for by other sensory systems. The study of the sagittal plane movements of the same individuals walking on a treadmill showed little effect on the kinematic control of gait when compared to age matched nonneuropathic control groups. This may indicate the dominance of efferent input over afferent feedback during gait. We believe that the study of the biomechanical consequences of diabetes can act as a model for many other diseases that have yet to come under the scrutiny of a multidisciplinary team.

Biomechanical Phenomena↗

PubMed1989

Taste-to-postingestive consequence conditioning: is the rise in sham feeding with repeated experience a learning phenomenon?

Although the progressive increase in intake with repeated sham feeding experience is assumed to reflect the extinction of learned satiety, the involvement of associative learning in this phenomenon has never been directly demonstrated. We show that: a) animals attenuate sham feeding on initial exposure only with foods tasting like those they have fed normally before, and b) latent inhibition, which retards the formation of CS-US associations in classical conditioning preparations, prevents the association of a taste with its postingestive consequences. These data suggest both that learning plays a role in the development of sham feeding and that associative linking of a food's taste with its postingestive consequences occurs during ingestion. The present results identify properties of taste-to-postingestive consequence conditioning and indicate how the sham feeding preparation can be used to identify the physiological events mediating this learning.

Animals↗

PubMed1984

Perceived vulnerability in adolescents to the health consequences of cigarette smoking.

Adolescent feelings of vulnerability, an aspect of the Health Belief Model and Elkind's concept of adolescent egocentrism, were examined in two groups of white, middle-class 6th to 12th graders. Feelings of vulnerability were examined with respect to developmental course, antecedents, and relationship to the specific risk-taking behavior of cigarette smoking. Feelings of vulnerability to the negative consequences of smoking were found to decrease rapidly from sixth to eighth grade and to increase slowly thereafter. Experience with illness and accidents was correlated with the general vulnerability measure. However, experience with illness due to smoking was not related to smoking vulnerability. This may have been because few adolescents were found to have had personal experiences with the health consequences of smoking. Feelings of vulnerability with respect to the negative consequences of cigarette smoking were correlated with adolescent smoking behavior. General feelings of vulnerability were unrelated to cigarette smoking.

Adolescent↗

PubMed1986

Perceived personal immunity: the development of beliefs about susceptibility to the consequences of smoking.

Students ages 10 to 18 were given the task of estimating the probability of four possible consequences of cigarette smoking: heart trouble, cancer, carbon monoxide in alveolar air, and breathlessness during strenuous exercise. Subjects made estimates for generalized others who smoke, for themselves as hypothetical lifelong smokers, and for their actual selves. Comparisons of generalized others with hypothetical self and of hypothetical self with actual self suggest that subjects engage in significant denial. Smokers denied their susceptibility more than nonsmokers for generalized others and for themselves as hypothetical lifelong smokers. Compared with nonsmokers, smokers admitted an increased likelihood of experiencing the consequences of smoking when they predicted for their actual self, suggesting some objective awareness of their increased risk status. Smokers saw themselves as highly susceptible to carbon monoxide and breathlessness. This lends support to the current focus on instruction about immediate consequences of smoking as being potentially efficacious in deterring smoking in youth.

Adolescent↗

PubMed1982

Causes and consequences of harsh parental punishment. An empirical investigation in a representative sample of 570 German families.

This article examines a multifactorial model of causes and consequences of harsh parental punishment. The social-psychological model as developed by Gelles was extended to also include the antecedent conditions leading to rigid assertion of parental power relating to the child. Furthermore, personality problems of the child observable as consequences of harsh parental punishment were included in our model. The conditions which predict harsh parental punishment are--in the rank order of their importance: a child perceived as difficult to handle, i.e., a "problem child"; parental anger-proneness; the rigid assertion of parental power; and intra-familial problems and conflicts. As consequences of harsh parental punishment and rejection as perceived by the child, two types of personality problems were observed: a syndrome named "Conduct Disorder" and a syndrome including personality problems such as anxiety and helplessness.

Child↗

PubMed1988

School sexual abuse prevention: unintended consequences and dilemmas.

In view of the recent proliferation of school sexual abuse prevention programs and materials, this article critically examines current assumptions about the role of elementary school personnel in prevention and possible unintended consequences of such assumptions. These unintended consequences include emphasizing a simple solution to a complex social problem and contributing to victim blaming. Some dilemmas that arise for classroom teachers around predeveloped curricular materials and mandatory reporting are also explored. Teacher use of predeveloped materials may mean a diminishing of wider teaching skills and reduction of complex concepts to brief, noncontroversial interventions that may serve to mystify sexuality and unduly frighten students. Mandatory reporting, as it is frequently presented to teachers, can create further dilemmas by obscuring the ethical decisions inherent in the process, assuming consistently positive outcomes after reporting, and neglecting the context in which teachers work. The authors suggest that educators should be aware of these possible unintended consequences and dilemmas in order to maintain a broad perspective on child sexual abuse and to focus their efforts more effectively within a larger network addressing the problem.

Child↗

PubMed1983

Health systems as defences against the consequences of poverty: equity in health as social justice.

The main development problems in the Third World are known to be gross socioeconomic inequality, widespread poor health status accompanied by high fertility and infant mortality rates, low life expectancy, mass illiteracy and mass poverty. In most of these countries governments invest a great deal of scarce resources toward the consequences of poverty rather than it causes. The paucity of resources for such social services is exacerbated by continuously increasing demands and needs which have to be satisfied. Unmet needs tend to cause apathy in the population. For purposes of controlling poverty and its consequences, these must be clearly formulated and relevant policies, a commitment to implement such policies, adequate administrative capacity and reasonably adequate resources. In the case of the health services system, the same requirements apply. Above all, the health system has to be directed toward the greatest needs of the population. This must involve policy makers, implementors and the consumer community. This paper argues that health systems cannot be an effective weapon against the consequences of poverty unless the above kinds of policy exist and are implemented.

Africa↗

PubMed1992

Development and validation of the PCQ: a questionnaire to measure the psychological consequences of screening mammography.

We have developed a reliable and valid questionnaire to measure the psychological consequences of screening mammography. The questionnaire measures the effect of screening on an individual's functioning on emotional, social, and physical life domains. Content validity was ensured by extensive review of the relevant literature, discussion with professionals and interviews with attenders at a pilot Breast X-ray Screening Program in Melbourne, Australia. Discriminant validity was assessed by having expert judges sort items into dimensions which they appeared to be measuring. Acceptable levels of concordance (above 80%) with a priori classifications were found. Concurrent validity was demonstrated by comparison of subscale scores of 53 attenders at the Breast X-ray Program with an independent interview assessment of dysfunction on each of the emotional, social and physical dimensions. There was over 79% agreement between interview scores and questionnaire scores for each dimension. Construct validity was confirmed by showing that subscale scores varied in predicted ways. For women who were recalled for further investigation, scores on each subscale measuring negative consequences, were higher at the recall clinic than at screening clinic (emotional: t = -7.28; df = 70; P less than 0.001; physical: t = -2.53; df = 70; P = 0.014; social: t = -2.49; df = 70; P = 0.015). The internal consistency of all subscales was found to be acceptable. This questionnaire is potentially useful for assessing the psychological consequences of the screening process and should have wide application.

Female↗

PubMed1995

From headloading to the iron horse: the unequal health consequences of railway construction and expansion in the Gold Coast, 1898-1929.

This paper examines the health consequences of railway construction and expansion in the Gold Coast (present day Ghana) between 1898 and 1929. More specifically, it examines the differential effects of colonial railway development for the different socio-economic groups of the Gold Coast society. The case study utilizes sociological and historical perspectives to analyse primary historical data on the health of the three groups most affected by the Gold Coast railways: expatriate railway workers, African railway workers and African communities living both within and outside the immediate vicinity of the railways. The study unearths evidence of largely positive health consequences for expatriate workers and African elites, and considerable negative health consequences for the Africans employed as railway labourers, the newly created urban poor as well as those Africans living in the rural areas.

Accidents↗

PubMed1995

Periodically modulated inhibition and its postsynaptic consequences--I. General features. Influence of modulation frequency.

Our aim was to examine the relation, or "synaptic coding", between spike trains across a synapse with inhibitory postsynaptic potentials when the presynaptic rate is modulated periodically and the postsynaptic cell is a pacemaker. Experiments were on the synapse in crayfish stretch receptor organs. Spike trains were considered point processes along time; the time series of corresponding pre- and postsynaptic intervals were extracted. Analyses used displays of intervals along time and order ("basic graphs", and "rasters", respectively), displays of differences between intervals along order ("recurrence plots"), cycle histograms (as such and as Lissajous diagrams with presynaptic and postsynaptic on the abscissae and ordinate, respectively), and correlation histograms. Cycle histograms and correlation histograms demonstrated that all presynaptic modulation frequencies (1/60-10 Hz) are reflected postsynaptically; novel frequencies may arise, not always relating simply to the pre- or postsynaptic ones. The transferred frequency domain is broad and physiologically meaningful. Indeed, vitally important functions have strong periodicities in all portions of the explored domain, and so do the discharges of participating neurons. Overall, pre- and postsynaptic discharges change oppositely, one accelerating while the other slows. Locally, however, pre- and postsynaptic discharges contrast clearly in other ways. The presynaptic evolution is everywhere smooth and orderly, half-cycles usually are symmetric, and there is a single kind of discharge, as expected because the presynaptic axon follows well the controlling stimuli. The postsynaptic cycle shows marked local distortions. These involve presynaptic domains called "congruent portions" where changes are in the same sense (e.g., joint accelerations), "saturated" domains where postsynaptic discharges are arrested, and asymmetric sensitivities to presynaptic change with hysteretic loops in the Lissajous diagrams; the postsynaptic discharge is heterogeneous showing dissimilar forms in succession. Congruent portions are either "positive segments" with pre- to postsynaptic rate ratios practically 1:1, 2:1, 1:1, or parts of Lissajous loops. Different modulation frequencies have different postsynaptic consequences. Differences involve the width and number of positive segments, the proportion of the cycle with saturation, the sense, magnitude and lead-lag characteristics of the hysteretic loops, etc. Because their consequences are separable, frequencies are classified within categories labelled "low" (under 0.5 Hz), "high" (between 0.5 and 5.0 Hz) and "very high" (over 5.0 Hz). Categories arise widely but each prevails in different biological functions (e.g., low or high in, respectively, respiration or vibratory sensitivity). The refactoriness of the inhibitory fibre affects how it can be modulated: consequently, the very high category resembles pacemaker discharges and was not analysed.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗