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PubMed1998

Alcohol use and related consequences among students with varying levels of involvement in college athletics.

Alcohol use, binge drinking, and substance abuse-related consequences among students with varying levels of participation in intercollegiate athletics were examined. Between October 1994 and May 1996, 51,483 students at 125 institutions answered questions about their involvement in athletics, ranging from noninvolvement to participant to leadership positions, on the long form of the Core Alcohol and Drug Survey. In comparisons with nonathletes, both male and female athletes consumed significantly more alcohol per week, engaged in binge drinking more often, and suffered more adverse consequences from their substance use. No support was found for the hypothesis that athletic leaders were more responsible than other team participants in using alcohol. Male team leaders appeared to be at significantly greater risk than female team leaders; they also consumed more alcohol, binged more often, and suffered more consequences than other team members.

Adult↗

PubMed1999

Nature and consequences of stressful life events in homosexual HIV-positive men: a review.

A great deal of research has been conducted into the stressful experiences that befall HIV-infected individuals. In this review we have focused on the work that has been conducted with HIV-positive homosexual males and have examined issues concerning the measurement, nature and consequences of stressful life events. It is apparent that, in consort with most other life events research, the measurement of events in this patient group is affected by methodological difficulties. Such difficulties may have, in particular, led to the observation by some investigators that HIV-positive homosexual men experience greater numbers of such events than their HIV-negative counterparts. It is also evident that, while some of these events are typical of those faced by individuals with other life threatening conditions, others are peculiar to this patient group. Research into the consequences of these events for emotional and behavioural functioning indicate that the effects are far-reaching. Similarly, data on the consequences of stressful events for immune function suggest that they may play a role in the progression of the disease, although these data are equivocal.

Acquired Immunodeficiency Syndrome↗

PubMed2004

A qualitative study of the consequences of 'hidden dysfunctions' one year after a mild stroke in persons <75 years.

BACKGROUND AND PURPOSE: Increased mental fatiguability, concentration and memory difficulties, irritability, emotional instability, impaired stress tolerance, and sound and light sensitivity, in this paper operationalized through the astheno-emotional syndrome (AE syndrome) are known consequences of stroke. The aim of this study was to explore how persons with AE syndrome, one year after a mild stroke, experienced the consequences of the syndrome in everyday life. METHOD: A qualitative design was used. Fifteen respondents were chosen by strategic sampling and interviewed. The analysis was done using a grounded theory method. RESULTS: Data analysis yielded harmed/threatened self as the core category with four main categories covering the dimensions of: hidden-apparent dysfunction, predictability-unpredictability, independence-dependence and active life-passive life. The model grounded in data shows the structural properties and the processes that verify the dynamics and interactions of the everyday life consequences of AE syndrome. CONCLUSIONS: AE syndrome with mental fatiguability as the most common symptom affected many dimensions of everyday life, which in turn affected performance of activities and independence. The symptoms were 'hidden' in many ways, not only indetectable in the appearance of the person, but also on a more symbolic level not apparent to the patient and persons in their environment. The symptoms changed with environmental circumstances and were experienced as unpredictable.

Adult↗

PubMed2005

Multilevel modeling in traffic safety research: two empirical examples illustrating the consequences of ignoring hierarchies.

OBJECTIVES: This commentary illustrates the advantages of multilevel modeling compared to statistical techniques that ignore hierarchies, based on two empirical traffic safety examples. METHODS: The common concept shared by different definitions of multilevel modeling is identified and illustrated. Each definition defines multilevel modeling in its own way but they all refer to hierarchies. Conceptual issues inherently related to hierarchies are then pointed out and illustrated. RESULTS: Broadly speaking there are two important consequences of ignoring a hierarchical structure in the data. The first consequence, underestimation of standard errors, is illustrated with data from an observational study on seatbelt behavior. Two effects that were significant at the 5% level in a single-level model were no longer found to be significant in a two-level model. The single-level model is therefore bound to lead to erroneous conclusions regarding variables that could have an impact on seatbelt use and, ultimately, on increasing the level of traffic safety. The second consequence, related to contextual information, is illustrated with data from a roadside survey on drink driving. Of particular interest is the relationship between Traffic Count, an aggregated level 2 explanatory variable and Odds of drink driving, an individual level 1 dependent variable. CONCLUSIONS: Like every statistical technique, multilevel models should be used with caution and reservation. However, given certain limitations, multilevel modeling is very useful and valuable to traffic safety research.

Accidents, Traffic↗

PubMed2004

Feared consequences of panic attacks in panic disorder: a qualitative and quantitative analysis.

Cognitions are hypothesized to play a central role in panic disorder (PD). Previous studies have used questionnaires to assess cognitive content, focusing on prototypical cognitions associated with PD; however, few studies have qualitatively examined cognitions associated with the feared consequences of panic attacks. The purpose of this study was to conduct a qualitative and quantitative analysis of feared consequences of panic attacks. The initial, qualitative analysis resulted in the development of 32 categories of feared consequences. The categories were derived from participant responses to a standardized, semi-structured question (n = 207). Five expert-derived categories were then utilized to quantitatively examine the relationship between cognitions and indicators of PD severity. Cognitions did not predict PD severity; however, correlational analyses indicated some predictive validity to the expert-derived categories. The qualitative analysis identified additional areas of patient-reported concern not included in previous research that may be important in the assessment and treatment of PD.

Adolescent↗

PubMed2006

The causes and consequences of overactive bladder.

Overactive bladder (OAB) is a syndrome characterized by symptoms of urinary urgency with or without urgency urinary incontinence (UUI), usually with frequency and nocturia. OAB affects approximately 17% of women in the United States and Europe. The causes of OAB, as with many bladder disorders, are multifactorial and are not completely understood. The primary functions of the lower urinary tract (bladder and bladder outlet mechanism) are storage and evacuation of urine. The bladder and the micturition cycle are under complex neural control involving both the sympathetic and parasympathetic nervous systems. Micturition may occur in response to the activation of receptors in the bladder muscle and detection of chemical stimuli by receptors within the bladder lining. Neurogenic or myogenic bladder dysfunction can lead to the symptoms of urgency, frequency, and UUI that characterize OAB. The consequences of this condition are far-reaching and include direct medical consequences and coping strategies that adversely affect quality of life. Although the prevalence of OAB increases with age, it is not a normal consequence of aging. Antimuscarinic agents (e.g., oxybutynin, tolterodine, trospium, solifenacin, and darifenacin) have demonstrated efficacy for the treatment of OAB symptoms in multiple clinical trials. This review explores the physiological basis for OAB, the effects of OAB on health-related quality of life, and the pharmacotherapies that may provide relief to patients with this distressing condition.

Adaptation, Psychological↗

PubMed2004

Consequences of falling in older men and women and risk factors for health service use and functional decline.

OBJECTIVES: (1) to examine consequences of falls in older men and women and (2) to examine risk factors for health service use and functional decline among older fallers. METHODS: the study was performed within the Longitudinal Aging Study Amsterdam. In 1998/1999, potential risk factors were assessed during the third data collection. In 1999/2000, 204 community-dwelling persons (> or =65 years) who reported at least one fall in the year before the interview, were asked about consequences of their last fall, including physical injury, health service use, treatment and functional decline (i.e. decline in functional status, social and physical activities). RESULTS: as a consequence of falling, respondents reported physical injury (68.1%), major injury (5.9%), health service use (23.5%), treatment (17.2%), and decline in functional status (35.3%), and social (16.7%) and physical activities (15.2%). Using multivariate logistic regression, specific risk factors for health service use after falling could not be identified. Female gender (OR = 2.8, 95% CI = 1.5-5.1), higher medication use (OR = 1.5, 95% CI = 1.0-2.2) and depressive symptoms (OR = 1.9, 95% CI = 1.3-2.8) were independently associated with functional decline after falling. Depressive symptoms (OR = 2.0, 95% CI = 1.2-3.3) and falls inside (OR = 2.6, 95% CI = 1.1-6.5) were risk factors for decline in social activities, while female gender (OR = 2.7, 95% CI = 1.1-7.0) and depressive symptoms (OR = 1.9, 95% CI = 1.2-3.0) were risk factors for decline in physical activities after falling. CONCLUSIONS: almost 70% of the respondents suffered physical injury, almost one-quarter used health services and more than one-third suffered functional decline after falling. No risk factors were found for health service use needed after falling. Female gender, higher medication use, depressive symptoms and falls inside were risk factors for functional decline after falling.

Accidental Falls↗

PubMed1994

Nutritional consequences of chronic maternal conditions during pregnancy and lactation: lupus and diabetes.

Few treated chronic conditions preclude the ability of a mother to conceive. However, consequences of the condition may undermine the pregnancy or aggravate maternal disease. Most chronic conditions require nutritional intervention beyond the normal needs of pregnancy. Insulin-dependent diabetes mellitus (IDDM) and systemic lupus erythematosus (SLE) are two common autoimmune disorders that affect women of childbearing age. Little has been published about the long-term consequences of current medication regimens for SLE and their interactions with either nutrient metabolism or requirements. More information is available on macronutrient dietary needs and metabolism during pregnancy and lactation in women with IDDM, but little is published about the metabolism of other nutrients in this condition. Thus, the nutritional consequences of treating these diseases during pregnancy and lactation must be evaluated continually.

Adult↗

PubMed2005

Investigation on the causes of stoichiometric error in genome size estimation using heat experiments: consequences on data interpretation.

BACKGROUND AND AIMS: In microdensitometry and flow cytometry, estimation of nuclear DNA content in a sample requires a standard with a known nuclear DNA content. It is assumed that dye accessibility to DNA is the same in the sample and standard nuclei. Stoichiometric error arises when dye accessibility is not proportional between the sample and standard. The aim of the present study was to compare the effects of standardization (external-internal) on nuclear fluorescence of two Coffea species and petunia when temperature increases, and the consequences on genome size estimation. METHODS: Two coffee tree taxa, C. liberica subsp dewevrei (DEW) and C. pseudozanguebarieae (PSE), and Petunia hybrida were grown in a glasshouse in Montpellier, France. Nuclei were extracted by leaf chopping and at least 2 h after nuclei extraction they were stained with propidium iodide for approx. 3 min just before cytometer processing. In the first experiment, effects of heat treatment were observed in mixed (DEW + petunia) and unmixed extracts (petunia and DEW in separate extracts). Nine temperature treatments were carried out (21, 45, 55, 60, 65, 70, 75, 80 and 85 degrees C). In a second experiment, effects of heating on within-species genome size variations were investigated in DEW and PSE. Two temperatures (21 and 70 degrees C) were selected as representative of the maximal range of chromatin decondensation. KEY RESULTS AND CONCLUSIONS: In coffee trees, sample and standard nuclei reacted differently to temperature according to the type of standardization (pseudo-internal vs. external). Cytosolic compounds released in the filtrate would modify chromatin sensitivity to decondensation. Consequently, the 'genome size' estimate depended on the temperature. Similarly, intraspecific variations in genome size changed between estimations at 21 degrees C and 70 degrees C. Consequences are discussed and stoichiometric error detection methods are proposed, along with proposals for minimizing them.

Coffea↗

PubMed2005

Long-term cardiovascular consequences of obesity: 20-year follow-up of more than 15 000 middle-aged men and women (the Renfrew-Paisley study).

AIMS: To examine the long-term cardiovascular consequences of obesity and project the cardiovascular consequences of the recent increase in prevalence of obesity. METHODS AND RESULTS: Between 1972 and 1976, 15 402 individuals aged 45-64, living in two towns in the west of Scotland underwent comprehensive cardiovascular screening. We analysed all deaths and hospitalizations for cardiovascular reasons occurring over the subsequent 20 years according to baseline body mass index (BMI) category. Compared with normal weight individuals (BMI 18.5-24.9), obesity (BMI > or =30) was associated with an increased adjusted risk of coronary heart disease (hazard ratio for death or hospital admission: 1.60, 95% CI 1.45-1.78), heart failure (2.09, 1.68-2.59), stroke (1.41, 1.21-1.65), venous thrombo-embolism (2.29, 1.60-3.30), and atrial fibrillation (1.75, 1.17-2.65). Obesity was associated with nine additional cardiovascular deaths and 36 additional cardiovascular hospital admissions for every 100 affected middle-aged men over the subsequent 20 years (seven deaths and 28 admissions in women). Assuming no change in cardiovascular risk profile and outcomes related to obesity, the increase in prevalence in 1998, when compared with 1972, is projected to lead to an additional four cardiovascular deaths and 14 admissions per 100 middle-aged men and women over the next 20 years. CONCLUSION: Obesity is associated with an increase in a broad range of fatal and non-fatal cardiovascular events. Consideration of only coronary, only fatal, and only first events greatly underestimates the cardiovascular consequences of obesity.

Body Mass Index↗

PubMed2004

The transition to widowhood and the social regulation of health: consequences for health and health risk behavior.

OBJECTIVES: This study estimates the effects of the transition to widowhood on changes in the social regulation of health and examines the consequences of this association for health and health risk behavior following spousal death. METHODS: Analysis of longitudinal data from the Changing Lives of Older Couples Study tests the following hypotheses: (a) Widowed individuals experience greater declines in health regulation over time than their married counterparts and (b) the extent to which widowhood undermines health and increases health risk behavior depends on whether it is accompanied by a decline in health regulation. RESULTS: Compared with their continually married counterparts, those who experience the transition to widowhood report a significant decline in the frequency of health reminders and health assistance received from others. The decline in the frequency of health regulation has important consequences for health behavior and health outcomes. Widowhood undermines health and increases health risk behaviors only when it is accompanied by a decline in health regulation. Widowed individuals who experience increases in health regulation show improvements in health and declines in health risk behavior. DISCUSSION: Interventions targeted at improving the health habits of widowed individuals by mobilizing health-related support systems may be effective at minimizing the negative health consequences of spousal loss.

Aged↗

PubMed2004

Fetal cells in maternal tissue following pregnancy: what are the consequences?

The presence and persistence of fetal cells in murine maternal tissue was first reported over 20 years ago, although it is only more recently that the occurrence and potential consequences of fetomaternal cell trafficking in humans have been fully appreciated. Fetal cell microchimerism is a growing field of investigation, although the data are contradictory relative to the health consequences of persistent fetal cells in maternal tissues. Understanding of the types of cells being transferred from fetus to mother, the location of these fetal cells within the various maternal tissue types, and the functionality of these cells may ultimately lead to measures to minimize or eliminate the deleterious effects of the cells, or to efforts to take advantage of the presence of these cells for therapeutic purposes. This review focuses on the origins of fetal cell microchimerism research and the different hypotheses regarding the consequences of persistent fetal cells in the mother, the various diseases that have been evaluated with respect to fetomaternal cell trafficking, the potential variables associated with the frequency, persistence and tissue distribution of fetal cells in maternal tissue, and an assessment of future direction in this innovative field of inquiry.

Animals↗

PubMed2005

Errors in the medication process: frequency, type, and potential clinical consequences.

OBJECTIVE: To investigate the frequency, type, and consequences of medication errors in more stages of the medication process, including discharge summaries. DESIGN: A cross-sectional study using three methods to detect errors in the medication process: direct observations, unannounced control visits, and chart reviews. With the exception of errors in discharge summaries all potential medication error consequences were evaluated by physicians and pharmacists. SETTING: A randomly selected medical and surgical department at Aarhus University Hospital, Denmark. STUDY PARTICIPANTS: Eligible in-hospital patients aged 18 or over (n = 64), physicians prescribing drugs and nurses dispensing and administering drugs. MAIN OUTCOME MEASURES: Frequency, type, and potential clinical consequences of all detected errors compared with the total number of opportunities for error. RESULTS: We detected a total of 1065 errors in 2467 opportunities for errors (43%). In worst case scenario 20-30% of all evaluated medication errors were assessed as potential adverse drug events. In each stage the frequency of medication errors were-ordering: 167/433 (39%), transcription: 310/558 (56%), dispensing: 22/538 (4%), administration: 166/412 (41%), and finally discharge summaries: 401/526 (76%). The most common types of error throughout the medication process were: lack of drug form, unordered drug, omission of drug/dose, and lack of identity control. CONCLUSION: There is a need for quality improvement, as almost 50% of all errors in doses and prescriptions in the medication process were caused by missing actions. We assume that the number of errors could be reduced by simple changes of existing procedures or by implementing automated technologies in the medication process.

Adult↗

PubMed1998

Relationship of parental psychological distress to consequences of chronic health conditions in children.

OBJECTIVE: To assess whether parents' self-reported psychological distress was related to consequences of chronic health conditions in their children as reflected by three domains: functional limitations, reliance on compensatory mechanisms, and service use above routine care. METHODS: We used telephone survey data on children's health and parents' psychiatric symptoms from an inner-city community sample (n = 380) and a population-based national sample (n =398). RESULTS: In the national sample, parents of children with functional limitations were more distressed than parents whose children experienced other types of condition consequences or none. In the inner-city sample, presence of a health condition was associated with greater parental distress, but there were no significant effects by consequence type. CONCLUSION: Research needs to determine if parents of children with functional limitations represent a high-risk group and to identify the factors associated with their elevated distress.

Adolescent↗

PubMed2002

Social consequences of children's pain: when do they encourage symptom maintenance?

OBJECTIVE: To examine the influence of social factors (e.g., attention, relief from responsibility) and children's perceived competence on pediatric symptom maintenance. METHODS: Participants were 151 pediatric patients (ages 8-18) with recurrent abdominal pain. They were interviewed at a clinic visit and again 2 weeks later. The Social Consequences of Pain questionnaire assessed four types of social consequences: positive attention, negative attention, activity restriction, and privileges. RESULTS: Two types of social consequences (positive attention and activity restriction) predicted greater symptom maintenance, but this effect was moderated by children's perceived self-worth and academic competence. To the extent that children rated their self-worth and academic competence as low, the impact of social factors on symptom maintenance was stronger. CONCLUSIONS: Children's success in their normal social roles may affect the extent to which they identify with the sick role and find it a rewarding alternative to other social roles.

Abdominal Pain↗

PubMed2000

Consequences of late referral on patient outcomes.

There is growing awareness of a need not only to identify patients with chronic renal failure (CRF) at an earlier stage in the disease process, but also to initiate treatment strategies earlier, in order to delay both progression of CRF and co-morbid diseases and to define the optimal time required to prepare CRF patients for renal replacement therapy (RRT). These three strategies are linked, and rely on appropriate identification of patients at risk of renal disease. The challenge currently facing nephrologists is both how to minimize the consequences of late referral and how to improve the timeliness of referral. Published studies support the notion that outcomes are poor in patients who access specialized nephrology care late in the course of their renal disease (just prior to the need for dialysis). A National Institute of Health consensus publication recommends early referral to a multidisciplinary renal care team, and the recent Canadian Society of Nephrology guidelines recommend that at least 12 months are needed prior to initiation of dialysis for adequate medical and psychological preparation for RRT. Despite these recommendations, a substantial proportion (20-50%) of patients starts dialysis without prior exposure to nephrologists. Limited data exist on current referral patterns to nephrologists. Diabetes and/or hypertension cause renal disease in up to 40% of patients requiring dialysis. These patients are presumably being monitored by internists, endocrinologists or cardiologists, and many referrals come from these physicians; other patients may be referred by general practitioners. Data regarding disease status at the time of referral are also limited. Substantial cardiovascular disease and risk factors are evident at the time of referral. Most of the literature describes data for those starting dialysis (i.e. late referral) rather than a broader spectrum of all patients with renal insufficiency referred to nephrologists. Reasons for late referral include insensitivity of current screening tools. Serum creatinine is well known to be an inaccurate marker of renal dysfunction, and too insensitive to identify patients with very early stages of disease, thus contributing to the prevalence of late referrals. Physician and patient attitudes are other barriers to early referral and need to be studied more fully. The consequences of late referrals include increased morbidity, mortality, and resource utilization. There is also an impact on patients' quality of life and missed opportunities for pre-emptive transplantation. Late referral also limits therapeutic options, and these limitations have consequences on long-term outcomes once patients are on dialysis. It is clear that late referral of patients with CRF obviates the opportunity for significant delay of disease progression and institution of proactive strategies to reduce the overall burden of illness in the population. There is ample evidence that strategies to delay progression of renal disease are effective, as are strategies to reduce cardiovascular disease. Anaemia and a fall in haemoglobin concentration have been associated with left ventricular hypertrophy and with growth of the left ventricle. A combined approach is necessary for best nephrological clinical practice, with a clear definition of early renal insufficiency; this will involve the development of tools to permit early identification of patients with early renal insufficiency, and the implementation of strategies to optimize treatments aimed at both delaying progression and preparing patients for RRT.

Family Practice↗

PubMed1996

Hemodynamic consequences of obstructive sleep apnea.

Patients with obstructive sleep apnea demonstrate both acute and chronic hemodynamic changes attributable to their disease. Acutely, these patients experience repetitive nocturnal hemodynamic oscillations. Sudden increases in heart rate and arterial pressure occur in association with decreases in left ventricular stroke volume immediately following apnea termination. These hemodynamic changes are likely attributable primarily to the effects of oxygen desaturation and arousal, an abrupt change in state. These acute changes occur against a background of altered cardiovascular control. Patients with sleep apnea, even when sleeping without obstructions, fail to display the normal nocturnal decline in arterial pressure of 10-15% from the waking value. The absence of a nocturnal decline may have chronic consequences, such as development of left ventricular hypertrophy. Another chronic hemodynamic consequence of sleep apnea may be sustained diurnal hypertension. Epidemiologic studies suggest individuals with sleep disordered breathing are at greater risk of daytime hypertension, even after controlling for other risk factors. Although sleep apnea may contribute to pulmonary, as well as systemic hypertension, sleep apnea alone does not appear to be a cause of decompensated right heart failure. Although knowledge of the hemodynamic consequences of sleep apnea has grown in recent years, much remains to be learned.

Adult↗

PubMed1997

Chronic pain-associated depression: antecedent or consequence of chronic pain? A review.

OBJECTIVE: To determine the current status for the association of chronic pain and depression and to review the evidence for whether depression is an antecedent or consequence of chronic pain (CP). DESIGN: A computer and manual literature review yielded 191 studies that related to the pain-depression association. These reports were reviewed and sorted into seven categories relating to the topic of this paper. Eighty-three studies were then selected according to inclusion criteria and subjected to a structured review. SETTING: Any medical treatment setting including pain treatment as inclusion criteria for selection of studies. PATIENTS: Any patients with any type of chronic pain. RESULTS: The reviewed studies were consistent in indicating that there is a statistical relationship between chronic pain and depression. For the relationship between pain and depression, there was greater support for the consequence and scar hypotheses than the antecedent hypothesis. CONCLUSIONS: Depression is more common in chronic pain patients (CPPs) than in healthy controls as a consequence of the presence of CP. At pain onset, predisposition to depression (the scar hypothesis) may increase the likelihood for the development of depression in some CPPS. Because of difficulties in measuring depression in the presence of CP, the reviewed studies should be interpreted with caution.

Brain Chemistry↗