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PubMed2001

Long term metabolic consequences of ileal pouch-anal anastomosis for ulcerative colitis.

OBJECTIVES: Chronic inflammation in the ileal pouch is the most significant late complication after ileal pouch-anal anastomosis (IPAA). It leads to changes in mucosal morphology, with consequent decreased vitamin B12, bile acid and cholesterol absorption documented. The aims of this study were to evaluate long term metabolic consequences at least 5 yr after IPAA and the influence of pouchitis on pouch histology and on bile acid, lipid, and vitamin B12, A, E, and D metabolism. METHODS: A total of 104 patients with a J-pouch who were operated on between 1985 and 1994, as well as 21 ulcerative colitis patients with a conventional ileostomy were enrolled for the study. Routine blood tests, vitamin status, vitamin B12 levels, and bile acid absorption were determined, as well as endoscopy with biopsies. The pouchitis disease activity index (PDAI) was calculated. On the basis of histology, IPAA patients were divided into three subgroups: 1) those with no villous atrophy, 2) those with partial villous atrophy, and 3) those with subtotal or total villous atrophy. RESULTS: Incidence of pouchitis was 42.3%, and was strongly associated with villous atrophy. In IPAA patients with subtotal or total villous atrophy (32.7%), serum levels of albumin, calcium, total cholesterol, triglycerides, and vitamin E were significantly reduced (p < 0.05). The lowest bile acid and vitamin B12 absorption rates were seen in patients with inflammation in the proximal limb. Vitamin D deficiency was seen in 10.6%, and vitamin A and B12 deficiency in approximately 5% of IPAA patients. CONCLUSIONS: Metabolic consequences after IPAA are associated with pouchitis, grade of villous atrophy, and extent of inflammation in the remaining ileum. Patients with active chronic inflammation need long term follow-up.

Adult↗
PubMed1979

Effect of prostaglandin E2 and of indomethacin upon cerebral and pulmonary consequences of exposure to hyperbaric oxygen in rats.

There are few data in the literature suggesting that endogenous prostaglandins (PGs) might be involved in the pathomechanism of seizures. Since the mechanism of seizures inducted by exposure to oxygen high pressure (OHP) is not fully elucidated, this study was designed to investigate the effect of exogenous PG s and of indomethacin (a Pg synthesis inhibitor) upon the development and consequences of seizures in rats exposed to OHP (5 ata). In the animals pretreated with PGE2 (1 ng/kg s.c.) pre-seizure time was shortened, lung weight : body weight index increased and symptoms of respiratory failure potentiated, as compared with the control group. Indomethacin (5 mg/kg i.p) prevented the development of seizures and of pulmonary consequences of OHP exposure. Biochemical examination of brains has shown that velocity of free radical oxidation of lipids (reactions manifested by the breakdown of phospholipid fatty acids, mainly unsaturated ones) enhanced by OHP exposure, is further potentiated in rats pretreated with PGE2. Electron microscopic study has shown the alterations similar to those seen in brain ischemia and/or hypoxia, and the magnitude of changes was related to the intensity of symptoms evoked by OHP. The results show that cerebral and pulmonary consequences of OHP exposure are potentiated by exogenous PGE2 and prevented by inhibition of endogenous PG synthesis. This suggests that PGs and/or their active metabolites might be involved in the mechanism of oxygen toxicity during exposure to hyperbaric oxygen.

Animals↗
PubMed2003

Health consequences of obesity.

The recent epidemic of childhood obesity(1) has raised concern because of the possible clinical and public health consequences.(2,)(3) However, there remains a widespread perception among health professionals that childhood obesity is a largely cosmetic problem, with minor clinical effects. No systematic review has yet focused on the diverse array of possible consequences of childhood obesity, though older non-systematic reviews are available.(4,)(5) In addition, no review to date has considered the vast body of evidence on the health impact of childhood obesity which has been published recently. The aim of the present review was therefore to provide a critically appraised, evidence based, summary of the consequences of childhood obesity in the short term (for the child) and longer term (in adulthood).

Adolescent↗
PubMed1997

Injury consequences from participation in professional rugby league: a preliminary investigation.

OBJECTIVE: To conduct a preliminary investigation to determine if injuries sustained while playing professional rugby league have long term consequences for players after retirement from their playing careers. METHOD: Twenty eight retired players, who had competed in the professional Australian Rugby League competition, responded to a 23 item survey. Respondents were asked to recall all injuries that resulted in them being unable to play for five or more consecutive games. The survey asked players to provide information about age, playing weight, number of games played, position played, number and type of major injuries sustained during their career, and the effects of these injuries both during their career and after retirement. RESULTS: Within the limitations of this study's small sample, it is suggested that players with long term consequences of injury may experience a variety of detrimental effects into retirement, including job limitations, reduced income earning potential, and increased personal medical costs. CONCLUSION: Although research relating to the type and severity of injuries sustained while playing rugby league has been previously undertaken, investigation into the effect injuries sustained during a professional career have on players after retirement has been neglected. This preliminary investigation suggests that retired professional rugby league players may have at least one long term consequence of injuries sustained during their playing career.

Absenteeism↗
PubMed2003

Molecular consequences of cystic fibrosis transmembrane regulator (CFTR) gene mutations in the exocrine pancreas.

BACKGROUND AND AIMS: We tested the hypothesis that the actual or predicted consequences of mutations in the cystic fibrosis transmembrane regulator gene correlate with the pancreatic phenotype and with measures of quantitative exocrine pancreatic function. METHODS: We assessed 742 patients with cystic fibrosis for whom genotype and clinical data were available. At diagnosis, 610 were pancreatic insufficient, 110 were pancreatic sufficient, and 22 pancreatic sufficient patients progressed to pancreatic insufficiency after diagnosis. RESULTS: We identified mutations on both alleles in 633 patients (85.3%), on one allele in 95 (12.8%), and on neither allele in 14 (1.9%). Seventy six different mutations were identified. The most common mutation was DeltaF508 (71.3%) followed by G551D (2.9%), G542X (2.3%), 621+1G-->T (1.2%), and W1282X (1.2%). Patients were categorized into five classes according to the predicted functional consequences of each mutation. Over 95% of patients with severe class I, II, and III mutations were pancreatic insufficient or progressed to pancreatic insufficiency. In contrast, patients with mild class IV and V mutations were consistently pancreatic sufficient. In all but four cases each genotype correlated exclusively with the pancreatic phenotype. Quantitative data of acinar and ductular secretion were available in 93 patients. Patients with mutations belonging to classes I, II, and III had greatly reduced acinar and ductular function compared with those with class IV or V mutations. CONCLUSION: The predicted or known functional consequences of specific mutant alleles correlate with the severity of pancreatic disease in cystic fibrosis.

Child↗
PubMed1994

Consequences for patients of health care professionals' conscientious actions: the ban on abortions in South Australia.

The legitimacy of the refusal of South Australian nurses to care for second trimester abortion patients on grounds of conscience is examined as a test case for a theory of permissible limits on the autonomy of health care professionals. In cases of health care professional (HCP) conscientious refusal, it is argued that a balance be struck between the HCPs' claims to autonomous action and the consequences to them of having their autonomous action restricted, and the entitlement of patients to care and the consequences for them of being refused such care. Conscientious action that results in the disruption or termination of health care services, however, is always impermissible on two grounds. Firstly, because it is at this point that the action '... invades a patient's autonomy, puts a patient at serious risk ... [and] treats a patient unjustly' (1) Secondly, because the consequences of such refusals turn them into political acts--acts of civil disobedience. It is arguable that in order for acts of civil disobedience to be legitimate, certain obligations are required of the dissenter by the community. It is concluded that the actions of the South Australian nurses, which have over the last few years both terminated and disrupted second trimester services, are morally impermissible.

Abortion, Legal↗
PubMed2002

Conditions and consequences of medical futility--from a literature review to a clinical model.

OBJECTIVES: To present an analysis of "futility" that is useful in the clinical setting. DESIGN: Literature review. MATERIAL AND METHODS: According to Medline more than 750 articles have been published about medical futility. Three criteria (language, time period, and the authors expressed their own opinions) singled out 43 of them. The authors' opinions about futility were analysed using the scheme: "If certain conditions are satisfied, then a particular measure is futile" and "If a particular measure is futile, then certain moral consequences are implied". RESULTS: Regarding conditions, most authors stated that judgments about futility should be made by physicians. The measure was usually some kind of medical treatment, and the goals related to quality of life, physiological improvement, or prolongation of life. The probability of success in reaching the goal was in most cases described in semiquantitative terms. Regarding consequences, the authors stated that health care professionals may (sometimes ought or should) withhold or withdraw a futile measure, most often after a dialogue with the patient (29 articles), but sometimes without informing the patient (nine articles), or with one-way information (four articles). Over time more and more articles recommend that the patient should be involved in joint decision making. Based on this literature review a clinical model was developed. CONCLUSIONS: The model, requiring that conditions and consequences should be made explicit, may, in "futility situations", facilitate both the collection of the necessary information and make the moral implications visible. It also makes communication about measures considered to be futile possible without using such ambiguous terms as "futile".

Attitude of Health Personnel↗
PubMed1992

A six year longitudinal study of the occupational consequences of drinking over "safe limits" of alcohol.

Although much research has focused on the psychological, social, and economic consequences of heavy problem drinking, there has been far less attention paid to the consequences of "moderate" drinking. This study used a unique opportunity to carry out a six year follow up of a cohort of male and female white collar workers in whom there was baseline information on alcohol consumption and access to details on sickness absence, labour turnover, and promotion. It has provided evidence that even moderate alcohol consumption in the working population is associated with social costs for the employer and the employee, including substantial sickness absence, and lack of promotion in men, although the increase in labour turnover was not statistically significant. The longitudinal examination of consumption in this study suggests that early intervention in a drinking career may reduce alcohol consumption and consequently avoid years of morbidity and sickness absence, as well as having a favourable influence on performance and labour turnover.

Absenteeism↗
PubMed1999

Analysis by sex of low back pain among workers from small companies in the Paris area: severity and occupational consequences.

OBJECTIVES: To describe workers with low back symptoms, to identify risk factors and to assess the occupational consequences separately in men and women. METHODS: A descriptive study was conducted between 1 October 1996 and 31 December 1996 in a sample of workers selected at random from all types of small companies in the Paris area. A group of 202 occupational physicians interviewed 7129 workers with a standardised questionnaire including the Nordic questionnaire. Data analysis was performed by sex in the two groups: with low back pain and without low back pain over the previous 12 months. The group with low back pain was then divided into four subgroups: mild cases (without referred pain), moderate cases (with referred pain above the knee), serious cases (with referred pain below the knee), and low back pain with occupational consequences. RESULTS: 7010 questionnaires were able to be evaluated. The sample consisted of 54.8% of men (3842) and 45.2% of women (3168), with a mean age of 37.8 and 37.0 years, respectively (p < 0.05). The following risk factors occurred significantly more often in men: high weight, height, body mass index (BMI), smoking, number of children, increased driving time and work time, material handling tasks, uncomfortable working positions. Most women were clerks (53%). Non-conditional logistic regression applied to the whole sample identified female sex as a risk factor (odds ratio (OR) = 1.85, 95% confidence interval (95% CI) 1.58 to 2.13). The following risk factors were common to both sexes: lifting weights > 10 kg, in women (OR 1.69, 95% CI 1.27 to 2.25) and in men (OR 1.27, 95% CI 1.06 to 1.53), uncomfortable working positions (OR 2.04, 95% CI 1.58 to 2.17 and OR 1.85, 95% CI 1.69 to 2.43), and absence of means to achieve good quality work (OR 1.39, 95% CI 1.19 to 1.63 and OR 1.38, 95% CI 1.15 to 1.65), respectively. Driving was a risk factor only in men and its importance increased with driving time (driving > 4 hours a day (OR 1.61, 95% CI 1.24 to 2.09)). Severe low back pain was linked to female sex (10.2% of women v 6.6% of men), high BMI, aging, and uncomfortable working positions. Low back pain with occupational consequences (n = 258) was not linked to sex, but only to aging and severity. CONCLUSIONS: The incidence and severity of low back pain were higher in women, although they seemed to be less exposed to known occupational risk factors. However, our results indicate a preponderance of these risk factors among female workers. Particular attention must therefore be paid to lifting of weights and uncomfortable working positions in female jobs (clerk, trading, health care staff).

Adult↗
PubMed1999

Knowledge of Chlamydia trachomatis genital infection and its consequences in people attending a genitourinary medicine clinic.

OBJECTIVES: To assess knowledge of Chlamydia trachomatis infections, with a comparison of knowledge of Neisseria gonorrhoeae infections. METHODS: A cross sectional survey, by self completed questionnaire, of 200 subjects attending a genitourinary outpatient clinic. RESULTS: The response rate was 82% (90 male and 73 female). 51% of men (60% of females) had heard of chlamydia. 65 (82%) were unaware of the potential consequences of infection. 66% were unaware that the disease could be asymptomatic. Significantly more men (77%) than women (60%) had heard of gonorrhoea. Most participants (68%-82%) knew little of the possible consequences of this infection, and only 26% were aware that it could be asymptomatic. Knowledge was higher regarding fertility topics. There was no correlation between knowledge and either age or socioeconomic status. However, greater knowledge was displayed by those who read health information leaflets always or often. For both men and women, the preferred source of health information was the doctor. Other popular sources were health information leaflets, women's magazines, and television. CONCLUSIONS: Barely half the participants had heard of chlamydia and gonorrhoea. Further knowledge of either infection was very poor. There are serious implications for public health. The reasons for this are unclear and require exploration before targeted health promotion. Doctors and the popular media are acceptable, and potentially effective, sources of information. Acquisition of knowledge is important, both to reduce sexual risk taking behaviour and its consequences, and to allow for informed consent for chlamydia screening programmes.

Adolescent↗
PubMed1994

Physiological consequences of the S-layer of Aeromonas salmonicida in relation to growth, temperature, and outer membrane permeation.

S-layers are paracrystalline protein multimers that cover the entire cell surface of many bacterial species. The presence of an S-layer in Aeromonas salmonicida (also known as A-layer) predisposed this bacterium to apparently unrelated physiological consequences: inhibition of growth at 30 degrees C, enhanced cell filamentation at 37 degrees C, and enhanced uptake of the hydrophobic antibiotics streptonigrin and chloramphenicol. Growth inhibition or enhanced filamentation was not observed when the native A-layer was missing or its arrangement altered, as in Ca(2+)-limited or Ca(2+)- and Mg(2+)-limited cells, in A-layer-negative (A-) cells with an artificially reconstituted A-layer, or in mutants unable to correctly assemble this layer. A-layer-positive cells (A+) were far more sensitive to the intracellularly acting antibiotics streptonigrin and chloramphenicol than were A- cells, and streptonigrin-resistant mutants were predominantly A-. Hemin, a compound known to specifically bind to the A-layer, alleviated streptonigrin toxicity to A+, but not A-, cells. As well, Ca(2+)- and Mg(2+)-limited cells, or mutants harboring A-layer defects had a reduced sensitivity to streptonigrin, and A- cells with reconstituted A-layers remained resistant to streptonigrin and chloramphenicol. Thus, the presence of a native A-layer arrangement on the cell surface, and not the mere presence of A-layer protein subunits, predisposed A. salmonicida toward the aforementioned physiological consequences. The A-layer is suggested to specifically effect these consequences, in particular the permeation of streptonigrin or chloramphenicol, by a specific interaction of A-layer subunits with the outer membrane.

Aeromonas↗
PubMed2004

Perceptual consequences of disrupted auditory nerve activity.

Perceptual consequences of disrupted auditory nerve activity were systematically studied in 21 subjects who had been clinically diagnosed with auditory neuropathy (AN), a recently defined disorder characterized by normal outer hair cell function but disrupted auditory nerve function. Neurological and electrophysical evidence suggests that disrupted auditory nerve activity is due to desynchronized or reduced neural activity or both. Psychophysical measures showed that the disrupted neural activity has minimal effects on intensity-related perception, such as loudness discrimination, pitch discrimination at high frequencies, and sound localization using interaural level differences. In contrast, the disrupted neural activity significantly impairs timing related perception, such as pitch discrimination at low frequencies, temporal integration, gap detection, temporal modulation detection, backward and forward masking, signal detection in noise, binaural beats, and sound localization using interaural time differences. These perceptual consequences are the opposite of what is typically observed in cochlear-impaired subjects who have impaired intensity perception but relatively normal temporal processing after taking their impaired intensity perception into account. These differences in perceptual consequences between auditory neuropathy and cochlear damage suggest the use of different neural codes in auditory perception: a suboptimal spike count code for intensity processing, a synchronized spike code for temporal processing, and a duplex code for frequency processing. We also proposed two underlying physiological models based on desynchronized and reduced discharge in the auditory nerve to successfully account for the observed neurological and behavioral data. These methods and measures cannot differentiate between these two AN models, but future studies using electric stimulation of the auditory nerve via a cochlear implant might. These results not only show the unique contribution of neural synchrony to sensory perception but also provide guidance for translational research in terms of better diagnosis and management of human communication disorders.

Acoustic Stimulation↗
PubMed2006

[Falls in the elderly in the community: prevalence, consequences, and associated factors].

OBJECTIVE: To find the prevalence, characteristics, and consequences of falls in the elderly and related factors. DESIGN. Cross-sectional, descriptive study using personal interviews. SETTING: Three health districts in Cordoba city, Spain. PARTICIPANTS: A stratified sample of 362 people over 70. MAIN MEASUREMENTS: The assessment tools were the WHO questionnaire for the study of falls and the EuroQol-5D for the measurement of health-related quality of life. Uni-bivariate and multivariate analyses (P< .05) were run. RESULTS: The prevalence of falls was 31.78% (95% CI, 26.99%-36.6%); 12.98% of subjects had more than one fall in the previous year; 55.3% of falls happened at home; 71.8% of the falls had physical consequences, with 7.8% fractures; 44.7% of the elderly studied were scared of having a new fall, and 22% limited their mobility after the fall. In 30% of cases there was contact with the health system, and 3.3% needed hospital admission. The factors related to a greater risk of falls were: being older, being a woman, widowed, uneducated, with difficulties in moving both arms, suffering space disorientation, high drug consumption, and having worse perceived health status. CONCLUSIONS: Falls in the elderly living in the community are a frequent problem, with important physical, psychological and social consequences.

Accidental Falls↗
PubMed2005

Does bicarbonate transfer have relevant hemodynamic consequences in standard hemodialysis?

BACKGROUND: In a previous study we demonstrated that mild metabolic alkalosis resulting from standard bicarbonate hemodialysis induces hypotension. This study aimed to compare hemodynamic consequences of either a decrease in the dialysate bicarbonate from 32 to 26 mmol/l or an increase in the dialysate calcium of 0.25 mmol/l and to verify whether the calcium shift secondary to alkalemia explains the consequences on blood pressure. METHODS: In this randomized controlled trial with a single-blind, cross-over design, we used dialysis liquids with two different bicarbonate (32 mmol/l in modalities A and C, and 26 mmol/l in modality B) and calcium (1.25 mmol/l in modalities A and B, and 1.50 mmol/l in modality C) concentrations, and in 27 patients, 243 dialysis sessions, compared blood pressure, heart rate and the incidence of hypotension. RESULTS: No significant differences were seen between A and B while an increase in systolic and diastolic blood pressures and a decrease in the incidence of hypotension (10.5 vs. 1.2%, p < 0.05) were documented in C. The subgroup of patients who with A showed a lower mean systolic blood pressure received more angiotensin-converting enzyme inhibitors or angiotensin II type-1 receptor blockers (36 vs. 0%, p<0.05) and in C showed a less important increase in systolic and diastolic pressures, but the incidence of hypotensive episodes between A and B was not significantly different (9.1 vs. 15.1%). CONCLUSIONS: In the present study it was not possible to demonstrate hemo dynamic instability associated with mild metabolic alkalosis. Even in the subgroup showing a lower blood pressure with a higher dialysate bicarbonate, significant hemodynamic or clinical consequences were not noticed. The calcium shift (0.05 mmol/l) related to alkalemia would justify a mean decrease in systolic blood pressure of only about 1 mm Hg.

Aged↗
PubMed1997

Health consequences of fat distribution.

Body fat distribution is now recognized as an important predictor of the adverse health consequences of obesity. Upper body obesity, especially with increasing visceral fat, is associated with hypertension, insulin resistance, dyslipidemia, type II diabetes mellitus and premature coronary death. Several lines of evidence suggest that abnormal adipose tissue lipolysis, resulting in elevated free fatty acid (FFA) availability, may contribute to some of the metabolic consequences of upper body obesity. The vast majority of the elevated systemic FFA release appears to come from upper body, non-splanchnic adipose tissue. Thus, dysregulation of upper body, non-splanchnic adipose tissue lipolysis may play an important role in contributing to health consequences of fat distribution.

Adipose Tissue↗
PubMed2000

Proinflammatory consequences of transgenic fas ligand expression in the heart.

Expression of Fas ligand (FasL) renders certain tissues immune privileged, but its expression in other tissues can result in severe neutrophil infiltration and tissue destruction. The consequences of enforced FasL expression in striated muscle is particularly controversial. To create a stable reproducible pattern of cardiomyocyte-specific FasL expression, transgenic (Tg) mice were generated that express murine FasL specifically in the heart, where it is not normally expressed. Tg animals are healthy and indistinguishable from nontransgenic littermates. FasL expression in the heart does result in mild leukocyte infiltration, but despite coexpression of Fas and FasL in Tg hearts, neither myocardial tissue apoptosis nor necrosis accompanies the leukocyte infiltration. Instead of tissue destruction, FasL Tg hearts develop mild interstitial fibrosis, functional changes, and cardiac hypertrophy, with corresponding molecular changes in gene expression. Induced expression of the cytokines TNF-alpha, IL-1beta, IL-6, and TGF-beta accompanies these proinflammatory changes. The histologic, functional, and molecular proinflammatory consequences of cardiac FasL expression are transgene-dose dependent. Thus, coexpression of Fas and FasL in the heart results in leukocyte infiltration and hypertrophy, but without the severe tissue destruction observed in other examples of FasL-directed proinflammation. The data suggest that the FasL expression level and other tissue-specific microenvironmental factors can modulate the proinflammatory consequences of FasL.

Age Factors↗
PubMed1995

Social consequences of psychiatric disorders, I: Educational attainment.

OBJECTIVE: This is the first in a series of investigations of the social consequences of psychiatric disorders based on the National Comorbidity Survey. Data on the relationship between preexisting psychiatric disorders and subsequent educational attainment are presented. METHOD: The National Comorbidity Survey is a nationally representative survey of 8,098 respondents in the age range 15-54 years. A subsample of 5,877 respondents completed a structured psychiatric interview and a detailed risk factor battery. Diagnoses of DSM-III-R anxiety disorders, mood disorders, substance use disorders, and conduct disorder were generated, and survival analyses were used to project data on school terminations to the total U.S. population. RESULTS: Early-onset psychiatric disorders are present in more than 3.5 million people in the age range of the National Comorbidity Survey who did not complete high school and close to 4.3 million who did not complete college. The most important disorders are conduct disorder among men and anxiety disorders among women. The proportion of school dropouts with psychiatric disorders has increased dramatically in recent cohorts, and persons with psychiatric disorders currently account for 14.2% of high school dropouts and 4.7% of college dropouts. CONCLUSIONS: Early-onset psychiatric disorders probably have a variety of adverse consequences. The results presented here show that truncated educational attainment is one of them. Debate concerning whether society can afford universal insurance coverage for the treatment of mental disorders needs to take these consequences into consideration.

Adolescent↗
PubMed2001

An examination of the unintended consequences of the rule-out sepsis evaluation: a parental perspective.

In order to document unintended consequences of the "rule-out" sepsis (ROS) evaluation, a survey of parents of infants who had undergone such an evaluation at Primary Children's Medical Center in 1997 was conducted. Sixty parents were interviewed. Parental perceptions of the sepsis evaluation and its impact on their families were recorded. Specific data evaluated included parental anxiety, impact on breastfeeding, perceived complications, financial stress, and parental preferences. The majority of parents found the ROS evaluation very stressful. Parental perception of illness increased significantly after being told the infant would require an ROS evaluation, with nearly 30% of parents, after speaking with a physician, believing their infant might die. Breastfeeding problems were reported by 36% of the mothers. Iatrogenic complications were reported by 33%. Although all infants were covered by some form of insurance, 43% of parents reported financial stress. Forty-two percent of parents would have preferred to be treated at home and all parents would prefer an evaluation that could be accomplished in 24 hours. We conclude that unintended consequences of the ROS evaluation included excessive parental anxiety, cessation of breastfeeding, iatrogenic complications, and financial stress. Suggestions to decrease these adverse consequences are given.

Bacteremia↗