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PubMed2004

Cytogeneticists' stories around the ethics and social consequences of their work: a New Zealand case study.

This paper is based on anthropological research in three New Zealand cytogenetics laboratories involving participant observation carried out over three months and interviews with sixteen cytogeneticists in order to elucidate the distinctive characteristics of their views on the social consequences of their work in prenatal genetic testing. The discourses employed by cytogeneticists to describe their work are placed against other discourses in the contemporary debate surrounding prenatal genetic testing, i.e. clinical, ethical, feminist, social science and disability rights. In general, cytogeneticists frame their moral responsibilities in terms of the need to carry out what we have termed 'distanced care' of both the mothers being tested and the foetal cells which they cultivate in the laboratories. Certain paradoxes arise in these accounts of their work however, such as the idea of distanced care versus their demonstrated personalisation of the foetal cells with which they work and also between their burdensome awareness of the consequences for individual women of their karyotyping and their repeated references to the ethical and social consequences of their work as being determined by society not by their own actions.

Abortion, Eugenic↗
PubMedDate not supplied

The many faces of HIV nephropathy: results of the disease and consequences of treatment.

Impaired renal function is a consequence of HIV infection, even without a defined AIDS syndrome. While collapsing focal and segmental glomerulosclerosis is the clinical entity that is associated most commonly with progressive disease, the spectrum of renal involvement in patients who are HIV positive is expanding. In addition, consequences of anti-retroviral therapy are well-documented in the literature. The current case illustrates an unusual primary renal pathology picture presumably related to his underlying HIV disease and compounded by the unexpected consequences of anti-retroviral therapy, noted long after discontinuation of the medication.

AIDS-Associated Nephropathy↗
PubMed1992

[Priority tasks of the common program for the clean-up of the consequences of the accident at the Chernobyl Atomic Electric Power Station].

The paper is concerned with the problems pertaining to the implementation of the State Union-Republic program of urgent measures for 1990-1992 and Republican programs of the elimination of Chernobyl accident consequences. Among the basic priorities covered by the program, the author regards the problems of the living of the population at the polluted areas, criteria for accepting decisions as to the possibility of further living or settling out together with favourable and unfavourable consequences of such a measure as settling out. Emphasis is laid on some priorities of the optimal use of means alloted for implementing the programs of the elimination of Chernobyl accident consequences.

Accidents↗
PubMed2005

The third phase of HIV pandemic: social consequences of HIV/AIDS stigma & discrimination & future needs.

An overview of social responses to AIDS, characterized by high levels of stigma, discrimination central to the global AIDS challenge, as related to human dignity is described. Stigma is conceptualized as a problem of 'they' and 'us', or interactions perspective. Causes and consequences to enable the varied perspectives in understanding this third epidemic of social impact of HIV/AIDS are described. In the absence of an effective medical intervention, the social factors like stigma and discrimination attached to HIV/AIDS are a major obstacle in the curtailment of the disease requiring urgent action. The different forms of stigma associated with other diseases are compared. Ignorance about the disease, fear of discrimination and consequent denial for testing and treatment, contribute to spread of the disease. The disease status adds to vulnerability especially in women. The disease is often identified with groups like intravenous drug users (IDUs), and homosexuals who face a double stigma as a result of HIV. Research scenario on stigma associated with HIV/AIDS is reviewed to understand the future needs. Initiatives of ongoing intervention to reduce stigma exist globally. Emerging issues in research priorities have been highlighted to counter consequences of pandemic from social perspective of human dignity and rights.

Discrimination, Psychological↗
PubMed1991

[Epidemiologic and economic impact of child accidents: intensive care and accident consequences in Savoie].

In the context of a descriptive study of accidents occurring to children aged less than 16 yr old conducted in 1986 in Savoie, France (333,200 inhabitants; 74,400 children), the present survey focuses on their consequences during an 18-month period after hospitalization. The authors evaluate both the epidemiological impact of the accidents (14.2% of hospitalized children had mid-term consequences; 6.4% had sequelae, one-third of which were serious) and their economic impact: the medical and social costs of the consequences amounted to 1.4 million francs, totalizing almost 10.5 millions francs for the global cost of the accident after 18 months, in the Savoie department. The authors emphasize the difficulties of making such evaluations.

Accidents↗
PubMed2005

Use of description logic classification to reason about consequences of penetrating injuries.

The consequences of penetrating injuries can be complex, including abnormal blood flow through the injury channel and functional impairment of organs if arteries supplying them have been severed. Determining the consequences of such injuries can be posed as a classification problem, requiring a priori symbolic knowledge of anatomy. We hypothesize that such symbolic knowledge can be modeled using ontologies, and that the reasoning task can be accomplished using knowl-edge representation in description logics (DL) and automatic classification. We demonstrate the capabilities of automated classification using the Web Ontology Language (OWL) to reason about the consequences of penetrating injuries. We created in OWL a knowledge model of chest and heart anatomy describing the heart structure and the surrounding anatomic compartments, as well as the perfusion of regions of the heart by branches of the coronary arteries. We then used a domain-independent classifier to infer ischemic regions of the heart as well as anatomic spaces containing ectopic blood secondary to the injuries. Our results highlight the advantages of posing reasoning problems as a classification task, and lever-aging the automatic classification capabilities of DL to create intelligent applications.

Anatomy↗
PubMed2006

Community heritability measures the evolutionary consequences of indirect genetic effects on community structure.

The evolutionary analysis of community organization is considered a major frontier in biology. Nevertheless, current explanations for community structure exclude the effects of genes and selection at levels above the individual. Here, we demonstrate a genetic basis for community structure, arising from the fitness consequences of genetic interactions among species (i.e., interspecific indirect genetic effects or IIGEs). Using simulated and natural communities of arthropods inhabiting North American cottonwoods (Populus), we show that when species comprising ecological communities are summarized using a multivariate statistical method, nonmetric multidimensional scaling (NMDS), the resulting univariate scores can be analyzed using standard techniques for estimating the heritability of quantitative traits. Our estimates of the broad-sense heritability of arthropod communities on known genotypes of cottonwood trees in common gardens explained 56-63% of the total variation in community phenotype. To justify and help interpret our empirical approach, we modeled synthetic communities in which the number, intensity, and fitness consequences of the genetic interactions among species comprising the community were explicitly known. Results from the model suggest that our empirical estimates of broad-sense community heritability arise from heritable variation in a host tree trait and the fitness consequences of IGEs that extend from tree trait to arthropods. When arthropod traits are heritable, interspecific IGEs cause species interactions to change, and community evolution occurs. Our results have implications for establishing the genetic foundations of communities and ecosystems.

Animals↗
PubMed2006

Infertility and assisted reproduction in Denmark. Epidemiology and psychosocial consequences.

Clinically a couple is considered to be infertile after at least one year without contraception and without pregnancy. There was scant knowledge about the prevalences of infertility, involuntary childlessness and the seeking of fertility treatment and only few longitudinal studies about the psychosocial consequences of infertility and its treatment. This thesis is about the epidemiological aspects of infertility; the conceptualization and measurement of important psychosocial aspects of infertility; and a medical sociological analysis of the associations between these psychosocial variables among Danish women and men in fertility treatment. The thesis is based on nine papers. The three main purposes were: (i) to review critically, population based studies of infertility and medical care seeking in industrialised countries. Further, to examine these prevalences and subsequent motherhood among women in former assisted reproduction in a Danish population. (ii) To develop measures of psychosocial consequences of infertility: fertility problem stress, marital benefit, communication, coping strategies, attitudes to and evaluation of fertility treatment. (iii) To examine these phenomena and to analyse their interrelations among Danish women and men in fertility treatment. The thesis is based on four empirical studies: (i) The Women and Health Survey, a cross-sectional population-based study among 15-44 year old women (n=907, 25-44 year old) in Copenhagen County, 1989. (ii) The Psychosocial Infertility Interview Study, a qualitative interview study among 16 couples (n=2 participants) infertility treatment at The Fertility Clinic, Herlev University Hospital,1992. (iii) The Infertility Cohort, a longitudinal cohort study consecutively including all couples (n=250 participants) beginning anew fertility treatment period at one of four public (Braedstrup, Herlev, Odense, Rigshospitalet) and one private fertility clinic (Trianglen),2000-2002. (iv) The Communication and Stress Management Training Programme, an intervention study among couples(n=74 participants) in fertility treatment at The Fertility Clinic, The Juliane Marie Centre, Rigshospitalet, 2001-2003. Included is also a literature review of population-based infertility studies from industrialised countries. Data from (iii) and (iv) are studies from The Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme (www.compipro.dk). Epidemiological and demographic studies investigating the prevalences of infertility differed in how they defined the numerator (the infertile participants) and the denominator (the population at risk). It was important to calculate reliable estimates of the infertility prevalence by including only women who had tried to have at least one child in the population at risk, as a notable proportion of women in the fertile ages had not (yet) attempted to become a mother. The lifetime prevalence of infertility in the representative population-based study was 26.4%. In the age group 35 to 44 years 5.8% were primarily involuntarily in fecund (involuntarily childless). Even in a country with access to fertility treatment in a public health-care system without self-payment lower education was a predictor of lower treatment seeking. In the cohort study (2000-2002)of couples starting a new period of assisted reproduction treatment 62.6% reported a treatment-related pregnancy at the one-year follow-up. In total 32.4% reported a treatment-related delivery. In total 24.2% reported a current continuing pregnancy and spontaneous pregnancies accounted for 2.7% of these. We developed measures of fertility problem stress, marital benefit(that infertility has brought the partners closer together and strengthened their marriage), partner communication, infertility related communication, coping strategies, attitudes to fertility treatment and evaluation of care. The medical sociological analyses showed that the variables of psychosocial consequences of infertility and treatment are interwoven with each others in a complex pattern, a pattern that both differed and was similar when comparing women and men. The infertility-related communication strategy (secrecy, formal, open-minded)identified in the qualitative interviews was later confirmed in the COMPI Infertility Cohort. Using the formal strategy and not talking about the emotional aspects of infertility and its treatment suggested high fertility problem stress. The coping strategies studied showed significant social differences and active-avoidance coping was a significant predictor of high fertility problem stress. A positive effect of infertility on the marriage, marital benefit was common. Men using the secrecy communication strategy had increased risk of low marital benefit. Difficult partner communication was a significant predictor of high fertility problem stress and among men, of low marital benefit. The intervention study showed that it was possible for the participants to change their communication with partner and other people close to them and that participants achieved an increased awareness of what, how much and when to discuss with others. High fertility problem stress and high marital benefit were associated with high importance ratings of patient-centred care and intentions to use professional psychosocial services. Among women, high fertility problem stress was a predictor of lower satisfaction ratings with fertility treatment. High marital benefit was a predictor of high satisfaction ratings of both medical and patient-centred care. In conclusion, infertility is a common experience among couples attempting to become parents. Assisted reproduction in the public health-care system in Denmark has high success rates, i.e. pregnancies,deliveries and high patient satisfaction. A large minority of people in fertility treatment experience high fertility problem stress,and some use communication and coping strategies that predicts high stress. Developing and evaluating different psychosocial interventions are necessary to offer the psychosocial support needed for this minority of fertility patients.

Adaptation, Psychological↗
PubMed2007

Packed red blood cell transfusion in the intensive care unit: limitations and consequences.

OBJECTIVE: To review the literature on the limitations and consequences of packed red blood cell transfusions, with particular attention to critically ill patients. METHODS: The PubMed database of the National Library of Medicine was searched to find published articles on the indications, clinical utility, limitations, and consequences of red blood cell transfusion, especially in critically ill patients. RESULTS: Several dozen papers were reviewed, including case series, meta-analyses, and retrospective and prospective studies evaluating the physiological effects, clinical efficacy, and consequences and complications of transfusion of packed red blood cells. Most available data indicate that packed red blood cells have a very limited ability to augment oxygen delivery to tissues. In addition, the overwhelming preponderance of data accumulated in the past decade indicate that patients receiving such transfusions have significantly poorer outcomes than do patients not receiving such transfusions, as measured by a variety of parameters including, but not limited to, death and infection. CONCLUSIONS: According to the available data, transfusion of packed red blood cells should be reserved only for situations in which clear physiological indicators for transfusion are present.

Anemia↗
PubMed1989

Adolescent pregnancy and its consequences.

The consequences of childbearing for adolescent parents, their children, and society are severe. We have focused exclusively on one consequence of adolescent sexual activity, namely, pregnancy. In so doing we are not denying the presence of other serious consequences of sexual activity, including sexually transmitted diseases, particularly the acquired immunodeficiency syndrome. For almost all young people, pregnancy should be prevented or at least delayed. Prevention is difficult, however, because it involves understanding the complexities of adolescence as a stage in the development of the individual. It also requires increased understanding of the behavioral and cultural origins of adolescent sexual activity and pregnancy. Physicians are among those with a reasonable understanding of the individual and societal factors that influence the sexual activity of adolescents. Because of their contacts with patients and families, including adolescents, they are in a pivotal position to recognize early sexual activity, to counsel young people about ways to prevent pregnancy, and to prescribe contraceptives when appropriate. Physicians should consider taking leadership positions in the community in both educational efforts and preventive services. In some communities, physicians work closely with educators in developing and teaching family life programs in the schools. They also are in influential positions to improve the availability of preventive contraceptive services through development of community-based services. The Robert Wood Johnson High-Risk Youth Programs are an excellent example of the types of community-based services that should be provided for adolescents. Physicians can serve as an educational resource about a wide spectrum of health issues for young persons and their families and communities.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Induced↗
PubMed1988

HIV: epidemiology, immunopathogenesis, and clinical consequences.

HIV infection is a global problem, with the largest number of cases occurring in the United States. HIV affects men, women, and children with varying frequency in different parts of the world. The spectrum of HIV infection and its consequences is broad. HIV, a retrovirus, is responsible for gradual and progressive damage to the human immune system. Over the course of years (more than 7 in many), the resultant deficiency in cell-mediated immunity leaves the host susceptible to infections, malignancies, and possible neuropsychiatric abnormalities. Current efforts to better understand this virus, its interaction with the human immune system, its clinical consequences, and its detection will continue to bring us closer to finding effective means of preventing and treating HIV infection. In addition, an understanding of the epidemiology, immunopathogenesis, and clinical consequences of HIV infection will contribute to a more knowledgeable approach to caring for HIV-infected individuals and anticipating their many needs.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Medico-social consequences of asthma in children (author's transl)].

The author proposes a study of the medico-social consequences of asthma. Having shown the impossibility of a monolithic conception of asthma, he shows how much it is conditioned in the child by his social and family surroundings. Different levels of consequences are considered: restraints linked to the therapeutics of a chronic disease, effect on physical activity and leisure, importance of the repercussions on school life (absenteeism and slowness). In conclusion, the author stresses both the importance of these consequences on the personal and professional future of the child and the need to define high risk groups corresponding to criteria based on seriousness and social environment for whom the prevention of these repercussions must have priority.

Absenteeism↗
PubMed1981

Hemodynamic consequences of endotoxemia in sheep.

Sheep which have been previously prepared for cardiopulmonary studies and collection of lung lymph were given 0.75 micrograms/kg of E coli endotoxin iv. This induced sepsis produced a triphasic response. Phase 1 occurs during the first hour after endotoxin administration and is characterized by a decreased cardiac output, lymph to plasma protein ratio, neutrophil count, and an increased hematocrit, total plasma protein concentration, lymph flow, and pulmonary artery pressure. During phase 2 these variables tend to return toward their baseline values. Phase 3 begins 2.5 hr after the administration of endotoxin and shows many of the same changes that were observed in phase 1. Also during the late phase, the plasma protein concentration and lymphocyte count were reduced and the lymph to plasa protein ratio was increased. It is concluded that (1) An early fall in cardiac output occurs as a consequence of hypovolemia. The decreased volume is the result of fluid movement from the vascular compartment to the interstitial space consequent to a microvascular pressure increase. Since the changes occur coincidentally with a drop in neutrophil count, these cells may bear some causal relationship to the response. (2) The late fall in cardiac output in phase 3, also the result of a diminished vascular volume, occurs secondarily to extravasular fluid movement as a consequence of both an elevated microvascular pressure and an increased permeability to protein. The latter may be causally related to a fall in lymphocytes.

Animals↗
PubMed1994

Assortative mating in somatic traits and its consequences.

The problem of assortative mating embraces non-random mating of spouses. However, it is often discussed together with its consequences, which results from the fact that when we study similarities between spouses at various stages of their acquaintance and/or living together we must take into consideration not only the criteria of mating but also the consequences like, for instance, "resembling" (synchronous changes in husband and wife) and perhaps compensation of one's traits. This problem has not been sufficiently examined so far and further studies are necessary (Wolaánski 1970c, Nikityuk and Filipov 1975, Kasprzak and Wolański 1977, Thiessen and Gregg 1980, James 1989). The problem of assortative mating involves both the reasons principally genetic-evolutionary problems (Pearson 1896, Wolański and Siniarska 1983, 1984)--and the consequences as well, like, for instance homosis, that is transmitting to the offspring similar genes from defined loci, and heterosis, that is transmitting the different genes. Thus problem constitutes genetic foundations of auxology. Also an ecological problem is added, namely a synchronous resemble changes of spouses connected with similar living conditions and life style. Assortative mating seems to be a simple problem but in fact it is a scientific problem in which genetic, ecological and auxological approaches are combined. Below we will discuss assortative mating from these angles with reference to some anthropological traits. As a matter of fact, assortative mating is concerned with such a fundamental problem in the biomedical and social sciences as development the traits of the offspring (organism level) and of the whole future generations (population level). This is a problem of great importance by no means theoretical only. In our studies the main emphasis has been on spouses similarities in the morphological, physiological and psychomotor traits and also on some changes in the successive generations (which was connected with the lasting of marriage before the moment of investigations). The variations of traits of the populations were also taken into consideration as well as the effects of assortative mating of spouses on the development of their children. The above mentioned problems will constitute the contents of the present chapter. Studies on assortative mating have had a long tradition in Poland and most probably are one of the earliest in the world, apart from those conducted by Pearson (1896) in Great Britain and the Anonymous ones from 1903. This pertains mostly to B. Rosiński's (1923, 1925, 1926, 1929) investigations conducted in Poland in 1918 and on Polish immigrants to Brazil in 1931 and USA in 1929-30 (Stołyhwo 1931, Rosiński 1934).

Anthropometry↗
PubMed1995

[Consequences of laser CO2 treatment of cervical intraepithelial neoplasias on the anatomic and functional integrity of the cervix].

OBJECTIVES: Retrospective study to analyse objectively the effectiveness and anatomic and functional consequences for the cervix of conservative CO2 laser treatment for cervical intraepithelial neoplasia. PATIENTS AND METHODS: Analysis of therapeutic effectiveness and anatomic consequences of 1,114 treated patients followed at our colpolaparotomy surgery clinic for cervical dysplasia since 1987. Evaluation of function consequences by comparison with a group of patients who delivered after laser CO2 therapy for dysplasia (n = 56) and a group of control patients (n = 95) with a similar type of dysplasia after delivery and no treatment. The clinical course of the pregnancy and delivery were compared between the groups in search for risk of prematurity. RESULTS: Good preservation of cervical anatomy was achieved after a rigorous treatment protocol only applicable with CO2 laser. The preservation of the junctional zone facilitated diagnosis of recurrence. The risk of prematurity was low. Therapy was successful in 93.4% of the cases. CONCLUSION: The choice of conservative therapy is essential, not only when the patient desires a pregnancy but also in others since preserved anatomy facilitates diagnosis of recurrence. This findings implicate the need for an unagressive energy source and also accepting the early diagnosis and treatment.

Female↗
PubMed1994

Splitting as a consequence of severe abuse in childhood.

Clinical data suggest that Kernberg's description of splitting as a defense mechanism is useful in conceptualizing the psychological consequences of abuse in childhood in certain patients. The splitting in these patients is similar to his description of splitting in borderline patients in that it compartmentalizes and sequesters certain overwhelming and painful ego states accompanying negative introjects of the betraying primary object and the betrayed self. These sequestered introjects, furthermore, act as automatons, generating behaviors that arbitrarily re-enact their content even though the patient remains consciously unaware of their historical meaning. Another consequence of the sequestration of these traumatic introjects is that their affects retain their initial power and primitive quality, unmodulated by the usual homogenizing process that is a part of the synthesis of part-object introjects into whole-object introjects; the sequestration, therefore, often painful in itself, must nevertheless be rigidly maintained lest traumatic anxiety in the face of overwhelming affects be re-experienced. Shengold calls the sequence of events that results in this brittle but stubborn painful constriction of the personality "soul murder." He borrowed the phrase from Freud who used it to refer to what Schreber had suffered at the hands of his sadistic father. That phrase--"soul murder"--may sound melodramatic, but it powerfully conveys what these patients communicate of their experience of themselves. As with Kernberg's patients, the defensive splitting serves to protect the positive introjects. These patients fear their negative introjects, even more than they feel uncomfortable about the split. They fear their desperate rage will destroy their love objects, and leave them feeling abandoned and hating themselves. As one of my patients put it: "I fear that my destructive anger will leave me all alone in a sea of rubble of my own making." In the transference, he feared destroying me and our positive bond. In these cases it would seem that the turning to splitting occurred at a later age than it does with Kernberg's borderline patients. His proposition is that the developmentally normal "splitting," related to the undifferentiation of the infantile ego, persists as a defensive splitting, perhaps as a consequence of a consistently derailed mother-child dialogue; whereas in my patients it would seem that the normal developmental splitting had waned as ego differentiation proceeded, but that in the face of overwhelming traumata at perhaps 3 or 4 years of age, the primitive defense was invoked regressively.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

[Late consequences of cranio-cerebral traumas in light of clinical, psychologic and computerized tomography examinations].

The paper presents remote consequences of cranio-cerebral traumas in a selected group of 62 patients with a varying degree of severity. Neurological, psychological consequences as well as changes in morphology of brain tissues have been taken into consideration. The aim of the paper was to evaluate the neurologic--psychological state, and to perform analyses covering the morphological changes of encephalon in remote (3 months--3 years) period after the cranio-cerebral trauma, and also to study the interdependences between the severity of injury on the one hand, and the clinical--psychological status as CT scan of the head in the late period, on the other. Disability features ware disclosed in a total of 39% of the examined subjects. Diminution of general mental capability was recorded in 43% of persons studied. There were changes in remote CT scanning in 81% of cases, whereas internal hydrocephalus was disclosed in 47% of the examined subjects. A high degree of interdependence was found to exist between the severity of cranio-cerebral trauma, the remote result of therapy and the changes in brain tissues morphology. Definitely the poorest therapeutic result was observed in individuals with post-traumatic internal hydrocephalus. Wide applicability of Bander's organic test was shown for evaluating the character of late psychic consequences in subjects in the remote period after cranio-cerebral trauma. In the overwhelming part of cases, the observed neurologic-psychological disturbances could be related to changes in brain morphology revealed by CT scanning.

Adolescent↗
PubMedDate not supplied

[Consequences of discrepancies between current data of the science and medical practice].

The target population for drug treatment is composed of all patients likely to benefit from it. It is defined on the basis of all the data collected during the clinical evaluation of the therapy (on the studied population). The dissemination population comprises those patients who are given the therapy once it has been released. Several surveys have shown that these two population do not coincide, although they should. The consequences of this gap can theoretically be measured. However, in order to do such an evaluation, we need relevant indices representing the consequences in terms of lack of expected benefit for the patients. We constructed models that represent the gap and its impact on life span and explored them by simulation. It came out that the consequences can be assessed in practice provided that outcome measurement technology is applied.

Controlled Clinical Trials as Topic↗