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PubMed1996

Cerebral consequences of hypertension: where do they lead?

BACKGROUND: Hypertension is a major risk factor for two distinct kinds of vascular problems: complications of atherosclerosis including myocardial and cerebral infarction, as well as complications of hypertensive small vessel disease, including renal failure, intracerebral hemorrhage and lacunar infarctions. If these consequences were solely due to elevation of blood pressure, they should be equally prevented by treatments that reduce blood pressure. OBSERVATION: The installation of a computed tomography (CT) scanner in our hospital before the initiation of a large study by the Department of Family Medicine markedly increased the detection and treatment of hypertension in our region. As a result, we found that treating high blood pressure prevented arteriolar but not atherosclerotic strokes. HYPOTHESIS: Our observation raises questions about the nature of hypertension, which can be regarded as a disorder of fluid energy, with arteriolar consequences being due to elevated pressure, and atherosclerotic consequences being related to kinetic energy, derived from pressure energy when flow patterns become disturbed. It is hypothesized that the remodelling of arteries to conform to flow patterns may be driven by increased nitric oxide at regions of high shear, leading the artery to 'grow away' from high shear, whereas endothelin released in regions of low shear may cause the artery to 'fill in' the low shear region. This may, in part, explain the protection that women enjoy until menopause, as estrogen increases nitric oxide release and probably reduces endothelin production in the endothelium. PREDICTORS OF ATHEROSCLEROSIS PROGRESSION: The pressure kinetic construct has led to studies on the effects of antihypertensive drugs on flow disturbances in arteries leading, in turn, to studies on the relationship between mental stress and atherosclerosis. We have shown that the rise in blood pressure during mental stress is a stronger predictor of atherosclerosis progression than any of the standard risk factors such as age, sex, blood pressure, smoking, lipids or diabetes. The regression model used to make explicit the effect of stress responses on atherosclerosis not only offers a powerful new way to identify new causes of atherosclerosis, but also leads to a new quantitative trait, the rate of progression of atherosclerosis not explained by the Framingham risk factors. This trait, "unexplained atherosclerosis progression', in combination with three-dimensional ultrasound measurement of atherosclerosis, may lead to the discovery of new genes for atherosclerosis and thus help to manage the genetic heterogeneity of this disease.

Adaptation, Physiological↗

PubMedDate not supplied

[Reflections on the cause and consequences of exposure to violent presentations in children].

The article deals with the questions why children and adolescents nowadays have an intensive use of violent videos and which are the consequences of this use. The motives of the use are compensation and flight of daily problems and of inner psychic emptiness, identification with grandiose heroes, the experience of anxiety-joy, protest against the parents' generation and the test of courage to obtain a social status in the peer group. The consequences of violent presentations can be understood by different psychological concepts as social cognitive learning theory, suggestion hypothesis, justification hypothesis, habituation hypothesis, catharsis theory, priming effect, arousal theory. These findings lead to the following consequences: Media critical lectures at school, governmental protection of children against harmful products, solution of the underlying social problems which lead to resignation and hopelessness in children and adolescent.

Adolescent↗

PubMed1998

The pathogenesis and consequences of AGE formation in uraemia and its treatment.

Advanced glycation endproducts (AGEs) accumulate in uraemia as a consequence of diminished clearance of low molecular weight forms which retain their reactivity and may subsequently combine with circulating and tissue macromolecules. Successful renal transplantation is the only form of renal replacement therapy which effectively clears these circulating AGEs; both haemodialysis and peritoneal dialysis are comparatively ineffective although high-flux haemodialysis confers some benefits. De novo AGE formation may be accelerated in uraemia due to carbonyl and oxidative stress leading to further accumulation. The consequences for the patient with chronic renal failure may be acceleration of vascular disease, renal failure progression and dialysis-related amyloidosis. Accelerated peritoneal AGE formation as a consequence of treatment with peritoneal dialysis fluids may be detrimental to peritoneal membrane function but does not appear to contribute to systemic elevation of AGEs.

Cardiovascular Diseases↗

PubMed1998

[Dysthymia and cyclothymia--serious consequences of rarely diagnosed disorders].

Dysthymia and cyclothymia are chronic affective disorders with a minimum duration of 2 years. Both ICD-10 and DSM-IV define cyclothymia as a bipolar disorder with low intensity. This disorder is rare and little research has been done on it. Its economic and social consequences vary from case to case. In contrast dysthymias, chronic depressive disorders, are frequent (prevalence 3-6%) and cause considerable distress. They have serious economic and social consequences, which are comparable to those caused by other chronic conditions such as arthritis or diabetes mellitus. Despite widely held conviction a majority of dysthymias improves under consequent pharmaco- and psychotherapy.

Cyclothymic Disorder↗

PubMed1999

Diagnostic and therapeutic consequences of repeat brain imaging and follow-up vascular imaging in stroke patients.

BACKGROUND AND PURPOSE: Recently, the diagnostic and therapeutic importance of repeat radiologic imaging in stroke patients has been questioned. The aim of this study was to show the therapeutic and diagnostic consequences of both repeat brain imaging and follow-up vascular imaging in this group of patients. METHODS: Neuroradiologic images and reports as well as clinical records of 317 patients (209 men and 108 women; mean age, 63 years) were reviewed retrospectively to determine the number of modifications made to the diagnosis and therapeutic regimen and to the classification of neuroradiologic findings. RESULTS: Two hundred thirty-eight repeat imaging procedures were performed in 171 patients. Of these, 76 were vascular imaging examinations (11 CT angiograms, 13 MR angiograms, 52 digital subtraction angiograms) and 162 were cross-sectional brain imaging studies (54 MR images, 108 CT scans). Forty of the 76 vascular imaging procedures and 77 of the 162 repeat cross-sectional brain imaging studies led to important diagnostic modifications with consequences for the patients' therapy and prognosis. CONCLUSION: Our study establishes that vascular imaging methods as well as cross-sectional brain imaging used as repeat imaging procedures in stroke patients can have important diagnostic and therapeutic consequences. We believe that repeat imaging in selected subgroups will be cost-effective.

Angiography, Digital Subtraction↗

PubMed1992

Somatic consequences of violence against women.

The rapidly growing literature on the somatic, nonpsychiatric effects of violence on women's health is reviewed, including rape, battery, and the adult consequences of child sexual abuse. The sequelae of these victimizations are summarized with consideration of acute effects (genital and nongenital injuries, sexually transmitted disease, and pregnancy), late consequences (chronic pelvic pain and other forms of chronic pain, gastrointestinal symptoms, premenstrual symptoms, and negative health behaviors), and long-term increases in the use of medical services. A recurrent theme across the literature is that the medical treatment of all types of victimized women can be improved by providing attention to the underlying cause of their symptoms. Achievement of this goal requires that physicians identify victimization history and provide access to appropriate support services. Because all forms of violence against women are prevalent among primary care populations, and victimization is clearly linked to health, health care providers cannot afford to miss this relevant history. The article concludes with suggestions for fostering and responding to disclosures of victimization.

Female↗

PubMedDate not supplied

The electronic house call. Consequences of telemedicine consultations for physicians, patients, and society.

Within the next 10 years, telemedicine technology is likely to become widely available in physicians' offices and patients' homes. Rather than describing the technology of telemedicine, we discuss the implications of its widespread use among physicians, patients, and society as a whole, focusing on that mainstay of communication between physician and patient, the "electronic house call." After exploring the new relationship that is likely to develop between patients and physicians as a consequence of the use of telemedicine, we discuss the broader economic, legal, and political consequences of the widespread use of this technology.

Communication↗

PubMed1999

Iatrogenic diseases as a reason for admission to the intensive care unit: incidence, causes, and consequences.

BACKGROUND: Data on iatrogenic diseases (IDs) have been recorded for the past 25 years. We determined whether aging of the general population and medical advances, including more powerful drugs and complex procedures, have altered the incidence, causes, and consequences of severe IDs during this period. METHODS: One-year retrospective study was conducted in an adult medical-surgical intensive care unit (ICU) affiliated with a French general hospital in an area of 200 000 inhabitants. All the patients admitted to the ICU during 1994 were screened for IDs. Patients with community or hospital-acquired IDs on admission were included. Follow-up assessed morbidity, mortality, workload, and costs of care for IDs, and the rate of preventable IDs. were included; the cause of the ID was drugs in 41, medical acts in 12, and surgical acts in 15. These 68 patients were in the ICU for 472 days, with a 13% fatality rate (9 patients) and a financial cost of US $688 470. They were not different from the 555 other ICU patients in terms of severity, mortality, workload, and length of stay in the ICU. Risk factors for ID were old age and the number of prescribed drugs. The rate of preventable ID was 51%. CONCLUSIONS: Iatrogenic diseases are a persistent and important reason for admission to the ICU, and the risk factors, causes, and consequences remain unchanged since 1980. Despite 25 years of experience with high-technology medicine, ID still has a negative impact on the health and resources of society.

Adolescent↗

PubMed1982

Narcolepsy-cataplexy. II. Psychosocial consequences and associated psychopathology.

The emotional and psychosocial correlates of narcolepsy were evaluated in 50 adults who had a current complaint of sleep attacks and cataplexy. The psychosocial consequences of narcolepsy were extensive; most patients reported that the condition seriously affected their interpersonal, marital, work, and social relationships. Many of these consequences were caused by others' misunderstanding of the symptoms of the disorder, which resulted in negative attitudes toward the patients. Th narcoleptic patients showed high levels of psychopathology compared with controls, but this difference is considered to be primarily a reaction to the disorder and its effects. The narcoleptic patients were overly concerned with emotional control, which appeared to lead to their generalized lack of expressiveness and tendency to build up emotional pressure. Based on these findings, recommendations are given for the psychosocial management of the narcoleptic patient.

Adolescent↗

PubMed2002

Consequences and correlates of adolescent depression.

OBJECTIVE: To examine the correlates and consequences of high levels of depressive symptoms among adolescents. DESIGN: Secondary analysis of the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a survey of a nationally representative sample of 4648 adolescent boys and girls between the ages of 10 and 18 years, inclusive, conducted in school settings. The self-administered questionnaire contains a screening instrument for depression based on the Children's Depression Inventory. OUTCOME: Days of school missed, performance at grade level, alcohol use, drug use, smoking, and bingeing. RESULTS: After controlling for sociodemographics, life events, sexual abuse, physical abuse, and exposure to violence, relative to other children, children and adolescents with high degrees of depressive symptoms missed about 1 day more of school in the month preceding the survey (P<.05) and had higher odds of smoking (odds ratio, 1.84; P<.001), bingeing (odds ratio, 2.02; P<.001), and suicidal ideation (odds ratio, 16.59; P<.001). CONCLUSION: High levels of depressive symptoms are correlated with serious and significant consequences, even after controlling for life circumstances.

Absenteeism↗

PubMed2001

Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences.

Concern for potential bioterrorist attacks causing mass casualties has increased recently. Particular attention has been paid to scenarios in which a biological agent capable of person-to-person transmission, such as smallpox, is intentionally released among civilians. Multiple public health interventions are possible to effect disease containment in this context. One disease control measure that has been regularly proposed in various settings is the imposition of large-scale or geographic quarantine on the potentially exposed population. Although large-scale quarantine has not been implemented in recent US history, it has been used on a small scale in biological hoaxes, and it has been invoked in federally sponsored bioterrorism exercises. This article reviews the scientific principles that are relevant to the likely effectiveness of quarantine, the logistic barriers to its implementation, legal issues that a large-scale quarantine raises, and possible adverse consequences that might result from quarantine action. Imposition of large-scale quarantine-compulsory sequestration of groups of possibly exposed persons or human confinement within certain geographic areas to prevent spread of contagious disease-should not be considered a primary public health strategy in most imaginable circumstances. In the majority of contexts, other less extreme public health actions are likely to be more effective and create fewer unintended adverse consequences than quarantine. Actions and areas for future research, policy development, and response planning efforts are provided.

Bioterrorism↗

PubMed2005

The unintended consequences of publicly reporting quality information.

Health care report cards publicly report information about physician, hospital, and health plan quality in an attempt to improve that quality. Reporting quality information publicly is presumed to motivate quality improvement through 2 main mechanisms. First, public quality information allows patients, referring physicians, and health care purchasers to preferentially select high-quality physicians. Second, public report cards may motivate physicians to compete on quality and, by providing feedback and by identifying areas for quality improvement initiatives, help physicians to do so. Despite these plausible mechanisms of quality improvement, the value of publicly reporting quality information is largely undemonstrated and public reporting may have unintended and negative consequences on health care. These unintended consequences include causing physicians to avoid sick patients in an attempt to improve their quality ranking, encouraging physicians to achieve "target rates" for health care interventions even when it may be inappropriate among some patients, and discounting patient preferences and clinical judgment. Public reporting of quality information promotes a spirit of openness that may be valuable for enhancing trust of the health professions, but its ability to improve health remains undemonstrated, and public reporting may inadvertently reduce, rather than improve, quality. Given these limitations, it may be necessary to reassess the role of public quality reporting in quality improvement.

Benchmarking↗

PubMed2026

Management and Consequences of Genotype-Positive Familial Hypercholesterolemia.

IMPORTANCE: Familial hypercholesterolemia (FH) is a common genetic condition that causes hypercholesterolemia and increased risk for premature atherosclerotic cardiovascular disease (ASCVD). The prevalence, management, and consequences of genetically confirmed FH across the US are poorly understood. OBJECTIVE: To identify genotype-positive FH in a national US cohort and describe its prevalence, consequences, and lipid-lowering management. DESIGN, SETTING, AND PARTICIPANTS: In the All of Us (AoU) cohort study, whole-genome sequencing and phenotypic data from US adult participants enrolled between May 2018 and July 2022 were analyzed to identify and study genotype-positive FH. Data were analyzed between May 2024 and May 2025. EXPOSURE: FH variants (pathogenic or likely pathogenic) in LDLR, APOB, and PCSK9 genes were manually classified with standard criteria. MAIN OUTCOMES AND MEASURES: The primary outcomes were demographic characteristics, lipid measurements, ASCVD, and prevalence of FH and noncarriers in AoU. Lipid management was then characterized among individuals with FH through lipid-lowering therapy (LLT) documentation and guideline-based low-density lipoprotein cholesterol (LDL-C) targets. RESULTS: A total of 245 388 participants were included, with mean (SD) age of 56.5 (16.9) years and 145 563 female participants (59.3%). Genotype-positive FH was identified in 865 participants (prevalence, 0.35%; 95% CI, 0.33%-0.38%; 1 in 287 participants). Among individuals with genotype-positive FH, 349 (40%) were prescribed statins, and 332 (38.4%) had LDL-C measured. Coronary artery disease, peripheral artery disease, and transient ischemic attack or stroke were significantly more common in genotype-positive FH carriers compared to noncarriers (coronary artery disease: odds ratio [OR], 2.91; 95% CI, 2.34-3.58; peripheral artery disease: OR, 1.51; 95% CI, 1.16-1.96; and transient ischemic attack or stroke: OR, 1.54; 95% CI, 1.11-2.09). Only 30.1% of participants positive for FH variants had LDL-C less than 100 mg/dL at their most recent result compared to 48.2% of noncarriers (P < .001). Of the total participants with ASCVD and LLT prescription, significantly fewer individuals with FH met the secondary prevention LDL-C target (<70 mg/dL; 19.33% vs 43.12%; P < .001) compared to noncarriers. CONCLUSIONS AND RELEVANCE: This cohort study finds a prevalence of genotype-positive FH in All of Us participants of 0.35% (95% CI, 0.33%-0.38%), with state-level variation. A minority of individuals with genotype-positive FH met guideline-recommended LDL-C targets and had increased rates of ASCVD.

Humans↗

PubMed1996

Social consequences of insulin-dependent diabetes mellitus are limited: a population-based comparison of young adult patients vs healthy controls.

In a population-based study, the social situation of 91 young adult patients with Type 1 diabetes mellitus (IDDM) since childhood was compared to that of an age- and sex-matched group of 189 healthy persons. Their mean age was 37.2 years, duration of diabetes 28.7 years and severe complications were present in 13 of the 91 patients. A nearly 10-fold increased mortality rate was found in diabetic patients, mainly due to diabetic nephropathy and trauma, including suicide. The employment rate was lower in diabetic patients (71% vs 85%, p < 0.05); the need for welfare benefits was greater (15% vs 3%, p < 0.01). These differences were mainly the consequence of diabetic late complications. Education, housing conditions, life style, civil state, alcohol and smoking habits were similar in both groups. Confidence in the future was slightly less in diabetic patients (p < 0.05). In conclusion, besides an increased mortality rate, the present study has shown no serious social consequences in adult Type 1 diabetic patients without severe late complications, as compared to matched controls. Our results indicate that IDDM affects social life only to a limited extent, in the absence of severe vascular complications.

Adult↗

PubMed1999

The social consequences for families with Alzheimer's disease patients: potential impact of new drug treatment.

The social consequences of Alzheimer's disease are highlighted in this review with regard to impact on family situation, a changing treatment context caused by demographic changes, reorganization of long-term care, a financial crisis in the public health systems and the introduction of antidementia drugs. In the early phase of dementia there may be significant consequences for the patients and the family members which are largely unrecognized by the healthcare system. As the disease progresses, the impact on caregivers in terms of physical and emotional burden, financial and employment status may be enormous. The current care provision in Sweden, the UK and The Netherlands is described. Innovative care alternatives and strategies may improve the situation. The introduction of antidementia drugs such as the acetylcholine esterase inhibitors may also contribute to improved circumstances for patients and caregivers. There is still a great need for further research in this field.

Activities of Daily Living↗

PubMed2000

Mechanisms leading to uniparental disomy and their clinical consequences.

Uniparental disomy (UPD) refers to the situation in which both copies of a chromosome pair have originated from one parent. In humans, it can result in clinical conditions by producing either homozygosity for recessive mutations or aberrant patterns of imprinting. Furthermore, UPD is frequently found in conjunction with mosaicism for a chromosomally abnormal cell line, which can also contribute to phenotypic abnormalities. Investigations into the mechanisms by which UPD may arise have helped to expand our general awareness of the impact of chromosomal abnormalities and chromosomal mosaicism in normal human development. Specifically, it appears that errors in the transmission of a chromosome from parent to gamete and during early somatic cell divisions are remarkably common but that embryo and cell selection during early embryogenesis help to ensure the presence of a numerically balanced chromosome complement in the developing fetus. UPD is also likely to occur within a portion of cells in all individuals simply as a consequence of somatic recombination occurring during mitotic cell divisions. This can be an important step in cancer development as well as a contributing factor to other late onset diseases. This review summarizes mechanisms by which UPD may arise and their associated clinical consequences.

Animals↗

PubMed1981

The consequences of the chemotherapy of Hodgkin's disease: The 10th David A. Karnofsky Memorial Lecture.

The most important consequence of using chemotherapy for Hodgkin's disease is its cure. Results of the MOPP program, developed at the National Cancer Institute in 1964, indicate that the majority of the 80% of patients who attain complete remission, who are at risk for ten years, have remained disease-free. The presence of symptoms and the histologic subtype, nodular sclerosis, has had important negative influences on prognosis. Review of three long-term adverse consequences of chemotherapy revealed sterility to be the most significant effect of drug treatment in this young population. Adverse effects of the immunosuppressive drugs in MOPP proved to be minimal. The carcinogenic effect of MOPP when used alone was surprisingly small, but increased significantly when combined with irradiation. National mortality from Hodgkin's disease has decreased abruptly since the introduction of effective chemotherapy for Hodgkin's disease in 1970.

Antineoplastic Agents↗

PubMed1986

Psychosocial consequences of cure.

Survivors of childhood cancer, having overcome the biggest hurdle to a normal life span, must continue to be vigilant toward health care issues as well as toward certain psychological and social problems for which they are at a greater than normal risk. The long-term survivor's knowledge about his/her illness, its treatment, and the consequent need for health surveillance and maintenance practices must be continually updated. Equally important is the survivor's preparation for coping with any long-term consequences of disruption in family, academic, and social activities engendered by cancer treatment. Existing research has frequently focused on patients diagnosed in early childhood. Recent studies, however, suggest that the developmental disruptions may have special significance for the adolescent, who is already struggling with unique issues of separation, changes in peer relationships, emergent sexuality, and future academic and occupational goals. Previous investigations addressing the medical and psychiatric problems encountered by the long-term survivor of adolescent cancer are presented with a focus on current psychological adjustment and degree of emancipation achieved. A recent pilot study, from three major medical centers, collected extensive interview data on a group of long-term survivors and sibling controls. Preliminary analyses of these data are described, and areas for future research are suggested.

Adaptation, Psychological↗