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PubMed2001

Consequences of overutilization and underutilization of thrombolytic therapy in clinical practice. TRACE Study Group. TRAndolapril Cardiac Evaluation.

OBJECTIVES: The aim of this study was to evaluate the consequences, measured as mortality and in-hospital stroke, of the use of thrombolytic therapy among patients with acute myocardial infarction (AMI), who do not fulfill accepted criteria or who have contraindications to thrombolytic therapy (i.e., overutilization) and among patients who are withheld thrombolytic treatment despite fulfilling indications and having no contraindications (i.e., underutilization). BACKGROUND: The implementation of treatment with thrombolysis in clinical practice is not in accordance with the accepted criteria from randomized studies. The consequence has been over- and underutilization of thrombolytic therapy among patients with AMI in clinical practice. The outcome of overutilization of thrombolytic therapy has not been described previously. METHODS: We examined 6,676 consecutive patients admitted to the hospital with an AMI and recorded characteristics, in-hospital complications and long-term mortality. RESULTS: Overall, 41% of the patients received thrombolytic therapy. Thrombolytic therapy was underutilized in 14.3% and overutilized in 12.9% of the patients. The use of thrombolytic therapy was associated with reduced mortality in every subgroup examined, including patients without an accepted indication, with an accepted indication and in patients with prior stroke. The risk ratio of in-hospital stroke was not increased in connection with thrombolytic therapy, not even in patients with prior stroke (relative risk = 0.237, 95% confidence interval: 0.031 to 1.810, p = 0.17). CONCLUSIONS: With the large benefit known to be associated with thrombolytic therapy and the favorable result of thrombolytic therapy in patients with contraindications observed in this study, we conclude that a formal evaluation of thrombolytic therapy in wider patient categories is warranted.

Aged↗
PubMed1996

Delayed appendectomy for appendicitis: causes and consequences.

This study was undertaken to describe the causes and consequences of delayed diagnosis and intervention in cases of appendicitis. The hospital records of adult patients undergoing appendectomy during a 4-year period (November 1989 to November 1993) were reviewed, with concentration on 40 patients who had a delay of 72 hours or more from initial symptoms to operation. The initial medical contact points for patients were walk-in clinics and community emergency departments. Definitive care was provided in a general hospital. Patients were adults with appendicitis who underwent an operation for definitive management 72 or more hours after the onset of symptoms. Length of hospital stay, reasons for delay in diagnosis, incidence of perforation, and complications were recorded. Delay in diagnosis and treatment was attributed to factors controlled by the patient in 15 cases (27.5%) and by the physician in 25 cases (62.5%). Perforation, postoperative complications, and hospital length of stay were related to the delay in diagnosis; with delay, the mean hospital length of stay was 9 days, the incidence of perforation was 90%, and major complications were recorded in 60% of the patients. Early diagnosis and surgical management for appendicitis remains an important and, at times, elusive goal. Delays of 72 hours or more have serious consequences. Patient education and the experience, intuitiveness, and persistence of the physician are important elements to improving these findings.

Adolescent↗
PubMed2000

Effectiveness of coerced addiction treatment (alternative consequences): a review of the clinical research.

Of central importance is that our clinical experience and treatment outcome studies to date strongly suggest that coercion is fundamental to addiction treatment and favorable outcomes from therapeutic interventions. Often the alcoholic/drug abuser must be given an opportunity to feel, face, or experience the "consequences" of their alcohol and drug addiction before the denial of their illness can be penetrated and motivation for treatment to recover from addictive illness can be developed. Continued use of alcohol and drugs is an unhealthy and dangerous state for those who are addicted and for others who are affected by their addictive illnesses. Effective therapeutic interventions and long-term recovery are more likely to succeed if avoiding "alternative consequences" are contingent on continued compliance with addiction treatment by those who suffer from addictive illnesses.

Alcoholism↗
PubMed2000

Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters.

OBJECTIVE: This study examined the health consequences of having experienced both sexual and physical abuse relative to women experiencing physical abuse but not sexual abuse. METHODS: A cross-sectional study was conducted among 203 women seeking refuge in battered women's shelters. Controlling for sociodemographics, logistic regression analyses were conducted to assess the consequences of experiencing both sexual and physical abuse. RESULTS: Compared to women experiencing physical abuse, women experiencing both sexual and physical abuse were more likely to have a history of multiple sexually transmitted diseases (STDs) in their abusive relationships, have had an STD in the past 2 months, be worried about being infected with HIV, use marijuana and alcohol to cope, attempt suicide, feel as though they had no control in their relationships, experience more episodes of physical abuse in the past 2 months, rate their abuse as more severe, and be physically threatened by their partner when they asked that condoms be used. CONCLUSIONS: Given the prevalence of adverse health outcomes, domestic violence shelters could counsel women to avoid using alcohol/drugs as a coping strategy, educate women about alternative healthy coping strategies, counsel women about methods of STD prevention that they can control, and provide STD screening and treatment.

Adult↗
PubMed1999

The uroprotection of mesna on cyclophosphamide cystitis in rats. Its consequences on behaviour and brain activities.

We studied the uroprotective effect of mesna, at doses of 40-300 mg/kg/i.p., in single or fractioned injections, on the development of cyclophosphamide (CP, 100 mg/kg/i.p.) cystitis in rats. The study concerns the histological, behavioural and nervous aspects of the disease. The specific effects of mesna, when injected alone, have also been considered. The mesna itself does not have specific deleterious effects, except at a dose of 300 mg/kg which provokes a moderate vesical inflammation although without consequence on the animal's behaviour. Mesna offers good protection against CP cystitis for only certain posologies. The uroprotective effects of mesna reach maxima at doses of 40-100 mg/kg and for fractioned injections given over the entire time frame of the urinary toxic release. The uroprotective effects of other posologies are only partial. The nervous activities were studied through the expression of Fos protein. The repetitive intraperitoneal injection of mesna induced a spinal activity and a preferential contralateral activity of the trigemino/reticular areas of the brainstem spinal cord junction--an effect which was reduced in the presence of CP. The prevention of cystitis by mesna was accompanied only by a reduction in spinal Fos activity, the supraspinal activities remaining high and in strict relationship with the vagal afferent activity. In conclusion, the uroprotective effect of mesna, which requires appropriate posologies, has led to the confirmation of the spinal actions of the CP cystitis, probably via the pelvic nerve, but did not allow a clear distinction between the consequences of the systemic (vagal) and local (spinal, pelvic) actions of CP at supraspinal level.

Animals↗
PubMedDate not supplied

Timing: A critical determinant of the functional consequences of neonatal 6-OHDA lesions.

Previous data have indicated that intrastriatal (IS) lesions of the dopamine (DA) system early in development result in a selective effect on D1 receptor expression and sensitivity, which is not seen with adult lesions or lesions made later in development. The purpose of the present study was to test the hypothesis that the timing of the lesion is a critical determinant of the consequences of DA depletion during development. Rats received IS injections of 6-hydroxydopamine (6-OHDA) on day of birth/postnatal day 1 (P0/1) or P7, which resulted in similar decreases in the number of DA uptake sites (> or =70% loss), a measure of DA terminal density. As adults, lesioned rats were challenged with DA receptor agonists to examine the functional sensitivity of D1 and D2 receptors. In adulthood, P0/1-lesioned rats exhibited increases in oral dyskinesias and rearing behavior following treatment with the partial D1 receptor agonists, SKF38393 and SKF77434, whereas rats lesioned on P7 exhibited increases in grooming. P7-lesioned rats also exhibited increases in gnawing, explosive jumping, and self-biting behavior following treatment with the full D1 receptor agonist SKF82958, which were not observed in the other groups. The results support the hypothesis that the timing of DA denervation is of paramount importance for governing the functional consequences of neonatal lesions, as measured by the incidence of DA agonist-induced behaviors in adulthood.

Aging↗
PubMed2002

Neuroimaging methods to evaluate the etiology and consequences of epilepsy.

Magnetic resonance imaging (MRI) is widely available and is generally the imaging method of first choice for identifying the structural basis of seizure disorders, having both sensitivity and specificity. Positron emission tomography (PET) and single photon emission computed tomography (SPECT) scans may be more sensitive in some patients when MRI is unremarkable, but do not confer specificity of etiological diagnosis. Methods to assess the consequences of epilepsy on the brain need to be quantitative, reliable, reproducible and safe. They must be acceptable to patients and to a healthy control group for repeated use, and the acquisition and analytical methods must be stable over years. Longitudinal studies are necessary to determine whether secondary cerebral damage occurs as a consequence to the epilepsies. Patient groups will be heterogeneous in this regard and analysis will need to be not only of changes in group means, but also of the number of patients who show significant changes in imaging parameters, that exceed the limits of test-retest reliability and of changes in age-matched controls. MRI is an attractive tool to evaluate the presence and development of cerebral damage in patients with epilepsy as it is readily available, non-invasive, and acceptable to patients and controls. MRI volumetry is reliable and reproducible, but the sensitivity of the method to detect subtle abnormalities has not yet been established. Preliminary analysis of longitudinal studies of patients with newly diagnosed and chronic active epilepsy suggests that 10% of newly diagnosed patients and 25% of those with chronic active epilepsy develop significant cerebral, hippocampal or cerebellar atrophy over 3.5 years. MR spectroscopy may be more sensitive for detecting abnormalities, but the test-retest reliability is less good. Other MRI tools such as diffusion tensor imaging (DTI) may be useful methods for evaluating secondary cerebral damage acutely and chronically.

Animals↗
PubMed1999

A new questionnaire assessing the opinions of the relatives of patients with schizophrenia on the causes and social consequences of the disorder: reliability and validity.

This paper describes the development and the validation of a questionnaire assessing the opinions of the relatives of patients with schizophrenia on the causes and the social consequences of the disorder. The final version of the questionnaire includes 28 items, grouped in four sub-scales (social restrictions, social distance, utility of treatments, biopsychosocial causes of schizophrenia), whose intra-rater reliability ranges from 0.36 to 0.84. Cronbach's alpha coefficient, which tests the content validity of the sub-scales, ranges from 0.56 to 0.66. Factor analysis identifies two factors (opinions on social consequences and the utility of treatments, and the beliefs on the causes of schizophrenia), which account for the 73% of the total variance. This questionnaire may be particularly useful to assess relatives'beliefs about schizophrenia and to target psychosocial interventions in the families of patients with schizophrenia.

Adaptation, Psychological↗
PubMed1997

[Consequences of cocaine addiction during pregnancy on the development in the child].

Cocaine facilitates neurotransmitter release from the central nervous system, decreases their re-uptake at the synapse junction level and increases their blood level due to receptors blockade. During pregnancy cocaine inhibits uterine adrenergic beta receptors and easily crosses the placenta, the main obstetrical consequences of overstimulation of the noradrenergic system being miscarriage, retroplacental haematoma, ruptured uterus, short and premature labour. Fetal and neonatal consequences resulting from both a decreased uterine blood flow and a direct effect of cocaine on fetal development can be severe. Decreased uterine blood flow lowers oxygen and nutriment transport which in turn can induce intra-uterine growth retardation. The direct effect of cocaine on the fetus is responsible for an increased catecholamine plasma concentration leading to vasoconstriction episodes, increased heart rate and blood pressure, and subsequent oxygen requirement. Several malformations have been reported, sometimes severe (involving central nervous system, heart, digestive tract, urinary tract and bone) that are mainly due to fetal circulation failure. Cocaine can also directly alter brain development because of neuronal mistargeting within the cerebral cortex.

Child↗
PubMed2003

The consequences of lateral release in total knee replacement: a review of over 1000 knees with follow up between 5 and 11 years.

BACKGROUND: The relationship between lateral release in total knee arthroplasty and subsequent patello-femoral problems is contentious. Variable rates of instability, patella fracture and other complications have been demonstrated after lateral release. Significant measures have been taken by some surgeons to avoid a lateral release. We wished to determine whether lateral release was detrimental or beneficial in terms of mid- to long- term patellofemoral problems. METHODS: We examined 1071 total knee arthroplasties with a follow-up of 5 to 11 years to determine the longer-term consequences of lateral release. Lateral release was performed as clinically indicated after a 'no thumbs' assessment in 51% of cases. The knees requiring a lateral release had lower pre-operative Hospital for Special Surgery (HSS) scores and demonstrated a greater improvement in post-operative HSS scores. RESULTS: The difference in HSS scores, between the groups, was significantly less post-operatively than prior to surgery. Overall, we had a high incidence of lateral release (51%), but low fracture rate (1.2%), and very low instability rate (0.6%). Only three surgeries were required for patello-femoral problems. CONCLUSION: This study suggests that any negative consequences of lateral release are minimal and we recommend lateral release continue to be performed as clinically indicated.

Aged↗
PubMed1999

Age-adjusted death rates: consequences of the Year 2000 standard.

PURPOSE: For nearly 60 years, official U.S. mortality statistics have been age-adjusted using the age distribution from the U.S. population for the year 1940. A new population standard, the projected Year 2000 U.S. standard, has been approved for use by the Department of Health and Human Services (DHHS). It will be implemented for official U.S. Government statistics published for deaths occurring in 1999. The new standard reflects the older age distribution of the population; 6.8% of the population was age 65 years or more in 1940, as compared to 12.6% projected for 2000. METHODS: This paper investigates the consequences of the new age distribution standard by comparing death rates by time, place, and population characteristics, adjusted to both the 1940 and projected 2000 population standards. RESULTS: The new standard changes the level of the age-adjusted death rate for total mortality and for many causes of death, as compared to the 1940 standard. For example, the 1995 death rate for diseases of the heart is 138 per 100,000 population when adjusted using the 1940 standard, but is 296 per 100,000 using the Year 2000 standard. The new standard may change the comparison of age-adjusted rates if there are substantial differences in the age-specific rates. For example, the ratio of age-adjusted death rates for ischemic heart disease in black relative to white males is 1.07 using the 1940 standard, but is 0.96 using the Year 2000 standard. CONCLUSIONS: The new Year 2000 age standard has the potential to change both levels and comparisons of age-adjusted rates. Age-adjustment is an averaging process, and consequently, has the potential to view the data effectively as a whole while possibly obscuring important age-specific details.

Adolescent↗
PubMedDate not supplied

Long-term health consequences of delayed childbirth: NHANES III.

Medicine has pointed to short-term, immediate health risks to child and mother of delaying childbearing past the age of 35 years. The long-term health consequences of delayed childbearing have not been the subject of research. Are women who delay having children to pursue education and career goals placing their later health status at risk? To address this question, the study utilizes data from the National Health and Nutrition Examination Survey III 1988-1994. The analyses used odds ratios obtained from stepwise logistic regression analysis to assess women's health risks. The results are suggestive of selective risk enhancement from delayed childbirth with regard to cardiovascular disease and risk factors, especially diabetes and hypertension, and congestive heart failure. Risks were further enhanced in terms of dental health, blood abnormalities, physical mobility, and vision difficulties. Whereas delaying childbearing may indicate a readiness on the part of women and men to delay becoming parents, the present study suggests that not all is currently known about the long-term health consequences of such decisions to delay childbearing.

Adult↗
PubMed2003

Changes in cerebral morphology consequent to peripheral autonomic denervation.

Pure autonomic failure (PAF) is characterized by an acquired, selective, peripheral denervation of the autonomic nervous system. Patients with PAF fail to generate bodily states of arousal via the autonomic nervous system in response to physical or cognitive effort. We used voxel-based morphometry to test the hypothesis that changes in the morphology of brain regions involved in autonomic control would arise as a consequence to the longstanding absence of peripheral autonomic responses in PAF patients. Optimized voxel-based morphometry of structural magnetic resonance scans was used to test for regional differences in grey and white matter in 15 PAF patients and matched controls. There were no group differences observed in global measures of grey matter, white matter, or cerebrospinal fluid (CSF). We identified morphometric differences reflecting regional decreases in grey matter volume and concentration in anterior cingulate and insular cortices in PAF patients relative to controls. Morphometric differences in brainstem and subcortical regions did not reach statistical significance. Our findings suggest that peripheral autonomic denervation is associated with grey matter loss in cortical regions encompassing areas that we have previously shown are functionally involved in generation and representation of bodily states of autonomic arousal. The nature of these changes cannot be determined from morphometric analysis alone, but we suggest that they reflect experience-dependent change consequent upon loss of afferent input to brain regions involved in representation of autonomic states.

Adult↗
PubMed1999

The physiological consequences of bed rest and inactivity.

Most dialysis patients experience prolonged periods of physical inactivity and often bedrest. The physiological consequences of bed rest and inactivity are many and detrimentally affect the functioning of many bodily systems, several of which affect physical functioning. Reductions in plasma volume reduce cardiac filling, stroke volume, and cardiac output. Skeletal muscle fiber size, diameter, and capillarity are reduced, as is bone density. These changes result in profound reductions in physical work capacity. The effects of bed rest and inactivity in patients with chronic renal failure may have more serious consequences, in that they may exacerbate the pathophysiology of renal failure such as cardiac dysfunction, anemia, muscle wasting, muscle weakness, neuropathy, glucose intolerance, and reduced bone density.

Bed Rest↗
PubMed1998

Electrocardiographic consequences of a peripatetic lifestyle in gray wolves (Canis lupus).

Cardiac chamber enlargement and hypertrophy are normal physiologic responses to repetitive endurance exercise activity in human beings and domestic dogs. Whether similar changes occur in wild animals as a consequence of increased activity is unknown. We found that free-ranging gray wolves (Canis lupus, n = 11), the archetypical endurance athlete, have electrocardiographic evidence of cardiac chamber enlargement and hypertrophy relative to sedentary captive gray wolves (n = 20), as demonstrated by significant increases in QRS duration, QT interval, and QT interval corrected for heart rate, a tendency towards increased Q, R, and S wave voltages in all leads, and a significant decrease in heart rate. We conclude that exercise activity level and therefore lifestyle affects physiologic variables in wild animals. An immediate consequence of this finding is that physiologic measurements obtained from a captive wild-animal population with reduced exercise activity level may not accurately reflect the normal physiologic state for free-ranging members of the same species.

Adaptation, Physiological↗
PubMed2005

Undermining self-efficacy: the consequence of nurse unfriendliness on client wellbeing.

Although unfriendly nurse behaviours are noted in research findings, no study names these behaviours as such, nor investigates the impact of nurse unfriendliness on clients. Because the present findings reveal the phenomenon of nurse unfriendliness, they allow both the phenomenon and its consequences to be understood. These findings were developed through secondary data analysis of a text where participants discussed their encounters, during hospitalisation/s in 2002-2003, with friendly and unfriendly nurses. Findings reveal nurse unfriendliness is characterised by frostiness, officiousness and apathy. It results in thoughtless and inept nursing and in a hostile environment where clients feel unsafe, unwelcome and unaided. Unfriendly nurses create barriers--they are disrespectful, cheerless, unresponsive and domineering so clients feel belittled, disheartened, unprotected and distressed. When clients are placed in this position, their self-efficacy is undermined. By revealing the consequences of nurse unfriendliness on client wellbeing, findings from this study advance nursing knowledge.

Adult↗
PubMed2002

Prevalence and consequences of insomnia disorders in the general population of Italy.

OBJECTIVES: To assess the prevalence of insomnia disorders using DSM-IV classification, and the consequences of insomnia in the Italian general population. METHODS: A representative sample of the Italian general population composed of 3970 individuals aged 15 years or older were interviewed by telephone using the Sleep-EVAL system (participation rate: 89.4%). Participants were interviewed about their sleep habits and sleep disorders. DSM-IV classification was used by Sleep-EVAL to determine the sleep disorder diagnosis. RESULTS: Insomnia symptoms were reported by 27.6% of the sample. Sleep dissatisfaction was found in 10.1% and insomnia disorder diagnoses in 7% of the sample. The use of sleep-enhancing medication was reported by 5.7% of the sample. Most of these subjects were using anxiolytics. Dissatisfaction with sleep was associated with daytime sleepiness. Middle-aged drivers dissatisfied with their sleep were three times more likely to have had a road accident in the previous year compared to other drivers. However, fewer than 30% of subjects dissatisfied with their sleep or with an insomnia disorder diagnosis had consulted a physician about their sleep problem. CONCLUSIONS: As in other European and non-European countries, insomnia is widespread in Italy. The consequences are important. Appropriate recognition and treatment of insomnia should be part of an educational program for general practitioners everywhere.

Journal Article↗
PubMed2003

Gastrointestinal disorders of the critically ill. Systemic consequences of ileus.

Ileus refers to the partial or complete blockage of the small and/or large intestine either by functional (adynamic or paralytic ileus) or mechanical bowel obstruction. The diffuse gastrointestinal dysmotility during functional and mechanical ileus may result in intestinal dilatation, increased luminal pressure and gut wall ischaemia which may lead to increased intra-abdominal pressure (IAP). Any type of ileus may promote abdominal fluid sequestration with severe systemic hypovolaemia, intestinal bacterial overgrowth with the evolution of bacterial translocation and systemic invasive infections and inflammation of the intestinal wall with concomitant release of cytokines and the development of the systemic inflammatory response syndrome. The most serious complications of ileus are mediated by an increase in IAP. Intra-abdominal hypertension has been found in up to 20% of critically ill patients and may lead to a broad pattern of systemic consequences with multiple organ dysfunction, including cardiovascular, hepatic, pulmonary, renal and neurological function. The abdominal compartment syndrome is an emergency condition which is defined as elevation of IAP above 20 to 25 mmHg and the presence of systemic consequences. Therapeutic considerations include the maintenance of adequate hydration status, avoidance of drugs known to impair intestinal perfusion, stimulation of gastric and intestinal motility and various nutritional aspects. Colonic tube placement after decompressive colonoscopy may be effective in reducing intestinal dilatation. In the abdominal compartment syndrome the 'open abdominal approach' with decompressive laparotomy by opening the peritoneal cavity and temporary abdominal closure is the therapy of choice.

Critical Illness↗