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Results for “Expression of Concern”

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PubMed2006

A focus group study of consumer attitudes toward genetic testing and newborn screening for deafness.

PURPOSE: Progress in identifying genes for deafness together with implementation of universal audiologic screening of newborns has provided the opportunity for more widespread use of molecular tests to detect genetic forms of hearing loss. Efforts to assess consumer attitudes toward these advances have lagged behind. METHODS: Consumer focus groups were held to explore attitudes toward genetic advances and technologies for hearing loss, views about newborn hearing screening, and reactions to the idea of adding molecular screening for hearing loss at birth. Focus group discussions were recorded, transcribed and analyzed. RESULTS: Five focus groups with 44 participants including hearing parents of deaf children, deaf parents and young deaf adults were held. Focus group participants supported the use of genetic tests to identify the etiology of hearing loss but were concerned that genetic information might influence reproductive decisions. Molecular newborn screening was advocated by some; however, others expressed concern about its effectiveness. CONCLUSION: Documenting the attitudes of parents and other consumers toward genetic technologies establishes the framework for discussions on the appropriateness of molecular newborn screening for hearing loss and informs specialists about potential areas of public education necessary prior to the implementation of such screening.

Adolescent↗

PubMed2006

Views of female breast cancer patients who donated biologic samples regarding storage and use of samples for genetic research.

Although social and ethical issues related to the storage and use of biologic specimens for genetic research have been discussed extensively in the medical literature, few empiric data exist describing patients' views. This qualitative study explored the views of 26 female breast cancer patients who had consented to donate blood or tissue samples for breast cancer research. Participants generally did not expect personal benefits from research and had few unprompted concerns. Few participants had concerns about use of samples for studies not planned at the time of consent. Some participants did express concerns about insurance or employment discrimination, while others believed that current privacy protections might actually slow breast cancer research. Participants were generally more interested in receiving individual genetic test results from research studies than aggregate results. Most participants did not want individual results of uncertain clinical significance, although others believed that they should be able to receive such information. These data examined the range of participants' views regarding the storage and use of biologic samples. Further research with different and diverse patient populations is critical to establishing an appropriate balance between protecting the rights of human subjects in genetic research and allowing research to progress.

Breast Neoplasms↗

PubMedDate not supplied

The disclosure decisions of parents who conceive children using donor eggs.

STUDY OBJECTIVE: To identify variables that influence the disclosure decisions of parents who conceive children using donor eggs and to compare such variables among disclosing, nondisclosing, and undecided families. DESIGN: Exploratory, comparative, descriptive. SETTING: A university hospital-assisted reproductive technology program in the Midwest. PARTICIPANTS: Thirty-one couples with children conceived with anonymously donated eggs. METHODS: Audiotaped telephone interviews, measures of social support and family environment, and a demographic survey. MAIN OUTCOME MEASURES: Content analysis of interview transcripts and comparison of recurring themes among groups. RESULTS: The majority of parents intended disclosure. Dominant themes among disclosing parents included the belief that a child has a right to know and concerns about the harmful effects of family secrets. Among nondisclosing parents, common themes were knowing of no compelling reason to tell and perceiving potential harm in telling. Undecided parents reported concerns about how and when to tell and the child's possible reaction. Parents in all groups expressed concern about their disclosure decisions. CONCLUSIONS: Dominant decisional influences were beliefs and values and concerns about possible harm. Longitudinal study is needed to determine the impact of disclosure decisions on children, families, and society.

Adult↗

PubMed1998

Human umbilical vein endothelial cells lack expression of the estrogen receptor.

Estrogens may influence the expression of various cytokines, adhesion molecules, von Willebrand factor and prostacyclin produced by endothelial cells. However, reports concerning expression of the estrogen receptor in endothelial cells are controversial. Primary human umbilical vein endothelial cells (HUV-EC), the non continuous human umbilical vein endothelial cell line HUV-EC-C (ATCC CRL 1730) and endothelial cells from 10 frozen umbilical cords were analyzed for the expression of the estrogen receptor. Immunological studies using estrogen receptor specific antibodies failed to detect the expression of the receptor in all human umbilical vein endothelial cells tested. No estrogen receptor transcripts were found in primary HUV-EC or HUV-EC-C by reverse transcriptase-polymerase chain reaction. Weak hybridization signals were detected when the PCR amplicons were hybridized with estrogen receptor cDNA sequences as a probe. In vitro protein-DNA interaction studies revealed no complexes between a fully consensus estrogen response element and HUV-EC-C extracts. Finally, transient transfection studies in HUV-EC-C could not demonstrate 17beta-estradiol-induced transcription of the beta-galactosidase reporter gene linked to a consensus estrogen response element. These observations suggest that human umbilical vein endothelial cells lack the estrogen receptor.

Blotting, Western↗

PubMed1991

Airline pilot incapacitation survey.

A survey, replicating one originally conducted by the International Federation of Airline Pilots' Associations (IFALPA) in 1967, was carried out to investigate the aetiology of inflight incapacitation on commercial flight decks. The questionnaire was constructed by IFALPA and distributed worldwide by its member associations. Since response to the questionnaire was voluntary, no control of the sample population was possible. The results indicate that 29% of the 4,345 respondents had been incapacitated at least once. As in 1967, gastro-intestinal symptoms accounted for the majority (58%) of incidents, other main causes being symptoms of nasal and sinus congestion ('blocked' ear and sinus pain), headaches, and faintness or general weakness. Of those who had experienced an incident of incapacitation, 48% claimed that safety was actually, or potentially, affected. However, when all respondents were asked whether they were concerned about safety in the event of incapacitation inflight (excluding take-off and landing), only 25% expressed concern. Slightly more pilots operating in three-man crews (50.5%) thought incapacitation affected the safety of the flight than those operating in two-man crews (45.3%).

Adult↗

PubMed1979

Spinal injuries in the F/FB-111 crew escape system.

During the years 1970-75, a larger than expected number of aircrewmen, forced to use the F/FB-111 crew escape module, experienced acute spinal trauma during otherwise uneventful ejection. This trend in the incidence and severity of F/FB-111 aircrew spinal injuries attracted considerable attention and stimulated extensive inquiry concerning the ethiology of the trauma in order to implement appropriate corrective measures. In response to the expressed concerns, an investigation was initiated to analyze the biodynamic pathogenetic mechanism associated with ejection in the F/FB-111 crew escape module. The purpose of this retrospective investigation is to identify the frequency and severity of spinal trauma in the F/FB-111 crew escape module and to shed additional light on the patterns and severity along with the orthopaedic biomechanics of spinal injury.

Accidents, Aviation↗

PubMed1986

Phenotypic analysis of cultured melanoma cells. Expression of cytokeratin-type intermediate filaments by the M5 human melanoma cell line.

Expression of intermediate filament (IF) isotypes was studied in six human and two murine melanoma cell lines. With one exception, these lines expressed IFs only of the vimentin type; neurofilament peptides, desmin and GFAP were not detected. However, the M5 human melanoma line also expressed extensive cytokeratin tonofilament arrays, as visualized by immunofluorescence with a panel of eleven monoclonal antibodies and hetero-antisera to cytokeratins; only the keratin 19-specific antibody BA16 did not react. By 2 D gel electrophoresis, five major keratin peptides were detected (keratins 7, 8, 13, 17 and 18), and an additional 57 kD peptide was detected on immunoblots with several antikeratin antibodies. Also observed in M5 cells was focal collapse of tonofilament arrays in mitotic cells. All the melanoma lines tested were positive for S100; M5 and two other cell lines were also positive for the 220-240 kD neuroectoderm-associated cell-surface differentiation antigen defined by monoclonal antibody UJ 127:11. In all the melanoma cell lines, secretion of extracellular matrix proteins (fibronectin, laminin and collagen type IV) was sparse or absent, and all were negative for the epithelial cell markers HMG-1 and HMG-2. Co-expression of keratin and vimentin by a melanoma cell line is discussed in the light of recent controversy concerning expression of cytokeratins by other neoplasms of putative neuroectodermal origins.

Antibodies, Monoclonal↗

PubMed1999

Pharmacological, molecular and functional characterization of glial neurotensin receptors.

The pharmacological properties, molecular identity and physiopathological regulation of neurotensin receptors expressed by central astrocytes were investigated in primary glial cultures and sections from the adult rat brain. Binding experiments carried out on astrocytes in culture revealed the presence of a single apparent class of neurotensin binding sites. These sites bound [125]neurotensin with an affinity (6 nM) comparable to that of the recently cloned NT2 low-affinity receptor expressed in transfected cells. The glial receptor was sensitive to the antihistamine, levocabastine, but less so than the NT2 site expressed in heterologous expression systems, suggesting the presence of an additional site or a differential coupling of the NT2 receptor in glia. Reverse transcription-polymerase chain reaction experiments demonstrated that both NT2 and NT3 neurotensin receptor sub-types were in fact expressed by cortical glial cells in culture. Confocal microscopic visualization of specifically bound fluorescent neurotensin indicated that this expression concerned only a sub-population of astrocytes in culture, in conformity with earlier reports of a heterogeneous expression of neuropeptides and their receptors by glial cells. To further investigate the functionality of NT2 receptors expressed in astrocytes, dual immunohistochemical labeling of glial fibrillary acidic protein and in situ hybridization of NT2 messenger RNA was performed on sections of normal and lesioned rat brain. In sections from normal brain, only a small subset of immunolabeled astrocytes hybridized NT2 messenger RNA. By contrast, in sections of stab-wounded rat brains, there was a marked increase in the number of NT2-hybridizing astrocytes in the surround of the lesion. Furthermore, NT2 expression within immunopositive reactive astrocytes was significantly enhanced as compared to immunolabeled glial cells in the brain of control animals. These results indicate that NT2 receptor expression is up-regulated during astrocytic reaction, suggesting that NT2 receptors may play a role in regulating glial response to injury.

Animals↗

PubMed1995

A survey of environmental and occupational health needs of GPs.

OBJECTIVE: To investigate general practitioners' experience of the nature and frequency of patient consultations about environmental health matters, and about preferred sources of information to assist in designing continuing medical educational programs in environmental and occupational health. STUDY DESIGN/PARTICIPANTS: 491 randomly selected Victorian GPs were mailed a 16-item questionnaire. RESULTS: 80% of GPs responded to the survey questionnaire. GPs reported that between 1% and 4% of consultations were environmental health related in their average caseload. The commonest environmental health concerns expressed by patients were allergy or chemical sensitivity, outdoor and indoor air quality, asbestos, and fears about exposure to environmental carcinogens. Significant differences in concerns were observed between rural, large town and urban GPs, reflecting the types of exposures encountered in those environments. Seventy-two per cent of GPs said they did not have enough access to information of environmental health, and 55% were prepared to undertake further educational activities. Preferred methods of education included journal articles, CHECK programs and clinical meetings. CONCLUSIONS: Most GPs see a need for further education and improved access to information and resources to manage patients' environmental health concerns. It is suggested a variety of avenues be utilised to meet the range of preferred ways of learning expressed by GPs.

Data Collection↗

PubMed2003

Cognitive behavioural therapy: a study of rural general practitioners' understanding and expectations.

INTRODUCTION: Cognitive behavioural therapy (CBT) has been extensively used to manage depression and anxiety. It has been offered to general practitioners (GPs) as a technique suited to primary care. METHODS AND RESULTS: Forty-two GPs, who had participated in workshops on CBT, in rural Victoria, were surveyed about their use, expectations and understanding of CBT. Most of the GPs either occasionally or regularly used CBT. Respondents expressed concern that CBT would lengthen their consultations, while recognising its usefulness in their practice and capacity to enhance doctor-patient communication. CONCLUSIONS: The GPs in this study, while regarding CBT as an appropriate technique in general practice, expressed both broad outcome expectations from its use and concerns about its time management impact. This study indicates the need for further research on the role of CBT in rural general practice.

Adult↗

PubMed1980

Typical behaviors of one-year-old children and their mothers.

Behaviors of 504 middle-class children at 1 year of age and their mothers were assessed with descriptive checklists. Many typical stage-related behaviors led to parental concern or frequent parent-child conflict; 24% of the mothers identified at least one conflict area and 42% expressed concern about at least one aspect of thier children's behaviors. Approximately 13% of the mothers thought their children were very or moderately difficult to rear, and about 6% thought their children had behavioral or emotional problems. The mothers reported considerable variation in the number and type of cognitively stimulating activities that they engaged in with their children. The implications of these findings for well-child care are discussed.

Adult↗

PubMed1995

Umbilical veins in dichorionic twins. A morpho-functional assessment.

Investigations on singleton and twin pregnancies show different functional behaviour on maternal-fetal relationship. In some ways twin pregnancies may be considered at risk and they may develop associated pathologies such as hypertension. The aim of this work was to evaluate the morpho-functional behaviours of umbilical cord veins in twin and singleton gestations to better understand the role of these extra-embryonic tissues in the regulation of pregnancies. The umbilical cords were studied from singleton pregnancies and from dichorionic twin pregnancies. Biochemical and morphological investigations were carried out. A significant decrease in the anisotropy values was observed in endothelial cells from twins compared with singletons. Our ultrastructural data show immaturity features at the vein vessel wall level in twins. Furthermore, immunohistochemical investigations showed a lower degree of expressivity concerning adhesion molecules such as ICAM-1 and ELAM. Morphogenetic extracellular glycoproteins like fibronectin and tenascin seem over-expressed in twin pregnancies. Our morpho-functional data well testify the lower maturation degree of umbilical cord veins in twins with respect to singletons.

Anisotropy↗

PubMed2005

Patient-identified barriers to asthma treatment adherence: responses to interviews, focus groups, and questionnaires.

This article reviews 32 patient-interview studies that revealed that the most common barriers to adherence revealed by patients included concerns about drug safety and cost and a belief that the patient's asthma was not severe enough to require daily treatment. Important but less commonly cited concerns included worry about dependence or diminished effectiveness with long-term use of the medication. Children and their parents expressed concerns about safety, dependence, peer stigmatization, and parent-child conflict over taking medication. Low-income and minority patients cited similar concerns and barriers that included cost, difficulty of obtaining medication, daily life hassles, and a general distrust of the medical establishment. The information obtained from patients' perspectives indicates the need to reappraise current strategies for the management of asthma, including a more flexible approach to the use of expert guidelines for the treatment of asthma.

Activities of Daily Living↗

PubMed2001

Client communication behaviors with health care providers in Indonesia.

Patient participation in health care consultations can improve the quality of decision making and increase patients' commitment to the treatment plan. This study examines client participation, operationally defined as client active communication, during family planning consultations in Indonesia. Data were collected on 1203 consultations in the provinces of East Java and Lampung. Sessions were audiotaped and the conversation coded using an adaptation of the roter interaction analysis system (RIAS). Culturally acceptable ways for Indonesian clients to participate in consultations include asking questions, requesting clarification, stating opinions, and expressing concerns. Factors significantly associated with client active communication were, in order of importance, providers' information giving, providers' facilitative communication, providers' expressions of negative emotion, client educational level, and province. The latter suggests the influence of culture on client participation. The results suggest that a combination of provider training and client education on key communication skills could increase client participation in health care consultations.

Adult↗

PubMed1998

Reassuring the woman facing menopause: strategies and resources.

Reassurance and reliable information are the prime requirements of women in premenopause, perimenopause and postmenopause. Women in premenopause want to know what to expect; women in perimenopause want to know that their experiences fall within the range of 'normal'; women in peri- and postmenopause need help in making sensible decisions about the use of hormone therapy. Based on the concerns expressed in over 7000 letters and other messages sent to the international newsletter, A Friend Indeed, this article discusses the concerns of North American women facing menopause in the last decade of the 20th century.

Adaptation, Psychological↗

PubMedDate not supplied

Implications of managed care for methadone treatment. Findings from five case studies in New York State.

Several policy changes are being debated in New York State that may affect the financing and delivery of methadone maintenance treatment. The goals of this article are to provide greater understanding of the potential impact of managed care on methadone treatment in New York State, and greater understanding of the consequences of arbitrary limits on methadone treatment. Toward these goals, in October 1996, we conducted 1-day site visits at five methadone treatment programs in New York State to learn their views and concerns, and to examine their strategic responses to potential changes in treatment financing and delivery. The treatment programs we visited expressed concern about subjecting methadone patients to any of the potential policy changes because they felt that, if implemented without regard for the special needs of methadone patients, these reforms could hurt treatment access, retention, and quality of care. All the programs stated that limits on treatment would increase drug use and, consequently, increase crime and risk of infectious disease, and cause overall deterioration of the community.

Humans↗

PubMed1990

Symptoms in 298 infants under 6 months old, seen at home.

Symptoms were assessed in 298 infants under 6 months old seen at home. Their mothers were asked if they were concerned about their babies and then questioned about the presence, duration, and severity of 28 predefined symptoms. Forty seven mothers expressed concern about their babies (16%), whereas on direct questioning 241 (81%) reported symptoms present within the last 24 hours. One hundred and twenty three (41%) reported three or more. Many of the symptoms occurred in more than 15 babies (5%). The commonest were cold peripheries (117, 39%), noisy breathing (88, 30%), and rash (68, 23%). These had often been present for many days. Only 257/819 reported symptoms (31%) were of recent onset (less than 4 days) with 168 (21%) graded by the mother as moderate or severe. A few highly specific symptoms that were associated with serious conditions were rare. Symptoms cannot be interpreted without detailed questioning taking their severity and duration into account, and most occur too often to be used as indicators for referral.

Attitude to Health↗

PubMed1994

Transforming information use in preventive medicine: learning to balance technology with the art of caring.

CompuHx* is an Interactive Health Appraisal System (IHAPS) used in the examining room to record patient information, assist in diagnosis, and provide a legible summary of findings. This paper describes Phase I of a longitudinal study in which 22 examiners (five system users and 17 non-users) responded to detailed surveys and interviews about the system. Findings indicated that both users and non-users had mixed feelings about the system's ease of use and impact on their jobs, but agreed that it would have value for their practice. Underlying their acceptance of the system was a common concern for maintaining a caring relationship with patients and not allowing computer technology to depersonalize the examining room. Examiners also expressed concerns about the implementation process.

Artificial Intelligence↗