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Results for “Expression of Concern”

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PubMed2005

Preferences of Women Evaluating Risks of Tamoxifen (POWER) study of preferences for tamoxifen for breast cancer risk reduction.

BACKGROUND: The objective of this study was to understand the attitudes and preferences of risk-eligible women regarding use of tamoxifen for breast cancer risk reduction. METHODS: A cross-sectional, mixed-methods interview study was conducted at a university medical center and at community sites. Participants were women who had an estimated 5-year breast cancer risk > or = 1.7% and no prior breast cancer. Interviews were conducted in English or Spanish. The interview included a 15-minute, standardized educational session on the potential benefits and harms of tamoxifen followed by close-ended and open-ended questions about participants' inclinations to take tamoxifen and factors important to their decision. A demographic questionnaire, a test on knowledge of potential benefits and harms of tamoxifen, and an interview evaluation were included. RESULTS: Two hundred fifty-five women completed interviews. Their estimated mean 5-year breast cancer risk was 2.8%; and their mean self-perceived 5-year risk was 32.7%. After the educational intervention, 45 women (17.6%) were inclined to take tamoxifen. Very high risk women (> 3.5%) were no more inclined to take it than women with lower risk (1.7-3.5%). In a multivariable analysis, lower income, confidence in the effectiveness of tamoxifen, and concern about fractures were associated with being inclined to take it; concern about pulmonary embolism, dyspareunia, cataracts, and low self-perceived breast cancer risk were associated negatively with taking tamoxifen. Participants expressed concerns about adverse effects. CONCLUSIONS: Less than 20% of women were interested in tamoxifen after education about potential benefits and harms, despite a very high self-perceived breast cancer risk. Candidate chemoprevention agents must have few potential adverse effects to achieve widespread acceptance.

Adult↗

PubMed1987

Survey of attitudes of nurses working with AIDS patients.

This article reports the results of a ten-question anonymous survey given to nurses at Westchester County Medical Center in July 1983 and January 1984 concerning attitudes about caring for AIDS patients. Two-thirds of the responding nurses reported that they had friends or family express concern about associating with hospital personnel who have contact with AIDS patients. Other questions showed that between one fourth and one half of nurses have a fear of caring for homosexual men and male prisoners because of their awareness about AIDS. One half of the nurses believe that AIDS can be transmitted to hospital personnel because of contact with patients despite precautions. The fear of caring for patients with AIDS as compared to caring for patients with hepatitis, a more contagious but less serious disease than AIDS, was highest in the intensive care unit staff. Eighty-five percent of the health care personnel responding believed that pregnant nurses should not care for AIDS patients and one half of the nurses responding indicated that they would ask for a transfer if they had to care for AIDS patients on a regular basis. The implication of these findings for future treatment programs, medical and nursing education and psychologic support for staff are discussed.

Acquired Immunodeficiency Syndrome↗

PubMed1986

Concern about cancer in women undergoing elective gynaecological surgery.

Interviews were conducted with 63 women aged 18-75 shortly after their admission to hospital for routine non-cancer gynaecological surgery. Three groups were studied: major surgery, chiefly hysterectomy, carried out for benign conditions (n = 25); minor surgery such as dilatation and curettage (n = 29); fertility investigations and sterilisations (n = 9). Women were asked whether they worried if they were suffering from seven serious illnesses including heart disease, breast cancer and gynaecological cancer (cancer of the cervix, womb or ovaries). Significantly more women were concerned that they suffered from gynaecological cancer than any other illness. When asked why they were worried, over 85% of those expressing concern believed that their current gynaecological problem stemmed from cancer. Worry about gynaecological cancer was positively associated with psychiatric status and gynaecological knowledge, and negatively with satisfaction with treatment. A link with presenting clinical symptoms was also identified. This study revealed high levels of unwarranted distress in women undergoing routine surgery. Such fears may not be allayed, since surgeons and staff may not consider cancer to be relevant to the patient's clinical condition.

Adolescent↗

PubMedDate not supplied

Integrating healthy steps into PNP graduate education.

INTRODUCTION: The purpose of this project was to explore a) the value of an adapted version of the Healthy Steps program for Pediatric Nurse Practitioner (PNP) graduate students and b) the perceptions of PNP program directors regarding practice issues, educational preparation and the Healthy Steps program. METHOD: A four-part workshop was offered to students in their final year of the program. Outcomes were measured through evaluations and a pre-test/post-test design. A survey was also mailed to 24 PNP program directors. RESULTS: More than 90% of the participating students rated this workshop as "good or excellent." All of the students recommended integration of Healthy Steps content into PNP graduate education. PNP program directors voiced concern about the effect of the managed care environment on PNP practice, acknowledged the importance of strengthening health supervision visits, and expressed interest in the Healthy Steps program. DISCUSSION: This project demonstrated that an adapted version of the Healthy Steps program enhanced the education of final year PNP students. PNP program directors expressed concern about practice issues, preparation for practice, and would consider potential adoption of portions of the Healthy Steps curriculum.

Curriculum↗

PubMed2000

Localization of prostaglandin synthase type-1 (PGHS-1) mRNA and prostaglandin synthase type-2 (PGHS-2) mRNA in ovine myometrium and endometrium throughout gestation.

Increased prostaglandin production by tissues in the sheep uterus and placenta are thought to be important for the onset of parturition. In the sheep placenta, this is most likely due to increased expression of prostaglandin synthase type-2 (PGHS-2) rather than prostaglandin synthase type-1 (PGHS-1). However, there is no information concerning expression of PGHS isoenzymes in maternal uterine tissues during pregnancy. Therefore, the purpose of the present study was to examine the expression of PGHS-1 and PGHS-2 in the sheep myometrium and endometrium during late gestation using in situ hybridization and immunohistochemistry. Using (35)S-labelled oligonucleotide probes, which give specific hybridization signals in other tissues, we localized PGHS-2 mRNA to endometrial epithelium, and apparently to other cells in both endometrium and myometrium. This artefactual signal was still present with 100-fold excess unlabelled oligonucleotide probe and with sense probes, but was resolved with the use of (33)P-oligonucleotides. Using (33)P-labelled oligonucleotide probes we could not detect either PGHS-1 or PGHS-2 mRNA in myometrium, and found expression only of PGHS-2 mRNA in endometrium. PGHS-2 mRNA localized to the endometrial epithelium and was undetectable in glandular epithelium. The level of PGHS-2 expression rose significantly between days 80 and 85 of pregnancy and term, and this corresponded to the appearance of immunoreactive PGHS-2 protein, measured by immunohistochemistry, in the endometrial epithelium. Therefore we conclude that (33)P-labelled probes are preferred for detection of mRNAs encoding PGHS-2 in ovine uterine tissues. Expression of PGHS-2 mRNA is greater than that of PGHS-1, increases during gestation, and predominates in the endometrial epithelium, consistent with the site of PGHS-2 protein localization.

Animals↗

PubMed2005

Science, law, and politics in FDA's genetically engineered foods policy: scientific concerns and uncertainties.

The Food and Drug Administration's (FDA's) 1992 policy statement granted genetically engineered foods presumptive GRAS (generally recognized as safe) status. Since then, divergent views have been expressed concerning the scientific support for this policy. This paper examines four sources to better understand the basis for these claims: 1) internal FDA correspondence; 2) reports from the National Academy of Sciences; 3) research funded by US Department of Agriculture from 1981 to 2002; and 4) FDA's proposed rules issued in 2001. These sources reveal that little research has been conducted on unintended compositional changes from genetic engineering. Profiling techniques now make this feasible, but the new debate centers on the functional meaning of compositional changes.

Consumer Product Safety↗

PubMed2000

Occupational exposure to inhaled anesthetic. Is it a concern for pregnant women?

QUESTION: Two of my pregnant patients are exposed to inhaled anesthetic on the job. One is an anesthetist, and the other is a veterinarian. They have both expressed concern about this exposure. How should I advise them? ANSWER: Occupational exposure to waste anesthetic gas is not associated with increased risk of major malformations. Risk of spontaneous abortion might be slightly increased, however. This risk can be reduced, if not eliminated, by good gas scavenging systems.

Abortion, Spontaneous↗

PubMed1989

Assessing risks and preventing disease from environmental chemicals.

In the last 25 years there has been considerable concern expressed about the extent to which chemical agents in the ambient and work environments are contributing to the causation of disease. This concern is a logical extension of our increased knowledge of the real and potential effects of environmental chemicals and the methodological difficulties in applying new knowledge that could help prevent environmentally induced disease. Chemical risk assessment offers an approach to estimating risks and involves consideration of relevant information including identification of chemical hazards, evaluation of the dose-response relationship, estimation of exposure and finally, risk characterization. Particularly significant uncertainties which are inherent in use of this and other risk models include animal-human and low dose-high dose extrapolation and estimation of exposure. Community public health risks from exposure to environmental chemicals appear to be small relative to other public health risks based on information related to cancer trends, dietary intake of synthetic chemicals, assessment data on substances such as DDT and "dioxin," public health effects of hazardous waste sites and contextual considerations. Because of inherent uncertainty in the chemical risk assessment process, however, we need to apply what methods are available in our efforts to prevent disease induced by environmental chemicals. There are a number of societal strategies which can contribute to overall reduction of risk from environmental chemicals. These include acquisition of information on environmental risk including toxicity, intensity and extensity of exposure, biological monitoring, disease surveillance, improvement in epidemiological methods, control of environmental chemical exposures, and dissemination of hazardous chemical information. Responsible environmental risk communication and information transfer appear to be among the most important of the available strategies for preventing disease induced by chemicals in the environment.

Communication↗

PubMed1991

Neural influence on the expression of acetylcholinesterase molecular forms in fast and slow rabbit skeletal muscles.

With the aim of investigating the roles of motor innervation and activity on muscle characteristics, we studied the molecular forms of acetylcholinesterase (AChE) in fast-twitch (semimembranosus accessorius; SMa) and slow-twitch (semimembranosus proprius; SMp) muscles of the rabbit. We have shown that SMa and SMp express different patterns and tissue distribution of AChE forms and that the effect of long denervation varies with age. Three principal findings concerning expression of AChE molecular forms emerge from these studies. (1) The activity of AChE and the pattern of its molecular forms are particularly altered in adult denervated SMa and SMp muscles. AChE activity increases by 10-fold in both muscles, but asymmetric forms disappear in SMa and increase by 20-fold in SMp muscles. A similar alteration of AChE is found after tenotomy of these muscles, showing that the effect of denervation may be partly due to suppression of muscle activity. (2) The different changes occurring in the composition of AChE molecular forms in adult denervated SMa and SMp muscles are consistent with fluorescent staining with anti-AChE monoclonal antibodies and with DBA or VVA lectins, which bind to AChE asymmetric, collagen-tailed forms. These lectins poorly stain denervated SMa muscle surfaces but intensely stain neuromuscular junctions and extrasynaptic areas in denervated SMp muscle. (3) In contrast with the adult, denervation of 1-day-old muscles does not markedly modify the total amount of AChE or the proportions of its molecular forms, despite dramatic effects on muscle structure. These results are supported by studies of labeling with fluorescent DBA: the lectin only slightly stains the muscle fiber surface of denervated 15-day-old SMp muscle. Taken together, these data show that denervated muscles escape physiological regulation, producing increased levels of AChE with highly variable cellular distribution and patterns of molecular forms, depending on the age of operation and on the type of muscle.

Acetylcholinesterase↗

PubMed2000

Occupational health concerns in the welding industry.

The Workplace Safety and Health Branch initiated a proactive study in the welding industry in Manitoba. Eight welding companies participated in this study. Health concerns raised by welders were welders' flash, sore/red/teary eyes, headaches, nosebleeds, and a black mucous discharge from their nasal membrane. Most welders expressed concern regarding excessive smoke levels in the workplace and inadequate ventilation. Types of welding identified were MIG mild steel, MIG stainless steel, and TIG aluminum. Monitoring involved an assessment of noise levels, fume composition, and carbon monoxide and ozone concentrations. Metal analyses were according to National Institute for Occupational Safety and Health (NIOSH) Method 7300. Noise dosimeters used were the Quest model 100 and Micro 14 & 15. Carbon monoxide was monitored using the Gastech Model 4700 and ozone using the AID Portable Ozone Meter Model 560. In Manitoba, a hearing conservation program is required when the equivalent sound exposure level (normalized Lex 8-hr) exceeds 80 dBA-weighted. The American Conference of Governmental Industrial Hygienists' threshold limit value-time weighted average (ACGIH TLV-TWA) for iron is 5.0 mg/m3, manganese is 0.2 mg/m3, carbon monoxide is 25 ppm, and ozone is 0.05 ppm (heavy work), 0.08 ppm (moderate work), and 0.1 ppm (light work). Welders' personal exposures to manganese ranged from 0.01-4.93 mg/m3 (N = 42; AM = 0.5; GM = 0.2; SD +/- 0.9; GSD +/- 3.2) and to iron ranged from 0.04-16.29 mg/m3 (N = 42; AM = 3.0; GM = 1.4; SD +/- 3.5; GSD +/- 2.5). Noise exposures ranged from 79-98 dBA (N = 44; AM = 88.9; GM = 88.8; SD +/- 4.2; GSD +/- 1.0). Carbon monoxide levels were less than 5.0 ppm (at source) and ozone levels varied from 0.4-0.6 ppm (at source). Ventilation upgrades in the workplace were required in most welding shops. Only 7 percent of the welders wore respiratory protection. A hearing conservation program and hearing protection were required at all monitored workplaces.

Adult↗

PubMed1995

Coexpression of the c-kit and stem cell factor genes in breast carcinomas.

Expression of the c-kit tyrosine kinase growth factor receptor has been reported in some breast tumors; however, no data exist concerning expression of its ligand, stem cell factor. The aim of this study was to determine how frequently the c-kit and stem cell factor genes were coexpressed in breast tumors and tumor-derived cell lines and to determine whether coexpression of c-kit and stem cell factor could result in growth stimulation of breast tumor cells. Expression of the c-kit and stem cell factor genes in tissue specimens and cell lines was determined using an RNase protection assay, with confirmation of c-kit protein expression by immunohistochemistry and Western blotting in tumor tissue and cell lines, respectively. Of 11 tumor specimens studied, 9 expressed variable but detectable quantities of c-kit; 7 of 13 tumor-derived cell lines also expressed c-kit. All tumor specimens and cell lines expressed detectable stem cell factor mRNA, suggesting that an autocrine growth loop could exist in the majority of breast carcinomas. To determine the biological effects of coexpression of c-kit and stem cell factor, the MCF-7 cell line, which expresses only stem cell factor, was transfected with a c-kit expression vector. Coexpression of c-kit and stem cell factor in MCF-7 cells resulted in an enhanced growth rate and cloning efficiency but not a loss of the dependence of this cell line upon estrogen. Analysis of subclones expressing different amounts of c-kit protein revealed that, although they all showed enhanced growth relative to control transfectants in serum-free medium containing IGF-1, only the highest c-kit expressor responded with additional growth to exogenous soluble stem cell factor. However, all c-kit-expressing clones, but not control clones, showed growth inhibition when exposed to a blocking anti-c-kit antibody. This blocking antibody also significantly inhibited the growth of the established ZR75-1 cell line in serum-free medium containing IGF-1. Taken together, these data suggest that coexpression of stem cell factor and c-kit could be responsible for growth deregulation in a significant number of breast carcinomas.

Adenocarcinoma↗

PubMed2006

Testing effective connectivity changes with structural equation modeling: what does a bad model tell us?

Structural equation modeling (SEM) is a statistical method that can assess changes in effective connectivity across tasks or between groups. In its initial application to neuroimaging data, anatomical connectivity provided the constraints to decompose interregional covariances to estimate effective connections. There have been concerns expressed, however, with the validity of interpreting effective connections for a model that does not adequately fit the data. We sought to address this concern by creating two population networks with different patterns of effective connectivity, extracting three samples sizes (N = 100, 60, 20), and then assessing whether the ability to detect effective connectivity differences depended on absolute model fit. Four scenarios were assessed: (1) elimination of a region showing no task differences; (2) elimination of connections with no task differences; (3) elimination of connections that carried task differences, but could be expressed through alternative indirect routes; (4) elimination of connections that carried task differences, and could not be expressed through indirect routes. We were able to detect task differences in all four cases, despite poor absolute model fit. In scenario 3, total effects captured the overall task differences even though the direct effect was no longer present. In scenario 4, task differences that were included in the model remained, but the missing effect was not expressed. In conclusion, it seems that when independent information (e.g., anatomical connectivity) is used to define the causal structure in SEM, inferences about task- or group-dependent changes are valid regardless of absolute model fit.

Algorithms↗

PubMed1980

Anxiety levels and concerns among pregnant women.

Since maternal anxiety has been implicated as one variable in the etiology of maternal and fetal complications, this study was done to identify specific concerns and anxiety levels among pregnant women. One hundred pregnant women, 48 private and 52 clinic patients, completed the Taylor Manifest Anxiety Scale, a concerns questionnaire, and an information sheet. Twenty-nine specific concerns were identified by 50% or more of the pregnant women. Major concerns identified were "if your baby will be healthy and normal" (94%) and "your baby's condition at birth" (93%). The number of expressed concerns showed a statistically significant correlation with anxiety level (rs = .5678; p = .001), with clinic patients having significantly higher anxiety levels than private patients.

Age Factors↗

PubMed1998

High expression of bcl-2 mRNA as a determinant of poor prognosis in acute myeloid leukemia.

BACKGROUND: The bcl-2 oncoprotein is suggested to be directly involved in the emergence of drug resistance by disrupting or delaying the apoptotic program and promoting tumor survival. PATIENTS AND METHODS: In order to define the clinical relevance of the bcl-2 mRNA expression in acute myeloid leukemia (AML) and its correlation to therapy outcome and prognosis, we analyzed 219 AML bone marrow (BM) samples, including 119 patients with de novo AML at presentation, 37 with AML following myelodysplastic syndrome (MDS), as well as 42 BM samples of AML in relapse and 21 in complete remission (CR) using RT-PCR. For performing quantitative measurements of bcl-2 mRNA, we developed a quantitative RT-PCR. RESULTS: Bcl-2 mRNA was detectable in 133 of 156 (84%) patients at diagnosis and 40 of 42 (95%) at relapse. AML patients with high bcl-2 mRNA expression achieved lower CR rates than those with no or low expression. Concerning the long-term outcome, the overall (OS) and disease-free survival (DFS) was significantly worse in AML patients with high expression levels of bcl-2 mRNA. The three-year OS for all newly diagnosed AML patients was 49% and 10% (P = 0.028), respectively, and 71% and 15% (P = 0.0004) for patients < 60 years. Comparable significant differences were observed for the DFS. In AML following MDS and patients > 60 years, the bcl-2 expression was not associated with remission rate or survival. CONCLUSIONS: The expression of bcl-2 mRNA may serve as a prognostic factor predicting remission outcome and long-term prognosis in AML.

Drug Resistance, Neoplasm↗

PubMedDate not supplied

Confronting competing demands to improve quality: a five-country hospital survey.

This paper reports on a 2003 comparative survey of hospital executives in Australia, Canada, New Zealand, the United Kingdom, and the United States. Reflecting higher spending levels, U.S. hospitals as a group stand out for generally more positive ratings of facilities and finances and short or no waiting times. Yet U.S. hospital executives are also the most negative about their country's health care system. Hospital executives in all five countries expressed concerns about staffing shortages and emergency department waiting times and quality. Asked about future strategies to improve quality, executives in all five countries expressed support for making information technology an investment priority.

Data Collection↗

PubMed1998

[Service expectations facing Saxony's newly established social psychiatric services. Attitudes of established neurologists, physicians in psychiatric clinics and social psychiatry service staff].

In the wake of the disintegration of the policlinical system which had prevailed in the former German Democratic Republic, far-reaching restructuring has become necessary in the "new" German laender in the field of complementary psychiatric care. Establishment throughout the state of Saxony of a uniform outreach-based ambulatory service ranks as a first component towards building regionalized community psychiatric networks. In light of some twenty years of experience in the old laender, this function is considered a task of the Social Psychiatric Services ("Sozialpsychiatrische Dienste", SPDIs). The present study had been directed at a state-wide investigation of the expectations community-practice psychiatrists (n = 165), physicians in psychiatric clinics (n = 95) and staff working in SPDIs (n = 138) in Saxony hold regarding service programmes and operating methods of these newly established service delivery structures. Given the high return rates in this anonymous postal questionnaire study, the findings presented are considered near-representative. A concurrent finding for all of the groups interviewed, expectations concerning the client population to be serviced by the SPDIs focus on the group of persons with chronic mental illness. Also, the expectations expressed concerning major care/therapeutic services to be rendered by the SPDIs concur in their emphasis on a core area of immediately client-oriented SPDI activities. Between the two medical groups, a major difference found is that community-practice psychiatrists more frequently expect high SPDI commitment regarding sociotherapeutic programmes at an institutional level, whereas clinical physicians expect them to focus on taking over medical therapies in the narrower sense. The expectations SPDI staff hold relative to the therapeutic services to be rendered by themselves go beyond the scope of what has so far been implemented in their current activity, and qualitative content analyses are presented in the article for each of the areas concerned. Along with better staffing levels, removal of in-service organizational and further education deficits are identified by SPDI staff as the two main requirements for stabilizing their operations. In order to counter undue burdening of the SPDI with service expectations and to enable a more clear-cut positioning of its programme structures within a complex psychosocial service delivery system, it is necessary--at least in the state of Saxony--that further needs-oriented establishment and/or extension of community-based psychiatric services and agencies take place.

Attitude of Health Personnel↗

PubMed1995

Voices of Korean-American students.

The purpose of this study was to identify the special needs or concerns of Korean-American students by utilizing a survey questionnaire. Further, this data can be used to assess if any significant subset of these students are educationally at risk and in need of specialized services beyond regular education. A total sample of 207 Korean-American students in selected cities in California participated in the study. The findings suggest that the overwhelming majority of these students are well-adjusted to the way of life at home and school in California, and their self-concept appears to be highly positive. On the other hand, the majority (78%) of these students were concerned about their parents' limited English proficiency. Also, a considerable number (56%) were not happy with their school work, and approximately one third expressed concern regarding learning difficulties and the English language barrier.

Adolescent↗

PubMed1994

Concerning the analysis of 2 x 2 tables.

Recent papers (R. M. Engeman and G. D. Swanson, 1991, Comput. Biomed. Res. 24, 509; M. R. Massai and P. Barbini, 1993, Comput. Biomed Res. 26, 98) have expressed concern regarding differences in results among statistical methods of hypothesis testing for 2 x 2 contingency tables. These papers did not present current statistical thought on this topic, and they did not discuss measures of effect for such analyses. In this paper statistical literature on the 2 x 2 contingency table is presented and philosophical issues underlying the methods discussed. Measures of effect appropriate for several data origins or designs which result in 2 x 2 arrays are also presented. The paper presents an empirical adjustment to the Fisher's exact test known as the mid-P approach. The information should help provide the user of statistics a better understanding of the analysis of 2 x 2 tables. An example using data from Engeman and Swanson (1991) is provided, and some recommendations for the analysis of 2 x 2 tables are given.

Aged↗