SEARCH · PubMed Health

Results for “Expression of Concern”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 487 records · Page 27Linked to original sources

PubMed2006

Depression and suicidal ideation after predictive testing for Huntington's disease: a two-year follow-up study.

The present study reports a two-year follow-up of psychological effects of predictive testing for Huntington's disease. Questionnaires assessing depression, general health, well-being, self injurious behavior, life satisfaction, and lifestyle were completed by 35 carriers and 58 non-carriers before the predictive test, and 2, 6, 12, and 24 months afterwards. Both carriers and non-carriers showed high suicidal ideation before the predictive testing. Depression scores and frequency of suicidal thoughts increased for carriers, compared to non-carriers, over time. There were no differences regarding life satisfaction or life style between carriers and non-carriers. Predictive testing was beneficial in reducing overall ill-health symptoms and increasing well-being for those initially expressing concern about Huntington's disease. The importance of assessing suicidal ideation and of continuing to provide adequate support is emphasized.

Depression↗

PubMed2006

Self-reported reproductive outcomes among male and female 1991 Gulf War era US military veterans.

BACKGROUND: Following the 1991 Gulf War, some veterans expressed concerns regarding their reproductive health. Our objective was to assess whether an association exists between deployment to the 1991 Gulf War and self-reported adverse pregnancy outcomes. METHODS: Using a modified Dillman technique with telephone follow-up, we conducted a survey via a postal questionnaire from February 1996-August 1997 to compare selected reproductive outcomes among 10,000 US veterans deployed to the 1991 Gulf War with those of 10,000 nondeployed Gulf War era veterans. RESULTS: A total of 8742 individuals responded to the survey, a response rate of 51 percent. Using multivariable analyses, results showed no differences in number of reported pregnancies between Gulf War veterans and nondeployed veterans. Among 2233 female and 2159 male participants, there were no differences in birth weight of infants born to Gulf War veterans compared with nondeployed Gulf War era veterans. In multivariable models, male and female Gulf War veterans did not significantly differ in risk for ectopic pregnancies, stillbirths, or miscarriages when compared with nondeployed veterans of the same era. CONCLUSIONS: These results do not suggest an association between service in the 1991 Gulf War and adverse reproductive outcomes for both male and female veterans during the 4 years after the war.

Abortion, Spontaneous↗

PubMed2004

Endoscopic techniques for treatment of gastroesophageal reflux disease: a review of abstracts from Digestive Disease Week 2003.

Endoscopic treatments of gastroesophageal reflux disease (GERD) are a new and potentially useful form of therapy for reflux disorders. This type of treatment was first introduced at Digestive Disease Week (DDW) in 2000, and the most recent DDW, in 2003, included a growing number of abstracts describing further experience with endoscopic GERD treatments. The studies are still generally open-label trials involving relatively small patient groups given a variety of unique endoscopic GERD treatments, including radiofrequency, thermal ablation, plication suturing, and polymer injection and implantation techniques. Longer patient follow-up after Stretta (Curon Medical, Sunnyvale, CA) procedures, the permanency rate of EndoCinch (Bard Interventional Products, Billerica, MA) plication sutures, and new experiences with Enteryx (Boston Scientific, Natick, MA) and Gatekeeper (Medtronic, Minneapolis, MN) procedures were highlighted at DDW 2003. Despite these unique devices with significant potential for treatment of GERD, caution was expressed concerning their clinical use in anything other than appropriately designed, scientifically validated clinical trials.

Catheter Ablation↗

PubMed2026

"Will it be enough to be respected?": understanding personal, institutional, and societal harms and benefits of genomics research.

BACKGROUND: Transgender Identity Genomics Research (TIGR)-research examining potential associations between genetic factors and transgender, nonbinary, and gender diverse (trans) identities-takes place in a complex landscape with significant potential to either benefit or harm trans communities. As public and political scrutiny of trans communities intensifies, the stakes and potential impacts of TIGR are heightened and ethical, legal and social implications must be considered. To better understand how those who would be most affected by TIGR view such research, we explored trans adults' perceptions of TIGR in the current environment and how they perceive TIGR may impact their futures. METHODS: Using a community-based participatory research approach, we partnered with a trans-led Executive Stakeholder Board to conduct in-depth interviews with 31 trans adults in the United States between June-December 2024 and conducted a Reflexive Thematic Analysis. RESULTS: Participants (mean age=34 years, range=19-73 years; 61% people of color; 39% nonbinary, 39% transgender women, 22% transgender men) identified possible benefits of TIGR such as personal affirmation, increased social acceptance, and improved access to gender-affirming healthcare. They also expressed concerns about potential harms, including further stigmatization, discrimination, and pathologization of trans identities. While most viewed research in trans communities (including TIGR) as a net positive, some participants felt it less useful compared to addressing more urgent, material challenges trans communities face. CONCLUSION: Our findings underscore that TIGR, like all scientific research, is shaped by the sociopolitical environment. It is imperative that TIGR researchers engage meaningfully and ethically with trans communities to minimize potential harms and center community needs.

Genetics↗

PubMed1993

Safety restraint usage in fatal motor vehicle crashes.

In 1987, following implementation of the Washington safety restraint mandatory usage law, collision statistics indicated an increase in motor vehicle crashes in which occupants had died while utilizing safety restraints. Because of concerns expressed by restraint use law advocates, a "Fatal Collision Research Team" was established to evaluate and reconstruct collisions in which restrained occupants had died. Collisions were analyzed over a three-year period and included 337 crashes involving 1,058 occupants, of whom 446 died. The team analyzed fatal collisions involving restrained occupants and documented restraint usage as well as severity of the crash. Crash severity was measured using either the Collision Deformation Classification (CDC) system, which defines the extent of crush to the vehicle, and/or intrusion into the passenger occupant area, or by measuring deceleration forces (delta v) acting on the vehicle, where sufficient data existed to do so. The survivability of the crash was determined individually for each occupant and independently of whether the occupant lived or died, as well as whether the occupant was restrained or not. The major findings were: (i) that in the majority of cases where a restrained occupant died, the fatality can be attributed to the extent of vehicle crush and deceleration forces, i.e. the crash forces and dynamics made the crash nonsurvivable, and (ii) restraint misuse seemed not to be a major contributory factor in fatal crash injuries.

Accidents, Traffic↗

PubMed1990

At what levels of total low- or high-density lipoprotein cholesterol should diet/drug therapy be initiated? United States guidelines.

Guidelines for the detection, evaluation and treatment of hypercholesterolemia in adults have been established in the United States. These guidelines recommend that total cholesterol levels be used for screening purposes. Total cholesterol levels greater than 240 mg/dl are considered "high," those from 200 to 239 mg/dl "borderline," and those less than 200 mg/dl "normal," regardless of the person's age or gender. All persons in the high category, as well as those in the borderline category who have other risk factors or established vascular disease, require measurements of low-density lipoprotein (LDL) cholesterol levels. LDL cholesterol levels are used to guide the selection of treatment. Patients with LDL cholesterol levels greater than 130 mg/dl are candidates for active diet therapy. Those whose LDL cholesterol levels are 160 to 190 mg/dl after 3 to 6 months of diet therapy are candidates for drug therapy. A high-density lipoprotein (HDL) level less than 35 mg/dl is considered a risk factor and may influence the level of LDL at which drug therapy is initiated. Some observers have expressed concern that these guidelines overemphasize LDL cholesterol at the expense of total cholesterol, HDL cholesterol and triglyceride levels. Nevertheless, the guidelines have been broadly accepted and currently serve as the basis for a widespread public-health education program.

Cholesterol↗

PubMed1981

Factors influencing lesbian gynecologic care: a preliminary study.

One hundred seventeen homosexual women were surveyed to determine their health care utilization patterns, their gynecologic and obstetric problems, and their attitudes toward physicians. It was found that these women actively utilized the health care system, although many chose less traditional sources. The gamut of both obstetric and gynecologic problems were seen, but venereal disease and cervical dysplasia were uncommon. No medical problems specific to homosexual women were identified. Many of these lesbians expressed concern about the effect on their health care of physicians' negative attitude toward homosexuals.

Adult↗

PubMed1991

End-to-end repair of aortic coarctation using absorbable polydioxanone suture.

Based on previous laboratory work, we have used polydioxanone absorbable suture in a variety of vascular and cardiac repairs in pediatric patients. However, some investigators have expressed concern about the potential for aneurysm formation at the anastomotic site. Between March 1983 and June 1989, 15 patients (7 male, 8 female) aged 2.5 months to 9.2 years (mean, 3.7 years) had resection of coarctation of the aorta and end-to-end anastomosis with polydioxanone absorbable suture. Thirteen patients have returned for routine postoperative evaluation, the follow-up time ranging from 11 to 49 months (mean, 23 months). Noninvasive two-dimensional, pulsed-wave Doppler and color echocardiography and magnetic resonance imaging studies demonstrated good anatomical repair and no anastomotic aneurysm formation or residual coarctation of the aorta in any patient after end-to-end anastomosis with polydioxanone. In summary, this intermediate follow-up study has revealed no vascular complications related to the repair of coarctation with absorbable polydioxanone suture.

Abnormalities, Multiple↗

PubMed1983

The surgeon general's "epidemiologic criteria for causality": a criticism of Burch's critique.

In this paper, it has not been possible to critically and objectively assess each of the points made by Burch, since it would be time-consuming both for this author as well as for the reader. However, the major areas of concern expressed by Burch have been reviewed and evaluated. This has in many instances required going back to the original reports of studies to which Burch refers. In doing so, it came as a complete surprise to note that Burch has incompletely presented the findings of several studies or has omitted discussing others more fully. This is, needless to say, most disturbing. In viewing the issue of the causal interpretation of the cigarette smoking--lung cancer relationship, it would appear that Burch would not be satisfied unless there is a randomized controlled experiment in humans. However, since such an experiment seems hardly feasible, one must depend upon a synthesis of findings of epidemiologic observations, experimental work on animals and studies of chemical constituents of tobacco and cigarette smoke. However, these do not seem to satisfy Burch, who has developed a theoretical conceptual framework for the etiology of cancer and many other diseases, based upon statistical models and equations. Such an approach is extremely limited. Scientific information and inferences are in the public domain, thereby allowing criticism and evaluation. It is customary, in the experimental sciences, for a scientist who is dissatisfied with the findings of another scientist, to attempt to repeat the experiment to see if his findings are the same or different. This should also be expected in the cigarette smoking-lung cancer issue.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1982

Emotional reactions to the diagnosis and treatment of early breast cancer.

Fourty-four patients with early breast cancer were interviewed before mastectomy and on three occasions during the following year about psychiatric symptomatology, and their emotional reactions to various aspects of the illness and its treatment. Eight patients developed symptoms of depressive illness. Thirty-five patients expressed emotional distress related to the diagnosis or the loss of the breast or both. All ten who had adjuvant chemotherapy considered this the most unpleasant aspect of treatment. Post-operative distress could often be predicted by a high score on the General Health Questionnaire, or a high level of expressed concern before the operation.

Adaptation, Psychological↗

PubMed1990

General practitioners use of hormone-replacement therapy in Yorkshire.

Questionnaires were sent to 1000 general practitioners (GPs) in the Yorkshire Region to obtain information about their approach to the use of hormone-replacement therapy (HRT) in the menopause. A total of 310 GPs returned completed questionnaires. These showed widely varying views. The majority of GPs estimated that less than 10% of their perimenopausal patients had taken HRT at some time. There was confusion about the reported effects of HRT, on the risks of endometrial carcinoma and on ischaemic heart disease. Thus, while 86% correctly judged that HRT was protective against osteoporosis, 70% concluded against prevailing opinion that combined preparations increase the risk of endometrial cancer. In contrast to the bulk of evidence, nearly 50% of respondents believed that the risk of ischaemic heart disease was also increased by HRT. A number of GPs considered lack of an authoritive lead from epidemiology to be their greatest difficulty in forming an opinion on the desirability of HRT. The general approach to HRT was cautious in respect of both the frequency and the duration of the therapy. Less than a quarter of the GPs were sympathetic to the idea of prophylactic HRT and only 7% routinely discussed this possibility with menopausal patients, while the majority felt that the duration of therapy should be limited to 2 years or less. Most respondents also showed intuitive resistance to the idea of 'mass therapy' at the menopause and expressed concern at the idea of 'interfering with nature'.

Attitude of Health Personnel↗

PubMed1992

Contraindications to vasoconstrictors in dentistry: Part III. Pharmacologic interactions.

This article discusses the relative contraindications to the use of vasoconstrictor in patients currently medicated with tricyclic antidepressants, monoamine oxidase inhibitors, phenothiazines and beta-blockers. It reviews drug interactions and emphasizes potential detrimental systemic effects that epinephrine contained in local anesthetics can have when administered concomitantly with these drugs. Finally, special considerations are expressed concerning patients who abuse illicit drugs such as cocaine.

Acute Disease↗

PubMedDate not supplied

Initial report of a hepatitis investigation in rural Belize.

In spring 1991, Belizian health officials expressed concern about a possible hepatitis outbreak in a banana farming district. A study was designed to identify cases and to address the serological prevalence of hepatitis virus markers. Three populations were studied: (i) persons meeting a clinical case definition for hepatitis; (ii) designated banana workers; and (iii) people in a random sample of households in the community. Information was collected using questionnaires and sera were collected for laboratory testing. This report presents the preliminary results of a study conducted in June 1991. Among people who met the clinical case definition, 24% of 42 tested had immunoglobulin M antibody to hepatitis B virus (HBV) core antigen (anti-HBc IgM). In the worker and household survey populations, 284 and 280 people, respectively, were tested for anti-HBc IgM. In each group, 4% were positive. HBV surface antigen was found in 37% of 43 clinical cases, 18% of workers, and 13% of people in the household survey. Among the 3 study populations, the prevalence of HBV core antibody (anti-HBc) ranged from 73% to 81%. Almost all tested persons had evidence of prior hepatitis A virus infection. Evidence of prior infection with hepatitis viruses A and B was widespread, but an aetiology could not be established for most of the clinical cases. However, the prevalence of hepatitis B markers in this population was very high compared to other reports from the Caribbean.

Adolescent↗

PubMed1991

One explanation of the asthma paradox: inhibition of natural anti-inflammatory mechanism by beta 2-agonists.

Our understanding of the mechanisms contributing to the pathogenesis of bronchial asthma has increased substantially over the past decade. This has been accompanied by the introduction of a range of new drugs for the treatment of this disorder, and the usage of anti-asthma drugs is increasing. Despite these changes and an increased awareness of the disease, asthma remains the only "preventable" disease where the morbidity and mortality are still increasing in most parts of the world. This "asthma paradox" requires explanation, and this article is an attempt to provide a plausible scientific one. The hypothesis expresses concern that a long recognised, but little publicised, pharmacological property of the drug class most widely prescribed for the treatment of asthma, the beta 2-adrenoceptor agonists--namely, the inhibition of mast-cell degranulation--may be contributing to the world wide increase in morbidity and mortality from asthma via the inhibition of a natural anti-inflammatory mechanism.

Adrenergic beta-Agonists↗

PubMed1992

Routine ultrasonography in utero and school performance at age 8-9 years.

Most fetuses in developed countries are exposed in utero to diagnostic ultrasound examination. Many pregnant women express concern about whether the procedure harms the fetus. Since most routine ultrasound examinations are done at weeks 16-22, when the fetal brain is developing rapidly, effects on neuronal migration are possible. We have sought an association between routine ultrasonography in utero and reading and writing skills among children in primary school. At the age of 8 or 9 years, children of women who had taken part in two randomised, controlled trials of routine ultrasonography during pregnancy were followed-up. The women had attended the clinics of 60 general practitioners in central Norway during 1979-81. The analysis of outcome was by intention to treat: 92% of the "screened" group had been exposed to ultrasound screening at weeks 16-22, and 95% of controls had not been so exposed, but there was some overlap. 2428 singletons were eligible for follow-up, and the school performance of 2011 children (83%) was assessed by their teachers on a scale of 1-7; the teachers were unaware of ultrasound exposure status. A subgroup of 603 children underwent specific tests for dyslexia. There were no statistically significant differences between children screened with ultrasound and controls in the teacher-reported school performance (scores for reading, spelling, arithmetic, or overall performance). Results from the dyslexia test sample showed no differences between screened children and controls in reading, spelling, and intelligence scores, or in discrepancy scores between intelligence and reading or spelling. The test results classified 21 of the 309 screened children (7% [95% confidence interval 3-10%]) and 26 of the 294 controls (9% [4-12%]) as dyslexic. The risk of having poor skills in reading and writing was no greater for children whose mothers had been offered routine ultrasonography than for those whose mothers had not been offered the procedure.

Adult↗

PubMed1993

Carcinogenicity of azathioprine: an S-AR investigation.

Besides its use in the treatment of a variety of presumed autoimmune diseases, azathioprine is given as an immunosuppressant to patients who have had renal transplants. Though epidemiological studies have provided "sufficient" evidence of its carcinogenicity in humans, the carcinogenicity tests in rats and mice are considered to be inconclusive because of limitations in the design and results of these tests (IARC, 1981, 1987). Rosenkranz and Klopman (1991) used the CASE program to identify the structural features responsible for its carcinogenicity. They concluded that this genotoxic chemical was a carcinogen due to the presence of the molecular fragment C"-S-C=. The finding was based on the presence of this biophore fragment in five other compounds, namely: 2-amino-5-nitrothiazole, 2-mercaptobenzothiazole, fenthione, 4,4'-thiodianiline and nithiazide. Recently, Ashby (1992) has expressed concern over the validity of their findings. With the aim of contributing to this debate on the mechanism of carcinogenicity of azathioprine, we have analyzed the structural basis of carcinogenicity of azathioprine and the five support compounds using the carcinogenicity predictor of our toxicity prediction program, TOPKAT. The results, more in line with Ashby's concerns, indicate that no molecular fragment involving the S atom is associated with the carcinogenic properties of these molecules. According to the TOPKAT program the carcinogenicity, if any, of azathioprine is due to the NO2 electrophile because its other major structural features are found to be either associated with non-carcinogenicity or do not discriminate carcinogens from non-carcinogens.

Algorithms↗

PubMed1993

WHO under stress: implications for health policy.

A crisis is increasingly challenging the authority and prestige of the United Nations' specialized agencies. Although the World Health Organization is still held in great repute, it has not escaped criticism. Member countries have expressed concern about WHO's bureaucratic procedures, costs, proliferation of meetings, reports, lack of budget transparency. Doubts have been cast on the effectiveness of some programmes. This paper argues that such criticisms must be understood within the context of the huge changes that have occurred since WHO was established in the late 1940s. There has been a major shift in the financing of WHO, with extrabudgetary funding now providing more than half the total budget, which has implications for policy influence within the Organization. Policy is also being decided within an increasingly political milieu. These changes put significant pressure on the Organization in a number of ways, and it is essential to generate a public debate about WHO's future role if the Organization is to retain the esteem within which it is generally held. This paper makes an initial contribution to that debate.

Budgets↗

PubMed1988

Factors associated with cytomegalovirus excretion in hospitalized children.

Hospital employees, especially pregnant women, have expressed concern over exposure to patients excreting cytomegalovirus (CMV). However, the vast majority of CMV excreters are asymptomatic and are not identified while hospitalized. As part of a 2-year, longitudinal study of nosocomial transmission of CMV in a children's hospital, the prevalence rates of CMV excretion by patients in different areas of the hospital were determined. The average prevalence rates were neonatal intensive care unit, 5.7%; intermediate care nurseries, 4%; premature nursery, 6.3%; normal newborn nursery, 3%; hematology-oncology, 3.7%; pediatric intensive care unit, 3.6%; general pediatric ward, 6%; and a chronic care unit, 16%. During this 2-year study, 315 patients admitted to the chronic care unit were investigated to determine which clinical factors might help predict children likely to excrete CMV. With the use of multiple logistic regression analysis of variables, prior excretion of CMV, multiple hospital admissions, female sex, and Hispanic ethnic background were correlated with excretion. Although not identified as significant factors, a history of premature, bronchopulmonary dysplasia and positive results of CMV serologic studies were more commonly associated with excretion. CMV excretion occurred in all areas within a children's hospital, and certain factors were associated with excretion, but it is unlikely that this information could adequately identify "safe" patients or safe areas within a hospital. This study reinforces the need to follow proper precautions with all patients.

Adult↗