***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Study question Does the disease label ' polycystic ovary syndrome ' ( PCOS ) have an impact on desire for medical testing and psychosocial outcomes ? Summary answer When given the disease label PCOS in a hypothetical scenario , participants had higher intention to have an  ultrasound , perceived the condition to be more severe and had lower self-esteem than those not given the disease label . What is known already Widening diagnostic criteria and improved imaging sensitivity have increased the number of reproductive-aged women diagnosed with PCOS from 4 % to 8 % to up to 21 % . The uncertain clinical benefit of knowing this diagnosis needs to be weighed against the potential for poor psychological outcomes in women labelled with PCOS . Study design , size , duration This experimental online study r and omised 181 young women to receive one of four hypothetical scenarios of a doctor 's visit in a 2 ( PCOS disease label versus no disease label ) x 2 ( information about unreliability of ultrasounds in clarifying diagnosis versus no information ) design . Participants / material s , setting , methods Participants were university students ( mean age : 19.4 ) . After presenting the scenario , intention to have an ultrasound , negative affect , self-esteem , perceived severity of condition , credibility of the doctor and interest in a second opinion were measured . Participants were then presented with a second scenario , where the possibility of PCOS overdiagnosis was mentioned . Change in intention and perceived severity were then measured . Main results and the role of chance Participants given the PCOS label had significantly higher intention to have an ultrasound ( mean = 6.62 versus mean = 5.76 , P = 0.033 , 95 % CI(difference ) = 0.069 - 1.599 ) , perceived the condition to be more severe ( 17.17 versus 15.82 , P = 0.019 , 95 % CI(difference ) = 0.229 - 2.479 ) and had lower self-esteem ( 25.86 versus 27.56 , P = 0.031 , 95 % CI(difference ) = -3.187 to -0.157 ) . After receiving overdiagnosis information , both intention and perceived severity decreased , regardless of condition ( both P < 0.001 ) . Limitations , reasons for caution This study used hypothetical scenarios ; it is likely that for women facing a real diagnosis of PCOS , outcomes would be more affected than in the current study . The hypothetical design , however , allowed the symptoms and risks of PCOS to be held constant across conditions , the impact on intention and psychosocial outcomes directly attributable to the effect of the disease label . Wider implication s of the findings These findings demonstrate the potential negative consequences of PCOS labelling . It is crucial we consider the impact of the label before diagnosing more women with PCOS when clinical benefit of this diagnosis is uncertain . Study funding /competing interest(s ) This paper was written with support from a NHMRC grant awarded to the Screening and Test Evaluation Program . J.J. is supported by an NHMRC Early Career Fellowship . K.M. is supported by an NHMRC Career Development Fellowship . The authors declare that no competing interests exist . Trial registration number ACTRN12617000111370 . Trial registration date 20/01/2017 . Date of first patient 's enrolment 01/06/2015 A study of hypertension in an industrial setting allowed us to confirm and explore an earlier retrospective finding that the labeling of patients as hypertensive result ed in increased absenteeism from work . After screening and referral , we found that absenteeism rose ( mean + /- 1 S.E. ) 5.2 + /- 2.3 days per year ( P less than 0.025 ) ; this 80 per cent increase greatly exceeded the 9 per cent rise in absenteeism in the general employee population during this period . The main factors associated with increased absenteeism were becoming aware of the condition ( P less than 0.01 ) and low compliance with treatment ( P less than 0.001 ) . Subsequent absenteeism among patients unaware of their hypertension before screening was not related to the degree of hypertension , whether the worker was started on therapy , the degree of blood-pressure control achieved or exposure to attempts to promote compliance . These results have major implication s for hypertension screening programs , especially since absenteeism rose among those previously unaware of their condition , regardless of whether antihypertensive therapy was begun Objective There have been calls to remove ‘ carcinoma ’ from terminology for in situ cancers such as ductal carcinoma in situ ( DCIS ) , to reduce overdiagnosis and overtreatment . We investigated the effect of describing DCIS as ‘ abnormal cells ’ versus ‘ pre-invasive breast cancer cells ’ on women 's concern and treatment preferences . Setting and participants Community sample of Australian women ( n=269 ) who spoke English as their main language at home . Design R and omised comparison within a community survey . Women considered a hypothetical scenario involving a diagnosis of DCIS described as either ‘ abnormal cells ’ ( arm A ) or ‘ pre-invasive breast cancer cells ’ ( arm B ) . Within each arm , the initial description was followed by the alternative term and outcomes reassessed . Results Women in both arms indicated high concern , but still indicated strong initial preferences for watchful waiting ( 64 % ) . There were no differences in initial concern or preferences by trial arm . However , more women in arm A ( ‘ abnormal cells ’ first term ) indicated they would feel more concerned if given the alternative term ( ‘ pre-invasive breast cancer cells ’ ) compared to women in arm B who received the terms in the opposite order ( 67 % arm A vs 52 % arm B would feel more concerned , p=0.001 ) . More women in arm A also changed their preference towards treatment when the terminology was switched from ‘ abnormal cells ’ to ‘ pre-invasive breast cancer cells ’ compared to arm B. In arm A , 18 % of women changed their preference to treatment while only 6 % changed to watchful waiting ( p=0.008 ) . In contrast , there were no significant changes in treatment preference in arm B when the terminology was switched ( 9 % vs 8 % changed their stated preference ) . Conclusions In a hypothetical scenario , interest in watchful waiting for DCIS was high , and changing terminology impacted women 's concern and treatment preferences . Removal of the cancer term from DCIS may assist in efforts towards reducing overtreatment OBJECTIVE We tested whether adding interpretive labels ( eg , " negative test " ) to prenatal genetic screening test results changes perceived risk and preferences for amniocentesis .  STUDY DESIGN Women ( N = 1688 ) completed a hypothetical pregnancy scenario on the Internet . We r and omly assigned participants into 2 groups : high risk of fetal chromosomal problems ( 12.5/1000 ) or low risk ( 2/1000 ) . After prenatal screening , estimated risk was identical ( 5/1000 ) for all participants , but results were provided either alone or with interpretive labels . RESULTS When receiving test results without labels , all participants react similarly . With labels , the participants who received " positive " or " abnormal " results reported a higher perceived risk ( P < .001 ) , greater worry ( P < .001 ) , and greater interest in amniocentesis ( 57 % vs 37 % ; P < .001 ) than did the participants who received " negative " or " normal " results . CONCLUSION Interpretive labels for test results can induce larger changes to a woman 's risk perception and behavioral intention than can numeric results alone , which create decision momentum . This finding has broad clinical implication s for patient-provider communication BACKGROUND : The factors that drive overtreatment of gastroesophageal reflux disease ( GERD ) are not well understood , but it has been proposed that the use of the “ GERD ” disease label could perpetuate use of medication in otherwise healthy infants . METHODS : To determine if use of the disease label GERD influences parents ’ perceived need to medicate an infant , we surveyed parents in a general pediatric clinic . Parents were given a hypothetical clinical scenario describing an infant who cries and spits up excessively but is otherwise healthy . Using a 2 × 2 factorial design , parents were r and omized to receive a scenario in which the doctor either gave a diagnosis of GERD or did not provide a disease label ; additionally , half of parents were told that existing medications are probably ineffective , whereas the rest were not given any effectiveness information . We measured parent interest in medication , perception of illness severity , and appreciation of medication offer . RESULTS : Parents who received a GERD diagnosis were interested in medicating their infant , even when they were told that the medications are likely ineffective . However , parents not given a disease label were interested in medication only when medication effectiveness was not discussed ( and hence likely assumed ) . CONCLUSIONS : Labeling an otherwise healthy infant as having a “ disease ” increased parents ’ interest in medicating their infant when they were told that medications are ineffective . These findings suggest that use of disease labels may promote overtreatment by causing people to believe that ineffective medications are both useful and necessary The present study was aim ed at examining the effects of awareness of hypertension on blood pressure and sympathetic responses to the cold pressor test .  Nineteen-year-old men with similarly elevated mean blood pressure at a medical screening , but without knowledge of this , were r and omized into two groups . The first group ( n = 16 ) was sent a letter saying that their pressure was too high , and the second ( n = 13 ) was sent a neutral letter . Information increased mean blood pressure both after 15 min sitting , by an average of 11.5 mm Hg ( P less than .01 ) , and after 30 min supine rest , by an average of 4.5 mm Hg ( P less than .05 ) . Changes in heart rate ( 8.4 + /- 2.4 v 1.9 + /- 1.7 beats/min ) and plasma epinephrine ( 0.11 + /- 0.04 v 0.01 + /- 0.03 nmol/L ) during execution of a cold pressor test were significantly greater in the informed group ( P less than .05 ) . Plasma dopamine was lower in the informed group ( P less than .05 ) . Thus , psychological stress caused by the awareness of hypertension may increase blood pressure and sympathetic responses to a provocative maneuver . Ideally , studies on sympathetic function in essential hypertension should be undertaken on subjects unaware of their blood pressure status Parents of children who presented for a pediatrics appointment responded to a clinical vignette that described a child with symptoms consistent with acute viral conjunctivitis . In a 2 × 2 r and omized survey design , the physician in the vignette either used the term “ pink eye ” or “ eye infection ” to describe the symptoms , and either told parents that antibiotics are likely ineffective at treating the symptoms or did not discuss effectiveness . When the symptoms were referred to as “ pink eye , ” parents remained interested in antibiotics , despite being informed about their ineffectiveness . By contrast , when the symptoms were referred to as an “ eye infection , ” information about antibiotic ineffectiveness significantly reduced interest , Mdiff = 1.63 , P < .001 . Parents who received the “ pink eye ” label also thought that the symptoms were more contagious and were less likely to believe that their child could go to child care , compared with parents who received the “ eye infection ” label , Mdiff = 0.37 , P = .38 
    Output:
    
Based on a narrative synthesis of the data , when a more medicalised or precise term was used to describe the condition , it generally result ed in a shift in preference towards more invasive managements , and /or higher ratings of anxiety and perceived severity of the condition .
Different terminology given for the same condition influenced management preferences and psychological outcomes in a consistent pattern in these studies .