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Ochoa-Morales A, Dávila-Ortiz de Montellano DJ, Chávez-Oliveros M, Rodríguez-Agudelo Y, Longoria-Ibarrola M, Sosa-Ortiz AL, Boll MC, Jara-Prado A, Yescas-Gómez P, Guerrero-Camacho J, Ramírez-García MÁ. Presymptomatic Testing for Huntington's Disease in Mexico: 28 Years of Experience. Arch Med Res 2024; 55:103004. [PMID: 38714041 DOI: 10.1016/j.arcmed.2024.103004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION Huntington's disease (HD) is a genetic neurodegenerative disorder with dominant inheritance. Our center in Mexico City has offered presymptomatic testing (PT) since 1995. OBJECTIVE To describe the main clinical and demographic characteristics of at-risk HD individuals who applied to the PT program, the reasons for seeking it, and the molecular results. METHODS A cross-sectional study was conducted with sociodemographic and clinical data of all PT applicants from 1995-2023. Reasons for seeking PT were assessed using a modified questionnaire. In addition, anxiety, and depressive symptoms before and after PT were evaluated with Beck's instruments; cognitive impairment (CI) was assessed with the Mini-Mental State Examination (MMSE) and molecular results. RESULTS 214 people applied for PT (2.1% of the at-risk population identified in our center); 63% were women (mean age of 37.11 years). 204 (95.3%) were accepted and 190 received results. 70% indicated that the main reason for applying for PT was to inform their offspring about the risk of inheriting HD. Significant differences were observed in the reasons for seeking PT by age group. Although some subjects received treatment, Beck's instrument scores did not indicate special attention or pharmacological treatment. The MMSE showed probable CI in 20 subjects. Of those who received results, 37% were carriers of a full penetrance allele. CONCLUSION Our center has the only formal PT program for HD in Mexico. The reasons for seeking PT are varied and age-related. Although PT is offered to all subjects at risk for HD, uptake remains low.
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Affiliation(s)
- Adriana Ochoa-Morales
- Genetics Department, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | | | - Mireya Chávez-Oliveros
- Clinical Neuropsychology Laboratory, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez. Mexico City, Mexico
| | - Yaneth Rodríguez-Agudelo
- Clinical Neuropsychology Laboratory, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez. Mexico City, Mexico
| | - Mariana Longoria-Ibarrola
- Dementia Laboratory, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Ana Luisa Sosa-Ortiz
- Dementia Laboratory, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Marie-Catherine Boll
- Clinical Research Laboratory, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Aurelio Jara-Prado
- Genetics Department, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Petra Yescas-Gómez
- Genetics Department, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Jorge Guerrero-Camacho
- Genetics Department, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico
| | - Miguel Ángel Ramírez-García
- Genetics Department, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez, Mexico City, Mexico.
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Tommel J, Kenis D, Lambrechts N, Brohet RM, Swysen J, Mollen L, Hoefmans MJF, Pusparum M, Evers AWM, Ertaylan G, Roos M, Hens K, Houwink EJF. Personal Genomes in Practice: Exploring Citizen and Healthcare Professionals’ Perspectives on Personalized Genomic Medicine and Personal Health Data Spaces Using a Mixed-Methods Design. Genes (Basel) 2023; 14:genes14040786. [PMID: 37107544 PMCID: PMC10137790 DOI: 10.3390/genes14040786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Ongoing health challenges, such as the increased global burden of chronic disease, are increasingly answered by calls for personalized approaches to healthcare. Genomic medicine, a vital component of these personalization strategies, is applied in risk assessment, prevention, prognostication, and therapeutic targeting. However, several practical, ethical, and technological challenges remain. Across Europe, Personal Health Data Space (PHDS) projects are under development aiming to establish patient-centered, interoperable data ecosystems balancing data access, control, and use for individual citizens to complement the research and commercial focus of the European Health Data Space provisions. The current study explores healthcare users’ and health care professionals’ perspectives on personalized genomic medicine and PHDS solutions, in casu the Personal Genetic Locker (PGL). A mixed-methods design was used, including surveys, interviews, and focus groups. Several meta-themes were generated from the data: (i) participants were interested in genomic information; (ii) participants valued data control, robust infrastructure, and sharing data with non-commercial stakeholders; (iii) autonomy was a central concern for all participants; (iv) institutional and interpersonal trust were highly significant for genomic medicine; and (v) participants encouraged the implementation of PHDSs since PHDSs were thought to promote the use of genomic data and enhance patients’ control over their data. To conclude, we formulated several facilitators to implement genomic medicine in healthcare based on the perspectives of a diverse set of stakeholders.
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Affiliation(s)
- Judith Tommel
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
- Correspondence: (J.T.); (D.K.)
| | - Daan Kenis
- Department of Philosophy, University of Antwerp, Rodestraat 14, 2000 Antwerp, Belgium
- Correspondence: (J.T.); (D.K.)
| | | | - Richard M. Brohet
- Department of Epidemiology and Statistics, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands
| | | | | | | | - Murih Pusparum
- VITO Health, Boeretang 200, 2400 Mol, Belgium
- Data Science Institute, I-Biostat, Hasselt University, 3500 Hasselt, Belgium
| | - Andrea W. M. Evers
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | | | - Marco Roos
- Department of Human Genetics, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Kristien Hens
- Department of Philosophy, University of Antwerp, Rodestraat 14, 2000 Antwerp, Belgium
| | - Elisa J. F. Houwink
- Department of Family Medicine, Mayo Clinic, 221 Fourth Avenue SW, Rochester, MN 55905, USA
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Black KJ, Barton SK, Perlmutter JS. Presymptomatic Testing and Confidentiality in the Age of the Electronic Medical Record. J Neuropsychiatry Clin Neurosci 2021; 33:80-83. [PMID: 32669021 DOI: 10.1176/appi.neuropsych.20030068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Recent introduction of a commercial electronic medical record (EMR) system at the authors' institution raised a number of questions about documenting visits for presymptomatic testing for Huntington's disease (HD). Specifically, adoption of the EMR potentially compromised patient confidentiality and the personal delivery of test results, both of which are strongly recommended by professional consensus and lay organizations. METHODS The authors surveyed peer institutions about their experience with EMR systems in the setting of presymptomatic testing for HD. RESULTS Answers from 10 well-known HD specialty centers demonstrated a wide variety of approaches to managing these concerns. The responses did not clarify how to resolve the collision between the virtues of a shared medical record and the goal of patient control of sensitive medical information. CONCLUSIONS These results demonstrate that important issues remain unresolved. The authors propose that medical record systems must adapt to and respect the patient's desires for confidentiality and allow people undergoing presymptomatic testing to restrict access to this sensitive information.
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Affiliation(s)
- Kevin J Black
- Departments of Psychiatry (Black), Neurology (Black, Barton, Perlmutter), Radiology (Black, Perlmutter), and Neuroscience (Black, Perlmutter), and Programs in Physical Therapy and Occupational Therapy (Perlmutter), Washington University School of Medicine, St. Louis
| | - Stacey K Barton
- Departments of Psychiatry (Black), Neurology (Black, Barton, Perlmutter), Radiology (Black, Perlmutter), and Neuroscience (Black, Perlmutter), and Programs in Physical Therapy and Occupational Therapy (Perlmutter), Washington University School of Medicine, St. Louis
| | - Joel S Perlmutter
- Departments of Psychiatry (Black), Neurology (Black, Barton, Perlmutter), Radiology (Black, Perlmutter), and Neuroscience (Black, Perlmutter), and Programs in Physical Therapy and Occupational Therapy (Perlmutter), Washington University School of Medicine, St. Louis
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Genetic counseling and testing practices for late-onset neurodegenerative disease: a systematic review. J Neurol 2021; 269:676-692. [PMID: 33649871 PMCID: PMC7920548 DOI: 10.1007/s00415-021-10461-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/10/2021] [Accepted: 02/10/2021] [Indexed: 12/28/2022]
Abstract
Objective To understand contemporary genetic counseling and testing practices for late-onset neurodegenerative diseases (LONDs), and identify whether practices address the internationally accepted goals of genetic counseling: interpretation, counseling, education, and support. Methods Four databases were systematically searched for articles published from 2009 to 2020. Peer-reviewed research articles in English that reported research and clinical genetic counseling and testing practices for LONDs were included. A narrative synthesis was conducted to describe different practices and map genetic counseling activities to the goals. Risk of bias was assessed using the Qualsyst tool. The protocol was registered with PROSPERO (CRD42019121421). Results Sixty-one studies from 68 papers were included. Most papers focused on predictive testing (58/68) and Huntington’s disease (41/68). There was variation between papers in study design, study population, outcomes, interventions, and settings. Although there were commonalities, novel and inconsistent genetic counseling practices were identified. Eighteen papers addressed all four goals of genetic counseling. Conclusion Contemporary genetic counseling and testing practices for LONDs are varied and informed by regional differences and the presence of different health providers. A flexible, multidisciplinary, client- and family-centered care continues to emerge. As genetic testing becomes a routine part of care for patients (and their relatives), health providers must balance their limited time and resources with ensuring clients are safely and effectively counseled, and all four genetic counseling goals are addressed. Areas of further research include diagnostic and reproductive genetic counseling/testing practices, evaluations of novel approaches to care, and the role and use of different health providers in practice. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10461-5.
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