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Metcalfe SA, Dougherty MJ, Gaff CL. Editorial: Educating Health Professionals in Genomic Medicine: Evidence-Based Strategies and Approaches. Front Genet 2020; 11:696. [PMID: 32849770 PMCID: PMC7427515 DOI: 10.3389/fgene.2020.00696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Pediatrics, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | | | - Clara L Gaff
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Pediatrics, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.,Melbourne Genomics Health Alliance, Parkville, VIC, Australia
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McClaren BJ, Crellin E, Janinski M, Nisselle AE, Ng L, Metcalfe SA, Gaff CL. Preparing Medical Specialists for Genomic Medicine: Continuing Education Should Include Opportunities for Experiential Learning. Front Genet 2020; 11:151. [PMID: 32194628 PMCID: PMC7063730 DOI: 10.3389/fgene.2020.00151] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 02/10/2020] [Indexed: 12/30/2022] Open
Abstract
With the demand for genomic investigations increasing, medical specialists will need to, and are beginning to, practice genomic medicine. The need for medical specialists from diverse specialties to be ready to appropriately practice genomic medicine is widely recognised, but existing studies focus on single specialties or clinical settings. We explored continuing education needs in genomic medicine of a wide range of medical specialists (excluding genetic specialists) from across Australia. Interviews were conducted with 86 medical specialists in Australia from diverse medical specialties. Inductive content analysis categorized participants by career stage and genomics experience. Themes related to education needs were identified through constant comparison and discussion between authors of emerging concepts. Our findings show that participants believe that experiential learning in genomic medicine is necessary to develop the confidence and skills needed for clinical care. The main themes reported are: tailoring of education to the specialty and the individual; peer interactions contextualizes knowledge; experience will aid in developing confidence and skills. In fact, avenues of gaining experience may result in increased engagement with continuing education in genomic medicine as specialists are exposed to relevant applications in their clinical practice. Participants affirmed the need for continuing education in genomic medicine but identified that it would need to be tailored to the specialty and the individual: one size does not fit all, so a multifaceted approached is needed. Participants infrequently attended formal continuing education in genomic medicine. More commonly, they reported experiential learning by observation, case-review or interacting with a "genomics champion" in their specialty, which contextualized their knowledge. Medical specialists anticipate that genomic medicine will become part of their practice which could lessen demand on the specialist genetic workforce. They expect to look to experts within their own medical specialty who have gained genomics expertise for specific and contextualized support as they develop the skills and confidence to practice genomic medicine. These findings highlight the need to include opportunities for experiential learning in continuing education. Concepts identified in these interviews can be tested with a larger sample of medical specialists to ascertain representativeness.
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Affiliation(s)
- Belinda J. McClaren
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, VIC, Australia
| | - Erin Crellin
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, VIC, Australia
| | - Monika Janinski
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, VIC, Australia
| | - Amy E. Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, VIC, Australia
| | - Larissa Ng
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, VIC, Australia
| | - Sylvia A. Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, VIC, Australia
| | - Clara L. Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, VIC, Australia
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McClaren BJ, King EA, Crellin E, Gaff C, Metcalfe SA, Nisselle A. Development of an Evidence-Based, Theory-Informed National Survey of Physician Preparedness for Genomic Medicine and Preferences for Genomics Continuing Education. Front Genet 2020; 11:59. [PMID: 32194615 PMCID: PMC7063665 DOI: 10.3389/fgene.2020.00059] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 01/17/2020] [Indexed: 01/31/2023] Open
Abstract
Despite some early implementation of genomic medicine globally, there is a lack of rigorous, large-scale assessments of medical specialists' current practice and continuing education needs. As a first step to addressing this gap, we describe the development of a robust, expert-reviewed, survey using a mixed-methods sequential study design. We conducted semi-structured qualitative interviews with 32 education providers and 86 non-genetic medical specialists about current genomic medicine practice and need for continuing education. Key concepts were identified and used as an initial framework for the survey. These were: personal characteristics (medical specialty, years of practice); current practice of genomics in clinical and research settings; perception of how proximal genomic medicine is to practice; perception of preparedness (competence and confidence); and, preferences for future roles and models of care in genomic medicine and for continuing education. Potential survey questions that related to at least one of these concepts were identified from the literature or were created if no suitable question existed. Using a modified, reactive Delphi approach, questions were reviewed by a panel of 22 experts. Experts were selected purposefully representing four areas of expertise: non-genetic medical specialties; clinical genetics; genetic/genomic education and evaluation; and implementation science. Three Delphi rounds assessed relevance, clarity and importance of each question. The questions were also mapped to the behaviour change wheel theoretical framework which encompasses capability, opportunity and motivation (COM-B). The survey (included as supplementary material) was then tested with a small group of non-genetic medical specialists and feedback was written or verbal in 'talk-aloud', cognitive interviews. The final survey was then piloted with a further 29 specialists. We describe the methodology to create a robust, data- and theory-informed survey. The final survey captures not only levels of experience, practice of genomics and preferences for education but also the challenges around engaging with education. Survey data will provide evidence for education providers to inform development of education which meets learner needs and contributes to a medical workforce that is literate in genomics and more confident to competently practice genomic medicine.
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Affiliation(s)
- Belinda J. McClaren
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Emily A. King
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
| | - Erin Crellin
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Clara Gaff
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Sylvia A. Metcalfe
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy Nisselle
- Australian Genomics Health Alliance, Melbourne, VIC, Australia
- Genomics in Society, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
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Abstract
Background: Personal genomic testing (PGT) offers individuals genetic information about relationships, wellness, sporting ability, and health. PGT is increasingly accessible online, including in emerging markets such as Australia. Little is known about what consumers expect from these tests and whether their reflections on testing resonate with bioethics concepts such as autonomy.Methods: We report findings from focus groups and semi-structured interviews that explored attitudes to and experiences of PGT. Focus group participants had little experience with PGT, while interview participants had undergone testing. Recordings were transcribed and analyzed using thematic analysis. Findings were critically interpreted with reference to bioethics scholarship on autonomy.Results: Fifty-six members of the public participated in seven focus groups, and 40 individuals were interviewed separately. Both groups valued the choice of PGT, and believed that it could motivate relevant actions. Focus group themes centered on the perceived value of choices, knowledge enabling action and knowledge about the self. Interview themes suggest that participants reflexively engage with their PGT information to make meaning, and that some appreciate its shortcomings. Critical interpretation of findings shows that while consumers of PGT are able to exercise a degree of autonomy in choosing, they may not be able to achieve a substantive conceptualization of autonomy, one that promotes alignment with higher-order desires.Conclusions: PGT consumers can critically reason about testing. However, they may uncritically accept test results, may not appreciate drawbacks of increased choice, or may overestimate the potential for information to motivate behavioral change. While consumers appear to be capable of substantive autonomy, they do so without ongoing support from companies. PGT companies promote a problematic ("default") account of autonomy, reliant on empowerment rhetoric. This leaves consumers vulnerable to making decisions inconsistent with their higher-order desires. As PGT expands, claims about its power and value need to be carefully drawn.
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Affiliation(s)
- Jacqueline Savard
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
| | - Chriselle Hickerton
- Genetics Education and Health Research, Murdoch Children’s Research Institute, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Sylvia A. Metcalfe
- Genetics Education and Health Research, Murdoch Children’s Research Institute, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Clara Gaff
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Walter and Eliza Hall Institute of Medical Research, Victoria, Australia
| | - Anna Middleton
- Society and Ethics Research, Wellcome Genome Campus Society and Ethics Research Group, Hinxton, Cambridge, United Kingdom
- Faculty of Education, University of Cambridge, Cambridge, United Kingdom
| | - Ainsley J. Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, NSW, Australia
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Tutty E, Hickerton C, Adamski MM, Metcalfe SA. Personal genomic testing for nutrition and wellness in Australia: A content analysis of online information. Nutr Diet 2019; 76:263-270. [PMID: 30693631 DOI: 10.1111/1747-0080.12516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/04/2018] [Accepted: 12/09/2018] [Indexed: 12/16/2022]
Abstract
AIM Personal genomic testing for nutrition and wellness (PGT-NG) offers a new service delivery model to nutritionists and dietitians. However, research indicates that this type of testing currently lacks sufficient clinical validity and utility to be commercially available. Despite Australian guidelines to the contrary, healthcare professionals are currently offering testing to clients, and promoting these services online. Thus, it is important to understand how PGT-NG is currently framed online to the public. METHODS A mixed methods content analysis was conducted to assess the content, quality and marketing approaches of websites offering PGT-NG to Australians. Websites were identified using popular search engines to mimic the behaviour of a consumer. A novel framework was developed for the purposes of the analysis. RESULTS Thirty-nine websites were analysed, comprising four nutritional genomic testing company websites and 35 healthcare provider websites. Healthcare providers relied on information from the testing companies. The content was emotive, and little attention was given to the scientific and ethical aspects of personal genomic testing. Websites appealed to consumer empowerment and framed testing as an essential and superior tool for optimising health. CONCLUSIONS Websites lacked the transparency necessary for informed consent. A basic checklist of key information was developed to aid healthcare providers when informing potential clients of PGT-NG online.
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Affiliation(s)
- Erin Tutty
- Murdoch Children's Research Institute, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Chriselle Hickerton
- Murdoch Children's Research Institute, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Melissa M Adamski
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Sylvia A Metcalfe
- Murdoch Children's Research Institute, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Savard J, Hickerton C, Tytherleigh R, Terrill B, Turbitt E, Newson AJ, Wilson B, Gray K, Gaff C, Middleton A, Stackpoole E, Metcalfe SA. Australians' views and experience of personal genomic testing: survey findings from the Genioz study. Eur J Hum Genet 2019; 27:711-720. [PMID: 30666046 PMCID: PMC6461785 DOI: 10.1038/s41431-018-0325-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/22/2018] [Accepted: 11/22/2018] [Indexed: 12/25/2022] Open
Abstract
Personal genomic tests (PGTs) for multiple purposes are marketed to ostensibly healthy people in Australia. These tests are generally marketed and purchased online commercially or can be ordered through a health professional. There has been minimal engagement with Australians about their interest in and experience with ordering a PGT. As part of a multistage, interdisciplinary project, an online survey (Stage 2 of the Genioz study) was available from May 2016 to May 2017. In total, 3253 respondents attempted the survey, with 2395 completed Australian responses from people with and without experience of having a PGT: 72% were female; 59% of the whole sample were undertaking/or had a university education; and, overall, age ranged from 18—over 80. A total of 571 respondents reported having had a genetic test, 373 of these classifiable as a PGT. A bivariate analysis suggests people who have undergone PGT in our sample were: women aged 25 and over; or in a high socioeconomic group, or have a personal or family diagnosis of a genetic condition (P ≤ 0.03). After a multivariate analysis, socioeconomic status and a genetic condition in the family were not of significance. The most common types of PGT reported were for carrier status and ancestry. Findings suggest greater awareness of, and an increasing demand for non-health related PGT in Australia. To support both consumers and health care professionals with understanding PGT results, there is a need for appropriate support and resources.
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Affiliation(s)
- Jacqueline Savard
- Deakin University, School of Medicine, Faculty of Health, Geelong, Victoria, Australia.,The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, NSW, 2006, Australia.,Garvan Institute of Medical Research, Sydney, Australia
| | - Chriselle Hickerton
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Rigan Tytherleigh
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Bronwyn Terrill
- Garvan Institute of Medical Research, Sydney, Australia.,Genome.One, Sydney, Australia.,St. Vincent's Clinical School, University NSW, Sydney, Australia
| | - Erin Turbitt
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,National Human Genome Research Institute, Bethesda, MD, USA
| | - Ainsley J Newson
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, Sydney, NSW, 2006, Australia.,Garvan Institute of Medical Research, Sydney, Australia
| | - Brenda Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Memorial Hospital, St John's, Newfoundland, Canada
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, The University of Melbourne, Melbourne, Australia
| | - Clara Gaff
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Anna Middleton
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Elaine Stackpoole
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Genetic Services of Western Australia, Subiaco, WA, Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
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7
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Metcalfe SA, Hickerton C, Savard J, Terrill B, Turbitt E, Gaff C, Gray K, Middleton A, Wilson B, Newson AJ. Australians' views on personal genomic testing: focus group findings from the Genioz study. Eur J Hum Genet 2018; 26:1101-1112. [PMID: 29706641 PMCID: PMC6057916 DOI: 10.1038/s41431-018-0151-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/13/2018] [Accepted: 03/20/2018] [Indexed: 12/30/2022] Open
Abstract
Personal genomic testing provides healthy individuals with access to information about their genetic makeup for purposes including ancestry, paternity, sporting ability and health. Such tests are available commercially and globally, with accessibility expected to continue to grow, including in Australia; yet little is known of the views/expectations of Australians. Focus groups were conducted within a multi-stage, cross-disciplinary project (Genioz) to explore this. In mid-2015, 56 members of the public participated in seven focus groups, allocated into three age groups: 18–24, 25–49, and ≥50 years. Three researchers coded transcripts independently and generated themes. Awareness of personal genomic testing was low, but most could deduce what “personal genomics” might entail. Very few had heard of the term “direct-to-consumer” testing, which has implications for organisations developing information to support individuals in their decision-making. Participants’ understanding of genetics was varied and drawn from several sources. There were diverse perceptions of the relative influence of genetics and environment on health, mental health, behavior, talent, or personality. Views about having a personal genomic test were mixed, with greater interest in health-related tests if they believed there was a reason for doing so. However, many expressed scepticisms about the types of tests available, and how the information might be used; concerns were also raised about privacy and the potential for discrimination. These exploratory findings inform subsequent stages of the Genioz study, thereby contributing to strategies of supporting Australians to understand and make meaningful and well-considered decisions about the benefits, harms, and implications of personal genomic tests.
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Affiliation(s)
- Sylvia A Metcalfe
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia. .,Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Chriselle Hickerton
- Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jacqueline Savard
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Garvan Institute of Medical Research, Sydney, Australia
| | - Bronwyn Terrill
- Garvan Institute of Medical Research, Sydney, Australia.,Genome.One, Sydney, Australia.,St Vincent's Clinical School, University NSW, Sydney, Australia
| | - Erin Turbitt
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Genetics Education and Health Research, Murdoch Children's Research Institute, Melbourne, Australia.,National Human Genome Research Institute, Bethesda, MD, USA
| | - Clara Gaff
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,The Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | - Kathleen Gray
- Health and Biomedical Informatics Centre, The University of Melbourne, Melbourne, Australia
| | - Anna Middleton
- Society and Ethics Research, Connecting Science, Wellcome Genome Campus, Cambridge, UK
| | - Brenda Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ainsley J Newson
- Sydney Health Ethics, Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Abstract
Genomic technologies are now being applied to reproductive genetic screening. Circulating cell-free DNA testing in pregnancy for fetal chromosomal abnormalities is becoming more widely used as a screening test, and expanded carrier screening for autosomal and X-linked recessive conditions for more than a hundred conditions is available to couples for testing before and during pregnancy. These are most typically available as a commercial test. The purpose of reproductive genetic screening is to facilitate autonomous reproductive choices. Previous studies would suggest that many women do not make informed decisions about prenatal genetic screening, and the introduction of genomic technologies has generally added to the ethical debate. Appropriate pre-test genetic counselling is recommended, and healthcare providers should include information that is balanced, accurate and up-to-date, comprising written and/or e-learning tools, as well as providing psychosocial support so that couples consider the pros and cons of being tested and can make informed decisions.
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Affiliation(s)
- Sylvia A Metcalfe
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
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9
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Affiliation(s)
- Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Genetics Education and Health Research, Royal Children's Hospital, Melbourne, Victoria, Australia.
| | - Martin B Delatycki
- Murdoch Childrens Research Institute, Genetics Education and Health Research, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jonathan Cohen
- Murdoch Childrens Research Institute, Genetics Education and Health Research, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alison D Archibald
- Murdoch Childrens Research Institute, Genetics Education and Health Research, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Jon D Emery
- Murdoch Childrens Research Institute, Genetics Education and Health Research, Royal Children's Hospital, Melbourne, Victoria, Australia
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10
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Henneman L, Borry P, Chokoshvili D, Cornel MC, van El CG, Forzano F, Hall A, Howard HC, Janssens S, Kayserili H, Lakeman P, Lucassen A, Metcalfe SA, Vidmar L, de Wert G, Dondorp WJ, Peterlin B. Responsible implementation of expanded carrier screening. Eur J Hum Genet 2017; 25:1291. [PMID: 29023436 DOI: 10.1038/ejhg.2017.159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This corrects the article DOI: 10.1038/ejhg.2015.271.
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11
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Metcalfe SA, Martyn M, Ames A, Anderson V, Archibald AD, Couns GDG, Carter R, Cohen J, Cotter M, GenCouns M, Dang W, Delatycki MB, Donath S, Edwards S, Educ PGD, Couns GDG, Forbes R, Couns GDG, Gavrila M, MedSci M, Halliday J, Hickerton C, Hill M, Couns GDG, Jacobs L, Ultrasound PGD, Petrou V, Couns GDG, Plunkett L, GenCouns M, Sheffield L, Racp F, Thornton A, Couns GDG, Younie S, Econ PGDH, Emery JD. Informed decision making and psychosocial outcomes in pregnant and nonpregnant women offered population fragile X carrier screening. Genet Med 2017; 19:1346-1355. [PMID: 28661491 DOI: 10.1038/gim.2017.67] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/05/2017] [Indexed: 01/13/2023] Open
Abstract
PurposePopulation-based carrier screening for fragile X syndrome (FXS) is still not universally endorsed by professional organizations due to concerns around genetic counseling for complex information and potential for psychosocial harms.MethodsWe determined uptake levels, decision making, and psychosocial impact in a prospective study of pregnant and nonpregnant Australian women offered FXS carrier screening in clinical settings. Women received pretest genetic counseling, and completed questionnaires when deciding and one month later.ResultsOf 1,156 women recruited, 83.1% returned the first questionnaire with 70.6% nonpregnant and 58.8% pregnant women choosing testing (χ2=16.98, P<0.001). Overall, informed choice was high in both nonpregnant (77.4%) and pregnant (72.9%) women (χ2=0.21, P=0.644), and more tested (76.0%) than not-tested (66.7%) women (χ2=6.35, P=0.012) made an informed choice. Measures of depression, stress, and anxiety were similar to population norms for ~85% of women. Decisional conflict and regret were generally low; however, decisional uncertainty and regret were greater in pregnant than nonpregnant women, and not-tested than tested women (uncertainty: χ2=18.51, P<0.001 and χ2=43.11, P<0.001, respectively; regret: χ2=6.61, P<0.037 and χ2=35.54, P<0.001, respectively).ConclusionWe provide evidence to inform guidelines that population FXS carrier screening can be implemented with minimal psychosocial harms following appropriate information and prescreening genetic counseling.
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Affiliation(s)
- Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Martyn
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Alice Ames
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Alison D Archibald
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Grad Dip Gen Couns
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Rob Carter
- Faculty of Health, Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Jonathan Cohen
- Fragile X Alliance Clinic and Centre for Developmental Disability Health Victoria, Monash University, Melbourne, Victoria, Australia
| | - Megan Cotter
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Austin Health, Melbourne, Victoria, Australia
| | - M GenCouns
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Austin Health, Melbourne, Victoria, Australia
| | - William Dang
- Australian Clinical Labs (formerly Healthscope Pathology), Clayton, Victoria, Australia
| | - Martin B Delatycki
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Susan Donath
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Samantha Edwards
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - PGrad Dip Educ
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - Grad Dip Gen Couns
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - Robin Forbes
- Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | | | - Mioara Gavrila
- Australian Clinical Labs (formerly Healthscope Pathology), Clayton, Victoria, Australia
| | - M MedSci
- Australian Clinical Labs (formerly Healthscope Pathology), Clayton, Victoria, Australia
| | - Jane Halliday
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Melissa Hill
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Great Ormond Street Hospital for Children, London, UK
| | - Grad Dip Gen Couns
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Great Ormond Street Hospital for Children, London, UK
| | - Lorilli Jacobs
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - PGrad Dip Ultrasound
- School of Primary Aboriginal and Rural Health Care, University of Western Australia
| | - Vicki Petrou
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | - Loren Plunkett
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - M GenCouns
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Leslie Sheffield
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,MyDNA Life Australia, Melbourne, Victoria, Australia
| | - F Racp
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Services, Melbourne, Victoria, Australia.,MyDNA Life Australia, Melbourne, Victoria, Australia
| | - Alison Thornton
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | | | - Sandra Younie
- Faculty of Health, Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - PGrad Dip Hlth Econ
- Faculty of Health, Deakin Health Economics, Deakin University, Melbourne, Victoria, Australia
| | - Jon D Emery
- School of Primary Aboriginal and Rural Health Care, University of Western Australia.,Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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12
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Henneman L, Borry P, Chokoshvili D, Cornel MC, van El CG, Forzano F, Hall A, Howard HC, Janssens S, Kayserili H, Lakeman P, Lucassen A, Metcalfe SA, Vidmar L, de Wert G, Dondorp WJ, Peterlin B. Responsible implementation of expanded carrier screening. Eur J Hum Genet 2016; 24:e1-e12. [PMID: 26980105 PMCID: PMC4867464 DOI: 10.1038/ejhg.2015.271] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/09/2015] [Accepted: 11/18/2015] [Indexed: 02/07/2023] Open
Abstract
This document of the European Society of Human Genetics contains recommendations regarding responsible implementation of expanded carrier screening. Carrier screening is defined here as the detection of carrier status of recessive diseases in couples or persons who do not have an a priori increased risk of being a carrier based on their or their partners' personal or family history. Expanded carrier screening offers carrier screening for multiple autosomal and X-linked recessive disorders, facilitated by new genetic testing technologies, and allows testing of individuals regardless of ancestry or geographic origin. Carrier screening aims to identify couples who have an increased risk of having an affected child in order to facilitate informed reproductive decision making. In previous decades, carrier screening was typically performed for one or few relatively common recessive disorders associated with significant morbidity, reduced life-expectancy and often because of a considerable higher carrier frequency in a specific population for certain diseases. New genetic testing technologies enable the expansion of screening to multiple conditions, genes or sequence variants. Expanded carrier screening panels that have been introduced to date have been advertised and offered to health care professionals and the public on a commercial basis. This document discusses the challenges that expanded carrier screening might pose in the context of the lessons learnt from decades of population-based carrier screening and in the context of existing screening criteria. It aims to contribute to the public and professional discussion and to arrive at better clinical and laboratory practice guidelines.
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Affiliation(s)
- Lidewij Henneman
- Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Davit Chokoshvili
- Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
- Centre for Medical Genetics Ghent, University Hospital Ghent, Ghent, Belgium
| | - Martina C Cornel
- Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Carla G van El
- Department of Clinical Genetics, Section Community Genetics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | - Heidi C Howard
- Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - Sandra Janssens
- Centre for Medical Genetics Ghent, University Hospital Ghent, Ghent, Belgium
| | - Hülya Kayserili
- Department of Medical Genetics, Koç University School of Medicine (KUSoM), Istanbul, Turkey
| | - Phillis Lakeman
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands
| | - Anneke Lucassen
- Department of Clinical Ethics and Law (CELS), University of Southampton and Wessex Clinical Genetic Service, Southampton, UK
| | - Sylvia A Metcalfe
- Murdoch Children's Research Institute and Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Lovro Vidmar
- Clinical Institute of Medical Genetics, Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - Guido de Wert
- Department of Health, Ethics & Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - Wybo J Dondorp
- Department of Health, Ethics & Society, Research Schools CAPHRI and GROW, Maastricht University, Maastricht, The Netherlands
| | - Borut Peterlin
- Clinical Institute of Medical Genetics, Ljubljana University Medical Centre, Ljubljana, Slovenia
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13
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Cotter M, Archibald AD, McClaren BJ, Burgess T, Francis D, Hills L, Martyn M, Oertel R, Slater H, Cohen J, Metcalfe SA. Clinical audit of genetic testing and referral patterns for fragile X and associated conditions. Am J Med Genet A 2016; 170:1439-49. [DOI: 10.1002/ajmg.a.37603] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/12/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Megan Cotter
- Genetics Education and Health Research; Murdoch Childrens Research Institute, Royal Children's Hospital; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Clinical Genetics; Austin Health; Heidelberg VIC Australia
| | - Alison D. Archibald
- Genetics Education and Health Research; Murdoch Childrens Research Institute, Royal Children's Hospital; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Victorian Clinical Genetics Services and Murdoch Childrens Research Institute; Parkville VIC Australia
| | - Belinda J. McClaren
- Genetics Education and Health Research; Murdoch Childrens Research Institute, Royal Children's Hospital; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
| | - Trent Burgess
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Victorian Clinical Genetics Services and Murdoch Childrens Research Institute; Parkville VIC Australia
| | - David Francis
- Victorian Clinical Genetics Services and Murdoch Childrens Research Institute; Parkville VIC Australia
| | - Louise Hills
- Victorian Clinical Genetics Services and Murdoch Childrens Research Institute; Parkville VIC Australia
| | - Melissa Martyn
- Genetics Education and Health Research; Murdoch Childrens Research Institute, Royal Children's Hospital; Parkville VIC Australia
| | - Ralph Oertel
- Victorian Clinical Genetics Services and Murdoch Childrens Research Institute; Parkville VIC Australia
| | - Howard Slater
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Victorian Clinical Genetics Services and Murdoch Childrens Research Institute; Parkville VIC Australia
| | - Jonathan Cohen
- Genetics Education and Health Research; Murdoch Childrens Research Institute, Royal Children's Hospital; Parkville VIC Australia
- Fragile X Alliance Inc, North Caulfield, VIC and Center for Developmental Disability Health Victoria; Monash University; Clayton VIC Australia
| | - Sylvia A. Metcalfe
- Genetics Education and Health Research; Murdoch Childrens Research Institute, Royal Children's Hospital; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
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14
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Archibald AD, Hickerton CL, Wake SA, Jaques AM, Cohen J, Metcalfe SA. "It gives them more options": preferences for preconception genetic carrier screening for fragile X syndrome in primary healthcare. J Community Genet 2016; 7:159-71. [PMID: 26842720 DOI: 10.1007/s12687-016-0262-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/17/2016] [Indexed: 01/10/2023] Open
Abstract
This study aims to explore stakeholder views about offering population-based genetic carrier screening for fragile X syndrome. A qualitative study using interviews and focus groups with stakeholders was undertaken to allow for an in-depth exploration of views and perceptions about practicalities of, and strategies for, offering carrier screening for fragile X syndrome to the general population in healthcare settings. A total of 188 stakeholders took part including healthcare providers (n = 81), relatives of people with fragile X syndrome (n = 29), and members of the general community (n = 78). The importance of raising community awareness about screening and providing appropriate support for carriers was emphasized. There was a preference for preconception carrier screening and for providing people with the opportunity to make an informed decision about screening. Primary care was highlighted as a setting which would ensure screening is accessible; however, challenges of offering screening in primary care were identified including time to discuss screening, knowledge about the test and possible outcomes, and the health professionals' approach to offering screening. With the increasing availability of genetic carrier tests, it is essential that research now focuses on evaluating approaches for the delivery of carrier screening programs. Primary healthcare is perceived as an appropriate setting through which to access the target population, and raising awareness is essential to making genetic screening more accessible to the general community.
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Affiliation(s)
- Alison D Archibald
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetics Services, Melbourne, VIC, Australia
| | | | - Samantha A Wake
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetics Services, Melbourne, VIC, Australia
| | - Alice M Jaques
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Jonathan Cohen
- Fragile X Alliance Inc., Melbourne, VIC, Australia.,Centre for Developmental Disability Health Victoria, Monash University, Melbourne, VIC, Australia
| | - Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia. .,Genetics Education and Health Research, Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC, 3052, Australia.
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15
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Abstract
Many international guidelines recommend that carrier testing in minors should be postponed either until the age of majority or until the child can be actively involved in the decision making process. Although a number of high school programs exist which provide carrier screening to adolescents in at-risk populations, recent guidelines published by the American Society of Human Genetics do not advocate this testing. Despite this, there are some circumstances in which carrier testing does occur in minors. This testing might be intentional, in which identification of carrier status is the goal of the test, or unintentional, where carrier status is identified as a by-product of testing. In this review we outline the situations in which carriers may be identified in childhood and the positions of professional guidelines that address carrier testing in children. We then review the arguments for and against carrier testing presented in the literature and compare this to the empirical evidence in this field.
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Affiliation(s)
- Danya F Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research, Murdoch Childrens Research Institute, The Royal Children's Hospital and Department of Paediatrics, The University of Melbourne, Parkville, Australia
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16
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Cornish KM, Kraan CM, Bui QM, Bellgrove MA, Metcalfe SA, Trollor JN, Hocking DR, Slater HR, Inaba Y, Li X, Archibald AD, Turbitt E, Cohen J, Godler DE. Novel methylation markers of the dysexecutive-psychiatric phenotype in FMR1 premutation women. Neurology 2015; 84:1631-8. [PMID: 25809302 DOI: 10.1212/wnl.0000000000001496] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/08/2014] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To examine the epigenetic basis of psychiatric symptoms and dysexecutive impairments in FMR1 premutation (PM: 55 to 199 CGG repeats) women. METHODS A total of 35 FMR1 PM women aged between 22 and 55 years and 35 age- and IQ-matched women controls (CGG <45) participated in this study. All participants completed a range of executive function tests and self-reported symptoms of psychiatric disorders. The molecular measures included DNA methylation of the FMR1 CpG island in blood, presented as FMR1 activation ratio (AR), and 9 CpG sites located at the FMR1 exon1/intron 1 boundary, CGG size, and FMR1 mRNA levels. RESULTS We show that FMR1 intron 1 methylation levels could be used to dichotomize PM women into greater and lower risk categories (p = 0.006 to 0.037; odds ratio = 14-24.8), with only FMR1 intron 1 methylation, and to a lesser extent AR, being significantly correlated with the likelihood of probable dysexecutive or psychiatric symptoms (p < 0.05). Furthermore, the significant relationships between methylation and social anxiety were found to be mediated by executive function performance, but only in PM women. FMR1 exon 1 methylation, CGG size, and FMR1 mRNA could not predict probable dysexecutive/psychiatric disorders in PM women. CONCLUSIONS This is the first study supporting presence of specific epigenetic etiology associated with increased risk of developing comorbid dysexecutive and social anxiety symptoms in PM women. These findings could have implications for early intervention and risk estimate recommendations aimed at improving the outcomes for PM women and their families.
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Affiliation(s)
- Kim M Cornish
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia.
| | - Claudine M Kraan
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Quang Minh Bui
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Mark A Bellgrove
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Sylvia A Metcalfe
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Julian N Trollor
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Darren R Hocking
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Howard R Slater
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Yoshimi Inaba
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Xin Li
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Alison D Archibald
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Erin Turbitt
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - Jonathan Cohen
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
| | - David E Godler
- From the School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences (K.M.C., C.M.K., M.A.B.), and the Centre for Developmental Disability Health Victoria (J.C.), Monash University, Clayton; the Centre for Epidemiology and Biostatistics (Q.M.B.), Melbourne School of Population and Global Health, University of Melbourne; Genetics Education and Health Research (S.A.M., A.D.A., E.T.), the Cytomolecular Diagnostic Research Laboratory (H.R.S., Y.I., X.L., D.E.G.) and Victorian Clinical Genetics Services (A.D.A.), Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Melbourne; the Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences (S.A.M., A.D.A., E.T.), The University of Melbourne, Parkville; the Department of Developmental Disability Neuropsychiatry and Centre for Healthy Brain Ageing (J.N.T.), UNSW Australia, Sydney; Olga Tennison Autism Research Centre (D.R.H.), School of Psychological Science, La Trobe, Bundoora; and Fragile X Alliance Inc. (Clinic) (J.C.), North Caufield, Australia
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17
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Wong SH, McClaren BJ, Archibald AD, Weeks A, Langmaid T, Ryan MM, Kornberg A, Metcalfe SA. A mixed methods study of age at diagnosis and diagnostic odyssey for Duchenne muscular dystrophy. Eur J Hum Genet 2015; 23:1294-300. [PMID: 25626706 DOI: 10.1038/ejhg.2014.301] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/05/2014] [Accepted: 12/16/2014] [Indexed: 01/15/2023] Open
Abstract
The delayed diagnosis of Duchenne muscular dystrophy (DMD) may be an ongoing problem internationally. We aimed to ascertain age at diagnosis and explore parents' experiences of the diagnosis of DMD in Australia. Using mixed methods, data were collected from laboratory and clinical record audits of testing for DMD in Victoria and Tasmania, interviews and a national survey of parents regarding their experiences from first noticing symptoms to receiving a diagnosis. The audits revealed that the median age at diagnosis for DMD was 5 years (n=49 during 2005-2010); this age had not changed substantially over this period. Fourteen parents interviewed reported age at diagnosis ranging from 2 to 8 years with a 6 month to 4 year delay between initial concerns about their child's development and receiving the DMD diagnosis. Sixty-two survey respondents reported the median age at diagnosis was 3 years and 9 months, while the median age when symptoms were noticed was 2 years and 9 months. Parents experienced many emotions in their search for a diagnosis and consulted with a wide range of health professionals. Half the survey respondents felt that their child could have been diagnosed earlier. Despite advances in testing technologies and increasing awareness of DMD, the age at diagnosis has remained constant in Australia. This mixed methods study shows that this diagnostic delay continues to have a negative impact on parents' experiences, places families at risk of having a second affected child and may have a deleterious effect on affected children's treatment.
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Affiliation(s)
- Siaw H Wong
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | | | - Alison Dalton Archibald
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Victorian Clinical Genetics Services, Parkville, VIC, Australia
| | - Alice Weeks
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Tess Langmaid
- Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Monique M Ryan
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of Neurology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Andrew Kornberg
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.,Department of Neurology, Royal Children's Hospital, Parkville, VIC, Australia
| | - Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Parkville, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
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18
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Hocking DR, Kraan CM, Godler DE, Bui QM, Li X, Bradshaw JL, Georgiou-Karistianis N, Metcalfe SA, Archibald AD, Turbitt E, Fielding J, Trollor J, Cohen J, Cornish KM. Evidence linking FMR1 mRNA and attentional demands of stepping and postural control in women with the premutation. Neurobiol Aging 2014; 36:1400-8. [PMID: 25541421 DOI: 10.1016/j.neurobiolaging.2014.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/25/2014] [Accepted: 11/21/2014] [Indexed: 10/24/2022]
Abstract
Recent studies in young adult females with the fragile X mental retardation 1 (FMR1) gene premutation (PM) have shown subtle but significant impairments in executive control and postural stability. Less is known about the influence of age and FMR1 gene expression on executive control and postural stability in females with the PM. Here, we examined the attentional demands of reactive stepping using a well-validated measure of choice stepping reaction time under dual-task interference. We explored the interrelationships between step initiation times during a concurrent verbal fluency task and specific impairments in executive control previously reported in females with the PM. Our results showed increased dual-task interference on step initiation times and variability in female PM compared with control subjects. In addition, we observed greater choice stepping reaction time dual-task costs above the breakpoint of 81 CGG repeats relative to below this CGG range. Dual-task interference on both reaction time and movement time were significantly predicted by low working memory capacity in female PM carriers. Importantly, we revealed that FMR1 messenger RNA level is the most significant predictor accounting for dual-task stepping variability in both reaction time and movement time in PM females. These findings for the first time provide evidence linking elevated FMR1 messenger RNA levels that have been previously associated with FMR1 RNA toxicity and deficits in cerebellar motor and cognitive networks in a subgroup of at-risk PM women.
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Affiliation(s)
- Darren R Hocking
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia.
| | - Claudine M Kraan
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - David E Godler
- Cyto-molecular Diagnostics Research, Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Quang M Bui
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Xin Li
- Cyto-molecular Diagnostics Research, Victorian Clinical Genetics Services, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - John L Bradshaw
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Nellie Georgiou-Karistianis
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison D Archibald
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Victorian Clinical Genetics Services, Parkville, Victoria, Australia
| | - Erin Turbitt
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Joanne Fielding
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Jonathan Cohen
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Centre for Developmental Disability Health Victoria, Monash University, Clayton, Victoria, Australia; Fragile X Alliance Inc (Clinic and Resource Centre), North Caulfield, Victoria, Australia
| | - Kim M Cornish
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
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19
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Turbitt E, Wiest MM, Halliday JL, Amor DJ, Metcalfe SA. Availability of treatment drives decisions of genetic health professionals about disclosure of incidental findings. Eur J Hum Genet 2014; 22:1225-8. [PMID: 24496062 PMCID: PMC4169537 DOI: 10.1038/ejhg.2014.11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/30/2013] [Accepted: 01/07/2014] [Indexed: 01/10/2023] Open
Abstract
Contrasting opinions exist regarding the disclosure of incidental findings detected through clinical genomic testing. This study used a discrete choice experiment to investigate genetic health professionals' preferences for the disclosure of incidental findings in an Australian paediatric setting. Four attributes of conditions relating to incidental findings were investigated: availability of prevention and treatment, chance of symptoms ever developing, age of onset and severity. Questionnaires from 59 Australian genetic health professionals were analysed. Results show that when evaluating incidental findings for disclosure, these professionals value the availability of prevention and treatment for the condition above all other characteristics included in the study. The framework of this discrete choice experiment can be used to investigate the preferences of other stakeholders such as paediatricians and parents about disclosure of incidental findings. The results of this study may be considered when assessing which categories of incidental findings are most suitable for disclosure in clinical practice.
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Affiliation(s)
- Erin Turbitt
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michelle M Wiest
- Department of Statistical Science, University of Idaho, Moscow, ID, USA
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Jane L Halliday
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Public Health Genetics, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - David J Amor
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Genetics Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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20
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Kraan CM, Hocking DR, Georgiou-Karistianis N, Metcalfe SA, Archibald AD, Fielding J, Trollor J, Bradshaw JL, Cohen J, Cornish KM. Age and CGG-repeat length are associated with neuromotor impairments in at-risk females with the FMR1 premutation. Neurobiol Aging 2014; 35:2179.e7-13. [PMID: 24814676 DOI: 10.1016/j.neurobiolaging.2014.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 01/11/2023]
Abstract
Recent studies report a higher risk of dementia and motor symptoms in females with the fragile X mental retardation 1 premutation (PM-carriers) than has hitherto been appreciated. Here, we use dual-task gait paradigms to identify potential markers of cognitive and motor decline in female PM-carriers. Spatiotemporal gait characteristics and variability of gait were assessed during single- and dual-task conditions in 28 female PM-carriers (mean age 41.32 ± 8.03 years) and 31 female controls with normal fragile X mental retardation 1 alleles (mean age 41.61 ± 8.30 years). Despite comparable gait characteristics at baseline, gait performance was significantly poorer for PM-carriers when performing concurrent working memory tasks (counting backwards by 3's or 7's) when compared with controls. Correlational analyses showed that low working memory capacity was significantly associated with dual-task interference for the gait domains of pace (speed, step length) and variability (step time, swing time) in PM-carriers. Multiple regression analyses further showed that the interaction between age and CGG repeat length was strongly predictive of gait variability during dual-task performance. These findings indicate for the first time that vulnerability in specific domains of gait control may act as sensitive surrogate markers of future decline in female PM-carriers.
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Affiliation(s)
- Claudine M Kraan
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Darren R Hocking
- Olga Tennison Research Centre, School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia
| | - Nellie Georgiou-Karistianis
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison D Archibald
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Victorian Clinical Genetics Services, Parkville, Victoria, Australia
| | - Joanne Fielding
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Health Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - John L Bradshaw
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jonathan Cohen
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Centre for Developmental Disability Health Victoria, Monash University, Clayton, Victoria, Australia; Fragile X Alliance Inc (Clinic and Resource Centre), North Caufield, Victoria, Australia
| | - Kim M Cornish
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
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21
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Hodgson JM, Metcalfe SA, Aitken M, Donath SM, Gaff CL, Winship IM, Delatycki MB, Skene LLC, McClaren BJ, Paul JL, Halliday JL. Improving family communication after a new genetic diagnosis: a randomised controlled trial of a genetic counselling intervention. BMC Med Genet 2014; 15:33. [PMID: 24628824 PMCID: PMC3995589 DOI: 10.1186/1471-2350-15-33] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/04/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Genetic information given to an individual newly diagnosed with a genetic condition is likely to have important health implications for other family members. The task of communicating with these relatives commonly falls to the newly diagnosed person. Talking to relatives about genetic information can be challenging and is influenced by many factors including family dynamics. Research shows that many relatives remain unaware of relevant genetic information and the possible impact on their own health. This study aims to evaluate whether a specific genetic counselling intervention for people newly diagnosed with a genetic condition, implemented over the telephone on a number of occasions, could increase the number of at-risk relatives who make contact with genetics services after a new genetic diagnosis within a family. METHODS This is a prospective, multi-centre randomised controlled trial being conducted at genetics clinics at five public hospitals in Victoria, Australia. A complex genetic counselling intervention has been developed specifically for this trial. Probands (the first person in a family to present with a diagnosis of a genetic condition) are being recruited and randomised into one of two arms - the telephone genetic counselling intervention arm and the control arm receiving usual care. The number of at-risk relatives for each proband will be estimated from a family pedigree collected at the time of diagnosis. The primary outcome will be measured by comparing the proportion of at-risk relatives in each arm of the trial who make subsequent contact with genetics services. DISCUSSION This study, the first randomised controlled trial of a complex genetic counselling intervention to enhance family communication, will provide evidence about how best to assist probands to communicate important new genetic information to their at-risk relatives. This will inform genetic counselling practice in the context of future genomic testing. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register (ANZCTR): ANZCTRN12608000642381.
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Affiliation(s)
- Jan M Hodgson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Sylvia A Metcalfe
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - MaryAnne Aitken
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Susan M Donath
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Clara L Gaff
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
- Walter and Eliza Hall Institute, Melbourne, Australia
| | - Ingrid M Winship
- Genetic Medicine, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Martin B Delatycki
- Bruce LeFroy Centre for Genetic Health Research, MCRI, Melbourne, Australia
- Department of Genetics, Austin Health, Melbourne, Australia
| | - Loane LC Skene
- Melbourne Law School, University of Melbourne, Melbourne, Australia
| | - Belinda J McClaren
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Jean L Paul
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
| | - Jane L Halliday
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, MCRI, 5th Floor Royal Childrens Hospital, Melbourne 3052, Australia
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22
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Kraan CM, Hocking DR, Bradshaw JL, Georgiou-Karistianis N, Metcalfe SA, Archibald AD, Fielding J, Trollor J, Cohen J, Cornish KM. Symbolic sequence learning is associated with cognitive-affective profiles in female FMR1 premutation carriers. Genes Brain Behav 2014; 13:385-93. [PMID: 24521091 DOI: 10.1111/gbb.12122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/08/2014] [Accepted: 02/05/2014] [Indexed: 01/30/2023]
Abstract
This study examines implicit sequence learning impairments that may indicate at-risk cerebellar profiles proposed to underlie some aspects of subtle cognitive and affective dysfunctions found among female fragile X mental retardation 1 (FMR1) premutation (PM)-carriers. A total of 34 female PM-carriers and 33 age- and intelligence-matched controls completed an implicit symbolically primed serial reaction time task (SRTT) previously shown to be sensitive to cerebellar involvement. Implicit learning scores indicated a preservation of learning in both groups; however, PM-carriers demonstrated poorer learning through significantly elevated response latencies overall and at each specific block within the symbolic SRTT. Group comparisons also revealed a core deficit in response inhibition, alongside elevated inattentive symptoms in female PM-carriers. Finally, strong and significant associations were observed between poor symbolic SRTT performance and executive, visuospatial and affective deficits in the PM-carrier group. These associations remained strong even after controlling motor speed, and were not observed in age- and intelligence quotient-matched participants. The findings implicate cerebellar non-motor networks subserving the implicit sequencing of responses in cognitive-affective phenotypes previously observed in female PM-carriers. We contend that symbolic SRTT performance may offer clinical utility in future pharmaceutical interventions in female PM-carriers.
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Affiliation(s)
- C M Kraan
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University
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23
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Ioannou L, McClaren BJ, Massie J, Lewis S, Metcalfe SA, Forrest L, Delatycki MB. Population-based carrier screening for cystic fibrosis: a systematic review of 23 years of research. Genet Med 2014; 16:207-16. [PMID: 24030436 DOI: 10.1038/gim.2013.125] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 07/10/2013] [Indexed: 11/09/2022] Open
Abstract
Cystic fibrosis is the most common severe autosomal recessive disease, with a prevalence of 1 in 2,500-3,500 live births and a carrier frequency of 1 in 25 among Northern Europeans. Population-based carrier screening for cystic fibrosis has been possible since CFTR, the disease-causing gene, was identified in 1989. This review provides a systematic evaluation of the literature from the past 23 years on population-based carrier screening for cystic fibrosis, focusing on the following: uptake of testing; how to offer screening; attitudes, opinions, and knowledge; factors influencing decision making; and follow-up after screening. Recommendations are given for the implementation and evaluation of future carrier-screening programs.
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Affiliation(s)
- Liane Ioannou
- 1] Murdoch Childrens Research Institute, Parkville, Victoria, Australia [2] Department of Medicine, Monash University, Clayton, Victoria, Australia
| | | | - John Massie
- 1] Murdoch Childrens Research Institute, Parkville, Victoria, Australia [2] Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Victoria, Australia [3] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Sharon Lewis
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Laura Forrest
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Martin B Delatycki
- 1] Murdoch Childrens Research Institute, Parkville, Victoria, Australia [2] Department of Medicine, Monash University, Clayton, Victoria, Australia [3] Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia [4] Clinical Genetics, Austin Health, Heidelberg, Victoria, Australia
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24
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Ioannou L, McClaren BJ, Massie J, Lewis S, Metcalfe SA, Forrest L, Delatycki MB. In This Issue. Genet Med 2014. [DOI: 10.1038/gim.2014.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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25
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Cousens NE, Gaff CL, Delatycki MB, Metcalfe SA. Prenatal β-thalassemia carrier screening in Australia: healthcare professionals' perspectives of clinical practice. Prenat Diagn 2014; 34:246-50. [PMID: 24338659 DOI: 10.1002/pd.4297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/20/2013] [Accepted: 12/08/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To gain a better understanding of healthcare professionals' practice and attitudes regarding prenatal β-thalassemia carrier screening in Australia. METHOD Qualitative study with semi-structured interviews of healthcare professionals (obstetricians, general practitioners, midwives, genetic counselors, and hematologists) involved in prenatal thalassemia carrier screening in public and private practice. RESULTS Twenty-three healthcare providers were interviewed and several themes emerged. Participants described and acknowledged inconsistencies in the β-thalassemia screening processes, such as variability in ordering the tests, communicating the diagnosis, and action taken after diagnosis. They indicated a preference for more structure and valued the importance of screening guidelines but many of those involved in ordering the screening test were unaware of their availability. These healthcare professionals recognized they lacked knowledge regarding the screening process, and many had not undertaken education activities in this area in recent times. There were mixed views about the consent process, particularly at which stage this should be obtained, and what information is provided. CONCLUSIONS β-thalassemia screening in Victoria occurs with apparent lack of awareness of guidelines and an acknowledged preference for a more systematic process and educational support. Informed consent was not considered an important component of this screening process.
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Affiliation(s)
- Nicole E Cousens
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
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26
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Shelton AL, Cornish K, Kraan C, Georgiou-Karistianis N, Metcalfe SA, Bradshaw JL, Hocking DR, Archibald AD, Cohen J, Trollor JN, Fielding J. Exploring inhibitory deficits in female premutation carriers of fragile X syndrome: through eye movements. Brain Cogn 2014; 85:201-8. [PMID: 24424424 DOI: 10.1016/j.bandc.2013.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 12/13/2013] [Accepted: 12/17/2013] [Indexed: 01/21/2023]
Abstract
There is evidence which demonstrates that a subset of males with a premutation CGG repeat expansion (between 55 and 200 repeats) of the fragile X mental retardation 1 gene exhibit subtle deficits of executive function that progressively deteriorate with increasing age and CGG repeat length. However, it remains unclear whether similar deficits, which may indicate the onset of more severe degeneration, are evident in female PM-carriers. In the present study we explore whether female PM-carriers exhibit deficits of executive function which parallel those of male PM-carriers. Fourteen female fragile X premutation carriers without fragile X-associated tremor/ataxia syndrome and fourteen age, sex, and IQ matched controls underwent ocular motor and neuropsychological tests of select executive processes, specifically of response inhibition and working memory. Group comparisons revealed poorer inhibitory control for female premutation carriers on ocular motor tasks, in addition to demonstrating some difficulties in behaviour self-regulation, when compared to controls. A negative correlation between CGG repeat length and antisaccade error rates for premutation carriers was also found. Our preliminary findings indicate that impaired inhibitory control may represent a phenotype characteristic which may be a sensitive risk biomarker within this female fragile X premutation population.
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Affiliation(s)
- Annie L Shelton
- School of Psychiatry and Psychology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Kim Cornish
- School of Psychiatry and Psychology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Claudine Kraan
- School of Psychiatry and Psychology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Nellie Georgiou-Karistianis
- School of Psychiatry and Psychology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3025, Australia
| | - John L Bradshaw
- School of Psychiatry and Psychology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3800, Australia
| | - Darren R Hocking
- Olga Tennison Autism Research Centre, School of Psychological Science, La Trobe University, Bundoora 3086, Australia
| | - Alison D Archibald
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3025, Australia; Victorian Clinical Genetics Services, Flemington Rd, Parkville, Victoria 3052, Australia
| | - Jonathan Cohen
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia; Centre for Developmental Disability Health Victoria, Monash University, Clayton, Victoria 3800, Australia; Fragile X Alliance Inc., Clinic and Resource Centre, 263 Glen Eira Road, North Caulfield, Victoria 3161, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry and Centre for Health Brain Ageing, School of Psychiatry, University of New South Wales, Sydney 2052, Australia
| | - Joanne Fielding
- School of Psychiatry and Psychology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 3800, Australia.
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27
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Kraan CM, Hocking DR, Georgiou-Karistianis N, Metcalfe SA, Archibald AD, Fielding J, Trollor J, Bradshaw JL, Cohen J, Cornish KM. Impaired response inhibition is associated with self-reported symptoms of depression, anxiety, and ADHD in female FMR1 premutation carriers. Am J Med Genet B Neuropsychiatr Genet 2014; 165B:41-51. [PMID: 24166828 DOI: 10.1002/ajmg.b.32203] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/27/2013] [Indexed: 12/30/2022]
Abstract
Fragile X Mental Retardation 1 (FMR1) premutation carriers (PM-carriers) have a defective trinucleotide expansion on the FMR1 gene that is associated with continuum of neuropsychological and mental disorders. Currently, little is known about the distinct subcomponents of executive function potentially impaired in female PM-carriers, and there have been no investigations into associations between executive function and incidences of mental disorders. A total of 35 female PM-carriers confirmed by Asuragen triple primed PCR DNA testing and 35 age- and intelligence-matched controls completed tests of executive function (i.e., response inhibition and working memory) and self-reported on social anxiety, depression, and ADHD predominantly inattentive (ADHD-PI) symptoms. Compared to controls, PM-carriers were significantly elevated on self-reported social anxiety and ADHD-PI symptoms. Irrespective of mental symptoms, female PM-carries performed significantly worse than controls on a response inhibition test, and further investigations revealed significant correlations between executive function performance and self-reported symptoms of anxiety, depression and ADHD-PI. Critically, among PM-carriers with good executive function performance, no women exceeded threshold markers for probable caseness of mental disorder. However, rates of probable caseness were elevated in those with average performance (response inhibition: social anxiety: 41.7%; depression: 20%; ADHD: 44.4%; working memory: social anxiety: 27.3%; depression: 9.1%; ADHD: 18.2%) and highly elevated for those with poor executive function performance (response inhibition: social anxiety: 58.3%; depression: 80%; ADHD: 55.6%; working memory: social anxiety: 100%; depression: 50%; ADHD: 83.3%). These data suggest that subtle executive dysfunction may be a useful neuropsychological indicator for a range of mental disorders previously reported in female PM-carriers.
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Affiliation(s)
- Claudine M Kraan
- Faculty of Medicine, Nursing, and Health Sciences, School of Psychology & Psychiatry, Monash University, Clayton, Melbourne, Victoria, Australia
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Cousens NE, Gaff CL, Metcalfe SA, Delatycki MB. "He didn't say that thalassaemia might come up" - β-thalassaemia carriers' experiences and attitudes. J Community Genet 2013; 4:223-32. [PMID: 23315178 PMCID: PMC3666831 DOI: 10.1007/s12687-012-0136-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/29/2012] [Indexed: 01/19/2023] Open
Abstract
Tests for haemoglobinopathy carrier status are the commonest genetic screening tests undertaken internationally. Carrier screening for β-thalassaemia is not coordinated in Victoria, Australia, and is instead incorporated into routine practice where most women are screened antenatally, through a full blood examination (FBE). Little is known about how women are screened for β-thalassaemia in Australia as well as their attitudes towards the screening process. This study was conducted to explore carriers' and carrier couples' experiences of and attitudes towards β-thalassaemia screening in Australia. Semi-structured interviews with 26 recently pregnant female carriers and ten carrier couples of β-thalassaemia were carried out. Interviews were analysed using inductive content analysis. Unexpectedly, more than half of the women had been made aware of their carrier status prior to pregnancy, with FBEs carried out for numerous reasons other than thalassaemia screening. Most women did not recall being told about thalassaemia before notification of their carrier status and therefore did not make a decision about being screened. They were generally accepting for doctors to decide about testing; however, would have preferred to have been made aware of the screening test. Women also reported receiving insufficient information after being notified of their carrier status, leading to misconceptions and confusion. This genetic screening process, incorporated into routine care whereby informed decisions were not being made by patients, was apparently acceptable overall. Based on the results of this study, we make the following recommendations: (1) individuals should be made aware that they are being tested for thalassaemia at least before a specific thalassaemia diagnostic test is performed; (2) current understanding by known carriers of thalassaemia should be assessed and any misconceptions corrected; (3) written information should be provided to carriers; (4) referral of carrier couples to specialists in thalassaemia and genetics is strongly recommended; (5) the term 'carrier of β-thalassaemia' should be used rather than 'thalassaemia minor'.
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Affiliation(s)
- Nicole E. Cousens
- />Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria Australia
| | - Clara L. Gaff
- />Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria Australia
- />Department of Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria Australia
| | - Sylvia A. Metcalfe
- />Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria Australia
| | - Martin B. Delatycki
- />Murdoch Childrens Research Institute, Parkville, Victoria Australia
- />Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria Australia
- />Department of Clinical Genetics, Austin Health, Heidelberg, Victoria Australia
- />Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Royal Childrens Hospital, Flemington Road, Parkville, Victoria 3052 Australia
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Abstract
BACKGROUND Advances in genetic technologies have resulted in the diagnosis during pregnancy of increasing numbers of fetal abnormalities. A few published personal commentaries have indicated that health professionals' interactions with couples at risk of a fetal abnormality can be emotionally and ethically challenging, highlighting the need for empirical research in this area. This study sought to explore whether working in the fetal medicine setting has an effect on health professionals and to ascertain any supports used to manage these effects. METHODS In-depth interviews were conducted with 40 medical and allied health professionals working in fetal medicine settings in Melbourne, Australia. Qualitative analysis of the interview data was performed using thematic analysis. RESULTS Participants discussed at length the emotional impact of working with patients who were experiencing adverse pregnancy outcomes. All participants reported that working in fetal medicine had an impact on their daily lives, and many spoke about dreaming about or losing sleep over patient outcomes. Participants described working in this setting as being particularly difficult when they were pregnant themselves. Most spoke about feeling largely unsupported in their work and felt that these effects resulted in burnout and staff turnover. CONCLUSIONS This study explored several work force concerns in fetal medicine. Health professionals working with couples at risk of a fetal abnormality are vulnerable to the phenomena of compassion fatigue and burnout. The need for formal support and self-care management is suggested.
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Affiliation(s)
- Melody A Menezes
- Genetics Education and Health Research Department, Murdoch Childrens Research Institute, Melbourne, Australia
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McClaren BJ, Aitken M, Massie J, Amor D, Ukoumunne OC, Metcalfe SA. Cascade carrier testing after a child is diagnosed with cystic fibrosis through newborn screening: investigating why most relatives do not have testing. Genet Med 2013; 15:533-40. [DOI: 10.1038/gim.2012.175] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 12/03/2012] [Indexed: 11/09/2022] Open
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Turbitt E, Amor DJ, Halliday JL, Metcalfe SA. Considerations for reporting genome results to patients. J Paediatr Child Health 2013; 49:82. [PMID: 23320589 DOI: 10.1111/jpc.12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Erin Turbitt
- Genetics Education and Health Research; Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - David J Amor
- Clinical Genetics Research; Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Jane L Halliday
- Public Health Genetics; Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research; Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
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Wolthuizen M, Nisselle A, Halliday J, Metcalfe SA, Aitken M, Allen KJ, Delatycki MB. Why Do People Choose Not to Have Screening for Hemochromatosis? Genet Test Mol Biomarkers 2013; 17:21-4. [DOI: 10.1089/gtmb.2012.0247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Amy Nisselle
- Murdoch Childrens Research Institute, Parkville, Australia
- Cold Spring Harbor Laboratory, DNA Learning Center, Cold Spring Harbor, New York
| | - Jane Halliday
- Murdoch Childrens Research Institute, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
| | - Sylvia A. Metcalfe
- Murdoch Childrens Research Institute, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
| | | | - Katie J. Allen
- Murdoch Childrens Research Institute, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Martin B. Delatycki
- Murdoch Childrens Research Institute, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Department of Clinical Genetics, Austin Health, Heidelberg, Australia
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Archibald AD, Hickerton CL, Jaques AM, Wake S, Cohen J, Metcalfe SA. "It's about having the choice": stakeholder perceptions of population-based genetic carrier screening for fragile X syndrome. Am J Med Genet A 2012; 161A:48-58. [PMID: 23239566 DOI: 10.1002/ajmg.a.35674] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 08/31/2012] [Indexed: 01/15/2023]
Abstract
This project explored, the views of key stakeholders regarding population-based genetic carrier screening for fragile X syndrome (FXS). Interviews and focus groups were conducted with healthcare providers, relatives of individuals with FXS and members of the general population. Data were transcribed verbatim and coded into themes. 188 individuals took part in this study. Perceived benefits of carrier screening included: learning the risk of having a child with FXS; learning the risk of fragile X-associated primary ovarian insufficiency; and the opportunity for carriers to access reproductive options. Concerns included: the emotional impact of screening and receiving a carrier result; the predictive testing nature of the carrier test with respect to fragile X-associated tremor/ataxia syndrome; potential confusion created by receiving an intermediate result; and implications of genetic screening for society. Overall, population-based genetic carrier screening was perceived to be acceptable provided it is optional and offered at an appropriate stage of life. With the support of the participants to promote individual choice by offering a population-based carrier screening program for FXS, it is essential to carefully consider how screening might be offered in order to ensure broad accessibility and facilitation of decision-making.
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Delatycki MB, Wolthuizen M, Aitken MA, Hickerton C, Metcalfe SA, Allen KJ. To tell or not to tell - what to do about p.C282Y heterozygotes identified by HFE screening. Clin Genet 2012; 84:286-9. [PMID: 23121079 DOI: 10.1111/cge.12053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 10/30/2012] [Accepted: 10/30/2012] [Indexed: 11/30/2022]
Abstract
Hereditary hemochromatosis (HH) is a common preventable disorder of iron overload that can result in liver cirrhosis and reduced lifespan. Most HH is due to homozygosity for the HFE p.C282Y substitution. We conducted a study of screening for p.C282Y in high schools where p.C282Y heterozygotes (CY) individuals were informed of their genotype by letter. We studied whether these individuals understood the implications of their genotype, whether this resulted in anxiety or reduced health perception and whether cascade testing was higher in families of CY than wild-type homozygous (CC) individuals. We found 586 of 5757 (1 in 10) screened individuals were CY. One month after receiving their result, 83% correctly answered that they have one copy of p.C282Y. There was no adverse change in anxiety or health perception from prior to screening to 1 month after receiving results. Significantly more family members of CY individuals than CC individuals were informed about HH and had testing for HH. In conclusion, we found that informing CY individuals of their genotype does not increase anxiety and the implications are generally well understood. This leads to cascade testing in a minority of families. CY individuals should be informed of their genetic status when identified by population screening.
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Affiliation(s)
- M B Delatycki
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
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Ames AG, Jaques A, Ukoumunne OC, Archibald AD, Duncan RE, Emery J, Metcalfe SA. Development of a fragile X syndrome (FXS) knowledge scale: towards a modified multidimensional measure of informed choice for FXS population carrier screening. Health Expect 2012; 18:69-80. [PMID: 23067225 DOI: 10.1111/hex.12009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Genetic carrier screening is increasingly possible for many conditions, but it is important to ensure decisions are informed. The multidimensional measure of informed choice (MMIC) is a quantitative instrument developed to evaluate informed choice in prenatal screening for Down syndrome, measuring knowledge, attitudes and uptake. To apply the MMIC in other screening settings, the knowledge scale must be modified. OBJECTIVE To develop and validate a modified MMIC knowledge scale for use with women undergoing carrier screening for fragile X syndrome (FXS). SETTING AND PARTICIPANTS Responses to MMIC items were collected through questionnaires as part of a FXS carrier screening pilot study in a preconception setting in Melbourne, Australia. DESIGN Ten knowledge scale items were developed using a modified Delphi technique. Cronbach's alpha and factor analysis were used to validate the new FXS knowledge scale. We summarized the knowledge, attitudes and informed choice status based on the modified MMIC. RESULTS Two hundred and eighty-five women were recruited, 241 eligible questionnaires were complete for analysis. The FXS knowledge scale items measured one salient construct and were internally consistent (alpha = 0.70). 71% (172/241) of participants were classified as having good knowledge, 70% (169/241) had positive attitudes and 27% (65/241) made an informed choice to accept or decline screening. DISCUSSION AND CONCLUSIONS We present the development of a knowledge scale as part of a MMIC to evaluate informed choice in population carrier screening for FXS. This can be used as a template by other researchers to develop knowledge scales for other conditions for use in the MMIC.
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Affiliation(s)
- Alice G Ames
- Department of Paediatrics, The University of Melbourne, Parkville, Vic., Australia; Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia
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Inaba Y, Herlihy AS, Schwartz CE, Skinner C, Bui QM, Cobb J, Shi EZ, Francis D, Arvaj A, Amor DJ, Pope K, Wotton T, Cohen J, Hewitt JK, Hagerman RJ, Metcalfe SA, Hopper JL, Loesch DZ, Slater HR, Godler DE. Fragile X–related element 2 methylation analysis may provide a suitable option for inclusion of fragile X syndrome and/or sex chromosome aneuploidy into newborn screening: a technical validation study. Genet Med 2012; 15:290-8. [DOI: 10.1038/gim.2012.134] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Delatycki MB, Wolthuizen M, Collins V, Varley E, Craven J, Allen KJ, Gurrin LC, Aitken M, Trembath MK, Bond L, Wilson GR, Stephenson SEM, Macciocca I, Hickerton C, Lockhart PJ, Metcalfe SA. ironXS: high-school screening for hereditary haemochromatosis is acceptable and feasible. Eur J Hum Genet 2012; 20:505-9. [PMID: 22234159 DOI: 10.1038/ejhg.2011.247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
As the results of the Human Genome Project are realised, screening for genetic mutations that predispose to preventable disease is becoming increasingly possible. How and where such screening should best be offered are critical, unanswered questions. This study aimed to assess the acceptability and feasibility of genetic screening for preventable disease, using the model of hereditary haemochromatosis, in high-school students. Screening was offered for the HFE C282Y substitution to 17,638 students. Questionnaires were administered at the time of screening (Q1) and approximately 1 month after results were communicated (Q2). Outcomes assessed were uptake of screening, change in scores of validated anxiety, affect and health perception scales from Q1 to Q2, knowledge and iron indices in C282Y homozygous individuals. A total of 5757 (32.6%) students had screening and 28 C282Y-homozygous individuals (1 in 206) were identified, and none of the 27 individuals who had iron indices measures had significant iron overload. There was no significant change in measures of anxiety, affect or health perception in C282Y homozygous or non-homozygous individuals. Over 86% of students answered each of five knowledge questions correctly at Q1. Genetic population-based screening for a preventable disease can be offered in schools in a way that results in minimal morbidity for those identified at high risk of disease. The results of this study are not only relevant for haemochromatosis, but for other genetic markers of preventable disease such as those for cardiovascular disease and cancer.
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Affiliation(s)
- Martin B Delatycki
- Bruce Lefroy Centre for Genetic Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
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Abstract
Discussing carrier screening during preconception consultation in primary care has a number of advantages in terms of promoting autonomy and enabling the greatest range of reproductive choices. For those with a family history of an inherited condition, this ought to be a routine discussion; however, this can be expanded to include the wider population, especially for those conditions for which carrier frequencies are considered relatively common. There is published literature from around the world regarding experiences with carrier screening in primary care for cystic fibrosis, haemoglobinopathies, fragile X syndrome, Tay-Sachs disease and spinal muscular atrophy, although many of these have tended to focus on consultations during rather than before pregnancy. Overall, these studies reveal that population carrier screening is well received by the participants with apparent minimal psychosocial harms; however, challenges exist in terms of approaches to ensure couples receive adequate information to make personally relevant decisions and for ongoing health professional engagement.
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Affiliation(s)
- Sylvia A Metcalfe
- Murdoch Childrens Research Institute, Royal Children's Hospital and Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, 3052, Australia,
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McClaren BJ, Metcalfe SA, Amor DJ, Aitken M, Massie J. A case for cystic fibrosis carrier testing in the general population. Med J Aust 2011; 194:208-9. [PMID: 21401469 DOI: 10.5694/j.1326-5377.2011.tb03781.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 11/24/2010] [Indexed: 11/17/2022]
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Flouris A, Hawthorne G, Aitken M, Gaff C, Metcalfe SA. Development of a questionnaire for evaluating genetics education in general practice. J Community Genet 2010; 1:175-83. [PMID: 22460300 PMCID: PMC3185998 DOI: 10.1007/s12687-010-0027-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 09/28/2010] [Indexed: 10/18/2022] Open
Abstract
To support developments in genetics education, we constructed the GPGeneQ questionnaire to assess skills required for the practice of genetics by general practitioners (GPs). We describe the process of developing and validating this questionnaire to provide a detailed guide in the construction for questionnaires in the application of evaluating genetics education. The GPGeneQ was developed through a multi-step process with the initial draft based on a theoretical framework and literature review. The subsequent draft instrument contained three scales pertaining to GPs' knowledge, self-reported behaviour and attitudes regarding genetics in medicine. Content and ecological validity were measured by an iterative Delphi process involving experts, GPs and consumers of health services. Piloting to assess construct and criterion validity was conducted with a sample of GPs attending an educational workshop that was presented on a number of separate occasions in Victoria, Australia. Results from evaluations of 145 GPs participating in ten workshops revealed evidence for validity and reliability of the GPGeneQ: knowledge change (p < 0.001; CI, -1.63 to -0.68), behaviour change (p < 0.001; CI, -4.15 to -2.21), attitudinal change (p = 0.002; CI, -2.68 to -0.62). This paper details the procedures involved in developing and validating an assessment questionnaire for genetics education. The GPGeneQ is the first validated questionnaire covering a broad range of topics that is designed to provide a reliable measure for the evaluation of genetics education specifically in general practice. The procedures used are transferable to the construction of any instrument for use in genetics or other medical education.
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Affiliation(s)
- Anna Flouris
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, 3052 VIC Australia
- Department of Paediatrics, The University of Melbourne, Parkville, 3052 VIC Australia
| | - Graeme Hawthorne
- Department of Psychiatry, The University of Melbourne, Parkville, 3052 VIC Australia
| | - MaryAnne Aitken
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, 3052 VIC Australia
- Department of Paediatrics, The University of Melbourne, Parkville, 3052 VIC Australia
| | - Clara Gaff
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, 3052 VIC Australia
- Department of Paediatrics, The University of Melbourne, Parkville, 3052 VIC Australia
- Genetic Health Services Victoria, Royal Children’s Hospital, Parkville, 3052 VIC Australia
| | - Sylvia A. Metcalfe
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, 3052 VIC Australia
- Department of Paediatrics, The University of Melbourne, Parkville, 3052 VIC Australia
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Abstract
PURPOSE To conduct a systematic review of literature regarding population-based screening for fragile X syndrome in newborns and women of reproductive age, either before or during pregnancy. METHODS Seven electronic databases were searched for English language studies published between January 1991 and November 2009. Data extraction was performed for all included studies. Results were synthesized using a narrative approach. RESULTS One article that examined offering newborn screening for fragile X syndrome and 10 that examined the offer of fragile X syndrome screening to women of reproductive age were identified. Two of these articles also addressed psychosocial aspects of population screening for fragile X syndrome such as attitudes to screening and experiences of screening, and a further nine addressed these issues alone. Studies exploring psychosocial issues demonstrated challenges for counseling arising from a lack of awareness or personal experience with fragile X syndrome in the general population. CONCLUSIONS Targeted counseling and educational strategies will be essential to support women from the general population. It is crucial that future studies offering screening for fragile X syndrome explore a range of psychosocial aspects in addition to looking at uptake of testing and mutation frequency.
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Affiliation(s)
- Melissa K Hill
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Australia
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Menezes MA, Hodgson JM, Sahhar MA, Aitken M, Metcalfe SA. “It’s Challenging on a Personal Level”—Exploring the ‘Lived Experience’ of Australian and Canadian Prenatal Genetic Counselors. J Genet Couns 2010; 19:640-52. [DOI: 10.1007/s10897-010-9315-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 07/07/2010] [Indexed: 10/19/2022]
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Abstract
β-thalassaemia is one of the most common single-gene inherited conditions in the world, and thalassaemia carrier screening is the most widely performed genetic screening test, occurring in many different countries. β-thalassaemia carrier screening programmes provide a unique opportunity to compare the delivery of carrier screening programmes carried out in different cultural, religious and social contexts. This review compares the key characteristics of β-thalassaemia carrier screening programmes implemented in countries across the world so that the differences and similarities between the programmes can be assessed. The manner in which thalassaemia carrier screening programmes are structured among different populations varies greatly in several aspects, including whether the programmes are mandatory or voluntary, the education and counselling provided and whether screening is offered pre-pregnancy or antenatally. National and international guidelines make recommendations on the most appropriate ways in which genetic carrier screening programmes should be conducted; however, these recommendations are not followed in many programmes. We discuss the implications for the ethical and acceptable implementation of population carrier screening and identify a paucity of research into the outcomes of thalassaemia screening programmes, despite the fact that thalassaemia screening is so commonly conducted.
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Affiliation(s)
- Nicole E Cousens
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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McClaren BJ, Metcalfe SA, Aitken M, Massie RJ, Ukoumunne OC, Amor DJ. Uptake of carrier testing in families after cystic fibrosis diagnosis through newborn screening. Eur J Hum Genet 2010; 18:1084-9. [PMID: 20512163 DOI: 10.1038/ejhg.2010.78] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Newborn screening (NBS) for cystic fibrosis (CF) provides the opportunity for cascade carrier testing of relatives. Uptake of testing by adult non-parent relatives of children diagnosed with CF through NBS has not been previously described, and this study describes uptake by both parents and adult non-parent relatives in Victoria, Australia. Pedigrees were taken from parents of children who were born in 2000-2004 and diagnosed with CF. A total of 40 families were eligible for the study and 30 (75%) were recruited. In all, 716 non-parent relatives were identified from the pedigrees as eligible for carrier testing, and 82 (adjusted uptake percentage: 11.8%; 95% confidence interval 8.0-15.7) have had carrier testing by March 2009. On average, 2.7 non-parent relatives per family had CF carrier testing after diagnosis through NBS. The odds of being tested were greater for females than males (adjusted odds ratio 1.61; 95% confidence interval 1.11-2.33; P=0.01) and greater for those more closely related to the child with CF (adjusted odds ratio 5.17; 95% confidence interval 2.38-11.24; P<0.001). Most relatives who undergo testing are tested immediately after the baby's diagnosis; however, some testing is undertaken up to 8 years later. These results indicate that in a clinical setting, the diagnosis of a baby with CF by NBS does not lead to carrier testing for the majority of the baby's non-parent relatives. We suggest re-contact with parents to offer cascade carrier testing.
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Affiliation(s)
- Belinda J McClaren
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Delatycki MB, Wolthuizen M, Collins V, Varley E, Craven J, Allen KJ, Aitken MA, Bond L, Lockhart PJ, Wilson GR, Macciocca I, Metcalfe SA. Implementation of ironXS: a study of the acceptability and feasibility of genetic screening for hereditary hemochromatosis in high schools. Clin Genet 2010; 77:241-8. [DOI: 10.1111/j.1399-0004.2009.01308.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Archibald AD, Jaques AM, Wake S, Collins VR, Cohen J, Metcalfe SA. âIt's something I need to considerâ: Decisions about carrier screening for fragile X syndrome in a population of non-pregnant women. Am J Med Genet A 2009; 149A:2731-8. [DOI: 10.1002/ajmg.a.33122] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hodgson JM, Gillam LH, Sahhar MA, Metcalfe SA. “Testing Times, Challenging Choices”: An Australian Study of Prenatal Genetic Counseling. J Genet Couns 2009; 19:22-37. [DOI: 10.1007/s10897-009-9248-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 07/17/2009] [Indexed: 11/29/2022]
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Emery J, Barlow-Stewart K, Metcalfe SA. There's cancer in the family. Aust Fam Physician 2009; 38:194-198. [PMID: 19350067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Patients will sometimes raise the issue of cancer 'running in their family' or it may be identified by the general practitioner when enquiring about a patient's family history. OBJECTIVE This article discusses how to deal with concerns about familial cancers including details of the common familial cancer syndromes. It provides further sources of information to use when determining a patient's risk of cancer based on their family history. DISCUSSION The family history is an important predictor of cancer risk and can be used to tailor cancer prevention strategies and to identify high risk families who may be eligible for predictive genetic testing.
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Affiliation(s)
- Jon Emery
- Discipline of General Practice, University of Western Australia, Australia.
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Affiliation(s)
- Adrienne C Sexton
- Murdoch Childrens Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia
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