Knowledge, group-based medical mistrust, future expectations, and perceived disadvantages of medical genetic testing: perspectives of Black African immigrants/refugees

BACKGROUND

Reasons for low participation of ethnic minorities in genetic studies are multifactorial and often poorly understood. Based on published literature, participation in genetic testing is low among Black African immigrants/refugees although they are purported to bear disproportionate disease burden. Thus, research involving Black African immigrant/refugee populations that examine their perspectives on participating in genetic studies is needed.

OBJECTIVES

This report examines and describes the knowledge of medical genetics, group-based medical mistrust, and future expectations of genetic research and the influence of these measures on the perceived disadvantages of genetic testing among Black African immigrants/refugees.

METHODS

Using a cross-sectional survey design, a nonprobability sample (n = 212) of Black African immigrants/refugees was administered a questionnaire. Participants ranged in age from 18 to 61 years (mean = 38.91, SD = 9.78). The questionnaire consisted of 5 instruments: (a) sociodemographic characteristics, (b) Knowledge of Medical Genetics scale, (c) Group-Based Medical Mistrust Scale, (d) Future Expectations/Anticipated Consequences of Genetics Research scale, and (e) Perceived Disadvantages of Genetic Testing scale.

RESULTS

Participants were concerned that genetic research may result in scientists 'playing God,' interfering with the natural order of life. In multivariate analyses, the perceived disadvantages of genetic testing increased as medical mistrust and anticipated negative impacts of genetic testing increased. Increase in genetic knowledge contributed to a decrease in perceived disadvantages.

CONCLUSIONS

Our findings suggest that recruitment of Black African immigrants/refugees in genetic studies should address potential low knowledge of genetics, concerns about medical mistrust, the expectations/anticipated consequences of genetic research, and the perceived disadvantages of genetic testing.

The VANILLA sensor as a beam monitoring device for X-ray radiation therapy

Cancer treatments such as intensity-modulated radiotherapy (IMRT) require increasingly complex methods to verify the accuracy and precision of the treatment delivery. In vivo dosimetry based on measurements made in an electronic portal imaging device (EPID) has been demonstrated. The distorting effect of the patient anatomy on the beam intensity means it is difficult to separate changes in patient anatomy from changes in the beam intensity profile. Alternatively, upstream detectors scatter and attenuate the beam, changing the energy spectrum of the beam, and generate contaminant radiation such as electrons. We used the VANILLA device, a Monolithic Active Pixel Sensor (MAPS), to measure the 2D beam profile of a 6 MV X-ray beam at Bristol Hospital in real-time in an upstream position to the patient without clinically significant disturbance of the beam (0.1% attenuation). MAPSs can be made very thin (~20 μm) with still a very good signal-to-noise performance. The VANILLA can reconstruct the collimated beam edge with approximately 64 μm precision.

The addition of a large caliber needle during endoscopic ultrasound-guided fine needle aspiration of solid and lymph node lesions: any importance?

AIM

The benefits of using multiple gauge needles during EUS-FNA of solid and lymph node lesions are unknown. The purpose of our study was to find out the significance of adding a large caliber needle if small caliber needle fail to achieve diagnostic specimen after few passes.

METHODS

It was a retrospective review of all EUS-FNA procedures performed by one of the two experienced endosonographers. A large (22 or 19 gauge) needle was added if on-site cytologic analysis did not reveal adequate specimen after ≥2 passes. The adequacy of the specimen was determined by the Cytopathologist, and categorized as either satisfactory for analysis or unsatisfactory. The cytologic findings were reported as either benign or malignant.

RESULTS

Out of total 1200 EUS cases, FNA was performed in 306 cases with different solid and lymph node lesions. Multiple gauge needles were used in 188/306 (39%) cases. There was no statistically significant difference in the diagnostic yield and definitive diagnosis between multiple and single gauge needle groups. The finding was unchanged after controlling the number of needle passes. No complications were noted.

CONCLUSION

The addition of a large caliber needle achieved at least the same (or even slightly higher diagnostic yield), and can be a method of rescue in certain cases.

Evidence of endogenous volatile organic compounds as biomarkers of diseases in alveolar breath

The effect of oxygen on markers of oxidative stress has been partially elucidated. Volatile organic compounds (VOCs) are created during the oxidative burst and excreted in the human alveolar breath, which indeed contains biomarkers. A general concept including collection, separation, detection and clinical biomakers validation is presented in this article: (i) a method for the collection and GC-MS of halogenated VOCs in human alveolar breath is described: a transportable apparatus which sampled specifically alveolar breath; the VOCs were captured in a thermal desorption tube, Carbotrap 200® and each sample was thermally desorbed from the trap in an automated GC-MS apparatus; (ii) the inhibitory effects of halogenated alkanes on mitochondria are suspected likely to fight against oxidative stress deleterious reactions; (iii) two-dimensional gas chromatography occurs by the repeated and re-injection of effluent from one chromatographic column into a second column of orthogonal phase. A new commercial GCxGC system is presented; it is accomplished with a dual-stage, quad-jet thermal modulator positioned between the two columns; (iv) the affinity-based sensors usually used in connection with the GCxGC system face a difficulty to take into account different biases coming from different sources of drifting. Compared to other affinity-based sensing modes like electrical ones, gravimetric sensors enable a better decoupling. Nano Electro Mechanical Systems (NEMS)-based resonators are a particular type of gravimetric gas sensors. They are coated with a sensitive layer of polymer where gases of interest present in the atmosphere adsorb, generating an additional mass load which is measured through a frequency shift; (v) examination of exhaled breath has the potential to change the existing routine approaches in human medicine. Breath sampling to identify volatile biomarkers in diseases has been proposed in several respiratory diseases. Several VOCs have been identified in these patients by GC-MS. However, the use of traditional analytical instruments such as GC-MS to detect biomarkers of diseases has not become a routine for clinical applications. Consequently the electronic nose was the logical instrument of choice for disease diagnosis due to the capability of identifying complex mixtures of VOCs (as a whole) within sampled air using pattern-recognition algorithms.

Anaemia, diabetes and chronic kidney disease: where are we now?

Anaemia is a common finding in people with diabetes and chronic kidney disease and failure of the kidney to produce erythro-poietin in response to a falling haemoglobin concentration is a key component, correlating with the degree of albuminuria, renal dysfunction and iron deficiency. Anaemia in diabetes is associated with a number of adverse outcomes, including increased risk of all cause and cardiovascular mortality. Whether or not anaemia is a marker or mediator of adverse outcome still remains to be completely resolved. Treatment of anaemia in diabetes has quality of life benefits and reduces transfusion requirements. Correction of anaemia to normal haemoglobin concentrations is associated with significant adverse cardiovascular outcomes and is not recommended, escalating doses of erythropoiesis-stimulating agents should be avoided. The treatment of anaemia in people with diabetes and chronic kidney disease should begin with optimisation of iron stores. An aspirational haemoglobin concentration range of 10-12 g/dl with anaemia management, balances proven benefits of anaemia treatment with potential cardiovascular risk.

Whole body imaging in the diagnosis of blunt trauma, ionizing radiation hazards and residual risk

Ever since the introduction of radiographic imaging, its utility in identifying injuries has been well documented and was incorporated in the workup of injured patients during advanced trauma life support algorithms [American College of Surgeons, 8th ed. Chicago, 2008]. More recently, computerized tomography (CT) has been shown to be more sensitive than radiography in the diagnosis of injury. Due to the increased use of CT scanning, concerns were raised regarding the associated exposure to ionizing radiation [N Engl J Med 357:2277-2284, 2007]. During the last several years, a significant amount of research has been published on this topic, most of it being incorporated in the BEIR VII Phase 2 report, published by the National Research Council of the National Academies [National Academy of Sciences, Washington DC, 2006]. The current review will analyze the scientific basis for the concerns over the ionizing radiation associated with the use of CT scanning and will examine the accuracy of the typical advanced trauma life support work-up for diagnosis of injuries.

Estimating glomerular filtration rate: comparison of the CKD-EPI and MDRD equations in a large UK cohort with particular emphasis on the effect of age

BACKGROUND

The chronic kidney disease (CKD)-Epidemiology Collaboration (CKD-EPI) equation was developed to address the underestimation of measured glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) equation at levels >60 mL/min/1.73 m(2).

AIM

To assess the impact of the CKD-EPI equation on the estimation of GFR in a large adult UK population (n = 561,400), particularly looking at the effect of age.

DESIGN

Serum creatinine results (ID-MS-aligned enzymatic assay) were extracted from the pathology database during 1 year on adult (≥ 18 years) patients from primary care.

METHODS

The first available creatinine result from 174,448 people was used to estimate GFR using both equations and agreement assessed.

RESULTS

Median CKD-EPI GFR was significantly higher than median MDRD GFR (82 vs. 76 mL/min/1.73 m(2), P < 0.0001). Overall mean bias between CKD-EPI and MDRD GFR was 5.0%, ranging from 13.0% in the 18-29 years age group down to -7.5% in those aged ≥ 90 years. Although statistically significant at all age groups the difference diminished with age and the agreement in GFR category assignment increased. Age-adjusted population prevalence of CKD Stages 3-5 was lower by CKD-EPI than by MDRD (4.4% vs. 4.9%).

CONCLUSION

CKD-EPI produces higher GFR and lower CKD estimates, particularly among 18-59 year age groups with MDRD estimated GFRs of 45-59 mL/min/1.73 m(2) (Stage 3A). However, at ages >70 years there is very little difference between the equations, and among the very elderly CKD-EPI may actually increase CKD prevalence estimates.

Disclosure of medical error to parents and paediatric patients: assessment of parents' attitudes and influencing factors

OBJECTIVE

To assess parental preferences for medical error disclosure and evaluate associated factors.

DESIGN

Prospective survey.

SETTING

Hospital for Sick Children, Toronto, Canada.

PARTICIPANTS

Parents of inpatients and outpatients.

MAIN EXPOSURE

Anonymous questionnaire administered on May to August 2006, surveying demographic characteristics and identifying parents' thresholds for disclosure using a vignette with six levels of harm.

MAIN OUTCOME MEASURES

Preferred thresholds for parent and patient disclosure and associated factors.

RESULTS

99% of 431 parents (181 inpatients, 250 outpatients) wanted disclosure if there was potential or actual harm versus 77% if there was none (p<0.0001). Most parents (71% vs 41%) wanted their child similarly informed (p<0.0001). Parental age, education, experience with error and child's age did not affect preferences for disclosure. Parents of inpatients (p=0.03, OR 1.65, 95% CI 1.04 to 2.62) and those born in Asia (vs North America) had a lower disclosure threshold (p=0.014, OR 2.4, 95% CI 1.2 to 4.9), and administering the survey with increasing harm had a higher disclosure threshold (p<0.0001, OR 2.46; 95% CI 1.58 to 3.83). EXPERIENCE WITH ERROR: (p=0.05, OR 1.5, 95% CI 1 to 2.2) and child age (eg, <or=6 years vs >or= 11 years (p<0.0001, OR 2.74, 95% CI 1.73 to 4.33)) directly affected preferences for informing the child. Asian parents had a lower threshold for informing the child than North American parents.

CONCLUSIONS

Most parents want disclosure and want their child informed of errors with harm. While parental birth country, experience with error and patient age influenced parents' desire for disclosure to their child, the details of disclosure warrant study.

An alternative real-time PCR method for the detection of thermotolerant Bacillus sensu lato contaminants in naturally-contaminated gelatine

AIMS

Comparison of an internally-controlled real-time PCR assay with the current plate-based assay for the detection of Bacillus sensu lato contaminants in gelatine.

METHODS AND RESULTS

A comprehensive TaqMan probe was designed allowing the real-time PCR assay to be fully inclusive for the gelatine-contaminating Bacillus s.l. species. An internal amplification control was implemented at 500 copies per reaction without impact on target detection. Specific and selective detection of target cells was achieved with a quick and simple DNA preparation procedure. No significant difference (Kappa value = 0.94) was observed between the performance of the real-time PCR and the current plate-based method on naturally contaminated gelatines (n = 162). Relative accuracy, relative sensitivity and relative specificity were 97.5%.

CONCLUSIONS

The real-time PCR assay is an adequate alternative of the current plate-based assay.

SIGNIFICANCE AND IMPACT OF THE STUDY

The real-time PCR assay decreased the time between sample collection and result from 2 days to 2 h. The gelatine-producing industry can ensure gelatine quality in a much faster way.