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Alawattegama LH, Gaddah M, Kimani L, Antoniou GA. The effect of diabetes on abdominal aortic aneurysm growth - updated systematic review and meta-analysis. VASA 2024. [PMID: 39206613 DOI: 10.1024/0301-1526/a001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Studies have shown that diabetes mellitus is associated with a reduced prevalence and growth of abdominal aortic aneurysms (AAA). Establishing the factors that influence AAA growth will enable us to risk stratify patients and potentially optimise management. We aimed to provide an updated systematic review and meta-analysis that would inform more targeted screening practices based on patient demographics. MEDLINE, EMBASE, and DARE were searched using the Ovid interface and PubMed search engine. Studies were deemed eligible if they compared the growth rate of AAA between diabetic and non-diabetic populations. The mean difference (MD) and 95% confidence internal (CI) was used for data synthesis. Twenty-four studies from 20 articles with a total of 10,121 participants were included in our meta-analysis. An overall negative effect was shown between AAA growth and diabetes, with an annual mean effect of -0.25 mm/year (95% CI -0.35, -0.15; I2 = 73%). Our meta-analysis, which is larger and scientifically more robust compared to previous analyses, has confirmed that diabetes reduces the growth of AAA by approximately 0.25 mm a year compared to non-diabetic populations. This could have significant implications for AAA screening practices.
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Affiliation(s)
- Lakna Harindi Alawattegama
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mariam Gaddah
- Department of General Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Linda Kimani
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, United Kingdom
| | - George A Antoniou
- Department of Vascular and Endovascular Surgery, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Centre, The University of Manchester, United Kingdom
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2
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Litchfield I, Quinn LM, Boardman F, Boiko O, Narendran P, Choundhary S, Setti N, Sheth V, Greenfield SM. Preferences for Peer Support Amongst Families Engaged in Paediatric Screening Programmes: The Perspectives of Parents Involved in Screening for Type 1 Diabetes in Children Aged 3-13. Health Expect 2024; 27:e70007. [PMID: 39189410 PMCID: PMC11348000 DOI: 10.1111/hex.70007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/08/2024] [Accepted: 08/13/2024] [Indexed: 08/28/2024] Open
Abstract
INTRODUCTION This work describes a secondary analysis of a qualitative data set originally used to understand parent participants' preferences for the design and implementation of a screening programme for paediatric Type 1 diabetes (T1D). From this, their spontaneous preferences for peer support emerged, described here in the context of existing peer support programmes for the newly diagnosed alongside suggestions for their incorporation into screening programmes for T1D and a range of other conditions. METHODS Data were collected from semi-structured interviews conducted with parents of children aged 3-13 years to explore their expectations, perceptions and preferences of a T1D paediatric screening programme. A secondary analysis of interviews from participants who spontaneously raised preferences for peer support was used to populate a novel framework informed by NHS England's key principles for the same, namely, Shared experiences and reciprocated support, Accessibility and inclusivity and Person-centred and integrated peer support. RESULTS Parents in 29 of 33 interviews spontaneously described the potential value of peer support if receiving a result indicating a positive (presymptomatic T1D result) from a screening programme. Specifically, the value of 'Shared experiences and reciprocated support' in terms of emotional support and reassurance, and access to more directly interpretable and relevant information related to the condition; 'Accessibility and inclusivity' relating to access to a community of similar individuals, whether in person or online; 'Person-centred and integrated peer-support' and the need for support reflecting the changing need of the child and the integration of peer support with clinical care. CONCLUSIONS The needs of peer support described by parents involved in T1D paediatric screening appear to be shared with those of families with children diagnosed with a range of life-altering conditions. Although the needs of peer support for paediatric screening may differ across conditions, our findings are a valuable starting point for its design both in T1D and other examples of similar population screening programmes. PATIENT OR PUBLIC CONTRIBUTION Patients and the public have been involved throughout the design of the ELSA study and have worked with us to inform the study process. They contributed to the design and content of patient-facing materials, the content of our topic guides and the analysis and interpretation of our findings.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Lauren M. Quinn
- Institute of Immunology and Immunotherapy, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | | | - Olga Boiko
- Institute of Applied Health Research, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
- Department of DiabetesThe Queen Elizabeth HospitalBirminghamUK
| | - Shivam Choundhary
- Institute of Immunology and Immunotherapy, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Naga Setti
- Institute of Immunology and Immunotherapy, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Veer Sheth
- Institute of Immunology and Immunotherapy, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Sheila M. Greenfield
- Institute of Applied Health Research, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
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Rengelshausen J, Randerath I, Schettgen T, Esser A, Kaifie A, Lang J, Kraus T, Ziegler P. Ten years after: findings from the medical surveillance program on Health Effects in High-Level Exposure to PCB (HELPcB). Arch Toxicol 2023; 97:2609-2623. [PMID: 37594590 PMCID: PMC10474999 DOI: 10.1007/s00204-023-03578-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
After the detection of high environmental and occupational exposure to polychlorinated biphenyls (PCBs) in a German recycling company for transformers and capacitors in 2010, the multidisciplinary medical surveillance program "HELPcB" (Health Effects in High-Level Exposure to PCB) was established for former PCB-exposed workers of the company, their family members, employees of surrounding companies, and area residents to investigate potential adverse health effects by PCB exposure in a longitudinal study approach with up to seven examination time points between 2010 and 2019. More than 300 individuals were enrolled into the program. Assessments particularly included plasma and urine concentrations of PCB congeners and their metabolites, clinical laboratory parameters, Comet assay, analysis of telomere length, neuropsychological examinations, psychological screening, abdominal and thyroid ultrasound examination. This review summarizes the main results of the studies conducted in the HELPcB program yielding relevant new data on potential adverse effects of PCB exposure in humans and potential mechanisms that underlie these effects. Even larger studies in PCB-exposed individuals are warranted to confirm the results of this program and to further establish causality between PCB exposure and clinical effects in humans.
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Affiliation(s)
- Jens Rengelshausen
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Isabella Randerath
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Thomas Schettgen
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andre Esser
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Andrea Kaifie
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jessica Lang
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Thomas Kraus
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Patrick Ziegler
- Institute for Occupational, Social and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
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Anokye R, Jackson B, Dimmock J, Dickson JM, Blekkenhorst LC, Hodgson JM, Lewis JR, Stanley M. Psychological distress and quality of life in asymptomatic adults following provision of imaging results for prevention of cardiovascular disease events: a scoping review. Eur J Cardiovasc Nurs 2023; 22:13-22. [PMID: 35709338 DOI: 10.1093/eurjcn/zvac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 01/14/2023]
Abstract
AIMS Psychological distress and changes in health-related quality of life (HRQoL) may occur after screening for disease. Reporting outcomes related to potential benefits and harms of screening is a key recommendation in the guidelines for reporting high-quality trials or interventions. However, no reviews have directly investigated outcomes related to psychological distress and/or changes in HRQoL following imaging assessment of cardiovascular risk and communication of cardiovascular findings to asymptomatic adults. A scoping review was conducted to map research on psychological distress and/or HRQoL following screening. METHODS AND RESULTS Six electronic databases (MEDLINE, PsychINFO, Social Work Abstracts, Psychology and Behavioural Sciences Collection, CINAHL, and EMBASE) were searched for articles that assessed psychological distress and/or HRQoL following screening. Two investigators independently screened titles and abstracts for all records retrieved using predefined criteria. Studies were conducted among active smokers, military personnel, athletes, post-menopausal women, and high-risk individuals. Seven constructs related to psychological distress and HRQoL appeared across 11 articles (randomized controlled trials, n = 4 and non-randomized studies, n = 7). Worry, depression, perceived stress, anxiety, and quality of life were most prominent. Multiple-item measures of psychological distress (e.g. Taylor Anxiety Score and Beck Depression Inventory) were used in 5/9 (56%) studies. Key findings on psychological distress and/or changes in HRQoL following screening were mixed. CONCLUSIONS Findings support the need for multiple-item measures with better psychometric properties to examine the psychological responses to screening results in future studies. Strategies to support individuals during and following vascular screening to maximise potential benefits of screening and minimize harms are discussed.
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Affiliation(s)
- Reindolf Anokye
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, WA, Australia
| | - Ben Jackson
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - James Dimmock
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia.,Department of Psychology, College of Healthcare Sciences, James Cook University, Queensland, Australia
| | - Joanne M Dickson
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, WA, Australia.,School of Arts and Humanities (Psychology Discipline), Edith Cowan University, Joondalup, WA, Australia.,Department of Psychological Science, University of Liverpool, Liverpool, UK
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, Australia
| | - Jonathan M Hodgson
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, Australia
| | - Joshua R Lewis
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Royal Perth Hospital Research Foundation, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Mandy Stanley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Tan H, Li T, Huang L, Duan Q, Fan L, Yu M, Wang J, DNA G, Luo S. Genetic placebo effect on psychological resilience: the moderating role of self-compassion. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03426-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Goldman JS, Vallabh SM. Genetic counseling for prion disease: Updates and best practices. Genet Med 2022; 24:1993-2003. [PMID: 35819418 DOI: 10.1016/j.gim.2022.06.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022] Open
Abstract
Prion disease is a rare, fatal, and often rapidly progressive neurodegenerative disease. Ten to fifteen percent of cases are caused by autosomal dominant gain-of-function variants in the prion protein gene, PRNP. Rarity and phenotypic variability complicate diagnosis, often obscuring family history and leaving families unprepared for the genetic implications of an index case. Several recent developments inspire this update in best practices for prion disease genetic counseling. A new prion-detection assay has transformed symptomatic diagnosis. Meanwhile, penetrance, age of onset, and duration of illness have been systematically characterized across PRNP variants in a global cohort. Clinically, the traditional genotype-phenotype correlation has weakened over time, and the term genetic prion disease may now better serve providers than the historical subtypes Creutzfeldt-Jakob disease, fatal familial insomnia, and Gerstmann-Sträussler-Scheinker disease. Finally, in the age of genetically targeted therapies, clinical trials for prion disease are being envisaged, and healthy at-risk individuals may be best positioned to benefit. Such individuals need to be able to access clinical services for genetic counseling and testing. Thus, this update on the genetics of prion disease and best practices for genetic counseling for this disease aims to provide the information needed to expand genetic counseling services.
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Affiliation(s)
| | - Sonia M Vallabh
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA; Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Prion Alliance, Cambridge, MA.
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Choi I, Ho N, Morris R, Harvey SB, Calvo RA, Glozier N. The impact of communicating personal mental ill-health risk: A randomized controlled non-inferiority trial. Early Interv Psychiatry 2021; 15:932-941. [PMID: 32930513 DOI: 10.1111/eip.13038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/22/2020] [Accepted: 08/21/2020] [Indexed: 11/28/2022]
Abstract
AIM Risk algorithms predicting personal mental ill-health will form an important component of digital and personalized preventive interventions, yet it is unknown whether informing people of personal risk may cause unintended harm. This trial evaluated the comparative effect of communicating personal mental ill-health risk profiles on psychological distress. METHODS Australian participants using a mood-monitoring app were randomly allocated to receiving their current personal mental ill-health risk profile (n = 119), their achievable personal risk profile (n = 118) or to a control group (n = 118) in which no risk information was communicated, in a non-inferiority trial design. The primary outcome was psychological distress at four-weeks as assessed on the Kessler Psychological Distress Scale. RESULTS There was high attrition in the trial with 64% of data missing at follow up. Per-protocol (completer) analysis found that the lower bounds of the confidence intervals of the estimated mean change of the current risk (m = 0.19, 95% CI: -2.59- 2.98) and achievable risk (m = -0.09, 95% CI: -2.84 to 2.66) groups were within the non-inferiority margin of the control group's mean at follow up. Supplementary intention-to-treat analysis using Multivariate Imputation by Chained Equations (MICE) found that 98/100 imputed datasets of the current risk profile group, and all imputed datasets of the achievable risk profile group showed non-inferiority to the control group. CONCLUSIONS This study provides preliminary support that providing personal mental health risk profiles does not lead to unacceptable worsening of distress compared to no risk feedback, although this needs to be replicated in a fully powered RCT.
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Affiliation(s)
- Isabella Choi
- Central Clinical School, Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Ho
- Central Clinical School, Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Morris
- Central Clinical School, Faculty of Medicine and Health, Centre for Translational Data Science, University of Sydney, Sydney, New South Wales, Australia
| | - Samuel B Harvey
- Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rafael A Calvo
- Faculty of Engineering, Dyson School of Design Engineering, Imperial College London, London, UK
| | - Nicholas Glozier
- Central Clinical School, Faculty of Medicine and Health, Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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8
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Lang J, Felten MK, Kraus T. Are the knowledge of non-malignant asbestos-related diseases and lung function impairment differentially associated with psychological well-being? A cross-sectional study in formerly asbestos-exposed workers in Germany. BMJ Open 2019; 9:e030094. [PMID: 31662369 PMCID: PMC6830594 DOI: 10.1136/bmjopen-2019-030094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The knowledge of past asbestos exposure may lead to chronic psychological strain. In addition, the information about an increased cancer risk can place a psychological burden on individuals triggering mental health symptoms of depression or anxiety. This applies in particular to individuals with non-malignant asbestos-related disease (ARD) such as lung fibrosis and pleural thickening with or without lung function impairment. ARDs with or without lung function impairment may develop even years after exposure cessation. Therefore, the aim of the present study was to test for our cohort whether non-malignant ARD and lung function impairment have differential effects on mental health and psychological strain. DESIGN Cross-sectional study. PARTICIPANTS AND SETTING Overall, 612 male participants (mean age=66.2 years, SD=9.5) attending a surveillance programme for ARDs received routine examinations including lung function testing (24% refused to fill in the psychological questionnaire) at a German university hospital study centre from August 2008 to August 2013. OUTCOME MEASURES Using multiple hierarchical regression analysis, ARD diagnosis and lung function impairment were used to predict psychological health as measured with validated questionnaires for depression and anxiety. Psychological strain was operationalised by intrusive thoughts and specific fear of cancer. RESULTS The strongest predictor for mental health was obstructive functional impairment (eg, anxiety: β=0.22, p<0.001). Psychological strain was predicted by the presence of a non-malignant ARD (eg, intrusive thoughts: β=0.17, p=0.003). CONCLUSIONS The presence of mental health symptoms is associated with ventilation disturbances, whereas the knowledge of an already initiated morphological change-caused by asbestos exposure-is primarily associated with psychological strain. Specifically, the affected individuals are more prone to intrusive thoughts and specific fear of asbestos-related cancer. As an implication, physicians should be sensitised about possible consequences of risk communication and functional impairment to counteract excessive fear or anxiety.
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Affiliation(s)
- Jessica Lang
- Institute of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Michael K Felten
- Institute of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
| | - Thomas Kraus
- Institute of Occupational, Social and Environmental Medicine, RWTH Aachen University, Aachen, Germany
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MacLeod R, Moldovan R, Stopford C, Ferrer-Duch M. Genetic Counselling and Narrative Practices: A Model of Support following a "Negative" Predictive Test for Huntington's Disease. J Huntingtons Dis 2019; 7:175-183. [PMID: 29562548 DOI: 10.3233/jhd-170276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Predictive testing for Huntington's disease (HD) has been available for individuals at risk of HD by direct mutation analysis since 1993. International Predictive test guidelines recommend that support is offered following the result regardless of test outcome. However, there is lack of an evidence base regarding what this support should look like and how it might work in practice. OBJECTIVE A service improvement initiative looked at the feasibility of offering a narrative group session co-facilitated by a genetic counsellor and clinical psychologist, to individuals who had tested mutation negative for HD. The narrative session was evaluated from the perspective of group participants. METHODS Individuals who tested mutation negative at a genetic centre in the North of England over a 5-year period were invited to attend a narrative group session. 52 people were contacted and 9 people agreed to participate. Participants completed standardised questionnaires (PHQ-9 and GAD-7) before and after the session and a detailed written evaluation. Participants' comments were analysed thematically. RESULTS Participants were overwhelmingly positive about the narrative session finding it a safe and enjoyable way to explore difficult life experiences. Reported benefits included feeling less isolated, being inspired by other people's stories and connecting as a group. All 9 participants said they would recommend the narrative session to anyone impacted by HD. CONCLUSIONS The narrative group session was considered an interesting and useful approach to facilitating adaptation following a negative predictive test result for HD.
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Affiliation(s)
- Rhona MacLeod
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Ramona Moldovan
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Cheryl Stopford
- Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK
| | - Mariangels Ferrer-Duch
- Leeds Family Therapy and Research Centre, Leeds Institute of Health Sciences, Leeds University School of Medicine, University of Leeds, Leeds, UK
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Hendy J, Vandrevala T, Ahmed A, Kelly C, Gray L, Ala A. Feeling misidentified: Understanding migrant's readiness to engage in health care screening. Soc Sci Med 2019; 237:112481. [DOI: 10.1016/j.socscimed.2019.112481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/22/2019] [Accepted: 08/03/2019] [Indexed: 02/07/2023]
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Impact on Quality of Life of Men with Screening-Detected Abdominal Aortic Aneurysms Attending Regular Follow ups: A Narrative Literature Review. Eur J Vasc Endovasc Surg 2019; 57:589-596. [PMID: 30910494 DOI: 10.1016/j.ejvs.2018.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study aimed to review, summarise, and assess the available evidence regarding the impact on the quality of life (QoL) of men undergoing screening for abdominal aortic aneurysm (AAA) and attending regular follow ups. METHODS PubMed, MEDLINE, CINAHL, and PsycINFO were used for searching. The search was performed from April to July 2016, with an update in February-March 2018. The quality of the studies was appraised with respective checklists from the Critical Appraisal Skills Programme. A narrative synthesis of the included studies was performed. The analysis included studies evaluating QoL in relation to one or more of the following concepts: physical function, psychological impact and social life in men undergoing AAA screening, but excluded studies evaluating QoL in AAA patients diagnosed outside a screening program. RESULTS The initial results from the search were 128 articles. Duplicates were removed, titles and abstracts were screened, and 22 full text articles were collected. Based on the inclusion criteria, 11 quantitative studies were included. Inferior quality of life among men with detected AAA was identified compared to those without the diagnosis and the general population in the included studies. The self-perceived health decreased over time for the participants with AAA. Assessments after surgery showed that the participants returned to similar health as before the screening. A wide variety of factors regarding the methodologies, designs, measurements, sample sizes, and the time for the assessment were noted in the included studies. CONCLUSION Quality of life is an important outcome for AAA screening and studies have been conducted in an attempt to address the imbalance between benefits and harm. However, it is still difficult to draw clear conclusions, possibly due to the heterogeneity of the original studies. Nevertheless, it is important to identify men with an AAA who develop conditions influencing their health and QoL in order to understand their care needs to further support them and improve their situation.
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12
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Krogsbøll LT, Jørgensen KJ, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2019; 1:CD009009. [PMID: 30699470 PMCID: PMC6353639 DOI: 10.1002/14651858.cd009009.pub3] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND General health checks are common elements of health care in some countries. They aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used individual screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is therefore important to assess whether general health checks do more good than harm. This is the first update of the review published in 2012. OBJECTIVES To quantify the benefits and harms of general health checks. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, two other databases and two trials registers on 31 January 2018. Two review authors independently screened titles and abstracts, assessed papers for eligibility and read reference lists. One review author used citation tracking (Web of Knowledge) and asked trial authors about additional studies. SELECTION CRITERIA We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening for more than one disease or risk factor in more than one organ system. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias in the trials. We contacted trial authors for additional outcomes or trial details when necessary. When possible, we analysed the results with a random-effects model meta-analysis; otherwise, we did a narrative synthesis. MAIN RESULTS We included 17 trials, 15 of which reported outcome data (251,891 participants). Risk of bias was generally low for our primary outcomes. Health checks have little or no effect on total mortality (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.97 to 1.03; 11 trials; 233,298 participants and 21,535 deaths; high-certainty evidence, I2 = 0%), or cancer mortality (RR 1.01, 95% CI 0.92 to 1.12; 8 trials; 139,290 participants and 3663 deaths; high-certainty evidence, I2 = 33%), and probably have little or no effect on cardiovascular mortality (RR 1.05, 95% CI 0.94 to 1.16; 9 trials; 170,227 participants and 6237 deaths; moderate-certainty evidence; I2 = 65%). Health checks have little or no effect on fatal and non-fatal ischaemic heart disease (RR 0.98, 95% CI 0.94 to 1.03; 4 trials; 164,881 persons, 10,325 events; high-certainty evidence; I2 = 11%), and probably have little or no effect on fatal and non-fatal stroke (RR 1.05 95% CI 0.95 to 1.17; 3 trials; 107,421 persons, 4543 events; moderate-certainty evidence, I2 = 53%). AUTHORS' CONCLUSIONS General health checks are unlikely to be beneficial.
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Affiliation(s)
- Lasse T Krogsbøll
- RigshospitaletNordic Cochrane CentreBlegdamsvej 9, 7811CopenhagenDenmark2100
| | | | - Peter C Gøtzsche
- RigshospitaletNordic Cochrane CentreBlegdamsvej 9, 7811CopenhagenDenmark2100
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Parental anxiety towards 'refer' results in newborn hearing screening (NHS) in south India: A hospital based study. Int J Pediatr Otorhinolaryngol 2019; 116:25-29. [PMID: 30554702 DOI: 10.1016/j.ijporl.2018.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/01/2018] [Accepted: 10/11/2018] [Indexed: 11/21/2022]
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14
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Davison J, Scott J. Should we intervene at stage 0? A qualitative study of attitudes of asymptomatic youth at increased risk of developing bipolar disorders and parents with established disease. Early Interv Psychiatry 2018; 12:1112-1119. [PMID: 28188672 DOI: 10.1111/eip.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/08/2016] [Accepted: 11/13/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies of potential interventions for asymptomatic individuals at risk of severe mental disorders (ie, clinical stage 0) have focused on genetic counselling or the views of adults with established disease. No study has interviewed youth at risk of bipolar disorders (BD). METHODS Qualitative analysis of interviews with asymptomatic adolescent offspring of adults with BD (OSBD = 7) and unrelated parents with bipolar disorders (PBD = 6) to examine manifest and latent themes in the dialogue. RESULTS Core themes in both groups were ignorance regarding the magnitude of risk of BD onset in offspring and greater concerns for the health of other family members than for oneself. Parents expressed anxieties in coping with the uncertainty about whether their children would inherit BD and their desire to reduce this risk was partly driven by guilt and their sense of responsibility; PBD favoured the introduction of specialized clinical OSBD services. In contrast, the priority for OSBD was advice on coping with a parent with BD; OSBD favoured access to generic non-clinical peer group support, which they perceived as less stigmatizing than specialist services. CONCLUSION The study highlights that youth at risk of BD should be allowed to express their ideas on what interventions they believe are likely to be most beneficial for them, as their views may differ from other advocates who are routinely consulted, such as PBD. A noteworthy finding was that OSBD thought that being included in the clinical dialogue about their parents' BD would decrease rather than increase their stress levels.
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Affiliation(s)
- Jo Davison
- Newcastle Early Intervention in Psychosis Service, NTW NHS Trust, Newcastle, UK
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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15
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Lebowitz MS, Ahn WK. Testing positive for a genetic predisposition to depression magnifies retrospective memory for depressive symptoms. J Consult Clin Psychol 2018; 85:1052-1063. [PMID: 29083221 DOI: 10.1037/ccp0000254] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Depression, like other mental disorders and health conditions generally, is increasingly construed as genetically based. This research sought to determine whether merely telling people that they have a genetic predisposition to depression can cause them to retroactively remember having experienced it. METHOD U.S. adults (men and women) were recruited online to participate (Experiment 1: N = 288; Experiment 2: N = 599). After conducting a test disguised as genetic screening, we randomly assigned some participants to be told that they carried elevated genetic susceptibility to depression, whereas others were told that they did not carry this genetic liability or were told that they carried elevated susceptibility to a different disorder. Participants then rated their experience of depressive symptoms over the prior 2 weeks on a modified version of the Beck Depression Inventory-II. RESULTS Participants who were told that their genes predisposed them to depression generally reported higher levels of depressive symptomatology over the previous 2 weeks, compared to those who did not receive this feedback. CONCLUSIONS Given the central role of self-report in psychiatric diagnosis, these findings highlight potentially harmful consequences of personalized genetic testing in mental health. (PsycINFO Database Record
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Affiliation(s)
- Matthew S Lebowitz
- Center for Research on Ethical, Legal and Social Implications of Psychiatric, Neurologic and Behavioral Genetics, Department of Psychiatry, Columbia University
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16
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Uttinger M, Koranyi S, Papmeyer M, Fend F, Ittig S, Studerus E, Ramyead A, Simon A, Riecher-Rössler A. Early detection of psychosis: helpful or stigmatizing experience? A qualitative study. Early Interv Psychiatry 2018; 12:66-73. [PMID: 26362478 DOI: 10.1111/eip.12273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Abstract
AIM Despite the large scientific debate concerning potential stigmatizing effects of identifying an individual as being in an at-risk mental state (ARMS) for psychosis, studies investigating this topic from the subjective perspective of patients are rare. This study assesses whether ARMS individuals experience stigmatization and to what extent being informed about the ARMS is experienced as helpful or harmful. METHODS Eleven ARMS individuals, currently participating in the follow-up assessments of the prospective Basel Früherkennung von Psychosen (FePsy; English: Early Detection of Psychosis) study, were interviewed in detail using a semistructured qualitative interview developed for this purpose. Data were analysed using Interpretative Phenomenological Analysis. RESULTS Most individuals experiencing first symptoms reported sensing that there was 'something wrong with them' and felt in need of help. They were relieved that a specific term was assigned to their symptoms. The support received from the early detection centre was generally experienced as helpful. Many patients reported stigmatization and discrimination that appeared to be the result of altered behaviour and social withdrawal due to the prepsychotic symptoms they experienced prior to contact with the early detection clinic. CONCLUSIONS The results suggest that early detection services help individuals cope with symptoms and potential stigmatization rather than enhancing or causing the latter. More emphasis should be put on the subjective experiences of those concerned when debating the advantages and disadvantages of early detection with regard to stigma. There was no evidence for increased perceived stigma and discrimination as a result of receiving information about the ARMS.
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Affiliation(s)
- Martina Uttinger
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Susan Koranyi
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland.,Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Martina Papmeyer
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland.,Division of Systems Neuroscience of Psychopathology, Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Fabienne Fend
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Sarah Ittig
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Erich Studerus
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Avinash Ramyead
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| | - Andor Simon
- Department of Psychiatry, Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Bruderholz, Switzerland
| | - Anita Riecher-Rössler
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
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17
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Gaum PM, Gube M, Schettgen T, Putschögl FM, Kraus T, Fimm B, Lang J. Polychlorinated biphenyls and depression: cross-sectional and longitudinal investigation of a dopamine-related Neurochemical path in the German HELPcB surveillance program. Environ Health 2017; 16:106. [PMID: 29017568 PMCID: PMC5635510 DOI: 10.1186/s12940-017-0316-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/02/2017] [Indexed: 05/30/2023]
Abstract
BACKGROUND Exposure to polychlorinated biphenyls (PCBs) is associated with depressive symptomatology. A cause of depressive symptoms is a disturbance in the neurotransmitter system of dopamine (DA). Animal as well as human studies report that PCBs can influence the DA system. This study examined whether PCB-related depressive symptoms are affected by DA metabolites in humans with high PCB body burden. METHODS This study is part of the German HELPcB surveillance program (Health Effects in high Level exposure to PCB) for occupationally exposed workers and their relatives. Data was collected from 178 participants on two measurement time points (t1 and t2) with a one-year time lag in between the two time points. PCBs were analyzed in plasma via human biomonitoring and a validated questionnaire was used to identify existence and severity of depressive symptoms. As a surrogate for DA, we measured its metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA) in urine. Mediation analyses were performed to test whether the association between PCB exposure and severity of depressive symptoms is mediated by urinary concentration of DA metabolites HVA and VMA. The mediation was tested with the SPSS macro MEDIATE. RESULTS We found a significant mediation over time for lower-chlorinated, higher-chlorinated and dioxin-like PCBs. The positive association between PCB exposure with severity of depressive symptoms was mediated by the main DA metabolite HVA. At t1 a higher exposure with PCBs was associated with lower concentration in urinary HVA. A reduced HVA concentration at t1 was correlated with increased depressive symptoms severity at t2. No meditations were found for VMA. CONCLUSIONS This work indicates that the association of PCB exposure and an increase of depressive symptoms after one year is mediated by the DA metabolite HVA as a surrogate for DA. These are first steps towards finding an explanation for an underlying neurochemical pathomechanism of PCB-related depressive symptomatology.
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Affiliation(s)
- Petra Maria Gaum
- Institute for Occupational Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Monika Gube
- Institute for Occupational Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
- Health Office of the city and area of Aachen, Trierer Straße 1, 52070 Aachen, Germany
| | - Thomas Schettgen
- Institute for Occupational Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Franziska Maria Putschögl
- Institute for Occupational Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, J 5, 68159 Mannheim, Germany
| | - Thomas Kraus
- Institute for Occupational Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Bruno Fimm
- Clinic for Neurology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Jessica Lang
- Institute for Occupational Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074 Aachen, Germany
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18
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Oonk AMM, Ariens S, Kunst HPM, Admiraal RJC, Kremer H, Pennings RJE. Psychological impact of a genetic diagnosis on hearing impairment-An exploratory study. Clin Otolaryngol 2017; 43:47-54. [PMID: 28556609 DOI: 10.1111/coa.12908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Genetic testing for hereditary hearing impairment has become more routinely available as a diagnostic tool in the outpatient clinic. However, little is known about the psychological impact of a genetic diagnosis. To evaluate this impact, an exploratory study was conducted. DESIGN Prospectively, 48 individuals who underwent genetic testing for hereditary hearing impairment were included in this study. Study participants were asked to fill out the following questionnaires: Hospital Anxiety Depression Scale, Impact of Event Scale, Self-Efficacy 24, Illness Cognition Questionnaire and the Inventory for Social Reliance. Questionnaires were filled out on three occasions: before genetic testing, directly after counselling on either positive or negative test results, and six weeks thereafter. RESULTS No significant differences were found between the group that received a genetic diagnosis for their hearing impairment and the group that did not. CONCLUSION This study did not demonstrate differences between receiving a genetic diagnosis or not; however, special attention to psychological well-being should be offered to hearing-impaired patients who seek a genetic diagnosis for their hearing impairment. Additionally, the psychological impact of sensorineural hearing impairment might be greater than the impact of a genetic diagnosis itself. Based on the current exploratory study, there are no psychological reasons in favour of or against genetic testing for hereditary hearing impairment.
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Affiliation(s)
- A M M Oonk
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - S Ariens
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H P M Kunst
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - R J C Admiraal
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - H Kremer
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R J E Pennings
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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19
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Manning M, Albrecht TL, Yilmaz-Saab Z, Shultz J, Purrington K. Influences of race and breast density on related cognitive and emotion outcomes before mandated breast density notification. Soc Sci Med 2016; 169:171-179. [PMID: 27733299 PMCID: PMC6816018 DOI: 10.1016/j.socscimed.2016.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE Many states have adopted laws mandating breast density (BD) notification for applicable women; however, very little is known about what women knew or felt about BD and related breast cancer (BC) risk before implementation of BD notification laws. OBJECTIVE We examined between-race differences in the extent to which having dense breasts was associated with women's related BD cognition and emotion, and with health care providers' communication about BD. METHODS We received surveys between May and October of 2015 assessing health care provider (HCP) communication about BD, BD-related knowledge, BD-related anxiety and BC worry from 182 African American (AA) and 113 European American (EA) women in the state of Michigan for whom we had radiologists' assessments of BD. RESULTS Whereas having dense breasts was not associated with any BD-related cognition or emotion, there were robust effects of race as follows: EA women were more likely to have been told about BD by a HCP, more likely to know their BD status, had greater knowledge of BD and of BC risk, and had greater perceptions of BC risk and worry; AA women had greater BD-related anxieties. EA women's greater knowledge of their own BD status was directly related to the increased likelihood of HCP communication about BD. However, HCP communication about BD attenuated anxiety for AA women only. CONCLUSION We present the only data of which we are aware that examines between-race differences in the associations between actual BD, HCP communication and BD related cognition and emotion before the implementation of BD notification laws. Our findings suggest that the BD notification laws could yield positive benefits for disparities in BD-related knowledge and anxiety when the notifications are followed by discussions with health care providers.
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Affiliation(s)
- Mark Manning
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States.
| | - Terrance L Albrecht
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Zeynep Yilmaz-Saab
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Julie Shultz
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
| | - Kristen Purrington
- Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R Rd, Detroit, MI 48201, United States
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20
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Barr O, McConkey R. A different type of appointment: the experiences of parents who have children with intellectual disabilities referred for genetic investigation. J Res Nurs 2016. [DOI: 10.1177/1744987107083516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Current research endeavours in genetics largely concentrate on developing more effective approaches to genetic investigation and treatment for individuals. By contrast, less attention has been paid to the impact of genetic referral on the parents of children undergoing investigation, in particular which aspects of the referral process that contribute to increased anxiety reported by parents attending a genetics appointment. The overall aim of this project was to gain an understanding of the experience of parents who have a child referred for genetic investigation. This paper reports how parents perceived an appointment with a geneticist as being `different' from appointments with other doctors they had attended. Using an Interpretative Phenomenological Analysis (IPA) design information was obtained using preappointment self-completion questionnaires with 19 parents that they completed in the two weeks prior to their appointment. After the appointment semi-structured interviews with 17 of these parents within three months of the appointment with the geneticist. In addition, a second interview with 10 parents (of the above 17 parents) for whom genetic investigation were continuing was completed approximately nine months following their initial appointment with the geneticist. All parents who agreed to participate in this study were parents of children with intellectual disabilities. Overall, four superordinate themes were identified, these were: seeking information — the wider context; a different type of appointment; interpreting information and experiences and parents' changing perspectives. The findings reinforce the findings of previous studies that have highlighted the desire of parents to receive an explanation of their child's condition, the wider impact of being referred to and attending an appointment with a geneticist and the role that receiving a diagnosis can play in parents' process of adaptation to their child's condition. However, this study provided a new insight into how parents perceive their appointment with a geneticist as being different from other doctors they have attended. The findings of this study highlight the need to recognise the different manner in which parents perceive an appointment with a geneticist in comparison with appointments with other doctors. The illumination of the perceived `differentness' that parents have prior to and during an appointment with a geneticist appointment provides a new insight into why parents may be anxious as a result of the processes involved. In seeking to support the parents of children referred to a geneticist, health professionals should identify parents' understanding and expectations of the appointment and provide timely information and support in order to assist parents prepare for the appointment and make maximum use of this opportunity to raise and understand new information.
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Affiliation(s)
- Owen Barr
- Institute of Nursing Research and School of Nursing Magee Campus, University of Ulster, Londonderry, UK,
| | - Roy McConkey
- Institute of Nursing Research and School of Nursing Jordanstown Campus, University of Ulster, Newtownabbey, UK
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21
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Whyte S, Green A, McAllister M, Shipman H. Family Communication in Inherited Cardiovascular Conditions in Ireland. J Genet Couns 2016; 25:1317-1326. [PMID: 27271705 DOI: 10.1007/s10897-016-9974-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/16/2016] [Indexed: 12/28/2022]
Abstract
Over 100,000 individuals living in Ireland carry a mutated gene for an inherited cardiac condition (ICC), most of which demonstrate an autosomal dominant pattern of inheritance. First-degree relatives of individuals with these mutations are at a 50 % risk of being a carrier: disclosing genetic information to family members can be complex. This study explored how families living in Ireland communicate genetic information about ICCs and looked at the challenges of communicating information, factors that may affect communication and what influence this had on family relationships. Face to face interviews were conducted with nine participants using an approved topic guide and results analysed using thematic analysis. The participants disclosed that responsibility to future generations, gender, proximity and lack of contact all played a role in family communication. The media was cited as a source of information about genetic information and knowledge of genetic information tended to have a positive effect on families. Results from this study indicate that individuals are willing to inform family members, particularly when there are children and grandchildren at risk, and different strategies are utilised. Furthermore, understanding of genetics is partially regulated not only by their families, but by the way society handles information. Therefore, genetic health professionals should take into account the familial influence on individuals and their decision to attend genetic services, and also that of the media.
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Affiliation(s)
- Sinead Whyte
- Centre for Medical Education, School of Medicine, Institute of Medical Genetics, Cardiff University, Heath Park, Cardiff, CF14 4XW, UK. .,Institute of Medical Genetics, All Wales Medical Genetics Service, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Andrew Green
- National Centre for Medical Genetics, Our Lady's Hospital, Crumlin, Dublin 12, Ireland
| | - Marion McAllister
- Centre for Medical Education, School of Medicine, Institute of Medical Genetics, Cardiff University, Heath Park, Cardiff, CF14 4XW, UK
| | - Hannah Shipman
- Department of Clinical Genetics, Addenbrooke's Hospital NHS Trust, PO Box 134, Cambridge, CB2 0QQ, UK
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22
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Patil S, Lu H, Saunders CL, Potoglou D, Robinson N. Public preferences for electronic health data storage, access, and sharing - evidence from a pan-European survey. J Am Med Inform Assoc 2016; 23:1096-1106. [PMID: 27107445 PMCID: PMC5070520 DOI: 10.1093/jamia/ocw012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/24/2015] [Accepted: 01/16/2016] [Indexed: 11/18/2022] Open
Abstract
Objective
To assess the public’s preferences regarding potential privacy threats from devices or services storing health-related personal data.
Materials and Methods
A pan-European survey based on a stated-preference experiment for assessing preferences for electronic health data storage, access, and sharing.
Results
We obtained 20 882 survey responses (94 606 preferences) from 27 EU member countries. Respondents recognized the benefits of storing electronic health information, with 75.5%, 63.9%, and 58.9% agreeing that storage was important for improving treatment quality, preventing epidemics, and reducing delays, respectively. Concerns about different levels of access by third parties were expressed by 48.9% to 60.6% of respondents.
On average, compared to devices or systems that only store basic health status information, respondents preferred devices that also store identification data (coefficient/relative preference 95% CI = 0.04 [0.00-0.08],
P
= 0.034) and information on lifelong health conditions (coefficient = 0.13 [0.08 to 0.18],
P
< 0.001), but there was no evidence of this for devices with information on sensitive health conditions such as mental and sexual health and addictions (coefficient = −0.03 [−0.09 to 0.02],
P
= 0.24). Respondents were averse to their immediate family (coefficient = −0.05 [−0.05 to −0.01],
P
= 0.011) and home care nurses (coefficient = −0.06 [−0.11 to −0.02],
P
= 0.004) viewing this data, and strongly averse to health insurance companies (coefficient = −0.43 [−0.52 to 0.34],
P
< 0.001), private sector pharmaceutical companies (coefficient = −0.82 [−0.99 to −0.64],
P
< 0.001), and academic researchers (coefficient = −0.53 [−0.66 to −0.40],
P
< 0.001) viewing the data.
Conclusions
Storing more detailed electronic health data was generally preferred, but respondents were averse to wider access to and sharing of this information. When developing frameworks for the use of electronic health data, policy makers should consider approaches that both highlight the benefits to the individual and minimize the perception of privacy risks.
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23
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Inter-arm blood pressure difference and mortality: a cohort study in an asymptomatic primary care population at elevated cardiovascular risk. Br J Gen Pract 2016; 66:e297-308. [PMID: 27080315 DOI: 10.3399/bjgp16x684949] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/04/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Differences in blood pressure between arms are associated with increased cardiovascular mortality in cohorts with established vascular disease or substantially elevated cardiovascular risk. AIM To explore the association of inter-arm difference (IAD) with mortality in a community-dwelling cohort that is free of cardiovascular disease. DESIGN AND SETTING Cohort analysis of a randomised controlled trial in central Scotland, from April 1998 to October 2008. METHOD Volunteers from Lanarkshire, Glasgow, and Edinburgh, free of pre-existing vascular disease and with an ankle-brachial index ≤0.95, had systolic blood pressure measured in both arms at recruitment. Inter-arm blood pressure differences were calculated and examined for cross-sectional associations and differences in prospective survival. Outcome measures were cardiovascular events and all-cause mortality during mean follow-up of 8.2 years. RESULTS Based on a single pair of measurements, 60% of 3350 participants had a systolic IAD ≥5 mmHg and 38% ≥10 mmHg. An IAD ≥5 mmHg was associated with increased cardiovascular mortality (adjusted hazard ratio [HR] 1.91, 95% confidence interval [CI] = 1.19 to 3.07) and all-cause mortality (adjusted HR 1.44, 95% CI = 1.15 to 1.79). Within the subgroup of 764 participants who had hypertension, IADs of ≥5 mmHg or ≥10 mmHg were associated with both cardiovascular mortality (adjusted HR 2.63, 95% CI = 0.97 to 7.02, and adjusted HR 2.96, 95% CI = 1.27 to 6.88, respectively) and all-cause mortality (adjusted HR 1.67, 95% CI = 1.05 to 2.66, and adjusted HR 1.63, 95% CI = 1.06 to 2.50, respectively). IADs ≥15 mmHg were not associated with survival differences in this population. CONCLUSION Systolic IADs in blood pressure are associated with increased risk of cardiovascular events, including mortality, in a large cohort of people free of pre-existing vascular disease.
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24
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Barengo NC, Tuomilehto JO. How can we identify candidates at highest risk – to screen or not to screen? Herz 2016; 41:175-83. [DOI: 10.1007/s00059-016-4417-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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25
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Rafiq M, Ianuale C, Ricciardi W, Boccia S. Direct-to-consumer genetic testing: a systematic review of european guidelines, recommendations, and position statements. Genet Test Mol Biomarkers 2015; 19:535-47. [PMID: 26313927 DOI: 10.1089/gtmb.2015.0051] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Personalized healthcare is expected to yield promising results, with a paradigm shift toward more personalization in the practice of medicine. This emerging field has wide-ranging implications for all the stakeholders. Commercial tests in the form of multiplex genetic profiles are currently being provided to consumers, without the physicians' consultation, through the Internet, referred to as direct-to-consumer genetic tests (DTC GT). OBJECTIVES The objective was to review all the existing European guidelines on DTC GT, and its associated interventions, to list all the supposed benefits and harms, issues and concerns, and recommendations. METHODS We conducted a systematic review of position statements, policies, guidelines, and recommendations, produced by professional organizations or other relevant bodies for use of DTC GT in Europe. RESULTS Seventeen documents met the inclusion criteria, which were subjected to thematic analysis, and the texts were coded for statements related to use of DTC GT. DISCUSSION AND CONCLUSIONS Professional societies and associations are currently more suggestive of potential disadvantages of DTC GT, recommending improved genetic literacy of both populations and health professionals, and implementation research on the genetic tests to integrate public health genomics into healthcare systems.
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Affiliation(s)
- Muhammad Rafiq
- 1 Medical Management Center (MMC), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet , Stockholm, Sweden .,2 SDA Bocconi School of Management , Milan, Italy
| | - Carolina Ianuale
- 3 Section of Hygiene, Institute of Public Health , Università Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Ricciardi
- 3 Section of Hygiene, Institute of Public Health , Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- 3 Section of Hygiene, Institute of Public Health , Università Cattolica del Sacro Cuore, Rome, Italy
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26
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Johnson JE, Gulanick M, Penckofer S, Kouba J. Does knowledge of coronary artery calcium affect cardiovascular risk perception, likelihood of taking action, and health-promoting behavior change? J Cardiovasc Nurs 2015; 30:15-25. [PMID: 24434820 DOI: 10.1097/jcn.0000000000000103] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Evidence indicates that a healthy lifestyle can reduce cardiovascular disease risk, yet many people engage in unhealthy behaviors. New technologies such as coronary artery calcium (CAC) screening detect atherosclerosis before clinical disease is manifested. Knowledge of an abnormal finding could provide the "teachable moment" to enhance motivation for change. OBJECTIVE The aim of this study was to examine how knowledge of CAC score affects risk perception, likelihood of taking action, and health-promoting behavior change in persons at high risk for cardiovascular disease. METHODS This study used a descriptive prospective design with 174 high-risk adults (≥3 major risk factors) recruited at a radiology center offering CAC scans. Baseline self-report surveys using the Perception of Risk of Heart Disease Scale, the Benefits and Barriers Scale, the Quality of Life Index, and the Health-Promoting Lifestyle Profile II were completed immediately after a screening CAC scan but before results were known. Follow-up occurred 3 months later using mailed packets. RESULTS Participants' mean age was 58 years; 62% were men, 89% were white, and most were well educated. There was no significant change in risk perception scores over time or between groups, except for a positive interaction in the moderate-risk group (CAC scores of 101-400) (P = .004). Quality of life remained unchanged. Health-promoting behavior changes increased in all groups over time (P < .001). McNemar χ² analysis indicated that risk reduction medication use increased in all groups, with a significant increase in statin (P < .001) and aspirin (P < .001) intake. Predictors of behavior change were perceived barriers (β = -.41; P < .001) and quality of life (β = .44; P < .001). CONCLUSIONS Knowledge of CAC score does impact risk perception for some at-risk groups. This knowledge does enhance motivation for behavior change. Knowledge of CAC score does not impact quality of life. It is hoped that through improved understanding of the effect of CAC scoring on behavior change, nurses can better assist patients to modify behaviors during teachable moments.
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Affiliation(s)
- Jennie E Johnson
- Jennie E. Johnson PhD, RN-BC Lifestyle Counselor, Owner, Living For A Healthy Heart, LLC, Post Falls, Idaho. Meg Gulanick, PhD, APRN, FAAN Professor Emeritus, Niehoff School of Nursing, Loyola University, Chicago, Illinois. Sue Penckofer, PhD, RN, FAAN Professor and Loyola Faculty Scholar, Niehoff School of Nursing, Loyola University, Chicago, Illinois. Joanne Kouba, PhD, RD, LDN Director, Dietetics Programs, Niehoff School of Nursing, Loyola University, Chicago, Illinois
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Chowdhury S, Henneman L, Dent T, Hall A, Burton A, Pharoah P, Pashayan N, Burton H. Do Health Professionals Need Additional Competencies for Stratified Cancer Prevention Based on Genetic Risk Profiling? J Pers Med 2015; 5:191-212. [PMID: 26068647 PMCID: PMC4493496 DOI: 10.3390/jpm5020191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/15/2015] [Accepted: 05/27/2015] [Indexed: 11/20/2022] Open
Abstract
There is growing evidence that inclusion of genetic information about known common susceptibility variants may enable population risk-stratification and personalized prevention for common diseases including cancer. This would require the inclusion of genetic testing as an integral part of individual risk assessment of an asymptomatic individual. Front line health professionals would be expected to interact with and assist asymptomatic individuals through the risk stratification process. In that case, additional knowledge and skills may be needed. Current guidelines and frameworks for genetic competencies of non-specialist health professionals place an emphasis on rare inherited genetic diseases. For common diseases, health professionals do use risk assessment tools but such tools currently do not assess genetic susceptibility of individuals. In this article, we compare the skills and knowledge needed by non-genetic health professionals, if risk-stratified prevention is implemented, with existing competence recommendations from the UK, USA and Europe, in order to assess the gaps in current competences. We found that health professionals would benefit from understanding the contribution of common genetic variations in disease risk, the rationale for a risk-stratified prevention pathway, and the implications of using genomic information in risk-assessment and risk management of asymptomatic individuals for common disease prevention.
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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, PO Box 7057, 1007 MB, The Netherlands.
| | - Tom Dent
- PHG Foundation, 2 Worts Causeway, Cambridge CB1 8RN, UK.
| | - Alison Hall
- PHG Foundation, 2 Worts Causeway, Cambridge CB1 8RN, UK.
| | - Alice Burton
- UCL Division of Infection and Immunity, University College London, Cruciform Building, 90 Gower Street, London WC1E 6BT, UK.
| | - Paul Pharoah
- Departments of Oncology and of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
| | - Nora Pashayan
- UCL Department of Applied Health Research, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | - Hilary Burton
- PHG Foundation, 2 Worts Causeway, Cambridge CB1 8RN, UK.
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Frølund JC, Primdahl J. Patients' Experiences of Nurse-Led Screening for Cardiovascular Risk in Rheumatoid Arthritis. Musculoskeletal Care 2015; 13:236-47. [PMID: 25951366 DOI: 10.1002/msc.1104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have increased morbidity and mortality due to cardiovascular disease (CVD). Screening for cardiovascular risk is recommended by the European League Against Rheumatism (EULAR). There is a lack of evidence of the experiences of RA patients who are screened for CVD. Such information is important in order to organize and further develop screening programmes for CVD in patients with RA. The aim of the present study was to explore RA patients' experiences of participation in nurse-led screening for CVD and to identify key issues for the future organization of screening programmes. METHODS Three qualitative focus group interviews were carried out with 14 outpatients diagnosed with RA. The participants were stratified into groups, depending on whether they had a low-to-moderate or high ten-year risk of cardiovascular death according to the European Systematic Coronary Risk Evaluation (SCORE) system. Data were analysed using meaning condensation to identify key themes. RESULTS Five themes were identified: reactions to receiving the invitation to the screening consultation; screening consultation adapted to needs and RA; duration reflected needs; screening consultation brought a sense of relief; and motivation and sense of control. Regardless of their CV risk, the participants found it important that the screening consultation was adapted to their needs and their illness as RA had a major impact on their daily life. CONCLUSIONS When planning future screening programmes for CVD for patients with RA, it is important that the screening consultation is individualized and tailored to patients' needs and their RA. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Jette Primdahl
- King Christian 10th Hospital for Rheumatic Diseases, Graasten, Denmark
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Owen J, Beck J, Campbell T, Adamson G, Gorham M, Thompson A, Smithson S, Rosser E, Rudge P, Collinge J, Mead S. Predictive testing for inherited prion disease: report of 22 years experience. Eur J Hum Genet 2014; 22:1351-6. [PMID: 24713662 PMCID: PMC4091984 DOI: 10.1038/ejhg.2014.42] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 11/29/2013] [Accepted: 12/18/2013] [Indexed: 11/08/2022] Open
Abstract
The inherited prion diseases (IPD) are a group of untreatable neurodegenerative diseases that segregate as autosomal dominant traits. Mutations in the prion protein gene (PRNP) were first found to be causal of IPD in 1989, before the molecular genetic characterisation of any other neurodegenerative disease. Predictive testing for IPD has subsequently been carried out at a single UK clinical and research centre for 22 years. We have analysed the uptake, consequences and factors influencing the decision for predictive testing over this period. In all, 104 predictive tests were done on individuals at 50% risk, compared with 135 positive diagnostic tests. Using genealogies from clinical records, we estimated that 23% of those at 50% risk have completed testing. There was no gender bias, and unsurprisingly, there was a slight excess of normal results because some patients were already partly through the risk period because of their age. An unexpectedly large number of patients developed symptoms shortly after predictive testing, suggesting that undisclosed early symptoms of disease may prompt some patients to come forward for predictive testing. Fifteen per cent of predictive tests were done >10 years after molecular diagnosis in a proband. A strong determinant of the timing of testing in these patients was a second diagnosis in the family. IPD may generate infectious prions that might be transmitted by surgical procedures; however, we found no evidence that public health information influenced decisions about predictive testing.
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Affiliation(s)
- Jane Owen
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
| | - Jon Beck
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Tracy Campbell
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Gary Adamson
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Michele Gorham
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
| | - Andrew Thompson
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | | | | | - Peter Rudge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
| | - John Collinge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon Mead
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK
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Kalantari S, Jafarinezhad A, Zohrevand B. Association of depression with type 2 diabetes and relevant factors. Adv Biomed Res 2014; 3:244. [PMID: 25538930 PMCID: PMC4260271 DOI: 10.4103/2277-9175.145753] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 03/12/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Based on the high prevalence of diabetes and depression in Rasht, we conducted a study to evaluate the prevalence of depression in type 2 diabetic patients, and its association with glycemic control, chronic complications, and some clinical and paraclinical parameters in this northern state of Iran. MATERIALS AND METHODS Beck depression inventory was used for evaluating depression on 90 type 2 diabetics and 90 healthy controls selected. Information on demographic and clinical and paraclinical characteristics was collected by interviews and from medical records. RESULTS This cross-sectional study was performed on 90 type 2 diabetic patients (63 female and 27 male with a mean age of 54.17 ± 10.57 years) and 90 healthy matched controls. Overall, depression was significantly more prevalent in case group [37.8% vs. 16%, odds ratio (OR) = 3.29, P = 0.001]. The prevalence of depression in diabetic women was significantly higher than nondiabetic ones (39.7% vs. 15%, P = 0.002). We could not find any significant correlation between depression and positive family history of depression, duration of diabetes, HBA1c level, and body mass index. The prevalence of depression was prominently more in diabetic patients with retinopathy than in those without this complication (55.6% vs. 24%, P = 0.015). Logistic regression analysis indicated that diabetes itself was the only significant determinant of having depression (OR = 3.29, P = 0.005, 95% confidence interval: 0.118-0.667). CONCLUSION There was a prominent prevalence of depression in type 2 diabetics overall. Depression was not correlated with duration of diabetes and glycemic control. There was a significant association between depression and retinopathy in diabetic patients. Diabetes itself was the only significant determinant of having depression after matching with other variables.
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Affiliation(s)
- Saeed Kalantari
- Department of Endocrinology, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafarinezhad
- Department of Internal Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Behzad Zohrevand
- Department of Emergency Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Birt L, Emery JD, Prevost AT, Sutton S, Walter FM. Psychological impact of family history risk assessment in primary care: a mixed methods study. Fam Pract 2014; 31:409-18. [PMID: 24728773 PMCID: PMC5926455 DOI: 10.1093/fampra/cmu012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Routine family history risk assessment for chronic diseases could enable primary care practitioners to efficiently identify at-risk patients and promote preventive management strategies. OBJECTIVES To investigate patients' understanding and responses to family history risk assessment in primary care. METHOD A mixed methods study set in 10 Eastern England general practices. Participants in a family history questionnaire validation study were triaged into population or increased risk for four chronic diseases (type 2 diabetes, cardiovascular disease, breast cancer, colorectal cancer). Questionnaires completed immediately prior to the family history consultation (baseline) and 4 weeks later (follow-up) assessed the psychological impact, including State-Trait Anxiety Inventory scores. Semi-structured interviews explored the meaning participants gave to their personal familial disease risk. RESULTS Four hundred and fifty-three participants completed both baseline and follow-up questionnaires and 30 were interviewed. At follow-up, there was no increase in anxiety among either group, or differences between the groups [difference in mean change 0.02, 95% confidence interval -2.04, 2.08, P = 0.98]. There were no significant changes over time in self-rated health in either group. At follow-up, participants at increased risk (n = 153) were more likely to have recent changes to behaviour and they had stronger intentions to make changes to diet (P = 0.001), physical activity (P = 0.006) and to seek further information in the future than those at population risk (n = 300; P < 0.001). Using qualitative analysis, five themes were developed representing ways in which participants gave meaning to familial disease risk ('Being reassured', 'Controlling risk', 'Dealing with it later', 'Beyond my control', 'Disbelieving the risk'). The meanings they attributed to increased risk appeared to shape their intention to undertake behaviour change. CONCLUSION Routine assessment for familial risk of chronic diseases may be undertaken in primary care without causing anxiety or reducing self-rated health. Patient responses to family history risk assessment may inform promotion of preventive management strategies.
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Affiliation(s)
- Linda Birt
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK,
| | - Jon D Emery
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK, General Practice and Primary Care Academic Centre, University of Melbourne, Parkville VIC 3010, Australia, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley WA 6009, Australia
| | - A Toby Prevost
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK, King's College London, Department of Primary Care and Public Health Sciences, Capital House, London, UK and
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK, General Practice and Primary Care Academic Centre, University of Melbourne, Parkville VIC 3010, Australia, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley WA 6009, Australia
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Godefrooij M, Spigt M, van der Minne W, Jurrissen G, Dinant GJ, Knottnerus A. Implementing cardiometabolic health checks in general practice: a qualitative process evaluation. BMC FAMILY PRACTICE 2014; 15:132. [PMID: 24998671 PMCID: PMC4097043 DOI: 10.1186/1471-2296-15-132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 05/27/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND A stepwise screening approach for the detection and management of cardiometabolic disease is proposed in various primary care guidelines. The aim of this study was to explore the implementation of a cardiometabolic health check as perceived by the involved caregivers and patients. METHODS Qualitative process evaluation of the implementation of a cardiometabolic screening programme in a multidisciplinary primary healthcare centre in Eindhoven, the Netherlands, in which 1270 patients had participated. We explored the caregivers' experiences though focus group discussions and collected patients' experiences through a written questionnaire containing two open-ended questions. We analyzed our data using a thematic content analysis based on grounded theory principles. RESULTS Five general practitioners, three practice nurses and five medical receptionists participated in the focus groups. Additionally we collected experiences of 657 (52% of 1270) participating patients through an open-ended questionnaire.GPs were enthusiastic about offering a health check and preferred systematic screening over case-finding, both in terms of yield and workload. The level of patient participation was high and most participants were enthusiastic about the health check being offered by their GP. Despite their enthusiasm, the GPs realized that they lacked experience in the design and implementation of a structured, large-scale prevention programme. This resulted in suboptimal instruction of the involved practice nurses and medical receptionists. The recruitment strategy was unnecessarily aggressive. There were shortcomings in communicating the outcomes of the health check to the patients and there was no predefined follow-up programme. Based on our findings we developed a checklist that can be used by designers of similar health checks. CONCLUSIONS A number of fundamental issues may arise when GPs organize a systematic screening programme in their practice. These issues are related to the preparation of the involved staff, the importance of integration with everyday clinical practice, the approach of healthy patients and the provision of adequate follow-up programmes. The identified challenges and recommendations can be taken into account during future screening programmes.
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Affiliation(s)
- Merijn Godefrooij
- CAPHRI: School for Public Health and Primary Care, Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, Maastricht 6200MD, The Netherlands
| | - Mark Spigt
- CAPHRI: School for Public Health and Primary Care, Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, Maastricht 6200MD, The Netherlands
| | - Wim van der Minne
- Woensel Primary Healthcare Centre, Eindhoven Corporation of Primary Healthcare Centres, PO Box 8736, Eindhoven 5605LS, The Netherlands
| | - Georgette Jurrissen
- Woensel Primary Healthcare Centre, Eindhoven Corporation of Primary Healthcare Centres, PO Box 8736, Eindhoven 5605LS, The Netherlands
| | - Geert-Jan Dinant
- CAPHRI: School for Public Health and Primary Care, Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, Maastricht 6200MD, The Netherlands
| | - André Knottnerus
- CAPHRI: School for Public Health and Primary Care, Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, Maastricht 6200MD, The Netherlands
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Gaum PM, Esser A, Schettgen T, Gube M, Kraus T, Lang J. Prevalence and incidence rates of mental syndromes after occupational exposure to polychlorinated biphenyls. Int J Hyg Environ Health 2014; 217:765-74. [PMID: 24951400 DOI: 10.1016/j.ijheh.2014.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/01/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022]
Abstract
Mental disorders were often reported following hazardous substance exposure. The present study analyses this association in relation to a work-related exposure to PCBs (polychlorinated biphenyls). Specifically, the aim was to investigate (a) the relationship of inner PCB burden and the severity of mental symptoms and (b) the prevalence and incidence of mental syndromes. This study was initiated as part of the occupational medical surveillance program HELPcB (Health Effects in high level exposure to PCB). A total of 136 individuals were included in the analysis. The plasma PCBs were collected via biomonitoring and the psychological syndromes (i.e., somatoform, depressive, anxiety, panic) with a standardized screening instrument. The relationship of PCB and the severity of mental syndromes were analyzed via linear regression. Prevalence rates, the respective odds ratios (OR) and the incidence rates were calculated with logistic regressions. We thereby compared the higher-PCB burdened individuals with those individuals showing PCB levels comparable to the general population. We found especially a significant relationship between PCB burden and depressivity. Within the higher-PCB-exposed group prevalence rates were descriptively higher than for normal-exposed participants, except for anxiety syndrome. Similarly, the higher exposed group had a higher risk for developing a depressive syndrome. The incidence rates were always descriptively higher in higher-exposed group. To summarize, this study supports a relationship between PCB exposure and mental illness.
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Affiliation(s)
- Petra M Gaum
- Institute for Occupational Medicine, RWTH Aachen University, Germany.
| | - André Esser
- Institute for Occupational Medicine, RWTH Aachen University, Germany
| | - Thomas Schettgen
- Institute for Occupational Medicine, RWTH Aachen University, Germany
| | - Monika Gube
- Institute for Occupational Medicine, RWTH Aachen University, Germany
| | - Thomas Kraus
- Institute for Occupational Medicine, RWTH Aachen University, Germany
| | - Jessica Lang
- Institute for Occupational Medicine, RWTH Aachen University, Germany
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Graffigna G, Leone D, Vegni E. "Am I carrier?" The patient's lived experience of thrombophilia genetic screening and its outcome. Health Psychol Behav Med 2014; 2:696-712. [PMID: 25750812 PMCID: PMC4345974 DOI: 10.1080/21642850.2014.918512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 04/23/2014] [Indexed: 11/17/2022] Open
Abstract
How do patients with thrombophilia experience a physician's request to undergo a genetic test? How do they experience the test outcome? To answer these questions, we conducted an interpretative phenomenological analysis study, based on 10 in-depth interviews with patients who underwent genetic testing for thrombophilia in Italy, half with positive and half with negative results. The experience of undergoing genetic screening for thrombophilia plays an important role in reconfiguring patients' signification of their illness experience. A positive outcome becomes a cue to reorganize in a more adaptive way the illness meaning at the cognitive and emotive levels, whereas a negative outcome appears more distressing and confusing. As a clinical implication of the study, clinicians should consider communicating carefully with the patients regardless from the positive/negative test results and they should explore the patient's specific reaction and understanding of test result.
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Affiliation(s)
| | - Daniela Leone
- Department of Health Science, Università degli Studi di Milano , Milan , Italy
| | - Elena Vegni
- Department of Health Science, Università degli Studi di Milano , Milan , Italy
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Shkedi-Rafid S, Ofer-Bialer G, Meiner V, Calderon-Margalit R. Clinicians' Attitudes toward General Screening of the Ashkenazi-Jewish Population for Prevalent Founder BRCA1/2 and LRRK2 Mutations. Public Health Genomics 2013; 16:174-83. [DOI: 10.1159/000351592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 04/22/2013] [Indexed: 11/19/2022] Open
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Armon G, Toker S. The Role of Personality in Predicting Repeat Participation in Periodic Health Screening. J Pers 2013; 81:452-64. [DOI: 10.1111/jopy.12021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The impact and desirability of news of risk for schizophrenia. PLoS One 2013; 8:e62904. [PMID: 23638164 PMCID: PMC3639267 DOI: 10.1371/journal.pone.0062904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/26/2013] [Indexed: 11/19/2022] Open
Abstract
In studies of schizotypy, investigators seldom inform participants that they are engaged in research designed to shed light on risk for schizophrenia. Such nondisclosure is justified in part by the argument that disclosure of risk status may be harmful. However, there is little evidence that this is the case. Harm arising from disclosure of risk status was examined in two experiments. In the first, participants (n = 114 psychology undergraduates) were asked to anticipate their reactions to news of risk for schizophrenia, depression, cancer, and diabetes, and also to indicate whether they would want to know their schizophrenia risk status. Participants anticipated schizophrenia risk would have a negative impact that was significantly greater than depression or diabetes risk but similar to cancer risk. The anticipated impact of schizophrenia risk was predicted by expectations of stigmatization as well as confidence in the accuracy of biological screening. Although 81% indicated a preference for knowing their risk status, just 11% were prepared to undergo an assessment to find out. In the second, a between-subjects deception paradigm was used to inform participants (n = 144 psychology undergraduates) they had an enzyme deficiency that placed them at increased risk for schizophrenia, cancer, or depression. Impact was assessed using prospective self-report and salivary cortisol and retrospective self-report. Impact was modeled using measures of stigmatization and health locus of control. Retrospectively, schizophrenia, cancer, and depression risk had strong negative impacts relative to a control group, but there was no effect on prospective measures. Together, the findings suggest that news of risk for schizophrenia has the potential to engender distress, although participants’ anticipations and reflections of responses are not corroborated in prospectively measured outcomes.
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Abstract
Dealing effectively with risks in complex projects is difficult and requires management interventions that go beyond simple analytical approaches. This is one finding of a major field study into risk management practices and business processes of 35 major product developments in 17 high-technology companies. Almost one-half of the contingencies that occur are not being detected before they impact project performance. Yet, the risk-impact model presented in this article shows that risk does not affect all projects equally but depends on the effectiveness of collective managerial actions dealing with specific contingencies. The results of this study discuss why some organizations are more successful in detecting risks early in the project life cycle, and in decoupling risk factors from work processes before they impact project performance. The field data suggest that effective project risk management involves an intricately linked set of variables, related to work process, organizational environment, and people. Some of the best success scenarios point to the critical importance of recognizing and dealing with risks early in their development. This requires broad involvement and collaboration across all segments of the project team and its environment, and sophisticated methods for assessing feasibilities and usability early and frequently during the project life cycle. Specific managerial actions, organizational conditions, and work processes are suggested for fostering a project environment most conducive to effective cross-functional communication and collaboration among all stakeholders, a condition important to early risk detection and effective risk management in complex project situations.
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Esplen MJ, Cappelli M, Wong J, Bottorff JL, Hunter J, Carroll J, Dorval M, Wilson B, Allanson J, Semotiuk K, Aronson M, Bordeleau L, Charlemagne N, Meschino W. Development and validation of a brief screening instrument for psychosocial risk associated with genetic testing: a pan-Canadian cohort study. BMJ Open 2013; 3:bmjopen-2012-002227. [PMID: 23485718 PMCID: PMC3612753 DOI: 10.1136/bmjopen-2012-002227] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To develop a brief, reliable and valid instrument to screen psychosocial risk among those who are undergoing genetic testing for Adult-Onset Hereditary Disease (AOHD). DESIGN A prospective two-phase cohort study. SETTING 5 genetic testing centres for AOHD, such as cancer, Huntington's disease or haemochromatosis, in ambulatory clinics of tertiary hospitals across Canada. PARTICIPANTS 141 individuals undergoing genetic testing were approached and consented to the instrument development phase of the study (Phase I). The Genetic Psychosocial Risk Instrument (GPRI) developed in Phase I was tested in Phase II for item refinement and validation. A separate cohort of 722 individuals consented to the study, 712 completed the baseline package and 463 completed all follow-up assessments. Most participants were female, at the mid-life stage. Individuals in advanced stages of the illness or with cognitive impairment or a language barrier were excluded. INTERVENTIONS Phase I: GPRI items were generated from (1) a review of the literature, (2) input from genetic counsellors and (3) phase I participants. Phase II: further item refinement and validation were conducted with a second cohort of participants who completed the GPRI at baseline and were followed for psychological distress 1-month postgenetic testing results. PRIMARY AND SECONDARY OUTCOME MEASURES GPRI, Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Brief Symptom Inventory (BSI) and Impact of Event Scale (IES). RESULTS The final 20-item GPRI had a high reliability-Cronbach's α at 0.81. The construct validity was supported by high correlations between GPRI and BSI and IES. The predictive value was demonstrated by a receiver operating characteristic curve of 0.78 plotting GPRI against follow-up assessments using HAM-D and HAM-A. CONCLUSIONS With a cut-off score of 50, GPRI identified 84% of participants who displayed distress postgenetic testing results, supporting its potential usefulness in a clinical setting.
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Affiliation(s)
- Mary Jane Esplen
- University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- de Souza Institute, Toronto, Ontario, Canada
| | - Mario Cappelli
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jiahui Wong
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- de Souza Institute, Toronto, Ontario, Canada
| | - Joan L Bottorff
- University of British Columbia's Okanagan Campus, Kelowna, British Colombia, Canada
| | - Jon Hunter
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Family & Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - June Carroll
- Department of Family & Community Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michel Dorval
- Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | | | - Judith Allanson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kara Semotiuk
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Louise Bordeleau
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Vegni E, Leone D, Graffigna G, Faioni EM, Moja EA. To be or not to be: the patient's view of thrombophilia testing. PATIENT EDUCATION AND COUNSELING 2013; 90:386-391. [PMID: 22177659 DOI: 10.1016/j.pec.2011.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 06/13/2011] [Accepted: 11/09/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The literature on the psychological effects of thrombophilia testing is unclear. Little is known about the complex world of significance subjects construct around the test. OBJECTIVE The study explored the peculiar network of implicit meanings that may be linked to the experience of being tested. MATERIALS AND METHODS The research was designed according to Interpretative Phenomenological Analysis (IPA). 19 patients were interviewed. Integral verbatim reports of the interviews were analyzed through an inductive process aimed at gaining a holistic understanding of the narratives. RESULTS Two main issues were identified, each with sub-issues: (1) the clinical problem: (1.1) unhealthy blood and (1.2) the family issue; (2) the test: (2.1) knowing for the sake of knowing; (2.2) knowing for the sake of doing; (2.3) not knowing. CONCLUSIONS The thrombophilia test is part of a larger network of meanings, where information about the test and its results seem to be lost. PRACTICE IMPLICATION The study suggests the importance of paying greater attention to the process of doctor-patient communication at the time of the test. The theme of being informed is important for patients, yet often they are not able to understand or retain the information they receive, increasing the risk of misunderstandings.
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Palmer CGS, Boudreault P, Baldwin EE, Fox M, Deignan JL, Kobayashi Y, Sininger Y, Grody W, Sinsheimer JS. Deaf genetic testing and psychological well-being in deaf adults. J Genet Couns 2013; 22:492-507. [PMID: 23430402 DOI: 10.1007/s10897-013-9573-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Abstract
Limited data suggest that enhanced self-knowledge from genetic information related to non-medical traits can have a positive impact on psychological well-being. Deaf individuals undertake genetic testing for deaf genes to increase self-knowledge. Because deafness is considered a non-medical trait by many individuals, we hypothesized that deaf individuals receiving a genetic explanation for why they are deaf will experience increased psychological well-being. We report results from a prospective, longitudinal study to determine the impact of genetic testing (GJB2, Cx26; GJB6, Cx30) on perceived personal control (PPC), anxiety, and depression in deaf adults (N = 209) assessed following pre-test genetic counseling as well as 1-month and 6-months following test result disclosure. Participants were classified as Cx positive (n = 82) or Cx negative/inconclusive (n = 127). There was significant evidence for Cx group differences in PPC and anxiety over time (PPC: Cx group*time interaction p = 0.0007; anxiety: Cx group*time interaction p = 0.002), where PPC scores were significantly higher, and anxiety scores were significantly lower for the Cx positive group relative to the negative/inconclusive group following test result disclosure. Compared to pre-test, PPC scores increased at 1-month (p = 0.07) and anxiety scores decreased at 6-months (p = 0.03) for the Cx positive group. In contrast, PPC scores decreased (p = 0.009, p < 0.0001) and anxiety scores increased (p = 0.09, p = 0.02) for the Cx negative/inconclusive group at 1- and 6-months post test result disclosure. Genetic testing for deaf genes affects the psychological well-being of deaf individuals. Increasing deaf adults' access to genetic testing may potentially enhance self-knowledge and increase psychological well-being for those who receive a genetic explanation, which could offer downstream health benefits.
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Affiliation(s)
- Christina G S Palmer
- Department of Psychiatry & Biobehavioral Sciences, University of California-Los Angeles, CA, USA.
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Abstract
Genetic susceptibility testing for common complex disease is a practice that is currently in clinical use. There are two types of gene mutations, and therefore, two varieties of genotype testing: deterministic and susceptibility. As the term suggests, deterministic genes determine whether or not a person will develop a given trait in mendelian fashion, such as Huntington's disease. Genotype screening for such deterministic mutations has existed for decades, and is commonly used in routine medical practice. In recent years, the sequencing of the human genome has identified several 'susceptibility genes' or genes with incomplete penetrance. Mutations in these genes may increase disease susceptibility, but are not causative for disease. Genetic susceptibility testing allows unaffected individuals to obtain risk information for a variety of common complex diseases and health conditions including Alzheimer's disease (AD), CVD, cancer and diabetes. The availability of genetic susceptibility testing has increased over the past decade, and several studies are now focusing on the impact that genetic testing has on health and other lifestyle behaviours related to nutrition. The aim of this paper is to review the literature and evaluate what, if any, impact genetic risk assessment has on behaviours related to nutrition and physical activity. This paper summarises seven clinical studies that evaluated the impact of disclosing genetic risk information for disease on nutrition-related health behaviour changes. Of these seven studies, only three studies reported that health behaviour change was influenced by genotype disclosure.
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Krogsbøll LT, Jørgensen KJ, Grønhøj Larsen C, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 2012; 10:CD009009. [PMID: 23076952 DOI: 10.1002/14651858.cd009009.pub2] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND General health checks are common elements of health care in some countries. These aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used screening tests offered in general health checks have been incompletely studied. Also, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is, therefore, important to assess whether general health checks do more good than harm. OBJECTIVES We aimed to quantify the benefits and harms of general health checks with an emphasis on patient-relevant outcomes such as morbidity and mortality rather than on surrogate outcomes such as blood pressure and serum cholesterol levels. SEARCH METHODS We searched The Cochrane Library, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE, EMBASE, Healthstar, CINAHL, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) to July 2012. Two authors screened titles and abstracts, assessed papers for eligibility and read reference lists. One author used citation tracking (Web of Knowledge) and asked trialists about additional studies. SELECTION CRITERIA We included randomised trials comparing health checks with no health checks in adults unselected for disease or risk factors. We did not include geriatric trials. We defined health checks as screening general populations for more than one disease or risk factor in more than one organ system. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias in the trials. We contacted authors for additional outcomes or trial details when necessary. For mortality outcomes we analysed the results with random-effects model meta-analysis, and for other outcomes we did a qualitative synthesis as meta-analysis was not feasible. MAIN RESULTS We included 16 trials, 14 of which had available outcome data (182,880 participants). Nine trials provided data on total mortality (155,899 participants, 11,940 deaths), median follow-up time nine years, giving a risk ratio of 0.99 (95% confidence interval (CI) 0.95 to 1.03). Eight trials provided data on cardiovascular mortality (152,435 participants, 4567 deaths), risk ratio 1.03 (95% CI 0.91 to 1.17) and eight trials on cancer mortality (139,290 participants, 3663 deaths), risk ratio 1.01 (95% CI 0.92 to 1.12). Subgroup and sensitivity analyses did not alter these findings.We did not find an effect on clinical events or other measures of morbidity but one trial found an increased occurrence of hypertension and hypercholesterolaemia with screening and one trial found an increased occurence of self-reported chronic disease. One trial found a 20% increase in the total number of new diagnoses per participant over six years compared to the control group. No trials compared the total number of prescriptions, but two out of four trials found an increased number of people using antihypertensive drugs. Two out of four trials found small beneficial effects on self-reported health, but this could be due to reporting bias as the trials were not blinded. We did not find an effect on admission to hospital, disability, worry, additional visits to the physician, or absence from work, but most of these outcomes were poorly studied. We did not find useful results on the number of referrals to specialists, the number of follow-up tests after positive screening results, or the amount of surgery. AUTHORS' CONCLUSIONS General health checks did not reduce morbidity or mortality, neither overall nor for cardiovascular or cancer causes, although the number of new diagnoses was increased. Important harmful outcomes, such as the number of follow-up diagnostic procedures or short term psychological effects, were often not studied or reported and many trials had methodological problems. With the large number of participants and deaths included, the long follow-up periods used, and considering that cardiovascular and cancer mortality were not reduced, general health checks are unlikely to be beneficial.
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Landstra JMB, Ciarrochi J, Deane FP, Botes LP, Hillman RJ. The psychological impact of anal cancer screening on HIV-infected men. Psychooncology 2012; 22:614-20. [PMID: 22290831 DOI: 10.1002/pon.3040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 01/09/2012] [Accepted: 01/11/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anal cancer rates are increasing in HIV-infected men. Screening programmes similar to prostate and cervical cancer have been recommended to reduce morbidity and mortality. Research shows that screening processes have psychological consequences that need to be considered. Limited investigation of the psychological impact of anal cancer screening has been conducted. METHODS A prospective longitudinal survey of 291 men was conducted at three time points over 14 weeks at a public HIV clinic in Sydney, Australia. Self-report questionnaires measuring worry, distress, depression, anxiety, stress and health-related quality of life (SF-12) were collected. RESULTS Those who had a biopsy recommended were significantly more worried about anal cancer, rated their anal health worse and were less optimistic about their future health than the control group who needed no further medical investigation. The group receiving high grade histology results remained worried about anal cancer at time 3. We found no evidence that general anxiety, depression or quality of life was significantly affected by the process. CONCLUSIONS Anal cancer specific worry increases throughout the screening process. Clear communication prior to procedures about the procedure itself, potential adverse events, the recovery process and non-technical explanations of results should be implemented in anal screening programmes.
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Affiliation(s)
- Jodie M B Landstra
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia.
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Brown K, Dormandy E, Reid E, Gulliford M, Marteau T. Impact on informed choice of offering antenatal sickle cell and thalassaemia screening in primary care: a randomized trial. J Med Screen 2012; 18:65-75. [PMID: 21852698 PMCID: PMC3157892 DOI: 10.1258/jms.2011.010132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Offering antenatal sickle cell and thalassaemia (SCT) screening early in pregnancy can maximize the range of post-screening choices available, however these benefits should not be obtained at the expense of informed choice. This study examined whether offering this screening in primary care at the time of pregnancy confirmation compromises women making informed choices. Design Partial factorial, cluster randomized controlled trial. Setting 25 general practices in two socially deprived UK areas. Participants 464 pregnant women offered antenatal SCT screening. Intervention Practices were randomly allocated to offer pregnant women screening: i) in primary care at time of pregnancy confirmation, with parallel partner testing (n = 191), ii) in primary care at time of pregnancy confirmation, with sequential partner testing (n = 158), or iii) in secondary care by midwives, with sequential partner testing (standard care, n = 115). Main outcome Informed choice – a classification based on attitudes, knowledge and test uptake. Results 91% of woman underwent screening. About a third (30.6%) made an informed choice to accept or decline screening: 34% in primary care parallel group; 23.4% in primary care sequential and 34.8% in secondary care sequential. Allowing for adjustments, rates of informed choice did not vary by intervention group: secondary care versus primary care with parallel partner testing OR 1.07 (95% CI 0.56 to 2.02); secondary care versus primary care with sequential partner testing OR 0.67 (95% CI 0.36 to 1.25). Uninformed choices were generally attributable to poor knowledge (65%). Conclusion Offering antenatal SCT screening in primary care did not reduce the likelihood that women made informed choices. Rates of informed choice were low and could be increased by improving knowledge.
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Affiliation(s)
- Katrina Brown
- Department of Psychology, King's College London, Health Psychology Section, 5th Floor Bermondsey Wing, Guy's Campus, London SE1 9RT
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Landstra JMB, Ciarrochi J, Deane FP. Psychosocial aspects of anal cancer screening: a review and recommendations. Sex Health 2012; 9:620-7. [DOI: 10.1071/sh11169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 05/29/2012] [Indexed: 12/21/2022]
Abstract
Cancer screening programs have the potential to decrease psychosocial wellbeing. This review investigates the evidence that anal cancer screening has an impact on psychosocial functioning and outlines considerations for supporting participants. The review suggested that screening has no significant effect on general mental health but may increase cancer-specific worry. Having worse anal or HIV symptoms, being younger, higher baseline distress or worse histology results were predictive of greater worry. The findings suggest the need to increase education campaigns, particularly targeting those with HIV infection and men who have sex with men. There is a need to develop a consensus on measuring the psychosocial impact of screening and stepped care approaches for responding to any resulting distress.
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Fisher BG, Ang YLE, Goodhart C, Simmons RK. Record-based, stepwise screening for type 2 diabetes integrated into an annual cardiovascular care review system: Findings from a UK general practice. Prim Care Diabetes 2011; 5:265-269. [PMID: 21968319 DOI: 10.1016/j.pcd.2011.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 08/08/2011] [Accepted: 09/01/2011] [Indexed: 11/28/2022]
Abstract
AIMS Screening high-risk individuals for type 2 diabetes (T2DM) is recommended by many organisations. We report results from a pragmatic stepwise T2DM screening programme integrated into an annual review system in a UK general practice. METHODS Patients with hypertension, cardiovascular disease or chronic kidney disease attending an annual review were screened for dysglycaemia by random blood glucose (RBG) measurement. At the discretion of the usual doctor, individuals with an RBG≥6.1 mmol/l were invited to return for fasting blood glucose (FBG) or HbA(1C) measurement, allowing diagnosis of T2DM. RESULTS 786 eligible patients were invited for T2DM screening as part of their annual review. 544 attended screening, of whom 120 had an RBG≥6.1 mmol/l. 40 individuals attended FBG measurement and 8 individuals attended HbA(1C) measurement, leading to 9 T2DM diagnoses. The positive predictive value of the test for T2DM was 19% and the laboratory cost was £91 per patient diagnosed with T2DM. CONCLUSIONS It is feasible to integrate a simple T2DM screening programme within an annual review system in a UK general practice. Different strategies may be required to increase initial attendance and ensure completion of the screening programme.
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Weston JM, Norris EV, Clark EM. The invisible disease: making sense of an osteoporosis diagnosis in older age. QUALITATIVE HEALTH RESEARCH 2011; 21:1692-1704. [PMID: 21810994 PMCID: PMC3240909 DOI: 10.1177/1049732311416825] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Osteoporosis (low bone density) is a potentially serious disease which mainly affects women older than 50 years. National screening programs for osteoporosis are being developed in the United Kingdom. It is important to assess the psychological experience of receiving a positive diagnosis from a population-based screening program so that psychological distress does not outweigh medical benefits. Little research has been conducted in this field. In our study, we explored the experience of being diagnosed with osteoporosis following screening. We interviewed 10 women aged 68 to 79 who were recruited from a population-based osteoporosis screening trial. Four themes emerged from our interpretative phenomenological analysis of the interviews: osteoporosis is a routine medical condition, lack of physical evidence creates doubt, the mediating role of medical care, and protecting the self from distress. Our findings emphasize the complexity attached to receiving a positive screening result. We suggest considerations for health care providers.
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van den Donk M, Sandbaek A, Borch-Johnsen K, Lauritzen T, Simmons RK, Wareham NJ, Griffin SJ, Davies MJ, Khunti K, Rutten GEHM. Screening for type 2 diabetes. Lessons from the ADDITION-Europe study. Diabet Med 2011; 28:1416-24. [PMID: 21679235 DOI: 10.1111/j.1464-5491.2011.03365.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIMS To describe and compare attendance rates and the proportions of people identified with Type 2 diabetes mellitus in people with previously unknown diabetes who participated in screening programmes undertaken in general practice in the UK, Denmark and the Netherlands as part of the ADDITION-Europe study. METHODS In Cambridge, routine computer data searches were conducted to identify individuals aged 40-69 years at high risk of Type 2 diabetes using the Cambridge Diabetes Risk Score. In Denmark, the Danish Diabetes Risk Score was mailed to individuals aged 40-69 years, or completed by patients visiting their general practitice. In the Netherlands, the Hoorn Symptom Risk Questionnaire was mailed to individuals aged 50-69 years. In these three centres, high-risk individuals were invited to attend subsequent steps in the screening programme, including random blood glucose, HbA(1c) , fasting blood glucose and/or oral glucose tolerance test. In Leicester, eligible people aged 40-69 years were invited directly for an oral glucose tolerance test. In all centres, Type 2 diabetes was defined according to World Health Organization 1999 diagnostic criteria. RESULTS Attendance rates ranged from 20.2% (oral glucose tolerance test in Leicester without pre-stratification) to 95.1% (random blood glucose in opportunistic screening in Denmark in high-risk people). The percentage of people with newly detected Type 2 diabetes from the target population ranged from 0.33% (Leicester) to 1.09% (the Netherlands). CONCLUSIONS Screening for Type 2 diabetes was acceptable and feasible, but relatively few participants were diagnosed in all participating centres. Different strategies may be required to increase initial attendance and ensure completion of screening programmes.
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Affiliation(s)
- M van den Donk
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Tutton R, Prainsack B. Enterprising or altruistic selves? Making up research subjects in genetics research. SOCIOLOGY OF HEALTH & ILLNESS 2011; 33:1081-95. [PMID: 21507012 DOI: 10.1111/j.1467-9566.2011.01348.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The emergence of direct-to-consumer (DTC) personal genomics companies in 2007 was accompanied by considerable media attention and criticism from clinical geneticists and other health professionals, regulators, policy advisors, and ethicists. As well as offering genetic testing services, some firms are also engaged in building their own databases and conducting research with the data obtained from their customers. In this paper, we examine how one of these companies, 23andMe, is creating a certain kind of 'research subject' in opposition to that constituted in conventional forms of disease research. Drawing on debates about neoliberalism, contemporary health discourses and subjectivity, we consider two kinds of subjectivities produced through the discursive and material practices of 23andMe and UK Biobank, namely, 'enterprising' and 'altruistic' selves. We argue that the 23andMe model promotes the idea that curiosity about one's genome on the one hand, and participation in research on the other, are not only compatible but complementary aspects of being an entrepreneurial subject of contemporary health and medicine framed by the technologies of web 2.0.
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Affiliation(s)
- Richard Tutton
- ESRC Centre for Economic and Social Aspects of Genomics (Cesagen), Department of Sociology, Lancaster University.
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