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Zhu Y, Li J, Pan Y, Huang W, Xi H, Duan R. Attitudes of medical professionals toward fragile X carrier screening and genetic counseling in China. J Community Genet 2024; 15:177-185. [PMID: 38277068 PMCID: PMC11031535 DOI: 10.1007/s12687-024-00696-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
Fragile X syndrome is the most common inherited cause of intellectual disability. Considering China's low prevalence, distinct healthcare system, middle-income economic status, and unique culture, China cannot simply replicate the screening systems in European and American countries. In this study, we investigated the attitudes of 450 Chinese medical professionals who received fragile X training on fragile X carrier screening and genetic counseling. Before the training, 57.6% of the respondents were unfamiliar with FXS. After the training, 7.3% of participants are unable to fully master the knowledge. Furthermore, 71.8% believe that the absence of phenotypes during the reproductive age and the availability of simple and feasible testing methods are prerequisites for screening. The presence of the phenotype would still require screening. Regarding the target population, over 90% of the participants support fragile X carrier screening in high-risk pregnant women. As for influencing factors, they consider cost as the most influential factor in pregnant women's decision to undergo screening. The acceptable price range for screening is determined to be ¥200-1000 ($30-150). In terms of the issues and challenges of screening, most medical professionals support the need for genetic counseling for intermediate alleles and 55-60 repeat premutation results. Additionally, some respondents believe that informing patients' family members of positive screening results is necessary. It is also recognized that positive results may lead to anxiety for patients. The findings of this study will provide valuable information for the establishment of fragile X carrier screening system, particularly for low-prevalence or middle-income countries.
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Affiliation(s)
- Yingbao Zhu
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Jia Li
- Xiangxi Autonomous Prefecture People's Hospital, The First Affiliated Hospital of Jishou University, Jishou, Hunan, China
| | - Yi Pan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Wen Huang
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Hui Xi
- Department of Medical Genetics & the Prenatal Diagnosis Center of Hunan Province, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Ranhui Duan
- Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, China.
- Hunan Key Laboratory of Medical Genetics, Central South University, Changsha, China.
- Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, China.
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The impact of needs-based education on the change of knowledge and attitudes towards medical genetics in medical students. Eur J Hum Genet 2021; 29:726-735. [PMID: 33398082 PMCID: PMC8110770 DOI: 10.1038/s41431-020-00791-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 01/29/2023] Open
Abstract
In this research we aimed to (1) develop and validate a new questionnaire examining attitudes and knowledge towards medical genetics, (2) examine the knowledge and attitudes towards medical genetics in students of the Medical Faculty in Rijeka, Croatia and (3) evaluate the impact of education from the mandatory course Medical Genetics on the change of knowledge and attitudes. The study was conducted on 191 fifth- and sixth-year students of the Integrated Undergraduate and Graduate University Study of Medicine in the academic year 2019/2020. Students completed the validated online questionnaire anonymously and voluntarily. Fifth-year students completed the questionnaire twice (beginning/end of the course), while sixth-year students completed the questionnaire once, 3 months after completing the course. The education was carefully designed for medical students according to the CoreCompetences in Genetics for Health Professionals in Europe issued by the European Society of Human Genetics. Using the Kruskal-Wallis test, a statistically significant difference was found between fifth year before and after education and between the fifth year before education and sixth year for (a) total knowledge (P < 0.001), (b) total attitudes (P < 0.001) and (c) personal assessment of knowledge in medical genetics (P < 0.001). Moreover, positive attitudes were associated with higher levels of knowledge. In conclusion, our results emphasise the importance of needs-based education in medical genetics for medical students, which is indispensable for the increase in the level of knowledge and development of positive attitudes in order to provide better health care for patients with genetic disorders.
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Gao F, Huang W, You Y, Huang J, Zhao J, Xue J, Kang H, Zhu Y, Hu Z, Allen EG, Jin P, Xia K, Duan R. Development of Chinese genetic reference panel for Fragile X Syndrome and its application to the screen of 10,000 Chinese pregnant women and women planning pregnancy. Mol Genet Genomic Med 2020; 8:e1236. [PMID: 32281281 PMCID: PMC7284044 DOI: 10.1002/mgg3.1236] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Fragile X syndrome (FXS) is the most common inherited form of intellectual disability caused by a CGG repeat expansion in the 5' untranslated region of the FMR1 gene. When the number of repeats exceeds 200, the gene becomes hypermethylated and is transcriptionally silenced, resulting in FXS. Other allelic forms of the gene that are studied because of their instability or phenotypic consequence include intermediate alleles (45-54 CGG repeats) and premutation alleles (55-200 repeats). Normal alleles are classified as having <45 CGG repeats. Population screening studies have been conducted among American and Australian populations; however, large population-based studies have not been completed in China. METHODS AND RESULTS In this work we present FXS screening results from 10,145 women of childbearing age from China. We first created and tested a standard panel that was comprised of normal, intermediate, premutation, and full mutation samples, and we performed the screening after confirming the consistency of genotyping results among laboratories. CONCLUSION Based on our findings, we have determined the intermediate and premutation carrier prevalence of 1/130 and 1/634, respectively, among Chinese women.
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Affiliation(s)
- Fei Gao
- Center for Medical GeneticsSchool of Life SciencesCentral South UniversityChangshaHunanChina
- National Institutes for Food and Drug ControlBeijingChina
| | - Wen Huang
- Center for Medical GeneticsSchool of Life SciencesCentral South UniversityChangshaHunanChina
| | - Yanjun You
- National Institutes for Food and Drug ControlBeijingChina
| | - Jie Huang
- National Institutes for Food and Drug ControlBeijingChina
| | - Juan Zhao
- Center for Medical GeneticsSchool of Life SciencesCentral South UniversityChangshaHunanChina
| | - Jin Xue
- Center for Medical GeneticsSchool of Life SciencesCentral South UniversityChangshaHunanChina
| | - Huaixing Kang
- Center for Medical GeneticsSchool of Life SciencesCentral South UniversityChangshaHunanChina
| | - Yingbao Zhu
- Center for Medical GeneticsSchool of Life SciencesCentral South UniversityChangshaHunanChina
| | - Zhengmao Hu
- Center for Medical GeneticsSchool of Life SciencesCentral South UniversityChangshaHunanChina
- Hunan Key Laboratory of Medical GeneticsCentral South UniversityChangshaHunanChina
| | - Emily G. Allen
- Department of Human GeneticsEmory University School of MedicineAtlantaGAUSA
| | - Peng Jin
- Department of Human GeneticsEmory University School of MedicineAtlantaGAUSA
| | - Kun Xia
- Center for Medical GeneticsSchool of Life SciencesCentral South UniversityChangshaHunanChina
- Hunan Key Laboratory of Medical GeneticsCentral South UniversityChangshaHunanChina
| | - Ranhui Duan
- Center for Medical GeneticsSchool of Life SciencesCentral South UniversityChangshaHunanChina
- Hunan Key Laboratory of Medical GeneticsCentral South UniversityChangshaHunanChina
- Hunan Key Laboratory of Animal Models for Human DiseasesCentral South UniversityChangshaHunanChina
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Budimirovic DB, Cvjetkovic S, Bukumiric Z, Duy PQ, Protic D. Fragile X-Associated Disorders in Serbia: Baseline Quantitative and Qualitative Survey of Knowledge, Attitudes and Practices Among Medical Professionals. Front Neurosci 2018; 12:652. [PMID: 30297982 PMCID: PMC6160902 DOI: 10.3389/fnins.2018.00652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 08/30/2018] [Indexed: 12/12/2022] Open
Abstract
We conducted a knowledge, attitude, and practice (KAP) survey of fragile X-associated disorders (FXD) in Serbia in order to obtain baseline quantitative and qualitative KAP data on fragile X mental retardation 1 gene (FMR1) pre- and full mutations (PM, FM). The survey's 16-item questionnaire included a knowledge component (12/16), such as self-assessment knowledge (SAK) and factual knowledge (FK, 2/5 questions for PM, FXTAS and FXPOI). Education-directed attitudes in the FXD field and FMR1 DNA testing practices had 4/16 items, including brief case vignettes of FXTAS and FXPOI, respectively. The study's cohort consisted of primary care physicians (referred to as “physicians” in the rest of the text) throughout Serbia (n = 284, aged 26–64 years, 176/284, 62.2% in Belgrade, Serbia) and senior medical students (n = 245, aged 23–30 years; 33.5% males) at the Belgrade School of Medicine. Strikingly, half of the survey respondents indicated “not having any” knowledge for the fragile X gene premutation and FXD. Physicians were more likely to indicate “not having any” knowledge than students (41.2% of physicians vs. 13.1% of students, P < 0.05). Roughly half of the students had “minimal knowledge” (53.5 vs. 30.5% of physicians, P < 0.05). Low FK was common in the cohort, as few physicians had “all correct answers” (7.5 vs. 3.7% of students, P < 0.05; 16.5 vs. 9.5% of students for the 2/5 premutation-related questions). Statistical analyses identified physicians' practice setting and length of clinical experience as predictors of the lack of FK on questions related to FXD. Physicians were more likely than students to indicate “strongly agreed” to expand their knowledge of the gene premutation and FXD (90.9 vs. 66.7% of students, P < 0.01). However, students more frequently indicated that they are willing to recommend DNA testing in their future practices than physicians (93.5 vs. 64.8% of physicians, P < 0.001). In conclusion, there is a major gap in knowledge regarding fragile X gene PM and FXD among the study's participants in Serbia. The study's informative-educational survey serves as an initial step in the process of enhancing the KAP of medical professionals with regards to the fragile X gene premutation and FXD.
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Affiliation(s)
- Dejan B Budimirovic
- Clinical Trials Unit, Fragile X Clinic, Department of Psychiatry, Clinical Research Center, Kennedy Krieger Institute, Johns Hopkins Medical Institutions Baltimore, MD, United States
| | | | | | - Phan Q Duy
- Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, United States
| | - Dragana Protic
- School of Medicine, Belgrade University, Belgrade, Serbia
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Niu M, Han Y, Dy ABC, Du J, Jin H, Qin J, Zhang J, Li Q, Hagerman RJ. Fragile X Syndrome: Prevalence, Treatment, and Prevention in China. Front Neurol 2017. [PMID: 28634468 PMCID: PMC5459883 DOI: 10.3389/fneur.2017.00254] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability and the leading monogenic cause of autism spectrum disorder. Although FXS has been studied for several decades, there is relatively little basic science or clinical research being performed on FXS in China. Indeed, there is a large gap between China and Western countries in the FXS field. China has a potentially large number of FXS patients. However, many of them are underdiagnosed or even misdiagnosed, and treatments are not always administered in the Chinese population. This review discusses the prevalence, treatment, and prevention of FXS in China to facilitate an understanding of this disease in the Chinese population.
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Affiliation(s)
- Manman Niu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Han
- Department of Pediatrics, Peking University First Hospital, Beijing, China.,MIND Institute, University of California-Davis Medical Center, Sacramento, CA, United States
| | - Angel Belle C Dy
- MIND Institute, University of California-Davis Medical Center, Sacramento, CA, United States.,Ateneo de Manila University - School of Medicine and Public Health, Quezon, Philippines
| | - Junbao Du
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Hongfang Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, China
| | - Jing Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Qinrui Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Randi J Hagerman
- MIND Institute, University of California-Davis Medical Center, Sacramento, CA, United States.,Department of Pediatrics, University of California-Davis Medical Center, Sacramento, CA, United States
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Chen X, Wang J, Xie H, Zhou W, Wu Y, Wang J, Qin J, Guo J, Gu Q, Zhang X, Ji T, Zhang Y, Xiong Z, Wang L, Wu X, Latham GJ, Jiang Y. Fragile X syndrome screening in Chinese children with unknown intellectual developmental disorder. BMC Pediatr 2015; 15:77. [PMID: 26174701 PMCID: PMC4502947 DOI: 10.1186/s12887-015-0394-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 06/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background Fragile X syndrome is the most common genetic disorder of intellectual developmental disorder/mental retardation (IDD/MR). The prevalence of FXS in a Chinese IDD children seeking diagnosis/treatment in mainland China is unknown. Methods Patients with unknown moderate to severe IDD were recruited from two children’s hospitals. Informed consent was obtained from the children's parents. The size of the CGG repeat was identified using a commercial TP-PCR assay. The influence of AGG interruptions on the CGG expansion during maternal transmission was analyzed in 24 mother-son pairs (10 pairs with 1 AGG and 14 pairs with 2 AGGs). Results 553 unrelated patients between six months and eighteen years of age were recruited. Specimens from 540 patients (male:female = 5.2:1) produced high-quality TP-PCR data, resulting in the determination of the FMR1 CGG repeat number for each. The most common repeat numbers were 29 and 30, and the most frequent interruption pattern was 2 or 3 AGGs. Five full mutations were identified (1 familial and 4 sporadic IDD patients), and size mosaicism was apparent in 4 of these FXS patients (4/5 = 80 %). The overall yield of FXS in the IDD cohort was 0.93 % (5/540). Neither the mean size of CGG expansion (0.20 vs. 0.79, p > 0.05) nor the frequency of CGG expansion (2/10 vs. 9/14, p > 0.05) was significantly different between the 1 and 2 AGG groups following maternal transmission. Conclusions The FMR1 TP-PCR assay generates reliable and sensitive results across a large number of patient specimens, and is suitable for clinical genetic diagnosis. Using this assay, the prevalence of FXS was 0.93 % in Chinese children with unknown IDD. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0394-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaoli Chen
- Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China.
| | - Jingmin Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Hua Xie
- Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China.
| | - Wenjuan Zhou
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Ye Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Jun Wang
- Department of Neurology, Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China.
| | - Jian Qin
- Beijing Microread Genetech Co., Ltd, Beijing, China.
| | - Jin Guo
- Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China.
| | - Qiang Gu
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Xiaozhen Zhang
- Department of Genetics, Jiangxi Previncial Children's Hospital, Jiangxi, China.
| | - Taoyun Ji
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Yu Zhang
- Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China.
| | - Zhiming Xiong
- State Key Lab of Medical Genetics, Central South University, Changsha, China.
| | - Liwen Wang
- Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China.
| | - Xiru Wu
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
| | - Gary J Latham
- Research & Technology Development, Asuragen, Inc., Austin, TX, USA.
| | - Yuwu Jiang
- Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China. .,Department of Pediatrics, Peking University First Hospital, Beijing, China.
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Huang W, Xia Q, Luo S, He H, Zhu T, Du Q, Duan R. Distribution of fragile X mental retardation 1 CGG repeat and flanking haplotypes in a large Chinese population. Mol Genet Genomic Med 2015; 3:172-81. [PMID: 26029703 PMCID: PMC4444158 DOI: 10.1002/mgg3.128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Fragile X syndrome is mainly caused by a CGG repeat expansion within the 5' UTR of the fragile X mental retardation 1 (FMR1) gene. Previous analyses of the FMR1 CGG repeat patterns and flanking haplotypes in Caucasians and African Americans have identified several factors that may influence repeat instability. However, the CGG repeat patterns and distribution for FRAXAC2 have not yet been investigated in mainland Chinese. We surveyed the CGG repeat lengths in 1113 Han Chinese (534 males and 579 females), and the CGG repeat patterns of 534 males were determined by sequence analysis. We also explored the flanking haplotypes (DXS548-FRAXAC1-FRAXAC2) in 566 unaffected and 28 unrelated fragile X Chinese males. The most frequent alleles for DXS548 and FRAXAC1 were identical between our Chinese population and other Asian populations. We identified several low-abundance alleles for DXS548 and FRAXAC1 not found in previous studies in mainland Chinese and Taiwanese cohorts. The most frequent allele was (CGG)29 followed by (CGG)30, and the most frequent patterns were 9 + 9 + 9, 10 + 9 + 9, and 9 + 9 + 6 + 9, similar to those in Singaporeans. We identified only one premutation female carrier with 89 CGG repeats in the 1113 Han Chinese. A few associations between the CGG repeat patterns and flanking haplotypes were determined in this study. In general, the Chinese population had a smaller number of alleles and lower expected heterozygosity for all three STR markers and FRAXA locus when compared with Caucasians and African Americans. We identified a novel haplotype 7-3-5 + that is significantly associated with the full mutation.
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Affiliation(s)
- Wen Huang
- The State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University Changsha, 410078, Hunan, China
| | - Qiuping Xia
- The State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University Changsha, 410078, Hunan, China
| | - Shiyu Luo
- The State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University Changsha, 410078, Hunan, China
| | - Hua He
- The State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University Changsha, 410078, Hunan, China
| | - Ting Zhu
- The State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University Changsha, 410078, Hunan, China
| | - Qian Du
- The State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University Changsha, 410078, Hunan, China
| | - Ranhui Duan
- The State Key Laboratory of Medical Genetics & School of Life Sciences, Central South University Changsha, 410078, Hunan, China
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