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O'Connor FG, Franzos MA, Nye NS, Nelson DA, Shell D, Voss JD, Anderson SA, Coleman NJ, Thompson AA, Harmon KG, Deuster PA. Summit on Exercise Collapse Associated with Sickle Cell Trait: Finding the "Way Ahead". Curr Sports Med Rep 2021; 20:47-56. [PMID: 33395130 DOI: 10.1249/jsr.0000000000000801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Although largely benign, sickle cell trait (SCT) has been associated with exertion-related events, to include sudden death. In 2011, a summit on SCT introduced the term exercise collapse associated with SCT (ECAST). A series of ECAST deaths in military personnel in 2019 prompted reevaluation of current efforts and led to a second summit in October 2019 hosted by the Consortium for Health and Military Performance of the Uniformed Services University in Bethesda, MD. The goals were to (1) review current service policies on SCT screening, (2) develop draft procedural instructions for executing current policy on SCT within the Department of Defense, (3) develop draft clinical practice guidelines for management of ECAST, (4) establish a framework for education on SCT and ECAST, and (5) prepare a research agenda to address identified gaps.
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Affiliation(s)
- Francis G O'Connor
- Department of Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD
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Schultz CL, Tchume-Johnson T, Jackson T, Enninful-Eghan H, Schapira MM, Smith-Whitley K. Reproductive intentions in mothers of young children with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28227. [PMID: 32065500 DOI: 10.1002/pbc.28227] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 01/16/2020] [Accepted: 01/31/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy associated with morbidity and mortality. We sought to understand family planning intentions of parents of young children with SCD including the awareness of three reproductive options (adoption, in vitro fertilization with egg/sperm donation [IVFD], in vitro fertilization [IVF] with preimplantation genetic testing [IVF/PGT]) to decrease the risk of having a child with SCD. PROCEDURE Qualitative, semistructured, one-on-one interviews with 18 female parents of young children with SCD at an urban, tertiary care pediatric hospital. RESULTS Half of the parents knew their hemoglobinopathy status or their partner's status before pregnancy. Eight parents chose to have no further children because of fear of SCD in another child. Awareness of reproductive options prior to study enrollment was limited. After brief introduction, 7 parents would consider adoption, 2 IVFD, and 10 IVF/PGT. Desire for a biological child, fear of parental jealousy, ethical or religious considerations, and cost affected the acceptability of these options. Participants universally wanted information about reproductive options available to others prior to pregnancy. CONCLUSIONS There is limited awareness and variable acceptability of alternative reproductive options available to decrease the risk of a future child having SCD. Participants universally endorsed the need for education regarding hemoglobinopathy status, SCD, and reproductive options prior to pregnancy because for many participants having a child with SCD affected their reproductive intentions. Educational interventions to ensure informed reproductive decision making should be sensitive to desires for a biological child, and ethical and financial considerations.
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Affiliation(s)
- Corinna L Schultz
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Trudy Tchume-Johnson
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Tannoa Jackson
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Marilyn M Schapira
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,The Center for Health Equity and Research Promotion, Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Kim Smith-Whitley
- Department of Hematology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Campbell MLH, McNamee MJ. Ethics, Genetic Technologies and Equine Sports: The Prospect of Regulation of a Modified Therapeutic Use Exemption Policy. SPORT ETHICS AND PHILOSOPHY 2020. [DOI: 10.1080/17511321.2020.1737204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M. L. H Campbell
- Department of Production and Population Sciences, The Royal Veterinary College, South Mymms, UK
| | - M. J. McNamee
- School of Sport and Exercise Sciences, Swansea University, Swansea, UK
- Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Reeves SL, Jary HK, Gondhi JP, Kleyn M, Spector-Bagdady K, Dombkowski KJ. Incidence, demographic characteristics, and geographic distribution of sickle cell trait and sickle cell anemia births in Michigan, 1997-2014. Mol Genet Genomic Med 2019; 7:e795. [PMID: 31210022 PMCID: PMC6687629 DOI: 10.1002/mgg3.795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/22/2019] [Accepted: 04/27/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study describes the incidence, demographic characteristics, and geographic distribution of sickle cell anemia (SCA) and sickle cell trait births in Michigan. METHODS Michigan newborn screening records and birth certificates (1997-2014) were used to identify sickle cell trait and SCA births, as well as demographic characteristics and mother's residential address. Incidence was calculated overall and by county. RESULTS During the study period, there were 592 SCA births and 33,404 sickle cell trait births in Michigan. The majority of SCA (86.3%) and trait (80.2%) cases were among children who were black. Children with SCA were born in 23% of Michigan counties; children with trait were born in 93%. CONCLUSION Compared to SCA, sickle cell trait births occur at 50-fold greater incidence and have a substantially expanded geographic distribution. Further research is necessary to understand the most appropriate and impactful use of resources to increase the proportion of families and adults that are aware of their sickle cell trait status.
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Affiliation(s)
- Sarah L Reeves
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Hannah K Jary
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Jennifer P Gondhi
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Mary Kleyn
- Michigan Department of Health and Human Services, Lansing, Michigan
| | - Kayte Spector-Bagdady
- Department of Obstetrics and Gynecology, Center for Bioethics & Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kevin J Dombkowski
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
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Xu JZ, Thein SL. The carrier state for sickle cell disease is not completely harmless. Haematologica 2019; 104:1106-1111. [PMID: 31097635 PMCID: PMC6545856 DOI: 10.3324/haematol.2018.206060] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/29/2019] [Indexed: 01/19/2023] Open
Affiliation(s)
- Julia Zhe Xu
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MA, USA
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MA, USA
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Genetic Testing by Sports Medicine Physicians in the United States: Attitudes, Experiences, and Knowledge. Sports (Basel) 2018; 6:sports6040145. [PMID: 30424536 PMCID: PMC6315998 DOI: 10.3390/sports6040145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/04/2018] [Accepted: 11/08/2018] [Indexed: 01/01/2023] Open
Abstract
It remains unknown whether and how sports medicine physicians currently utilize genetic testing in their clinical practice. This study sought to assess knowledge of, experience with, and attitudes towards genetic testing by sports medicine physicians in the United States (US). An email with a survey hyperlink was distributed twice to members of the American Medical Society for Sports Medicine (AMSSM) listserv in September 2016, with approximately a 10% response rate. Questions focused on knowledge of, experience with, and attitudes towards testing for different genes related to sports proficiency, injury risk, and disease risk. Few AMSSM physicians believe that genetic testing to adapt training (12%) or to choose a sport (2%) is ready for clinical adoption. Most respondents self-reported minimal knowledge about, and limited experience with, genetic testing. The main exception was screening for sickle cell trait (SCT) for which most (84%) reported moderate/significant/expert knowledge and over two-thirds had ordered testing. Although most respondents thought it appropriate to counsel and test for health conditions associated with cardiac and connective tissue disorders in the setting of a positive family history, only a minority had been asked to do so. Five or fewer respondents (2%) had been asked to test for performance-associated variants (Angiotensin Converting Enzyme (ACE) II and Alpha-Actinin 3 (ACTN3)), and five or fewer (2%) would recommend changes based on the results. Our study provides a baseline of current US sports medicine physicians’ minimal experiences with, and knowledge of, genetic testing. The findings of our study indicate that sports medicine physicians require further genetics education as it relates to sports and exercise in order to be prepared to competently engage with their patients and to develop sound professional organizational policies.
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Thompson TL, Nguyen TX, Karodeh CR. Twelve cases of exertional rhabdomyolysis in college football players from the same institution over a 23-year span: a descriptive study. PHYSICIAN SPORTSMED 2018; 46:331-334. [PMID: 29855209 DOI: 10.1080/00913847.2018.1481717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Rhabdomyolysis is a syndrome characterized by muscle necrosis that leads to release of the intracellular contents of muscle cells into the systemic circulation. Rhabdomyolysis due to overexertion is an uncommon but well-known severe complication of strenuous activity. Exertional rhabdomyolysis (ER) is typically described in weight lifters and military recruits undergoing basic training. Few cases have been reported in football players without known predisposing risk factors. We report our experience with this condition in college football players in a single institution. MATERIALS AND METHODS College football players hospitalized for heat illness complicated by rhabdomyolysis were identified over a 23-year period. Clinical and laboratory findings were collected. Clinical course was recorded. RESULTS Twelve patients were identified. All were Black males. One had sickle cell trait. BMI averaged 33 kg/m2 (range 23-45 kg/m2). Peak creatine phosphokinase (CPK) averaged 14,850 IU/L (range 1,021-109,616 IU/L). Serum creatinine averaged 1.9 mg/dl (range 1.2-3.1 mg/dl). Ten of twelve cases occurred in August. All responded to intravenous hydration with normalization of CPK and renal function. All returned to football. CONCLUSIONS ER is a serious complication of strenuous physical activity that can threaten renal function. ER tends to occur in August, which coincides with the start of football practice when athletes are more likely to be detrained. The condition can occur in Black athletes in the absence of sickle cell trait. ER carries a good prognosis when recognized early and treated adequately.
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Affiliation(s)
- Terry L Thompson
- a Department of Orthopaedic Surgery and Rehabilitation , Howard University College of Medicine , Washington, DC , USA
| | - Thomas X Nguyen
- b Orthopaedic Resident , Howard University Hospital , Washington, DC , USA
| | - Cina R Karodeh
- c Medical Student , Howard University College of Medicine , Washington, DC , USA
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McDonald MA, Creary MS, Powell J, Daley LA, Baker C, Royal CD. Perspectives and Practices of Athletic Trainers and Team Physicians Implementing the 2010 NCAA Sickle Cell Trait Screening Policy. J Genet Couns 2017; 26:1292-1300. [PMID: 28578465 DOI: 10.1007/s10897-017-0107-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/02/2017] [Indexed: 11/25/2022]
Abstract
Sickle cell trait (SCT) is usually benign. However, there are some conditions that may lead to SCT-related problems and put athletes with the trait at particular risk. In 2010 the National Collegiate Athletic Association (NCAA) issued a policy that required all Division I (DI) student-athletes to confirm their SCT status or sign a liability waiver to opt out of testing. Athletic trainers and team physicians play key roles in the policy implementation and we examined their perceptions and practices. Between December 2013 and March 2014 we interviewed 13 head athletic trainers and team physicians at NCAA Division I colleges and universities in North Carolina. We used an interview guide with open-ended questions covering knowledge of SCT, historical screening and education practices, current implementation, and policy benefits and challenges. Participants were knowledgeable about SCT and thought the policy was beneficial in providing SCT health information to and for student-athletes. Schools varied in provision of genetic counseling, offering the waiver, SCT tests administered, and other aspects. Challenges included: insufficient guidance from the NCAA; financial considerations; and misunderstanding of the relationships of race and ancestry to SCT risk. Athletic staff found the policy valuable, but felt it needs clarity and standardization.
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Affiliation(s)
- Mary Anne McDonald
- Center on Genomics, Race, Identity, Difference, Duke University, Durham, NC, USA
| | - Melissa S Creary
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Jill Powell
- Center on Genomics, Race, Identity, Difference, Duke University, Durham, NC, USA
| | - Lori-Ann Daley
- Center on Genomics, Race, Identity, Difference, Duke University, Durham, NC, USA
| | - Charlotte Baker
- Institute of Public Health, Florida A&M University, Tallahassee, FL, USA
| | - Charmaine Dm Royal
- Center on Genomics, Race, Identity, Difference, Duke University, Durham, NC, USA. .,Department of African and African American Studies, Duke University, Durham, NC, USA.
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Hercher LS, Caudle M, Griffin J, Herzog M, Matviychuk D, Tidwell J. Student-Athletes' Views on APOE Genotyping for Increased Risk of Poor Recovery after a Traumatic Brain Injury. J Genet Couns 2016; 25:1267-1275. [PMID: 27207686 DOI: 10.1007/s10897-016-9965-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/28/2016] [Indexed: 11/28/2022]
Abstract
Use of apolipoprotein E genotyping to personalize the risk of a poor recovery after traumatic brain injury is complicated by the potential for genetic discrimination and the potential to reveal an increased risk for late onset Alzheimer's disease. We developed a survey to gauge interest in testing among athletes participating in National Collegiate Athletic Association programs. Eight hundred and forty seven student-athletes were surveyed to determine their interest in genetic testing, their willingness to share the results of testing with parents, coaches and physicians, their concerns about privacy and/or discrimination, and their interest in genetic counseling. Nearly three quarters of respondents expressed some level of interest in testing, with the largest number describing themselves as 'possibly interested' (54.9 %, n = 463) and a smaller number describing themselves as 'very interested' (18.9 %, n = 159). Most student-athletes said that receiving secondary information about their risk for late-onset Alzheimer's disease made them more likely to test (50.6 %, n = 426) rather than less likely to test (12.4 %, n = 104). Student-athletes were open to apolipoprotein E genotyping and willing to share test results with their parents, coaches and physicians. They did not anticipate that test results would impact their behavior or ability to play. Testing programs may be welcome but should provide clear information as to risks and benefits.
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Affiliation(s)
- Laura S Hercher
- Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics, 1 Mead Way, Bronxville, NY, 10708, USA.
| | - Michelle Caudle
- Sarah Lawrence College Joan H. Marks Graduate Program in Human Genetics, 1 Mead Way, Bronxville, NY, 10708, USA
| | - Julie Griffin
- Weisskopf Child Evaluation Center, Department of Pediatrics, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Matthew Herzog
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Diana Matviychuk
- Medical Genetics Unit, Kingston General Hospital, Kingston, ON, Canada
| | - Jenna Tidwell
- Cancer Risk and Prevention Program, MemorialCare Cancer Institute at MemorialCare Health System, Laguna Hills, CA, USA
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