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Barak-Corren Y, Tsurel D, Keidar D, Gofer I, Shahaf D, Leventer-Roberts M, Barda N, Reis BY. The value of parental medical records for the prediction of diabetes and cardiovascular disease: a novel method for generating and incorporating family histories. J Am Med Inform Assoc 2023; 30:1915-1924. [PMID: 37535812 PMCID: PMC10654871 DOI: 10.1093/jamia/ocad154] [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: 05/01/2023] [Revised: 07/16/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To determine whether data-driven family histories (DDFH) derived from linked EHRs of patients and their parents can improve prediction of patients' 10-year risk of diabetes and atherosclerotic cardiovascular disease (ASCVD). MATERIALS AND METHODS A retrospective cohort study using data from Israel's largest healthcare organization. A random sample of 200 000 subjects aged 40-60 years on the index date (January 1, 2010) was included. Subjects with insufficient history (<1 year) or insufficient follow-up (<10 years) were excluded. Two separate XGBoost models were developed-1 for diabetes and 1 for ASCVD-to predict the 10-year risk for each outcome based on data available prior to the index date of January 1, 2010. RESULTS Overall, the study included 110 734 subject-father-mother triplets. There were 22 153 cases of diabetes (20%) and 11 715 cases of ASCVD (10.6%). The addition of parental information significantly improved prediction of diabetes risk (P < .001), but not ASCVD risk. For both outcomes, maternal medical history was more predictive than paternal medical history. A binary variable summarizing parental disease state delivered similar predictive results to the full parental EHR. DISCUSSION The increasing availability of EHRs for multiple family generations makes DDFH possible and can assist in delivering more personalized and precise medicine to patients. Consent frameworks must be established to enable sharing of information across generations, and the results suggest that sharing the full records may not be necessary. CONCLUSION DDFH can address limitations of patient self-reported family history, and it improves clinical predictions for some conditions, but not for all, and particularly among younger adults.
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Affiliation(s)
- Yuval Barak-Corren
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - David Tsurel
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
- Clalit Research Institute, Ramat Gan, Israel
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daphna Keidar
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
- Clalit Research Institute, Ramat Gan, Israel
| | - Ilan Gofer
- Clalit Research Institute, Ramat Gan, Israel
| | - Dafna Shahaf
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maya Leventer-Roberts
- Clalit Research Institute, Ramat Gan, Israel
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Noam Barda
- Clalit Research Institute, Ramat Gan, Israel
| | - Ben Y Reis
- Predictive Medicine Group, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Rasooly D, Moonesinghe R, Littrell K, Hull L, Khoury MJ. Association Between a First-Degree Family History and Self-Reported Personal History of Obesity, Diabetes, and Heart and Blood Conditions: Results From the All of Us Research Program. J Am Heart Assoc 2023; 12:e030779. [PMID: 37947093 PMCID: PMC10727309 DOI: 10.1161/jaha.123.030779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
Background Family history reflects the complex interplay of genetic susceptibility and shared environmental exposures and is an important risk factor for obesity, diabetes, and heart and blood conditions (ODHB). However, the overlap in family history associations between various ODHBs has not been quantified. Methods and Results We assessed the association between a self-reported family history of ODHBs and their risk in the adult population (age ≥20 years) of the AoU (All of Us) Research Program, a longitudinal cohort study of diverse participants across the United States. We conducted a family history-wide association study to systematically assess the association of a first-degree family history of 15 ODHBs in AoU. We performed stratified analyses based on racial and ethnic categories, education, household income and gender minority status, and quantified associations by type of affected relatives. Of 125 430 participants, 76.8% reported a first-degree family history of any ODHB, most commonly hypertension (n=64 982, 51.8%), high cholesterol (49 753, 39.7%), and heart attack (29 618, 23.6%). We use the FamWAS method to estimate 225 familial associations among 15 ODHBs. The results include overlapping associations between family history of different types of cardiometabolic conditions (such as type 2 diabetes and coronary artery disease), and their risk factors (obesity, hypertension), where adults with a family history of 1 ODHB exhibited 1.1 to 5.6 times (1.5, on average) the odds of having a different ODHB. Conclusions Our findings inform the utility of family history data as a risk assessment and screening tool for the prevention of ODHBs and to provide additional insights into shared risk factors and pathogenic mechanisms.
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Affiliation(s)
- Danielle Rasooly
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Ramal Moonesinghe
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Kevin Littrell
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Leland Hull
- Division of General Internal Medicine, Massachusetts General HospitalBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Muin J. Khoury
- Division of Blood Disorders and Public Health GenomicsNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and PreventionAtlantaGAUSA
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Vergaro G, Gentile F, Modena M, Emdin M. Understanding family history of heart disease: a (good) patient interview vs. genetics. Eur J Prev Cardiol 2023; 30:1569-1570. [PMID: 37178350 DOI: 10.1093/eurjpc/zwad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Giuseppe Vergaro
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa PI, Italy
- Cardiothoracic Department, Fondazione Toscana "Gabriele Monasterio", Via Giuseppe Moruzzi, 1, 56124 Pisa PI, Italy
| | - Francesco Gentile
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa PI, Italy
- Cardiothoracic Department, Fondazione Toscana "Gabriele Monasterio", Via Giuseppe Moruzzi, 1, 56124 Pisa PI, Italy
| | - Martina Modena
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa PI, Italy
| | - Michele Emdin
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127 Pisa PI, Italy
- Cardiothoracic Department, Fondazione Toscana "Gabriele Monasterio", Via Giuseppe Moruzzi, 1, 56124 Pisa PI, Italy
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Haga SB, Orlando LA. Expanding Family Health History to Include Family Medication History. J Pers Med 2023; 13:jpm13030410. [PMID: 36983592 PMCID: PMC10053261 DOI: 10.3390/jpm13030410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/02/2023] Open
Abstract
The collection of family health history (FHH) is an essential component of clinical practice and an important piece of data for patient risk assessment. However, family history data have generally been limited to diseases and have not included medication history. Family history was a key component of early pharmacogenetic research, confirming the role of genes in drug response. With the substantial number of known pharmacogenes, many affecting response to commonly prescribed medications, and the availability of clinical pharmacogenetic (PGx) tests and guidelines for interpretation, the collection of family medication history can inform testing decisions. This paper explores the roots of family-based pharmacogenetic studies to confirm the role of genes in these complex phenotypes and the benefits and challenges of collecting family medication history as part of family health history intake.
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Pessanha RM, Schuab SIPDC, Nunes KZ, Lopes-Júnior LC. Use of family history taking for hereditary neoplastic syndromes screening in primary health care: A systematic review protocol. PLoS One 2022; 17:e0271286. [PMID: 35877607 PMCID: PMC9312395 DOI: 10.1371/journal.pone.0271286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 06/23/2022] [Indexed: 01/11/2023] Open
Abstract
Background Although most neoplasms result from complex interactions between the individual’s genome and the environment, a percentage of cases is particularly due to inherited alterations that confer a greater predisposition to the development of tumors. Hereditary Neoplastic Syndromes have a high psychosocial and economic burden, in addition to being characterized by an increased risk for one or more types of cancer, onset of malignancy at a young age, high risk of secondary malignancies, and occurrence in successive generations of the family. Personal and family history, as well as pedigree, may be useful resources to estimate the risk for developing cancer, especially in Primary Health Care settings. Objective To identify and evaluate the evidence regarding the impact of using family history as a genomic technology for Hereditary Neoplastic Syndromes screening at Primary Health Care. Methods This systematic review protocol was elaborated in compliance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). We will include all observational as well as experimental study designs published up to end of July 2022, and studies covering the impact of family history on screening for Hereditary Neoplastic Syndromes in primary health care. Qualitative studies, as well as guidelines, reviews, and studies undertaken in hospitals, outpatient clinic, or medical environments will be excluded. Five databases will be searched, including MEDLINE/PubMed, Cochrane Library, EMBASE, Web of Science, and LILACS. Additional sources will also be retrieved, including Clinical trials.gov-NIH, The British Library, and Google Scholar. No restriction to language or date will be employed in the search strategy. Three investigators will select studies independently, perform data extraction, and conduct the critical appraisal of the risk of bias and overall quality of the selected studies according to their designs. Regarding data synthesis, the study characteristics will be summarized and presented in tables and results will be presented according to the study design. A qualitative synthesis of data will also be provided in this systematic review. Discussion To the best of our knowledge, this systematic review will be the first to identify and critically assess evidence regarding the impact of using family history as a genomic technology for Hereditary Neoplastic Syndromes screening in Primary Health Care settings worldwide. This study is expected to provide consistent evidence that will aid the primary care decision-makers regarding hereditary cancer screening, thus helping individuals and families at risk for cancer. PROSPERO registration number CRD42020166211.
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Affiliation(s)
- Raphael Manhães Pessanha
- Graduate Program in Public Health-PPGSC, Health Sciences Center at the Federal University of Espírito Santo (UFES), Vitoria, ES, Brazil
| | | | - Karolini Zuqui Nunes
- Health Sciences Center at the Federal University of Espírito Santo (UFES), Vitoria, ES, Brazil
| | - Luís Carlos Lopes-Júnior
- Graduate Program in Public Health-PPGSC, Health Sciences Center at the Federal University of Espírito Santo (UFES), Vitoria, ES, Brazil
- * E-mail:
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Yuan Y, Zhang F, Qiu J, Chen L, Xiao M, Tang W, Luo Q, Ding X, Tang X. Association Between Snoring and Diabetes Among Pre- and Postmenopausal Women. Int J Gen Med 2022; 15:2491-2499. [PMID: 35282647 PMCID: PMC8904760 DOI: 10.2147/ijgm.s352593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To examine the relationship between diabetes and snoring frequency and determine the effect of menopause and postmenopausal years on this relationship. Methods We included 12,218 premenopausal and postmenopausal women from part of the baseline of the China Multi-Ethnic Cohort study (CMEC) in Chongqing province. Face-to-face questionnaires, physical examination, and biological samples were used to collect data. Logistic regression and subgroup analysis were used to explore the relationship between snoring and diabetes in women with various menopausal statuses. Results The risk of diabetes increased with the snoring frequency, with adjusted odds ratios of 1.23 (95% CI:1.05–1.43) and 1.47 (95% CI:1.25–1.73) for sometimes snoring and frequent snoring, compared to non-snoring. In premenopausal and postmenopausal women, frequent snoring increased the odds of diabetes by 58% (95% CI: 7–132%) and 43% (95% CI: 20–72%), respectively, compared to non-snoring. Only in women who were ≥10 years postmenopausal had a statistical association between frequent snoring and diabetes, with a 54% (95% CI: 23–92%) increased odds of diabetes, compared to women who did not snore. Conclusion Snoring frequency is positively associated with diabetes. Women who snore frequently before and for at least ten years after menopause are at higher risk of developing diabetes. Frequent snorers and long-term postmenopausal women should monitor blood glucose levels to aid in the early detection and treatment of diabetes.
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Affiliation(s)
- Yun Yuan
- School of Public Health and Management, Medical and Social Development Research Center, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Fan Zhang
- School of Public Health and Management, Medical and Social Development Research Center, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Jingfu Qiu
- School of Public Health and Management, Medical and Social Development Research Center, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Liling Chen
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, People’s Republic of China
| | - Meng Xiao
- School of Public Health and Management, Medical and Social Development Research Center, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Wenge Tang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, People’s Republic of China
| | - Qinwen Luo
- School of Public Health and Management, Medical and Social Development Research Center, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Xianbin Ding
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, People’s Republic of China
- Xianbin Ding, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, People’s Republic of China, Tel +86-13896096430, Email
| | - Xiaojun Tang
- School of Public Health and Management, Medical and Social Development Research Center, Chongqing Medical University, Chongqing, 400016, People’s Republic of China
- Correspondence: Xiaojun Tang, School of Public Health and Management, Medical and Social Development Research Center, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86-13668023656, Email
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Jansen N, Hollman F, Bovendeert F, Moh P, Stegmann A, Staal HM. Blount disease and familial inheritance in Ghana, area cross-sectional study. BMJ Paediatr Open 2021; 5:e001052. [PMID: 33981863 PMCID: PMC8070876 DOI: 10.1136/bmjpo-2021-001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The objective of this study is to study familial inheritance for Blount disease to create better understanding of the aetiology of Blount disease. Methods After reviewing patient files and conventional roentgenologic imaging, 139 patients with Blount disease were included in this cross-sectional study, of which 102 patients were interviewed. During the interviews, patient characteristics and family history were collected. Blood samples were taken from five patients and three families and a whole exome sequencing was performed. Results Although patients came from all over the country, 90% of the patients belonged to the Akan tribe. A positive family history was found in 63 families (62%), of which, almost two-third had a positive family history in a first-degree family member. In most of the cases (64%), the varus legs resolved over time. In 9%, severe bowing remained 'just like the patient'. The results of the whole exome sequencing did not show a genetic predisposition. Conclusion This study describes a large group of Blount patients. Because of the high numbers of positive family history and the centralisation of patients in the Akan region, a familial predisposition is suggested. Further genetic research is essential for better understanding of the possible multifactorial aetiology in Blount disease.
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Affiliation(s)
- Niels Jansen
- Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Freek Hollman
- Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frans Bovendeert
- Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Prosper Moh
- Orthopaedics, Saint John of God Hospital, Duayaw Nkwanta, Ghana
| | | | - Heleen M Staal
- Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Padmanabhan J. The value of family history in screening for type 2 diabetes comorbidity. Schizophr Res 2020; 216:12-13. [PMID: 32005563 DOI: 10.1016/j.schres.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 01/18/2020] [Accepted: 01/19/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Jaya Padmanabhan
- Takeda Pharmaceuticals, 40 Landsdowne St, Cambridge MA 02139, United States of America.
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Rasooly D, Ioannidis JPA, Khoury MJ, Patel CJ. Family History-Wide Association Study to Identify Clinical and Environmental Risk Factors for Common Chronic Diseases. Am J Epidemiol 2019; 188:1563-1568. [PMID: 31172187 PMCID: PMC6670049 DOI: 10.1093/aje/kwz125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 01/15/2023] Open
Abstract
Family history is a strong risk factor for many common chronic diseases and summarizes shared environmental and genetic risk, but how this increased risk is mediated is unknown. We developed a "family history-wide association study" (FamWAS) to systematically and comprehensively test clinical and environmental quantitative traits (CEQTs) for their association with family history of disease. We implemented our method on 457 CEQTs for association with family history of diabetes, asthma, and coronary heart disease (CHD) in 42,940 adults spanning 8 waves of the 1999-2014 US National Health and Nutrition Examination Survey. We conducted pooled analyses of the 8 survey waves and analyzed trait associations using survey-weighted logistic regression. We identified 172 (37.6% of total), 32 (7.0%), and 78 (17.1%) CEQTs associated with family history of diabetes, asthma, and CHD, respectively, in subcohorts of individuals without the respective disease. Twenty associated CEQTs were shared across family history of diabetes, asthma, and CHD, far more than expected by chance. FamWAS can examine traits not previously studied in association with family history and uncover trait overlap, highlighting a putative shared mechanism by which family history influences disease risk.
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Affiliation(s)
- Danielle Rasooly
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | | | - Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
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Developing community-based health education strategies with family history: Assessing the association between community resident family history and interest in health education. Soc Sci Med 2019; 271:112160. [PMID: 30862375 DOI: 10.1016/j.socscimed.2019.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Family history (FH) is an underutilized genetically informative tool that can influence disease prevention and treatment. It is unclear how FH fits into the development of community-based health education. This study examines the role that FH plays in perceived threat and health education related to mental and chronic physical conditions in the context of the health belief model. METHODS Data were collected from 1,048 adult participants aged 18-90 years. Approximately 76% of participants indicated African-American race/ethnicity and 35% had less than high school level education. Self-report data were collected on FH of four disorders: anxiety, depression, diabetes, and high blood pressure. Interest in receiving information regarding prevention as well as future testing efforts was assessed broadly. A series of logistic regressions examined the association between FH for each of the disorders and interest in receiving information on (1) prevention of diseases in general and (2) testing for diseases in general. These associations were also analyzed after accounting for the influence of perceived threat of conditions. RESULTS Interest in receiving general health education was significantly associated with FH of depression (OR = 2.72, 95% CI = 1.74-4.25), anxiety (OR = 2.26, 95% CI = 1.45-3.22), and high blood pressure (OR = 2.54, 95% CI = 1.05-6.12). After adjustment for perceived threat, the magnitude of these associations was reduced substantially. The associations between perceived threat and either interest in receiving information on disease testing or receiving general health education were strong and significant across all conditions (OR = 2.11-3.74). DISCUSSION These results provide evidence that perceived threat mediates the association between FH and engagement with health education. Currently available health education programs may benefit from considering the role of FH in an individual's motivation for participation in health education activities alongside other factors.
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Flória-Santos M, Lopes-Júnior LC, Alvarenga LDM, Ribeiro MS, Ferraz VEDF, Nascimento LC, Pereira-da-Silva G. Self-reported cancer family history is a useful tool for identification of individuals at risk of hereditary cancer predisposition syndrome at primary care centers in middle-income settings: a longitudinal study. Genet Mol Biol 2016; 39:178-83. [PMID: 27275666 PMCID: PMC4910551 DOI: 10.1590/1678-4685-gmb-2014-0362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 02/11/2016] [Indexed: 11/21/2022] Open
Abstract
Analysis of cancer family history (CFH) offers a low-cost genetic tool to identify
familial cancer predisposition. In middle-income settings, the scarcity of individual
records and database-linked records hinders the assessment of self-reported CFH
consistency as an indicator of familial cancer predisposition. We used self-reported
CFH to identify those families at risk for hereditary cancer syndromes in
community-based primary care centers of a low-income Brazilian area. We also
evaluated the consistency of the information collected by reassessing CFH five years
later. We interviewed 390 families and constructed their pedigrees for genetic cancer
risk assessment. We found 125 families affected by cancer, 35.2% with moderate to
high risk of familial susceptibility to cancer, a number that represents a relatively
high prevalence of potential hereditary cancer syndromes in the overall study sample.
Upon reassessment of CFH in 14/20 families that were previously identified as having
at least one first-degree and one second-degree relative affected by cancer, and
presented moderate to high risk for developing cancer, 90% of initial pedigrees were
confirmed. These results demonstrate the reliability of self-reports as a means of
early identification of healthy individuals at risk, encouraging the wider use of
this method in low- and middle-income primary care settings.
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Affiliation(s)
- Milena Flória-Santos
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Luís Carlos Lopes-Júnior
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Larissa de Melo Alvarenga
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mayara Segundo Ribeiro
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | | | - Lucila Castanheira Nascimento
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Gabriela Pereira-da-Silva
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Molavi Vardanjani H, Baneshi MR, Haghdoost A. Cancer Visibility among Iranian Familial Networks: To What Extent Can We Rely on Family History Reports? PLoS One 2015; 10:e0136038. [PMID: 26308087 PMCID: PMC4550411 DOI: 10.1371/journal.pone.0136038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/30/2015] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Patients' unawareness of their cancer diagnosis (PUAW) and their tendency for non-disclosure (TTND) to relatives leads to a lack of cancer visibility among familial networks. Lack of familial cancer visibility could affect the accuracy of family cancer history (FCH) reports. In this study, we investigated familial cancer visibility and its potential determinants. PATIENTS AND METHODS A sample of patients with a confirmed cancer diagnosis was interviewed. Participants were asked about their number of relatives, number of their relatives who are aware about the cancer diagnosis, and the number of relatives from whom they intended to conceal their diagnosis. PUAW was also assessed. Point estimates and 95% confidence intervals were calculated using the bootstrap technique. Multivariate analyses were conducted using mixed Poisson and logistic regression analyses. RESULTS A total of 415 participants with a mean age of 53±15 years and a male to female ratio of 0.53 were enrolled in this study. The rates of PUAW, TTND, and familial cancer visibility in the total sample were 0.20 (95% confidence interval (CI): 0.16, 0.24), 0.16 (95% CI: 0.12, 0.19), and 0.86 (95% CI: 0.83, 0.89), respectively. PUAW (adjusted rate ratio (RR) = 1.32, 95% CI: 1.27, 1.38), TTND (RR = 0.92, 95% CI: 0.91, 0.93), and the patients' gender (RR = 0.92, 95% CI: 0.82, 0.95) were the most important determinants of familial cancer visibility. CONCLUSION Familial cancer visibility may be a point of concern among the Iranian population. Self-reported cancer histories and FCHs may have low sensitivities (not exceeding 80% and 86%, respectively) in this population. However, these estimates may vary across different societies, because of societal and cultural contexts.
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Affiliation(s)
- Hossein Molavi Vardanjani
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Baneshi
- Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - AliAkbar Haghdoost
- Regional Knowledge Hub, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Schlichting JA, Mengeling MA, Makki NM, Malhotra A, Halfdanarson TR, Klutts JS, Levy BT, Kaboli PJ, Charlton ME. Increasing colorectal cancer screening in an overdue population: participation and cost impacts of adding telephone calls to a FIT mailing program. J Community Health 2014; 39:239-47. [PMID: 24499966 DOI: 10.1007/s10900-014-9830-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many people who live in rural areas face distance barriers to colonoscopy. Our previous study demonstrated the utility of mailing fecal immunochemical tests (FIT) to average risk patients overdue for colorectal cancer (CRC screening). The aims of this study were to determine if introductory and reminder telephone calls would increase the proportion of returned FITs as well as to compare costs. Average risk patients overdue for CRC screening received a high intensity intervention (HII), which included an introductory telephone call to see if they were interested in taking a FIT prior to mailing the test out and reminder phone calls if the FIT was not returned. This HII group was compared to our previous low intensity intervention (LII) where a FIT was mailed to a similar group of veterans with no telephone contact. While a higher proportion of eligible respondents returned FITs in the LII (92 vs. 45 %), there was a much higher proportion of FITs returned out of those mailed in the HII (85 vs. 14 %). The fewer wasted FITs in the HII led to it having lower cost per FIT returned ($27.43 vs. $44.86). Given that either intervention is a feasible approach for patients overdue for CRC screening, health care providers should consider offering FITs using a home-based mailing program along with other evidence-based CRC screening options to average risk patients. Factors such as location, patient population, FIT cost and reimbursement, and personnel costs need to be considered when deciding the most effective way to implement FIT screening.
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Affiliation(s)
- Jennifer A Schlichting
- VA Office of Rural Health, Rural Health Resource Center - Central Region, Iowa City VA Healthcare System, 601 Hwy 6 West, Iowa City, IA, 52246, USA
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15
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McCarty CA, Berg R, Rottscheit CM, Waudby CJ, Kitchner T, Brilliant M, Ritchie MD. Validation of PhenX measures in the personalized medicine research project for use in gene/environment studies. BMC Med Genomics 2014; 7:3. [PMID: 24423110 PMCID: PMC3896802 DOI: 10.1186/1755-8794-7-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/07/2014] [Indexed: 11/16/2022] Open
Abstract
Background The purpose of this paper is to describe the data collection efforts and validation of PhenX measures in the Personalized Medicine Research Project (PMRP) cohort. Methods Thirty-six measures were chosen from the PhenX Toolkit within the following domains: demographics; anthropometrics; alcohol, tobacco and other substances; cardiovascular; environmental exposures; cancer; psychiatric; neurology; and physical activity and physical fitness. Eligibility criteria for the current study included: living PMRP subjects with known addresses who consented to future contact and were not currently living in a nursing home, available GWAS data from eMERGE I for subjects where age-related cataract, HDL, dementia and resistant hypertension were the primary phenotypes, thus biasing the sample to the older PMRP participants. The questionnaires were mailed twice. Data from the PhenX measures were compared with information from PMRP questionnaires and data from Marshfield Clinic electronic medical records. Results Completed PhenX questionnaires were returned by 2271 subjects for a final response rate of 70%. The mean age reported on the PhenX questionnaire (73.1 years) was greater than the PMRP questionnaire (64.8 years) because the data were collected at different time points. The mean self-reported weight, and subsequently calculated BMI, were less on the PhenX survey than the measured values at the time of enrollment into PMRP (PhenX means 173.5 pounds and BMI 28.2 kg/m2 versus PMRP 182.9 pounds and BMI 29.6 kg/m2). There was 95.3% agreement between the two questionnaires about having ever smoked at least 100 cigarettes. 139 (6.2%) of subjects indicated on the PhenX questionnaire that they had been told they had a stroke. Of them, only 15 (10.8%) had no electronic indication of a prior stroke or TIA. All of the age-and gender-specific 95% confidence limits around point estimates for major depressive episodes overlap and show that 31% of women aged 50–64 reported symptoms associated with a major depressive episode. Conclusions The approach employed resulted in a high response rate and valuable data for future gene/environment analyses. These results and high response rate highlight the utility of the PhenX Toolkit to collect valid phenotypic data that can be shared across groups to facilitate gene/environment studies.
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Affiliation(s)
- Catherine A McCarty
- Division of Research, Essentia Institute of Rural Health, 502 East Second Street, Duluth, MN 55805, USA.
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16
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Bloss CS, Schork NJ, Topol EJ. Direct-to-consumer pharmacogenomic testing is associated with increased physician utilisation. J Med Genet 2013; 51:83-9. [PMID: 24343916 DOI: 10.1136/jmedgenet-2013-101909] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Direct-to-consumer (DTC) genomic testing has generated controversy, however the actual impact of testing on consumer behaviour has been understudied, particularly for pharmacogenomic (PGx) testing. METHODS We recruited a sample of adults who purchased a DTC genomic test and had previously received their genomic test results for complex disease risk. All participants additionally underwent PGx testing. At follow-up, to assess the impact of PGx testing on consumer behaviour, healthcare utilisation and psychological status were compared between approximately a third of participants who had received their PGx results and the remaining two-thirds of participants who were still awaiting results. The PGx test included genetic testing for drug effectiveness or risk of side effects for 12 medications. RESULTS At follow-up, there were 481 PGx test recipients and 844 non-recipients still awaiting results. PGx test recipients had more physician visits (p=0.04) and were more likely to share their results with their physician (p=0.001). Both groups showed a decrease in anxiety symptoms from baseline to follow-up, with a trend for PGx recipients to show less of a decrease compared with non-recipients (p=0.10). PGx recipients were more likely to report that their physician ordered additional tests (p=0.01) based on their genomic test. There were no group differences in follow-up test-related distress (p=0.67). CONCLUSIONS DTC PGx risk profiling among a selected sample of individuals was associated with increased physician utilisation and did not result in any adverse changes in psychological health or follow-up test-related distress.
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Affiliation(s)
- Cinnamon S Bloss
- Scripps Genomic Medicine, Scripps Translational Science Institute, and Scripps Health, La Jolla, California, USA
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17
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van den Berg L, Henneman P, Willems van Dijk K, Delemarre-van de Waal HA, Oostra BA, van Duijn CM, Janssens ACJW. Heritability of dietary food intake patterns. Acta Diabetol 2013; 50:721-6. [PMID: 22415036 PMCID: PMC3898132 DOI: 10.1007/s00592-012-0387-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 02/27/2012] [Indexed: 11/18/2022]
Abstract
The quality and quantity of food intake affect body weight, but little is known about the genetics of such human dietary intake patterns in relation to the genetics of BMI. We aimed to estimate the heritability of dietary intake patterns and genetic correlation with BMI in participants of the Erasmus Rucphen Family study. The study included 1,690 individuals (42 % men; age range, 19-92), of whom 41.4 % were overweight and 15.9 % were obese. Self-report questionnaires were used to assess the number of days (0-7) on which participants consumed vegetables, fruit, fruit juice, fish, unhealthy snacks, fastfood, and soft drinks. Principal component analysis was applied to examine the correlations between the questionnaire items and to generate dietary intake pattern scores. Heritability and the shared genetic and shared non-genetic (environmental) correlations were estimated using the family structure of the cohort. Principal component analysis suggested that the questionnaire items could be grouped in a healthy and unhealthy dietary intake pattern, explaining 22 and 18 % of the phenotypic variance, respectively. The dietary intake patterns had a heritability of 0.32 for the healthy and 0.27 for the unhealthy pattern. Genetic correlations between the dietary intake patterns and BMI were not significant, but we found a significant environmental correlation between the unhealthy dietary intake pattern and BMI. Specific dietary intake patterns are associated with the risk of obesity and are heritable traits. The genetic factors that determine specific dietary intake patterns do not significantly overlap with the genetic factors that determine BMI.
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Affiliation(s)
- Linda van den Berg
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Henneman
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ko Willems van Dijk
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of General Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ben A. Oostra
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cornelia M. van Duijn
- Genetic-Epidemiology Unit, Department of Epidemiology and Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
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Aiyar L, Shuman C, Hayeems R, Dupuis A, Pu S, Wodak S, Chitayat D, Velsher L, Davies J. Risk estimates for complex disorders: comparing personal genome testing and family history. Genet Med 2013; 16:231-7. [DOI: 10.1038/gim.2013.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 06/24/2013] [Indexed: 11/09/2022] Open
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Walter FM, Prevost AT, Birt L, Grehan N, Restarick K, Morris HC, Sutton S, Rose P, Downing S, Emery JD. Development and evaluation of a brief self-completed family history screening tool for common chronic disease prevention in primary care. Br J Gen Pract 2013; 63:e393-400. [PMID: 23735410 PMCID: PMC3662456 DOI: 10.3399/bjgp13x668186] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/09/2012] [Accepted: 01/30/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Family history is an important risk factor for many common chronic diseases, but it remains underutilised for diagnostic assessment and disease prevention in routine primary care. AIM To develop and validate a brief self-completed family history questionnaire (FHQ) for systematic primary care assessment for family history of diabetes, ischaemic heart disease, breast cancer, and colorectal cancer. DESIGN AND SETTING Two-stage diagnostic validation study in 10 general practices in eastern England. Method Participants aged 18-50 years were identified via random sampling from electronic searches of general practice records. Participants completed a FHQ then had a three-generational 'gold standard' pedigree taken, to determine disease risk category. In stage 1, the FHQ comprised 12 items; in stage 2 the shorter 6-item FHQ was validated against the same 'gold standard'. RESULTS There were 1147 participants (stage 1: 618; stage 2: 529). Overall, 32% were at increased risk of one or more marker conditions (diabetes 18.9%, ischaemic heart disease 13.3%, breast cancer 6.2%, colorectal cancer 2.2%). The shorter 6-item FHQ performed very well for all four conditions: pooled data from both stages show diabetes, sensitivity = 98%, specificity = 94%; ischaemic heart disease, sensitivity = 93%, specificity = 81%; breast cancer, sensitivity = 81%, specificity = 83%; colorectal cancer, sensitivity = 96%, specificity = 88%, with an area under the receiver operating characteristic curve of 0.90 for males and 0.89 for females. CONCLUSION This brief self-completed FHQ shows good diagnostic accuracy for identifying people at higher risk of four common chronic diseases. It could be used in routine primary care to identify patients who would be most likely to benefit from a more detailed pedigree and risk assessment, and consequent management strategies.
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Affiliation(s)
- Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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20
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Armstrong K, Handorf EA, Chen J, Bristol Demeter MN. Breast cancer risk prediction and mammography biopsy decisions: a model-based study. Am J Prev Med 2013; 44:15-22. [PMID: 23253645 PMCID: PMC3527848 DOI: 10.1016/j.amepre.2012.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 09/27/2012] [Accepted: 10/02/2012] [Indexed: 01/25/2023]
Abstract
BACKGROUND Controversy continues about screening mammography, in part because of the risk of false-negative and false-positive mammograms. Pre-test breast cancer risk factors may improve the positive and negative predictive value of screening. PURPOSE To create a model that estimates the potential impact of pre-test risk prediction using clinical and genomic information on the reclassification of women with abnormal mammograms (BI-RADS3 and BI-RADS4 [Breast Imaging-Reporting and Data System]) above and below the threshold for breast biopsy. METHODS The current study modeled 1-year breast cancer risk in women with abnormal screening mammograms using existing data on breast cancer risk factors, 12 validated breast cancer single-nucleotide polymorphisms (SNPs), and probability of cancer given the BI-RADS category. Examination was made of reclassification of women above and below biopsy thresholds of 1%, 2%, and 3% risk. The Breast Cancer Surveillance Consortium data were collected from 1996 to 2002. Data analysis was conducted in 2010 and 2011. RESULTS Using a biopsy risk threshold of 2% and the standard risk factor model, 5% of women with a BI-RADS3 mammogram had a risk above the threshold, and 3% of women with BI-RADS4A mammograms had a risk below the threshold. The addition of 12 SNPs in the model resulted in 8% of women with a BI-RADS3 mammogram above the threshold for biopsy and 7% of women with BI-RADS4A mammograms below the threshold. CONCLUSIONS The incorporation of pre-test breast cancer risk factors could change biopsy decisions for a small proportion of women with abnormal mammograms. The greatest impact comes from standard breast cancer risk factors.
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Affiliation(s)
- Katrina Armstrong
- Department of Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Das M, Pal S, Ghosh A. Family history of type 2 diabetes and prevalence of metabolic syndrome in adult Asian Indians. J Cardiovasc Dis Res 2012; 3:104-8. [PMID: 22629026 PMCID: PMC3354451 DOI: 10.4103/0975-3583.95362] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Our objective was to test the association between familial risk of type 2 diabetes mellitus (T2DM) and the prevalence of metabolic syndrome (MS) in adult Asian Indians. Materials and Methods: A total of 448 adult (>30 years) individuals (257 males and 191 females) participated in the study. Familial risk of T2DM was classified into three groups viz., 1=both parents affected; 2=parent and/or siblings affected and 3=none or no family history for T2DM. Anthropometric measures, blood pressures, fasting blood glucose and metabolic profiles were studied using standard techniques. MS was defined accordingly. The prevalence of MS phenotypes was estimated and compared among the three familial risk strata. Results: Individuals with a history of both parents affected from diabetes had significantly higher (P<0.001) body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and fasting blood glucose (FBG; P=0.035) than individuals having no family history of T2DM. Significant difference was also noticed between individuals with and without MS according to the family history of diabetes (P<0.001). Differences were evident between individuals who fulfilled all the MS criteria (P=0.001) and individuals with only one or two criteria (phenotypes) according to family history of T2DM. Conclusion: Family history of T2DM had significant effect on individuals with MS as compared to their counterparts (individuals having no family history of T2DM). It therefore seems reasonable to argue that family history of T2DM could be useful as a predictive tool for early diagnosis and prevention of MS in Asian Indian population.
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Affiliation(s)
- Mithun Das
- Department of Anthropology, Sree Chaitanya College, Habra, India
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The use of genealogy databases for risk assessment in genetic health service: a systematic review. J Community Genet 2012; 4:1-7. [PMID: 22806134 DOI: 10.1007/s12687-012-0103-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 05/31/2012] [Indexed: 10/28/2022] Open
Abstract
UNLABELLED The use of electronic genealogical databases facilitates the construction of accurate and extensive pedigrees for potential use in genetic services. Genealogy databases can be linked to specific disease databases, such as cancer registries, in order to increase the accuracy of pedigrees used, and inform the genetic risk assessment. To review the published literature on the use of genealogy databases to construct pedigrees for risk assessment in genetic health service, a systematic literature search was undertaken using 12 combined search terms to identify all relevant published articles. DATA SOURCES EbscoHost, PubMed, Web of Science, Ovid and the "grey literature", as well as the reference lists of identified studies. Of 1,035 titles identified, two papers described a study on the use of genealogy databases in cancer risk assessment and two were discussion papers. While authors of the four papers described the potential use of genealogy databases in clinical genetic services, such use has not been adequately investigated and further research is required.
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