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Smith RA, Sillars A, Chesnut RP, Zhu X. Investigating Married Adults' Communal Coping with Genetic Health Risk and Perceived Discrimination. COMMUNICATION MONOGRAPHS 2017; 85:181-202. [PMID: 29731540 PMCID: PMC5930874 DOI: 10.1080/03637751.2017.1404618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/28/2017] [Indexed: 06/08/2023]
Abstract
Increased genetic testing in personalized medicine presents unique challenges for couples, including managing disease risk and potential discrimination as a couple. This study investigated couples' conflicts and support gaps as they coped with perceived genetic discrimination. We also explored the degree to which communal coping was beneficial in reducing support gaps, and ultimately stress. Dyadic analysis of married adults (N = 266, 133 couples), in which one person had the genetic risk for serious illness, showed that perceived discrimination predicted more frequent conflicts about AATD-related treatment, privacy boundaries, and finances, which, in turn, predicted wider gaps in emotion and esteem support, and greater stress for both spouses. Communal coping predicted lower support gaps for both partners and marginally lower stress.
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Affiliation(s)
| | | | | | - Xun Zhu
- The Pennsylvania State University
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2
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Genetic Insurance Discrimination in Sudden Arrhythmia Death Syndromes. ACTA ACUST UNITED AC 2017; 10:CIRCGENETICS.116.001442. [DOI: 10.1161/circgenetics.116.001442] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 11/02/2016] [Indexed: 12/12/2022]
Abstract
Background—
There is virtually no information assessing the insurability of families affected with Sudden Arrhythmia Death Syndromes (SADS) for the determination of the nonclinical implications of genetic screening. It is important to identify the barriers and challenges faced by families as a result of genetic screening for SADS to enable equitable access to insurance coverage.
Methods and Results—
To explore the insurance coverage experiences of SADS-affected families, we administered a cross-sectional online survey across North America from April 28, 2012 to November 13, 2013. Participants included individuals with a SADS diagnosis and their relatives who have applied for insurance (health, life, travel, and disability) or have existing insurance coverage. Of 202 participants, 92% had a SADS diagnosis (92%) as either a proband (50%) or an affected relative (42%); 8% of participants were unaffected family members of a proband; and genetic confirmation was reported by 73%. Of the 54% of SADS respondents who applied for insurance, 60% were rejected by insurers. The preexisting SADS diagnosis was the major reason reported for rejection (57%). Most respondents (80%) had insurance coverage through a spouse/parent plan at the time of diagnosis; 14% experienced a subsequent negative effect on coverage. Thirty-nine percent of affected SADS respondents reported an increase in insurance premium rates.
Conclusions—
Increased genetic testing has negatively impacted insurability for SADS patients and affected family members. The challenges in obtaining life and health insurance are mainly because of the preexisting condition, even in the presence of protective laws in the United States.
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Horgan D, Jansen M, Leyens L, Lal JA, Sudbrak R, Hackenitz E, Bußhoff U, Ballensiefen W, Brand A. An index of barriers for the implementation of personalised medicine and pharmacogenomics in Europe. Public Health Genomics 2014; 17:287-98. [PMID: 25401385 DOI: 10.1159/000368034] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Personalised medicine (PM) is an innovative way to produce better patient outcomes by using an individualised or stratified approach to disease and treatment rather than a collective treatment approach for patients. Despite its tangible advantages, the complex process to translate PM into the member states and European healthcare systems has delayed its uptake. The aim of this study is to identify relevant barriers represented by an index to summarise challenging areas for the implementation of PM in Europe. METHODS A systematic literature review was conducted, and a gaps-and-needs assessment together with a strengths-weaknesses-opportunities-and-threats analysis were applied to review strategic reports and conduct interviews with key stakeholders. Furthermore, surveys were sent out to representatives of stakeholder groups. The index was constructed based on the priorisation of relevant factors by stakeholders. RESULTS A need for stakeholder-agreed standards at all levels of implementation of PM exists, from validating biomarkers to definitions of 'informed consent'. The barriers to implement PM are identified in 7 areas, namely, stakeholder involvement, standardisation, interoperable infrastructure, European-level policy making, funding, data and research, and healthcare systems. CONCLUSIONS Challenges in the above-mentioned areas can and must be successfully tackled if we are to create a healthier Europe through PM. In order to create an environment in which PM can thrive for the patients' best outcomes, there is an urgent need for systematic actions to remove as many barriers as possible.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine (EAPM), Brussels, Belgium
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4
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Gharani N, Keller MA, Stack CB, Hodges LM, Schmidlen TJ, Lynch DE, Gordon ES, Christman MF. The Coriell personalized medicine collaborative pharmacogenomics appraisal, evidence scoring and interpretation system. Genome Med 2013; 5:93. [PMID: 24134832 PMCID: PMC3978656 DOI: 10.1186/gm499] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 09/16/2013] [Indexed: 12/15/2022] Open
Abstract
Implementation of pharmacogenomics (PGx) in clinical care can lead to improved drug efficacy and reduced adverse drug reactions. However, there has been a lag in adoption of PGx tests in clinical practice. This is due in part to a paucity of rigorous systems for translating published clinical and scientific data into standardized diagnostic tests with clear therapeutic recommendations. Here we describe the Pharmacogenomics Appraisal, Evidence Scoring and Interpretation System (PhAESIS), developed as part of the Coriell Personalized Medicine Collaborative research study, and its application to seven commonly prescribed drugs.
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Affiliation(s)
- Neda Gharani
- The Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA
| | - Margaret A Keller
- The Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA ; Current Address: American Red Cross, 700 Spring Garden Street, Philadelphia, PA 19123, USA
| | - Catharine B Stack
- The Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA ; Current Address: Annals of Internal Medicine, 190 N. Independence Mall West, Philadelphia, PA 19106, USA
| | - Laura M Hodges
- The Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA
| | - Tara J Schmidlen
- The Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA
| | - Daniel E Lynch
- The Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA
| | - Erynn S Gordon
- The Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA
| | - Michael F Christman
- The Coriell Institute for Medical Research, 403 Haddon Avenue, Camden, NJ 08103, USA
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Ethnicity, educational level and attitudes contribute to parental intentions about genetic testing for child obesity. J Community Genet 2013; 4:243-50. [PMID: 23389423 DOI: 10.1007/s12687-013-0137-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 01/20/2013] [Indexed: 10/27/2022] Open
Abstract
The objective of this paper is to assess parental beliefs and intentions about genetic testing for their children in a multi-ethnic population with the aim of acquiring information to guide interventions for obesity prevention and management. A cross-sectional survey was conducted in parents of native Dutch children and children from a large minority population (Turks) selected from Youth Health Care registries. The age range of the children was 5-11 years. Parents with lower levels of education and parents of non-native children were more convinced that overweight has a genetic cause and their intentions to test the genetic predisposition of their child to overweight were firmer. A firmer intention to test the child was associated with the parents' perceptions of their child's susceptibility to being overweight, a positive attitude towards genetic testing, and anticipated regret at not having the child tested while at risk for overweight. Interaction effects were found in ethnic and socio-economic groups. Ethnicity and educational level play a role in parental beliefs about child overweight and genetic testing. Education programmes about obesity risk, genetic testing and the importance of behaviour change should be tailored to the cultural and behavioural factors relevant to ethnic and socio-economic target groups.
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Meisel SF, Beeken RJ, van Jaarsveld CHM, Wardle J. Genetic test feedback with weight control advice: study protocol for a randomized controlled trial. Trials 2012; 13:235. [PMID: 23216922 PMCID: PMC3575361 DOI: 10.1186/1745-6215-13-235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 11/14/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Genetic testing for risk of weight gain is already available over the internet despite uncertain benefits and concerns about adverse emotional or behavioral effects. Few studies have assessed the effect of adding genetic test feedback to weight control advice, even though one of the proposed applications of genetic testing is to stimulate preventive action. This study will investigate the motivational effect of adding genetic test feedback to simple weight control advice in a situation where weight gain is relatively common. METHODS/DESIGN First-year university students (n = 800) will be randomized to receive either 1) their personal genetic test result for a gene (FTO) related to weight gain susceptibility in addition to a leaflet with simple weight control advice ('Feedback + Advice' group, FA), or 2) only the leaflet containing simple weight control advice ('Advice Only' group, AO).Motivation to avoid weight gain and active use of weight control strategies will be assessed one month after receipt of the leaflet with or without genetic test feedback. Weight and body fat will be measured at baseline and eight months follow-up. We will also assess short-term psychological reactions to the genetic test result. In addition, we will explore interactions between feedback condition and gene test status. DISCUSSION We hope to provide a first indication of the clinical utility of weight-related genetic test feedback in the prevention context. TRIAL REGISTRATION Current controlled trials ISRCTN91178663.
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Affiliation(s)
- Susanne F Meisel
- Health Behavior Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Rebecca J Beeken
- Health Behavior Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Cornelia HM van Jaarsveld
- Health Behavior Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Jane Wardle
- Health Behavior Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
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Otlowski M, Taylor S, Bombard Y. Genetic Discrimination: International Perspectives. Annu Rev Genomics Hum Genet 2012; 13:433-54. [DOI: 10.1146/annurev-genom-090711-163800] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - S. Taylor
- School of Sociology and Social Work, University of Tasmania, Hobart, Tasmania 7001, Australia;
| | - Y. Bombard
- Department of Epidemiology and Public Health, Division of Health Policy and Administration, Yale University, New Haven, Connecticut 06510
- Department of Epidemiology and Biostatistics, Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center, New York, NY 10065;
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Meisel SF, Shankar A, Kivimaki M, Wardle J. Consent to DNA collection in epidemiological studies: findings from the Whitehall II cohort and the English Longitudinal Study of Ageing. Genet Med 2012; 14:201-6. [PMID: 22261757 DOI: 10.1038/gim.0b013e31822e5778] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Epidemiological studies increasingly include DNA sampling in their protocols, but participation may vary by demographic, psychological, or health characteristics. This analysis explored sociodemographic (age, gender, religion, and education), health-related, and psychological predictors of participation in genetic data collection in two large epidemiological studies: the Whitehall II cohort and the English Longitudinal Study of Ageing. DNA consent in both studies was not obtained on initial enrollment, but after long-standing participation in the study. METHODS Study participants who accepted or declined DNA sampling were compared. RESULTS Very few participants declined DNA sampling; 1.6% in Whitehall II and 1.0% in English Longitudinal Study of Ageing. In both cohorts, participants who declined were more likely to be female, nonwhite, and involved in religious activities; although only the ethnic effect consistently survived multivariate analyses. Decliners also felt less in control of events in their lives than those who consented, and this remained significant in multivariate analysis in the English Longitudinal Study of Ageing sample. CONCLUSION Consent to DNA sampling was very high in two established UK cohort studies. Differences between the subset of the population unwilling to provide DNA samples and those who consented were modest, although this may be due to the highly selected populations in these cohorts. However, our findings suggest that a greater proportion of decliners would create an important source of selection bias.
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Affiliation(s)
- Susanne F Meisel
- Health Behaviour Research Centre, University College London, London, UK.
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Ross S, Anand SS, Joseph P, Paré G. Promises and challenges of pharmacogenetics: an overview of study design, methodological and statistical issues. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012001. [PMID: 24175062 PMCID: PMC3738322 DOI: 10.1258/cvd.2012.012001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Pharmacogenetics is the study of inherited variation in drug response. The goal of pharmacogenetics is to develop novel ways of maximizing drug efficacy and minimizing toxicity for individual patients. Personalized medicine has the potential to allow for a patient's genetic information to predict optimal dosage for a drug with a narrow therapeutic index, to select the most appropriate pharmacological agent for a given patient and to develop cost-effective treatments. Although there is supporting evidence in favour of pharmacogenetics, its adoption in clinical practice has been slow because of sometimes conflicting findings among studies. This failure to replicate findings may result from a lack of high-quality pharmacogenetic studies, as well as unresolved methodological and statistical issues. The objective of this review is to discuss the benefits of incorporating pharmacogenetics into clinical practice. We will also address outstanding methodological and statistical issues that may lead to heterogeneity among reported pharmacogenetic studies and how they may be addressed.
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Affiliation(s)
- Stephanie Ross
- Population Health Research Institute, Hamilton Health Sciences, McMaster University , Hamilton, Ontario L8L 2X2 , Canada
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Meisel SF, Walker C, Wardle J. Psychological responses to genetic testing for weight gain: a vignette study. Obesity (Silver Spring) 2012; 20:540-6. [PMID: 22030987 DOI: 10.1038/oby.2011.324] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Genetic testing for obesity risk is increasingly available to the public but few studies have examined motivational or affective reactions. Here we report findings from a "vignette" study investigating reactions to "higher-risk" and "average-risk" results for the obesity-related FTO gene in two groups: a panel sample of individuals with weight concerns, for whom testing may have treatment implications (n = 306, mean age = 45 years, mean BMI = 35) and a student sample (n = 395, mean age = 25 years, mean BMI = 23), for whom testing would have implications for obesity prevention. Participants were given FTO gene information that described higher-risk alleles as linked with modest weight gain and slightly higher risk of obesity. They responded to both higher- and average-risk vignettes, with order randomized. Interest in genetic testing was high overall, and higher in panel respondents than students (93% vs. 78% would "probably" or "definitely" have the test; P < 0.001). In students, a higher-risk result generated higher motivation to change (d = 0.15; P < 0.001), but also slightly higher negative affect (d = 0.03, P < 0.001) and fatalism (d = 0.05, P < 0.001) than an average-risk result. Panel respondents also had higher motivation to change (d = 0.17, P < 0.001) as well as relief about having an explanation for their body weight (d = 0.02, P = 0.013) in the higher-risk condition, but no increase in fatalism or depression. These results suggest that at the level of anticipated responses to FTO gene feedback, higher-risk results had positive motivational effects with minimal changes in negative affect or fatalism. Genetic testing has the potential to be a useful clinical or preventive tool when combined with appropriate information.
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Affiliation(s)
- Susanne F Meisel
- Health Behavior Research Centre, University College London, London, UK.
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Springer JA, Iannotti NV, Sprague JE, Kane MD. Construction of a drug safety assurance information system based on clinical genotyping. ISRN BIOINFORMATICS 2012; 2012:982737. [PMID: 25969745 PMCID: PMC4407205 DOI: 10.5402/2012/982737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 09/11/2011] [Indexed: 11/23/2022]
Abstract
To capitalize on the vast potential of patient genetic information to aid in assuring drug safety, a substantial effort is needed in both the training of healthcare professionals and the operational enablement of clinical environments. Our research aims to satisfy these needs through the development of a drug safety assurance information system (GeneScription) based on clinical genotyping that utilizes patient-specific genetic information to predict and prevent adverse drug responses. In this paper, we present the motivations for this work, the algorithms at the heart of GeneScription, and a discussion of our system and its uses. We also describe our efforts to validate GeneScription through its evaluation by practicing pharmacists and pharmacy professors and its repeated use in training pharmacists. The positive assessment of the GeneScription software tool by these domain experts provides strong validation of the importance, accuracy, and effectiveness of GeneScription.
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Affiliation(s)
- John A Springer
- Department of Computer and Information Technology, Purdue University, West Lafayette, IN 47907, USA ; Bindley Bioscience Center, Purdue University, IN 47907, USA
| | - Nicholas V Iannotti
- Department of Computer and Information Technology, Purdue University, West Lafayette, IN 47907, USA
| | - Jon E Sprague
- Raabe College of Pharmacy, Ohio Northern University, Ada, OH 45810, USA
| | - Michael D Kane
- Department of Computer and Information Technology, Purdue University, West Lafayette, IN 47907, USA ; Bindley Bioscience Center, Purdue University, IN 47907, USA
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Taylor S. A Population-Based Survey in Australia of Men’s and Women’s Perceptions of Genetic Risk and Predictive Genetic Testing and Implications for Primary Care. Public Health Genomics 2011; 14:325-36. [DOI: 10.1159/000324706] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 01/26/2011] [Indexed: 11/19/2022] Open
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Rose JE, Behm FM, Drgon T, Johnson C, Uhl GR. Personalized smoking cessation: interactions between nicotine dose, dependence and quit-success genotype score. Mol Med 2010; 16:247-53. [PMID: 20379614 PMCID: PMC2896464 DOI: 10.2119/molmed.2009.00159] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 03/16/2010] [Indexed: 11/06/2022] Open
Abstract
Improving and targeting nicotine replacement therapy (NRT) are cost-effective strategies for reducing adverse health consequences for smokers. Treatment studies document the efficacy of precessation NRT and support important roles for level of nicotine dependence and precessation smoking reduction in successful quitting. However, prior work has not identified the optimal precessation dose or means for personalizing NRT. Genome-wide association has identified groups of genomic markers associated with successful quitting, allowing us to develop a v1.0 "quit-success" genotype score. We now report influences of v1.0 quit-success genotype score, level of dependence and precessation smoking reduction in a smoking cessation trial that examined effects of 21 versus 42 mg/24 h precessation NRT. Four hundred seventy-nine smokers were randomized to 21 or 42 mg NRT, initiated 2 wks prior to target quit dates. We monitored self-reported abstinence and end-expired air carbon monoxide (CO). Genotyping used Affymetrix arrays (Santa Clara, CA, USA). The primary outcome was 10-wk continuous smoking abstinence. NRT dose, level of nicotine dependence and genotype scores displayed significant interactive effects on successful quitting. Successful abstinence also was predicted by CO reductions during precessation NRT. These results document ways in which smoking cessation strategies can be personalized based on levels of nicotine dependence, genotype scores and CO monitoring. These assessments, taken together, can help match most smokers with optimal NRT doses and help rapidly identify some who may be better treated using other methods.
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Affiliation(s)
- Jed E Rose
- Department of Psychiatry and Center for Nicotine and Smoking Cessation Research, Duke University, Durham, North Carolina 27705, USA.
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Margaret A Keller, Erynn S Gordon, Catharine B Stack, Neda G. Coriell Personalized Medicine Collaborative®: a prospective study of the utility of personalized medicine. Per Med 2010; 7:301-317. [DOI: 10.2217/pme.10.13] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There is a dearth of large prospective studies to determine if genetic risk factors are useful predictors of health outcomes and if reporting them to individuals or physicians changes health behavior. The Coriell Personalized Medicine Collaborative® (CPMC, NJ, USA) is a prospective observational study with three cohorts – community, cancer and chronic disease cohorts. Participants provide detailed medical history through a dynamic internet-based portal. DNA is tested and personalized risk reports are provided for potentially actionable health conditions. To date, the community cohort has enrolled 4372 participants. The internet-based portal supplies educational content, captures phenotypic data and delivers customized risk reports. The Informed Cohort Oversight Board has approved 16 health conditions to date, and risk reports with genetic and nongenetic risks for six conditions have been released. The majority (87%) of participants who completed requisite questionnaires viewed at least one report. The CPMC is a cohort study delivering customized risk reports for actionable conditions using a web interface and measuring outcomes longitudinally.
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Tercyak KP. Introduction to the special issue: psychological aspects of genomics and child health. J Pediatr Psychol 2009; 34:589-95. [PMID: 19060299 PMCID: PMC2699249 DOI: 10.1093/jpepsy/jsn127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Revised: 11/04/2008] [Accepted: 11/04/2008] [Indexed: 12/20/2022] Open
Affiliation(s)
- Kenneth P Tercyak
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA.
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