1
|
Torre-Hernandez CADL, Guedez Y, Pineda-Bernal L, Ojeda HA, Guevara-Guerra YA. [Medical genetics services in VenezuelaServiços de genética médica na Venezuela]. Rev Panam Salud Publica 2019; 42:e78. [PMID: 31093106 PMCID: PMC6386045 DOI: 10.26633/rpsp.2018.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
Objetivo. Caracterizar los servicios de genética médica de Venezuela con el fin de conocer la distribución de sus recursos, servicios, tecnologías y formación profesional. Métodos. Se realizó una investigación descriptiva, de tipo documental, entre febrero y noviembre de 2016 de los servicios de genética, mediante la revisión de fuentes documentales primarias y el uso de una ficha de recolección de datos en las instituciones de investigación para información referente a disponibilidad de recursos humanos, servicios de atención y diagnóstico, así como formación profesional, y la base de datos de la Sociedad Venezolana de Genética Humana, que permitió identificar los recursos humanos en centros de genética. El criterio de inclusión fue instituciones con recursos humanos formados en genética. Resultados. Los criterios fueron cumplidos por cuatro instituciones de investigación, siete universidades y cuatro hospitales, todos del sector público. En estas instituciones trabajan 124 profesionales, 56 son médicos y 68 se desempeñan en el área de laboratorio. Sesenta y dos por ciento de los profesionales pertenecen a las instituciones de investigación; estas cuentan con servicios de atención clínico, diagnóstico molecular, bioquímico y, con menos frecuencia, los análisis citogenéticos, prenatales y forenses. Cinco regiones del país tienen entre dos y cuatro médicos genetistas por millón de habitantes. El 96% de los profesionales de laboratorio se localizan en dos regiones (Capital y Zuliana), cinco regiones carecen de ellos. Las instituciones de investigación han formado en genética el 40% de los recursos humanos actuales del país. Conclusiones. Los servicios de genética presentan gran variabilidad de opciones diagnósticas, un acceso limitado y grandes aportes en formación profesional; se requieren políticas coordinadas que los integre y disminuya las brechas.
Collapse
Affiliation(s)
| | - Yvonne Guedez
- Servicio Autónomo Instituto de Altos Estudios "Dr. Arnoldo Gabaldón", Aragua, Venezuela
| | - Lennie Pineda-Bernal
- Instituto de Investigaciones Genéticas "Dr. Heber Villalobos Cabrera", Universidad del Zulia, Maracaibo, Venezuela
| | - Héctor A Ojeda
- Laboratorio de Genética Humana, Instituto Venezolano de Investigaciones Científicas (IVIC), Miranda, Venezuela
| | - Yuliana A Guevara-Guerra
- Unidad de Errores Innatos del Metabolismo, Fundación Instituto de Estudios Avanzados (IDEA), Miranda, Venezuela
| |
Collapse
|
2
|
Bucio D, Ormond KE, Hernandez D, Bustamante CD, Lopez Pineda A. A genetic counseling needs assessment of Mexico. Mol Genet Genomic Med 2019; 7:e668. [PMID: 30938092 PMCID: PMC6503023 DOI: 10.1002/mgg3.668] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/03/2019] [Accepted: 02/11/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND While genetic counseling has expanded globally, Mexico has not adopted it as a separate profession. Given the rapid expansion of genetic and genomic services, understanding the current genetic counseling landscape in Mexico is crucial to improving healthcare outcomes. METHODS Our needs assessment strategy has two components. First, we gathered quantitative data about genetics education and medical geneticists' geographic distribution through an exhaustive compilation of available information across several medical schools and public databases. Second, we conducted semi-structured interviews of 19 key-informants from 10 Mexican states remotely with digital recording and transcription. RESULTS Across 32 states, ~54% of enrolled medical students receive no medical genetics training, and only Mexico City averages at least one medical geneticist per 100,000 people. Barriers to genetic counseling services include: geographic distribution of medical geneticists, lack of access to diagnostic tools, patient health literacy and cultural beliefs, and education in medical genetics/genetic counseling. Participants reported generally positive attitudes towards a genetic counseling profession; concerns regarding a current shortage of available jobs for medical geneticists persisted. CONCLUSION To create a foundation that can support a genetic counseling profession in Mexico, the clinical significance of medical genetics must be promoted nationwide. Potential approaches include: requiring medical genetics coursework, developing community genetics services, and increasing jobs for medical geneticists.
Collapse
Affiliation(s)
- Daiana Bucio
- Department of Genetics, School of Medicine, Stanford University, Stanford, California.,Department of Clinical Genetics and Genomics, Roy and Patricia Disney Family Cancer Center, Providence Saint Joseph Medical Center, Burbank, California
| | - Kelly E Ormond
- Department of Genetics, School of Medicine, Stanford University, Stanford, California.,Stanford Center for Biomedical Ethics, School of Medicine, Stanford University, Stanford, California
| | - Daisy Hernandez
- Department of Genetics, School of Medicine, Stanford University, Stanford, California.,Department of Pediatric Genetics, Loma Linda University Health, San Bernardino, California
| | - Carlos D Bustamante
- Department of Genetics, School of Medicine, Stanford University, Stanford, California.,Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California.,Chan Zuckerberg Biohub, San Francisco, California
| | - Arturo Lopez Pineda
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California
| |
Collapse
|
3
|
Penchaszadeh VB. Ethical issues in genetics and public health in Latin America with a focus on Argentina. J Community Genet 2015; 6:223-30. [PMID: 25666434 PMCID: PMC4524838 DOI: 10.1007/s12687-015-0217-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022] Open
Abstract
This paper reviews the health situation and developments in medical genetics and bioethics in Latin America, with a focus on Argentina. The region is the most inequitable in the world, with an average Gini Index of 52.5 and 25 % of the population living in poverty. Health expenditures are low and health systems are fragmented and privatised, with curtailed governmental responsibility and regulation. Health-care decision making is mostly in the hands of private insurance corporations and the medical-industrial complex, so that what is (or is not) covered by health plans is arbitrary and determined by the market and not by population health needs. This inequity and the lack of meaningful governmental intervention in the provision of health care, including genetic services, are at the heart of the bioethical dilemmas in Latin America. It is not surprising, therefore, that bioethics in the region has developed an approach grounded in social justice, equity and human rights as guiding principles, in contrast to the individualism espoused by Anglo-Saxon bioethics. The main ethical issues identified in genetics in Latin America are (1) inequity in access to genetic services, particularly in prenatal diagnosis, (2) genetic discrimination and (3) the lack of adherence to internationally accepted requisites of clinical validity and utility for diagnostic and predictive genetic testing. In this context, there is a risk that the impressive advances in genetics/genomics occurring in developed countries may fail to improve the public's health and deepen inequity, with the implementation of expensive genetic technologies of unproven validity.
Collapse
|
4
|
Rodas-Pérez C, Clarke A, Powell J, Thorogood M. Challenges for providing genetic counselling in Colombian genetic clinics: the viewpoint of the physicians providing genetic consultations. J Community Genet 2015; 6:301-11. [PMID: 26088032 DOI: 10.1007/s12687-015-0237-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022] Open
Abstract
This study explores the provision of clinical genetic services in Colombia, in order to promote improvements in these services. We carried out semi-structured interviews with 20 doctors working in genetic clinics, and we report the challenges in providing genetic counselling that they have identified. Education and training in genetics in Colombian medical schools were described as inadequate, and interviewees found that many of their medical colleagues knew too little to be able to refer appropriately to a genetics service. The doctors interviewed recognised their own limitations, including lack of knowledge, absence of training in communication skills and the strong influence of religious beliefs on the consultations of some colleagues. There may also be communication problems during the consultation: patients may fail to understand the explanations given or to accept the incurable nature of genetic conditions. There are also problems with access, because genetic services are not covered by the health insurance system in Colombia. More training in genetics is required at medical schools in Colombia, at the undergraduate and postgraduate level. There was a consensus that most medical specialities are limited in their knowledge, awareness and understanding of genetics. Furthermore, many medical geneticists did not believe that other health professionals should work as genetic counsellors. These findings may assist in the development of improved genetic counselling services in Colombia and in the establishment of an enhanced academic curriculum of basic and clinical genetics at Colombian universities.
Collapse
|
5
|
Rojas-Martínez A, Giraldo-Ríos A, Jiménez-Arce G, de Vargas AF, Giugliani R. RELAGH - The challenge of having a scientific network in Latin America: An account from the presidents. Genet Mol Biol 2014; 37:305-9. [PMID: 24764765 PMCID: PMC3983587 DOI: 10.1590/s1415-47572014000200017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Latin America and the Caribbean region make up one of the largest areas of the world, and this region is characterized by a complex mixture of ethnic groups sharing Iberian languages. The area is comprised of nations and regions with different levels of social development. This region has experienced historical advances in the last decades to increase the minimal standards of quality of life; however, several factors, such as concentrated populations in large urban centers and isolated and poor communities, still have an important impact on medical services, particularly genetics services. Latin American researchers have greatly contributed to the development of human genetics and historic inter-ethnic diversity, and the multiplicity of geographic areas are unique for the study of gene-environment interactions. As a result of regional developments in the fields of human and medical genetics, the Latin American Network of Human Genetics (Red Latinoamericana de Genética Humana - RELAGH) was created in 2001 to foster the networking of national associations and societies dedicated to these scientific disciplines. RELAGH has developed important educational activities, such as the Latin American School of Human and Medical Genetics (ELAG), and has held three biannual meetings to encourage international research cooperation among the member countries and international organizations. Since its foundation, RELAGH has been admitted as a full regional member to the International Federation of Human Genetics Societies. This article describes the historical aspects, activities, developments, and challenges that are still faced by the Network.
Collapse
Affiliation(s)
- Augusto Rojas-Martínez
- Facultad de Medicina and Centro de Investigación y Desarrollo en Ciencias de la Salud, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Gerardo Jiménez-Arce
- Sección Genética y Biotecnología, Escuela de Biología, Universidad de Costa Rica, San José, Costa Rica
| | | | - Roberto Giugliani
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| |
Collapse
|
6
|
Delivering Genetic Education and Genetic Counseling for Rare Diseases in Rural Brazil. J Genet Couns 2013; 22:830-4. [DOI: 10.1007/s10897-013-9570-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 01/01/2013] [Indexed: 10/27/2022]
|
7
|
Genetic testing and services in Argentina. J Community Genet 2012; 4:343-54. [PMID: 22528519 DOI: 10.1007/s12687-012-0093-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 03/21/2012] [Indexed: 10/28/2022] Open
Abstract
Argentina is a middle-income country with a population of 40 million people. The structure of morbidity and mortality approaches that of more developed nations, with congenital and genetic disorders contributing significantly to ill health. The health delivery system is mixed, with public, social security, and private sectors which together spend close to 10 % of the GNP. Health subsectors are decentralized at provincial and municipality levels, where health planning and financing occurs, leading to fragmentation, inefficiency, and inequities. There are about 41 clinical genetic units in major medical centers in large cities, staffed by about 120 clinical geneticists, although only a few units are fully comprehensive genetic centers. Duplications, deficiencies, and poor regionalization and coordination affect health care delivery in general and in genetics. Funding for genetic services is limited due to poor understanding and lack of political will on the part of health authorities. Recently, however, there have been some interesting initiatives by national and provincial ministries of health to improve genetic services delivery by increasing coordination and regionalization. At the same time, training in genetics of health professionals is occurring, particularly in primary health care, and registries of congenital defects are being put in place. These developments are occurring in conjunction with a new awareness by health authorities of the importance of genetics in health care and research, a heightened activism of patient organizations demanding services for neglected conditions, as well as of women movements for the right to safe abortion.
Collapse
|
8
|
Oliveira CIF, Richieri-Costa A, Carvalho Ferrarese VC, Móz Vaz DC, Fett-Conte AC. Birth defects in newborns and stillborns: an example of the Brazilian reality. BMC Res Notes 2011; 4:343. [PMID: 21906299 PMCID: PMC3180470 DOI: 10.1186/1756-0500-4-343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 09/09/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study constitutes a clinical and genetic study of all newborn and stillborn infants with birth defects seen in a period of one year in a medical school hospital located in Brazil. The aims of this study were to estimate the incidence, causes and consequences of the defects. METHODS For all infants we carried out physical assessment, photographic records, analysis of medical records and collection of additional information with the family, besides the karyotypic analysis or molecular tests in indicated cases. RESULT The incidence of birth defects was 2.8%. Among them, the etiology was identified in 73.6% (ci95%: 64.4-81.6%). Etiology involving the participation of genetic factors single or associated with environmental factors) was more frequent 94.5%, ci95%: 88.5-98.0%) than those caused exclusively by environmental factors (alcohol in and gestational diabetes mellitus). The conclusive or presumed diagnosis was possible in 85% of the cases. Among them, the isolated congenital heart disease (9.5%) and Down syndrome (9.5%) were the most common, followed by gastroschisis (8.4%), neural tube defects (7.4%) and clubfoot (5.3%). Maternal age, parental consanguinity, exposure to teratogenic agents and family susceptibility were some of the identified risk factors. The most common observed consequences were prolonged hospital stays and death. CONCLUSIONS The current incidence of birth defects among newborns and stillbirths of in our population is similar to those obtained by other studies performed in Brazil and in other underdeveloped countries. Birth defects are one of the major causes leading to lost years of potential life. The study of birth defects in underdeveloped countries should continue. The identification of incidence, risk factors and consequences are essential for planning preventive measures and effective treatments.
Collapse
Affiliation(s)
- Camila Ive Ferreira Oliveira
- Departamento de Biologia, Instituto de Biociências, Letras e Ciências Exatas, Universidade Estadual Paulista - UNESP, São José do Rio Preto, SP, Brasil
| | - Antonio Richieri-Costa
- Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - USP, Bauru, SP, Brasil
| | | | - Denise Cristina Móz Vaz
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
| | - Agnes Cristina Fett-Conte
- Departamento de Biologia Molecular, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
| |
Collapse
|
9
|
Strauss E. Barriers to care of chronic hepatitis patients in Latin America. Arch Med Res 2007; 38:711-5. [PMID: 17613362 DOI: 10.1016/j.arcmed.2007.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 02/02/2007] [Indexed: 02/07/2023]
Abstract
Delay in diagnosis of chronic hepatitis due to HCV or HBV is mainly caused by lack of information about these prevalent and life-threatening disorders. Diagnostic tests are either not easily available or not requested by primary care physicians. When cases positive for hepatitis-B markers or anti-HCV are found, misleading guidance may be given to patients. Absence of symptoms associated with lack of information is another barrier to the care of chronic hepatitis patients. Management of these diseases is not simple, and treatment options and schedules are in rapid and continuous evolution. Surveillance of patients with chronic hepatitis before, during and after antiviral therapy is mandatory. For patients with no indication for therapy, identification of optimal follow-up frequency constitutes a problem, as does determination of the correct amount and type of diagnostic tests to be used. Another important barrier to care of patients with chronic hepatitis is the absence of an ideal drug, namely, one that is inexpensive, does not have collateral effects, and has very high percentages of cure or resolution. Access to therapy is uncertain, and the side effects of interferon frighten some patients and physicians. Lack of adherence to the medication, early interruption, and the need for other supportive therapies are frequent barriers to successful treatment.
Collapse
Affiliation(s)
- Edna Strauss
- Internal Medicine, School of Medicine, University of São Paulo, Brazil.
| |
Collapse
|
10
|
Kofman-Alfaro S, Penchaszadeh VB. Community Genetic Services in Latin America and Regional Network of Medical Genetics. Public Health Genomics 2004; 7:157-9. [PMID: 15542925 DOI: 10.1159/000080789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The World Health Organization sponsored a Consultation on Community Genetic Services and a Regional Network of Medical Genetics in Latin America in Porto Alegre, Brazil, on June 19, 2003. The main recommendations of the meeting included: (a) the call for government funding of services, research and education in medical genetics; (b) the conduct of epidemiological research on the prevalence and types of birth defects, genetic disorders and genetic predispositions to common diseases; (c) the education of health professionals in genetics; (d) the education of genetic professionals in community health and public health genetics; (e) the fostering of interactions between clinical geneticists, public health personnel, primary health care workers and community organizations, and (f) a better planning of regionalized services to avoid duplication and inefficiency.
Collapse
Affiliation(s)
- Susana Kofman-Alfaro
- Department of Genetics, General Hospital of Mexico, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | |
Collapse
|