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Tawfik SM, Elhosseiny AA, Galal AA, William MB, Qansuwa E, Elbaz RM, Salama M. Health inequity in genomic personalized medicine in underrepresented populations: a look at the current evidence. Funct Integr Genomics 2023; 23:54. [PMID: 36719510 DOI: 10.1007/s10142-023-00979-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Abstract
Improvements in sequencing technology coupled with dramatic declines in the cost of genome sequencing have led to a proportional growth in the size and number of genetic datasets since the release of the human genetic sequence by The Human Genome Project (HGP) international consortium. The HGP was undeniably a significant scientific success, a turning point in human genetics and the beginning of human genomics. This burst of genetic information has led to a greater understanding of disease pathology and the potential of employing this data to deliver more precise patient care. Hence, the recognition of high-penetrance disease-causing mutations which encode drivers of disease has made the management of most diseases more specific. Nonetheless, while genetic scores are becoming more extensively used, their application in the real world is expected to be limited due to the lack of diversity in the data used to construct them. Underrepresented populations, such as racial and ethnic minorities, low-income individuals, and those living in rural areas, often experience greater health disparities and worse health outcomes compared to the general population. These disparities are often the result of systemic barriers, such as poverty, discrimination, and limited access to healthcare. Addressing health inequity in underrepresented populations requires addressing the underlying social determinants of health and implementing policies and programs which promoted health equity and reduce disparities. This can include expanding access to affordable healthcare, addressing poverty and unemployment, and promoting policies that combat discrimination and racism.
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Affiliation(s)
- Sherouk M Tawfik
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, 11835, Egypt.,Department of Pharmacology and Biochemistry, Faculty of Pharmacy, The British University in Egypt (BUE), Cairo, 11837, Egypt
| | - Aliaa A Elhosseiny
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, 11835, Egypt.,Department of Pharmacology and Biochemistry, Faculty of Pharmacy, The British University in Egypt (BUE), Cairo, 11837, Egypt
| | - Aya A Galal
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, 11835, Egypt.,Systems Genomics Laboratory, The American University in Cairo, New Cairo, Egypt
| | - Martina B William
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, 11835, Egypt.,Department of Clinical Pharmacy, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Esraa Qansuwa
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, 11835, Egypt
| | - Rana M Elbaz
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, 11835, Egypt
| | - Mohamed Salama
- Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, 11835, Egypt. .,Faculty of Medicine, Mansoura University, Mansoura, Egypt. .,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
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Boardman FK, Clark C, Jungkurth E, Young PJ. Social and cultural influences on genetic screening programme acceptability: A mixed-methods study of the views of adults, carriers, and family members living with thalassemia in the UK. J Genet Couns 2020; 29:1026-1040. [PMID: 32114710 PMCID: PMC7754126 DOI: 10.1002/jgc4.1231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/01/2020] [Accepted: 02/01/2020] [Indexed: 12/15/2022]
Abstract
As population‐level carrier screening panels for reprogenetic information emerge globally, conditions to be included, and the timing of implementation is widely debated. Thalassemia is the only condition for which population‐based prenatal carrier screening is offered in the UK. However, little is known about the views and experiences of the UK thalassemia‐affected community toward this screening or other forms of genetic screening for thalassemia (newborn, preconception), despite the range of direct consequences of screening programmes for this group. Using a mixed‐methods integrative analysis (qualitative interviews n = 20 and quantitative survey n = 80), this study outlines the experiences and attitudes of adults with thalassemia, their family members, and screen‐identified thalassemia carriers toward preconception, prenatal, and newborn screening for thalassemia. The majority of participants described thalassemia as a burdensome condition with a range of negative impacts, which contributed to their strong support for screening in all its potential formats. However, the data also highlight the challenges of each screening mode for this group, reflected in the high level of value conflict in participants' accounts and decisions. Cultural, social, and (to a lesser extent) religious factors were found to mitigate against the advantages of early screens, particularly within faith communities. Social stigma emerged as key to this process, informing the way that thalassemia severity was not only perceived, but also experienced by affected adults, which ultimately influenced screening uptake and outcomes. These findings suggest that cultural and social sensitivity is as important as the mode of screening delivery itself, if the iatrogenic and unintended harms of screening—particularly the social/psychological burden of value conflict—are to be adequately addressed and minimized.
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Affiliation(s)
- Felicity K Boardman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Corinna Clark
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Philip J Young
- School of Life Sciences, University of Warwick, Coventry, UK
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Ngim CF, Lai NM, Ibrahim H, Ratnasingam V. Attitudes towards prenatal diagnosis and abortion in a multi-ethnic country: a survey among parents of children with thalassaemia major in Malaysia. J Community Genet 2013; 4:215-21. [PMID: 23296641 DOI: 10.1007/s12687-012-0133-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 12/20/2012] [Indexed: 11/26/2022] Open
Abstract
Thalassaemia is a public health problem in multi-ethnic Malaysia which mainly affects the Malays, Kadazan-Dusuns and Chinese. This study, the first in Malaysia, aims to evaluate the acceptability of prenatal diagnosis and abortion among Malaysian parents who have a child or children with thalassaemia major and the socio-demographic factors affecting their decision-making. A pre-structured questionnaire was distributed to parents of children with thalassaemia major. Response rate for completed surveys was 99.1 %. Out of 116 respondents, the majority (83/71.6 %) were agreeable for prenatal diagnosis, but only 33 (28.4 %) agreed to both prenatal diagnosis followed by termination of affected foetuses. Of parents who declined abortion, 77.6 % cited religious restriction as the main reason, and their religious background was a significant factor (p = 0.001), with 73.4 % of Muslim participants against termination compared to 25 % of Christians and 13.3 % of Buddhists. Gender, age, highest education level and number of children affected with thalassaemia were non-significant predictors in decision-making regarding abortion. The acceptance rate for termination of foetuses with thalassaemia major in Malaysia is low especially among the Muslims due to religious non-permissibility. Therefore, scholarly deliberations among the Malaysian Muslim religious authorities that result in a supportive stance in this issue may contribute to a more successful prevention programme.
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Affiliation(s)
- Chin Fang Ngim
- Department of Paediatrics, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway Campus, Johor Bahru, Malaysia,
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Attitudes of health care professionals toward carrier screening for cystic fibrosis. A review of the literature. J Community Genet 2012; 5:13-29. [PMID: 23275180 DOI: 10.1007/s12687-012-0131-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022] Open
Abstract
Recent technological developments in molecular genetics facilitate the large-scale detection of inherited genetic disorders and allow an increasing number of genetic conditions to be screened for (American College of Medical Genetics 2012). This technological evolution creates the background which makes reflection necessary about the desirability to offer community-based (preconception) carrier screening in the healthcare system. A positive attitude of potential providers is vital to the success of a screening program. Therefore, the objective of this article is to elaborate a review of the attitudes of healthcare professionals toward carrier screening. Examination of existing carrier screening programs could provide such information. The literature review will be focused on the attitudes toward carrier screening for cystic fibrosis (CF). The databases Pubmed and Web of Science, as well as the interface Google Scholar, were searched using the keywords for the period 1990-2011. Studies were selected if they were published in a peer-reviewed journal in English and described the attitudes of potential providers toward carrier screening. Eleven studies were retrieved describing the attitudes toward carrier screening for CF. In total, seven studies reported attitudes toward the best time for carrier screening; four studies described opinions toward the best setting to offer CF carrier screening; six studies investigated the willingness to be involved in a carrier screening program, and in total 11 articles reported the concerns about offering carrier screening. Ten papers described a general attitude toward carrier screening. We can conclude that health care providers state willingness to be involved in a carrier screening program, but there is need for appropriate education as well as adequate support given the time constraints already present in consultation. The prospect of an increasing number of genetic disorders for which screening becomes possible, and the potential increasing demand for such screening in the future calls for the need for further debate on the desirability of carrier screening and relevant questions such as the conditions screened, the providers involved, the information provision, and counseling.
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Abstract
The existing research base on public attitudes about genetics shows that people's attitudes vary according to the specific technologies and purposes to which genetic knowledge is applied. Genetic testing is viewed highly favorably, genetically modified food is viewed with ambivalence, and cloning is viewed negatively. Attitudes are favorable for uses that maintain a perceived natural order and unfavorable for uses that are perceived to change it. Public concerns about control of genetic information and eugenics are evident, but their strength and relevance to policy preference are unclear. The pattern of attitudes can be explained by theories of attitude formation, and the existing base of information can be deepened and given more explanatory and predictive power by integrating future research into the various traditions that theorize attitude formation.
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Affiliation(s)
- Celeste M Condit
- Department of Speech Communication, University of Georgia, Athens, GA 30602, USA.
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Cousens NE, Gaff CL, Metcalfe SA, Delatycki MB. Carrier screening for beta-thalassaemia: a review of international practice. Eur J Hum Genet 2010; 18:1077-83. [PMID: 20571509 DOI: 10.1038/ejhg.2010.90] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
β-thalassaemia is one of the most common single-gene inherited conditions in the world, and thalassaemia carrier screening is the most widely performed genetic screening test, occurring in many different countries. β-thalassaemia carrier screening programmes provide a unique opportunity to compare the delivery of carrier screening programmes carried out in different cultural, religious and social contexts. This review compares the key characteristics of β-thalassaemia carrier screening programmes implemented in countries across the world so that the differences and similarities between the programmes can be assessed. The manner in which thalassaemia carrier screening programmes are structured among different populations varies greatly in several aspects, including whether the programmes are mandatory or voluntary, the education and counselling provided and whether screening is offered pre-pregnancy or antenatally. National and international guidelines make recommendations on the most appropriate ways in which genetic carrier screening programmes should be conducted; however, these recommendations are not followed in many programmes. We discuss the implications for the ethical and acceptable implementation of population carrier screening and identify a paucity of research into the outcomes of thalassaemia screening programmes, despite the fact that thalassaemia screening is so commonly conducted.
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Affiliation(s)
- Nicole E Cousens
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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Al Sulaiman A, Suliman A, Al Mishari M, Al Sawadi A, Owaidah TM. Knowledge and attitude toward the hemoglobinopathies premarital screening program in Saudi Arabia: population-based survey. Hemoglobin 2009; 32:531-8. [PMID: 19065330 DOI: 10.1080/03630260802508384] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Genetic screening is an important tool to control, minimize, and prevent genetic disorders. Saudi Arabia started the first national premarital screening (PMS) program to control inherited hemoglobin (Hb) disorders that are the most commonly inherited genetic disorders in the Kingdom of Saudi Arabia. The aim of this study was to assess the knowledge, perception, and attitude among the Saudi population about the PMS program through a questionnaire-based survey. A total of 1,047 candidates were included, divided into three groups. Group A represented the general population, group B was composed of couples presenting for PMS, and group C represented couples who had received their results. There was a fair knowledge among participants of the three groups about the nature of the tests and the targeted disorders, with more than 80% believing that it should include both sexually and genetically transmitted diseases. The concept of genetic counseling was liked by most of the participants. There was a positive attitude toward the program and the majority agreed to apply the PMS program to all couples in all country regions. More than 60% of all the participants were in favor of preventing at-risk marriages.
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Affiliation(s)
- Ayman Al Sulaiman
- Department of Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.
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Karimi M, Bonyadi M, Galehdari MR, Zareifar S. Termination of pregnancy due to Thalassemia major, Hemophilia, and Down's syndrome: the views of Iranian physicians. BMC Med Ethics 2008; 9:19. [PMID: 19105809 PMCID: PMC2628659 DOI: 10.1186/1472-6939-9-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 12/23/2008] [Indexed: 11/18/2022] Open
Abstract
Background Genetic disorders due to kindred marriages are common medical conditions in Iran; however, the legal aspects of abortion remain controversial. This study was undertaken to determine physicians' opinions regarding the termination of pregnancy for three genetic diseases: thalassemia major, hemophilia, and Down's syndrome. Methods A questionnaire was administered to selected physicians by stratified random sampling to determine the following: age, gender, knowledge about prenatal diagnosis of diseases in high risk pregnancies, agreement with abortion, recommended gestational age for abortion, and, if opposed to abortion, the reason. Results Of 323 physicians, who participated in the study, 91.3(295), 40.6(131), and 78.6%(254) were in agreement and 8.7(28), 59.4(192), and 21.4%(69) were opposed to abortion for thalassemia major, hemophilia, and Down's syndrome, respectively. Among 289 physicians opposed to abortion in respect of each of all three conditions, the following reasons were cited: religion, 18; emotional, 10; quality of care, 23; hope to find a new treatment option in the future, 103; miscellaneous reasons, 6; and a combination of these reasons, 129. Among 680 physicians in agreement with abortion in relation to all of the diseases, 4.6%(31) were agreed with abortion in less than 12 weeks gestation, 79.2%(538) in less than 16 weeks gestation, 5.6%(38) in less than 20 weeks gestation, 2.2%(15) in less than 24 weeks gestation, and 8.4%(58) were agreed with beyond the 24 weeks of gestational age. Conclusion The majority of physicians were in agreement with abortion for thalassemia major and Down's syndrome because of the overall prognosis, but opposed to abortion for hemophilia.
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Affiliation(s)
- Mehran Karimi
- Thrombosis and Hemostasis Unit, Hematology Research Center, Dept, of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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van den Heuvel A, Marteau TM. Cultural variation in values attached to informed choice in the context of prenatal diagnosis. Semin Fetal Neonatal Med 2008; 13:99-102. [PMID: 18255366 DOI: 10.1016/j.siny.2007.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the ethical implications of the widespread introduction of non-invasive prenatal diagnosis (NIPD) is that it might undermine the making of informed choices. There is an almost universal agreement among health professionals and policy makers that prenatal testing decisions should reflect informed choices. It is, however, unclear the extent to which this is a universally held value. We present evidence to suggest that although informed choice is highly valued in Western, individualistically orientated countries, it is less highly valued in non-Western, more collectivist countries. This raises questions as to whether it is beneficial - and indeed appropriate - to recommend facilitating informed choices in countries where this is not a dominant value.
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Affiliation(s)
- Ananda van den Heuvel
- King's College London, Institute of Psychiatry, Department of Psychology at Guy's, Health Psychology Section, 5th Floor, Thomas Guy House, London SE1 9RT, UK
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