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Hudani A, Kimani K, Njambi L, Dimaras H. Navigating familial retinoblastoma in Kenya: A mother's journey. Pediatr Blood Cancer 2024; 71:e31191. [PMID: 38965705 DOI: 10.1002/pbc.31191] [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: 03/21/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 07/06/2024]
Affiliation(s)
- Ashna Hudani
- International Development, The University of Toronto, Toronto, Canada
| | - Kahaki Kimani
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Lucy Njambi
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, The University of Toronto, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Canada
- Centre for Global Child Health, SickKids Research Institute, Toronto, Canada
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Irvine T, Brundage M, Hudani A, Kabiru J, Kimani K, Njuguna F, Njambi L, Dimaras H. Development and preliminary evaluation of a genetics education booklet for retinoblastoma. J Genet Couns 2024. [PMID: 39087554 DOI: 10.1002/jgc4.1944] [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: 12/22/2023] [Revised: 05/13/2024] [Accepted: 06/17/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Parents and survivors of retinoblastoma often hold misconceptions about the disease and desire more extensive and detailed information about its genetic nature. The aim of this study was to co-develop and evaluate a genetic education booklet for retinoblastoma. METHODS A human-centered design approach was employed, in which the study team consulted with clinician and patient knowledge user groups to design, produce, and refine an educational booklet. Over three phases of consultation, the study team met with each knowledge user group to review booklet prototypes and collect feedback for its further refinement. A preliminary evaluation using quantitative and qualitative methods was completed with six mothers of children with retinoblastoma. RESULTS The iterative, phased design process produced an educational booklet rich in images and stories, with complex genetic topics described in simplified terms. The preliminary evaluation showed an average improvement in knowledge between pre- and post-test questionnaire of 10%. Participants were satisfied with content and comprehensiveness of the information included in the booklet. CONCLUSION A novel educational tool for families affected by retinoblastoma was developed through collaboration with health care and patient knowledge users. Preliminary evaluation results indicate it is feasible to implement and study the booklet in a prospective, pragmatic trial to evaluate its efficacy.
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Affiliation(s)
- Taylor Irvine
- The Humanities Program, The University of Toronto, Toronto, Ontario, Canada
| | - Monica Brundage
- Human Biology Program, The University of Toronto, Toronto, Ontario, Canada
| | - Ashna Hudani
- International Development, The University of Toronto, Toronto, Ontario, Canada
| | - Joy Kabiru
- Eye Unit, PCEA Kikuyu Hospital, Kikuyu, Kenya
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Festus Njuguna
- Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Lucy Njambi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Helen Dimaras
- Human Biology Program, The University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, The University of Toronto, Toronto, Ontario, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, Ontario, Canada
- Centre for Global Child Health, SickKids Research Institute, Toronto, Ontario, Canada
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3
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Quinonez SC, O’Connor BC, Jacobs MF, Mekonnen Tekleab A, Marye A, Bekele D, Yashar BM, Hanson E, Yeshidinber A, Wedaje G. The introduction of genetic counseling in Ethiopia: Results of a training workshop and lessons learned. PLoS One 2021; 16:e0255278. [PMID: 34297771 PMCID: PMC8301664 DOI: 10.1371/journal.pone.0255278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the past two decades non-communicable diseases (NCDs) have steadily increased as a cause of worldwide disability and mortality with a concomitant decrease in disease burden from communicable, maternal, neonatal and nutritional conditions. Congenital anomalies, the most common NCD affecting children, have recently become the fifth leading cause of under-five mortality worldwide, ahead of other conditions such as malaria, neonatal sepsis and malnutrition. Genetic counseling has been shown to be an effective method to decrease the impact of congenital anomalies and genetic conditions but is absent in almost all sub-Saharan Africa countries. To address this need for counseling services we designed and implemented the first broad-based genetic counseling curriculum in Ethiopia, launching it at St. Paul's Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia. METHODS The curriculum, created by Michigan Medicine and SPHMMC specialists, consisted of medical knowledge and genetic counseling content and was delivered to two cohorts of nurses. Curriculum evaluation consisted of satisfaction surveys and pre- and post-assessments covering medical knowledge and genetic counseling content. Following Cohort 1 training, the curriculum was modified to increase the medical knowledge material and decrease Western genetic counseling principles material. RESULTS Both cohorts reported high levels of satisfaction but felt the workshop was too short. No significant improvements in assessment scores were seen for Cohort 1 in terms of total scores and medical knowledge and genetic counseling-specific questions. Following curriculum modification, improvements were seen in Cohort 2 with an increase in total assessment scores from 63% to 73% (p = 0.043), with medical knowledge-specific questions increasing from 57% to 79% (p = 0.01) with no significant change in genetic counseling-specific scores. Multiple logistic, financial, cultural and systems-specific barriers were identified with recommendations for their consideration presented. CONCLUSION Genetics medical knowledge of Ethiopian nurses increased significantly following curriculum delivery though difficulty was encountered with Western genetic counseling material.
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Affiliation(s)
- Shane C. Quinonez
- Division of Pediatric Genetics, Metabolism and Genomic Medicine, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, United States of America
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Bridget C. O’Connor
- Division of Pediatric Genetics, Metabolism and Genomic Medicine, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, United States of America
| | - Michelle F. Jacobs
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Atnafu Mekonnen Tekleab
- Department of Pediatrics, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ayalew Marye
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Obstetrics and Gynecology, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Beverly M. Yashar
- Department of Human Genetics, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Erika Hanson
- Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Abate Yeshidinber
- Department of Pediatrics, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Getahun Wedaje
- Department of Pediatrics, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Zhong A, Xia K, Hadjis Z, Lifman G, Njambi L, Dimaras H. Opportunities and barriers for genetic service delivery in Kenya from a health personnel perspective. J Community Genet 2021; 12:525-538. [PMID: 34228349 PMCID: PMC8257851 DOI: 10.1007/s12687-021-00532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Abstract
Genetic counselling and testing are essential health services for the management of heritable diseases. However, in low-and-middle income countries like Kenya, genetic counsellors are not yet a licenced profession, and there is limited availability of and access to genetic testing. This study aimed to uncover opportunities and barriers for genetic service delivery in the Kenyan healthcare system from the perspectives of those who provide genetic testing and/or genetic counselling. Participants included Kenyan health personnel who deliver genetic services. This was a qualitative study that collected data via semi-structured one-on-one interviews and analyzed it using inductive thematic analysis. Participant demographics and characteristics of clinical genetic service provision were collected using a survey and results summarized using descriptive statistics. Themes revealed during analysis were compared to the clinical characteristics of genetic service provision to inform the opportunities and barriers. Fifteen interviews were conducted in total. Thematic analysis indicated that participants believed that the barriers facing genetic service delivery were linked to three themes: (1) education and training, (2) costs, and (3) counselling challenges. The opportunities for genetic service delivery were linked to four themes: (1) demand, (2) education and training, (3) encouraging a multidisciplinary approach to care, and (4) enhancing laboratory infrastructure. These findings are crucial for the development of a national evidence-informed and culturally appropriate model for genetic service delivery.
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Affiliation(s)
- Adrina Zhong
- Department of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kaiwen Xia
- Department of Molecular Genetics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zissis Hadjis
- The Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, ON, Canada
| | - Gavin Lifman
- Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada
| | - Lucy Njambi
- Department of Ophthalmology, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Helen Dimaras
- Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada.
- Division Clinical Public Health, Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology & Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Child Health Evaluative Sciences Program, SickKids Research Institute, Toronto, ON, Canada.
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
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Quinonez SC, Terefework Z. The introduction of clinical genetic testing in Ethiopia: Experiences and lessons learned. Am J Med Genet A 2021; 185:2995-3004. [PMID: 34169623 DOI: 10.1002/ajmg.a.62396] [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: 03/10/2021] [Revised: 05/22/2021] [Accepted: 05/31/2021] [Indexed: 11/08/2022]
Abstract
Limited data are available on genetic testing laboratories in low- and middle-income countries including those in sub-Saharan Africa (SSA). To characterize the need for genetic testing in SSA we describe the experience of MRC-ET Advanced Laboratory, a genetic testing laboratory in Ethiopia. Test results were analyzed based on indication(s) for testing, referral category, and diagnostic yield. A total of 1311 tests were run using the full MRC-Holland catalogue of Multiplex-Ligation Probe Amplification assays. Of all samples, 77% were postnatal samples, 15% products of conception (POC), and 8% amniotic samples. Of postnatal samples, the most common testing categories were multiple congenital anomalies (32%), disorders of sex development (17%), and Obstetrics/Gynecology (16%). Forty-three percent of postnatal samples were diagnostic, 11% were variants of uncertain significance (VUS), and 46% were normal with Trisomy 21 the most common diagnosis. Of POC samples, 10% were diagnostic, 34% revealed VUSs, and 55% were normal with Trisomy 18 the most common diagnosis. Of amniotic samples 17.5% were diagnostic, 3% revealed VUSs, and 79% were normal with Trisomy 18 the most common diagnosis. There is increasing demand for genetic testing in Ethiopia. Diagnostic genetic testing in SSA deserves increased attention as testing platforms become more affordable.
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Affiliation(s)
- Shane C Quinonez
- Division of Pediatric Genetics, Metabolism, and Genomic Medicine, Department of Pediatrics, Michigan Medicine, Ann Arbor, Michigan, USA.,Division of Genetic Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Zhang Z, Xiao YS, Shen R, Jiang HC, Tan L, Li RQ, Yang XH, Gu HY, He WJ, Ma J. Next generation sequencing of RB1gene for the molecular diagnosis of ethnic minority with retinoblastoma in Yunnan. BMC MEDICAL GENETICS 2020; 21:230. [PMID: 33225895 PMCID: PMC7682003 DOI: 10.1186/s12881-020-01150-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
Background Retinoblastoma is a rare intraocular malignancy and typically initiated by inactivating biallelic mutations of RB1 gene. Each year, ~ 8000 children worldwide are diagnosed for retinoblastoma. In high-income countries, patient survival is over 95% while low-income countries is ~ 30%.If disease is diagnosed early and treated in centers specializing in retinoblastoma, the survival might exceed 95% and many eyes could be safely treated and support a lifetime of good vision. In China, approximate 1100 newly diagnosed cases are expected annually and 28 hospitals covering 25 provinces established centers classified by expertise and resources for better treatment options and follow-up. Comparing with other province of eastern China, Yunnan province is remote geographically. This might result that healthcare staff have low awareness of the role of genetic testing in management and screening in families. Methods The patients with retinoblastoma were selected in Yunnan. DNA from blood was used for targeted gene sequencing. Then, an in-house bioinformatics pipeline was done to detect both single nucleotide variants and small insertions/deletions. The pathogenic mutations were identified and further confirmed by conventional methods and cosegregation in families. Results Using our approach, targeted next generation sequencing was used to detect the mutation of these 12 probands. Bioinformatic predictions showed that nine mutations were found in our study and four were novel pathogenic variants in these nine mutations. Conclusions It’s the first report to describe RB1 mutations in Yunnan children with retinoblastoma. This study would improve role of genetic testing for management and family screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12881-020-01150-7.
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Affiliation(s)
- Zhen Zhang
- Key Laboratory of Children's Major Disease Research, and Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China.,Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, 510080, PR China
| | - Yi-Shuang Xiao
- Department of Ophthalmology, Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Ru Shen
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Hong-Chao Jiang
- Key Laboratory of Children's Major Disease Research, and Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Li Tan
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Ren-Qiu Li
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Xiao-Hong Yang
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China
| | - Huai-Yu Gu
- Department of Human Anatomy, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong, 510080, PR China.
| | - Wen-Ji He
- Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China.
| | - Jing Ma
- Key Laboratory of Children's Major Disease Research, and Yunnan Institute of Pediatrics, Kunming Children's Hospital, Kunming Medical University, Kunming, Yunnan, 650228, PR China. .,Department of Otolaryngology-Head Neck Surgery, Kunming Children's Hospital, Kunming Medical University,, Kunming, Yunnan, 650228, PR China.
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Jacobs MF, O'Connor BC, Weldetsadik AY, Tekleab AM, Bekele D, Hanson E, Quinonez SC. Knowledge and attitudes about genetic counseling in patients at a major hospital in Addis Ababa, Ethiopia. J Genet Couns 2020; 30:544-552. [PMID: 33118289 DOI: 10.1002/jgc4.1340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 11/11/2022]
Abstract
Previous work at St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia, demonstrated a need for genetic counseling (GC) services, with 4% of pediatric, neonatal intensive care, and prenatal patients identified as having indications for genetic evaluation (Quinonez et al, 2019). The aim of this study was to investigate SPHMMC patients' familiarity with, knowledge of, and attitudes toward GC services. Surveys were adapted from previous work in North America populations (Riesgraf et al, 2015 and Gemmell et al, 2017) and administered to 102 patients, and results were compared to North American populations using Student's t test. 30% of respondents reported at least some familiarity with GC, primarily via the media or healthcare providers. Patients had generally positive attitudes toward GC, reporting they would trust information provided by a genetic counselor and that GC is in line with their values. Knowledge of GC showed similar trends overall when compared to results from North American populations. Our work indicates limited exposure to GC in this population, but generally positive feelings toward GC. Patients' attitudes toward GC were comparable to rural North American populations surveyed using the same tool on most items; however, cultural differences including views on abortions and directiveness of healthcare providers could account for discrepancies and are important considerations when implementing genetic services globally.
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Affiliation(s)
- Michelle F Jacobs
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA
| | | | | | - Atnafu Mekonnen Tekleab
- Department of Pediatrics, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Delayehu Bekele
- Department of Gynecology/Obstetrics, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Erika Hanson
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shane C Quinonez
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
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Chu CS, Bancone G, Kelley M, Advani N, Domingo GJ, Cutiongo-de la Paz EM, van der Merwe N, Cohen J, Gerth-Guyette E. Optimizing G6PD testing for Plasmodium vivax case management and beyond: why sex, counseling, and community engagement matter. Wellcome Open Res 2020; 5:21. [PMID: 32766454 PMCID: PMC7388194 DOI: 10.12688/wellcomeopenres.15700.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 01/02/2023] Open
Abstract
Safe access to the most effective treatment options for
Plasmodium vivax malaria are limited by the absence of accurate point-of-care testing to detect glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common human genetic disorder. G6PD-deficient patients are at risk of life-threatening hemolysis when exposed to 8-aminoquinolines, the only class of drugs efficacious against
P. vivax hypnozoites. Until recently, only qualitative tests were available in most settings. These can identify patients with severe G6PD deficiency (mostly male) but not patients with intermediate G6PD deficiency (always female). This has led to and reinforced a gap in awareness in clinical practice of the risks and implications of G6PD deficiency in females—who, unlike males, can have a heterozygous genotype for G6PD. Increasing recognition of the need for radical cure of
P. vivax, first for patients’ health and then for malaria elimination, is driving the development of new point-of-care tests for G6PD deficiency and their accessibility to populations in low-resource settings. The availability of user-friendly, affordable, and accurate quantitative point-of-care diagnostics for the precise classification of the three G6PD phenotypes can reduce sex-linked disparities by ensuring safe and effective malaria treatment, providing opportunities to develop supportive counseling to enhance understanding of genetic test results, and improving the detection of all G6PD deficiency phenotypes in newborns and their family members.
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Affiliation(s)
- Cindy S Chu
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Germana Bancone
- Shoklo Malaria Research Unit, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maureen Kelley
- The Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | - Eva M Cutiongo-de la Paz
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila, Philippines.,Philippine Genome Center, University of the Philippines System, Quezon City, Philippines
| | - Nicole van der Merwe
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
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Xiao W, Ji X, Ye H, Zeng H, Gao Y, Chen R, Chen X, Mao Y, Yang H. Parent Knowledge of Screening and Genetic Testing in Retinoblastoma. J Ophthalmol 2020; 2020:3839792. [PMID: 32351720 PMCID: PMC7171634 DOI: 10.1155/2020/3839792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate parent knowledge of screening and genetic testing for retinoblastoma and its potential correlation with demographics, clinical features, and socioeconomical factors. METHODS It was a cross-sectional study conducted at the ocular oncology unit of a tertiary ophthalmic center in Southern China. A face-to-face interview was administered to parents of retinoblastoma children during hospitalization. Parent knowledge was assessed using the sum score of a 7-item questionnaire. Demographics and socioeconomic status were collected from the interview, and clinical data were retrieved from the medical records. RESULTS A total of 126 parents of retinoblastoma children were included. Parents accurately answered 66.7% to 84.9% of each item in the questionnaire. Only 37 (29.4%) parents correctly answered all 7 questions. Parent knowledge was positively correlated with education, but it was not associated with patients' laterality, sex, or household income. Physicians and the Internet were the major sources of parental health-related information. During the median follow-up of 492 days, 13 (61.9%) of 21 patients in the full-score group without genetic testing at baseline actually conducted testing during follow-up compared to 29 of 67 (43.3%) in the less-than-full-score group (P=0.136). CONCLUSION Overall parent knowledge about retinoblastoma screening and genetic testing was moderate. Higher education was associated with greater parent knowledge. Future studies should validate our findings in other populations, especially in those with different cultural background and healthcare systems.
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Affiliation(s)
- Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xian Ji
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Huijing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Huiqi Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yang Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Rongxin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyun Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yuxiang Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Janic A, Kimani K, Olembo I, Dimaras H. Lessons for Patient Engagement in Research in Low- and Middle-Income Countries. Ophthalmol Ther 2020; 9:221-229. [PMID: 32222906 PMCID: PMC7196100 DOI: 10.1007/s40123-020-00246-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Indexed: 01/05/2023] Open
Abstract
Patient engagement in research is marked by partnership between clinicians, scientists, and people with lived experience of a disease, who jointly develop and implement research and disseminate results. Patient engagement in research has been shown to lead to more impactful and relevant findings. There is a global need for quality research contextualized for low- and middle-income countries (LMICs). Patient involvement in research could address this need, yet it remains a practice more commonly employed in high income countries. In this paper, the authors explore LMIC-specific challenges and opportunities for patient engagement in research. Limitations to patient engagement in research include gaps in health infrastructure, socioeconomic status, cultural stigma, and uncertain roles. Potential solutions to address these challenges include strategic national and international research partnerships, initiatives to combat stigma, and sensitization and training of stakeholders in patient engagement in research. Reflecting on their patient engagement experience with eye cancer research in Canada and Kenya, and supported by evidence of patient engagement in other low-resource settings, the authors provide a roadmap for patient engagement in research in LMICs.
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Affiliation(s)
- Ana Janic
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada.,The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Isabel Olembo
- Syndications and Agency Operations Department, Eastern and Southern African Trade and Development Bank, Nairobi, Kenya
| | - Helen Dimaras
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, ON, Canada. .,Child Health Evaluative Sciences Program, The Hospital for Sick Children, Toronto, ON, Canada. .,The Centre for Global Child Health, SickKids Research Institute, Toronto, ON, Canada. .,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. .,Division of Clinical Public Health, University of Toronto, Toronto, ON, Canada.
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Chu CS, Bancone G, Kelley M, Advani N, Domingo GJ, Cutiongo-de la Paz EM, van der Merwe N, Cohen J, Gerth-Guyette E. Optimizing G6PD testing for Plasmodium vivax case management: why sex, counseling, and community engagement matter. Wellcome Open Res 2020; 5:21. [DOI: 10.12688/wellcomeopenres.15700.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 11/20/2022] Open
Abstract
Safe access to the most effective treatment options for Plasmodium vivax malaria are limited by the absence of accurate point-of-care testing to detect glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common human genetic disorder. G6PD-deficient patients are at risk of life-threatening hemolysis when exposed to 8-aminoquinolines, the only class of drugs efficacious against P. vivax hypnozoites. Until recently, only qualitative tests were available in most settings. These accurately identify patients with severe G6PD deficiency (mostly male) but not patients with intermediate G6PD deficiency (always female). This has led to and reinforced a gap in awareness in clinical practice of the risks and implications of G6PD deficiency in females—who, unlike males, can have a heterozygous genotype for G6PD. Increasing recognition of the need for radical cure of P. vivax, first for patients’ health and then for malaria elimination, is driving the development of new point-of-care tests for G6PD deficiency and their accessibility to populations in low-resource settings. The availability of simple, affordable, and accurate point-of-care diagnostics for the precise classification of the three G6PD phenotypes can reduce sex-linked disparities by ensuring safe and effective malaria treatment, providing opportunities to develop supportive counseling to enhance understanding of genetic test results, and improving the detection of all G6PD deficiency phenotypes in newborns and their family members.
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Lee S, Gedleh A, Hill JA, Qaiser S, Umukunda Y, Odiyo P, Kitonyi G, Dimaras H. In Their Own Words: A Qualitative Study of Kenyan Breast Cancer Survivors' Knowledge, Experiences, and Attitudes Regarding Breast Cancer Genetics. J Glob Oncol 2018; 4:1-9. [PMID: 30241137 PMCID: PMC6180770 DOI: 10.1200/jgo.17.00061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Breast cancer ranks among the most common adult cancers in Kenya. Individuals with a family history of the disease are at increased risk. Mutations most commonly associated with breast cancer affect BRCA1 and BRCA2; mutations in several other genes may also confer breast cancer risk. Genetic testing and counseling can help patients understand their risk and assist clinicians in choosing therapies. We aimed to uncover what patients know, experience, and think with regard to breast cancer genetics in Kenya. METHODS Participants included breast cancer survivors age > 18 years. Participants completed a demographic questionnaire before participating in focus group discussions to uncover knowledge of, experiences with, and attitudes toward the genetics of breast cancer. Data were analyzed by inductive thematic analysis. RESULTS Four focus groups were conducted. Participants had rudimentary knowledge about genetics and cancer development, and although they understood breast cancer could be familial, many suspected environmental factors causing spontaneous disease. They reported limited experience with counseling about genetic risk, perceiving that their physicians were too busy to provide comprehensive information. Many indicated they promoted cancer screening among family to promote early diagnosis. Participants expressed a need for more comprehensive counseling and access to genetic testing, recognizing the added clarity it would bring to their families' risk of cancer. CONCLUSION Improved communication from health care teams could clarify the risk of cancer for affected families. The introduction of affordable genetic testing and counseling for breast cancer in Kenya is welcomed by survivors.
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Affiliation(s)
- Siwon Lee
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Amal Gedleh
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Jessica A. Hill
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Seemi Qaiser
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Yvonne Umukunda
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Philip Odiyo
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Grace Kitonyi
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
| | - Helen Dimaras
- Siwon Lee, Amal Gedleh, Seemi
Qaiser, Yvonne Umukunda, and Helen Dimaras,
University of Toronto; Jessica A. Hill and Helen
Dimaras, The Hospital for Sick Children; Helen Dimaras,
SickKids Research Institute, Toronto, Ontario, Canada; Grace
Kitonyi, and Helen Dimaras, University of Nairobi; and
Philip Odiyo, Faraja Cancer Support Trust, Nairobi,
Kenya
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Quinonez SC, Yeshidinber A, Lourie MA, Bekele D, Mekonnen Y, Nigatu B, Metaferia G, Jebessa S. Introducing medical genetics services in Ethiopia using the MiGene Family History App. Genet Med 2018; 21:451-458. [PMID: 29892089 DOI: 10.1038/s41436-018-0069-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/09/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Almost all low-income countries and many middle-income countries lack the capacity to deliver medical genetics services. We developed the MiGene Family History App (MFHA), which assists doctors with family history collection and population-level epidemiologic analysis. The MFHA was studied at St. Paul's Hospital in Addis Ababa, Ethiopia. METHODS A needs assessment was used to assess Ethiopian physicians' experience with genetics services. The MFHA then collected patient data over a 6-month period. RESULTS The majority of doctors provide genetics services, with only 16% reporting their genetics knowledge is sufficient. A total of 1699 patients from the pediatric ward (n = 367), neonatal intensive care unit (NICU) (n = 477), and antenatal clinic (n = 855) were collected using the MFHA with a 4% incidence of a MFHA-screened condition present. The incidence was 11.7% in the pediatric ward, 3% in the NICU, and 0.5% in the antenatal clinic. Heart malformations (5.5% of patients) and trisomy 21 (4.4% of patients) were the most common conditions in the pediatric ward. CONCLUSION Medical genetics services are needed in Ethiopia. As other countries increase their genetics capacity, the MFHA can provide fundamental genetics services and collect necessary epidemiologic data.
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Affiliation(s)
- Shane C Quinonez
- Department of Pediatrics and Communicable Diseases, Division of Genetics, Metabolism and Genomic Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | - Abate Yeshidinber
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | - Delayehu Bekele
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Yemisrach Mekonnen
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Balkachew Nigatu
- Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gesit Metaferia
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Solomie Jebessa
- Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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"Where Does it Come from?" Experiences Among Survivors and Parents of Children with Retinoblastoma in Kenya. J Genet Couns 2017; 27:574-588. [PMID: 29170903 DOI: 10.1007/s10897-017-0174-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/06/2017] [Indexed: 01/09/2023]
Abstract
Genetic testing and counseling have become integral to the timely control of heritable cancers, like the childhood eye cancer retinoblastoma. This study aimed to determine attitudes, knowledge and experiences related to retinoblastoma genetics, among survivors and parents of children with retinoblastoma in Kenya. This qualitative study used focus groups as the primary data collection method, coupled with a brief demographic questionnaire. Study settings were Kenyatta National Hospital and Presbyterian Church of East Africa Kikuyu Hospital. Thematic analysis was used to identify key themes. Thirty-one individuals participated in five focus groups. Two main concepts emerged: (1) the origins of retinoblastoma are unclear, and (2) retinoblastoma is associated with significant challenges. The lack of clarity surrounding the origins of retinoblastoma was linked to limited knowledge of retinoblastoma genetics, and limited genetic counseling delivery and uptake. The challenges associated with retinoblastoma were discussed in terms of the impact of the diagnosis on individuals and families, and unmet healthcare needs related to the diagnosis. Next steps will incorporate these findings to develop evidence-informed and accessible cancer genetic services in Kenya.
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Abstract
Retinoblastoma is the prototypic genetic cancer. India carries the biggest burden of retinoblastoma globally, with an estimated 1500 new cases annually. Recent advances in retinoblastoma genetics are reviewed, focusing specifically on information with clinical significance to patients. The Indian literature on retinoblastoma clinical genetics is also highlighted, with a comment on challenges and future directions. The review concludes with recommendations to help clinicians implement and translate retinoblastoma genetics to their practice.
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Affiliation(s)
- Helen Dimaras
- Department of Ophthalmology and Vision Sciences, University of Toronto, Canada; Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Human Pathology, University of Nairobi, Nairobi, Kenya,
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Soliman SE, ElManhaly M, Dimaras H. Knowledge of genetics in familial retinoblastoma. Ophthalmic Genet 2016; 38:226-232. [DOI: 10.1080/13816810.2016.1195846] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Sameh E. Soliman
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Division of Clinical Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mostafa ElManhaly
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Helen Dimaras
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Division of Clinical Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Human Pathology, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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Hill JA, Kimani K, White A, Barasa F, Livingstone M, Gallie BL, Dimaras H. Achieving optimal cancer outcomes in East Africa through multidisciplinary partnership: a case study of the Kenyan National Retinoblastoma Strategy group. Global Health 2016; 12:23. [PMID: 27229322 PMCID: PMC4882853 DOI: 10.1186/s12992-016-0160-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 05/07/2016] [Indexed: 11/23/2022] Open
Abstract
Background Strategic, interdisciplinary partnerships are essential to addressing the complex drivers of health inequities that result in survival disparities worldwide. Take for example the aggressive early childhood eye cancer retinoblastoma, where survival reaches 97 % in resource-rich countries, but is as low 30 % in some resource-limited nations, where 92 % of the burden lies. This suggests a need for a multifaceted approach to achieve a tangible and sustainable increase in survival. Methods We assembled the history the Kenyan National Retinoblastoma Strategy (KNRbS), using information documented in NGO reports, grant applications, news articles, meeting agendas and summaries. We evaluated the KNRbS using the principles found in the guide for transboundary research partnerships developed by the Swiss Commission for Research Partnerships with Developing Countries. Results A nationally co-ordinated approach drawing input and expertise from multiple disciplines and sectors presented opportunities to optimise cure of children with retinoblastoma. Annual meetings were key to achieving the over 40 major outputs of the group’s efforts, related to Awareness, Medical Care, Family Support and Resource Mobilization. Three features were found to be critical to the KNRbS success: multidisciplinarity, consistency and flexibility. Conclusion The KNRbS has achieved a number of key outputs with limited financial investment. As a partnership, the KNRbS meets most of the criteria identified for success. Challenges remain in securing the long-term sustainability of its achievements. Elements of the Kenyan National Retinoblastoma Strategy may be useful to other developing countries struggling with limited survival of retinoblastoma and other cancers or rare diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12992-016-0160-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jessica A Hill
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave., Room 7265, Toronto, ON, M5G 1X8, Canada
| | - Kahaki Kimani
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Abby White
- World Eye Cancer Hope (formerly Daisy's Eye Cancer Fund - International)
| | | | - Morgan Livingstone
- World Eye Cancer Hope (formerly Daisy's Eye Cancer Fund - International)
| | - Brenda L Gallie
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave., Room 7265, Toronto, ON, M5G 1X8, Canada.,Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Ave., Room 7265, Toronto, ON, M5G 1X8, Canada. .,Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Department of Human Pathology, University of Nairobi, Nairobi, Kenya.
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Dimaras H, Corson TW, Cobrinik D, White A, Zhao J, Munier FL, Abramson DH, Shields CL, Chantada GL, Njuguna F, Gallie BL. Retinoblastoma. Nat Rev Dis Primers 2015; 1:15021. [PMID: 27189421 PMCID: PMC5744255 DOI: 10.1038/nrdp.2015.21] [Citation(s) in RCA: 339] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Retinoblastoma is a rare cancer of the infant retina that is diagnosed in approximately 8,000 children each year worldwide. It forms when both retinoblastoma gene (RB1) alleles are mutated in a susceptible retinal cell, probably a cone photoreceptor precursor. Loss of the tumour-suppressive functions of the retinoblastoma protein (pRB) leads to uncontrolled cell division and recurrent genomic changes during tumour progression. Although pRB is expressed in almost all tissues, cone precursors have biochemical and molecular features that may sensitize them to RB1 loss and enable tumorigenesis. Patient survival is >95% in high-income countries but <30% globally. However, outcomes are improving owing to increased disease awareness for earlier diagnosis, application of new guidelines and sharing of expertise. Intra-arterial and intravitreal chemotherapy have emerged as promising methods to salvage eyes that with conventional treatment might have been lost. Ongoing international collaborations will replace the multiple different classifications of eye involvement with standardized definitions to consistently assess the eligibility, efficacy and safety of treatment options. Life-long follow-up is warranted, as survivors of heritable retinoblastoma are at risk for developing second cancers. Defining the molecular consequences of RB1 loss in diverse tissues may open new avenues for treatment and prevention of retinoblastoma, as well as second cancers, in patients with germline RB1 mutations.
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Affiliation(s)
- Helen Dimaras
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, Toronto, Canada
| | - Timothy W. Corson
- Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Cobrinik
- The Vision Center, Children’s Hospital Los Angeles & USC Eye Institute, University of Southern California, Los Angeles, CA USA
| | | | - Junyang Zhao
- Department of Ophthalmology, Beijing Children’s Hospital, Capital Medial University, Beijing, China
| | - Francis L. Munier
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne, Switzerland
| | - David H. Abramson
- Department of Ophthalmology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | | | - Festus Njuguna
- Department of Department of Child Health and Paediatrics, Moi University, Eldoret, Kenya
| | - Brenda L. Gallie
- Department of Ophthalmology & Vision Sciences, The Hospital for Sick Children & University of Toronto, 555 University Ave, Toronto, Ontario M5G1X8, Canada
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Hill JA, Lee SY, Njambi L, Corson TW, Dimaras H. Cancer genetics education in a low- to middle-income country: evaluation of an interactive workshop for clinicians in Kenya. PLoS One 2015; 10:e0129852. [PMID: 26035834 PMCID: PMC4452713 DOI: 10.1371/journal.pone.0129852] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/12/2015] [Indexed: 11/21/2022] Open
Abstract
Background Clinical genetic testing is becoming an integral part of medical care for inherited disorders. While genetic testing and counseling are readily available in high-income countries, in low- and middle-income countries like Kenya genetic testing is limited and genetic counseling is virtually non-existent. Genetic testing is likely to become widespread in Kenya within the next decade, yet there has not been a concomitant increase in genetic counseling resources. To address this gap, we designed an interactive workshop for clinicians in Kenya focused on the genetics of the childhood eye cancer retinoblastoma. The objectives were to increase retinoblastoma genetics knowledge, build genetic counseling skills and increase confidence in those skills. Methods The workshop was conducted at the 2013 Kenyan National Retinoblastoma Strategy meeting. It included a retinoblastoma genetics presentation, small group discussion of case studies and genetic counseling role-play. Knowledge was assessed by standardized test, and genetic counseling skills and confidence by questionnaire. Results Knowledge increased significantly post-workshop, driven by increased knowledge of retinoblastoma causative genetics. One-year post-workshop, participant knowledge had returned to baseline, indicating that knowledge retention requires more frequent reinforcement. Participants reported feeling more confident discussing genetics with patients, and had integrated more genetic counseling into patient interactions. Conclusion A comprehensive retinoblastoma genetics workshop can increase the knowledge and skills necessary for effective retinoblastoma genetic counseling.
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Affiliation(s)
- Jessica A Hill
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada
| | - Su Yeon Lee
- Laboratory Medicine and Pathobiology Program, University of Toronto, Toronto, Canada
| | - Lucy Njambi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - Timothy W Corson
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America; Department of Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, Toronto, Canada; Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada; Department of Human Pathology, University of Nairobi, Nairobi, Kenya
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