Evidence syntheses to support decision-making related to the Covid-19 pandemic

The COVID-19 pandemic generated a large volume of scientific productions with different quality levels. The speed with which knowledge was produced and shared worldwide imposed on health management the challenge of seeking ways to identify the best available evidence to support its decisions. In response to this challenge, the Department of Science and Technology of the Brazilian Ministry of Health started offering a service to produce and provide scientific knowledge addressing priority public health issues in the pandemic scenario. Drug treatments, non-pharmacological measures, testing, reinfection and immunological response, immunization, pathophysiology, post-COVID syndrome and adverse events are among the topics covered. In this article, we discuss the strengths and lessons learned, as well as the challenges and perspectives that present a real example of how to offer the best scientific evidence in a timely manner in order to assist the decision-making process during a public health emergency.

Incidence of Guillain-Barré syndrome in the world between 1985 and 2020: A systematic review

Introduction

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy that affects the peripheral nervous system. The study aimed to describe the incidence of GBS in the world up to the year 2020.

Methods

A systematic review was conducted. Searches were done in four databases, PUBMED, EMBASE, EBSCO and Biblioteca virtual em Saude (BVS), and in grey literature and manual search in the reference lists of eligible studies.

Results

A total of 72 studies were included. The incidence of GBS among the cohort studies varied from 0.30 to 6.08 cases per 100.000 habitants and 0.42 to 6.58 cases per 100.000 person-years. Among the self-controlled studies, the risk incidence ranged from 0.072 to 1 case per 100.000 habitants and 1.73 to 4.30 cases per 100.000 person-years.

Conclusions

The reported incidence of GBS in the world among the studies included in the review is slightly higher than that reported in previous studies. The highest incidence rates were associated with public health events of international concern.

Pre-task Intrinsic Cortical Activity in Novice and Experienced Military Specialists: A Cross-sectional Study

INTRODUCTION

Neuroscience studies brain dynamics through the analysis of electrical signals. Cortical activity estimated by electroencephalography brings accurate information about perceptions of human behavior. The examination of resting states in relation to subsequent behaviors indicates that intrinsic cortical activity (ICA) has implications for decision-making processes, especially when inserted in the context of military activities and associated with stress. The objective of this study was to compare the absolute alpha power (AAP) in the ICA in the pre-task moment of novice specialized military (NG) with experienced (ExpG), associating with the level of stress.

MATERIALS AND METHODS

This was a cross-sectional, observational study with 19 military personnel (32.1 years old), divided into NG (10) and ExpG (9). The ICA was the outcome variable, with the level of stress and the time of specialization in military tasks as the exposure variables. ICA analysis were carried out based on the cortical areas to compare the ICA of the NG with that of the ExpG. The association of stress level with ICA was estimated by linear regression via linear models.

RESULTS

There was a significant difference in almost all cortical areas, and the averages were always higher in Exp. The high stress level was associated with greater AAP both for the NG and for the ExpG, and at the medium level, the AAP was obtained, varying according to each cortical area.

CONCLUSION

The AAP in ExpG was significantly higher than that in NG, indicating a lower level of cortical activity and greater efficiency in sensory, motor, and visual tasks.

An evidence-informed policymaking (EIPM) competency profile for the Brazilian Health System developed through consensus: process and outcomes

BACKGROUND

Evidence-informed policymaking (EIPM) requires a set of individual and organizational knowledge, skills and attitudes that should be articulated with background factors and needs. In this regard, the development of an EIPM competency profile is important to support the diagnosis, planning and implementation of EIPM.

PURPOSE

To present the process and outcomes of the development of an EIPM competency profile by an expert committee, to be applied in different contexts of the Brazilian Health System.

METHODS

A committee of experts in EIPM shared different views, experiences and opinions to develop an EIPM competency profile for Brazil. In six consensus workshops mediated by facilitators, the committee defined from macro problems to key actions and performances essential for the competency profile. The development steps consisted of: (1) Constitution of the committee, including researchers, professionals with practical experience, managers, and educators; (2) Development of a rapid review on EIPM competency profiles; (3) Agreement on commitments and responsibilities in the processes; (4) Identification and definition of macro problems relating to the scope of the competency profile; and (5) Outlining of general and specific capacities, to be incorporated into the competency profile, categorized by key actions.

RESULTS

The development of the EIPM competency profile was guided by the following macro problems: (1) lack of systematic and transparent decision-making processes in health policy management; (2) underdeveloped institutional capacity for knowledge management and translation; and (3) incipient use of scientific evidence in the formulation and implementation of health policies. A general framework of key actions and performances of the EIPM Competency Profile for Brazil was developed, including 42 specific and general key actions distributed by area of activity (Health Management, Scientific Research, Civil Society, Knowledge Translation, and Cross-sectional areas).

CONCLUSIONS

The competency profile presented in this article can be used in different contexts as a key tool for the institutionalization of EIPM.

An accuracy study of the clinical diagnosis of periodontitis in pregnant women

BACKGROUND

There exists a diverse range of criteria used in epidemiological studies for the diagnosis of periodontitis. The results from these studies should be evaluated with consideration to the diagnostic criteria used, and this may account for differences between studies especially in some population groups such as pregnant females. The objective is to evaluate the diagnostic criteria used in a variety of epidemiologic studies of periodontitis in pregnant females.

METHODS

An accuracy study with cross-sectional design was performed out from a database of 671 pregnant females, using six different sets of criteria for the diagnosis of periodontitis. Women were classified for periodontitis, as follows: Center for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP, 2012 criterion), the gold standard, Gomes-Filho et al.(2018) criterion, Albandar et al.(2007) criterion, Bassani et al.(2007) criterion, López et al.(2002) criterion, and Nesse et al.(2008) criterion. For comparison amongst the gold standard and the other criteria, sensitivity, specificity, predictive values, and likelihood ratio were determined.

RESULTS

The frequency of periodontitis ranged from 25.0% to 90.2%. The Bassani et al. (2007) criterion was found to be more sensitive among the studies, and thus more suitable for diagnostic screening studies. Gomes-Filho et al.(2018), Albandar et al. (2007), López et al. (2002), and Nesse et al. (2008) criteria were considered more specific, which makes them more useful for studies of periodontitis with the aim of using diagnosis for confirmation of disease.

CONCLUSIONS

A variation in the occurrence of periodontitis was observed. The criterion must be chosen according to the research aims and population characteristics.

Terapia medicamentosa para infecções por coronavírus em humanos: revisão sistemática rápida

Resumo O objetivo deste trabalho foi avaliar efeitos de tratamentos medicamentosos para infecções por coronavírus. Revisão sistemática rápida com buscas nas bases MEDLINE, EMBASE, Cochrane, BVS, Global Index Medicus, Medrix, bioRxiv, Clinicaltrials.gov e International Clinical Trials Registry Platform. Foram incluídos 36 estudos avaliando alternativas medicamentosas contra SARS, SARS-CoV-2 e MERS. A maioria dos estudos incluídos foi conduzida na China com delineamento observacional para tratamento da COVID-19. Os tratamentos mais estudados foram antimaláricos e antivirais. Nos antimaláricos, a metanálise de dois estudos com 180 participantes não identificou benefício da hidroxicloroquina em relação à negativação da carga viral via reação em cadeia de polimerase em tempo real e o uso de antivirais comparado ao cuidado padrão foi similar em relação aos desfechos. As evidências científicas disponíveis são preliminares e de baixa qualidade metodológica, o que sugere cautela na interpretação dos dados. Pesquisas que avaliem a eficácia comparativa em ensaios clínicos randomizados, controlados, com tempo de acompanhamento adequado e com os métodos devidamente divulgados e sujeitos à revisão científica por pares são necessárias. Recomenda-se atualização periódica da presente revisão.

Eficácia da máscara facial (TNT) na população para a prevenção de infecções por coronavírus: revisão sistemática

Resumo O objetivo deste artigo é avaliar a eficácia das máscaras faciais padrão tecido não tecido (TNT) para a prevenção de doenças respiratórias (MERS CoV, SARS-CoV e SARS-CoV-2) na população. Foi realizada busca nas bases de dados Medline, Embase, Cinahl, The Cochrane Library, Trip. Também busca complementar no Google Acadêmico, Rayyan e medRxiv. Não foram aplicados filtros relacionados a data, idioma ou status de publicação. Títulos e resumos foram rastreados e, posteriormente, textos completos foram avaliados. Foram incluídos três estudos: um ensaio clínico randomizado tipo cluster e duas revisões sistemáticas. O ensaio clínico indica benefício potencial de máscaras médicas para controle da fonte de infecção, para a doença respiratória clínica. Em uma das revisões sistemáticas, não foi possível estabelecer relação conclusiva entre uso da máscara e proteção contra infecção respiratória. Por fim, outra revisão sistemática demonstrou que máscaras são eficazes na prevenção da propagação de vírus respiratórios. As evidências apontam para benefício potencial das máscaras faciais padrão TNT. Para o cenário atual de pandemia por COVID 19, recomenda-se educação sobre uso adequado de máscaras, associado a medidas individuais de proteção.

Maternal Exposure to Alcohol and Low Birthweight: A Systematic Review and Meta-Analysis

Objective To investigate the relationship between maternal exposure to alcohol and low birthweight (LBW).

Methods The literature search was performed in January 2017 using the following electronic databases: Medline, Embase, LILACS, SciELO, Web of Science, Scopus, CINHAL, Proquest, and PsychInfo. The search strategy used the following terms: alcohol drinking, binge drinking, alcohol-related disorders, alcoholism, alcohol addiction/use/abuse/consumption, light/moderate/social/low drinking, low birthweight, case-control studies, retrospective studies, and cohort studies. No restrictions regarding language or publication date were considered. The literature search yielded 2,383 articles, and after screening and eligibility assessment, 39 articles were included in the systematic review, and 38 studies were included in the meta-analysis.

Results Maternal alcohol consumption was associated with LBW among retrospective cohort studies (relative risk [RR] = 1.37; 95%CI [confidence interval]:1.10–1.77; I2 = 98.4%; p < 0.01). Prospective cohort studies (RR = 1.11; 95%CI: 0.98–1.25; I2 = 81.5%; p < 0.01), and case-control studies (odds ration [OR] = 1.16; 95%CI: 0.68–1.97; I2 = 61.2%; p = 0.05) showed no association between alcohol and LBW. No publication bias was identified, and the meta-regression showed that the sample size influenced the high heterogeneity among retrospective cohort studies. The subgroup analysis showed differences in association between groups when compared by sample size, type of adjustment, or crude measures and publication year.

Conclusions We have not found an association between alcohol consumption during gestation and LBW in the analysis in all of the subgroups. In addition, we have found a high heterogeneity between the primary studies, which is related to methodological differences in the conduction of these studies.

Clinical effectiveness of enzyme replacement therapy with galsulfase in mucopolysaccharidosis type VI treatment: Systematic review

INTRODUCTION

Mucopolysaccharidosis VI is a rare disease characterized by the arylsulfatase B enzyme deficiency, which is responsible for different clinical manifestations. The treatment consists of enzyme replacement therapy with intravenous administration of galsulfase.

OBJECTIVE

Evaluate the effectiveness of the enzyme replacement therapy with galsulfase for the mucopolysaccharidosis VI treatment.

METHOD

Systematic review of observational studies. The databases of PubMed, Cochrane Library, Lilacs, and Journal of Inherited Metabolic Disease were reviewed. The selection of studies, data mining, and methodological quality assessment were independently conducted by two authors.

RESULTS

Eighteen studies fulfilled the inclusion criteria. Two studies were cohorts, one was longitudinal study, one was cross-sectional, one was a case-control, eight were case series, and five were case reports. A total of 362 participants with mucopolysaccharidosis type VI were evaluated, and 14 different outcomes related to the treatment effect were identified. Seven outcomes showed positive results, characterized by the patient survival, quality of life, respiratory function, joint mobility, physical resistance, reduction of urinary glycosaminoglycans, and growth. The hearing function and the cognitive development were stable after the treatment. Other outcomes related to the cardiac function, visual acuity, sleep apnea, and the size of the liver and spleen presented inconclusive outcomes. Concerning safety, light adverse reactions of hypersensitivity were reported.

CONCLUSION

This review provided a broader panoramic view of the outcomes related to mucopolysaccharidosis type VI. Regardless of the inherent limitations of observational studies, the outcomes indicate that the enzyme replacement therapy has a positive effect on most of the outcomes associated to the disease.

The Effect of Physical Exercise on Frail Older Persons: A Systematic Review

Physical exercise is one of the most effective non-pharmacological interventions aimed to improve mobility and independence in older persons. The effect of physical exercise and the most effective type of exercise in frail older persons remain undefined. This systematic review examines the effectiveness of physical exercise on frail older persons. Seven databases were search for randomized control trials which assessed the effect of exercise on participants who were identified as being frail using specific and validated criteria. Nine articles were reviewed from eight studies, from which seven used a validated definition of frailty. Based on the articles analyzed in our systematic review, the evidence suggests that exercise has a positive effect on various measures used to determine frailty including cognition, physical functioning, and psychological wellbeing. Some studies revealed that exercise may prevent or delay the onset of frailty which can enhance quality of life in older adults. Despite the evidence for exercise interventions in frail older adults, it appears that there is no clear guidance regarding the most effective program variables. The reviewed studies were generally long in duration (≥6 months) with sessions lasting around 60 minutes performed three or more times per week, including multicomponent exercises. In conclusion, although exercise interventions appear to be effective in managing the various components of frailty and preventing/delaying the onset of frailty, the most effective exercise program in this population remains unidentified.

Study on the Hymenoptera parasitoid associated with Lepidoptera larvae in reforestation and agrosilvopastoral systems at Fazenda Canchim (Embrapa Pecuária Sudeste) São Carlos, SP, Brazil

The aim of this study was to characterize the local fauna of Hymenoptera parasitoids associated with Lepidoptera larvae in areas of reforestation and agrosilvopastoral systems at Fazenda Canchim (Embrapa Pecuária Sudeste, São Carlos, SP, Brazil). Lepidoptera larvae collected with entomological umbrella were kept in the laboratory until emergence of adults or their parasitoids. From those collected in the agrosilvopastoral system, emerged 267 specimens of hymenopteran parasitoids belonging to 16 genera: Braconidae, Agathidinae (Alabagrus), Braconinae (Bracon), Microgastrinae (Cotesia, Diolcogaster, Glyptapanteles, Pholetesor and Protapanteles), Orgilinae (Orgilus); Ichneumonidae, Campopleginae (Casinaria, Charops and Microcharops); Chalcididae, Chalcidinae (Brachymeria and Conura); Eulophidae, Entedoninae (Horismenus), Eulophinae (Elachertus and Euplectrus). From the Lepidoptera larvae collected in the reforestation, emerged 68 specimens of hymenopteran parasitoids, belonging to 8 genera: Chalcididae, Chalcidinae (Conura); Ichneumonidae, Pimplinae (Neotheronia), Campopleginae (Charops and Microcharops) and Braconidae, Microgastrinae (Apanteles, Diolcogaster, Distatrix, Glyptapanteles and Protapanteles). The results of this study suggest the occurrence of a wide variety of Hymenoptera parasitoids in the studied environments.

Validation of atmospheric aerosols parallel sampling in a multifold device

In this work, particulate matter was collected using an active sampling system consisting of a PM10 (<10 μm) inlet coupled to a multifold device containing six channels, connected to a vacuum pump. Each channel was equipped with a filter holder fitted with adequately chosen filters. The system was fixed on a metallic structure, which was placed on the roof of the laboratory building, at the Faculty of Sciences, in Lisbon. Sampling took place under flow-controlled conditions. Aerosols were extracted from the filters with water, in defined conditions, and the water-soluble fraction was quantified by ion chromatography (IC) for the determination of inorganic anions (Cl(-), NO3 (-) and SO4 (2-)). Equivalent sampling through the various channels was validated. Validation was based on the metrological compatibility of the content results for the various filters. Ion masses are metrologically equivalent when their absolute difference is smaller than the respective expanded uncertainty. When this condition is verified, the studied multifold device produces equivalent samples.

First report of Dolichozele koebelei Viereck, 1911 (Hymenoptera: Braconidae) on larvae of Spodoptera frugiperda (J. E. Smith, 1797) (Lepidoptera: Noctuidae) in maize (Zea mays L.) under different cropping systems

In the context of the modern agriculture, pest control is important in order to increase productivity in maize (Zea mays L.). However, this control should be done rationally, prioritising environmentally safer methods such as biological control. This paper aims to report the occurrence of Dolichozele koebelei Viereck, 1911 (Hymenoptera: Braconidae) in Spodoptera frugiperda (J. E. Smith, 1797) (Lepidoptera: Noctuidae) larvae collected in maize subjected to different cropping systems. The experiment was conducted at the Centro Nacional de Pesquisa de Milho e Sorgo (CNPMS) in Sete Lagoas, Minas Gerais State, Brazil, using organic and conventional production. Ten plants were sampled from each of the 24 plots and for each production system, three times a week during the entire cycle of maize (variety BR 106). In the laboratory, larvae were distributed in individual rearing containers with artificial diet until the end of the biological cycle. An increased number of S. frugiperda larvae was observed in organic single crop maize; hence a higher percentage of S. frugiperda larvae parasitised by Hymenoptera and Diptera also occurred in the maize under this production system. Dolichozele koebelei had not yet been described in association with larvae of S. frugiperda. The percentage of parasitism of S. frugiperda larvae was high in both experiments, indicating the importance of natural control agents in reducing the population density of S. frugiperda, and especially the importance of an appropriate crop management.

Biological aspects of Eriopis connexa (Germar) (Coleoptera: Coccinellidae) fed on different insect pests of maize (Zea mays L.) and sorghum [Sorghum bicolor L. (Moench.)]

Eriopis connexa (Germar) (Coleoptera: Coccinellidae) occurs in several countries of South America and its mass rearing is important for biological control programmes. This work evaluated biological aspects of E. connexa larva fed on eggs of Anagasta kuehniella (Zeller) (Lepidoptera: Pyralidae) and Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae) frozen for one day, fresh eggs of Diatraea saccharalis (Fabricius) (Lepidoptera: Pyralidae), S. frugiperda newly-hatched caterpillars, nymphs of Rhopalosiphum maidis (Fitch) and Schizaphis graminum (Rondani) (Hemiptera: Aphididae). Duration of larva, pupa and larva to adult stages differed among prey offered, whereas the prepupa stage was similar. Larva, pupa, prepupa and larva to adult viabilities were equal or major of 87.5% in all prey, except for larva fed on newly-hatched larvae of S. frugiperda. Eriopis connexa has good adaptation to different prey corroborating its polyphagous feeding habit, which evidences the potential of this natural enemy for controlling corn and sorghum pests.

Occurrence and biology of Dinocampus coccinellae (Schrank, 1802) (Hymenoptera; Braconidae: Euphorinae) parasitising different species of Coccinellidae (Coleoptera) in Neotropical region

Surveys on Coccinellidae (Coleoptera) in Sete Lagoas city, Minas Gerais state, Brazil, indicated the parasitism of adults of the species Coleomegilla maculata De Geer, 1775, Eriopis connexa (Germar, 1824) and Olla v-nigrum (Mulsant, 1866), by Dinocampus coccinellae (Schrank, 1802) (Hymenoptera; Braconidae: Euphorinae). Since then, the parasitoid have been maintained in its original hosts at the Insect Rearing Laboratory - LACRI of the Brazilian Agricultural Research Institution - Embrapa Milho e Sorgo. Besides the citation of occurrence in Brazil, this work also indicates the parasitoid preference for C. maculata (70% of parasitism), followed by O. v-nigrum (43.3% of parasitism) and E. connexa (36.7% of parasitism). Total life cycle of D. coccinellae was longer on C. maculata (32.4 ± 0.48 days), compared to O. v-nigrum (29.5 ± 0.49 days) and E. connexa (27.8 ± 0.4 days). Due to the relatively high percentage of field parasitism, D. coccinellae can reduce the efficiency of biological pest control by Coccinellidae predators especially in the case of C. maculata.

CD28 is required for T cell activation and IFN-gamma production by CD4+ and CD8+ T cells in response to Trypanosoma cruzi infection

In the present study we evaluated the mechanisms behind the implication of the costimulatory molecule CD28 for the immune response against the intracellular protozoan parasite Trypanosma cruzi. Our results reveal a critical role for CD28 in the activation of both CD4+ and CD8+ T cells and induction of the effector mechanisms that ultimately mediate the control of parasite growth and pathogenesis in infected mice. CD28-deficient (CD28-/-) mice are highly susceptible to T. cruzi infection, presenting higher parasitemia and tissue parasitism, but less inflammatory cell infiltrate in the heart than C57Bl/6 wild-type (WT) mice. All the infected WT mice survived acute infection, whereas 100% of CD28-/- mice succumbed to it. The increased susceptibility of the CD28-/- mice was associated with a dramatic decrease in the production of IFN-gamma by both CD4+ and CD8+ T cells resulting in a diminished capacity to produce nitric oxide (NO) and mediate parasite killing. T cell activation was also profoundly impaired in CD28-/- mice, which presented decreased lymphoproliferative response after the infection compared to WT mice. Together, these data represent the first evidence that CD28 is critical for efficient CD4+ T cell activation in response to T. cruzi infection in mice.

CTLA-4 Blockage Increases Resistance to Infection with the Intracellular ProtozoanTrypanosoma cruzi

Recent studies have revealed an important role for CTLA-4 as a negative regulator of T cell activation. In the present study, we evaluated the importance of CTLA-4 to the immune response against the intracellular protozoan, Trypanosoma cruzi, the causative agent of Chagas' disease. We observed that the expression of CTLA-4 in spleen cells from naive mice cultured in the presence of live trypomastigote forms of T. cruzi increases over time of exposure. Furthermore, spleen cells harvested from recently infected mice showed a significant increase in the expression of CTLA-4 when compared with spleen cells from noninfected mice. Blockage of CTLA-4 in vitro and/or in vivo did not restore the lymphoproliferative response decreased during the acute phase of infection, but it resulted in a significant increase of NO production in vivo and in vitro. Moreover, the production of IFN-gamma in response to parasite Ags was significantly increased in spleen cells from anti-CTLA-4-treated infected mice when compared with the production found in cells from IgG-treated infected mice. CTLA-4 blockade in vivo also resulted in increased resistance to infection with the Y and Colombian strains of T. cruzi. Taken together these results indicate that CTLA-4 engagement is implicated in the modulation of the immune response against T. cruzi by acting in the mechanisms that control IFN-gamma and NO production during the acute phase of the infection.

Agalactia in mares fed with grain contaminated with Claviceps purpurea

This article reports an outbreak of intoxication of female horses with Claviceps purpurea in southern Brazil. The outbreak affected twelve pregnant mares which were fed with black oat (Avena strigosa) during the pre-delivery period. Underdevelopment of the mammary gland in the pre-delivery period resulting in post-delivery agalactia was the most pronounced finding. These mares delivered weak and unviable foals, which showed no suckling reflex and died within a few hours of birth. Laboratory analysis of oat samples fed to the animals resulted in the identification of Claviceps purpurea sclerotia. The fungus was identified in 0.22% of the examined seeds.

Features of host cell invasion by different infective forms of Trypanosoma cruzi

Through its life cycle from the insect vector to mammalian hosts Trypanosoma cruzi has developed clever strategies to reach the intracellular milieu where it grows sheltered from the hosts' immune system. We have been interested in several aspects of in vitro interactions of different infective forms of the parasite with cultured mammalian cells. We have observed that not only the classically infective trypomastigotes but also amastigotes, originated from the extracellular differentiation of trypomastigotes, can infect cultured cells. Interestingly, the process of invasion of different parasite infective forms is remarkably distinct and also highly dependent on the host cell type.

Effects in high-performance liquid chromatography of a high pH in the mobile phase on poly(methyloctylsiloxane) immobilized by gamma-radiation on titanium-grafted silica

Effects of high-pH environments on a stationary phase prepared by gamma-radiation immobilization of poly(methyloctylsiloxane) on titanium-grafted silica were investigated by HPLC testing with standard sample mixtures. The HPLC parameters indicate good stationary phase stability to 10000 column volumes each of mobile phases with pH of 7, 9 and 12. At pH 13, the efficiency decreases slowly, although reasonably good separations are still possible until increasing flow resistance no longer allows easy passage of the mobile phase.

Community genetics: a new discipline and its application in Brazil

Community genetics is a new discipline which aims to provide genetic services to the community as a whole. As a science, community genetics encompasses all research needed to develop and evaluate its application. There is no question that the development of community genetics is necessary in Brazil. The implementation of such programs in our country, especially for hemoglobinopathies, has been recommended by the World Health Organization and other international organizations. Apart from the need for and appeal of community genetics programs, some aspects require serious review. This article discusses various cultural, social, psychological, and economic factors that can make genetic screening an invasion of individual privacy.