Pre-employment inquiries: drug testing, alcohol screening, physical exams, honesty testing, genetics screening--do they discriminate? An empirical study.
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AIDS Serodiagnosis↗
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Finnish physicians' interest in genetic screening.
OBJECTIVES: To report on Finnish physicians' opinions on the possible future use of genetic screening and their interest in knowing their own risk for diseases. METHODS: A questionnaire survey mailed to gynaecologists, paediatricians, general practitioners and clinical geneticists. Both leading physicians and a sample of other practitioners were included (response rate 74%, n=571). RESULTS: Physicians preferred genetic testing of people at risk over population-wide screening. Breast and colon cancer, familial hypercholesterolaemia and juvenile diabetes were diseases for which screening was most often considered useful. The most popular target group was the whole population. Opinions on the stability of genetic screening were not uniform, and physicians did not take a stand on genetic screening as a whole but differentiated by disease and target group. Those wanting to know their own risk for diseases supported screening procedures in general more than did other physicians. CONCLUSIONS: Physicians were not enthusiastic about genetic screening. Nevertheless, testing of individuals with a family history of certain diseases is likely to become more widespread.
Attitude of Health Personnel↗
Prenatal genetic screening for Down syndrome and open neural tube defects using maternal serum markers in Thai pregnant women.
Maternal serum screening has gained widespread acceptance as a major prenatal screening tool for chromosomal abnormalities in the US and Europe since Merkatz et al described an association between low maternal serum alpha fetoprotein (AFP) levels and increased risk for trisomy 21 in 1984. In 1988, Wald et al proposed a screening program based on maternal age in combination with three biochemical markers--AFP, hCG and unconjugated estriol. This study from January 1996--September 2002 included 1,793 pregnant women (between 14-22 weeks gestation) which were divided into 2 groups--1,083 women > 35 years (60.40%) and 710 women < 35 years (39.60%). A second trimester risk for trisomy 21 > 1 : 270 was considered a positive screen and genetic counseling to discuss risks and benefits of amniocentesis was offered. This study had 1,376 cases (76.7%) with negative screening (not increased risk for DS and NTD), 21 (1.2%) with negative screening (not increased risk for DS only) ; 292 (16.3%) with increased risk for DS; 5 cases (0.3%) with increased risk for DS and elevated AFP; 19 cases (1.1%) with elevated AFP; 33 cases (1.8%) with previous DS only; and 9 cases (0.5%) with previous NTD only. Two percent (2.1%) of the results could not be interpreted either because the test was done too early, too late or were grand multiple pregnancies. This study demonstrated that multiple marker screening offers another option for older women who traditionally have all been considered candidates for amniocentesis.
Adult↗
[Preconception screening for carrier state in cystic fibrosis; testing against Health Council's criteria for genetic screening].
OBJECTIVE: To determine if preconceptional screening for carriership of cystic fibrosis (CF) meets the requirements formulated by the Committee for Screening for Hereditary and Congenital Disorders of the Health Council. DESIGN: Theoretical evaluation. METHOD: Preconceptional screening for CF carriership by means of direct mutation analysis in a blood sample, cheek smear or mouth rinse sample of both partners of pairs desiring children was tested against the criteria of the Health Council. RESULTS: Preconceptional screening for CF carriership proves to meet most of the requirements for genetic screening. Current problems are the inadequate sensitivity of the screening (72% for pairs, 85% for individuals), the consequences of this for the meaning of the test results and reaching of the target group. Much attention is required for provision of information at all stages of the screening procedure. The desirability, feasibility and psychosocial effects of this type of screening have not yet been investigated sufficiently in the Netherlands.
Clinical Protocols↗
Medical and ethical issues in genetic screening--an academic view.
This article is intended to acquaint those whose principal concerns are the health and safety of workers with genetic screening and some of the medical and ethical issues it raises. Population-based genetic screening increasingly is being considered for predicting future disease in the person being screened. A major problem in screening for alleles that contribute to the development of common, multifactorial disorders is low sensitivity and positive predictive value. In many instances, no demonstrably effective prophylaxis or treatment is available to help those with positive test results. This creates ethical problems of assuring that testing is in the person's best interest and raises in turn issues of autonomy, discrimination, and privacy. Instead of screening for genetic predispositions to harm from workplace exposures, other means of improving the health of workers may bring greater benefits to a higher proportion of workers. The current state of genetic tests for chronic beryllium disease are considered. None are suitable for screening.
Beryllium↗
Analysis for heterozygosity of protein S mRNA: application to genetic screening and family studies in hereditary protein S deficiency.
We genetically screened patients with hereditary protein S deficiency for heterozygosity of protein S mRNA using PCR-RFLP for Pro626 polymorphism. All patients who showed hemizygous state of protein S mRNA, characterized by markedly decreased levels of one allele, had a phenotype of type I protein S deficiency. A putative mutation, such as a nonsense or splice site mutation, in the silent alleles may have affected the mutated mRNA metabolism and reduced the mutated mRNA accumulation, and consequently resulted in type I protein S deficiency in these patients. We also applied this mRNA-based analysis to family studies in hereditary protein S deficiency. In a family with type I protein S deficiency, all affected individuals showed a loss of one allele at the mRNA level and the silent allele cosegregated with the disease phenotype. Detection of hemizygous expression of protein S mRNA provided direct evidence for type I protein S deficiency without further precise genetic analysis. Our findings indicate that this mRNA-based analysis can be a useful strategy for genetic screening and family studies in hereditary protein S deficiency.
Codon↗
A cost-benefit analysis of genetic screening for susceptibility to occupational toxicants.
Genetic screening can identify individuals with increased susceptibility to certain workplace toxicants. One conceivable benefit is a reduction in occupational disease costs. We examine this rationale by considering the associations among genetic traits, exposure, disease risk, and disease incidence. Given appropriate information, we describe methods for computing the expectation and variance of the future number of disease cases and of the differential screening cost per worker hired (a cost-benefit measure). We present two hypothetical scenarios: (1) benzene-induced cancer with few expected cases, and (2) chronic beryllium disease with many expected cases. We show that variability in disease incidence and cost outcomes must be considered because in specific instances, screening can be cost-beneficial on average but yield an unfavorable outcome with high probability. This circumstance pertains to scenarios involving small differences between the expected number of cases in screened versus unscreened cohorts.
Benzene↗
The art and design of genetic screens: caenorhabditis elegans.
The nematode Caenorhabditis elegans was chosen as a model genetic organism because its attributes, chiefly its hermaphroditic lifestyle and rapid generation time, make it suitable for the isolation and characterization of genetic mutants. The most important challenge for the geneticist is to design a genetic screen that will identify mutations that specifically disrupt the biological process of interest. Since 1974, when Sydney Brenner published his pioneering genetic screen, researchers have developed increasingly powerful methods for identifying genes and genetic pathways in C. elegans.
Animals↗
Testing normality of fetal DNA concentration in maternal plasma at 10-12 completed weeks' gestation: a preliminary approach to a new marker for genetic screening.
OBJECTIVES: To test the distribution of fetal DNA in maternal plasma expressed as gen/eq in a population of normal pregnancies. METHODS: Peripheral blood samples were obtained from 63 women (85% > or =35 years of age at delivery) bearing a euploid male fetus. Each patient underwent chorionic villus sampling (CVS) for karyotype analysis and/or beta thalassemia screening. Ultrasound scanning was used to determine gestational age. At 10-12 weeks' gestation, a peripheral blood sample was collected followed by CVS. To detect the Y chromosome specific sequences (SRY) quantitative polymerase chain reaction (PCR) analysis was used. Normal distribution of the data was tested by means of the Kolmogorov-Smirnov (KS) test. A Symmetry test (reliability p>0.05) was used to evaluate the reliability of the median. RESULTS: Only after natural logarithmic transformation did the data display a normal distribution. The median value of fetal DNA was 23.3 gen/eq (range 2.08-195), interquartile range 18.57-45.4. A Pearson test showed a significant correlation between gestational age and fetal DNA concentration (r=0.25, p=0.045). CONCLUSION: The present finding is a preliminary step towards a possible integration of fetal DNA with other variables (biochemical and/or ultrasound). It may serve to improve the discrimination of the screening for genetic diseases in the first trimester. Because of the relatively high dispersion, adjustments for possible covariates would appear to be necessary in further studies.
Chorionic Villi Sampling↗
The stigma of disease: implications of genetic screening.
As the field of human genetics successfully continues to unravel the secrets of an individual's genetic makeup, the social processes of stigmatization and ostracism of those with "undesirable" traits have the potential to increase. An historical example that may shed light on the problems of applying genetic technology to disease prevention is the institution of quarantine. This essay discusses the concept of "quarantine mentality" and the desire for healthy society to separate itself from those labeled "ill" or abnormal, and addresses two episodes in American history when genetics was applied to the formulation of social policy toward the "diseased": the eugenics movement of the early 20th century and the early attempts of genetic screening programs for sickle cell anemia during the 1970s.
Anemia, Sickle Cell↗
[Clinical symptoms, diagnosis and treatment of multiple endocrine neoplasia type 1. Results of genetic screening in Hungarian patients].
Multiple endocrine neoplasia type 1 syndrome is an autosomal dominant disorder characterized by endocrinopathies involving the parathyroid glands, anterior pituitary gland, and pancreas. Also, it may be associated with foregut carcinoid, adrenocortical tumors and non-endocrine tumors. After reviewing the prevalence, genetic background, clinical symptoms, diagnosis and treatment of the disorder, the authors present their genetic screening method used for the detection of mutations of the MEN1 gene (prescreening of polymerase chain reaction amplified exons using temporal temperature gradient gel electrophoresis followed by direct DNA sequencing). Using this method, the authors identified disease-causing MEN1 gene mutations in 9 probands (small deletions in 2 cases, insertion in 2 cases, nonsense mutations in 2 cases and missense mutations in 3 cases). Of the 9 mutations, 4 proved to be novel mutation not reported in the literature. Family screening indicated de novo mutations in 2 probands. In addition to mutations, several sequence polymorphisms were also detected. The authors conclude that one of the major advantages of genetic screening in families with MEN1 syndrome was the identification of family members carrying the mutation who should be regularly screened for disease manifestations and those not carrying the mutation in whom clinical screening is unnecessary. Also, genetic screening may be useful in cases when MEN1 syndrome is suspected, but the clinical manifestations do not fully establish the diagnosis of MEN1 syndrome.
Adrenal Cortex Neoplasms↗
Genetic screening of donors for artificial insemination.
A routine has been established for genetic screening of donors in an artificial insemination and frozen sperm bank program. This report is a summary and analysis of the information obtained on the first 168 donor applicants and 89 recipients who were genetically screened. The specific forms for screening, family information obtained, characteristics of the donor and recipient groups, and guidelines for acceptance or rejection of donors are discussed. The donor and recipient often failed to perceive that the disorders in the family were genetic. The simple question of whether or not there were genetic or hereditary problems in the family was ineffective, even when the donor or recipient had formal medical training.
Age Factors↗
Genetic screening of prospective parents and of workers: some scientific and social issues.
Genetic screening programs are based on assumptions and values that reflect the history of racial and social eugenics in the United States and Europe. They stigmatize individuals by shifting the focus from social, economic, and political decisions that affect the health of prospective parents, newborns, and workers to "bad genes," that is, intrapersonal factors that are given the status of "causes" of disease. Prenatal screening, at best, can help the relatively few individuals who know that their future children are at risk for a particular inherited disease or disability; it has little positive value for the average person. Workplace genetic screening has not been shown to reduce occupational disease, but it has led to employment discrimination and has drawn attention away from controlling exposures to toxic chemicals in the workplace.
Amniocentesis↗
Genetic screening for deafness.
Genetic testing for deafness has become a reality. It has changed the paradigm for evaluating deaf and hard-of-hearing persons and will be used by physicians for diagnostic purposes and as a basis for treatment and management options. Although mutation screening is currently available for only a limited number of genes, in these specific instances, diagnosis, carrier detection, and reproductive risk counseling can be provided. In the coming years there will be an expansion of the role of genetic testing and counseling will not be limited to reproductive issues. Treatment and management decisions will be made based on specific genetic diagnoses. Although genetic testing may be a confusing service for the practicing otolaryngologist, it is an important part of medical care. New discoveries and technologies will expand and increase the complexity of genetic testing options and it will become the responsibility of otolaryngologists to familiarize themselves with current discoveries and accepted protocols for genetic testing.
Connexin 26↗
Effects of genetic screening on perceptions of health: a pilot study.
The aim of the current study was to determine how carriers of a recessive gene, which confers no risk to their own health, perceive their health, relative to non-carriers. Perceptions of health in three groups were compared: those screened and found to carry the gene for Tay-Sachs disease, those screened and not found to carry the gene for Tay-Sachs disease, and a community based sample who, it was presumed, had not undergone screening. The groups did not differ in their perceptions of their current health or their past health. Carriers, however, viewed their future health with less optimism than the other two groups. The causes and consequences of this altered perception need to be explored in future studies. With the advent of population based screening for cystic fibrosis carrier status, these results highlight the importance of assessing in detail people's experiences of screening before the introduction of any mass genetic screening programmes.
Adult↗
Mismatch repair genes identified using genetic screens in Blm-deficient embryonic stem cells.
Phenotype-driven recessive genetic screens in diploid organisms require a strategy to render the mutation homozygous. Although homozygous mutant mice can be generated by breeding, a reliable method to make homozygous mutations in cultured cells has not been available, limiting recessive screens in culture. Cultured embryonic stem (ES) cells provide access to all of the genes required to elaborate the fundamental components and physiological systems of a mammalian cell. Here we have exploited the high rate of mitotic recombination in Bloom's syndrome protein (Blm)-deficient ES cells to generate a genome-wide library of homozygous mutant cells from heterozygous mutations induced with a revertible gene trap retrovirus. We have screened this library for cells with defects in DNA mismatch repair (MMR), a system that detects and repairs base-base mismatches. We demonstrate the recovery of cells with homozygous mutations in known and novel MMR genes. We identified Dnmt1(ref. 5) as a novel MMR gene and confirmed that Dnmt1-deficient ES cells exhibit micro-satellite instability, providing a mechanistic explanation for the role of Dnmt1 in cancer. The combination of insertional mutagenesis in Blm-deficient ES cells establishes a new approach for phenotype-based recessive genetic screens in ES cells.
Adenosine Triphosphatases↗
Public health aspects of genetic screening for hereditary haemochromatosis in Australia.
Hereditary haemochromatosis (HH) is an inherited disorder of iron absorption. It meets several of the key public health principles for population-based screening and is considered to be a test-case for public health genetics. However, there has been relatively little debate in the public health or wider community regarding the merits of population-based genetic screening for HH. Genetic susceptibility to HH occurs in about 1:200 people and although mortality is low (age-standardised rate 2.75/million), there are potentially serious clinical manifestations of iron overload. Regular venesection is a simple and effective treatment for early stage iron overload. DNA-based testing is available and iron overload may be identified using serum transferrin saturation and ferritin tests. However, there are important gaps in knowledge relevant to screening for HH. The limited data on penetrance of HFE genotypes, and thus the uncertain probability that genetically susceptible individuals will develop clinically significant disease, is a major impediment to population-based genetic screening. Clinical evidence supports treating early-stage disease but no randomised controlled trials of the effectiveness of screening in reducing the burden of disease have been conducted. In addition, the natural history of early stages of HH and factors that may modify progression are unclear. Two intemational consensus panels on HH concluded that there is insufficient evidence for population-based screening at present. We present recommendations to advance the debate on screening for HH in Australia.
Australia↗
Medical and lay attitudes towards genetic screening and testing in Finland.
The purpose of this study was to compare physicians', midwives' and lay people's attitudes towards genetic screening and testing to find out whether medical education and experience influence attitudes of genetic screening and testing. The study was based on comparison of answers to joint questions in three different cross-sectional postal surveys between October 1996 and April 1998 in Finland. Target groups were physicians (study base n=772, response rate 74%, including gynaecologists, paediatricians, general practitioners and clinical geneticists), midwives and public health nurses (collectively referred to as midwives in the following; n=800, response rate 79%), and lay people (n=2000, response rate 62%). Midwives were more worried about the consequences of genetic testing and stressed the autonomy of the customer more strongly than lay people did. Furthermore, professionals considered that lay peoples' expectations as regards to genetic testing are too high. Having more medical education was related to having less 'cannot say' and missing responses. Our results do not suggest that major conflicts about the direction of genetic testing and screening would arise in near future. However, different positions and interests should be considered. Reporting in public about new prospects and developments in medical genetics should pay more attention also to concerns for balancing promises and drawbacks.
Attitude of Health Personnel↗