The Canadian genetic counseling workforce: Perspectives from employers and recent graduates.

There is a lack of literature devoted to the Canadian genetic counseling workforce. Current and prospective genetic counseling students, graduates, employers, programs, and funding agencies remain largely uninformed of trends in the job market. The purpose of this study was to investigate the employment experiences of recent Canadian genetic counseling graduates and employers of genetic counselors (GCs) in Canada. An online survey was distributed to Canadians who had graduated from North American genetic counseling programs from 2014 to 2018 and to employers with experience hiring patient-facing genetic counselors from 2016 to 2018. Quantitative data were analyzed through descriptive statistics and, where appropriate, logistic regression. Qualitative data were reviewed to illustrate and support the quantitative data. Half of the employer responders (11/22) reported hiring more or many more genetic counselors compared to 3 years ago (2016), and a majority (n = 19, 86%) reported a desire to hire at least one more genetic counselor if funding were available. Most graduates (45/70, 64%) reported securing employment before graduation, 33% (n = 23) within 6 months of graduation, and no one taking longer than 1 year. For recent graduates, location was the most important factor when looking for work, and those who chose to work in Canada experienced significantly more challenges gaining employment as opposed to those who worked internationally (p = 0.03). The specialties in highest demand for genetic counselors and the most common areas of practice for recent graduates included adult general genetics, prenatal genetics, and cancer genetics. Overall, our findings suggest that there is a growth of employment opportunities in Canada and more employer-reported need for clinical genetic counselors; however, there is a lack of funding to support this expansion.

Associations between positive parenting practices and child externalizing behavior in underserved Latino immigrant families.

This study examined whether five specific parenting practices (i.e., monitoring, discipline, skill encouragement, problem solving, and positive involvement) were associated with reduced child externalizing behaviors among a sample of Latino immigrant families. It utilized baseline data from 83 Latino couples with children participating in a larger randomized controlled trial of a culturally adapted parenting intervention. Results reveal that monitoring, discipline, skill encouragement, and problem solving each made independent contributions to the prediction of child externalizing behavior, although not all in the expected direction. Further analyses examining mothers and fathers separately suggest that mother-reported monitoring and father-reported discipline practices uniquely contributed to these findings. These results may have important implications for prevention and clinical intervention efforts with Latino immigrant families, including the cultural adaptation and implementation of parenting interventions with this underserved population.

Cost-effectiveness of MRI for breast cancer screening in BRCA1/2 mutation carriers.

BACKGROUND: Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting. METHODS: We constructed a Markov model of annual MRI and mammography screening for BRCA1/2 carriers, using local data and published values. We calculated cost-effectiveness as cost per quality-adjusted life-year gained (QALY), and conducted one-way and probabilistic sensitivity analysis. RESULTS: The incremental cost-effectiveness ratio (ICER) of annual mammography plus MRI screening, compared to annual mammography alone, was $50,900/QALY. After incorporating parameter uncertainty, MRI screening is expected to be a cost-effective option 86% of the time at a willingness-to-pay of $100,000/QALY, and 53% of the time at a willingness-to-pay of $50,000/QALY. The model is highly sensitive to the cost of MRI; as the cost is increased from $200 to $700 per scan, the ICER ranges from $37,100/QALY to $133,000/QALY. CONCLUSIONS: The cost-effectiveness of using MRI and mammography in combination to screen for breast cancer in BRCA1/2 mutation carriers is finely balanced. The sensitivity of the results to the cost of the MRI screen itself warrants consideration: in jurisdictions with higher MRI costs, screening may not be a cost-effective use of resources, but improving the efficiency of MRI screening will also improve cost-effectiveness.

Efficacy of ultraviolet C exposure for inactivating Senecavirus A on experimentally contaminated surfaces commonly found on swine farms.

The objective of this study was to evaluate the efficacy of ultraviolet C light (UVC) for inactivating Senecavirus A (SVA) on three different experimentally contaminated surfaces commonly found in swine farms. An experimental study under controlled conditions assessed the effect of UVC on an SVA isolate on coupons composed of three surface types: cardboard, cloth, and plastic. Each coupon was inoculated with 2 mL of SVA (107.5 TCID50/mL) and 1 mL of PBS or 1 g of feces on the top or bottom surface of the coupon and allowed to dry (90 min at 25℃). Coupons were exposed to UVC in a commercially available pass-through chamber (PTC) for 5 min or in a simulated supply entry room (SER) for 120 min. After exposure, virus isolation was attempted from each coupon and virus titers were determined in cell culture. The efficacy of UVC was determined by the reduction in virus titer for the UVC treated groups compared to their respective non-treated positive controls. UVC was effective at inactivating SVA on plastic surface free of organic material. The plastic coupons inoculated with SVA and PBS had a significantly lower virus titer (>7-log reduction) in both the PTC and SER when compared to their relative positive controls. All other groups in the PTC and SER had a 2-log reduction or less. The reduction in virus titer on the top and bottom inoculated surfaces, following exposure to UVC, were not statistically different. The data from this study provide some guidance when applying UVC for disinfection in the field.

Integrating Tumor Sequencing Into Clinical Practice for Patients With Mismatch Repair-Deficient Lynch Syndrome Spectrum Cancers.

INTRODUCTION: Uninformative germline genetic testing presents a challenge to clinical management for patients suspected to have Lynch syndrome, a cancer predisposition syndrome caused by germline variants in the mismatch repair (MMR) genes or EPCAM. METHODS: Among a consecutive series of MMR-deficient Lynch syndrome spectrum cancers identified through immunohistochemistry-based tumor screening, we investigated the clinical utility of tumor sequencing for the molecular diagnosis and management of suspected Lynch syndrome families. MLH1-deficient colorectal cancers were prescreened for BRAF V600E before referral for genetic counseling. Microsatellite instability, MLH1 promoter hypermethylation, and somatic and germline genetic variants in the MMR genes were assessed according to an established clinical protocol. RESULTS: Eighty-four individuals with primarily colorectal (62%) and endometrial (31%) cancers received tumor-normal sequencing as part of routine clinical genetic assessment. Overall, 27% received a molecular diagnosis of Lynch syndrome. Most of the MLH1-deficient tumors were more likely of sporadic origin, mediated by MLH1 promoter hypermethylation in 54% and double somatic genetic alterations in MLH1 (17%). MSH2-deficient, MSH6-deficient, and/or PMS2-deficient tumors could be attributed to pathogenic germline variants in 37% and double somatic events in 28%. Notably, tumor sequencing could explain 49% of cases without causal germline variants, somatic MLH1 promoter hypermethylation, or somatic variants in BRAF. DISCUSSION: Our findings support the integration of tumor sequencing into current Lynch syndrome screening programs to improve clinical management for individuals whose germline testing is uninformative.

The BRCA Self-Concept Scale: a new instrument to measure self-concept in BRCA1/2 mutation carriers.

UNLABELLED: Genetic testing for BRCA1/2 has psychosocial impacts including those related to views of personal health, sense of self and identity and body image. The centrality of a person's self-concept in maintaining physical and psychosocial well-being has been well recognized; however, to date research exploring altered self-concept related to carrier knowledge is limited. OBJECTIVE: The objective of the study was to develop and validate a scale to measure the self-concept among individuals testing positive for BRCA1/2 mutations. METHODS: The study was conducted in two phases: phase I: item generation and refinement and phase II: scale selection and initial validation. During phase I, scale items were generated through individual interviews and focus groups of women with BRCA1/2 mutations, including women with or without a prior diagnosis of cancer. In phase II items were selected based on several criteria resulting in a 25-item scale, which underwent a reliability analyses and preliminary validation with 115 women. A second sample of 126 women was used to conduct further validation and samples were pooled to conduct factor analysis and the final scale selection. RESULTS: A 17-item self-concept scale emerged having three factors: stigma, vulnerability and mastery demonstrating evidence for an instrument with promising psychometric properties (total scale alpha=0.90). CONCLUSIONS: The scale has direct relevance for research in facilitating our understanding of the specific aspects of the self, which are vulnerable to BRCA1/2 testing and which play a role in clinical outcomes, to facilitate the development and specific testing of interventions and may be used as an outcome measure. Specific measurement tools for genetic populations will ultimately assist in the clinical management of these populations.

Evaluation of group genetic counseling for hereditary breast and ovarian cancer.

As demand for genetic counseling regarding hereditary cancer continues to grow, more efficient methods of providing this service must be explored. In this pilot study, group genetic counseling was offered to two different cohorts of women seeking genetic counseling for Hereditary Breast and Ovarian Cancer. Seven group sessions, designed to cover all aspects of an individual genetic counseling appointment, were conducted. Although patients were receptive to group genetic counseling, a significant proportion chose individual counseling when given the option. Advantages of group genetic counseling include shared experience and increased efficiency. Disadvantages include increased frustration at not being eligible for genetic testing, group influence on decision-making, privacy concerns, increased need for follow-up, and difficulty booking group appointments. Overall, the level of patient satisfaction with group genetic counseling was similar to that of individual counseling. The results of this pilot study suggest that further research is needed to determine whether group genetic counseling is an acceptable alternative to individual counseling.

Antibiotic Therapy Does Not Alter the Humoral Response to Vaccination for Porcine Circovirus 2 in Weaned Pigs.

Recent reports suggest that antibiotic therapy may either reduce or enhance the immune response to various porcine vaccines. Based upon these findings, we asked if antibiotic therapy alters immune cell populations, as measured by flow cytometry and/or vaccine-specific humoral immunity, as measured by sample to positive (S/P) antibody ratios. Here, we investigated the immuno-modulatory effects of enrofloxacin, ceftiofur, and tulathromycin on the immune response to a Mycoplasma hyopneumoniae (M. hyopneumoniae) and porcine circovirus type 2 (PCV-2) combination vaccine in weaned pigs. Maternal antibody likely interfered with the induction of immunity to M. hyopneumoniae. Antibiotic administration did not affect immune cell populations, as assessed by flow cytometry and did not affect the induction of humoral immunity to PCV-2.

The Global State of the Genetic Counseling Profession.

The profession of genetic counseling (also called genetic counselling in many countries) began nearly 50 years ago in the United States, and has grown internationally in the past 30 years. While there have been many papers describing the profession of genetic counseling in individual countries or regions, data remains incomplete and has been published in diverse journals with limited access. As a result of the 2016 Transnational Alliance of Genetic Counseling (TAGC) conference in Barcelona, Spain, and the 2017 World Congress of Genetic Counselling in the UK, we endeavor to describe as fully as possible the global state of genetic counseling as a profession. We estimate that in 2018 there are nearly 7000 genetic counselors with the profession established or developing in no less than 28 countries.

A randomized controlled trial to test the effect of on-arrival vaccination and deworming on stocker cattle health and growth performance.

Our objective was to determine the effect of vaccination and deworming at arrival (d 0) on bovine respiratory disease (BRD) incidence, mortality, and growth of stocker calves. Calves (n=80) were stratified by d -3 weight and fecal egg count (FEC) into 20 pens of 4 calves. Pens were randomly assigned to treatments in a 2×2 factorial design, testing d 0 vaccination (modified-live respiratory virus and clostridial vaccine, or not) and deworming (oral fenbendazole and levamisole, or not). Body weights were measured on days 0, 14, 28, 42, 56, 70, and 85, and FEC were measured on days -3, 28, 56, and 85. Incidence of BRD was greater for d 0 vaccination (RR=3.2), high fever (≥104°F, ≥40°C) at d 0 (RR=6), and higher d -3 FEC (RR=1.2 per 100 epg). Mortality was greater for d 0 vaccination (OR=8.3) and high fever (OR=41.6). Growth was 10.3 lb (4.7 kg) lower for d 0 vaccination, 24 lb (11 kg) and 16 lb (7.3 kg) lower for moderate (103°F to 103.9°F; 39.4°C to 39.9°C) and high fever, respectively, and 17.6 lb (8 kg) lower for each additional BRD treatment a calf received. Deworming was neither beneficial nor detrimental to any health or performance factors. Health and growth performance of stocker calves may be adversely affected by vaccination at arrival, higher arrival FEC, and fever at arrival.

Notre objectif était de déterminer l'effet de la vaccination et de la vermifugation à l'arrivée (j0) sur l'incidence du complexe respiratoire bovin (CRB), la mortalité et la croissance des veaux d'élevage. Les veaux (n=80) ont été stratifiés selon le poids et le compte d'œufs fécaux (COF) à j-3 et placés dans 20 enclos avec chacun quatre veaux. Les enclos étaient assignés aléatoirement aux traitements selon un plan factoriel 2×2 avec la vaccination à j0 (avec ou sans vaccin anti-clostridial avec virus respiratoires vivants modifiés) et la vermifugation (avec ou sans injection orale de fenbendazole et de lévamisole) comme facteurs. Le poids corporel a été mesuré aux jours 0, 14, 28, 42, 56, 70 et 85 et le COF a été fait aux jours −3, 28, 56 et 85. L'incidence du CRB était plus élevée suivant la vaccination à j0 (RR=3.2), lorsque la fièvre était élevée à j0 (≥104°F, ≥40°C) (RR=6) et lorsque le COF était plus élevé à j-3 (RR=1.2 par 100 oeufs par gramme). La mortalité était plus élevée suivant la vaccination à j0 (RC=8.3) et lorsque la fièvre était élevée (RC=41.6). Il y a eu une perte de croissance de 10.3 lb (4.6 kg) suivant la vaccination à j0, une perte de 24.1 lb (11 kg) lorsque la fièvre était modérée (103­103.9°F), une perte de 16 lb (7.3 kg) lorsque la fièvre était élevée et une perte de 17.5 lb (8 kg) pour chaque traitement additionnel contre le CRB reçu par un veau. La vermifugation n'a pas eu d'effet bénéfique ou néfaste sur tous les facteurs reliés à la santé ou à la performance. La santé et la croissance des veaux d'élevage peuvent être affectées négativement par la vaccination à l'arrivée, par un COF initialement élevé et par la fièvre à l'arrivée.

Exploring Factors That Contribute to Positive Change in a Diverse, Group-Based Male Batterer Intervention Program: Using Qualitative Data to Inform Implementation and Adaptation Efforts.

Although batterer intervention programs (BIPs) are often mandated for perpetrators of intimate partner violence, the precursors and mechanisms of change operating within these programs remain unclear. The purpose of this qualitative study was to examine the perceptions and experiences of participants in a diverse, group-based male BIP to better understand factors facilitating positive change. Data were gathered through individual interviews with 15 men and were analyzed using grounded theory. Findings suggest that change is taking place through a reciprocal process in which change occurring via the group context facilitates change within participants and vice versa. The specific benefits of the group context and value of group diversity were emphasized. Factors supporting this change process include the role of group facilitators and providing group members with access to ongoing support. These results are useful for informing the continued implementation and adaptation of BIPs with the goal of reducing and ultimately terminating abusive behaviors.

Identifying relevant components to include in a parenting intervention for homeless families in transitional housing: Using parent input to inform adaptation efforts.

Homeless families in transitional housing face a number of distinct challenges, yet there is little research seeking to guide prevention and intervention work with homeless parents. Informed by the tenets of community-based participatory research, the purpose of this study was to identify relevant components to include in a parenting intervention for this population. Data were gathered from 40 homeless parents through semistructured individual interviews and were analyzed using qualitative content analysis. The resulting 15 categories suggest several topics, approach considerations, and activities that can inform parenting intervention work with homeless families in transitional housing. Study findings are discussed within the context of intervention fidelity versus adaptation, and implications for practice, research, and policy are suggested. This study provides important insights for informing parenting intervention adaptation and implementation efforts with homeless families in transitional housing. (PsycINFO Database Record

Testing women with endometrial cancer to detect Lynch syndrome.

PURPOSE: Women with endometrial cancer as a result of Lynch syndrome may not be identified as such by Amsterdam II criteria. We estimated the costs and benefits of different testing criteria to identify Lynch syndrome in women with endometrial cancer. METHODS: We developed a Markov Monte Carlo simulation model to compare six criteria for Lynch syndrome testing for women with endometrial cancer: Amsterdam II criteria; age younger than 50 years with at least one first-degree relative having a Lynch-associated cancer at any age (FDR); immunohistochemistry (IHC) triage if age younger than 50 years; IHC triage if age younger than 60 years; IHC triage at any age if 1 FDR; and IHC triage of all endometrial cancers. Net health benefit was life expectancy, and primary outcome was the incremental cost-effectiveness ratio (ICER). The model estimated the number of new colorectal cancers associated with each strategy. RESULTS: IHC triage of women with endometrial cancer having at least 1 FDR yielded a favorable ICER of $9,126 per year of life gained. This strategy would subject fewer cases to IHC but identify more mutation carriers than age thresholds of 50 or 60 years. IHC triage of all endometrial cancers could identify the most mutation carriers and prevent the most colorectal cancers but at considerable cost ($648,494 per year of life gained). CONCLUSION: IHC triage of women with endometrial cancer at any age having at least 1 FDR with a Lynch-associated cancer is a cost-effective strategy for detecting Lynch syndrome.