Health-related direct-to-consumer genetic tests: a public health assessment and analysis of practices related to Internet-based tests for risk of thrombosis.

BACKGROUND: Recent years have seen increased concern about direct-to-consumer (DTC) genetic testing (i.e., the sale and use of genetic tests without involving a health care provider). Numerous professional organizations have developed policies in this area. However, little systematic evidence exists to inform public policy about these tests. METHODS: We conducted a systematic search to identify genetic tests that are sold DTC without involving a health care provider. We evaluated the practices of companies offering DTC genetic tests for risk of thrombosis using criteria from multiple sources and a minimal set of key practices. RESULTS: We identified 84 instances of currently available health-related DTC genetic tests sold on 27 Web sites; the most common were for pharmacogenomics (12), risk of thrombosis (10), and nutrigenomics (10). For the DTC genetic tests for risk of thrombosis, we found low adherence to recommendations. Online information was frequently incomplete and had low agreement with professional recommendations. CONCLUSION: Our findings document the rapid growth in the availability of health-related DTC genetic tests and highlight the need to improve the delivery of DTC genetic tests. A major implication of this study is the need for the scientific and medical community to develop consistent recommendations to increase their impact.

Energy cost of walking in low lumbar myelomeningocele.

The aim of this study was to determine whether it is more efficient for adolescents with low lumbar myelomeningocele (MM) to walk with a reciprocal or a swing-through gait pattern. Energy measurements for subjects with MM were compared for reciprocal and swing-through gait and also with an able-bodied control group. The rate of oxygen consumption (in milliliters per kilogram per minute) was higher for both the reciprocal and swing-through conditions compared with the control group, but there was no difference in the rate of consumption between the two modes of walking. Walking velocities (in meters per minute) were slower for both the reciprocal and swing-through conditions compared with the control group, with reciprocal walking significantly slower than swing-through gait. Oxygen cost (in milliliters per kilogram per meter) was higher for both the reciprocal and the swing-through conditions compared with the control group. Oxygen cost was higher for reciprocal walking than for swing-through gait. Swing-through gait proved to be the more efficient walking pattern in this group of subjects with MM.