Direct-to-consumer genetic testing: where and how does genetic counseling fit?

Direct-to-consumer genetic testing for disease ranges from well-validated diagnostic and predictive tests to ‘research’ results conferring increased risks. While being targeted at public curious about their health, they are also marketed for use in reproductive decision-making or management of disease. By virtue of being ‘direct-to-consumer’ much of this testing bypasses traditional healthcare systems. We argue that direct-to-consumer genetic testing companies should make genetic counseling available, pre- as well as post-test. While we do not advocate that mandatory genetic counseling should gate-keep access to direct-to-consumer genetic testing, if the testing process has the potential to cause psychological distress, then companies have a responsibility to provide support and should not rely on traditional healthcare systems to pick up the pieces

Feasibility of large-scale population testing for SARS-CoV-2 detection by self-testing at home

The simplicity and low cost of rapid point-of-care tests greatly facilitate large-scale population testing, which can contribute to controlling the spread of the COVID-19 virus. We evaluated the applicability of a self-testing strategy for SARS-CoV2 in a population-based, cross-sectional study in Cantabria, Spain, between April and May 2020. For the self-testing strategy, participants received the necessary material for the self-collection of blood and performance of a rapid antibody test using lateral flow immunoassay at home without the supervision of healthcare personnel. A total of 1,022 participants were enrolled. Most participants correctly performed the COVID-19 self-test the first time (91.3% [95% CI 89.4-92.9]). Only a minority of the participants (0.7%) needed the help of healthcare personnel, while 6.9% required a second kit delivery, for a total valid test result in 96.9% of the participants. Incorrect use of the self-test was not associated with the educational level, age over 65, or housing area. Prevalence of IgG antibodies against SARS-CoV2 for subjects with a valid rapid test result was 3.1% (95% CI 2.2-4.4), similar to the seroprevalence result obtained using a conventional approach carried out by healthcare professionals. In conclusion, COVID-19 self-testing should be considered as a screening tool.Acknowledgements: We would like to acknowledge the participation of all the individuals in this study. JVL acknowledges support to ISGlobal from the Spanish Ministry of Science, Innovation and Universities through the “Centro de Excelencia Severo Ochoa 2019-2023” Programme (CEX2018-000806-S), and from the Government of Catalonia through the CERCA Programme

Legislation of direct-to-consumer genetic testing in Europe: a fragmented regulatory landscape

Despite the increasing availability of direct-to-consumer (DTC) genetic testing, it is currently unclear how such services are regulated in Europe, due to the lack of EU or national legislation specifically addressing this issue. In this article, we provide an overview of laws that could potentially impact the regulation of DTC genetic testing in 26 European countries, namely Austria, Belgium, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, the Netherlands and the United Kingdom. Emphasis is placed on provisions relating to medical supervision, genetic counselling and informed consent. Our results indicate that currently there is a wide spectrum of laws regarding genetic testing in Europe. There are countries (e.g. France and Germany) which essentially ban DTC genetic testing, while in others (e.g. Luxembourg and Poland) DTC genetic testing may only be restricted by general laws, usually regarding health care services and patients’ rights

Team members’ roles in home healthcare: Evidence from the “ακεσω−1” project in Greece

Home healthcare has just recently won the interest of policy decision makers in Greece and there is a lack of knowledge regarding the contributions provided by each team member. The aim of this study was to describe the home care interventions carried out by nurses, physicians, and physiotherapists during the ΑΚΕΣΩ-1 project. We examined the data from 1,094 patients who received home healthcare (HHC) from an interdisciplinary team from the Hellenic Red Cross HHC services in three major cities in Greece during a 20-month period. The visits and interventions by nurses, physicians, and physiotherapists were grouped and measured. Patients were mostly older adults (80.73%), women (68.37%) with medical problems (46.8%). Nurses conducted 70.76% of the visits, and provided 21,017 interventions. Physiotherapists conducted 22.83% of the visits and 4,627 interventions, and physicians conducted 6.4% of the visits and 2,117 interventions. Nurses provided a wide range of complex skilled nursing interventions that required knowledge of the community and ability to network. Physiotherapy and educating patients and caregivers were the most frequent interventions of physiotherapists. The main role of physicians was to conduct clinical exams. The Greek healthcare system is hospital- and physician-oriented. We documented that in HHC, nurses take a lead role in providing care, organizing services, and collaborating with other community services. From a health and social policy perspective, proper planning and staffing of HHC services are required. From an academic and licensing perspective, it is important to ensure that nurses working in the community have appropriate preparation. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved