Alcohol-use disorders during and within one year of pregnancy: a population-based cohort study 1985-2006.

OBJECTIVES: To examine alcohol-use disorders in pregnant women and the extent of under-reporting. DESIGN: Population-based cohort study. SETTING: Western Australia. POPULATION: Women with a birth recorded on the Western Australian Midwives Notification System (1985-2006). METHODS: Mothers with an International Classification of Diseases 9/10 alcohol-related diagnosis, indicating heavy alcohol consumption, recorded on population-based health datasets (non-Aboriginal n=5,839; Aboriginal n=2,583) were identified through the Western Australian data-linkage system. This 'exposed' cohort was frequency matched (on maternal age, year of birth of offspring, Aboriginal status) with comparison mothers without an alcohol-related diagnosis (non-Aboriginal n=33,979; Aboriginal n=8,005). MAIN OUTCOME MEASURES: Trends in maternal alcohol diagnoses in relation to pregnancy for non-Aboriginal and Aboriginal women. The proportion of children diagnosed with fetal alcohol syndrome (FAS) who had a mother with an alcohol diagnosis recorded during pregnancy. RESULTS: The proportion of Aboriginal mothers in Western Australia with an alcohol diagnosis (23.1%) is ten times greater than for non-Aboriginal mothers (2.3%). There has been a six-fold increase in the percentage of non-Aboriginal births with a maternal alcohol diagnosis recorded during pregnancy and a 100-fold increase for Aboriginal births. Around 70% of the mothers of children diagnosed with FAS did not have an alcohol diagnosis recorded during pregnancy and 18% of the mothers had no record of an alcohol diagnosis. CONCLUSIONS: Maternal alcohol exposure during pregnancy is significantly under-ascertained. Given the severe risks to the fetus from heavy prenatal alcohol exposure, assessment and recording of alcohol use should be routinely undertaken in maternity and other health settings.

Heavy prenatal alcohol exposure and increased risk of stillbirth.

OBJECTIVE: To investigate the association between heavy prenatal alcohol exposure and stillbirth. DESIGN: Data linkage cohort study. SETTING: Western Australia (WA). POPULATION: The exposed cohort included mothers with an alcohol-related diagnosis (International Classification of Diseases, ninth/tenth revisions) recorded in health data sets and all their offspring born in WA (1983-2007). Mothers without an alcohol-related diagnosis and their offspring comprised the comparison cohort. METHODS: Exposed and comparison mothers were identified through the WA Data Linkage System. Odds ratios for stillbirth at 20+ weeks of gestation were estimated by logistic regression, stratified by Aboriginal status. MAIN OUTCOME MEASURES: The proportion of stillbirths at 20+ weeks of gestation is presented per 1000 births, as well as adjusted odds ratios (aOR) and 95% confidence intervals (95% CI), and population-attributable fractions. RESULTS: Increased odds of stillbirth were observed for mothers with an alcohol-related diagnosis at any stage of their life for both non-Aboriginal (aOR 1.36; 95% CI 1.05-1.76) and Aboriginal (aOR 1.33; 95% CI 1.08-1.64) births. When an alcohol diagnosis was recorded during pregnancy, increased odds were observed for non-Aboriginal births (aOR 2.24; 95% CI 1.09-4.60), with the highest odds of Aboriginal stillbirth occurring when an alcohol diagnosis was recorded within 1 year postpregnancy (aOR 2.88; 95% CI 1.75-4.73). The population-attributable fractions indicate that 0.8% of non-Aboriginal and 7.9% of Aboriginal stillbirths are the result of heavy alcohol consumption. CONCLUSIONS: Prevention of heavy maternal alcohol use has the potential to reduce stillbirths. The lack of an association between exposure during pregnancy and Aboriginal stillbirth in this study needs further investigation.

Domiciliary detoxification: a cost effective alternative to inpatient treatment.

In this study, 20 subjects who had home detoxification with supervision and support from the Western Australian Alcohol and Drug Authority Community Nursing Service were matched with 20 subjects who had inpatient detoxification in the Authority's detoxification facility. Subjects were interviewed between nine and 22 months (mean 15.5 months) after detoxification to compare client outcomes and the costs of home and inpatient detoxification. The results indicate that, for suitable clients, home detoxification was at least as beneficial as inpatient detoxification and that it was achieved at a much lower cost than inpatient care.

A Western Australian Delphi survey of staff development research priorities.

A modified Delphi survey conducted during 1989-1990 identifies problems that Western Australian nurses consider research priorities. Participants were employed in hospital and health-care agencies throughout metropolitan and rural regions of the state. The large number of topics generated were analyzed and categorized into three areas of nursing: staff development, clinical practice, and management. Participants rated each topic on its importance to nurses and patients. The results are based on the 10 priority items identified in the staff development field.

A Delphi survey of clinical nursing research priorities in Western Australia.

In 1989-1990 an investigation was undertaken to ascertain which problems WA nurses considered required researching. A modified Delphi technique was employed to obtain data from nurses in hospitals and health care agencies throughout the metropolitan and rural regions in the state. Participants worked in areas of acute care, mental health, paediatrics, gerontology, community health and domiciliary services and addictions. Problems identified were categorised into three streams; clinical, management and staff development. Respondents were required to assign a value to items according to their importance to nurses and to patients. They were also asked to indicate whether they considered there was an adequate research base relevant to each item. Results reported here are based on the 10 priority items identified in the clinical stream.

Observations on community screening for alcohol problems: a pilot project to assess the feasibility of identifying heavy drinkers in a community setting.

Using a standard computerised alcohol screening questionnaire including the CAGE and SMAST instruments, 122 subjects in a suburban shopping centre in Perth, Western Australia, were screened in an attempt to estimate the prevalence of hazardous drinking and to investigate knowledge of and attitudes to safe and heavy alcohol consumption.