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1.
BMC Health Serv Res ; 19(1): 809, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694624

RESUMO

BACKGROUND: Fetal Alcohol Spectrum Disorder (FASD) is a public health problem globally, with South Africa having the highest recorded prevalence of all countries. Government programmes to prevent and manage FASD remain limited because of the lack of a specific policy. Herein, we developed a guideline to inform policy on the prevention and management of FASD in South Africa. METHODS: We applied a modified version of the World Health Organization's approach to guideline development in three phases. In the first phase, we designed the initial guideline prototype. To do this, we conducted an in-depth interview with policymakers and a focus group with relevant service providers on policy requirements for FASD, a document review of policies on FASD and a scoping review of various interventions for FASD. In phase 2, we refined the initially formulated guideline prototype through a discursive approach with seven local and international experts on FASD. Phase 3 involved refining the prototype using a modified Delphi approach. Forty-three and forty-one experts participated in rounds 1 and 2 of the Delphi approach, respectively. The acceptable consensus for each included policy statement was 85%. RESULTS: We identified three aspects of the proposed guideline, which are the approaches and guiding principles, the prevention measures and the management measures. The guideline proposes that a FASD policy should consider lifespan needs, be culturally diverse, collaborative, evidence-based, multi-sectoral and address social determinants of health contributing to FASD. The essential components of FASD prevention policy consist of awareness and education of the dangers of drinking alcohol, access to treatment for alcohol problems and training of service providers. The management components include capacity building related to diagnosis, educating parents regarding the needs and management, appropriate referral pathways, training of teachers regarding classroom management and support for parents and individuals with FASD. CONCLUSION: FASD in South Africa deserves urgent attention. Developing a specific policy to guide programmes could enhance and coordinate the efforts towards preventing and managing FASD. The guideline has the potential to assist policymakers in the development of a comprehensive and multi-sectoral policy for prevention and management of FASD, considering the consensus obtained from the experts.


Assuntos
Consenso , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Técnica Delfos , Feminino , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Transtornos do Espectro Alcoólico Fetal/terapia , Grupos Focais , Humanos , Formulação de Políticas , Guias de Prática Clínica como Assunto , Gravidez , África do Sul/epidemiologia
2.
BMC Pregnancy Childbirth ; 19(1): 316, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31481011

RESUMO

BACKGROUND: Alcohol screening and brief intervention (SBI) in antenatal care is internationally recommended to prevent harm caused by alcohol exposure during pregnancy. There is, however, limited understanding of how SBI is implemented within antenatal care; particularly the approach taken by midwives. This study aimed to explore the implementation of a national antenatal SBI programme in Scotland. METHODS: Qualitative interviews were conducted with antenatal SBI implementation leaders (N = 8) in eight Scottish health boards. Interviews were analysed thematically and using the 'practical, robust implementation and sustainability model' (PRISM) to understand differences in implementation across health boards and perceived setting-specific barriers and challenges. RESULTS: In several health boards, where reported maternal alcohol use was lower than expected, implementation leaders sought to optimize enquires about women's alcohol use to facilitate honest disclosure. Strategies focused on having positive conversations, exploring pre-pregnancy drinking habits, and building a trusting relationship between pregnant women and midwives. Women's responses were encouraging and disclosure rates appeared improved, though with some unexpected variation over time. Adapting the intervention to the local context was also considered important. CONCLUSIONS: This is the first study to explore implementation leaders' experiences of antenatal SBI delivery and identify possible changes in disclosure rates arising from the approach taken. In contrast with current antenatal alcohol screening recommendations, a conversational approach was advocated to enhance the accuracy and honesty of reporting. This may enable provision of support to more women to prevent Fetal Alcohol Spectrum Disorders (FASD) and will therefore be of international interest.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Consumo de Bebidas Alcoólicas/terapia , Revelação , Tocologia , Cuidado Pré-Natal/métodos , Relações Profissional-Paciente , Confiança , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Humanos , Ciência da Implementação , Programas de Rastreamento , Pesquisa Qualitativa , Escócia
3.
BMC Health Serv Res ; 19(1): 649, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500612

RESUMO

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is a highly prevalent neurodevelopmental disorder associated with prenatal alcohol exposure. Early identification can improve functioning for individuals and reduce costs to society. Gold standard methods of diagnosing FASD rely on specialists to deliver intensive, multidisciplinary assessments. While comprehensive, prevalence rates highlight that this assessment model cannot meet demand, nor is it feasible in remote areas where specialist services are lacking. This project aims to expand the capabilities of remote practitioners in north Queensland, Australia, where 23-94% of the community identify as First Nations people. Integrating cultural protocols with the implementation science theories of Knowledge-To-Action, Experience-Based Co-Design, and RE-AIM, remote practitioners with varying levels of experience will be trained in a co-designed, culturally appropriate, tiered neurodevelopmental assessment process that considers FASD as a potential outcome. This innovative assessment process can be shared between primary and tertiary health care settings, improving access to services for children and families. This project aims to demonstrate that neurodevelopmental assessments can be integrated seamlessly with established community practices and sustained through evidence-based workforce development strategies. METHODS: The Yapatjarrathati project (named by the local First Nations community and meaning 'to get well') is a mixed-method implementation trial of a tiered assessment process for identifying FASD within a remote Australian community. In collaboration with the community, we co-designed: (a) a culturally sensitive, tiered, neurodevelopmental assessment process for identifying FASD, and (b) training materials that up-skill remote practitioners with varying levels of expertise. Qualitative interviews for primary, secondary and end users will be undertaken to evaluate the implementation strategies. RE-AIM will be used to evaluate the reach, effectiveness, adoption, implementation and maintenance of the assessment and training process. DISCUSSION: Co-designed with the local community, integrated with cultural protocols, and based on implementation science theories, the assessment and training process from this project will have the potential to be scaled-up across other remote locations and trialed in urban settings. The Yapatjarrathati project is an important step towards increasing the availability of neurodevelopmental services across Australia and empowering remote practitioners to contribute to the FASD assessment process.


Assuntos
Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde Rural/organização & administração , Competência Cultural , Estudos de Avaliação como Assunto , Feminino , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/organização & administração , Humanos , Recém-Nascido , Gravidez , Queensland/epidemiologia , População Rural
4.
Elife ; 82019 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-31545168

RESUMO

Prenatal exposure to ethanol induces aberrant tangential migration of corticopetal GABAergic interneurons, and long-term alterations in the form and function of the prefrontal cortex. We have hypothesized that interneuronopathy contributes significantly to the pathoetiology of fetal alcohol spectrum disorders (FASD). Activity-dependent tangential migration of GABAergic cortical neurons is driven by depolarizing responses to ambient GABA present in the cortical enclave. We found that ethanol exposure potentiates the depolarizing action of GABA in GABAergic cortical interneurons of the embryonic mouse brain. Pharmacological antagonism of the cotransporter NKCC1 mitigated ethanol-induced potentiation of GABA depolarization and prevented aberrant patterns of tangential migration induced by ethanol in vitro. In a model of FASD, maternal bumetanide treatment prevented interneuronopathy in the prefrontal cortex of ethanol exposed offspring, including deficits in behavioral flexibility. These findings position interneuronopathy as a mechanism of FASD symptomatology, and posit NKCC1 as a pharmacological target for the management of FASD.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Bumetanida/administração & dosagem , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Complicações na Gravidez/prevenção & controle , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Membro 2 da Família 12 de Carreador de Soluto/metabolismo , Animais , Córtex Cerebral/efeitos dos fármacos , Modelos Animais de Doenças , Feminino , Transtornos do Espectro Alcoólico Fetal/fisiopatologia , Neurônios GABAérgicos/efeitos dos fármacos , Camundongos , Córtex Pré-Frontal/efeitos dos fármacos , Gravidez , Complicações na Gravidez/fisiopatologia , Resultado do Tratamento , Ácido gama-Aminobutírico/metabolismo
5.
J Natl Black Nurses Assoc ; 30(1): 7-13, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31465679

RESUMO

Fetal alcohol spectrum disorders (FASD) affect all nations harshly, however, very little is known about the scope of FASD in Swaziland. Alcohol exposure in utero is one of the leading preventable causes of poor fetal birth outcomes. This study assessed the knowledge and practices of pregnant Swazi women, revealing that most participants had knowledge deficit on the effects of consuming alcohol on both the woman (63.3%, n = 19) and her fetus (83.3%, n = 25). The majority (83.0%, n = 25) of the participants reported that they did not drink alcohol, while 16.7% (n = 5) reported that they did consume alcohol. In health facilities, there is a need to intensify health education concerning the effects of alcohol consumption to both the fetus and the pregnant woman. A policy that enforces screening of pregnant women at risk for giving birth to infants with FASD is essential.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Conhecimentos, Atitudes e Prática em Saúde , Gestantes/psicologia , Feminino , Transtornos do Espectro Alcoólico Fetal/etiologia , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Humanos , Gravidez
6.
Res Dev Disabil ; 93: 103428, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31357176

RESUMO

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is of significant concern for Australians for many reasons, one being Australia's drinking culture which increases the potential for FASD to occur. AIMS: The current study aimed to explore the lived experiences of Australian caregivers who received a FASD diagnosis for a child in their care, usingthe Australian Guide to the Diagnosis of FASD. METHODS AND PROCEDURES: Semi-structured interviews were conducted with seven caregivers whose children were assessed for FASD by a multidisciplinary team. Interviews explored how families experienced the FASD diagnostic process, and sought insight into outcomes for families following diagnosis, particularly in relation to accessing supports and services. OUTCOMES AND RESULTS: Through thematic analysis, five overarching themes were identified: (1) receiving a FASD diagnosis had a positive impact; (2) caregivers' evaluation of assessment process; (3) positive support services relative to FASD; (4) ongoing difficulties regardless of diagnosis; and (5) need for societal knowledge of FASD. CONCLUSIONS AND IMPLICATIONS: Given the global need for standardised FASD diagnostic procedures and accurate reporting of prevalence rates, the current study provides a contribution to the emerging diagnostic FASD literature, and insight into families' experiences who have children diagnosed with FASD. WHAT THIS PAPER ADDS: This study provides additional information to the developing pool of literature attempting to create a typical profile of FASD. Most importantly, this paper highlights the implementation of the Australian Guide to the Diagnosis of FASD, and evaluates caregivers' experiences of their child's FASD assessment process, within a public FASD diagnostic service, using the revised guidelines.


Assuntos
Consumo de Bebidas Alcoólicas , Serviços de Diagnóstico , Saúde da Família , Transtornos do Espectro Alcoólico Fetal , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Atitude do Pessoal de Saúde , Austrália/epidemiologia , Criança , Serviços de Diagnóstico/organização & administração , Serviços de Diagnóstico/normas , Família/psicologia , Feminino , Transtornos do Espectro Alcoólico Fetal/diagnóstico , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Transtornos do Espectro Alcoólico Fetal/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevalência , Pesquisa Qualitativa
7.
Artigo em Inglês | MEDLINE | ID: mdl-31242673

RESUMO

The global prevalence of Fetal Alcohol Spectrum Disorder (FASD) remains high despite the various preventive and management interventions that have been designed and implemented to tackle the issue in various settings. The aim of the scoping review is to identify and classify prevention and management interventions of FASD reported globally across the life span and to map the concentration of these interventions across the globe. We searched some selected databases with predefined terms. Framework and narrative approaches were used to synthesize and report on the findings. Thirty-two prevention intervention studies and 41 management interventions studies were identified. All the interventions were reported to be effective or showed promising outcomes for the prevention and management of FASD, except four. Although Europe and Africa have a relatively higher prevalence of FASD, the lowest number of interventions to address FASD were identified in these regions. Most of the interventions for FASD were reported in North America with comparatively lower FASD prevalence. The uneven distribution of interventions designed for FASD vis-à-vis the burden of FASD in the different regions calls for a concerted effort for knowledge and intervention sharing to enhance the design of contextually sensitive preventive and management policy in the different regions.


Assuntos
Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Transtornos do Espectro Alcoólico Fetal/terapia , Feminino , Saúde Global , Humanos , Colaboração Intersetorial , Gravidez
8.
Artigo em Inglês | MEDLINE | ID: mdl-31109087

RESUMO

Since the 1990s, a number of multi-service prevention programs working with women who have substance use, mental health, or trauma and/or related social determinants of health issues have emerged in Canada. These programs use harm reduction approaches and provide outreach and "one-stop" health and social services on-site or through a network of services. While some of these programs have been evaluated, others have not, or their evaluations have not been published. This article presents interim qualitative findings of the Co-Creating Evidence project, a multi-year (2017-2020) national evaluation of holistic programs serving women at high risk of having an infant with prenatal alcohol exposure. The evaluation utilizes a mixed-methods design involving semi-structured interviews, questionnaires, focus groups, and client intake/outcome "snapshot" data. Findings demonstrated that the programs are reaching vulnerable pregnant/parenting women who face a host of complex circumstances including substance use, violence, child welfare involvement, and inadequate housing; moreover, it is typically the intersection of these issues that prompts women to engage with programs. Aligning with these results, key themes in what clients liked best about their program were: staff and their non-judgmental approach; peer support and sense of community; and having multiple services in one location, including help with mandated child protection.


Assuntos
Bem-Estar da Criança , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Programas Governamentais , Promoção da Saúde , Adolescente , Adulto , Canadá , Feminino , Grupos Focais , Humanos , Gravidez , Avaliação de Programas e Projetos de Saúde , Transtornos Relacionados ao Uso de Substâncias , Inquéritos e Questionários , Violência , Adulto Jovem
9.
Health Res Policy Syst ; 17(1): 46, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036004

RESUMO

BACKGROUND: South Africa is considered to have the highest prevalence of fetal alcohol spectrum disorder (FASD) globally. Nevertheless, the extent to which the South African government has responded to the high FASD prevalence at the policy level is unclear. Herein, we aimed to identify targeted and generic clauses that could be attributed to the prevention and management of FASD in relevant South African policy documents. METHODS: We conducted a search of two search engines (PubMed and Google) and the websites of South African national and provincial departments from January to April 2018. A total of 33 policy documents were included in this review. Using content analysis, we sought documents that mention the terms 'fetal alcohol syndrome' and 'fetal alcohol spectrum disorder'. The Framework method was also used to thematically identify specific and generic clauses attributed to the prevention and management of FASD in South Africa. RESULTS: The content analysis indicated that 12 policy documents contained the searched terms. Findings from the thematic analysis showed that targeted and generic clauses for FASD exist in various policy documents. Some of the generic clauses focused on the regulation of liquor outlets, enforcement of liquor laws, and the general management of persons with mental and educational challenges. Specific clauses focused on creating platforms to improve the awareness, screening, identification and support for individuals with FASD. CONCLUSIONS: There is a noticeable increase in the number of policy documents that considered elements of FASD enacted in the last decade. Although this study revealed the existence of targeted and generic clauses that could be attributed to the prevention and management of FASD, the sustained high prevalence of FASD in South Africa, as reported in the literature, calls for more holistic and comprehensive approaches to tackle the FASD problem in South Africa.


Assuntos
Documentação , Etanol/efeitos adversos , Transtornos do Espectro Alcoólico Fetal/terapia , Governo , Política de Saúde , Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/complicações , Comércio/legislação & jurisprudência , Deficiências do Desenvolvimento/terapia , Feminino , Transtornos do Espectro Alcoólico Fetal/diagnóstico , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Regulamentação Governamental , Humanos , Transtornos Mentais/terapia , Gravidez , África do Sul/epidemiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-31067652

RESUMO

The association between fetal alcohol spectrum disorder (FASD), residential schools and subsequent assimilatory policies in Canada is of such significance that it was included in the groundbreaking Truth and Reconciliation Commission of Canada's Final Report through Call to Action #33, which focuses on collaboratively developing FASD prevention programs in Indigenous communities. A consensus statement with eight tenets for enacting Call to Action #33 was co-developed in May 2017 using a Two-Eyed Seeing approach during and after a meeting on Indigenous approaches to FASD prevention held in Canada. The consensus statement provides guidance for creating community-based, culture-led FASD prevention programs in Indigenous communities. The eight tenets reflect the diverse perspectives of Indigenous and non-Indigenous participants, are grounded in available research evidence, and align with Indigenous worldviews and wellness models. This paper uses the consensus statement and eight exemplary FASD prevention programs from Indigenous communities and organizations across Canada to highlight identity, culture, and relationships as central elements of FASD prevention in Indigenous communities. The consensus statement provides guidance for developing community- and culture-led FASD prevention programs and highlights the importance of Indigenous knowledge systems in developing and researching FASD prevention in, and with, Indigenous communities.


Assuntos
Transtornos do Espectro Alcoólico Fetal/etnologia , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Grupos Populacionais , Canadá , Serviços de Saúde Comunitária , Participação da Comunidade , Consenso , Feminino , Humanos , Gravidez , Desenvolvimento de Programas
11.
Issues Ment Health Nurs ; 40(7): 621-625, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31045467

RESUMO

Women of reproductive age who are drinking alcohol and not using effective contraception are at-risk for an alcohol-exposed pregnancy, which could result in a child with a fetal alcohol spectrum disorder (FASD). Nurses are an important partner in addressing at-risk alcohol use. It is imperative for alcohol education to be incorporated into nursing curricula so that future nurses have the tools to identify at-risk alcohol use. Three universities have worked together to create Fetal Alcohol Spectrum Disorders: A Toolkit. This toolkit was designed for nurses to facilitate the recognition and prevention of FASD and address gaps that exists around alcohol use.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Papel do Profissional de Enfermagem , Feminino , Humanos , Gravidez , Fatores de Risco
12.
Artigo em Inglês | MEDLINE | ID: mdl-30884766

RESUMO

Fetal alcohol spectrum disorder (FASD) has a high prevalence in South Africa, especially among the poor socioeconomic communities. However, there is no specific policy to address FASD. Using a qualitative study design, we explored the perspectives of policymakers on guidelines/policies for FASD, current practices and interventions, and what practices and interventions could be included in a policy for FASD. The data analysis was done using the Framework Method. Applying a working analytical framework to the data, we found that there is no specific policy for FASD in South Africa, however, clauses of FASD policy exist in other policy documents. Preventive services for women and screening, identification, assessment, and support for children are some of the current practices. Nevertheless, a multi-sectoral collaboration and streamlined program for the prevention and management of FASD are aspects that should be included in the policy. While there are generic clauses in existing relevant policy documents, which could be attributed to the prevention and management of FASD, these clauses have not been effective in preventing and managing the disorder. Therefore, a specific policy to foster a holistic and coordinated approach to prevent and manage FASD needs to be developed.


Assuntos
Atitude , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Guias como Assunto , Política de Saúde , Humanos , Pesquisa Qualitativa , África do Sul
13.
Neuropeptides ; 74: 88-94, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30642580

RESUMO

Clinical and experimental evidence have demonstrated that, use of alcohol during pregnancy can interrupt brain development. Alcohol-induced neurocognitive deficits in offspring's are involved with activation of oxidative-inflammatory cascade joined with extensive apoptotic neurodegeneration in different brain regions such as hippocampus. Obestatin is a newly discovered peptide with anti-inflammatory, antioxidant, activities in different animal models. In this study, we aimed to evaluate the protective effects of obestatin on alcohol-induced neuronal apoptosis and neuroinflammation in rat pups with postnatal ethanol exposure. Through intragastric intubation, ethanol (5/27 g/kg/day) was administered in male Wistar rat pups on postnatal days 2-10 (third trimester in humans). The animals received Obestatin (1 and 5 µg/kg, S.C.) on postnatal days 2-10. Thirty-six days after birth, the spatial memory test was performed using Morris water maze test, and then, antioxidant enzymes and TNF-α levels were measured by ELISA assay. The expression level of GFAP and caspase-3 proteins was determined via immunohistochemical staining after the behavioral test. Obestatin significantly improved spatial memory deficits (P < .01), and obestatin treatment could significantly increase glutathione and total superoxide dismutase activity (P < .05), reduce level of malondialdehyde (P < .05) and TNF-α in comparison with the ethanol group (P < .01). It's also reduced caspase-3 level, and decreased GFAP-positive cells in the hippocampus of ethanol-exposed rat pups (P < .01). The result of this study shows the potential involvement of oxidative-inflammatory cascade-mediated apoptotic signaling in cognitive deficits due to postnatal ethanol exposure, the results also indicated the neuroprotective effects of Obestatin on alcohol-related behavioral, biochemical and molecular deficits.


Assuntos
Apoptose/efeitos dos fármacos , Encefalite/prevenção & controle , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Transtornos da Memória/prevenção & controle , Fármacos Neuroprotetores/administração & dosagem , Hormônios Peptídicos/administração & dosagem , Memória Espacial/efeitos dos fármacos , Animais , Modelos Animais de Doenças , Encefalite/etiologia , Encefalite/metabolismo , Etanol/administração & dosagem , Transtornos do Espectro Alcoólico Fetal/metabolismo , Masculino , Transtornos da Memória/induzido quimicamente , Transtornos da Memória/metabolismo , Estresse Oxidativo/efeitos dos fármacos , Ratos Wistar
14.
Clin Obstet Gynecol ; 62(1): 142-155, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30575614

RESUMO

Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Fetal alcohol deficits are lifelong issues with no current treatment or established diagnostic or therapeutic tools to prevent and/or ameliorate some of these adverse outcomes. Despite the recommendation to abstain, almost half of the women consume alcohol in pregnancy in the United States. This review focuses on the trends in prenatal alcohol exposure, implications for maternal and fetal health, and evidence suggesting that preconception and the prenatal period provide a window of opportunity to intervene, mitigate, and ideally curtail the lifetime effects of fetal alcohol spectrum disorder.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Consumo de Bebidas Alcoólicas/efeitos adversos , Bebidas Alcoólicas/estatística & dados numéricos , Animais , Aleitamento Materno/efeitos adversos , Feminino , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Transtornos do Espectro Alcoólico Fetal/etiologia , Humanos , Gravidez , Inquéritos e Questionários
15.
Women Birth ; 32(1): 3-5, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29602689

RESUMO

BACKGROUND: Exposure to alcohol prenatally can result in a child being diagnosed with fetal alcohol spectrum disorder. Affected infants experience lifelong impairments that can involve, physical, cognitive, behavioural and emotional difficulties that impact on their functional capacity. Effective prevention of fetal alcohol spectrum disorder is critically needed in Australia. Reduction in the prevalence of this disorder will only be possible if we prevent alcohol consumption during pregnancy. AIM: This paper provides an overview of fetal alcohol spectrum disorder and discusses the role of caseload midwifery as part of a multi-level prevention approach. FINDINGS: Drawing on previous research, caseload midwifery has potential to support the prevention of fetal alcohol spectrum disorder through continuity of care. CONCLUSION: Prevention of fetal alcohol spectrum disorder will be more likely if women experience a supportive relationship with a known midwife, who has received appropriate training and can enable women to feel comfortable in discussing and addressing alcohol use.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Tocologia/organização & administração , Austrália , Feminino , Humanos , Gravidez
16.
BMJ Open ; 8(12): e022578, 2018 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-30573481

RESUMO

OBJECTIVES: Fetal alcohol spectrum disorders (FASD) is a worldwide problem. Maternal alcohol consumption is an important risk factor for FASD. It remains unknown which alcohol consumption patterns most strongly predict FASD. The objective of this study was to identify these. DESIGN: Systematic literature review. METHODS: We searched in PubMed, PsychINFO, PsycARTICLES, ERIC, CINAHL, Embase and MEDLINE up to August 2018. The query consisted of keywords and their synonyms related to FASD, pregnancy and behaviour. Studies were excluded when not published in English, were reviews or involved non-human subjects. Substantial heterogeneity precluded aggregation or meta-analysis of the data. Instead, data were qualitatively inspected. RESULTS: In total, 21 studies were eligible for further data analysis. All studies that measured both maternal alcohol drinking behaviours and FASD reported retrospective data on maternal drinking patterns, employing both continuous and categorical measures and exhibiting substantial heterogeneity in measures of alcohol consumption (eg, timing of exposure, quantification of alcohol measure and definition of a standard drink). Study quality improved over time and appeared higher for studies based on active case ascertainment, especially when conducted in schools and when behaviour was assessed through interviews. CONCLUSIONS: We aimed to identify specific maternal drinking behaviour(s) related to FASD. The state of the literature precludes such conclusions. Evidence-based preventive measures necessitate identifying which prenatal alcohol drinking behaviour(s) are most in need of intervention. Therefore, we formulate three recommendations for future research. First, future studies can optimise the value of the collected dataset through specifying measurements and reporting of maternal drinking behaviours and avoiding categorised measures (nominal or ordinal) whenever possible. Second, samples should not be selected based on FASD status, but instead, FASD status as well as maternal alcohol consumption should both be measured in a general population sample. Finally, we provide 10 reporting guidelines for FASD research.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos do Espectro Alcoólico Fetal/etiologia , Comportamento Materno , Abstinência de Álcool/psicologia , Consumo de Bebidas Alcoólicas/sangue , Consumo de Bebidas Alcoólicas/psicologia , Terapia Comportamental , Concentração Alcoólica no Sangue , Feminino , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Transtornos do Espectro Alcoólico Fetal/psicologia , Humanos , Recém-Nascido , Entrevista Psicológica , Gravidez , Estudos Retrospectivos , Fatores de Risco
17.
BMC Public Health ; 18(1): 1238, 2018 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-30400900

RESUMO

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is among the leading causes of developmental and intellectual disabilities in individuals. Although efforts are being made toward the prevention and management of FASD in South Africa, the prevalence remains high. The sustained high prevalence could be attributed to several factors, including the lack of policy for a coordinated effort to prevent, diagnose and manage FASD nationally. In this study, our aim was to explore the perspectives of service providers (health and allied professionals, teachers, social workers) on the prevention and management of FASD towards developing a guideline to inform policy. METHOD: Guided by the exploratory qualitative research design, we purposively sampled relevant service providers in the field of FASD prevention and management for focus group discussions. Nine of these discussions were conducted with to eight participants per discussion session. The discussants were asked various questions on the current and required interventions and practices for the prevention and management of FASD. Following the Framework Method, data were transcribed verbatim and analysed using the thematic content analysis approach. RESULTS: Our findings show that aspects of the prevention and management of alcohol-related conditions are present in various policies. However, there is no clear focus on coordinated, multi-sectoral efforts for a more comprehensive approach to the prevention and management of FASD. The participants recognized the need for specific requirements on broad-based preventive awareness programs, training and support for parents and caregivers, inclusive education in mainstream schools and training of relevant professionals. CONCLUSION: Comprehensive and coordinated prevention and management programs guided by a specific policy could improve the prevention and management of FASD. Policy formulation demonstrates commitment from the government, highlights the importance of the condition, and elaborates on context-specific prevention and management protocols.


Assuntos
Atitude do Pessoal de Saúde , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Pessoal de Saúde/psicologia , Feminino , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Grupos Focais , Pessoal de Saúde/estatística & dados numéricos , Política de Saúde , Humanos , Masculino , Guias de Prática Clínica como Assunto , Gravidez , Prevalência , Pesquisa Qualitativa , África do Sul/epidemiologia
18.
BMC Public Health ; 18(1): 1227, 2018 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-30390661

RESUMO

BACKGROUND: Fetal alcohol spectrum disorder (FASD) is a preventable, lifelong neurodevelopmental disorder caused by prenatal alcohol exposure. FASD negatively impacts individual Indigenous communities around the world. Although many prevention interventions have been developed and implemented, they have not been adequately evaluated. This systematic review updates the evidence for the effectiveness of FASD prevention interventions in Indigenous/Aboriginal populations internationally, and in specific populations in North America and New Zealand, and offers recommendations for future work. METHOD: The MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO, SocINDEX, and Informit databases were searched from inception to 22/08/2017 for all prevention and intervention papers published in peer-reviewed scientific journals, with results, targeting prenatal alcohol exposure and FASD in Indigenous populations. This review was limited to studies published in English and excluded interventions focusing on the workforce. All steps were completed independently by two reviewers with discrepancies resolved via consensus with the senior author. RESULTS: There was significant heterogeneity in the ten included studies. Populations targeted included non-pregnant women of child-bearing age, pregnant women, school children and the general public. Study designs included one randomised controlled trial, five cohort studies with pre-post design, one cross-sectional study with different pre- and post-intervention groups, and four studies collected post-intervention data. Studies assessed changes in knowledge, and/or changes in risk for prenatal alcohol exposure including self-reported alcohol consumption, use of birth control or a combination of both. One study was conducted in Australia and nine in the US. The methodological quality of all studies was rated as 'Poor' using the systematic review assessment tools developed by The National Heart, Lung and Blood Institute. Studies were subject to substantial bias due to issues such as high loss to follow-up, lack of control groups and the reliance on self-report measures to assess the main outcome. CONCLUSION: Overall, there is little evidence that previous interventions aiming to reduce the risk of prenatal alcohol exposure or FASD in Indigenous populations have been effective. Future intervention studies should address the cultural factors and historical context that are fundamental to successful work with Indigenous populations, and be designed, implemented and evaluated using rigorous methods. This systematic review was registered with PROSPERO, CRD42018086212.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Grupos Populacionais , Efeitos Tardios da Exposição Pré-Natal/prevenção & controle , Austrália , Feminino , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Estados Unidos
19.
J Paediatr Child Health ; 54(10): 1121-1126, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30294984

RESUMO

Fetal alcohol spectrum disorder (FASD) is a significant public health issue in Australia that is poorly diagnosed, chronic and costly. FASD is a diffuse acquired brain injury secondary to prenatal alcohol exposure. The prevalence rate of FASD among the general population in Australia is currently unknown; however, an Australian study in a selected high-risk population reported some of the highest rates of FASD in the world. A common misconception among clinicians is that a child must have 'the face' of FASD to have the disorder. This is incorrect. The three sentinel facial features only occur in the minority of individuals with FASD. FASD should be considered as a 'whole body' disorder as increased susceptibility to chronic health problems suggests suboptimal in utero environments places the individual at risk of later disease. Clinicians are reluctant to consider FASD as a possible diagnosis because of the concern of inducing stigma; however, this concern is neither supported by the evidence nor patient stories. The Australian Guide to the Diagnosis of FASD is now available to assist health professionals in providing timely and accurate diagnoses, which can lead to improved outcomes via evidence-based intervention and is an important first step in future prevention.


Assuntos
Transtornos do Espectro Alcoólico Fetal/diagnóstico , Terminologia como Assunto , Austrália/epidemiologia , Transtornos do Espectro Alcoólico Fetal/epidemiologia , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Humanos
20.
Soc Sci Med ; 215: 98-106, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30219750

RESUMO

BACKGROUND: The Western Cape Province of South Africa has one of the highest rates of fetal alcohol spectrum disorder (FASD) globally. Effective prevention of FASD requires understanding women's attitudes about alcohol use during pregnancy and whether these attitudes translate into behavior. OBJECTIVE: The goal of this mixed-methods study was to describe attitudes toward alcohol use during pregnancy and examine how these attitudes influence drinking behaviors during pregnancy. METHOD: Over a five month period, 200 women were recruited from alcohol-serving venues in a township in Cape Town; a sub-set of 23 also completed in-depth interviews. Potential gaps between attitudes and behavior were described, and logistic regression models examined predictors of harmful attitudes toward alcohol use during pregnancy. Interviews were reviewed and coded for emergent themes. RESULTS: Most women (n = 176) reported at least one pregnancy. Among these, the majority (83%) had positive preventive attitudes, but more than half of these still reported alcohol use during a previous pregnancy. The strongest predictors of harmful attitudes were a history of physical or sexual abuse and drinking during a previous pregnancy. Qualitative analysis revealed several themes that contributed to alcohol use during pregnancy: 1) having an unplanned pregnancy; 2) drinking because of stress or to cope with abuse/trauma; 3) reliance on the venue for support; 4) socialization; and 5) feelings of invincibility. CONCLUSIONS: The findings highlight an attitude-behavior gap and suggest that positive preventive attitudes are insufficient to elicit FASD preventive behavior. Interventions are needed that go beyond education to build intrinsic motivation and structural support to refrain from alcohol use during pregnancy.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Atitude Frente a Saúde , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Feminino , Transtornos do Espectro Alcoólico Fetal/prevenção & controle , Transtornos do Espectro Alcoólico Fetal/psicologia , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Fatores de Risco , África do Sul
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