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마더리스크라운드 - FASD 카톨릭의대 이해국 교수

마더리스크라운드 - FASD 카톨릭의대 이해국 교수






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    마더리스크라운드 - FASD 카톨릭의대 이해국 교수 마더리스크라운드 - FASD 카톨릭의대 이해국 교수 Presentation Transcript

    • Preliminary Results of Pilot Research on FASD in Korea Hae Kook Lee The Catholic University of Korea Uijeongbu St.Mary’s Hospital Department of Psychiatry
    • Alcohol consumption in Korea (Rehm J, 2009) See http://www.who.int/globalatlas/default.asp
    • Alcohol Use among Adult Women, 1989-2007 Source: Ministry for Health, Welfare and Family Affairs 3
    • Overall Trend in Gender Differen ce in Prevalence of AUD Lifetime Prevalence Alcohol Alcohol Abuse Dependence male female male female 1991 23.6 1.4 17.2 1.0 2001 12.6 1.8 16.0 4.6 (HK Lee, et al., 2010)
    • Age Difference in Prevalence of AUD (HK Lee, et al., 2010)
    • Drinking rate in pregnant women Alcohol Use Rate % The year before pregnancy Any use 77.1% 3 SD more 42.6% This pregnancy Any use 16.4% 12.2% of pregnant 3 SD more 2.9% women (about 1 in 8) reported any alcohol Previous 30 days use in the U.S. Any use 12.2% 3 SD moer 0.5% (SH Lee, et al., 2010)
    • And then,,, • The rate of drinking and alcohol use disorders are increasing especially in younger women in Korea. • Therefore, we could expect that there might be substantial risk of FASD in number of kids with FASD in Korea.
    • However, we have just several case reports on kids with FAS,,, • Hong KD, Yoo IC, Choi HS, Lee DH, Lee SJ. A case of fetal alcohol syndrome. Korean J Pediatr 1988;31:375-80. • Kim EJ, Yang SM, Yun J, Lee HK, Yu YH, Lee HS. A Case of Fetal Alcohol Syndrome. J Korean Pediatr Soc. 1998 Jul;41(7):1001-1005. • Kim JH, Han MK, Kim JL, Park YI, Lee JJ. A Case of Fetal Alcohol Syndrome. J Korean Child Neurol Soc. 2001 Oct;9(2):393-397. • Chang JH, Namgung R, Park MS, Park Kin, Lee JS, Lee Chul : A Case of Fetal Alcohol Syndrome with Persistent Pulmonary Hypertension of the Newborn. Korean J Pediatr. 2004 Nov;47(11):1220-1224. • Cho YY, Oh HJ, Han SJ, Sung SH, Bae GH, Shon HS, Yoon HD : A Case of Fetal Alcohol Syndrome with Secondary Amenorrhea. J Korean Soc Endocrinol. 2005 Oct;20(5):524-530. • Cho YK, Chang SD, Kim YC, Lee SY. A Case of Fetal Alcohol Syndrome with Esotropia. J Korean Ophthalmol Soc. 2005 Oct;46(10):1756-1759. • Bhang SY, Ahn DH, Lee YJ, An HY, Ahn JH The First Report of Fetal Alcohol Effect in a 12 Year-Old Child in Korea. Psychiatry Invest 2009;6:50-53. 8
    • How could we start ? Outreach to institution for disabled kid Drinking Work with disabled kid Mother registration system Reliable maternal drinking Difficult to getting information information about Barrier to getting maternal drinking information Easy to examination Long term follow up to about FASD with Kids confirm FASD Clinical based referral model Disabled Inter referral system Kids (OB - PD - NP)
    • Exploratory visit & Pilot study • Un experienced specialist • No social awareness • No data to support the need for research • Social stigma and denial Develop pilot project Work with experienced specialist Visit various setting of institution (High risk group) Trial of diagnosis of FASD kids
    • Process Selection of Institution Institution for MR kid, Orphanage, Special school,,, Screening Height or Weight is Under 10 percentile Diagnosis Dysmorphologic examination
    • Inclusion criteria for diagnostic examination • Age – from 5 to 16 yrs • Kids with Mental Retardation • Exclusion of Kids with Cerebral palsy, Down syndrome, and so forth… • Also, behavioral referrals were solicited from teachers.
    • Visiting Schedule Aug 2nd (Mon) Aug 3rd (Tue) Aug 4th(Wed) Aug 5th(Thur) 9 Ins for MR kid Orphanage Break Ins for MR 10 7:30 departure 8:30 departure 8:00 departure Uijeongbu city 11 Seoul(south) Seoul(north) (north) 12 1 pm finish 12:00 finish transfer & hospi 1 transfer transfer transfer tal visit 2 Orphanage Ins for MR kid Special edu. FASD workship 3 2:30 start Day care Hotel 4 Uijeongbu city(north) 5 Ins for MR 6 5:30 finish Seoul(north)
    • Overall Rate Total After Likely to be Institution Deffered Subject screening Confirmed Institution 4 site N=21 N=11 for Kid with 142 N=50 42% 22% MR 2 site N=15 N=2 Orphanage N=34 137 44% 6% Special 1 site N=4 N=0 N=9 Education 28 44% 0% N=40 N=13 307 N=93 Total 43% 14%
    • Prevalence of Fetal Alcohol Syndrome (FAS) and Partial Fetal Alcohol Syndrome (pFAS) in Students Entering Sch ool via Active Case Ascertainment FAS Location Socioeconomic Population (FAS+pFAS) (Reference Year) Status Rate per 1000 United States: Mid- 75% white; 25% Middle SES with full 6 – 11 Western Medium American Indian, range from Low to (14 – 25) Size City (May et al. African American Upper 2009) and Asian Italy; Lazio Region Predominantly white Middle SES 4–9 (May et al. 2007) (27 – 55) South Africa: 85% Mixed Ancestry Low Middle SES 51 – 67 Western Cape (“Coloured”), 15% White: Middle – (68 – 90) (2007) European White Upper SES South Africa: 64% Mixed Ancestry Low & Middle SES 6 – 11 Northern Cape 36% Native Black (14 – 25) (Urban et al. 2008)
    • Rate of facial dysmorphology Thin Short Rail road Smooth Hockey stick Clino- Campo- category Vermilion Palperbral track Philtrum crease dactyly dactyly border fissure Institution N=11 N=15 N=17 N=11 N=5 N=7 N=4 for MR 21% 32% 37% 21% 10% 15% 8% N=3 N=2 N=3 N=10 N=10 N=3 N=2 Orphanage 9% 8% 9% 30% 29% 9% 6% Special N=0 N=0 N=2 N=1 N=2 N=1 N=0 school 0% 0% 40% 14% 28% 14% 0% N=13 N=18 N=29 N=22 N=10 N=11 N=6 Total 15% 20% 33% 25% 10% 13% 7%
    • Rail road Track
    • Hockey Stick Crease
    • Clynodactyly & Campodactyly
    • FAS case with thin vermilion border-1
    • FAS case with thin vermilion border-2
    • Future Direction Clinic base case control studies Surveillance system Active case ascertainment approaches
    • Thanks !