Brian Giesbrecht was a provincial court judge from 1976 until 2007. He is now retired.
Republished from the Winnipeg Free Press print edition December 19, 2015 A15
The thesis I presented for my Master\'s program studied the effects of an after-school nutrition and physical activity intervention in a suburban middle school on the attitudes, knowledge, and behavior of the participants.a
Brian Giesbrecht was a provincial court judge from 1976 until 2007. He is now retired.
Republished from the Winnipeg Free Press print edition December 19, 2015 A15
The thesis I presented for my Master\'s program studied the effects of an after-school nutrition and physical activity intervention in a suburban middle school on the attitudes, knowledge, and behavior of the participants.a
A case study about Teenage pregnancy which is a widespread problem all over the world. Teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children.
Egg donation, for women, is no different. Ethicists and some women’s health advocates worry that lucrative
payments are enticing young women with credit card debts and heavy tuition fees to sell eggs without seriously
evaluating the risks.
Psychiatric concerns about the consequences of prenatal alcohol exposureBARRY STANLEY 2 fasd
Psychiatric concerns about the consequences of prenatal alcohol exposure
I have omitted the references in these papers. They can be downloaded.
In 2014 the US National Institute of Mental Health (NIMH) announced it was going to divert research funding from abstract psychiatry to the neurobiological roots of disease.
This has resulted in identification of the abnormal brain functions relating to the behavioral diagnoses of the DSM5. These brain disfunctions are not the cause of DSM5 mental illnesses: they are the true pathology of those mental illnesses. The question is- what is the cause of those brain disfunctions?
Psychiatry has never explored the role of prenatal alcohol, or preconceptual alcohol in the etiology of mental illnesses.
This is in spite of anecdotal, behavioral, epidemiological, neurological and epigenetic correlations.
Meanwhile mental illness, addictions and suicides continue unabated, in spite of huge expenditures.
The day will come when the genes that control individual aspects of brain function will be identified. Changes in gene expression will be related to clinical presentations, such as those in the DSM5: the generation at which those changes occurred will be determined.
The agent that caused those changes, with other environmental factors, will be identified.
Then we will understand to what degree alcohol has determined the nature of mental illness.
Submission to the Ontario Select Committee on developmental services. BARRY STANLEY 2 fasd
Submission to the Ontario Select Committee on developmental services. Jan. 2014: relating to the needs of those with FASD and the families who support them.
A case study about Teenage pregnancy which is a widespread problem all over the world. Teen pregnancy and childbearing bring substantial social and economic costs through immediate and long-term impacts on teen parents and their children.
Egg donation, for women, is no different. Ethicists and some women’s health advocates worry that lucrative
payments are enticing young women with credit card debts and heavy tuition fees to sell eggs without seriously
evaluating the risks.
Psychiatric concerns about the consequences of prenatal alcohol exposureBARRY STANLEY 2 fasd
Psychiatric concerns about the consequences of prenatal alcohol exposure
I have omitted the references in these papers. They can be downloaded.
In 2014 the US National Institute of Mental Health (NIMH) announced it was going to divert research funding from abstract psychiatry to the neurobiological roots of disease.
This has resulted in identification of the abnormal brain functions relating to the behavioral diagnoses of the DSM5. These brain disfunctions are not the cause of DSM5 mental illnesses: they are the true pathology of those mental illnesses. The question is- what is the cause of those brain disfunctions?
Psychiatry has never explored the role of prenatal alcohol, or preconceptual alcohol in the etiology of mental illnesses.
This is in spite of anecdotal, behavioral, epidemiological, neurological and epigenetic correlations.
Meanwhile mental illness, addictions and suicides continue unabated, in spite of huge expenditures.
The day will come when the genes that control individual aspects of brain function will be identified. Changes in gene expression will be related to clinical presentations, such as those in the DSM5: the generation at which those changes occurred will be determined.
The agent that caused those changes, with other environmental factors, will be identified.
Then we will understand to what degree alcohol has determined the nature of mental illness.
Submission to the Ontario Select Committee on developmental services. BARRY STANLEY 2 fasd
Submission to the Ontario Select Committee on developmental services. Jan. 2014: relating to the needs of those with FASD and the families who support them.
I have attached an e-mail exchange between Dr Carl Bell and myself, with his permission.
It followed the publication of a commentary by him - https://www.mdedge.com/psychiatry/article/205382/addictionmedicine/fetal-alcohol-exposure-overlooked-again
It is encouraging to know that some in the medical profession do understand. Dr Bell raises an important point.
Abstract: 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.
Challenges in accurately assessing prenatal alcohol exposure inBARRY STANLEY 2 fasd
Comment on the paper - Challenges in accurately assessing prenatal alcohol exposure in a study of Fetal Alcohol Spectrum Disorder in a youth detention center.
Put to the test as genetic screening gets cheaper and easier,.docxamrit47
Put to the test: as genetic screening gets cheaper and easier, it's raising questions that health-
care providers aren't prepared to answer
The American Prospect, November 2010
When my children were born in the mid-1990s, new parents could already see that prenatal genetic
testing was altering the terrain of pregnancy and childbirth. Growing numbers of educated women were
having children at older ages, with resulting difficulties and risks. More and more parents faced
challenging, deeply personal decisions about whether to engage in genetic testing and what to do if they
received unfavorable results.
I remember my own anxieties when my wife, Veronica, took a blood test that searched for elevated
alpha-fetoproteins, which are associated with diverse ailments ranging from spina bifida to
anencephaly. The mere prospect of these rare conditions--and even the choice to undergo the tests--
was surprisingly painful. At least genetic counselors and other professionals were available to help guide
us.
By that point, amniocentesis had been in wide use for more than two decades. As researchers identified
the genetic markers associated with a growing list of important conditions, educated, secular, and
affluent communities began to embrace genetic testing. A small but lucrative market in assisted
reproductive technologies quickly emerged, which provided parents with greater control over the
genetic characteristics of their offspring. In some parts of America, new diagnostic technologies
provoked unease regarding their eugenic potential.
In retrospect, these innovations were incredibly tame. Technological limits, cost, intrusiveness, and risk
constrained the scope of screening efforts. Roughly one in every 200 amniocenteses resulted in
miscarriage, which made the procedure too risky to justify screening the full population of pregnant
women. The human genome had yet to be sequenced. Newborn screening was routinely used to
identify a handful of important metabolic disorders, but it was a very expensive process. There was a
certain clarity, too. The most common use of amniocentesis was (and remains) to detect conditions
associated with very serious physical or intellectual disabilities. When such conditions were detected,
most parents chose to terminate the pregnancy.
Fast forward to 2010. Prospective parents can now be tested before pregnancy, and those found to be
carriers for serious conditions have the option of in-vitro fertilization, whereby embryos can be pre-
tested for genetic markers associated with Alzheimer's disease, hemophilia, muscular dystrophy, Tay-
Sachs disease, and more. Many of these same markers can also be detected by do-it-yourself genetic-
testing kits, which are beginning to appear on the Internet and on drugstore shelves. Walgreens may
soon sell a cheap home test that covers 37 genetic conditions. (Sales are postponed pending approval by
the Federal Drug Administration.) You will soon ...
A systematic review of prevention interventions to reduce prenatal alcohol ex...BARRY STANLEY 2 fasd
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.
Prevalence of fetal alcohol spectrum disorder among special subpopulations: a...BARRY STANLEY 2 fasd
Global subpopulations of children in care, correctional,
special education, specialized clinical and Aboriginal
populations have a significantly higher prevalence of
fetal alcohol spectrum disorder compared with the
general population, which poses a substantial global
health problem.
Similar to Incidence and Prevalence of FAS and ARND (10)
Conclusions reached from my involvement with the Canadian criminal justice system. 2011.
amd- 2021
References of papers published by Dr Mansfield Mela, and others regarding FASD, PAE, Mental Health, and the Justice System.
Dr Mela is one of the very few Forensic Psychiatrists who understands and advocates for those with FASD.
The Nomenclature of the Consequences of Prenatal Alcohol Exposure: PAE, and t...BARRY STANLEY 2 fasd
An historical account of the nomenclature relating to the effects of alcohol on the developing fetus.
The significance of facial features; the dose/threshold question; epigenetics, transgenerational consequences, and adult health issues, are raised.
The inadequacy of the present nomenclature is detailed
Effects of Hyperbaric Oxygen Therapy on Brain Perfusion, Cognition and Behavi...BARRY STANLEY 2 fasd
Abstract
A 15-year-old girl diagnosed with FASD underwent 100 courses of hyperbasic oxygen therapy (HBOT). Prior to HBOT, single motion emission compute tomographic begin imaging (SPECT)
revealed areas of hypo-perfusion bilaterally in the orbitofrontal region, temporal lobes and right dorsolateral—frontal, as well the medial aspect of the left cerebellum. Following two sets of HBOT treatments (60 plus 40), over 6 months, there was improvement in perfusion to the left cerebellum as well as the right frontal lobe. This was paralleled by improvement in immediate cognitive tests and an increase in functional brain volume. A follow-up 18 months after HBOT showed sustained
improvement in attention with no need for methylphenidate, as well as in math skills and writing.
This year as a priority of Proof Alliance’s legislative platform, major legislation that requires all children entering foster care be screened for prenatal exposure to alcohol in Minnesota was passed and signed into law. It is believed Minnesota is the first state in the nation to pass this legislation.
Four year follow-up of a randomized controlled trial of choline for neurodeve...BARRY STANLEY 2 fasd
Abstract
Background
Despite the high prevalence of fetal alcohol spectrum disorder (FASD), there are few interventions targeting its core neurocognitive and behavioral deficits. FASD is often conceptualized as static and permanent, but interventions that capitalize on brain plasticity and critical developmental windows are emerging. We present a long-term follow-up study evaluating the neurodevelopmental effects of choline supplementation in children with FASD 4 years after an initial efficacy trial
Abstract
This presentation includes a brief review of research into boredom, normal brain resting state and corresponding default mode[s].
The possible equivalence to the brain activity of those with FASD in relation to “being bored” is explored, with reference to brain anatomy and function.
Actual FASD clinical cases are presented to illustrate what individuals with FASD mean by “boredom”: describing the role of perseveration as a relief process.
Finally, the manner in which these processes are misinterpreted is explored, with implications for Psychiatry and the Justice System.
Association Between Prenatal Exposure to Alcohol and Tobacco and Neonatal Bra...BARRY STANLEY 2 fasd
IMPORTANCE Research to date has not determined a safe level of alcohol or tobacco use during pregnancy. Electroencephalography (EEG) is a noninvasive measure of cortical function that has previously been used to examine effects of in utero exposures and associations with
neurodevelopment.
OBJECTIVE To examine the association of prenatal exposure to alcohol (PAE) and tobacco smoking (PTE) with brain activity in newborns.
CONCLUSIONS AND RELEVANCE These findings suggest that even low levels of PAE or PTE are
associated with changes in offspring brain development.
Submitted to –
National Institute for Health and Care Excellence Fetal alcohol spectrum disorder
Consultation on draft quality standard – deadline for comments 5pm on 03/04/20
Clinical course and risk factors for mortality of adult inpatients with covid...BARRY STANLEY 2 fasd
Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help
clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale
for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
Outcomes of Online Mindfulness-Based Cognitive Therapy for Patients With Residual Depressive SymptomsA Randomized Clinical Trial
Zindel V. Segal, PhD1; Sona Dimidjian, PhD2; Arne Beck, PhD3; et alJennifer M. Boggs, PhD3; Rachel Vanderkruik, MA2; Christina A. Metcalf, MA2; Robert Gallop, PhD4; Jennifer N. Felder, PhD5; Joseph Levy, BA2
Author Affiliations
JAMA Psychiatry. Published online January 29, 2020. doi:10.1001/jamapsychiatry.2019.4693
Significance for fasd
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Incidence and Prevalence of FAS and ARND
1. FAS @ Street Level. Conference that was held on November 24
and 25th, 2003 in Toronto.
The Incidence and Prevalence of Fetal Alcohol Syndrome and
Alcohol-Related Neurodevelopmental Disorder - Implications for
Mental Health Workers.
How many of us know, directly or indirectly, of a person with FAS or
ARND between the ages of 1 and 16 years?
- How many of us know of a person with FAS or ARND, directly or
indirectly, between the ages of 35 or 50 years?
FAS was first described in North America in 1973. Prior to that there
had been two studies in France in 1960 and 1967, that described
physical and psychological abnormalities in children, following the
taking of alcohol during pregnancy. FAS has been with us since men
and women first consumed alcohol.
Aristotle apparently described the relationship between alcohol taken
during pregnancy and the birth of defective children. Aristotle also
said - “It is not once nor twice, but times without number, that the
same ideas make their appearance in the world.
What we forget or ignore from the past, we pay for in the future.
- From the Bible - “Behold, thou shalt conceive and bear a son; and
now drink no wine or strong drink”. In Carthage, there was a
prohibition against the bridal couple drinking on their wedding night,
for fear of producing a defective child.
Navajo tradition states that women who drink crazy water when
bearing a child will give birth to a child crazy in body and mind.
A report to the British House of Commons in 1834, stated that infants
of alcoholic mothers often have a starved, shriveled and imperfect
look.
Incidence is the number of new cases born or detected each year - in
a hospital, a province or a country. Prevalence is the total number of
cases in the population at any time, in a geographical area.
A prevalence of FAS of 40.5 to 46.4 per 1000 children between the
ages of 5 and 9, has been reported in one community of the wine
growing area of South Africa.
The parents of these children labour in the wine industry. The
children grow up to labour in the wine industry.
Before we condemn the South Africans, let us acknowledge that
many of those afflicted with FAS in North America end up in the
2. menial, dirty and boring jobs - if they are able to work at all.
The highest rate recorded in Canada for FAS - in a small native
community - is 120 per 1000
Children.
FAS, neo natal growth deficiency, characteristic facial abnormalities
and CNS dysfunction, was the first to be investigated statistically -
with difficulty.
Accurate statistics require an accurate diagnosis. Initially the
diagnosis was made by a few concerned physicians, mostly
pediatricians. Opinions might vary as to the diagnosis.
We now have more accurate, standardized assessments, that can be
reproduced and verified, leading to - - more accurate diagnoses,
- more appropriate patient care.
-earlier intervention with reduced severity of secondary disabilities
-and more accurate statistics regarding incidence and prevalence of
the condition.
St. Michaels Hospital, Toronto, has a Diagnostic Clinic that uses such
a system. Each major city in Ontario should have one.
There are basically three methods by which Incidence and
Prevalence are determined.
The first is Passive Surveillance , which was the first to be used. It is
the least expensive but also the least accurate. Criteria for the
diagnosis would be first established -(we have noted that historically
the diagnosis tended to be inaccurate) - and then retroactive studies
of records would be done - records such as birth certificates, hospital
and physician records etc. The problem with this method was that
most of those making the records knew nothing of the condition. It
was therefore under reported, and still is, depending on the
knowledge and diligence of those writing the records. Two retired
obstetricians recently told me that they had never diagnosed a single
case, during all the years that they practiced. In fairness, the facial
features are not so noticeable at birth, which is one of the problems of
maternity unit records of course, - if indeed FAS is considered at all.
No matter how smart we are, we can only diagnose what we know.
Incident rates of 0.2 to 0.67 per 1000 births have been determined
with the Passive Surveillance method.
The second method of obtaining statistics, clinic based, is pro-active
and more accurate.
Here, appropriately designed studies are established in prenatal
3. clinics. Relevant data can be obtained regarding the mother’s health,
alcohol intake etc. before, during and after pregnancy, and
assessment of the infant can be made at birth. At the same time, this
method allows for a degree of control over the variables, without
which conclusions may be inaccurate. There are, however, certain
problems with this method. Mothers who are most risk for FAS tend
not to use such clinics. Those attending the clinic may not be
representative of the general population, depending on the location of
the clinic. Finally, the FAS features are less noticeable at birth, and
the CNS dysfunction often not apparent.
The diagnosis is most accurately diagnosed after 3 years of age.
Clinic based studies give Incident rates of 1.9 to 2.2 per 1000 births.
The third method for estimating the Incidence and Prevalence of FAS
is through Active Case Centers. Here, Active Case Centers search
for mothers and their children who are at risk. Referrals are
encouraged, and referral networks developed. The diagnosis is made
by a number of individuals, each an expert in a particular aspect of
FAS.
St. Michael’s is an example of such a Centre. As far as I know, St.
Michael’s is the only Center in Canada that assesses individuals of all
ages. Because these Centers are so pro-active, early intervention for
those children at greater risk is more likely.
The main objection to this method is the expense.
The answer to that is that we can no longer afford the cost to society
that this condition creates.
The cost to society for the life span on one FAS child is estimated to
be 1.4 million dollars. The annual cost of FAS in the U.S. in 1998 was
estimated to be 2.8 Billion dollars.
Active Case Centers provide the most accurate statistics for the
referral area they serve. The greater the community is at risk, the
higher the Incidence . From Active Case Centers, the overall rate for
North America lies somewhere between 2 and 4 per 1000 births.
However, following the description of FAS, it soon became apparent
that some children did not have the facial features although they were
otherwise effected. The term, Fetal Alcohol Effects was used to cover
these cases. Because different people would have different
definitions of FAE, the term has been dropped in favour of Alcohol
Related Neurodevelopmental Disorder (ARND), for which there are
4. standard diagnostic criteria, including a history of alcohol
consumption during the pregnancy.
Research has shown that the facial features only develop when
alcohol is consumed during the first trimester of pregnancy - possibly
in only one week and yet brain damage from alcohol occurs
throughout the pregnancy. The most critical damage occurs in the
first few weeks, when often the mother does not know she is
pregnant. It follows then, that there are going to be more cases of
ARND than FAS.
When we look at the Incidence of FAS and ARND combined, then the
rates become more alarming. The estimated rate for FAS and ARND
combined is 9.1 per 1000 births in the U.S. - i.e. almost one in a
hundred. This is considered to be a conservative estimate. There is
no reason to believe that it is any less in Canada.
Why is this an underestimation? First of all, the diagnosis of ARND is
only made if there is a history of alcohol intake during the pregnancy.
So often it is not possible to obtain such a history for various reasons.
Secondly, there are very few Centers that have the ability to make the
diagnosis. Thirdly, there is a tremendous lack of knowledge on the
part of all professionals, regarding FAS and ARND. If it has been
difficult to diagnose FAS with the facial features how much more
difficult is it to diagnose ARND without the facial features?
Lastly, an unknown number of stillborn deliveries, that would have
FAS/ARND, are not included in these statistics.
All of these estimations of Incidence and Prevalence relate to
children. They are not a true estimation of the Prevalence in all of the
population.
Mysteriously these conditions seem to disappear around the age of
16 - 18..Which brings us to our original question. How many people
between the ages of 35 and 50 do we know that are FAS/ARND?
So what do we call these children, once they have become adults?
In 1996 a report was published by Ann Streissguth and others from
the University of Washington, Seattle. They had followed afflicted
children and determined that they developed secondary disabilities.
- Mental Health Problems, -Disrupted School Experience, -Trouble
with the Law, -Confinement,
-Inappropriate Sexual Behaviour, -Alcohol and Drug Problems, -
Dependant Living,
-and Problems with Employment.
5. Over 90% went on to have mental health problems - Attention Deficit
Disorder,
Depression
Suicide Threats,
Suicide Attempts,
Panic Attacks,
Hearing Voices, /Seeing Visions,/Behaviour Problems, Assaulting
Behaviour. Conduct Disorder,
Sexual Acting Out, psychotic behaviour.
ADHD is the most frequent mental health secondary disability. 60% of
FAS/ARND children go on to be diagnosed as ADHD between the
ages of 6yrs.- 20yrs.
According to Stats Canada, 10% of Canadians are diagnosed as
having mental health problems.
If 1% of Canadians have FAS/ARND and 95% of those with
FAS/ARND have mental health problems, then we can conclude that
almost one in ten patients that mental health professionals see, must
be FAS/ARND. These are conservative figures.
The question is - what diagnosis are we giving these patients when
they present as adults with mental health problems? The Diagnostic
and Statistical Manual of Mental Disorders is published by the
American Psychiatric Association. The Manual sets the diagnostic
standards for all mental health workers - psychiatrists,
psychotherapists, social workers, nurses. FAS and ARND are not
mentioned in the Manual. Yet one in ten mental health patients have
these conditions. The closest reference, under Predisposing Facts -
Mental Retardation, states that early alterations of embryonic
development may be caused by toxins such as alcohol.
However, if we look at the list of Mental Health problems that those
with FAS and ARND suffer from, and compare them to the criteria
used in the Manual, we can see where FAS and ARND patients might
fit in.
Examples in childhood -
Mental Retardation,
Learning Disorders,
Pervasive Developmental Disorders, Attention Deficit Disorder,
Reactive Attachment Disorder.
Examples in adulthood - Substance Related Disorders, Mood
Disorders,
Anxiety Disorders,
6. Impulse Control Disorders, Attention Deficit Disorder
And Personality Disorders.
Not all of those with these disorders are FAS/ARND. But it is surely
amongst these cases that the lost FAS/ARND will be found.
ADD and FAS/ARND.
Since Ann Streissguth’s report was published in1996, Clair Coles,
Director, Fetal Alcohol Centre, Emory University, Atlanta, has
published work that clarifies the difference between FAS/ARND and
ADHD. They are two distinct conditions and may be mutually
exclusive.
Whatever the final conclusions regarding the relationship of these
conditions, the fact is that ADHD is the most common mental health
problem that FAS/ARND individuals are diagnosed with, at this time.
It is not surprising then, that many individuals diagnosed as
FAS/ARND have previously been diagnosed with ADHD.
I would like to share with you my personal experience. It is anecdotal
and not at all conclusive, but does seem to confirm the points raised.
In my practice, I see adults, but more recently, through my
involvement with FASworld, I am seeing some FAS/ARND children
with their parents.
FAS/ARND children create stress in a marriage. It is not uncommon
to see a couple who have an adopted child. In talking to the parents it
often seems likely that the child might be FAS/ARND and when the
child is subsequently assessed for FAS/ARND, the diagnosis has
been confirmed. These children have usually previously been
diagnosed as ADHD.
In other cases, the diagnosis of FAS has been made before the
family comes to see me, and the history also includes previous
diagnosis of ADHD.
Some adult patients who come for depression, anxiety, anger, often
give a history of FAS/ARND secondary disabilities. They have often
been diagnosed as borderline personality disorder, and their
depression is of a chronic, intractable nature. A previous diagnosis of
ADHD is not uncommon. In some of these cases it can be
established that the mother drank during the pregnancy, and the
diagnosis of FAS/ARND confirmed.
If I had to choose one word to describe those who are afflicted with
FAS/ARND it would be “chaos”. Their lives are chaotic and when one
looks back over the life of an adult with this problem, that is what one
7. sees - a life of continuous chaos. Often, there are moments when
they say or do something that resonates with the potential that they
would have had, were they not FAS/ARND. Tragically, they seem to
be in some way aware of these potentials.
Their struggle is reconciling what they feel they should be able to
achieve, with the fact that they are not able to achieve it.
So what are the implications for mental health workers.? The
diagnosis of FAS/ARND should be considered for those clients who
have a history of secondary disabilities. Especially those diagnosed
with chronic mental health problems.
The importance of making the correct diagnosis of course is that the
FAS/ARND person needs to be handled in ways unique for that
condition.
- which is another topic.
Dr. Barry Stanley M.B. Ch.B., F.R.C.S.( C )
References-‐
Estimating the Prevalence of Fetal Alcohol Syndrome.
P.A. May et.al., Alcohol, Research & Health., Vo. 25, No 3, 2001.
Incidence of Fetal Alcohol Syndrome and Prevalence of Alcohol -
P.D.Sampson et.al., Teratology 56:317-326 [1997]
The History of Alcoholic Fetopathies [1997] Paul Lemoine, M.D.,
Nantes, France. JFAS Int. 2003, April 2003
Fetal Alcohol Syndrome- The South African Nightmare I.Fayez et.al.,
Hospital for Sick Children, Toronto.Scientific News - 2003.
On The Heavens - Aristotle, 340 B.C.
Bible - Judges 13-7, 1000 B.C.
Statistics Canada.- Mental Health
Diagnosing The Full Spectrum of Fetal Alcohol-Exposed Individuals:
Introducing The 4-digit Diagnostic Code.Susan J. Astley and Sterling
K. Clarren.
Alcohol and Alcoholism. Vol. 35, No. 4, 2000.
Fetal Alcohol Syndrome: Implications For Correctional Service. F.J.
Bolland et.al.
Research Report, Research Branch, Correctional Service Canada.
The 10th. Special Report to the U.S. Congress On Alcohol and
Health.
An Introduction to the Problem of Alcohol Related Birth Defects.
www.med.unc.edu/alcohol/ed/fas/slides
8. Fetal Toxicology Division, Bowles Centre for Alcohol Studies,
University of North Carolina.
Understanding the Occurrence of Secondary Disabilities in Clients
with Fetal Alcohol Syndrome [FAS] and Fetal Alcohol Effects [FAE]
Final Report, August 1996.Ann P. Streissguth et.al. Fetal Alcohol and
Drug Unit,
University of Washington School of Medicine.
Fetal Alcohol Exposure and Attention: Moving Beyond ADHD.. Claire
. Coles, Director, Fetal Alcohol Centre, Marcus Institute, Emory
University, Atlanta Georgia.Alcohol Research and Health, Vol.25, No
3, 2001.
SEE ALSO -
DEVELOPMENTAL
DISABILITIES
RESEARCH
REVIEWS
15:
176–192
(2009)
PREVALENCE
AND
EPIDEMIOLOGIC
CHARACTERISTICS
OF
FASD
FROM
VARIOUS
RESEARCH
METHODS
WITH
AN
EMPHASIS
ON
RECENT
IN-‐SCHOOL
STUDIES
Philip
A.
May,1,2,3*
J.
Phillip
Gossage,3
Wendy
O.
Kalberg,3
Luther
K.
Robinson,4
David
Buckley,3
Melanie
Manning,5
and
H.
Eugene
Hoyme6
****************************************************************************
Personal
Comment
This
is
an
excellent
up
to
date
review
of
the
Incidence
and
Prevalence
of
FAS,
PFAS,
ARND
and
FASD.
Points
to
note-‐
-‐The
authors
refer
to
FASD
as
a
diagnosis
-‐
The
importance
of
diagnostic
centers
in
the
estimation
of
the
incidence
and
prevalence
-‐The
alarming
upward
adjustments
of
these
estimations.