Table 3 Description of included articles
# | AUTHOR | COUNTRY | TYPE OF ARTICLE | MAIN RESULTS | |
|---|---|---|---|---|---|
PREVENTION | [20] | Masotti et Al. 2003 | Canada | Letter to the editor | Influential role of family in alcohol use among American adolescents Importance of considering multi-factorial elements (holistic, socio-economic, communication, family, notion of non-guilt) Approach must be culturally appropriate and accessible for Aboriginal women Primary role of the doctor/patient relationship (communication) Acceptable to clinicians and easily implemented |
[18] | Loock et al. 2005 | Canada | Expert recommendations | Primary care physicians have a key role in preventing FASD in heavy drinkers (any woman with > 7 drinks/week or 3 drinks/day) | |
[27] | Ramussen et al. 2010 | Canada | Retrospective study | Evaluation of a prevention program for women at risk of having a child with FASD and significant pre/post program improvement in at risk birth control | |
[21] | Zoorob et al. 2014 | USA | Review of the literature | The Centers for Disease Control and Prevention's (CDC), the American Academy of Family Physicians (AAFP), and the American Congress of Obstetrics and Gynecology (ACOG) recommend that all women of childbearing age be targeted regarding alcohol consumption to prevent the effects of alcohol on the newborn | |
[6] | M. Anne George et Al. 2014 | Canada | Observational study | A study of the needs of practitioners involved in the management of FASD in British Columbia FASD was a preventable health problem affecting approximately 10% of the population Canadian Guidelines for Diagnosis and Assessment Provincial Outreach Program for Fetal Alcohol Spectrum Disorder (POPFASD) | |
[28] | Floyd et al. 2007 | USA | Non-randomised retrospective comparative study | Study of 830 women at risk. Half received simple information on the risks of drinking during pregnancy, the other half received motivational talks (4 counseling sessions), a contraceptive consultation, a visit to hospital services (CHOICES project). Intervention goal: to encourage women to change either of the target behaviors (risky alcohol use and ineffective contraception) Significant difference in reduction of FASD for the group receiving counseling | |
[29] | George MA et al. 2007 | Canada | Action research | The goal was to assist in the prevention of FASD through a participatory research approach involving local women and health workers in developing culturally appropriate methods to help women reduce their alcohol use during pregnancy Designed four different models of culturally appropriate community-based interventions based on five key features: identification of at-risk women; assessment of the woman's substance use; provision of information to women; a delivery method that facilitates the decision to adopt healthier behaviors; and ways to monitor change | |
[30] | Peadon et al. 2007 | Australie | Recommendation | Identify the role of the general practitioner in the prevention and management of FASD Most health professionals have limited knowledge of FASD and lack confidence in diagnosing and managing children with FASD. General practitioners have an important role to play in identifying women and children at risk of alcohol-related harm and in arranging for referral for assessment and management when necessary | |
[31] | Mendoza R et al. 2020 | Espagne | Retrospective cross-sectional descriptive study | To analyze the extent to which pregnant women recalled receiving health advice about drinking during pregnancy, what the perceived message was, and whether there was a social inequity 43% of women surveyed reported that they had not received any health advice on this topic. Only 43.5% of the sample recalled receiving the correct message (not to drink alcohol at all during pregnancy) from their midwife, 25% from their obstetrician, and 20.3% from their general practitioner. Women with low levels of education reported the least amount of health advice on this topic The recommended health advice to avoid alcohol consumption during pregnancy did not effectively reach a large proportion of pregnant women | |
[32] | Crawford-Williams F et al. 2015 | Australie | Qualitative study | Health professionals demonstrated adequate knowledge that alcohol can cause lifelong physical and mental difficulties. However, knowledge of the term FASD was limited. Many did not incorporate the prevention message into their practice, and several questionable judgments were noted It is important to ensure that national guidelines are supported by health professionals | |
SCREENING | [18] | Loock et al. 2005 | Canada | Expert recommendations | Recommended screening tools: CRAFFT (for adolescents) (sensitivity 70%, specificity 94%) and CAGE (T-ACE (sensitivity 70%, specificity 85%) and TWEAK for all women (sensitivity 79%, specificity 83%)) Criteria for referral to expert centers |
[21] | Zoorob et al. 2014 | USA | Review of the literature | Primary care practitioners are ideally positioned to screen patients with alcohol use disorders. SBI can improve patient health, reduce alcohol dependence, and prevent future alcohol-exposed pregnancies | |
[19] | R.L Floyd et Al. 1999 | USA | Expert opinion | The Changing High risk alcOhol use and Increasing Contraception Effectiveness Study (CHOICES). Goal: to identify women at high risk of having an alcohol-exposed pregnancy before they become pregnant, to provide an alcohol risk reduction intervention and to delay pregnancy until alcohol withdrawal Need for multidisciplinary support including primary care | |
[33] | SK Clarren et Al. 1998 | USA | Retrospective study | Primary prevention essential in FASD Women with FAS children = prime targets (FASD often under-diagnosed) University of Washington: implementation of a screening tool: Fetal Alcohol Syndrome Diagnostic and Prevention Network | |
[22] | P M Davis et Al. 2008 | Canada | Retrospective study | Primary care practitioners play a key role in screening women at risk for FASD Primary care practitioners may find screening difficult, time-consuming and even uncomfortable Online questionnaire to assess the needs of primary care practitioners in screening | |
[34] | Tan CH et al. 2016 | USA | Cross-sectional study | The U.S. Preventive Services Task Force (USPSTF) recommended that primary care professionals screen all adults and conduct brief counseling interventions with those who misuse alcohol. The USPSTF preferred the use of three screening tools that measure alcohol use (Alcohol Use Disorders Identification Test, Alcohol Use Disorders Identification Test-Consumption, and National Institute on Alcohol Abuse and Alcoholism Single Question) because these tools detect the full spectrum of alcohol abuse in adults The objective was to estimate the prevalence of alcohol misuse screening practices by primary care professionals and examined factors associated with the use of a USPSTF preferred screening tool A cross-sectional study was conducted on self-reported 2016 DocStyles data from 1,506 primary care providers 96% of providers had reported screening their patients for alcohol abuse. Of those who screened, 38% used a USPSTF recommended screening tool. Provider specialty, knowledge of USPSTF guidelines, and mode of administration of the screening tool were associated with use of a preferred screening tool. About two-thirds did not use a tool capable of detecting FASD | |
[35] | O’Connor MJ et al. 2014 | Afrique du sud | Intervention | Training community workers to screen for FASD Community workers in Cape Town, South Africa, were trained to screen for FASD in 139 children aged 18 months with prenatal alcohol exposure (PAE). Children were assessed for salient characteristics of PAE subjects using height, weight, head circumference (OFC), philtrum, and lip measurements according to criteria established by the Institute of Medicine. Children who screened positive were referred for diagnostic evaluation to a pediatrician trained in the diagnosis of FASD Of the screen-positive children, 93% were diagnosed with FASD, suggesting that the screening procedure was highly sensitive. Diagnoses included 15% FAS, 23% partial FAS, and 62% ARND The use of community workers to screen for FASD is a promising approach for effective diagnosis of children affected by PAE in areas lacking adequate medical resources | |
[36] | Shanley DC et al. 2019 | Australie | Mixed intervention | The Yapatjarrathati (named by the local First Nations community and meaning "to be well") project is a mixed-methods implementation trial of a multi-level assessment process to identify FASD in a remote Australian community A culturally sensitive, multi-level neurodevelopmental assessment process to identify FASD and training materials to enhance the skills of remote practitioners with varying levels of expertise were implemented | |
[37] | Farlane et al. 2007 | Canada | historical article | The article describes the history of the Lakeland Centre for FASD in developing the model and the diagnostic process used to diagnose children and adults. Rural adaptations of similar urban models are discussed. Essential elements of rural in-kind services are also discussed, as well as current challenges. Given the evolution of terminology over the years covered by this article, the term FASD (Fetal Alcohol Spectrum Disorder) is used throughout | |
[38] | Washio Y 2017 | USA | Intervention | Community-based pilot program to reduce alcohol use among pregnant mothers Participants were required to provide daily breath samples with monetary incentives for negative samples for alcohol. The program has treated four pregnant mothers to date, with an average compliance rate of 94% and no positive alcohol breath samples. Planned future adjustments include the use of a remote reloadable debit card to reinforce daily sample submission, a shift to fully randomized testing programs to avoid false negative results, and expansion of the program's service to additional counties. The community-based program using mobile technology promises to increase opportunities to reinforce a healthy lifestyle during pregnancy | |
[22] | Davis PM et al. 2008 | Australie | Cross-sectional study | A mail and online survey was distributed in the spring of 2006 to family physicians/general practitioners and nurse practitioners to assess current alcohol risk assessment practices and learning and resource needs among primary health care professionals in Saskatchewan, A total of 876 surveys were distributed and 386 were returned, for an overall response rate of 44.1%. The majority of survey respondents reported rarely or never using a standardized screening tool to assess women's risk for alcoholism or using a less sensitive standardized screening tool. Current practices varied by gender, length of practice, and practice location, while learning and resource needs were more likely to be identified by nurse practitioners, female physicians, and physicians in rural areas. Physicians who had been in practice less than 5 years were more likely to want an online course | |
[24] | SC Tough et Al. 2008 | Canada | Descriptive article | Important role of primary care practitioners in the prevention and diagnosis of FASD | |
[39] | A Hanlon Dearman 2015 | Canada | Expert recommendations | Role of the primary care practitioner: screening for child maltreatment, aiming for stability or even placement, educational role to minimize and prevent further maltreatment Role of Primary Health Care Provider (PHCP) in screening children for communication problems in children exposed to alcohol prenatally and referring them early to speech-language pathologists | |
DIAGNOSIS | [18] | Loock et al. 2005 | Canada | Recommandations d’expert | Guide of recommendations for primary care practitioners to enable early diagnosis (and a more favorable evolutionary trajectory) Complex diagnosis facilitated by tools such as the 4-Digit Code |
[39] | A Hanlon Dearman 2015 | Canada | Expert recommendations | Important role of primary care practitioners in raising alcohol-related issues Primary care professionals do not routinely bring up alcohol issues (discomfort, lack of time, insufficient remuneration, fear of stigma, and/or lack of information about how to handle a discussion about alcohol use/intervention strategies) Need to have respectful, compassionate conversations; be informative Specific tools: CRAFFT for adolescents (sensitivity 70%, specificity 94%), modified CAGE (T-ACE (sensitivity 70%, specificity 85%) and TWEAK for pregnant and non-pregnant women (sensitivity 79%, specificity 83%)), AUDIT (Alcohol Use Disorder Identification Test) (sensitivity 81%, specificity 95%). Motivational interviewing has its place and is effective in reducing alcohol use during pregnancy Role of primary care professionals in the assessment of children with FASD (referral to care including mental health, information to families) Early diagnosis and treatment of co-morbidities will reduce the burden of care for individuals with FASD and their families. Important role of primary care professionals in early identification of individuals who may have been exposed to alcohol prenatally with a complete medical and prenatal history | |
[40] | Wagner B et al. 2018 | Australie | Randomised trial | This self-controlled cluster randomized trial evaluated the effectiveness of an 8-week school-based program of the Alert program in improving self-regulation and executive function in children living in remote Australian Aboriginal communities from grades 1 to 6. Trained teachers delivered the Alert program to students in weekly one-hour lessons. Student outcomes were assessed at three different time points. For the intervention condition, data collection took place 2 weeks immediately before and after the intervention, with a subsequent 8-week follow-up. For the control conditions in groups two through four, the control data collection corresponded to the data collection for the intervention condition in the previous group. The primary outcome is change in self-regulation. FASD diagnoses will be determined by review of medical records after data collection is complete | |
[41] | V K Temple et Al. 2015 | Canada | Descriptive article | An interdisciplinary clinic that diagnoses Fetal Alcohol Spectrum Disorder with a focus on adults. The clinic is part of an interdisciplinary community health agency specializing in intellectual and developmental disabilities | |
CARE | [39] | Hanlon Dearman 2015 | Canada | Expert recommendations | Importance of a multidisciplinary team with the PHCP (Primary Health Care Provider) as the coordinator, focused on the young patient and family Key role of the PHCP and support team in ensuring a successful transition from childhood to adulthood, planning for the resources the child will need in adulthood The PHCP should be aware of support services for individuals with FASD and make early referrals to school and family support services Urgent need for PHCP involvement in the active care of individuals with FASD and their families across the lifespan. PHCPs are trained in screening, prevention and management of health needs PHCP must ensure the transmission of academic knowledge about FASD and its management to families, the educational system (schools…) Role as coordinator of the multidisciplinary care team. The management of FASD involves education, social and justice systems Because specialized care is not always accessible to patients and families in remote areas, the PHCP has an important role as an expert and coordinator of care. The purpose of these guidelines is to provide the PHCP with the latest mental and physical health recommendations for the care of patients with FASD. The PHCP's commitment will provide an integrated system of care for individuals affected by prenatal alcohol exposure and their families |
[20] | Masotti 2003 | Canada | Letter to the editor | Major role of primary care in the management of FASD | |
[6] | George et Al. 2014 | Canada | Analysis | Professional skills program for youth, education program for police officers, social workers and others on how to deal effectively with people with FASD | |
[23] | Masotti et Al. 2015 | Canada | Expert recommendation | Management of people with FAS: multifactorial (medical and social) with difficulty in the coordination and continuity of care Primary care has a privileged place in the integration of multidisciplinary care This concerns prevention, diagnosis, treatment with an impact on quality of life |