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Kent N, Hayes N, Young S, Vanderpeet C, Shanley D, Harris K, Pestell C, Elliott E, Reid N. Exploring resource implications and models of care for assessment and diagnosis of fetal alcohol spectrum disorder: A scoping review. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2023; 47:2022-2032. [PMID: 38226761 DOI: 10.1111/acer.15198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/11/2023] [Accepted: 09/16/2023] [Indexed: 01/17/2024]
Abstract
Previous reviews have examined annual mean costs of care for individuals with fetal alcohol spectrum disorder (FASD), costs of the health burden, costs to the justice system, productivity losses for caregivers, and both the monetary and nonmonetary costs of reduced quality of life. However, because there have been no published reviews focused on understanding the resource implications and specific service features for the assessment and diagnostic process for FASD, the current scoping review investigated the available evidence on these topics. Eligible studies were identified through a systematic search of six databases and included if they contained information on the potential costs or models of care associated with undertaking an assessment for FASD. Data were charted, underwent content analysis, and were reported according to the PRISMA extension for scoping reviews. Eleven studies were included in the final qualitative synthesis. The primary patient costs were attributed to the lengthy time required for diagnosis (up to 47 h). The primary service costs were attributed to costs of clinicians and support personnel and the involvement of multidisciplinary teams in the assessment process. Estimates of the specific dollar values of diagnostic costs were limited and varied between studies. Several models of care were explored, primarily in Canadian clinics, which aimed to capitalize on available services to improve accessibility and patient care and reduce service costs. This study provides important preliminary insights into the resource implications and models of care involved in the diagnostic assessment of FASD. However, the low number of available studies and variability in available data highlight the need for formal costing studies and detailed information gathering on available models of care to inform future clinical practice and policy development.
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Affiliation(s)
- Nykola Kent
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Nicole Hayes
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sophia Young
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Chelsea Vanderpeet
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Dianne Shanley
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Katrina Harris
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Victoria, Australia
- Australian Childhood Foundation, Abbotsford, Victoria, Australia
| | - Carmela Pestell
- Australian Childhood Foundation, Abbotsford, Victoria, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Westmead, Sydney, New South Wales, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
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Shanley DC, Zimmer-Gembeck M, Wheeler AJ, Byrnes J, Ware RS, Liu W, Simcock G, White C, Horton S, Page M, Shelton D, Till H, Mills I, Hislop C, Harris K, Crichton A, Reid N, Reilly S, Moritz K, Walsh K, Rundle-Thiele S, Hawkins E. Diagnostic Accuracy and economic value of a Tiered Assessment for Fetal Alcohol Spectrum Disorder (DATAforFASD): Protocol. BMJ Open 2023; 13:e071004. [PMID: 37586864 PMCID: PMC10432646 DOI: 10.1136/bmjopen-2022-071004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/18/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Australian practices for diagnosing fetal alcohol spectrum disorder (FASD) are lengthy and require specialist expertise. Specialist teams are based in urban locations; they are expensive and have prolonged waitlists. Innovative, flexible solutions are needed to ensure First Nations children living in rural/remote communities have culturally appropriate and equitable access to timely diagnosis and support. This study compares the accuracy of rapid assessments (index tests) that can be administered by a range of primary healthcare practitioners to specialist standardised FASD assessments (reference tests). The cost-efficiency of index tests will be compared with reference tests. METHODS AND ANALYSIS At least 200 children aged 6-16 years at-risk of FASD will be recruited across at least seven study sites. Following standards for reporting diagnostic accuracy study (STARD) guidelines, all children will complete index and reference tests. Diagnostic accuracy statistics (including receiver operating curves, sensitivity, specificity, positive and negative predictive values and likelihood ratios) will identify whether rapid assessments can accurately identify: (1) the presence of an FASD diagnosis and (2) impairment in each neurodevelopmental domain, compared to comprehensive assessments. Direct and indirect healthcare costs for index tests compared to reference tests will be collected in primary healthcare and specialist settings. ETHICS AND DISSEMINATION OF RESULTS Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/20/QCHQ/63173); Griffith University Human Research Ethics Committee (2020/743). Results will assist in validating the use of index tests as part of a tiered neurodevelopmental assessment process that was co-designed with First Nations community and primary healthcare practitioners. Outcomes will be summarised and provided to participating practitioners and sites, and disseminated to community health services and consumers. Findings will be presented at national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000498796.
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Affiliation(s)
- Dianne C Shanley
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Melanie Zimmer-Gembeck
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
| | - Amanda J Wheeler
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Medical & Health Sciences, The University of Auckland, Auckland, Auckland, New Zealand
| | - Joshua Byrnes
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Wei Liu
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Gabrielle Simcock
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Codi White
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sarah Horton
- Family Health, Gidgee Healing, Mt Isa, Queensland, Australia
| | - Marjad Page
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- Primary Health Care, Kambu Aboriginal and Torres Strait Islander Corporation for Health, Ipswich, Queensland, Australia
| | - Doug Shelton
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Community Child Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Haydn Till
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Community Child Health, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Ianthe Mills
- Child and Adolescent Unit, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
| | - Carly Hislop
- Child Development Service, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Katrina Harris
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Alison Crichton
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Natasha Reid
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sheena Reilly
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Karen Moritz
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Kerryann Walsh
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Erinn Hawkins
- Menzies Health Institute of Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, Australia
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McLachlan K, Minhas M, Ritter C, Kennedy K, Joly V, Faitakis M, Cook J, Unsworth K, MacKillop J, Pei J. Latent classes of neurodevelopmental profiles and needs in children and adolescents with prenatal alcohol exposure. Alcohol Clin Exp Res 2023; 47:772-785. [PMID: 36799306 DOI: 10.1111/acer.15028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) resulting from prenatal alcohol exposure (PAE) is a common neurodevelopmental disorder, but substantial interindividual heterogeneity complicates timely and accurate assessment, diagnosis, and intervention. The current study aimed to identify classes of children and adolescents with PAE assessed for FASD according to their pattern of significant neurodevelopmental functioning across 10 domains using latent class analysis (LCA), and to characterize these subgroups across clinical features. METHODS Data from the Canadian National FASD Database, a large ongoing repository of anonymized clinical data received from diagnostic clinics across Canada, was analyzed using a retrospective cross-sectional cohort design. The sample included 1440 children and adolescents ages 6 to 17 years (M = 11.0, SD = 3.5, 41.7% female) with confirmed PAE assessed for FASD between 2016 and 2020. RESULTS Results revealed an optimal four-class solution. The Global needs group was characterized by high overall neurodevelopmental impairment considered severe in nature. The Regulation and Cognitive needs groups presented with moderate but substantively distinguishable patterns of significant neurodevelopmental impairment. The Attention needs group was characterized by relatively low probabilities of significant neurodevelopmental impairment. Both the Global and Regulation needs groups also presented with the highest probabilities of clinical needs, further signifying potential substantive differences in assessment and intervention needs across classes. CONCLUSIONS Four relatively distinct subgroups were present in a large heterogeneous sample of children and adolescents with PAE assessed for FASD in Canada. These findings may inform clinical services by guiding clinicians to identify distinct service pathways for these subgroups, potentially increasing access to a more personalized treatment approach and improving outcomes.
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Affiliation(s)
- Kaitlyn McLachlan
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Meenu Minhas
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Chantel Ritter
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Kathleen Kennedy
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Vannesa Joly
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Martina Faitakis
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Jocelynn Cook
- The Society of Obstetricians and Gynaecologists of Canada, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathy Unsworth
- Canada FASD Research Network, Vancouver, British Columbia, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, & Homewood Research Institute, Guelph, Ontario, Canada
| | - Jacqueline Pei
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
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Impact of Prenatal Alcohol Exposure on the Development and Myocardium of Adult Mice: Morphometric Changes, Transcriptional Modulation of Genes Related to Cardiac Dysfunction, and Antioxidant Cardioprotection. Antioxidants (Basel) 2023; 12:antiox12020256. [PMID: 36829814 PMCID: PMC9952294 DOI: 10.3390/antiox12020256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
The impact of prenatal alcohol exposure (PAE) varies considerably between individuals, leading to morphological and genetic changes. However, minor changes usually go undetected in PAE children. We investigated PAE's effects on gene transcription of genes related to cardiac dysfunction signaling in mouse myocardium and morphological changes. C57Bl/6 mice were subjected to a 10% PAE protocol. In postnatal days 2 and 60 (PN2 and PN60), morphometric measurements in the offspring were performed. Ventricular samples of the heart were collected in PN60 from male offspring for quantification of mRNA expression of 47 genes of nine myocardial signal transduction pathways related to cardiovascular dysfunction. Animals from the PAE group presented low birth weight than the Control group, but the differences were abolished in adult mice. In contrast, the mice's size was similar in PN2; however, PAE mice were oversized at PN60 compared with the Control group. Cardiac and ventricular indexes were increased in PAE mice. PAE modulated the mRNA expression of 43 genes, especially increasing the expressions of genes essential for maladaptive tissue remodeling. PAE animals presented increased antioxidant enzyme activities in the myocardium. In summary, PAE animals presented morphometric changes, transcription of cardiac dysfunction-related genes, and increased antioxidant protection in the myocardium.
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