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McQuire C, Frennesson NF, Parsonage J, Van der Heiden M, Troy D, Zuccolo L. Trends in fetal alcohol spectrum disorder research: A bibliometric review of original articles published between 2000 and 2023. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1819-1833. [PMID: 39118285 DOI: 10.1111/acer.15415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/16/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024]
Abstract
Fetal alcohol spectrum disorder (FASD) is a leading cause of neurodevelopmental disability globally. International organizations have highlighted an urgent need for improved prevention, diagnosis, and support. However, the evidence base needed to inform this is thought to be limited. We conducted two complementary reviews to (i) describe trends in the volume and characteristics of original FASD research articles (Review 1) and (ii) compare the volume of published research on FASD to that of other neurodevelopmental disorders (Review 2). In Review 1, we systematically searched MEDLINE, Embase, CINAHL and PsycInfo for original studies with FASD terms in the title, published between 2000 and 2023. We summarised study characteristics including the article topic(s), sample population, country of origin, and publication year using quantitative content analysis and time-series plots. A total of 854 studies were eligible. Studies showed a relative focus on diagnosis and screening, compared to prevention and intervention. FASD research originated from 31 countries, however most countries (68%) had fewer than 10 articles published over the 23-year review period. In Review 2, we searched PubMed for records published between 2000 and 2023 with FASD, autism, or attention-deficit-hyperactivity disorder (ADHD) terms in the title. We compared the volume of records for these conditions using descriptive statistics and time-series plots. Of the 64,069 records retrieved, 2% were for FASD, compared to 60% for autism and 38% for ADHD. FASD remains considerably under-researched. While there has been an increase in the number of original FASD research articles published annually over time, this is much lower than expected compared to publication trends for other neurodevelopmental conditions, and the wider scientific literature. Further research is needed to understand the impact of FASD across the lifespan, to inform evidence-based policy and support, and to advance progress in strength-based, stigma-reducing approaches to FASD research and practice.
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Affiliation(s)
- Cheryl McQuire
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nessie Felicia Frennesson
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - James Parsonage
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health and Care Research, School for Public Health Research (NIHR SPHR), Newcastle University, Newcastle upon Tyne, UK
| | | | - David Troy
- Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Luisa Zuccolo
- Health Data Science Centre, Fondazione Human Technopole, Milan, Italy
- MRC Integrative Epidemiology Unit and Population Health Sciences Department, Bristol Medical School, University of Bristol, Bristol, UK
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Jones JP, Williamson L, Konsoula Z, Anderson R, Reissner KJ, Parker W. Evaluating the Role of Susceptibility Inducing Cofactors and of Acetaminophen in the Etiology of Autism Spectrum Disorder. Life (Basel) 2024; 14:918. [PMID: 39202661 PMCID: PMC11355895 DOI: 10.3390/life14080918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/16/2024] [Accepted: 07/19/2024] [Indexed: 09/03/2024] Open
Abstract
More than 20 previously reported lines of independent evidence from clinical observations, studies in laboratory animal models, pharmacokinetic considerations, and numerous temporal and spatial associations indicate that numerous genetic and environmental factors leading to inflammation and oxidative stress confer vulnerability to the aberrant metabolism of acetaminophen during early development, leading to autism spectrum disorder (ASD). Contrary to this conclusion, multivariate analyses of cohort data adjusting for inflammation-associated factors have tended to show little to no risk of acetaminophen use for neurodevelopment. To resolve this discrepancy, here we use in silico methods to create an ideal (virtual) population of 120,000 individuals in which 50% of all cases of virtual ASD are induced by oxidative stress-associated cofactors and acetaminophen use. We demonstrate that Cox regression analysis of this ideal dataset shows little to no risk of acetaminophen use if the cofactors that create aberrant metabolism of acetaminophen are adjusted for in the analysis. Further, under-reporting of acetaminophen use is shown to be a considerable problem for this analysis, leading to large and erroneously low calculated risks of acetaminophen use. In addition, we argue that factors that impart susceptibility to acetaminophen-induced injury, and propensity for acetaminophen use itself, can be shared between the prepartum, peripartum, and postpartum periods, creating additional difficulty in the analysis of existing datasets to determine risks of acetaminophen exposure for neurodevelopment during a specific time frame. It is concluded that risks of acetaminophen use for neurodevelopment obtained from multivariate analysis of cohort data depend on underlying assumptions in the analyses, and that other evidence, both abundant and robust, demonstrate the critical role of acetaminophen in the etiology of ASD.
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Affiliation(s)
- John P. Jones
- WPLab, Inc., Durham, NC 27707, USA; (J.P.J.III); (Z.K.); (R.A.)
| | - Lauren Williamson
- Department of Biological Sciences, Northern Kentucky University, Highland Heights, KY 41099, USA;
| | | | - Rachel Anderson
- WPLab, Inc., Durham, NC 27707, USA; (J.P.J.III); (Z.K.); (R.A.)
| | - Kathryn J. Reissner
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - William Parker
- WPLab, Inc., Durham, NC 27707, USA; (J.P.J.III); (Z.K.); (R.A.)
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599, USA;
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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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