Dissertations / Theses on the topic 'Fetal alcohol syndrome'

The aim of the study was to develop a culturally sensitive Grounded Theory of Navajo parenting for families who are living with Fetal Alcohol Syndrome (FAS)/Fetal Alcohol Effects (FAE). The research question was: What are the social and cultural factors and processes that Navajo families use to mange care for a child with FAS/FAE? The philosophical perspectives that guided the study were: the Navajo philosophy, or view of life; resilience (middle range theory); the Family Stress Theory; and the Resiliency Mode of Family Stress, Adjustment, and Adaptation. Resilience was used as the over arching conceptual perspective for the study. A Grounded Theory of Navajo Parenting emerged from the data. Key categories to support the emerging theory were identified. The core category was Versatility through Transcendence. The supporting categories were: Strategies for Managing Challenges; Transcendence in Parenting; Intergenerational Alcohol Abuse, Violence and Suffering; and Knowledge/Acquisition of Needs. The families described their stories of transcendence through substance abuse, suffering, and violence to be able to parent their children who were living with the primary and secondary challenges of prenatal alcohol exposures. Further research is needed to test and expand this emerging theory of Navajo parenting of children with FAS/FAE. The challenges that were related to FAS/FAE were more easily managed with patterns of resilience within the families. Factors that influenced family's abilities to parent will be disseminated to assist other families who are managing the problems associated with FAS/FAE.

Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.<br>The National Institutes of Health defines Fetal Alcohol Syndrome (FAS) as a debilitating collection of birth defects that include craniofacial dysmorphisms, neurological and motor insufficiencies, growth retardation, and behavioral and social discrepancies. Characteristic craniofacial abnormalities, which include smooth philtrum, thin vermillion border, short palpebral fissures, and microcephaly, are used as a diagnostic tool for FAS. There is agreement across the literature that the characteristic craniofacial dysmorphisms are induced as a result of prenatal alcohol exposure in very specific doses, and during very particular time periods during embryonic development. However, ambiguity still exists about the critical time and dose relationship of prenatal alcohol exposure in the production of FAS. In regards to the critical timing, researchers have concluded that prenatal alcohol exposure during the second half of the first trimester, defined as days 43-94 postconception, was found to cause an increased incidence of smooth philtrum, thin vermillion border, microcephaly and reduced birth weight. Conversely, other studies found that prenatal alcohol exposure on day 7 of gestation in mice, which corresponds to week 3 of human gestation, induced craniofacial abnormalities comparable to those seen in humans with FAS. In regards to the critical dose, there is a linear relationship between the dose of prenatal alcohol exposure and the incidence of FAS-related craniofacial abnormalities, with no safe threshold. It was also found that a binge pattern of drinking was more significantly associated with the craniofacial abnormalities seen in FAS than a continuous or less condensed pattern of drinking, even if the binge pattern involved a smaller absolute dose of alcohol. These results regarding both dose and pattern on prenatal alcohol exposure, suggest that binge-drinking patterns are most significantly associated with craniofacial abnormalities if consumed before pregnancy or during late pregnancy, whereas absolute high doses of alcohol in a non-binge pattern were most significantly associated with craniofacial abnormalities in the first trimester. Further research is required for clarification of the critical time and dose relationships involved in the production of the characteristic craniofacial dysmorphisms seen in FAS. A definite conclusion will aid in the public education and prevention programs for FAS if solid information can be provided about the harms of alcohol consumption during pregnancy in regards to timing and dose.<br>2031-01-01

The parietal lobe has been shown to be one of the regions most affected by prenatal alcohol exposure. Functional domains dependent on intact parietal functioning, including mathematical and visuospatial ability, have been consistently implicated in fetal alcohol spectrum disorders. This thesis examines, in children, using blood oxygenation level dependent (BOLD) functional Magnetic Resonance Imaging, the effect of prenatal alcohol exposure on brain activation during symbolic and nonsymbolic number processing, and place learning in a virtual environment. These functional domains were investigated using tasks of proximity judgment and exact addition to assess neural correlates of symbolic number processing in 65 children (mean age ± SD = 9.45 ± 0.42 years), nonsymbolic number comparison at varying difficulties in 34 children (11.55 ± 1.15 years), and place learning in a virtual reality computer generated (CG) arena in 57 children (9.44 ± 0.42 years; 29 boys). In the symbolic number processing tasks greater prenatal alcohol exposure was related to less activation in the right horizontal intraparietal sulcus known to mediate mental representation and manipulation of quantity. Children with fetal alcohol syndrome and partial fetal alcohol syndrome appeared to compensate for this deficit by increased activation of the left angular gyrus during the proximity judgment task. Syndromal children with fetal alcohol syndrome or partial fetal alcohol syndrome also demonstrated poor recruitment of the right horizontal intraparietal sulcus during nonsymbolic number comparison, indicating that mental representation and manipulation of quantity are impaired in children with heavy prenatal alcohol exposure, irrespective of the representation format used. This impairment was compensated for by the left angular gyrus, with only exposed children needing to recruit the left angular gyrus to a greater extent as number comparison task difficulty increased. Further, reduced activation of the right posterior superior parietal lobule in children with increasing prenatal alcohol exposure suggests that exposed children may be less able to employ the attentional systems associated with number processing. Notably, activation of nonsyndromal heavily exposed children was impaired in the right posterior superior parietal lobule, but spared in the right horizontal intraparietal sulcus. In boys only, prenatal alcohol exposure was associated with poorer place learning and reduced activation during place learning in the precuneus and posterior cingulate, as well as parahippocampal gyrus, frontal and temporal lobes, caudate, insula, claustrum, lentiform nucleus and thalamus. In girls, prenatal alcohol exposure was not associated with place learning performance or activation during place learning in any regions. These results confirm that boys and girls use different navigation strategies that rely on different brain regions and suggest that the regions used by boys are more susceptible to alcohol damage, while the regions used by girls are relatively spared. In conclusion, all the tasks investigated showed prenatal alcohol exposure related alterations in parietal function, with the impairments being widespread throughout the parietal lobe bilaterally. Notably, activation of the bilateral precuneus was affected by prenatal alcohol exposure in both the spatial navigation and nonsymbolic number comparison tasks. It is possible that this is a key region linking the deficits in number processing and visuospatial skills in children with prenatal alcohol exposure.

Short-term memory function and learning in children with Fetal Alcohol Syndrome/Effects (FAS/E) was examined. Participants included twenty school-aged children diagnosed with either Fetal Alcohol Syndrome or Fetal Alcohol Effects (mean age = 11.13 years) and twenty normal controls (mean age = 11.11 years) matched on age and gender, all of which were Native American and lived on a rural reservation. All participants completed nine core subtests of the Wide Range Assessment of Memory and Learning. Results indicated that children with FAS/E performed significantly more poorly than controls on eight of the nine memory measures, including Number/Letter Memory, Sentence Memory, Story Memory, Finger Windows, Design Memory, Verbal Learning, Visual Learning, and Sound-Symbol. No statistically significant group differences were found on Picture Memory. Subsequent discriminant function analyses revealed that scores on the WRAML subtest provided useful discriminating information for children with FAS/E and controls. Scores on Story Memory, Design Memory, and Number/Letter Memory most strongly discriminated between groups. Implications of these results are discussed and recommendations for further research are provided.

Thesis (Ph. D.)--West Virginia University, 2003.<br>Title from document title page. Document formatted into pages; contains vii, 146 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references.

Fetal Alcohol Syndrome (FAS) is the most severe of a spectrum of birth defects caused by a mother drinking alcohol whilst pregnant. Its manifestation in the Central Nervous System causes intellectual and behavioural abnormalities, which pose considerable challenges in the classroom. This case study explores the classroom environment and educational outcomes of learners with FAS in a rural South African school. The study was conducted at Elizabethfontein Primary School (EFPS), a farm school near Clanwilliam in the Western Cape. The sample comprises of all 170 learners in Grade 1 to Grade 4. A prevalence rate of FAS of 124 per 1000 (12.4%) was found. EFPS is a Quintile 1 school that relies heavily on fundraising (especially in the form of Riel Dancing) and sponsorship to afford extra staff (such as Koshuis Tannies and teaching assistants), maintenance and transportation of learners. The lack of Grade R school preparation and the environment learners grow up in results in discipline problems, many learners repeating, being progressed before they are ready and a high dropout rate. Child abuse and neglect is common today, prompting the EFPS boarding house to act as "safe haven" during the week for two thirds of its learners. The school provides security, routine and constant meals (as part of the School Nutrition Program and supplemented by the school garden). Data on educational outcomes was collected through participant observation (classroom behaviour), collection of information from existing sauces (Home Language Marks and Mathematics Marks) and collection of new data (Reading Score). A physician diagnosed those children with FAS using a three-stage process. Having FAS is associated with lower home language marks ( 2.8 to 8.55 percentage points) and behavioural scores (1.73 to 4.21 percentage points). The mitigating effect of the school on FAS learners might have reduced the impact of FAS. Children with FAS struggle academically and in following rules and principles as they have lower intellectual capabilities and cannot generalise from one situation to the next. Memory deficits, especially verbally and visuospatially, present challenges in following instructions and copying from the board. Children with FAS are also hyperactive, distractible and inattentive, which causes classroom disruptions and pose a negative externality to other learners. They find it difficult to follow social cues, but want to be helpful and well liked, making children with FAS vulnerable to manipulation. Strategies for intervention have been explored by specialised schools and studies, but must be translated into viable options for the mainstream under-resourced classroom. In order to develop appropriate strategies for classroom intervention a comprehensive understanding of FAS in this context must first be established. Many learners are isolated by a lack of tarred roads and cell phone reception within the large catchment area of EFPS. As descendants of local tribes and slaves the history of this farming area still influences them today. The legacy of the Dop system can still be seen, as alcohol forms a cornerstone of social interactions, especially in binge drinking over weekends, which exposes children to the cycle of alcohol addiction from a young age. Racial segregation and the impact of Apartheid have influenced the educational trajectory of coloured children. The value of this study lies in the in-depth insight into the context learners find themselves in, and the specific challenges associated with FAS learners. Future studies can build on the methodology and explore ways to improve the lives of children with FAS. Research must be interdisciplinary and in collaboration with the community. In response to this research EFPS has declared 2016 as "The Year of Alcohol Awareness" . Intervention strategies must be aimed towards these isolated, under resourced communities.

Includes bibliographical references (leaves 100-104).<br>This project involved the statistical analysis of facial landmark used in Fetal Alcohol Syndrome (FAS) diagnosis. FAS is a clinical condition caused by excessive maternal consumption of alcohol during pregnancy. Diagnosis of FAS depends on evidence of growth retardation, CNS neurodevelopment abnormalities, and a characteristic pattern of facial anomalies, specifically a short palpebral fissure length, smooth philtrum, flat upper lip and flat midface. The unique facial appearance associated with FAS is emphasized in diagnosis that relies, in part, on the comparison of linear measurements of facial features to population norms.

Fetal alcohol syndrome (FAS), a leading cause of mental retardation, was initially described in the United States only twenty years ago. Because it is likely that fetal alcohol exposure contributes substantially to the heterogeneously-grouped learning disabled population, it is worthwhile to review the known cognitive and neurobiological bases of this syndrome, and to test promising neuropsychological hypotheses. For example, animal models of FAS indicate neuroanatomical and behavioral deficits attributable to dysfunction of the hippocampus, a neural structure important in learning and especially spatial memory. In addition, although humans with FAS have demonstrated difficulty with nonverbal problems that are spatial in nature, no specific tests of hippocampal dysfunction have been administered. Thus, fifteen children (x age = 9.8 ± 2.32) with alcohol related birth defects (ARBD), and 15 control children (x age = 9.7 ± 2.40) were tested on several spatial and object memory tasks. These tasks were administered in (1) a small-scale desk-work type environment, and (2) a large-scale environment designed to parallel animal work. The spatial tasks were presumed to be indicators of intact hippocampal functioning, but the object memory tasks were not. As expected, individuals with ARBD consistently demonstrated a deficit spatial memory performance. There was never a significant difference on an immediate object recall task, but the children with ARBD tended "to forget" more objects after a delay in two of the three experiments. Previous research emphasizes the role of the hippocampus in spatial memory (Morris, Garrud, Rawlins, & O'Keefe, 1982) as well as in visually-mediated delayed object recall. Left neocortical structures that subserve immediate object recall appear to be relatively intact. Visuospatial descriptive testing indicated a further disturbance in nonverbal information processing that could involve such neuroanatomical structures as the frontal lobe, parietal cortex, basal ganglia, corpus callosum, and cerebellum. Further studies that address intact vs. deficit performance in children with ARBD could illuminate some specific structural-functional attributes in the brains of children. Defining the neurodevelopmental role of the hippocampus in learning and memory is a priority to be accomplished.

Fetal alcohol exposure is the most common known cause of preventable mental retardation, yet we know little about how microglia respond to, or are affected by, alcohol in vivo. Using an acute (single day) model of moderate (3 g/kg) to severe (5 g/kg) alcohol exposure in postnatal day (P) 7 or P8 mice we have found that alcohol-induced cortical neuroapoptosis is closely correlated in space and time with the appearance of activated microglia near dead cells. Microglia found in close proximity to dying neurons selectively engulfed those that were in later stages of apoptosis. Remarkably, most dead cells were cleared and microglia began to deactivate within 1-2 days of the initial insult. Coincident with microglial activation and deactivation, in the 5 g/kg alcohol model, there was a transient but substantial increase in pro-inflammatory factor (PIFs) expression. Work in BAX-null mice demonstrated that microglial activation and PIF expression were linked to BAX-dependent neuroapoptosis. As such, the level of microglial activation scaled with alcohol-induced cell death. Therefore, acute alcohol exposure in the developing cortex causes transient microglial activation and mobilization, promoting clearance of dead cells and tissue recovery. Moreover, cortical microglia show a remarkable capacity to rapidly deactivate following even severe neurodegenerative insults in the developing brain. Given that alcohol exposure on either P7 or P8 induced comparable levels of neuroapoptosis and microglial activation, we hypothesized that alcohol exposure on two sequential days (P7 and P8) would exacerbate neuroapoptosis and extend microglial activation. Instead, we found that the period of neuroapoptosis and microglial activation was similar after one day of alcohol exposure on P7 or after two days of exposure on P7 and P8. This was true for both the moderate and severe alcohol paradigms. Potentially, the low levels of cell death produced by the second day of injection may be due to neuroprotective mechanisms elicited by the first day of alcohol injection. In support of this idea, a preliminary microarray analysis of cortical gene expression 12 and 24 h after 5 g/kg alcohol exposure shows a decrease in expression of several pro-apoptotic factors and an increase in the expression of pro-survival factors, including neurotrophins. Of particular interest, BDNF, which has previously been shown to inhibit alcohol-induced neuroapoptosis, showed an eight-fold increase in expression at 24 h following 5 g/kg alcohol exposure and in situ hybridization showed strong BDNF expression near cortical regions with high levels of cell death. Future studies will be needed to extend the analysis of microglial activation states in this two-day injection model and to further explore the possibility that BDNF expression by microglia enacts neuroprotective mechanisms against a second insult. Finally, work in cell culture has suggested that chronic alcohol exposure may potentiate or inhibit microglial phagocytosis of dead cells. These studies raise the possibility that alcohol may directly affect microglial mobility which is important for their surveillance and synaptic remodeling functions. Therefore, we measured the effect of increasing doses of alcohol (0, 0.25, 0.5 and 1%) on microglial migration, branch motility, and morphology in dissociated BV-2 cell cultures and in acutely isolated neonatal (P5-6) brain slices. The results indicate that alcohol dose-dependently inhibits microglial migration and ruffling in cell culture, but in brain slices even high alcohol concentrations (0.5%) only reduce microglial branch motility by ~2%. When combined with our evidence for efficient microglial phagocytic clearance of dead cells in the neonatal cortex, these data suggest that while there is a measurable effect of acute alcohol exposure on microglial mobility, it does not impede microglia from performing their surveillance and phagocytic functions in vivo.

Abstract Fetal alcohol syndrome (FAS) is a pattern of anomalies in affected children due to maternal alcohol administration at vulnerable stages of fetal development. Intrauterine growth restriction and facial malformation are the presenting phenotypes of FAS. In this investigation, novel pathomechanisms of intrauterine growth restriction and facial malformation were the primary aims. We found by a FAS mouse model that AceCS1 gene expression and polyamines are the immediate targets of fetal alcohol exposure. The AceCS1 product is a precursor for lipid synthesis and protein acetylation and possibly, for polycation acetylation. We cloned the Mus musculus nuclear-cytosolic AceCS1 gene, and showed that its expression is developmentally regulated with a dynamic localization in the cytosolic and nuclear compartment. The enzyme plays an essential role in de novo synthesis of acetyl Coenzyme A. Fetal alcohol administration targets nutrient supplying networks, which are localized at critical barriers. The main findings were reduced surface of the labyrinthine zone, destruction of gap junctions in the hemotrichorial placenta, reduced syncytiotrophoblastic cell layers and loosening of interaction between cell layers and embryo endothelial cells, reduced Reichert’s membrane thickness with discontinued Reichert’s trophoblast and loss of interaction by Reichert’s-parietal cells, reduction of capillary network and reduced vascularization in the brain area, and perturbed neural crest migration and formation of neural tube defect. Alteration of angiogenesis -regulating proteins such as VEGF, PlGF, PECAM was detected in FAS, with no significant changes in placental angiogenesis of the labyrinthine zone, but up-regulation of VEGF/PlGF caused permeability changes in the placenta and yolk sac. On the other hand, the PECAM pool in embryos’ brain was reduced, which in turn led to decreased angiogenesis and vascularization<br>Tiivistelmä Sikiön alkoholisyndrooma (engl. Fetal alcohol syndrome, FAS) on joukko muutoksia, joita esiintyy äidin raskaudenaikaisen alkoholin käytön seurauksena, kun käyttö osuu sikiökehityksen kannalta kriittiseen vaiheeseen. Kohdunsisäisen kasvun rajoittuminen ja kasvojen epämuodostumat ovat FAS:n tyypillisimpiä ilmentymiä. Tässä tutkimuksessa pyrittiin löytämään uusia patomekanismeja kohdunsisäisen kasvun rajoittumiselle ja kasvojen epämuodostumille. Hiiren FAS-mallin avulla selvisi, että sikiön altistuminen alkoholille vaikuttaa suoraan AceCS1-geenin ilmentymiseen ja polyamiinien pitoisuuteen. AceCS1-geenin tuote on esiaste lipidien synteesissä ja proteiinien asetylaatiossa sekä mahdollisesti myös polykationien asetylaatiossa. Työssä myös kloonattiin hiiren (Mus musculus) AceCS1-geeni, jonka tuotetta esiintyy sekä tumassa että solulimassa. Lisäksi osoitettiin, että geenin ekspressio oli kehityksen aikana säädelty tuottamaan entsyymiä dynaamisesti eri paikkoihin solussa. Entsyymillä on lisäksi merkittävä osuus asetyyli-koentsyymi-A:n de novo–synteesissä. Sikiön altistuminen alkoholille kohdistuu sellaisten ravintoaineiden saatavuuteen, jotka sijaitsevat kriittisesti tärkeissä kudosrajapinnoissa. Päälöydöksinä olivat vähentynyt labyrinttikudoksen pinta-ala, gap-liitosten tuhoutuminen istukan veriesteessä (hemotrichorial?), ohentunut trofoblastisolujen kerros ja Reichertin kalvon paksuus, harventunut hiusverisuonten verkosto sekä verisuonitus aivojen alueella sekä hermopienan solujen siirtymishäiriö ja hermostoputken sulkeutumishäiriö. Verisuonten muodostumista (angiogeneesiä) säätelevien proteiinien (kuten VEGF, PlGF, PECAM) muutoksia todettiin FAS:ssa, mutta merkittäviä muutoksia ei havaittu istukan verisuonten muodostumisessa. VEGF/PlGF-suhteen suureneminen muutti istukan ja ruskuaispussin verisuonten läpäisevyyttä. Toisaalta sikiöiden aivojen PECAM-määrä pieneni, mikä johti verisuonten ja verisuoniverkoston muodostumisen vähenemiseen

Thesis (Ph. D.)--West Virginia University, 2005.<br>Title from document title page. Document formatted into pages; contains vi, 124 p. : ill. Vita. Includes abstract. Includes bibliographical references.

Background: Prenatal alcohol exposure (PAE) is common in some Australian Aboriginal communities, placing children at risk for Fetal Alcohol Spectrum Disorders (FASD). Aboriginal communities invited researchers to estimate PAE and FASD prevalence among school-aged children. Methods: A population-based study was conducted, using active case-ascertainment. Children born in 2002/2003, living in the Fitzroy Valley, Western Australia during the study period (April 2010–November 2011) were eligible (N=134). Sociodemographic and antenatal data, including PAE, were collected by interview with 127/134 (95%) parents/caregivers. PAE risk levels were determined using the AUDIT-C questionnaire. Neurodevelopmental outcomes were determined through interdisciplinary assessments in 108/134 (81%) children, and FASD diagnoses assigned using modified Canadian FASD diagnostic guidelines. Results: PAE was reported in 55% of pregnancies; 88% in the first trimester, and 53% in all three trimesters. According to AUDIT-C scores, 95% of those who drank did so at risky or high-risk levels. Fetal Alcohol Syndrome (FAS) or partial FAS was diagnosed in 13/108 (120.4 per 1000, 95%CI 70 to 196) children; Neurodevelopmental Disorder-Alcohol Exposed was diagnosed in 8/108 children. Overall prevalence of FASD was 21/108 (194.4 per 1000, 95%CI 131 to 279) children. Conclusions: Rates of high-risk PAE and FASD in this community are among the highest worldwide. Adequate, coordinated, well-resourced child health and education services are imperative to support developmentally vulnerable children in remote communities. Strategies for prevention of PAE and FASD are urgently needed.

Dissertation (PhD)--Stellenbosch University, 2003.<br>ENGLISH ABSTRACT: Introduction: Fetal alcohol syndrome (FAS) consists of multi-system abnormalities and is caused by the excessive intake of alcohol during pregnancy. The teratogenic effect of alcohol on the human fetus has now been established beyond reasonable doubt and FAS is the most important human teratogenic condition known today. The syndrome, first described by Lemoine in1968 in the French literature and in the English literature by Jones and Smith in 1973, has since been corroborated by numerous animal and human studies. This study has grown out of several epidemiological, prenatal and infant studies in areas of the Western Cape that are currently being undertaken by the Foundation for Alcohol Related Research (FARR). Preliminary data from studies in Wellington have confirmed that a significant proportion of school-entry children have FAS. The prevalence ofF AS in this community exceeds that for Down syndrome by a factor of30 times. The frequency ofFAS in high-risk populations of the Western Cape is the highest reported anywhere in the world. With this background, and the paucity of FAS literature related to dentistry, the aim of this study was to determine the craniofacial and oral manifestations ofF AS in a sample of school-going children in the Western Cape. Methodology: This study is a descriptive, case-control, cross-sectional study using a random cluster sampling method. On the day of examination, children were weighed, and their height and head circumference were measured. They then had photographs and radiographs taken, followed by an oral examination. For each child, the following information was recorded on the data capture sheet: date of birth, gender, head circumference, weight and height, enamel opacities, dental fluorosis, plaque index, gingival bleeding index, dentition status, oral mucosal lesions and dentofacial anomalies. Results: The total sample of90 children with diagnosed FAS and 90 controls, were matched for age, gender and social class. There were no significant age differences between the two groups (p=0.3363) and the mean ages were 8.9 and 9.1 for the FAS and control groups respectively. Head circumference (HC) differed significantly between the two groups (p<O.OOO 1) and the three photographic diagnostic measurements were all influenced by head circumference. The prevalence of enamel opacities between FAS and controls was not significantly different and averaged around 15% for both groups. The opacities were found largely in the maxillary central incisor and lower first molar teeth. More than three quarters of both the cases and the controls demonstrated the presence of plaque and almost two thirds demonstrated gingival bleeding on probing. FAS patients had statistically significantly (p<O.OO 1) more dentofacial anomalies than the controls. The mean dmft score for the FAS sample was slightly higher, though not significantly different from that of the controls and the decayed component (d) made up the largest part of the index in both groups. None of the FAS children had any missing or filled teeth, and in the case of the controls these were also rarely found. Thirty nine children (21.67%) of the total sample were caries-free. Discussion: This study represents one of the largest sample sizes documenting the craniofacial and oral and dental manifestations of the FAS to date. Forty two per cent of the FAS sample manifested growth retardation and this was statistically significant (p<O.OOOl) when compared to their controls. Analysis of the face using anthropometry supports many of the previous clinical descriptions of the effects of neonatal alcohol exposure and offers some new perspectives on the FAS facial phenotype. The characteristic dysmorphic facial features found included ptosis of the upper eyelids, epicanthic folds, short upturned nose, thin vermillion border of the upper lip and a smooth philtrum. Overall the analysis of the caries data for this study in respect of differences between cases and controls was found to be unremarkable. The lack of difference in the primary and permanent dentitions between the cases and controls could have been anticipated in this population due to the high prevalence of dental caries among children from the Western Cape. The FAS children showed significantly lower dental ages when compared to the controls. Dental maturation has previously been shown to be mildly, but consistently, delayed in children with delayed development and therefore this is a not surprising finding for the FAS children in this study. Differences between skeletal age and chronological age were noted for both boys and girls, but as a whole, in the present study groups (FAS and controls) showed little variation in skeletal development. Measurements related to the face height and mandibular size appear to be the most important in distinguishing the FAS children from the controls. Most (5 out of8) of the discriminating linear measurements studied lie in the front of the skull area. Most of the discriminating measurements are vertical measurements and only two of the measurements are lines between soft tissue points. When comparing the photographic analyses of the facial features versus the cephalometric assessments; the four facial features most typical of aF AS child had a Positive Predictive Value (PPV) of92% and a Negative Predictive Value (NPV) of90% and the eight linear measurements from the cephalometric analyses had a PPV of 92% and a NPV of 95%. One can therefore conclude that the external facial features are probably more reliable in discriminating between the two groups than the cephalometric measures. For further analyses, other models where a single angular measurement explains a combination of linear measurements need to be investigated. This might further improve the discriminating abilities of the cephalometric measurements as a whole. Conclusions: This study has shown the importance of the oral and craniofacial features ofFAS. FAS can no longer be viewed as just a rare and peculiar childhood disorder. Awareness and recognition of children with FAS is important so that they can be correctly diagnosed and referred appropriately. Prevention of the secondary disabilities and most importantly, the prevention of FAS in subsequent programmes can be planned. The dentist who treats children with FAS must recognise that such patients might be emotionally and mentally handicapped and may make treatment difficult and there may be a need for the child to be treated with behaviour modification and/or premedication before restorative treatment. The dentist should also be aware of the need for an accurate medical history, and possible medical consultations, before treatment can be undertaken safely.<br>AFRIKAANSE OPSOMMING: Fetale alkoholsindroom (FAS) bestaan uit multisisteem abnormaliteite en word veroorsaak deur oormatige inname van alkohol tydens swangerskap. Die teratogeniese uitwerking van alkoholop die menslike fetus word nie meer betwyfel nie en FAS is die belangrikste menslike teratogeniese toestand tans bekend. Die sindroom, soos aanvanklik deur Jones en Smith in 1973 beskryf, is sedertdien deur vele studies op mens en dier bevestig. Hierdie studie het gegroei uit vele epidemiologiese-, prenatale- en kleuterstudies in dele van die Weskaap wat tans onderneem word deur die Stigting vir Alkoholverwante Navorsing. Voorlopige data van die studies in Wellington bevestig dat 'n betekenisvolle deel van skoolbeginners FAS het. Die prevalensie van FAS in hierdie gemeenskap oortref dié van Down se sindroom met 'n faktor van 30. Die frekwensie van FAS in die Weskaap is die hoogste wat in die wêreld gerapporteer is. Met hierdie agtergrond, en die skaarste aan FAS literatuur wat op tandheelkunde betrekking het, was die doel van hierdie studie om die kraniofasiale en mondmanifestasies van fetale alkoholsindroom in 'n monster van skoolkinders in die Weskaap te ondersoek. Metodologie: Hierdie studie was 'n beskrywende, gevallebeheerde deursneestudie waarin 'n lukrake gebondelde monstermetode gebruik is. Op die dag van die ondersoek is die kinders geweeg en hulle lengte en kopomtrek bepaal. Hierna is foto's en x-straalopnames geneem, gevolg deur 'n mondondersoek. Die volgende inligting is vir elke kind aangeteken: geboortedatum, geslag, kopomtrek, massa en lengte, glasuur-opasiteite, tandfluorose, plaakindeks, gingivale bloedingsindeks, gebitstatus, mukosale letsels en dentofasiale anomalieë. Resultate: Die totale monster, bestaande uit 90 kinders met gediagnoseerde fetale alkoholsindroom en 90 bypassende kontroles, is vergelyk ten opsigte van ouderdom, geslag en sosiale klas. Daar was geen betekenisvolle ouderdomsverskille tussen die twee groepe nie (p- =0.3363). Kopomtrek het betekenisvol tussen die twee groepe verskil (p<0.0001), en die drie fotografiese diagnostiese afmetings is almal beïnvloed deur kopomtrek. Die prevalensie van glasuur-opasiteite tussen die FAS- en kontrolegroep was nie betekenisvol nie en het rondom 15% vir beide gewissel. Die opasiteite is hoofsaaklik gesien in maksillêre sentrale snytande en mandibulêre eerste molare. Meer as driekwart van beide groepe het plaak getoon, en byna tweederdes het gingivale bloeding met sondering gehad. Die gevallegroep het statisties betekenisvol meer (p<O.OO1) dentofasiale anomalieë getoon. Die gemiddelde dmft telling vir die FAS groep was effens hoër, alhoewel nie betekenisvol nie, as die kontrolegroep, en die "delayed" (vertraagde erupsie) komponent (d) het die grootste deel van die indeks uitgemaak in beide groepe. Geen van die FAS kinders het enige afwesige tande (m) of hers telde tande (f) gehad nie, soos ook gevind in die kontrolegroep. Nege-en-dertig kinders (21.67%) van die totale monster was kariesvry. Bespreking: Hierdie studie verteenwoordig een van die grootste monstergroottes tot op datum waarin ondersoek ingestel is na die kraniofasiale en mond- en tandmanifestasies van die fetale alkoholsindroom. Twee-en-veertig persent van die FAS monster het vertraagde groei getoon en dit was statisties-betekenisvol (p<O.OOOl)vergeleke met die kontrolegroep. Antropometriese analise van die gesig steun die vele kliniese beskrywings van neonatale blootstelling aan alkohol, en bied ook nuwe perspektiewe op die FAS gesigsfenotipe. Die kenmerkende dismorfiese gesigseienskappe wat gevind word, sluit ptose van die boonste ooglede, epikantusvoue, kort opgedraaide neus, dun vermiljoen rand van die bolip en 'n gladde filtrum in. In die geheel was die analise van die karies data ten opsigte van verskille tussen gevalle en kontroles onopvallend. Die afwesigheid van 'n verskil in die primêre en sekondêre gebitte in die gevalle en kontroles kon in hierdie bevolking verwag gewees het as gevolg van die hoë voorkoms van tandkaries onder kinders in die Weskaap. Die FAS kinders het betekenisvol-laer gebitouderdomme gehad as die kontrolegroep. Gebitmaturasie is in geringe maar deurlopende mate vertraag in kinders met vertraagde ontwikkelings, soos voorheen al getoon, en is daarom nie verbasend vir die FAS kinders in hierdie studie nie. Verskille tussen skeletale ouderdom en chronologiese ouderdom is gevind in beide seuns en dogters, maar in die geheel het dié huidige groepe (FAS en kontroles) min variasie in skeletale ontwikkeling getoon. Dit wil voorkom of afmetings wat verband hou met die gesigshoogte en grootte van die mandibula die belangrikste is om FAS kinders van die kontrolegroep te onderskei. Meeste (5 uit 8) van die diskriminerende lineêre afmetings wat bestudeer is, lê op die voorkant van die skedel. Die meeste is vertikale afmetings, terwyl slegs twee lyne tussen sagte weefsel punte. Waneer die fotografiese analises van die gesigseienskappe vergelyk word met die sefalometriese waarnemings, word gevind dat die vier gesigseienskappe tipies van 'n FAS kind 'n Positiewe Voorspelbare Waarde (PVW) van 92% en 'n Negatiewe Voorspelbare Waarde (NVW) van 90% het, en die agt lineêre afmetings vanaf die sefalometriese analise 'n PVW van 92% en 'n NPV van 95% het. Daar kan dus afgelei word dat die eksterne gesigseienskappe waarskynlik meer betroubaar is om te onderskei tussen die twee groepe. Vir verdere analise behoort ander modelle waar 'n enkel hoekige afmeting 'n kombinasie van lineêre afmetings verduidelik, ondersoek te word. Dit mag die diskriminerende vermoëns van sefalometriese afmetings in die geheel verder bevorder. Gevolgtrekking: Hierdie studie het die belang van orale en kraniofasiale eienskappe van FAS getoon. Die toestand kan nie langer as 'n seldsame en eienaardige aandoening van kinders beskou word nie, en bewustheid en herkenning van fetale alkoholsindroom pasiënte is belangrik sodat hulle korrek gediagnoseer en op gepaste wyse verwys kan word. Die tandarts wat FAS pasiënte behandel, moet besef dat sulke pasiënte emosioneel en geestelik belemmer mag wees en dus hantering en behandeling bemoeilik. Daar mag 'n behoefte ontstaan vir gedragsmodifikasie enlofpremedikasie voor herstellende behandeling. Verder moet die tandarts bewus wees van die behoefte aan 'n akkurate mediese geskiedenis, en moontlik konsultasie met 'n geneesheer, voor behandeling veilig ingestel kan word.

Fetal alcohol syndrome (FAS) is a condition caused by prenatal alcohol exposure. The diagnosis of FAS is based on the presence of central nervous system impairments, evidence of growth abnormalities and abnormal facial features. Direct anthropometry has traditionally been used to obtain facial data to assess the FAS facial features. Research efforts have focused on indirect anthropometry such as 3D surface imaging systems to collect facial data for facial analysis. However, 3D surface imaging systems are costly. As an alternative, approaches for 3D reconstruction from a single 2D image of the face using a 3D morphable model (3DMM) were explored in this research study. The research project was accomplished in several steps. 3D facial data were obtained from the publicly available BU-3DFE database, developed by the State University of New York. The 3D face scans in the training set were landmarked by different observers. The reliability and precision in selecting 3D landmarks were evaluated. The intraclass correlation coefficients for intra- and inter-observer reliability were greater than 0.95. The average intra-observer error was 0.26 mm and the average inter-observer error was 0.89 mm. A rigid registration was performed on the 3D face scans in the training set. Following rigid registration, a dense point-to-point correspondence across a set of aligned face scans was computed using the Gaussian process model fitting approach. A 3DMM of the face was constructed from the fully registered 3D face scans. The constructed 3DMM of the face was evaluated based on generalization, specificity, and compactness. The quantitative evaluations show that the constructed 3DMM achieves reliable results. 3D face reconstructions from single 2D images were estimated based on the 3DMM. The MetropolisHastings algorithm was used to fit the 3DMM features to 2D image features to generate the 3D face reconstruction. Finally, the geometric accuracy of the reconstructed 3D faces was evaluated based on ground-truth 3D face scans. The average root mean square error for the surface-to-surface comparisons between the reconstructed faces and the ground-truth face scans was 2.99 mm. In conclusion, a framework to estimate 3D face reconstructions from single 2D facial images was developed and the reconstruction errors were evaluated. The geometric accuracy of the 3D face reconstructions was comparable to that found in the literature. However, future work should consider minimizing reconstruction errors to acceptable clinical standards in order for the framework to be useful for 3D-from-2D reconstruction in general, and also for developing FAS applications. Finally, future work should consider estimating a 3D face using multi-view 2D images to increase the information available for 3D-from-2D reconstruction.

The present study examined the scores of 450 Kainaiwa children from Kindergarten to grade 3 on social, behavioral, cognitive and cultural measures. The subjects consisted of children in three different classification groups: Fetal Alcohol Syndrome (FAS), Special Education, and Regular Education. The purpose of the study was to examine group membership to determine whether or not children who were diagnosed as FAS presented unique intellectual, behavioral, social and cultural characteristics from those of their regular and special education peers. These results support the conclusion of previous research that FAS children differ significantly from their special and regular education peers. No statistically significant differences were found on cultural measures. This study provides useful information for future diagnosis and psychoeducational assessment for FAS children in early childhood.

Thesis (MA)--University of Stellenbosch, 2004.<br>ENGLISH ABSTRACT: The objective of this thesis is to review and synthesize the scientific literature on cognitive and neuropsychological deficits associated with children who were exposed to alcohol prenatally and to highlight possible areas of future attention. High incidences of Fetal Alcohol Syndrome has been reported especially in patients from low socio-economic areas. The highest reported incidence is found in the Western Cape province in South Africa. The devastating part of FAS is that its affects are entirely preventable. Alcohol is a physical and a behavioural teratogen. Prenatal alcohol exposure causes structural damage to the central nervous system and the brain that is vulnerable throughout the pregnancy. A dose-response association exist as exposure to heavier amounts of alcohol can cause more harm. The timing and pattern of alcohol consumption also plays a role. To date though, no "safe" level of alcohol consumption during pregnancy can be advocated. Various neuropsychological decrements are found in individuals with fetal alcohol syndrome or alcohol related neuro-developmental deficits as evaluated on standardized tests. Mental retardation is commonly found and even individuals with normal IQ's still display other learning disabilities. IQ's remain stable over the life span. Along with impaired intellectual functioning they also struggle with mathematical tasks especially as their complexity increases. Speech and language development is also delayed in individuals with FAS. There is little variation in the pith and display poor language comprehension. Attentional deficits are also noted and especially impact on academic functioning. Clinically, children often present with ADHD but in-depth studies have revealed that neurobiologically there is some differences as children with FAS struggle more with encoding and shifting of attention as opposed to other patients with ADHD. Difficulties with visual-spatial functioning has also been found. Verbal learning and memory are also impaired in individuals with FAS. Their poor verbal learning are influenced by their shallow level of encoding. Problems with fine motor skills are also noted. It also appear that all executive functions are impaired. They demonstrate poor planning skills, initiation, cognitive shifting, slow information processing, their thinking is concrete and they have poor self-regulatory skills. Behavioural problems include impulsivity, hyperactivity, aggressiveness, poor social skills and impaired judgement. Early intervention is thus essential to lessen the impact of neuro-psychological deficits on functional adaptation. A sensitive battery of neuro-psychological tests are also required to identify all the impairments in affected individuals and to plan more focussed intervention strategies.<br>AFRIKAANSE OPSOMMING: In hierdie tesis word 'n oorsig aangebied van literatuur wat betrekking het op die disfunksie van kinders wie se moeders tydens swangerskap alkohol misbruik het. Leemtes asook moontlike areas van toekomstige navorsing, is bespreek. 'n Hoe voorkoms van fetale alkohol sindroom (FAS) word gerapporteer, pasiente uit die lae SES gebiede. Die hoogste voorkoms word gerapporteer in die Wes- Kaapse provinsie in Suid Afrika. Wat die probleem meer tragies maak, is die feit dat dit heeltemal voorkombaar is. Alkohol is 'n teratogeen wat fisieke, neurologiese en gedragsimplikasies het. Blootstelling aan alkohol voor geboorte veroorsaak strukturele veranderinge in die sentrale senuweestelsel en die brein. Blootstelling tot hoer volumes van alkohol veroorsaak noodwendig meer skade. Die spesifieke stadium van alkohol-inname tydens die swangerskap, en die moeder se drinkpatroon, speel 'n rol in die neurosielkundige uitkomste. Tot op hede kon geen veilige alkoholsvlak tydens swangerskap vasgestel word nie. Verskeie neurosielkundige uitvalle is gevind in kinders met FAS en ook kinders met alkohol-verwante neurologies ontwikkelings probleme, volgens neurosielkundige toetsing. Verstandelike gestremdheid kom algemeen voor in kinders met FAS. Kinders met FAS wat oor normale intellektuele vernoens beskik ervaar leerprobleme. Die intellektuele inkortings bly stabiel oor die lewenspan. Kinders met FAS ondervind erge probleme met wiskunde, veral wanneer die werk moeiliker raak. Die spraak-en taalontwikkeling wat kinders met FAS ervaar sluit in beperkte taalbegrip en intonasie. Hulle kort aandagspan affekteer veral hulle akademiese funksionering. Die aandagsteuring van kinders met FAS en kinders met aandagstekort-hiperaktiwiteit versteuring verskil neuro-biologies. Verdere verskille bestaan ook aangesien kinders met FAS spesifiek sukkel met swak enkoderingsvermoe en om kognitiewe aanpassings te maak. Visueel-ruimtelike verrnoe van kinders met FAS is ook benadeel. Hulle sukkel ook met verbale leer en hulle geheue is ook ingekort. Die inkortings dui op 'n oppervlakkige enkoderingsvermoe. Probleme met fyn-motoriese vaardighede is ook gevind, volgens toetseing. Toetse wat gemik is om uitvoerende funksies te evalueer, het verskeie uitvalle aan die lig gebring. Probleme in abstrakte redenering, beplanning, impulsiwiteit, self-regulering, en die lnlslerlnq en prosessering van informasie. Gedragsprobleme soos swak sosialiseringsvaardighede, aggresiwiteit, swak oordeel en hiperaktiwiteit. Die wye neurosielkundige uitvalle wat voorkom in kinders met FAS noodsaak vroee intervensie om die langtermyn-impak daarvan te verminder. Hiervoor word 'n sensitiewe battery neurosielkundige toetse benodig wat al die kognitiewe uitvalle kan identifiseer.

Fetal alcohol spectrum disorders (FASD), caused by maternal alcohol consumption during pregnancy, has been extensively studied in the human. Animal studies show that alcohol exposure during very early development may result in severe brain damage, often incompatible with a postnatal life. However, for surviving offspring it is unknown whether they suffer long term brain damage. The final assembly of the mature brain results from a controlled balance between proliferation of glial and neuronal precursors and programmed cell death. The overall aim of the current study was to use a physiologically relevant mouse model to assess the acute and long-term effects of binge alcohol exposure on the early embryo, to simulate human pregnancy at the third week of gestation when pregnancy may be undetected. A number of paradigms were used to assess the acute dose-response effect, the blood alcohol concentration (BAC) profile and the extent of cell death following alcohol exposure on gestational day (G) 7.5. The exposure paradigms were single binge IG6.5, IG4.5, IP4.5, or an extended binge IG4.5+, IG3.0+. Two control groups were Con6.5 and Con4.5+. Acute cell death was determined using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL), activated caspase-3 staining, and transmission electron microscopy. Cell proliferation was investigated using S-phase immuno-labeling, bromodeoxyuridine (BrdU) birthdating and immuno-detection (BrdU/anti-BrdU). The long-term effects were investigated at G18.5 and postnatal day (PN) 60. Unbiased stereological methods were used to assess the effect of ethanol exposure at G7.5 on neocortical volume, cell number and density of neurons, glial cells, and capillary cells at PN60. The first principal finding of the present study was that binge ethanol exposure during gastrulation resulted in acute apoptotic cell death in the ectoderm of the mouse embryo. Cell death was dependent on both peak BAC and the duration of elevated BAC. Significant increased cell death (TUNEL labeling) was observed in groups IG6.5 (9.43 � 2.08%) and IG4.5+ (8.97 � 2.12%) compared with control groups Con6.5 (2.14 � 0.09%) and Con4.5+ (2.81 � 0.36%). There was no significant increased cell death in ethanol exposed groups IG4.5 (3.43 � 0.45%), IP4.5 (3.68 � 0.67%), or IG3.0+ (1.72 � 0.24%). TEM analysis revealed that cell death exhibited characteristics of the apoptotic pathway. The second principal finding of the present study was that binge ethanol exposure during gastrulation resulted in acute arrested proliferation in the ectoderm of the mouse embryo. The S-phase proliferation was significantly decreased within the whole ectoderm in the ethanol exposed group IG6.5 (45.58 � 2.34%) compared with control group Con6.5 (62.08 � 3.11%). The third principal finding of the present study was that binge ethanol exposure during gastrulation induced the long term effect of laminate disorganization in the neocortex. The incidence of abnormal lamination was 87.5% in IG6.5 compared with 16.7% in IG3.0+ and 14.3% in Con6.5. Although ethanol exposure increased embryonic reabsorption, decreased litter size, and increased abnormal offspring, neocortical volume, and the total number of neurons, glial cells, and capillary cells was not affected. The total number (10⁶) of neurons, glial cells, and endothelial cells respectively was 12.221 � 0.436, 4.865 � 0.167, and 2.874 � 0.234 in IG6.5; 11.987 � 0.416, 4.942 � 0.133, and 2.922 � 0.130 in IG3.0+; and 11.806 � 0.368, 5.166 � 0.267, and 3.284 � 0.217 in controls, at PN60. These results provide important information pertinent to fetal outcome for those women who drink heavily in early pregnancy. The results also demonstrate the importance of the pattern of ethanol exposure and blood alcohol concentration in determining the magnitude of ethanol�s teratogenic impact. Ethanol exposure on G7.5 that resulted in a high transient BAC, induced disorganized neocortical lamination, indicative of a permanent structural change. This disruption may result in altered neocortical function and requires further investigation.

Includes abstract.<br>Includes bibliographical references (leaves 108-118).<br>Fetal Alcohol Syndrome (FAS) is a clinical condition caused by excessive pre-natal alcohol exposure and is regarded as a leading identifiable and preventable cause of mental retardation in the Western world. The highest prevalence of FAS was reported in the wine-growing regions of South Africa but data for the rest of the country is not available. Required, therefore, are large-scale screening and surveillance programmes to be conducted in South Africa in order for the epidemiology of the disease to be understood. Efforts to this end have been stymied by the cost and labour-intensive nature of collecting the facial anthropometric data useful in FAS diagnosis. Stereo-photogrammetry provides a low cost, easy to use and non-invasive alternative to traditional facial anthropometry. The design and implementation of a landmark-based stereo-photogrammetry system to obtain 3D facial information for fetal alcohol syndrome diagnosis (FAS) is described. The system consists of three high resolution digital cameras resting on a purpose-built stand and a control frame which surrounds the subject's head during imaging. Reliability and assessments of accuracy for the stereo-photogrammetric tool are presented using 275 inter-landmark distance comparisons between the system and direct anthropometry using a doll. These showed the system to be highly reliable and precise.

Includes bibliographical references.<br>Background: The Western Cape Province of South Africa has the highest reported rates of Foetal Alcohol Syndrome (FAS) in the world. Reported statistics on FAS in this province show that 40.5 to 46.4 per 1000 children aged 5 to 9 years have FAS compared to developed nations that reported 0.5 to 2 cases per 1000 births. The loss in human potential is immeasurable and various studies have shown that the financial cost is formidable. Each child affected by FAS may require an estimated $1 million to $2 million over the course of their lifetime to support remedial medical, educational and social costs. Primary prevention programmes targeted to women at risk of alcohol-exposed pregnancies could lead to measurable reductions in the incidence of FAS. An alcohol-exposed pregnancy (AEP) is a pregnancy that results when a sexually active woman is not on effective contraception and is involved in risky drinking. Aim: To evaluate the effectiveness of a training intervention to improve screening, identification and management of women at risk of alcohol exposed pregnancies.

Thesis (M Social Work)--Stellenbosch University, 2012.<br>ENGLISH ABSTRACT: Fetal alcohol spectrum disorders (FASD) is caused by maternal drinking during pregnancy. Pre-natal drinking has a range of deleterious effects including physical, mental and behavioural consequences for the affected child. Although FASD is completely preventable, it is irreversible with consequences that last into adulthood. The range of effects of FASD forms a spectrum with fully developed FAS on the one end and no effects on the other end of the spectrum. The Western Cape has one of the highest recorded rates of FAS in the world. This seriously affects almost all systems in society and strains the already overburdened educational-, health-, social- and judicial systems. For this reason preventing FASD is of the utmost importance and requires a comprehensive approach on multiple levels. This study explores and describes FASD prevention services in the Bonnievale, Robertson, Ashton and Montagu-areas – a wine-producing area in the Western Cape. Available FASD prevention services on all levels of prevention, the focus-areas of the different prevention activities, collaboration and co-ordination between the role-players and obstacles in delivering prevention services, was examined. By adopting an ecological approach, FASD prevention services could be investigated on multiple levels. This study used a combination of quantitative and qualitative research. An exploratory design and a purposive sampling method were used. Participants were interviewed individually and with the help of a semi-structured questionnaire. The findings of the empirical investigation show that, although prevention efforts are applied on the universal, selective and indicated levels of prevention, a lack of formal prevention efforts that are actively pursued - especially on the level of indicated prevention - exists. This is aggravated by the absence of formal co-ordination of services and structured systems of referrals. NGO‟s and government departments are, as a result, not clear about their respective roles and responsibilities and women with the highest risk for having a child with FAS, therefore, fall through the cracks of the system. This happens partly because social workers are often perceived as the only agents for social change in the community. According to the ecological approach all levels (micro, meso and macro) of organizations in the social environment should work together for change by repeating prevention messages on the different levels and thereby reinforcing it. In the study area, however, most FAS prevention services were on the micro-level with few on the meso-level and virtually none on macro-level. Participants identified a lack of co-ordination, unplanned families, a lack of resources, a lack of training and training material and low levels of education as obstacles in service delivery. Recommendations resulting from the study indicate that FAS prevention will benefit from structured, formal programs on all levels of prevention. This will require non-government organizations and government departments to co-ordinate services and to develop a formal system of referral amongst the role-players. Training of personnel in clinics, NGO‟s, government departments and volunteers, as well as the development of training material targeted at people on different levels of education, should receive attention. It is, in conclusion, recommended that community organizations and structures such as churches, places of business, farmer‟s associations and liquor outlets are actively involved in the prevention of FASD.<br>AFRIKAANSE OPSOMMING: Fetale Alkohol Spektrum Afwykings (FASA) word veroorsaak deur alkoholgebruik tydens swangerskap. Alkoholgebruik tydens swangerskap het „n reeks skadelike effekte, insluitend fisiese, psigiese en gedragsafwykings in die geaffekteerde kind. Alhoewel FASA heeltemal voorkombaar is, is dit onomkeerbaar en duur die gevolge daarvan voort in volwassenheid. Die reeks effekte van FASA vorm „n spektrum met volledig ontwikkelde FAS aan die een kant en geen effekte nie aan die ander kant van die spektrum. Die Wes-Kaap het een van die hoogste aangetekende voorkomssyfers van FAS in die wêreld. Dit affekteer feitlik alle sisteme in die samelewing en plaas nog meer druk op die reeds oorlaaide opvoedkundige-, gesondheids-, maatskaplike- en regssisteme. Om hierdie rede is die voorkoming van FASA van uiterste belang en word „n omvattende benadering op veelvuldige vlakke vereis. Hierdie studie ondersoek en beskryf FASA voorkomingsdienste in die Bonnievale-, Robertson-, Ashton- en Montagu-area – „n wynproduserende streek in die Wes-Kaap. Die beskikbaarheid van FASA voorkomingsdienste op alle vlakke van voorkoming, die fokus-areas van die verskillende voorkomingsaktiwiteite, samewerking en koördinering van dienste tussen die rolspelers, sowel as struikelblokke in voorkomingsdienste, is ondersoek. Deur die ekologiese benadering aan te neem, kon FASA voorkomingsdienste op veelvuldige vlakke ondersoek word. Die studie kombineer kwantitatiewe en kwalitatiewe navorsing. Die ontwerp van die studie is verkennend en daar is „n doelbewuste steekproef gedoen. Indivuduele onderhoude met deelnemers is met behulp van semi-gestruktureeerde vraelyste gevoer. Die bevindinge van die empiriese ondersoek toon dat, alhoewel voorkomingspogings aangewend word op die universele, selektiewe en indikatiewe voorkomingsvlakke, daar 'n gebrek bestaan aan formele voorkomingspogings wat aktief nagestreef word, veral op die indikatiewe vlak. Dit word vererger deur die afwesigheid van formele koördinering van dienste en gestruktureerde verwysingsisteme. Nie-regeringsorganisasies en staatsdepartemente het gevolglik nie duidelikheid oor hul onderskeie rolle en verantwoordelikhede nie. Die gevolg hiervan is dat vroue met die hoogste risiko om geboorte te skenk aan kinders met FAS, deur die krake in die sisteem val. Dit geskied deels omdat maatskaplike werkers dikwels gesien word as die enigste agente vir maatskaplike verandering in die gemeenskap. Volgens die ekologiese benadering behoort alle vlakke (mikro, meso en makro) van organisasie in die sosiale omgewing saam te werk om verandering teweeg te bring deurdat voorkomingsboodskappe op die verskillende vlakke te herhaal en sodoende te versterk word. In die studie-area is die meeste voorkomingsdienste egter op mikro-vlak gelewer met min op meso-vlak en feilik geen op makro-vlak nie. Deelnemers aan die studie het „n gebrek aan koördinasie van dienste, onbeplande gesinne, „n gebrek aan hulpbronne, „n gebrek aan opleiding en opleidingsmateriaal en lae vlakke van geletterdheid geïdentifiseer as struikelblokke in dienslewering. Aanbevelings wat uit die studie voortvloei, dui aan dat FASA voorkomingsdienste sal baat vind by gestruktureerde, formele programme op alle vlakke van voorkoming. Dit sal vereis dat nie-regeringsorganisasies en staatdepartemente hul dienste koördineer en „n formele verwysingstelsel tussen die verskillende rolspelers ontwikkel. Opleiding van personeel in klinieke, NRO‟s, staatsdepartemente en vrywilligers, sowel as die ontwikkeling van opleidingsmateriaal wat persone op verskillende vlakke van opvoeding teiken, behoort aandag te geniet. Dit word laastens ook aanbeveel dat gemeenskapsorganisasies en strukture byvoorbeeld kerke, besighede, boere-verenigings en verkoopspunte vir alkohol, aktief betrek word by die voorkoming van FASA.

Thesis (MEdPsych (Educational Psychology))--University of Stellenbosch, 2009.<br>ENGLISH ABSTRACT: Fetal Alcohol Spectrum Disorder, which is the most common cause of mental and learning disabilities in the world, is totally preventable. Fetal Alcohol Spectrum Disorder is not a genetic or inherited condition; however, it is permanent and reduces human potential. There is no cure or treatment. Fetal Alcohol Spectrum Disorder does not distinguish between race, class or culture and can affect children from all socio-economic groups. It is however more prevalent amongst poor, uneducated, uninformed and marginalised (minority groups) or aboriginal communities due to a variety of historical, sociopolitical and economic reasons. Fetal Alcohol Spectrum Disorder has become a public health problem in South Africa in provinces like the Western and Northern Cape (winegrowing areas), where substantial research has been conducted and where alcohol abuse can be traced back to the ‘dop’ system. The highest documented prevalence of Fetal Alcohol Spectrum Disorder in the world has been identified in these provinces amongst a marginalised group of people classified in South Africa as ‘coloured’. A substantial amount of research has been conducted on the characteristics, manifestation and prevalence of Fetal Alcohol Spectrum Disorder in South Africa, but no research has yet been done to ascertain educators’ knowledge of and attitude to learners with Fetal Alcohol Spectrum Disorder. In view of the high prevalence of Fetal Alcohol Spectrum Disorder in South Africa, and the possibility that many of the learners with learning and behavioural problems in our schools could be victims of Fetal Alcohol Spectrum Disorder (also known as a ‘hidden disability’) I concentrated my research on schools situated in low socio-economic areas on the Cape Flats where poverty and unemployment are high and shebeens are plentiful. Through this research I firstly wished to establish how much knowledge educators have of Fetal Alcohol Spectrum Disorder and what their attitudes are toward learners manifesting the disorder. Secondly, my aim was to ascertain to what extent educators are able to support and identify these learners. Qualitative research methods and an interpretive constructivist paradigm were used to conduct the study. Data was primarily collected through the use of interviews, focus group discussions, observations and a research journal. Nine participants, from three different low socio-economic schools (one from each educational phase) on the Cape Flats, were involved. Themes that emerged from the data were analysed and recorded through the constant comparative method. They are discussed together with the research findings. This study revealed important issues pertaining to educators’ knowledge of Fetal Alcohol Spectrum Disorder and whether they are able to assist learners presenting with this disorder in mainstream education in South Africa. A number of recommendations are made for further research in this field.<br>AFRIKAANSE OPSOMMING: Fetale Alkohol Spektrumsindroom, wat as die algemeenste oorsaak van verstandelike en leergestremdhede in die wêreld beskou word, is ʼn sindroom wat voorkom kan word. Die sindroom is nie geneties of oorerflik nie, maar die skade is permanent omdat daar geen behandeling en teenmiddel is nie. Dit het gevolglik ʼn negatiewe impak op menslike vermoëns. Fetale Alkohol Spektrumsindroom kan kinders van alle sosioekonomiese groepe affekteer en alhoewel dit nie kultuur-, ras- of klasgebonde is nie, is dit oorwegend ʼn algemene verskynsel onder groepe met ʼn lae opvoedingspeil, diegene wat oningelig en gemarginaliseer is (minderheidsgroepe) of dié wat as inboorlinggemeenskappe bekend staan, wat toegeskryf kan word aan verskeie historiese, sosio-politieke en ekonomiese redes. Fetale Alkohol Spektrumsindroom is tans ʼn openbare gesondheidsprobleem in Suid-Afrika, veral in die wynstreke van die Wes- en Noord-Kaap. Omvattende navorsing is al in genoemde provinsies gedoen waar alkoholmisbruik ʼn lang aanloop het en verbind word met die dopstelsel. Die Wes-Kaap en Noord-Kaap is alombekend as provinsies met die hoogste voorkomsyfer van Fetale Alkohol Spektrumsindroom FASD in die wêreld, veral onder ʼn gemarginaliseerde groep mense wat as die kleurlinge’ bekend staan. Alhoewel omvattende navorsing oor die karaktereienskappe, manifestasies en voorkoms van Fetale Alkohol Spektrumsindroom in Suid-Afrika reeds gedoen is, kon geen navorsing gevind word wat die kennis van opvoeders en hul en houdings jeens leerders met Fetale Alkohol Spektrumsindroom probeer vasstel nie. As die hoë voorkoms van Fetale Alkohol Spektrumsindroom in ag geneem word, asook die moontlikheid dat baie leerders in ons skole leer- en gedragsprobleme manifesteer, kan daar waarskynlik slagoffers van Fetale Alkohol Spektrumsindroom wees en wie se gestremdhede dus ‘onsigbaar’ is. My navorsing fokus daarom hoofsaaklik op skole in die lae sosio-ekonomiese areas van die Kaapse Vlakte, waar armoede en werkloosheid hoogty vier en waar daar ʼn hoë voorkoms van onwettige drankwinkels (‘sjebiens’) is. My primêre doel met hierdie navorsing was om die kennis van onderwysers oor Fetale Alkohol Spektrumsindroom te bepaal en om die houding van opvoeders jeens leerders wat met kenmerke van hierdie sindroom vas te stel. Ek wou ook vasstel tot welke mate opvoeders bevoeg om is leerders met Fetale Alkohol Spektrumsindroom te identifiseer en te ondersteun. Kwalitatiewe navorsingsmetodes en ʼn interpretatiewe konstruktivistiese paradigma is in die studie gebruik. Data is primêr ingesamel met behulp van onderhoude, fokusgroep-besprekings, observasies en ʼn navorsingsjoernaal. Nege deelnemers verbonde aan drie verskillende skole met lae sosio-ekonomiese vlakke (een opvoeder van elke opvoedingsfase), op die Kaapse Vlakte was by die studie betrokke. Temas wat blootgelê is deur die data is ontleed en by wyse van die konstante vergelykende metode opgeneem. Hulle word saam met die navorsingsbevindings bespreek. Die navorsing toon belangrike aspekte van opvoeders se kennis van Fetale Alkohol Spektrumsindroom. Dit bevraagteken ook of hoofstroom-opvoeders in staat is om leerders met Fetale Alkohol Spektrumsindroom te ondersteun. Voortspruitend uit die bevindings word aanbevelings gemaak vir verdere ondersoeke op hierdie gebied.

Made available in DSpace on 2016-03-15T19:40:27Z (GMT). No. of bitstreams: 1 Stella Maria Coda Pinto Alves.pdf: 2917004 bytes, checksum: 4023390b83759490fdd7f6eb4340a61f (MD5) Previous issue date: 2007-09-13<br>Alcohol consumption during pregnancy is associated with a wide range of effects on birth, from which fetal alcohol syndrome is considered to lead to the most severe phenotypes. The teratogenic effects of alcohol on the human growth represent a spectrum of features on facial anomalies, growth deficiency at intrauterine into postnatal period, attention deficits and poor academic achievements. The aim of the present investigation was to study cephalometry as a diagnostic tool concerning craniofacial disorders in children and adolescents with confirmed mothers' alcohol intake history during the pre natal period. The specific objective was to analyse McNamara and Björk-Jarabak craniofacial parameters of ten children and adolescents who were exposed to alcohol during their mothers' pregnancy. The age of the subjects ranged from 11 to 18 years old, 5 were female. It was measured linear and angular variables compared to previous standards as descrived by McNamara and Björk-Jarabak. For this purpose, five linear measures and four angular parameters were taken into account in order to better describe craniofacial growth changes: maxilla length, mandibular length, anterior facial height, anterior cranial base, posterior cranial base, saddle angle, articular angle, gonial angle, upper gonial angle. Posterior cranial base, anterior facial height, mandibular size and tegumentary profile parameters were analysed as a whole in order to undertake global craniofacial development. The study showed that ten children and adolescents who were exposed to alcohol during their mothers' pregnancy were associated with linear measurements changes relative to posterior cranial base (p=0.01), mandibular size (p= 0.0009), face height (p= 0.01) and upper gonial angle (p= 0.01).<br>A exposição ao álcool durante a gestação é responsável pelo amplo espectro de alterações ocasionadas ao feto, cuja manifestação mais grave é a síndrome fetal alcoólica. O efeito teratogênico do álcool no homem apresenta evidências clínicas caracterizadas por anomalias faciais, atraso no crescimento intrauterino ou após o nascimento, e deficiências relacionadas ao aprendizado e à atenção. O objetivo geral deste estudo foi testar a análise cefalométrica como auxílio diagnóstico dos efeitos fetais do álcool em sujeitos com história de exposição ao álcool durante a gestação. O objetivo específico foi estudar as análises cefalométricas de McNamara e Björk-Jarabak nestes indivíduos. Foram selecionados dez sujeitos com história de ingestão de bebidas alcoólicas pelas respectivas mães no período gestacional. As idades variam de 11 a 18 anos, sendo 5 de cada sexo. Foram mensuradas grandezas lineares e angulares, e comparadas com a norma destas medidas de acordo com padrões cefalométricos das análises de McNamara e Björk-Jarabak. Foram analisados os dados obtidos a partir de cinco medidas lineares (comprimento efetivo da maxila, comprimento efetivo da mandíbula, altura facial anterior e inferior, base anterior do crânio, base posterior do crânio) e quatro medidas angulares (ângulo da sela, ângulo articular, ângulo goníaco, plano superior do ângulo goníaco). As grandezas relacionadas à base do crânio, à altura facial, à mandíbula e ao perfil tegumentar foram avaliadas em conjunto para permitir análise global do crescimento craniofacial. Os dez sujeitos com história de exposição ao álcool no período gestacional mostraram as seguintes medidas com diferença estatística significante em relação à norma: grandezas lineares relacionadas à base posterior do crânio (p= 0,01), comprimento efetivo da mandíbula (p= 0,0009); altura facial antero inferior (p= 0,01) e a grandeza angular plano superior do ângulo-goníaco (p= 0,01).

While the rates of Fetal Alcohol Spectrum Disorder within Australia are unknown, the rates of alcohol use during pregnancy and at-risk alcohol use by women of childbearing age highlight the need for universal prevention strategies addressing prenatal alcohol exposure. Though many awareness-raising campaigns for alcohol use during pregnancy have been conducted, predominantly in North America, they have rarely been developed using formative research nor have they been comprehensively evaluated (Saskatchewan Prevention Institute, 2009; Elliott et al., 2008). This lack of published information on the development and evaluation of campaigns makes it difficult to determine what communication elements are most credible and persuasive for the target audience. This study conducted theory-based formative research to develop and test messages suitable for a mass media campaign targeting women who may consume low to moderate levels of alcohol during pregnancy. In alignment with the Australian national guidelines for alcohol use by pregnant women (National Health and Medical Research Council, 2009), the aim was to create messages that increased women‟s intentions to abstain from alcohol during pregnancy. An exploratory phase comprising four focus groups with pregnant women and women of childbearing age living in Perth, Western Australia identified motivators for behaviour change and provided insight into the theoretical constructs that could be used to guide the creation of persuasive messages. Positive motivations for abstinence, such as a desire to feel in control and gain social approval were identified, as were several negative motivations, such as wanting to be free of fear and worry, and to avoid possible poor pregnancy outcomes. Along with constructs from social cognition models such as Protection Motivation Theory (Maddux & Rogers, 1983; Rogers, 1983, 1975), these data underpinned the development of a series of communication objectives and communication materials, such as television concept executions, and copy and graphics for print media. The communication materials were then tested through five focus groups with pregnant women, women of childbearing age and male partners to identify those that were most motivating, and to identify specific copy and execution elements that appeared to enhance the persuasiveness and credibility of messages. Two television concept executions, one a threat appeal based on fear and worry, and the other a positive appeal based on self-efficacy, had particularly good potential to motivate behaviour change. These became the basis for five final concept executions that were tested against a control with 685 women (520 women of childbearing age and 165 pregnant women). Results showed the concept executions containing a threat appeal were significantly more effective at increasing women‟s intentions to abstain from alcohol during pregnancy, compared with the control and positive appeal. This study provides evidence of messages effectively increasing women‟s intentions to abstain from alcohol during pregnancy. It demonstrates the value of using theory-based formative research with the target audience to inform the creation of messages that promote abstinence from alcohol during pregnancy. The results and recommendations have direct implications for the potential use of threat appeals and self-efficacy messages in mass media campaigns aimed at preventing prenatal alcohol exposure.

Thesis (M Speech Path)--Stellenbosch University, 2014.<br>ENGLISH ABSTRACT: This study was done in collaboration with the Foundation for Alcohol Related Research (FARR), a non-governmental organization whose primary objective is to develop and maintain Fetal Alcohol Spectrum Disorder (FASD) prevention programmes across South Africa. Research has shown the occurrence of FASD in South Africa to be much higher than in other parts of the world. As part of their prevention programmes, FARR uses a three part diagnostic process, including a maternal interview, a dysmorphological examination, as well as a general developmental assessment. The maternal interview questionnaire that FARR currently uses takes an average of two hours per interviewee to complete. Even though a recent study indicates that FASD prevention programmes administered by FARR can potentially reduce FASD prevalence, shorter maternal interviews could improve the use of FARR resources and the ability of FASD research studies to gather meaningful information and inform future prevention efforts. The main purpose of this study was to adjust the maternal interview questionnaire used by FARR in order to make interviews with mothers shorter while delivering the information needed for successful FASD prevention programmes. Data related to the adequacy of the adjusted maternal interview questionnaire was collected and analysed according to an action research approach in four consecutive phases. The research procedures consisted of two separate focus group interviews with five key role players from FARR. During the first focus group interview the main problems with the questionnaire was identified as being (i) the length of the questionnaire, (ii) the unsuitability of the questionnaire to interview someone other than the biological mother, and (iii) inconsistency between interviewers when using the questionnaire. During the second phase of the study the questionnaire was adjusted and revised as part of a second focus group interview. The interviewers, data capturer and data analyst who used the adjusted questionnaire as part of a larger FASD prevention programme made several suggestions on how the questionnaire could be further adjusted to suit the needs of FARR. These suggestions were addressed during the final phase of the study, after which the adjusted questionnaire was finalized. Findings from the study suggest that identified problems with FARR’s original maternal interview questionnaire were successfully addressed by the adjusted questionnaire, while simultaneously satisfying the objectives of a maternal interview as identified by participants during the first focus group interview. Results confirmed that more maternal interviews could be conducted in the same time period using the adjusted interview questionnaire compared to when the original questionnaire was used, due to the fact that the questionnaire was shorter and took less time to administer. As part of this study an additional questionnaire was developed specifically for caregiver interviews. According to FARR role players, inconsistency between interviewers was for the most past successfully addressed by the development of this additional questionnaire and the development of an interviewer guideline. Recommendations for future research include the further development and evaluation of the caregiver questionnaire and interviewer guideline.<br>AFRIKAANSE OPSOMMING: Hierdie studie is uitgevoer in samewerking met die “Foundation for Alcohol Related Research” (FARR), ‘n nie-regeringsorganisasie met die primêre objektief om Fetale Alkohol Spektrum Afwyking (FASA) voorkomingsprogramme in Suid-Afrika te ontwikkel en te handhaaf. Volgens navorsing is die voorkoms van FASA in Suid-Afrika beduidend hoër as in ander dele van die wêreld. ‘n Drie-delige diagnostiese proses word as deel van FARR se voorkomingsprogramme gebruik, insluitend ‘n onderhoud gefokus op moeders, ‘n dismorfologiese ondersoek, asook ‘n evaluasie van die kind se algehele ontwikkeling. Die moeder-onderhoudsvraelys wat tans deur FARR gebruik word neem gemiddeld twee ure om te voltooi. Alhoewel ‘n onlangse studie aandui dat die voorkomingsprogramme deur FARR oor die potensiaal beskik om die prevalensie van FASA te verlaag, kan korter moeder-onderhoude potensieël daartoe lei dat bronne beter benut word, asook dat FASA voorkomingstudies betekenisvolle inligting versamel vir die ontwikkeling van toekomstige voorkomingsprogramme. Die hoofdoel van die huidge studie was om die moeder-onderhoudsvraelys wat tans deur FARR gebruik word aan te pas, om sodoende die onderhoude met moeders korter te maak terwyl die nodige inligting vir suksesvolle FASA voorkomingsprogramme steeds verkry word. Gedurende hierdie studie is data rakende die toereikendheid van die aangepaste moederonderhousdvraelys versamel en geanaliseer volgens ‘n aksie-navorsingsbenadering in vier opeenvolgende fases. Die navorsingsprosedures het bestaan uit twee afsonderlike fokusgroeponderhoude met vyf van die sleutelrolspelers van FARR. Gedurende die eerste fokusgroeponderhoud is die hoofprobleme met die vraelys geïdentifiseer as (i) die lengte van die vraelys, (ii) die ongeskiktheid van die vraelys om ‘n onderhoud met iemand anders as die biologiese moeder te voer, en (iii) die inkonsekwentheid tussen onderhoudvoerders met die gebruik van die vraelys. Gedurende die tweede fase van die studie is die vraelys aangepas en hersien as deel van ‘n tweede fokusgroeponderhoud. Die onderhoudvoerders, data verwerker en data analis wat die aangepaste vraelys gebruik het as deel van ‘n groter FASA voorkomingsprogram het verskeie aanbevelings gemaak rakende hoe die vraelys verder aangepas kan word om te voldoen aan FARR se behoeftes. Laasgenoemde aanbevelings is aangespreek gedurende die laaste fase van die studie, waarna die aangepaste vraelys gefinaliseer is. Die bevindinge van die studie dui aan dat die geïdentifiseerde probleme met FARR se oorspronklike moeder-onderhoudsvraelys suksesvol deur die aangepaste vraelys aangespreek is, terwyl die objektiewe van ‘n moeder-onderhoud (soos geïdentifiseer deur die deelnemers aan die eerste fokusgroeponderhoud) steeds vervul is. Resultate het bevestig dat meer moeder-onderhoude in dieselfde tydsperiode met behulp van die aangepaste vraelys gevoer kon word as met die oorspronklike vraelys, as gevolg van die feit dat dit korter was en minder tyd geneem het om te voltooi. As deel van die studie is ‘n bykomstige vraelys spesifiek vir sorggewer-onderhoude ontwikkel. Volgens die FARR rolspelers is inkonsekwentheid tussen die onderhoudvoerders grootliks suksesvol aangespreek deur middel van die ontwikkeling van hierdie bykomstige vraelys asook die ontwikkeling van ‘n riglyn vir onderhoudvoerders. Aanbevelings vir verdere navorsing sluit die verdere ontwikkeling en evaluasie van die sorggewer-vraelys en onderhoudvoerder riglyn in.