PROJECT CARE--COCAINE ABUSE IN THE RURAL ENVIRONMENT

这项前瞻性的纵向发展研究的目标是 确定产前吸食毒品对医学和心理健康的影响 年前3年婴儿的神经发育结果 在使用可卡因的农村卫生部门人口中，生活中 廉价、高度上瘾、强效的可卡因，没有其他非法的 毒品。在这一人群中，产前滥用毒品引起了额外的兴趣，因为 它对公共援助计划的潜在长期影响。特定的 目标包括：(1)评估对以下各项的单独和综合影响 发展中的吸毒儿童、母婴健康状况、婴儿 神经行为状态和气质，母性因素，以及 护理环境；(2)剂量反应效应的测定 产前使用，与其他婴儿、母亲和照料者分开 危险因素，与医学/神经状况和行为/发育有关 结果；(3)可卡因代谢物在 婴幼儿尿液标本对早期神经行为结局的影响 与后遗症的关系。 这项研究将提供以前从未报道过的有关人口的新数据 关于：(1)接受公共卫生保健但不能随时获得的妇女 戒毒；(2)几乎完全使用可卡因的妇女 选择可卡因形式，不使用其他非法药物；(3)农村， 南方人口。试点研究估计，在3000人中，至少有8% 我们医院每年出生的婴儿都被爆出了。150名母亲承认使用 150名匹配的对照组将被招募来回答研究假设。 孕妇尿液将在第一次产前检查时进行药物筛查， 每三个月的心理社会/药物史记录和随访。在… 分娩、胎儿和新生儿并发症将被记录下来并为父母 报告库存已完成。婴儿措施将包括尿药 筛查、头颅超声、哭声记录、医学/神经学，以及 发展性评估。在1个月、12个月和24个月时，母亲 特征和照顾环境将在家中进行评估 来访。在6个月、18个月和36个月时，医学/神经学、语言、发育 并将进行行为评估。所有患者都将被转诊为 需要的。使用交易分析，我们将检验以下假设：(1) 在剂量依赖的方式下，产前裂缝的使用将与更多的 胎儿/新生儿并发症，家庭功能障碍，更贫穷的母亲 照顾孩子，发育较差和(2)最有缺陷的儿童 暴露，最多的医疗并发症，最差的早期神经行为 结果，以及母亲最难相处的性情 心理社会问题，最不适当的照顾能力，以及 功能失调的家庭最有可能表现出不太适应 行为和不太理想的发展结果。 这项研究的独特性包括接触到农村的可卡因人口 使用者；收集大量产前吸毒史的能力；使用 最新的发展和照料评估措施.使用 用于评估裂缝使用影响的交易分析 发育结果；以及使用裂缝对短小和短小的人的剂量效应 长期发展成果。

The goal of this prospective, longitudinal developmental study is to determine the effects of prenatal crack use on the medical and neurodevelopmental outcomes of infants throughout the first 3 years of life, in a rural, health department population which uses crack, the inexpensive, highly-addictive, potent form of cocaine, and no other illicit drugs. Prenatal crack abuse in this population is of added interest because of its potential long-term impact on public assistance programs. Specific aims include: (1) evaluation of the separate and combined effects on the developing child of crack use, maternal and neonatal heath status, infant neurobehavioral status and temperament, maternal factors, and the caregiving environment; (2) determination of dose response effects of prenatal crack use, separate from other infant, maternal and caregiving risk factors, on medical/neurologic status and behavioral/developmental outcome; (3) determination of the relationship of cocaine metabolites in infant urine specimens to early neurobehavioral outcome and their relationship to sequelae. This study will provide new data about populations never before reported on: (1) women receiving public heath care who do not have ready access to drug rehabilitation; (2) women who use crack almost exclusively as their chosen form of cocaine and use no other illegal drugs; (3) a rural, Southern population. Pilot studies estimate at least 8% of the 3,000 births/year at our hospital are crack exposed. 150 mothers admitting use and 150 matched controls will be enrolled to answer research hypotheses. Maternal urine will be drug-screened at the first prenatal visit and psychosocial/drug histories taken at each trimester and followup visit. At delivery, fetal and neonatal complications will be recorded and parent report inventories completed. Infant measures will include urine drug screen, cranial ultrasound, cry recordings, medical/neurologic, and developmental evaluations. At 1, 12, and 24 months, maternal characteristics and the caregiving environment will be assessed during home visits. At 6, 18, and 36 months medical/neurologic, language, developmental and behavioral assessments will be made. All patients will be referred as needed. Using transactional analyses, we will test the hypotheses that: (1) Prenatal crack use, in a dose-dependent fashion, will be related to more fetal/neonatal complications, family dysfunction, poorer maternal caregiving, and poorer development and (2) children with the most crack exposure, the most medical complications, poorest early neurobehavioral outcome, and the most difficult temperament who have mothers with the most psychosocial problems, least adequate caregiving abilities, and the most dysfunctional families are the most likely to demonstrate less adaptive behavior and less optimal developmental outcome. The uniqueness of this study includes access to a rural population of crack users; the ability to collect extensive prenatal drug histories; use of state of the art developmental and caregiving assessment measures; use of transactional analysis for the evaluation of the effects of crack use on developmental outcome; and dose response effects of crack use on short and long-term developmental outcome.