Trajectory of FASD across the Lifespan: New Understandings in Intervention

描述(申请人提供)：世界上胎儿酒精谱系障碍(FASD)的发病率最高的是这些南非(ZA)城镇及其周围的农村地区，过去四年来，这些地区一直在进行全面的预防研究。流行病学研究在预防之前进行了十年，而且这项研究也在进行中。在预防社区(惠灵顿IV)最近一波已经敲定的特定FASD诊断中，基于人群的比率为：胎儿酒精综合征(FAS)94/1000，部分胎儿酒精综合征(PFAS)56/1000，酒精相关神经发育缺陷(ARND)30/1000。在另一波最后确定的比较地区(BRAM I)中，比率甚至更高：Fas、PFAS和ARND的比率分别为61/1000、46/1000和30/1000。FASD在该地区的发病率一直很高，我们的临床团队现在已经熟练掌握了对6-20岁儿童进行全谱诊断的能力。由于FASD在这些社区中的高流行率，以及那里正在进行的广泛的流行病学研究，可以有效地制定预防和干预研究并评估其有效性。此外，新的研究试验和病因学研究现在可以以系统、富有成效和强有力的方式开始，以便在整个生命周期内对FASD有更好的了解，并为基础科学提供信息。对这些ZA人群中FASD的具体特征和模式的更好的理解对大多数人类人群的公共卫生具有广泛的影响。通过这一延续申请，我们寻求发起：1.)针对24个月大的儿童的早期干预研究(发育和营养)，可减少或改善已确定的一组儿童产前酒精暴露的许多负面影响(FASD和对照)；酒精生物标志物(EtG和FAEE)测试结果与产前自我报告的酒精使用情况的比较研究；围产期母体营养的详细病例对照研究。我们将在上述队列中继续研究FASD从出生到7年的发展轨迹，并招募新的新生儿队列。这些年龄较小的儿童的理解将增加已经在多项其他横断面研究中收集的数据，让我们了解FASD从出生到23岁的情况。所有拟议的研究都是可行的，而且有可能由继续研究所进行 医学部(IOM)-推荐的预防服务和疗效研究，特别是针对我们目前在社区生活和工作的团队建立和提供的选定和指示的水平。最后，为了充分评估9年来综合预防的净效果，我们将重复联系评估(社区调查和在校流行率研究)，以评估总体预防模式、特殊预防技术和参与性研究可能对FASD的危险因素和实际发病率产生的影响。

DESCRIPTION (provided by applicant): The highest rates of fetal alcohol spectrum disorders (FASD) in the world have been found in these South African (ZA) towns and their surrounding rural areas where comprehensive prevention research has been ongoing for the past four years. Epidemiology research preceded the prevention for a decade and it is also ongoing. Population-based rates of specific FASD diagnoses in the most recent wave already finalized for the prevention community (Wellington IV) were: 94 per 1,000 for fetal alcohol syndrome (FAS), 56 per 1,000 for partial fetal alcohol syndrome (PFAS), and 30 per 1,000 for alcohol-related neuro-developmental deficits (ARND). In another finalized wave of the comparison areas (BRAM I), the rates were even higher: 61, 46, and 30 per 1,000 respectively for FAS, PFAS, and ARND. Rates of FASD have been persistently high in this region, and our clinical team's ability to diagnose the full spectrum for children age 6-20 years is now proficient. Because of the high prevalence of FASD in these communities, and the extensive epidemiology studies ongoing there, prevention and intervention research can be effectively instituted and evaluated for efficacy. Furthermore, new research trials and etiologic research can now be instituted in a systematic, productive, and potent manner for a refined understanding of FASD across the lifespan and to inform basic science. Improved understandings about the specific characteristics and patterns of FASD in these ZA populations have broad implications for public health in most every human population. With this continuation application, we seek to initiate: 1.) early intervention research (developmental and nutritional) for children as young as 24 months of age that may reduce or ameliorate many of the negative effects of prenatal alcohol exposure in an already-identified cohort of children (FASD and controls); 2.) a comparative study of results from alcohol biomarker (EtG and FAEE) tests and self-reported alcohol use in the prenatal period; and 3.) a detailed case control study of maternal nutrition in the prenatal period. We will continue to research the developmental trajectory of FASD from birth to 7 years in the above cohort and recruit a new newborn cohort. Understandings from these younger children will add to data already collected in multiple, other, cross-sectional studies to inform us about FASD from birth to 23 years. All proposed research is both feasible and possible by continuing Institute of Medicine (IOM)-recommended prevention services and efficacy research, targeting especially the selected and indicated levels established and provided by our current team living and working in the communities. Finally, to fully evaluate the net effect of the comprehensive prevention over 9 years, we will repeat linked evaluation (community survey and in-school prevalence studies) to assess any impact the overall prevention model, particular prevention techniques, and participatory research may have had on risk factors for and actual rates of FASD.