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Alcoholism: Clinical and Experimental Research 2016:39(12);2283-2295

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Alcoholism: Clinical and Experimental Research 2016:39(12);2283-2295


Background Individuals with fetal alcohol spectrum disorders (FASDs) can experience profound impairments and long-term adverse outcomes. This systematic review adopts a life span perspective providing an extensive analysis of the available literature.

Methods Studies were identified from PsycInfo, PubMed, Scopus, Web of Knowledge, CINAHL, ERIC, The Cochrane Central Register of Controlled Trials, and gray literature. Two reviewers independently screened the title and abstract of each reference, and the methodological rigor of the included studies was assessed using the Effective Public Health Project assessment tool. Results Thirty-two studies met the inclusion criteria, of which the vast majority targeted early to middle childhood. Two studies focused on early intervention in the postnatal period, and 6 studies aimed to improve attention and/or self-regulation in childhood. Three of these provided promising evidence on improving self-regulatory difficulties for children with FASDs. Nine studies focused on improving specific areas of dysfunction. Six studies addressed social skills; 3 of these used an adaptation of a well-validated social skills program. Three studies provided promising initial evidence that parents and caregivers could benefit from support with child behavior and a further 4 studies provided education and advocacy for parents/caregivers, teachers, or child welfare workers. The final 2 studies were aimed at supporting parents who were themselves affected by prenatal alcohol exposure. Conclusions There is growing evidence for interventions that improve outcomes for early to middle childhood. However, a lack of research exists outside of this developmental period. This lack of research is concerning given the potential positive impact of early intervention, for individuals and, financially, for governments. In addition, the lack of interventions for adolescents and adults further highlights the widening developmental gap and the potential influence of secondary disabilities for this at-risk population.

Keywords: Fetal Alcohol Spectrum Disorders; Prenatal Alcohol Exposure; Systematic Review; Intervention; Treatment

10. Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic Literature Review Including Meta-Analysis

Sylvia Roozen, Gjalt-Jorn Y. Peters, Gerjo Kok, David Townend, Jan Nijhuis and Leopold Curfs

Alcoholism: Clinical and Experimental Research 2016:40(1);18-32


Background Although fetal alcohol spectrum disorders (FASD) affect communities worldwide, little is known about its prevalence. The objective of this study was to provide an overview of the global FASD prevalence. Methods We performed a search in multiple electronic bibliographic databases up to August 2015, supplemented with the ascendancy and descendancy approach. Studies were considered when published in English, included human participants, and reported empirical data on prevalence or incidence estimates of FASD. Raw prevalence estimates were transformed using the Freeman–Tukey double arcsine transformation so that the data followed an approximately normal distribution. Once the pooled prevalence estimates, 95% confidence intervals and prediction intervals were calculated based on multiple meta-analyses with transformed proportions using random effects models, these estimates were transformed back to regular prevalence rates. Heterogeneity was tested using Cochran's Q and described using the I2 statistic.

Results Among studies that estimated prevalence in general population samples, considerable differences in prevalence rates between countries were found and therefore separate meta-analyses for country were conducted. Particularly high-prevalence rates were observed in South Africa for fetal alcohol syndrome (55.42 per 1,000), for alcohol-related neurodevelopmental disorder (20.25 per 1,000), and FASD (113.22 per 1,000), For partial fetal alcohol syndrome high rates were found in Croatia (43.01 per 1,000), Italy (36.89 per 1,000), and South Africa (28.29 per 1,000). In the case of alcohol-related birth defects, a prevalence of 10.82 per 1,000 was found in Australia. However, studies into FASD exhibited substantial heterogeneity, which could only partly be explained by moderators, most notably geography and descent, in meta-regressions. In addition, the moderators were confounded, making conclusions as to each moderator's relevance tentative at best.

Conclusions The worldwide pooled prevalence estimates are higher than assumed so far, but this was largely explained by geography and descent. Furthermore, prevalence studies varied considerably in terms of used methodology and methodological quality. The pooled estimates must therefore be interpreted with caution and for future research it is highly recommended to report methodology in a more comprehensive way. Finally, clear guidelines on assessing FASD prevalence are urgently needed, and a first step toward these guidelines is presented.

Keywords: Fetal Alcohol Spectrum Disorder(s); Epidemiology; Prevalence; Systematic Literature Review; Meta-Analysis

11. Alcohol Mixed with Energy Drink Use as an Event-Level Predictor of Physical and Verbal Aggression in Bar Conflicts

Kathleen E. Miller, Brian M. Quigley, Rebecca K. Eliseo-Arras and Natalie J. Ball

Alcoholism: Clinical and Experimental Research 2016:40(1);161-169


Background Young adult use of alcohol mixed with caffeinated energy drinks (AmEDs) has been globally linked with increased odds of interpersonal aggression, compared with the use of alcohol alone. However, no prior research has linked these behaviors at the event level in bar drinking situations. The present study assessed whether AmED use is associated with the perpetration of verbal and physical aggression in bar conflicts at the event level.

Methods In Fall 2014, a community sample of 175 young adult AmED users (55% female) completed a web survey describing a recent conflict experienced while drinking in a bar. Use of both AmED and non-AmED alcoholic drinks in the incident were assessed, allowing calculation of our main predictor variable, the proportion of AmEDs consumed (AmED/total drinks consumed). To measure perpetration of aggression, participants reported on the occurrence of 6 verbal and 6 physical acts during the bar conflict incident. Results Linear regression analyses showed that the proportion of AmEDs consumed predicted scores for perpetration of both verbal aggression (β = 0.16, p < 0.05) and physical aggression (β = 0.19, p < 0.01) after controlling for gender, age, sensation-seeking and aggressive personality traits, aggressive alcohol expectancies, aggressogenic physical and social bar environments, and total number of drinks. Conclusions Results of this study suggest that in alcohol-related bar conflicts, higher levels of young adult AmED use are associated with higher levels of aggression perpetration than alcohol use alone and that the elevated risk is not attributable to individual differences between AmED users and nonusers or to contextual differences in bar drinking settings. While future research is needed to identify motivations, dosages, and sequencing issues associated with AmED use, these beverages should be considered a potential risk factor in the escalation of aggressive bar conflicts.

Keywords: Aggression; Alcohol; Energy Drinks; Bar Conflict

12. Adult Binge Drinking: Childhood Sexual Abuse, Gender and the Role of Adolescent Alcohol-Related Experiences

Martie L. Skinner, Allison N. Kristman-Valente, Todd I. Herrenkohl

Alcohol and Alcoholism 2016:51(2);136-141

Aims This study examines gender differences in the pathway from childhood sexual abuse (CSA) to adult binge drinking. Methods Using longitudinal data on 313 males and females (31–41 years old, mean = 36.21) in the Lehigh Longitudinal Study, we test for gender differences in the pathway from CSA to adolescent drinking, norms and pro-alcohol peers, to adult binge drinking. Results Controlling for family history of alcohol problems, socioeconomic status (SES) and ethnicity, we found that for females there was a significant direct effect of CSA on adult binge drinking. For males there was no significant direct or indirect effect. Significant effects of family alcohol problems and SES were also moderated by gender. Conclusion There are gender differences in the impact of CSA on adult binge drinking. Service providers and program developers should pay special attention to the possibility that their female clients may have a history of sexual abuse which could have implications for the course of prevention and treatment services related to binge drinking. Early intervention could prevent alcohol-related risk in adolescence which in turn could reduce, but not eliminate, the binge drinking consequences of CSA for females.

13. Association of Alcohol Consumption with Perception of Attractiveness in a Naturalistic Environment

Olivia M. Maynard, Andrew L. Skinner, David M. Troy, Angela S. Attwood, Marcus R. Munafò

Alcohol and Alcoholism 2016:51(2);142-147

Aims To investigate the relationship between objectively-assessed alcohol consumption and perception of attractiveness in naturalistic drinking environments, and to determine the feasibility and acceptability of conducting a large-scale study in these environments.

Methods Observational study conducted simultaneously across three public houses in Bristol, UK. Participants were required to rate the attractiveness of male and female face stimuli and landscape stimuli administered via an Android tablet computer application, after which their expired breath alcohol concentration (BrAC) was measured. Results Linear regression revealed no clear evidence for relationships between alcohol consumption and either overall perception of attractiveness for stimuli, for faces specifically, or for opposite-sex faces. The naturalistic research methodology was feasible, with high levels of participant engagement and enjoyment. Conclusions We found no evidence for a relationship between alcohol consumption and perception of attractiveness in our large-scale naturalistic study. Our study is important given the large sample size, the successful translation of an experimental, laboratory-based paradigm to a naturalistic drinking environment and the high level of public engagement with the study. Future studies should use similarly ecologically-valid methodologies to further explore the conditions under which this effect may be observed and identify the mechanisms underlying any relationships.

14. Demographic Risk Factors for Alcohol-Related Aggression In and Around Licensed Venues

Lucy Zinkiewicz, Ashlee Curtis, Hannah Meurer, Peter Miller

Alcohol and Alcoholism 2016:51(2);196-200

Aims Few studies have examined the role of gender and both area-level and individual socio-economic status (SES) as independent predictors of alcohol-related aggression (ARA) in and around licensed venues. Methods The aim of the present study was to investigate the relationship between gender, area-level SES and individual SES (operationalised as occupational category) and ARA in and around licensed venues. The sample comprised 697 men and 649 women aged 16–47, who completed a patron intercept survey as part of a larger study assessing trends in harm and stakeholders' views surrounding local community level interventions in dealing with alcohol-related problems in the night-time economy.

Results Binary logistic regression analyses showed that age, gender, occupational category, area-level SES and level of intoxication at time of interview were all significant predictors of involvement in ARA. Being male doubled the odds of involvement in ARA, while age was a protective factor. Blue collar workers had more than double the odds of ARA involvement of professionals, while those living in the most socio-economically disadvantaged areas were over twice as likely to report experiencing ARA compared to those living in the most advantaged areas. However, assessment of the predictive model by gender revealed that effects of age, occupational category and area-level SES were restricted to male participants, with greater intoxication no longer predictive. Conclusions ARA among patrons was significantly more likely to occur among men, those in blue collar occupations, and individuals living in low SES areas, suggesting both individual and area-level disadvantage may play a role in ARA.

15. Drinking and mortality: long-term follow-up of drinking-discordant twin pairs

Pyry Sipilä, Richard J. Rose and Jaakko Kaprio

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