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Binder A, Kilian C, Hanke S, Banabak M, Berkenhoff C, Petersen KU, Batra A. Stigma and self-stigma among women within the context of the german "zero alcohol during pregnancy" recommendation: A qualitative analysis of online forums and blogs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104331. [PMID: 38241887 DOI: 10.1016/j.drugpo.2024.104331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND In many countries, including Germany, it is recommended to abstain from alcohol during pregnancy to avoid harm to the baby. In this qualitative research study, analysis of online forums was conducted to explore women's perception of the German "zero alcohol during pregnancy" recommendation with regard to stigma and self-stigma. METHODS We used a grounded theory approach to analyze online forum discussions on alcohol use during pregnancy. Data consisted of 9 discussion threads from 5 different forums and blogs involving 115 participants in total. We used key concepts developed during analysis and the theory of stigma to interpret the posts. RESULTS We identified five key themes: (1) Low alcohol health literacy as a breeding ground for stigmatization; (2) The widespread assumption that maternal abstinence is a prerequisite for being considered a "good mother"; (3) Interpersonal role conflicts and a guilty conscience as a result of stigmatization or self-stigmatization; (4) Paying little attention to the role of psychosocial factors in alcohol consumption, especially regarding partner responsibility during pregnancy.; (5) Understanding the "zero alcohol during pregnancy" recommendation as a complete ban, associated with loss of autonomy. CONCLUSION The current method of communicating the "zero alcohol during pregnancy" recommendation may have unintended consequences. Specifically, misconceptions about the harm associated with low alcohol consumption and setting high expectations of motherhood are factors that can contribute to stigma or self-stigma and potentially undermine self-efficacy, help-seeking behavior, and overcoming the barriers to alcohol health literacy.
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Affiliation(s)
- Annette Binder
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany; DZPG (German Center for Mental Health), partner site Tübingen, Tübingen, Germany.
| | - Carolin Kilian
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sara Hanke
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Meryem Banabak
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Clara Berkenhoff
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Kay Uwe Petersen
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany
| | - Anil Batra
- University Hospital Tübingen; Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tübingen, Tübingen, Germany; DZPG (German Center for Mental Health), partner site Tübingen, Tübingen, Germany
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Hebert LE, Vera MR, Sarche MC. Prenatal Alcohol Counseling Among American Indian and Alaska Native Women and Non-Hispanic White Women in the Pregnancy Risk Assessment Monitoring System. Womens Health Issues 2023; 33:515-523. [PMID: 37481336 PMCID: PMC10561562 DOI: 10.1016/j.whi.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE Universal screening and counseling are recommended for alcohol use during pregnancy, but no prior study has examined differences in prenatal counseling by race or ethnicity. We used Pregnancy Risk Assessment Monitoring System (PRAMS) data to assess differences in provision of counseling on prenatal alcohol use between American Indian/Alaska Native (AI/AN) and non-Hispanic White (NHW) women during prenatal care. METHODS We analyzed data from 2014-2015 from the four PRAMS states with the highest number of births to AI/AN women: Alaska, New Mexico, Oklahoma, and Washington. We estimated the prevalence of prenatal alcohol use, associated risk factors, and prenatal alcohol prevention counseling for AI/AN (n = 1,805) and NHW (n = 5,641) women. We then conducted multivariable logistic regression modeling stratified by race to estimate factors associated with receipt of prenatal alcohol prevention counseling. All analyses were weighted and accounted for the complex sampling design of PRAMS. RESULTS Results showed that AI/AN women were counseled on prenatal alcohol use more often than NHW women (77% vs. 67%, p < .05), although the likelihood of any prenatal alcohol use was the same in both groups. The likelihood of prenatal drinking increased with age, education, and income in both groups. Higher education levels were significantly associated with lower risk of prenatal alcohol counseling receipt among AI/AN women. Compared with those with less than a high school diploma, AI/AN women with a college degree or more had 39% reduced risk of receiving counseling (adjusted risk ratio [aRR] = 0.61; 95% confidence interval [CI]: 0.45-0.83). Among NHW women, living at 100% to 199% of the Federal Poverty Level was associated with lower risk (aRR = 0.88; 95% CI: 0.79-0.98) of counseling receipt compared with women living below the federal poverty line. Higher parity was significantly associated with lower risk of counseling for both groups of women. CONCLUSION Although race was not associated with prenatal alcohol use, AI/AN women were more likely than NHW women to be counseled about prenatal alcohol exposure. Factors associated with counseling receipt differed between the two groups. These findings suggest that receipt of counseling is associated with sociodemographic characteristics, and that counseling is not universally provided. More efforts to provide universal counseling are warranted.
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Affiliation(s)
- Luciana E Hebert
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington.
| | - Melissa R Vera
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington; College of Nursing, Washington State University, Spokane, Washington
| | - Michelle C Sarche
- Colorado School of Public Health, University of Colorado, Aurora, Colorado; Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Dyson J, Onukwugha F, Howlett H, Combe K, Catterick M, Smith L. Midwives and service users' perspectives on implementing a dialogue about alcohol use in antenatal care: A qualitative study. J Adv Nurs 2023. [PMID: 36861792 DOI: 10.1111/jan.15622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 02/03/2023] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Abstract
AIM There are barriers to midwives engaging in conversations about alcohol with pregnant women. Our aim was to capture the views of midwives and service users to co-create strategies to address these barriers. DESIGN Qualitative description. METHODS Structured Zoom-based focus group interviews of midwives and service users where we presented known barriers and sought solutions to midwives discussing alcohol use in antenatal settings. Data collection took place between July and August 2021. RESULTS Fourteen midwives and six service users attended five focus groups. Barriers considered were as follows: (i) lack of awareness of guidelines, (ii) poor skills in difficult conversations, (iii) lack of confidence, (iv) lack of belief in existing evidence, (v) women would not listen to their advice, and (vi) alcohol conversations were not considered part of their role. Five strategies to address barriers to midwives discussing alcohol with pregnant women were identified. These were as follows: Training that included mothers of children with Foetal Alcohol Spectrum Disorder, champion midwives, a service user questionnaire about alcohol for completion before the consultation, questions about alcohol added to the maternity data capture template and a structured appraisal to provide a means of audit and feedback on their alcohol dialogue with women. CONCLUSIONS Co-creation involving providers and users of maternity services yielded theoretically underpinned pragmatic strategies to support midwives to ask advise assist about alcohol during antenatal care. Future research will test if the strategies can be delivered in antenatal care settings, and if they are acceptable to service providers and service users. IMPACT If these strategies are effective in addressing barriers to midwives discussing alcohol with pregnant women, this could support women to abstain from alcohol during pregnancy, thus reducing alcohol-related maternal and infant harm. PATIENT AND PUBLIC CONTRIBUTION Service users were involved in the design and execution of the study, considering data, supporting intervention design and delivery and dissemination.
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Affiliation(s)
- Judith Dyson
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Franklin Onukwugha
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Helen Howlett
- Department of Health and Life Sciences, Northumbria University, Coach Lane, Newcastle-upon-Tyne, UK
| | | | - Maria Catterick
- Foetal Alcohol Spectrum Disorder Network Newton Community resource Centre, Stockton on Tees, UK
| | - Lesley Smith
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
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Olusanya OA, Greene KM, Rossheim ME, Barry AE. Midwives' knowledge and perceived barriers to screening alcohol use among pregnant women in a southwestern US state. Drug Alcohol Rev 2023; 42:384-388. [PMID: 36478421 DOI: 10.1111/dar.13576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Alcohol consumption during pregnancy can produce multiple damaging outcomes to the foetus, commonly referred to as fetal alcohol spectrum disorders (FASD). FASD represents the leading non-genetic cause of preventable birth defects in the United States where alcohol guidelines recommend pregnant woman abstain from alcohol use. This study examined: (i) midwives' knowledge, attitude and intent to screen for prenatal alcohol use; and (ii) assessed perceived barriers to communicating alcohol-related information. METHODS Using an online questionnaire, data were obtained from midwives (n = 61) in a southwestern US state between March and May 2018. Descriptive statistics were used to describe midwives' knowledge, attitude, intent and perceived barriers. RESULTS Several midwives considered one alcoholic beverage per occasion to be safe for the foetus (20.3%), some thought alcohol was safe during the 3rd trimester (14.8%) only and few thought it was safe in all trimesters. Many midwives (63.3%) were unaware that the TWEAK and T-ACE were validated alcohol screening tools for pregnant women. Furthermore, most midwives (>50%) agreed that limited time with patients, a need for additional training and lack of information on referral resources interfered with their sharing of alcohol abstinence guidelines. Midwives reported highly favourable attitudes and intentions toward sharing alcohol abstinence messages with their pregnant patients. DISCUSSION AND CONCLUSIONS More in-depth research and larger samples are needed to explore barriers (knowledge gaps, limited time with patients, need for additional training) that hinder midwives' dissemination of abstinence messages to pregnant women and limit the uptake of validated alcohol screening tools.
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Affiliation(s)
- Olufunto A Olusanya
- Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, USA
- Department of Health and Kinesiology, Texas A&M University, College Station, USA
| | - Kaylin M Greene
- Department of Sociology and Anthropology, Montana State University, Bozeman, USA
| | - Matthew E Rossheim
- Department of Health Behavior and Health Systems, The University of North Texas Health Science Center, Fort Worth, USA
| | - Adam E Barry
- Department of Health and Kinesiology, Texas A&M University, College Station, USA
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McCormack JC, Chu JTW, Marsh S, Bullen C. Knowledge, attitudes, and practices of fetal alcohol spectrum disorder in health, justice, and education professionals: A systematic review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 131:104354. [PMID: 36375286 DOI: 10.1016/j.ridd.2022.104354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/12/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND AIMS Fetal alcohol spectrum disorder (FASD) is one of the most common forms of developmental disability, and yet, anecdotally, is poorly understood by both the public and professionals across health, justice, education, and social services. This review aims to understand the knowledge, attitudes, and practices of professionals who work across a range of sectors - specifically health, education and justice - where they may encounter people with FASD, their families and caregivers. METHOD We conducted a systematic search for research using surveys or questionnaires to address knowledge, and attitudes of professionals in health, education, and justice with regards to FASD between 1990 and 2021. Our search consisted of electronic databases (APA PsychInfo, CINAHL, EMBASE, Medline, PubMed, and PAIS Index) and grey literature sources. RESULTS Our search yielded 971 results, of which 58 were relevant. The studies surveyed professionals from health (n = 35), education (n = 10), justice (n = 8), social services (n = 1), and multiple settings (n = 4). Most studies were conducted in North America. The areas surveyed included knowledge of FASD, attitudes towards people with FASD, experience with FASD, practices towards people with FASD, and education and training needs. CONCLUSIONS Knowledge, attitudes, and practices towards FASD have been surveyed extensively in healthcare professionals over the last 30 years, but less so with those working in justice and education sectors. Findings from surveys suggest that although most professionals had some knowledge of the effects of FASD, their knowledge of the specific criteria of Fetal Alcohol Syndrome (FAS) and FASD is poor across most professional groups, including most health professionals. Our review highlights the need to provide training and information across sectors ongoing surveillance to determine where gaps in knowledge are and what resources are needed. WHAT THIS PAPER ADDS This study is the first to systematically synthesize knowledge, attitudes, and practices toward FASD across different sectors. Poor knowledge and insufficient training were common. Knowledge, attitudes, and practices about FASD have been surveyed extensively in the healthcare setting, but surveys are more limited outside of this setting. Continuous surveillance is needed to identify and respond to knowledge gaps and changes in practice.
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Affiliation(s)
- Jessica C McCormack
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand
| | - Joanna Ting Wai Chu
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand.
| | - Samantha Marsh
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand; Social and Community Health, School of Population Health, The University of Auckland, New Zealand
| | - Chris Bullen
- National Institute for Health Innovation, School of Population Health, The University of Auckland, New Zealand
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Key Stakeholder Priorities for the Review and Update of the Australian Guide to Diagnosis of Fetal Alcohol Spectrum Disorder: A Qualitative Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105823. [PMID: 35627361 PMCID: PMC9140557 DOI: 10.3390/ijerph19105823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 12/04/2022]
Abstract
Since the 2016 release of the Australian Guide to the Diagnosis of Fetal Alcohol Spectrum Disorder (FASD), considerable progress has been made in the identification and diagnosis of the disorder. As part of a larger process to review and update the Guide, the aim of this study was to identify review priorities from a broad range of stakeholders involved in the assessment and diagnosis of FASD. Sixty-two stakeholders, including healthcare practitioners, researchers, other specialists, individuals with cultural expertise, lived experience and consumer representatives completed an online survey asking them to describe up to five priorities for the review of the Australian Guide to the Diagnosis of FASD. A total of 267 priorities were described. Content analysis of responses revealed priority areas relating to diagnostic criteria (n = 82, 30.7%), guideline content (n = 91, 34.1%), guideline dissemination (n = 15, 5.6%) and guideline implementation (n = 63, 23.6%). Other considerations included prevention and screening of FASD (n = 16, 6%). Engaging stakeholders in setting priorities will ensure the revised Australian Guide can be as relevant and meaningful as possible for the primary end-users and that it meets the needs of individuals with lived experience who will be most affected by the diagnosis.
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Hen-Herbst L, Ron El Levin M, Senecky Y, Frishman S, Berger A. Nutritionists' Practices and Knowledge about the Risks of Alcohol Consumption during Pregnancy: An Israeli Survey. Nutrients 2022; 14:nu14091885. [PMID: 35565852 PMCID: PMC9100759 DOI: 10.3390/nu14091885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023] Open
Abstract
Fetal alcohol spectrum disorders (FASDs) are lifelong disabilities and the leading preventable cause of developmental disabilities. Antenatal care providers may influence pregnant women’s dietary practices and their awareness of the risks of alcohol consumption during pregnancy. This study aimed to assess nutritionists’ self-reported knowledge about the risks of drinking alcohol during pregnancy, professional practices in this respect, and self-perceived competence to assess and guide women about alcohol consumption during pregnancy in Israel. A sample of 526 professional nutritionists completed an anonymous online questionnaire. Results showed significant differences between the nutritionists’ knowledge and professional practices scores. About 349 (66.3%) of the sample agreed (to any degree) that they did not have enough knowledge to guide pregnant women regarding drinking alcohol. The number of years of experience, combined with self-perceived competence and the mean knowledge score, explained 18% of the variance in professional practices. Nutritionists and other health professionals may have a crucial role in preventing FASD and should prioritize appropriate screening for prenatal alcohol use. Eliminating alcohol consumption at any point in pregnancy would reduce the risk for FASDs.
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Affiliation(s)
- Liat Hen-Herbst
- Department of Occupational Therapy, Ariel University, Ariel 4077000, Israel
- Correspondence:
| | | | - Yehuda Senecky
- Department of Pediatric Neurology and Child Development, Schneider Children’s Medical Center of Israel, Petach Tikva 4920235, Israel;
| | - Sigal Frishman
- Nutrition Department, Hospital Division, Clalit HMO, Petach Tikva 4941492, Israel;
| | - Andrea Berger
- Department of Psychology and Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel;
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“Now, with a bit more knowledge, I understand why I'm asking those questions.” Midwives’ perspectives on their role in the Greater Manchester Health and Social Care Partnership's programme to Reduce Alcohol Exposed Pregnancies (AEP). Midwifery 2022; 110:103335. [DOI: 10.1016/j.midw.2022.103335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/09/2022] [Accepted: 04/02/2022] [Indexed: 11/22/2022]
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Panisi C, Marini M. Dynamic and Systemic Perspective in Autism Spectrum Disorders: A Change of Gaze in Research Opens to A New Landscape of Needs and Solutions. Brain Sci 2022; 12:250. [PMID: 35204013 PMCID: PMC8870276 DOI: 10.3390/brainsci12020250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/21/2022] Open
Abstract
The first step for a harmonious bio-psycho-social framework in approaching autism spectrum disorders (ASD) is overcoming the conflict between the biological and the psychosocial perspective. Biological research can provide clues for a correct approach to clinical practice, assuming that it would lead to the conceptualization of a pathogenetic paradigm able to account for epidemiologic and clinical findings. The upward trajectory in ASD prevalence and the systemic involvement of other organs besides the brain suggest that the epigenetic paradigm is the most plausible one. The embryo-fetal period is the crucial window of opportunity for keeping neurodevelopment on the right tracks, suggesting that women's health in pregnancy should be a priority. Maladaptive molecular pathways beginning in utero, in particular, a vicious circle between the immune response, oxidative stress/mitochondrial dysfunction, and dysbiosis-impact neurodevelopment and brain functioning across the lifespan and are the basis for progressive multisystemic disorders that account for the substantial health loss and the increased mortality in ASD. Therefore, the biological complexity of ASD and its implications for health requires the enhancement of clinical skills on these topics, to achieve an effective multi-disciplinary healthcare model. Well-balanced training courses could be a promising starting point to make a change.
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Affiliation(s)
- Cristina Panisi
- Fondazione Istituto Sacra Famiglia ONLUS, Cesano Boscone, 20090 Milan, Italy
| | - Marina Marini
- Department of Experimental, Diagnostic and Specialty Medicine, School of Medicine, University of Bologna, 40126 Bologna, Italy;
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Screening for Alcohol Use in Pregnancy: a Review of Current Practices and Perspectives. Int J Ment Health Addict 2021; 21:1220-1239. [PMID: 34580577 PMCID: PMC8457028 DOI: 10.1007/s11469-021-00655-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 10/27/2022] Open
Abstract
Global trends of increasing alcohol consumption among women of childbearing age, social acceptability of women's alcohol use, as well as recent changes in alcohol use patterns due to the COVID-19 pandemic may put many pregnancies at higher risk for prenatal alcohol exposure (PAE), which can cause fetal alcohol spectrum disorder (FASD). Therefore, screening of pregnant women for alcohol use has become more important than ever and should be a public health priority. This narrative review presents the state of the science on various existing prenatal alcohol use screening strategies, including the clinical utility of validated alcohol use screening instruments. It also discusses barriers for alcohol use screening in pregnancy, such as practitioner constraints, unplanned pregnancies, delayed access to prenatal care, and stigma associated with substance use in pregnancy, providing recommendations to address these barriers. By implementing consistent alcohol use screening, prenatal care providers have the opportunity to facilitate access to counseling and brief interventions and thus, to prevent new cases of FASD and improve maternal and child health.
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Pentecost R, Schmidt K, Grassley JS. Health Care Providers' Perceived Barriers to Screening for Substance Use During Pregnancy. Nurs Womens Health 2021; 25:272-277. [PMID: 34146524 DOI: 10.1016/j.nwh.2021.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/07/2021] [Accepted: 05/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore health care providers' perceived barriers to conducting standardized screening processes for substance use during pregnancy. DESIGN Descriptive survey. SETTING/LOCAL PROBLEM A health system in the northwestern United States where there was a lack of consistent substance use screening in prenatal clinics. PARTICIPANTS A convenience sample of 12 women's health care providers from two hospitals in the health system, including obstetricians/gynecologists, women's health nurse practitioners, women's health physician assistants, and certified nurse-midwives. INTERVENTION/MEASUREMENTS We created a 16-item questionnaire that identified potential barriers to screening, such as education/resources for providers, screening tools, referral processes, legal implications, patient relations, and infrastructure. RESULTS A majority (n = 8, 66.7%) of participants indicated they had received adequate training regarding substance use during pregnancy and felt comfortable asking pregnant women about their substance use. All (n = 12, 100%) providers indicated that women would feel safe disclosing their substance use but might feel offended if their provider asked them about it. Although most reported screening women for substance use, they did not use a consistent screening tool or process. Participants identified lack of time, legal concerns, and lack of access to resources for referrals as other barriers to screening. CONCLUSION Clinicians perceive barriers to screening for substance use during pregnancy, and they may be unaware of legal implications for patients related to perinatal substance use. Identifying barriers to universal screening may facilitate development of best practices related to counseling patients about substance use during pregnancy.
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Wouldes TA, Crawford A, Stevens S, Stasiak K. Evidence for the Effectiveness and Acceptability of e-SBI or e-SBIRT in the Management of Alcohol and Illicit Substance Use in Pregnant and Post-partum Women. Front Psychiatry 2021; 12:634805. [PMID: 34025470 PMCID: PMC8131659 DOI: 10.3389/fpsyt.2021.634805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Alcohol and illicit psychoactive drug use during pregnancy have increased worldwide, putting women and their children's health and development at risk. Multiple drug use, comorbid psychiatric disorders, sexual and physical abuse are common in women who use alcohol and drugs during pregnancy. The effects on the mother include poor reproductive and life-long health, legal, family, and social problems. Additionally, the exposed child is at increased risk of long-term physical health, mental health, and developmental problems. The stigma associated with substance use during pregnancy and some clinicians' reticence to inquire about substance use means many women are not receiving adequate prenatal, substance abuse, and mental health care. Evidence for mHealth apps to provide health care for pregnant and post-partum women reveal the usability and effectiveness of these apps to reduce gestational weight gain, improve nutrition, promote smoking cessation and manage gestational diabetes mellitus, and treat depression and anxiety. Emerging evidence suggests mHealth technology using a public health approach of electronic screening, brief intervention, or referral to treatment (e-SBIRT) for substance use or abuse can overcome the typical barriers preventing women from receiving treatment for alcohol and drug use during pregnancy. This brief intervention delivered through a mobile device may be equally effective as SBIRT delivered by a health care professional in preventing maternal drug use, minimizing the effects to the exposed child, and providing a pathway to therapeutic options for a substance use disorder. However, larger studies in more diverse settings with women who have co-morbid mental illness and a constellation of social risk factors that are frequently associated with substance use disorders are needed.
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Affiliation(s)
- Trecia A Wouldes
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Andi Crawford
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
- Te Ara Manapou, Parenting and Pregnancy Service, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Suzanne Stevens
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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Smith LA, Dyson J, Watson J, Schölin L. Barriers and enablers of implementation of alcohol guidelines with pregnant women: a cross-sectional survey among UK midwives. BMC Pregnancy Childbirth 2021; 21:134. [PMID: 33588774 PMCID: PMC7885406 DOI: 10.1186/s12884-021-03583-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 01/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background In 2016, the UK Chief Medical Officers revised their guidance on alcohol and advised women to abstain from alcohol if pregnant or planning pregnancy. Midwives have a key role in advising women about alcohol during pregnancy. The aim of this study was to investigate UK midwives’ practices regarding the 2016 Chief Medical Officers Alcohol Guidelines for pregnancy, and factors influencing their implementation during antenatal appointments. Methods Online cross-sectional survey of a convenience sample of UK midwives recruited through professional networks and social media. Data were gathered using an anonymous online questionnaire addressing knowledge of the 2016 Alcohol Guidelines for pregnancy; practice behaviours regarding alcohol assessment and advice; and questions based on the Theoretical Domains Framework (TDF) to evaluate implementation of advising abstinence at antenatal booking and subsequent antenatal appointments. Results Of 842 questionnaire respondents, 58% were aware of the 2016 Alcohol Guidelines of whom 91% (438) cited abstinence was recommended, although 19% (93) cited recommendations from previous guidelines. Nonetheless, 97% of 842 midwives always or usually advised women to abstain from alcohol at the booking appointment, and 38% at subsequent antenatal appointments. Mean TDF domain scores (range 1–7) for advising abstinence at subsequent appointments were highest (indicative of barriers) for social influences (3.65 sd 0.84), beliefs about consequences (3.16 sd 1.13) and beliefs about capabilities (3.03 sd 073); and lowest (indicative of facilitators) for knowledge (1.35 sd 0.73) and professional role and identity (1.46 sd 0.77). Logistic regression analysis indicated that the TDF domains: beliefs about capabilities (OR = 0.71, 95% CI: 0.57, 0.88), emotion (OR = 0.78; 95%CI: 0.67, 0.90), and professional role and identity (OR = 0.69, 95%CI 0.51, 0.95) were strong predictors of midwives advising all women to abstain from alcohol at appointments other than at booking. Conclusions Our results suggest that skill development and reinforcement of support from colleagues and the wider maternity system could support midwives’ implementation of alcohol advice at each antenatal appointment, not just at booking could lead to improved outcomes for women and infants. Implementation of alcohol care pathways in maternity settings are beneficial from a lifecourse perspective for women, children, families, and the wider community. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03583-1.
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Affiliation(s)
- Lesley A Smith
- Institute of Clinical and Applied Health Research, Faculty of Health Sciences, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
| | - Judith Dyson
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Julie Watson
- Care Quality Commission, Citygate, Gallowgate, Newcastle Upon Tyne, NE1 4PA, UK
| | - Lisa Schölin
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
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14
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Thompson EL, Barnett TE, Litt DM, Spears EC, Lewis MA. Discordance Between Perinatal Alcohol Use Among Women and Provider Counseling for Alcohol Use: An Assessment of the Pregnancy Risk Assessment Monitoring System. Public Health Rep 2021; 136:719-725. [PMID: 33563096 DOI: 10.1177/0033354920984146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In the United States, guidelines indicate all pregnant women should be screened for and counseled on alcohol use to prevent adverse perinatal outcomes due to alcohol consumption. The objective of this study was to describe sociodemographic factors associated with receipt of prenatal alcohol counseling and perinatal alcohol use among US women. METHODS State health departments collected data for the Pregnancy Risk Assessment Monitoring System Phase 7 during 2012-2015, and we restricted the sample to a complete case analysis (N = 135 111). The 3 dichotomous outcomes were preconception alcohol use (3 months before pregnancy), prenatal alcohol use (during last 3 months of pregnancy), and prenatal alcohol counseling. Predictor variables were age, race, Hispanic ethnicity, education, marital status, health insurance status, and previous live births. We estimated survey-weighted logistic regression models for each outcome. RESULTS Half (56.0%) of pregnant women reported preconception alcohol use, 70.5% received prenatal alcohol counseling, and 7.7% reported prenatal alcohol use during the last 3 months of pregnancy. Black women were significantly less likely than White women (odds ratio [OR] = 0.49; 95% CI, 0.46-0.52) and Hispanic women were significantly less likely than non-Hispanic women (OR = 0.62; 95% CI, 0.58-0.66) to report preconception alcohol use. We found similar patterns for prenatal alcohol use among Black women. Black women were significantly more likely than White women (OR = 1.66; 95% CI, 1.55-1.77) and Hispanic women were significantly more likely than non-Hispanic women (OR = 1.51; 95% CI, 1.40-1.61) to receive prenatal alcohol counseling. We found similar patterns for age, education, and health insurance status. CONCLUSION Disparities in alcohol counseling occurred despite the national recommendation for universal screening and counseling prenatally. Continued integration of universal screening for alcohol use during pregnancy is needed.
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Affiliation(s)
- Erika L Thompson
- 12376 Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Tracey E Barnett
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Dana M Litt
- 12376 Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Erica C Spears
- 12376 Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Melissa A Lewis
- 12376 Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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15
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Olusanya OA, Olokunlade T, Rossheim ME, Greene K, Barry AE. Alcohol messages disseminated to pregnant women by midwives. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 47:255-264. [PMID: 33175601 DOI: 10.1080/00952990.2020.1836187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pregnant women frequently report inconsistent messages regarding alcohol consumption from their healthcare providers. Midwives play a major role in prenatal care. However, little research has examined alcohol-related information provided by midwives. OBJECTIVE To examine alcohol-related messages disseminated to pregnant women by midwives. METHODS In 2018, 61 certified professional midwives (CPMs) and certified nurse-midwives (CNMs) were recruited from professional organizations in a southwestern state. Midwives responded to an online cross-sectional survey containing the prompt: "A pregnant patient confides in you that she drinks alcohol. She then asks you to tell her a "safe" level of alcohol consumption that won't cause harm to her unborn fetus. How would you respond?" Open-ended responses were analyzed through content analysis and categorized using an inductive approach. RESULTS Responses were grouped into five non-exclusive themes: "harmful effects and unknown safe limits" (77.0%); "abstaining is best" (50.8%); "light drinking is acceptable" (16.4%); "describe your drinking" (21.3%); "I will refer you" (16.4%). The most frequently shared messages were "safe levels of prenatal alcohol use are unknown" (68.9%) and "discontinue alcohol during pregnancy" (45.9%). However, some messages contradicted US dietary guidelines, including "a little bit of alcohol unlikely to cause harm" (11.5%); "cut-down if having more than 1-2 drinks per occasion" (4.9%); and "if you must drink, wine is best" (1.6%). CPMs were less likely to share abstinence messages (p = .003) and more likely to suggest referrals (p = .024), compared to CNMs. CONCLUSION Concerted efforts are needed to ensure information disseminated aligns with health guidelines and encourages abstinence during pregnancy.
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Affiliation(s)
- Olufunto A Olusanya
- Department of Pediatrics, UTHSC-Oak Ridge National Laboratory Center for Biomedical Informatics, University of Tennessee Health Science Center (UTHSC), Le Bonheur Research Center, Memphis, USA
| | | | - Matthew E Rossheim
- Department of Global and Community Health, George Mason University, Fairfax, USA
| | - Kaylin Greene
- Department of Sociology and Anthropology, Montana State University, Bozeman, USA
| | - Adam E Barry
- Department of Health and Kinesiology, Texas A&M University, USA
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16
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Edwards A, Kelsey B, Pierce-Bulger M, Rawlins S, Ruhl C, Ryan S, King DK. Applying Ethical Principles When Discussing Alcohol Use During Pregnancy. J Midwifery Womens Health 2020; 65:795-801. [PMID: 32893962 DOI: 10.1111/jmwh.13159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/08/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
Over the past 2 decades, more women in the United States are engaging in excessive alcohol use, including women of reproductive age. Consuming alcohol in amounts greater than recommended limits is associated with an increased risk for adverse health effects, such as breast cancer, hypertension stroke, spontaneous abortion, and infertility. No safe time, safe amount, or safe type of alcohol to consume during pregnancy has been identified. Contradictory beliefs about alcohol use, fear of stigmatization, and potential legal consequences can provide challenges for health care providers who communicate these risks to clients. Health care providers can help to prevent alcohol-related health issues, including alcohol-exposed pregnancies, by providing their clients with factual information about alcohol and health and client-centered options for reducing their health risks. Clinicians can use alcohol screening and brief intervention as a framework for applying the ethical principles of autonomy, veracity, beneficence, and nonmaleficence when talking with women in ways that are nonstigmatizing and supportive to help reduce their health risks and prevent alcohol-exposed pregnancies.
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Affiliation(s)
- Alexandra Edwards
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, Alaska
| | - Beth Kelsey
- National Association of Nurse Practitioners in Women's Health, Washington, DC
| | | | - Susan Rawlins
- National Association of Nurse Practitioners in Women's Health, Washington, DC
| | - Catherine Ruhl
- Association of Women's Health, Obstetric, and Neonatal Nurses, Albuquerque, New Mexico
| | - Sharon Ryan
- American College of Nurse-Midwives, Silver Springs, Maryland
| | - Diane K King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, Alaska
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17
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Olusanya OA, Barry AE. Dissemination of Prenatal Drinking Guidelines: A Preliminary Study Examining Personal Alcohol Use Among Midwives in a Southwestern US State. J Midwifery Womens Health 2020; 65:634-642. [PMID: 32844544 DOI: 10.1111/jmwh.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 05/30/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The constellation of birth defects seen in fetuses exposed to alcohol in utero have been described as fetal alcohol spectrum disorders. Evidence suggests that health care providers' communication practices regarding prenatal alcohol use could have beneficial outcomes. There is a paucity of investigations, however, that have examined the health professionals' personal alcohol use and prenatal alcohol recommendations they provide. METHODS This study sought to examine and compare midwives' personal alcohol use and communication practices regarding prenatal alcohol consumption. Certified nurse-midwives (CNMs) and certified professional midwives (CPMs) in a southwestern US state participated. Inclusion criteria included training in prenatal care, labor, birth, and membership in a midwife professional organization. Personal drinking behaviors were assessed with Alcohol Use Disorder Identification Test-Consumption (AUDIT-C). RESULTS All midwives (N = 61; 100%) reported they typically screened a patient for alcohol use during an initial prenatal visit. However, 5 (8.2%) respondents opted for recommendations that advised patients to drink once in a while. Similarly, 4 (6.6%) midwives counseled no more than one drink per day. In the cohort of participants (n = 40) with AUDIT-C scores, 25 (62.5%) engaged in nonrisky drinking (AUDIT-C scores <3). Most respondents (n = 39 of 40; 97.5%) typically consumed 1 to 2 standard drinks on the day they drank. There was no statistically significant difference in mean overall AUDIT-C scores between CNMs and CPMs (P = .42). When examining midwives' (1) responses on the AUDIT-C questionnaire, (2) nonrisky or risky drinking behaviors, and 3) communication practices regarding prenatal alcohol use, Fisher's exact test showed no statistically significant differences between CNMs and CPMs. DISCUSSION Results of this study highlight the importance of advocating healthy lifestyles among health care professionals while also promoting communication practices that align with national alcohol guidelines. Future investigations that examine associations between health care professionals' personal alcohol use and type or effectiveness of services offered to patients may be beneficial.
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Affiliation(s)
| | - Adam E Barry
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas
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18
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Stevens S, Anstice N, Cooper A, Goodman L, Rogers J, Wouldes TA. Multiple Tools Are Needed for the Detection of Prenatal Alcohol Exposure: Findings From a Community Antenatal Setting. Alcohol Clin Exp Res 2020; 44:1001-1011. [PMID: 32142175 DOI: 10.1111/acer.14309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/05/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Although the toxic effects of prenatal alcohol exposure (PAE) on children are well established, there is emerging evidence about the dynamics and associated demographics of drinking patterns across pregnancy, with risky drinking more likely to take place in the period before pregnancy awareness. This study investigated the use of complementary measurement tools in the understanding of alcohol use across pregnancy and reports on the rates and patterns of alcohol use in a community antenatal setting. METHODS Data on alcohol consumption before and after awareness of pregnancy were collected via multiple measurement tools: anonymous lifestyle questionnaire, TWEAK (Tolerance, Worried, Eye-opener, Amnesia, K/Cut down) screener questionnaire, and Substance Use Inventory interviews across multiple pregnancy timepoints. Additionally, phosphatidylethanol (PEth), a direct biomarker of alcohol metabolism, collected from newborns' dried blood spot cards, was analyzed. RESULTS The TWEAK screener was more likely to identify risky drinking behavior than the lifestyle questionnaire. When pregnancy was unplanned, women were more likely to find out they are pregnant significantly later (p < 0.001) and consume alcohol at moderate-heavy levels (p = 0.03), prolonging the risk to the fetus. There was an association between maternal self-reported alcohol use on the lifestyle questionnaire and Substance Use Inventory interviews, but no association between maternal reports of alcohol use and PEth results (p = 0.72). Women self-reported moderate-heavy alcohol use in early pregnancy only and a positive PEth screen indicated PAE in late pregnancy, suggesting that these methods may identify different groups of women. CONCLUSIONS Multiple measurement tools and methods are needed to identify PAE at different points across pregnancy. Prospective sensitive interviewing is better suited to detecting PAE in early pregnancy, but not later when social desirability bias is stronger, and the use of an objective biomarker, such a PEth, may be useful for identifying the risk of PAE in late pregnancy.
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Affiliation(s)
- Suzanne Stevens
- From the, Department of Psychological Medicine, (SS, JR, TAW), University of Auckland, Auckland, New Zealand
| | - Nicola Anstice
- Discipline of Optometry and Vision Science, (NA), University of Canberra, Canberra, ACT, Australia.,School of Optometry and Vision Science, (NA, LG), University of Auckland, Auckland, New Zealand
| | - Aimee Cooper
- Faculty of Medical and Health Sciences, (AC), University of Auckland, Auckland, New Zealand
| | - Lucy Goodman
- School of Optometry and Vision Science, (NA, LG), University of Auckland, Auckland, New Zealand
| | - Jennifer Rogers
- From the, Department of Psychological Medicine, (SS, JR, TAW), University of Auckland, Auckland, New Zealand
| | - Trecia A Wouldes
- From the, Department of Psychological Medicine, (SS, JR, TAW), University of Auckland, Auckland, New Zealand
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