Purpose of the Essay
This essay will systematically analyse a public health issue, Foetal Alcohol Syndrome, with the aim of providing solutions concerning the resolution of the said problem The paper will depict knowledge and understanding of the current practices and policies associated with Foetal Alcohol Syndrome and highlight the means through which public health can be promoted by preventing Foetal Alcohol Syndrome. The findings and conclusions documented will be based on the review of contemporary research literature exploring the public health areas that require promotion through the improvement of services.
Public Health Review
The term public health is used to refer to the art and science of disease prevention, promotion of human health and prolonging life, through the application of systematic efforts and informed societal choices that trickle down to the individual level. Hence, public health is based on the analysis of the health of a population, and it accounts for psychological, social and physical well-being (Gostin & Wiley 2016 p. 3). Thus, according to the World Health Organization (WHO), public health is not merely the lack of disease as it encompasses the entire spectrum of wellbeing and health (Euro.who.int n.d., para. 2).
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Recently published literature explores varied aspects of public health like the effects of green urban space on public health. According to Wolch, Byrne and Newell (2014, p. 234), urban green areas like forests, community gardens, green roofs and parks, among others, are not only critical to the ecosystem but also public health. The authors indicate that the said facilities promote physical activity and psychological well-being, both of which are critical to public health. Additionally, their research suggests that many US cities have implemented strategies to enhance the supply of green space in urban areas but the strategies, thereof, are paradoxical because they are associated with higher property value and housing costs. Frumkin (2016, p. 117) also explores public health in an urban context, and he points out that public health interventions like seat belts and traffic signals have been critical to the promotion of public health owing to their influence in the reduction of both mortality and fatality rates that result from road accidents. The author explains that the public health interventions implemented in the form of traffic rules have made walking, which is beneficial to public health, much safer.
Moreover, authors have also analysed public health in the context of the prevalence of HIV/AIDS. The AIDS epidemic is a public health concern whose threat can be eradicated through increased access to treatment facilities by 2030. Thus, to realize the said goal, the World Health Organization proposes that the guidelines used for HIV care across countries around the globe must be harmonized as per the requirements of public health approaches (World Health Organization 2016, p. iv, xxi). Finally, Watts et al. (2015, p. 1861) in their analysis of the appropriate measures to protect public health indicate that investment in public health research, surveillance and monitoring is critical to the provision of a better understanding of crucial adaptation needs at both a local and national level. Additionally, they propose that the fundamentals of climate change must also be analysed and their association to public health determined, to safeguard global health through climate control.
Research Topic and Question
Foetal Alcohol Syndrome (FAS) is the most severe type of Foetal Alcohol Spectrum Disorders (FASDs) that affect babies who are exposed to alcohol, as a result of heavy drinking, while developing in the womb (D ö rrie et al. 2014, p. 864). The criteria used for FAS diagnosis highlights that one of the indicators of the FAS disorder is growth deficiency depicted by prenatal or postnatal weight or height that is below the 10 th percentile. Secondly, a child that affected by the FAS has distinct facial features including a thinner upper lip, a smooth philtrum and small eye openings. Moreover, the FAS disorder may also be associated with a damaged central nervous system causing clinically significant functional, structural or neurological impairment. Finally, diagnosis must also be backed by confirmed prenatal alcohol exposure (Cook et al. 2016, p. 194-195). However, upon diagnosis, children affected by FAS cannot be cured, but they can be exposed to various services and therapies that can allow them to cope better and realize their full potential. Among the treatments that may be crucial to such children are occupational, physical , a nd speech-language therapy as well as counseling. Moreover, doctors may provide medication to deal with issues associated with FAS like sleep disorders, depression and aggression (Wilhoit, Scott, & Simecka 2018, p. 715).
This paper is looking to answer the research question, “ How can the current policies and practices concerning Foetal Alcohol Syndrome be enhanced to provide solutions that lead to the promotion of public health? ” Research on the topic will be conducted through the analysis of primary research articles published in various scholarly databases including Google Scholar, Springer and Elsevier. The information obtained from the said sources will be analysed and compared, after which conclusions for this essay will be made.
Justification of Research Topic
Research on FAS as a critical public health issue was necessitated by the discovery that every 0.2:1.5 infants have FAS in every 1000 births (CDC 2018, Prevalence of FASDs, para. 2). According to CDC (2018, Cost of FADs, para. 1) , person assessment studies of school going children in the US between the ages of 6 and 9 indicate a higher prevalence of FAS, 6:9 of every 1000 children. As of 2002, the lifetime cost for a single individual living with FAS was estimated to be at $2 million. In the US alone $4 billion is spent on FAS treatment annually. According to Lange et al. (2017, p. 948), the prevalence of foetal alcohol spectrum disorder exhibited among children on a global level indicates that the number thereof exceeds 1% of the population in over 76 countries. The authors further suggest that the said statistics should be a cause for alarm to take universal preventive measures targeting the reduction of maternal alcohol consumption during pregnancies.
Relevance to Nursing Field
Research on Foetal Alcohol Syndrome is relevant to the nursing field because nurses can facilitate the prevention of FASDs if they take the right preventive measures. Since FASDs are 100% preventable provided pregnant mothers do not take alcohol, nursing intervention in educating expectant mothers, as well as women of reproductive age, on the same can facilitate the reduction of the rates of FAS within the population. Moreover, in case an expectant mother screens positive for alcohol consumption, nurses can promote “ brief interventions, ” incorporating motivational interviewing techniques to dissuade the mothers from the destructive tendency (Mitchell, Hagle & Kameg 2017, para. 2-4).
Methodology
The search for the articles that will be reviewed for this study was done on Google Scholar, Springer, Wiley Online Library, and Elsevier. All sources selected were primary research articles that reported the details of research conducted by the authors. The IMRAD (Introduction, Methodology, Results, Analysis and Discussion) format was critical to the identification of the said articles (Santha et al. 2015, p. 84). The databases mentioned above were selected because they are known for the publication of peer-reviewed studies, warranting the validity and reliability of the information acquired. Literature from sources published before 2014 was excluded because the author wanted to use current and relevant sources within five years of compiling the research.
The search terms used for research purposes were refined through the use of keywords. The keywords pointed out the aspects of FAS that the researcher was interested in including foetal alcohol syndrome, current practices and policies, FAS, FASDs, preventing FASDs/FAS, prevalence, behavioral effects, cognitive effects, physical effects and solutions for FASDs/FAS. The keywords used were necessary to narrow down the research field and suggest information that was likely to be relevant to the author (Chen et al. 2015, p. 552).
The literature used for the study was critically reviewed using the evaluation tool for mixed methods studies. The tool allowed the appraisal of qualitative collection and analysis of data as well as that of the quantitative research design. This tool was selected because it allowed the author to draw from the understanding and perceptions of the authors of the studies reviewed (Unisa.edu.au n.d., Evaluation Tool for Mixed Methods Studies, para. 1). See the appendix section for images of the tool. Finally, the literature used was compiled to come up with the selected themes based on the research question as the author was looking for topics that would allow them to answer the research question appropriately.
Themes
The themes that the author explored are prevalence, behavioral and cognitive effects and physical effects of foetal alcohol syndrome. The findings are discussed below.
Prevalence
The analysis of the prevalence of FAS in populations across the globe is critical if the issue is to be handled effectively. Thus, various researchers have dedicated their research to the analysis of the prevalence of FAS and FASDs among different population groups in society. First, Hughes et al. (2016, p.1214213) explore the prevalence of the said disorder among youths in the criminal justice system. Their study was based on the previously established association between criminality and criminalization with foetal alcohol spectrum disorders. The authors explain that according to the sources used for their research, it is evident that a disproportionate tendency is depicted in the comparison of the rates of prevalence of FASDs among the general youth population and the youths in the criminal justice system. Regardless, they point out that the statistics recorded in the studies reviewed varied significantly and indicated a more heightened prevalence of FASDs among indigenous youth.
Additionally, Popova et al. (2017, e290) review the prevalence of alcohol use during pregnancy on a national, regional, and global level. The authors specify that the use of alcohol by pregnant mothers is a direct cause of FAS. This is an opinion that Hughes et al. (2016, p.1214213) support as they indicate that besides the physical, behavioral and cognitive indicators of FAS, confirmed use of alcohol during pregnancy is part of the diagnostic criteria. Of 62 studies used for analysis of the prevalence of FAS, the global estimate of the same was recorded at 9 · 8% (95% CI 8 · 9–11 · 1) whereas the said estimated prevalence in the general population was recorded as 14.6 out of every 10000 people. Moreover, the findings of the authors also indicate that one in every 67 women who consumed alcohol when pregnant delivered a baby affected by FAS, translating to a total of about 119000 FAS affected babies are born globally annually. The said findings evidenced that alcohol use during pregnancy is common in many countries around the world, making FAS a prevalent congenital disability (Popova et al. 2017, e294-e295).
Moreover, researchers have also indicated that many comorbidities are associated with FASDs as a result of the permanent effects of foetal exposure to prenatal alcohol. From 127 studies, the researchers identified 428 comorbidities with the most common being chromosomal abnormalities, congenital malformations, deformities as well as behavioral and mental disorders. The authors conclude that the high prevalence of comorbid conditions among individuals diagnosed with FASD highlight the necessity of assessing prenatal alcohol intake as the harmful effects of alcohol on a developing foetus represent many preventable disability cases. Hence, alcohol use must be recognized as a public health issue on a global platform (Popova et al. 2016, p. 978). It is also proposed that for the sake of prioritizing public health policies, funding initiatives on public health and planning healthcare, the prevalence of FAS and that of alcohol consumption during pregnancy must be established (Popova et al. 2017, e291).
Nonetheless, the authors of the articles discussed above highlight the need for further research and education to curb the prevalence of FASDs. First, Hughes et al. (2016, p.1214213) indicate that the association of FASDs with criminality may require that researchers focus on the co-occurrence of multiple symptoms known to be indicators of FASDs. Secondly, Popova et al. (2017, e298) establish that more effort should be made to educate women in the childbearing age about the risk of using alcohol during pregnancy. Finally, Popova et al. (2016, p. 978) indicate that there is need to increase efforts made towards the reduction of alcohol consumption during pregnancy through the establishment of universal methods of screening for prenatal alcohol consumption.
Cognitive and Behavioral Effects of Foetal Alcohol Syndrome
Decades of previous research have indicated that the foetal environment, especially the neurodevelopmental adversity, may place individuals at high risk of social, behavioral and cognitive deficits. FASDs have an apparent cause, alcohol consumption during pregnancy, which results in both behavioral and cognitive abnormalities caused by the disruption of neurodevelopmental processes. The said abnormalities are preventable, but once they set in, they alter the brain functions of the affected individual for a lifetime (Kleiber et al. 2014, p. 161).
Additionally, research proves that the behavioral and cognitive impairments that are associated with FASDs are likely to lead to poor academic and social performance, increased risk of behavioral delinquency and high mental illness rates (Kleiber et al. 2014, p. 161). According to Bekdash et al. (2013, p. 1137), prenatal exposure to ethanol may result in the reduction of histone activation marks and the increase of repressive marks whose function is to control hypothalamic proopiomelanocortin (Pomc). The latter results in a heightened cortisol expression and reduced Pomc expression, suggesting a strong correlation between prenatal alcohol exposures, phenotypes associated with HPA and histone modifications relevant to FASD.
Kodituwakku and Kodituwakku (2014, p. 149) explain that over the last 20 years there has been a rapid increase in the publication of reports on the behavioral and cognitive functioning of children with FASDs. From the analysis of other studies, it is evident that children with FASD exhibit slow thought responses and also have deficits in associative learning. Nonetheless, the performance of such children decreases with increased task complexity. Moreover, in terms of behaviour, children that were exposed to alcohol while still in the womb tend to lack proper adaptive skills, especially in the social setting. Also, affected children may lack executive functioning and exhibit significant emotional and behavioral regulatory issues.
Furthermore, Kingdon, Cardoso and McGrath (2016, p. 116-120) express that child affected by FASDs are at an increased risk of mental health issues like attention-deficit/hyperactivity disorder (ADHD) and behavioral disorders. However, the authors point out that the overlap with which FASDs present themselves with other neurodevelopmental disorders, as is the case with ADHD, limits the accuracy of diagnosis among alcohol-affected children, especially in situations that information about maternal consumption of alcohol is not available. The authors indicate that the findings of their research support the consensus among researchers on the proposition that the interventions that are initiated mid or early childhood can produce maximum benefits to children with FASDs by helping them adapt to functional, cognitive and behavioral difficulties and through the reduction of their secondary disabilities.
Patten, Fontaine and Christie (2014, p. 93) indicate that the behavioral and cognitive issues associated with FAS are a result of central nervous system dysfunctions that result from prenatal exposure to alcohol. Additionally, the authors indicate that the nature and severity of the said cognitive impairments occur from the amount of alcohol consumed and the duration for which it was taken. The authors express that there is a need to establish the potential lifelong effects that FASDs may have to cover the information gap on the impact of prenatal alcohol exposure in adults, especially among the aged. Kingdon, Cardoso and McGrath (2016, p. 130) also propose further research to give more clarification on the behavioral and cognitive effects resulting from prenatal exposure to alcohol.
Physical Effects of Foetal Alcohol Syndrome
May et al. (2018, p.) express that the physical features associated with FASDs are optimal between the ages of 5 and 7. At the same age, the establishment neurobehavioral problems linked to the exposure of alcohol can also be evaluated for early detection. From their study, the authors concluded that the estimated prevalence rates of FASDs in the US range between 1.1% and 1.5%, statistics that may not be generalized for all American communities. Moreover, researchers have also established that the physical features of children affected by FASDs vary significantly compared to their healthy counterparts. Children diagnosed with FAS tend to be lighter, shorter and have smaller heads. Their BMI is also lower than that of their healthy counterparts. Also, FAS-affected children are deemed to have a smooth philtrum and a narrow upper lip vermillion border (May et al. 2014, p. 855-859). The said findings are also documented in a different study by May et al. (2015, p) claiming that children affected by FAS have smaller physical features compared to healthy children. The authors of the studies agree on the physical variations depicted by children diagnosed with FAS, as expressed above.
Service Improvement
Service improvement, as regards foetal alcohol syndrome, is dependent on the current prevalence rate of the said disorder. Owing to the high prevalence rates of FAS and FASDs that have been recorded by different authors in various regions around the globe, medical practitioners must seek to implement measures that counter the high prevalence rates by dealing with specific FAS-related issues within their communities. For instance, in the case of high prevalence rates of FAS in the criminal justice system, health care practitioners must tailor programs that educate women in the criminal justice system on the dangers of ingesting alcohol while pregnant and possibly also provide counselling services to allow them to cope with other environmental factors better.
Moreover, on the establishment of the physical, behavioral and cognitive effects associated with FAS, it is critical that medical practitioners become keener when assessing children, to spot the obvious indicators of FAS. The latter will facilitate early detection of the disorder and provide room for implementation of countermeasures. This may allow the child to cope better with the condition and give them an opportunity to realize their full potential. Countermeasures like counselling, coaching and mentoring may be vital in altering the adverse behavioral and cognitive characteristics children with FAS may express. It is likely to allow them the opportunity to become better adults who could even participate in breaking the cycle by leading more responsible lives and not exposing their offspring to prenatal alcohol, in the case of girls.
Conclusion
The policies and practices that are already in place are inadequate as the prevalence rates of FAS and FASDs continue to be at a record high around the globe, causing critical public health concerns. Hence, bettering the said preventive measures requires that medical practitioners be increasingly aware of the behavioral, cognitive and physical effects of FAS, to facilitate early detection of the same and offer a better understanding of the said condition. If medical practitioners have a better understanding of what they are dealing with, they will be better placed to provide their patients with the necessary education they may require to prevent FAS and associated disorders. Moreover, medical practitioners with extensive knowledge of the said disorder are likely to be better placed to provide coping services to those already affected by FAS to help them deal with the said condition better.
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