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Objective To examine fetal outcomes of mothers with an alcohol-related diagnosis. Design Population-based cohort. Setting Western Australia ( WA). Population Births on the WA Midwives Notification System (1983-2007). Methods Infants of mothers with an alcohol-related diagnosis [International Classification of Disease ( ICD), 9th/10th revisions] recorded on WA health data sets (non-Aboriginal n = 13 807; Aboriginal n = 9766) were identified through the WA data linkage system. A comparison cohort of infants born to mothers without an alcohol diagnosis was frequency matched on maternal age, year of birth of the offspring, and Aboriginal status (non-Aboriginal n = 40 148; Aboriginal n = 20 643). Main outcome measures Poisson regression-generated adjusted relative risk (a RR) and 95% confidence intervals (95% CIs) for small for gestational age ( SGA), preterm birth, and low-Apgar score, calculated separately for non-Aboriginal and Aboriginal infants of mothers with an alcohol diagnosis recorded during pregnancy and any alcohol diagnosis. Population-attributable fractions were calculated. Results The a RR for non-Aboriginal infants when a maternal alcohol diagnosis was recorded during pregnancy ranged from 1.79 (95% CI 1.42-2.16) for SGA to 2.57 (95% CI 1.69-4.27) for preterm birth <32 weeks of gestation, and for Aboriginal infants ranged from 2.69 (95% CI 2.28-3.16) to 1.99 (95% CI 1.40-2.84), respectively. The highest population-atributable fractions were for any alcohol diagnosis and for Aboriginal infants. For Aboriginal births, approximately 9% (95% CI 4.74-12.97) and 10.1% (95% CI 5.50-14.49) of moderate and very preterm births, respectively, and 24.4% (95% CI 13.5-21.2%) of SGAs were attributable to having a mother with any alcohol-related diagnosis. Conclusions Mothers with an alcohol diagnosis are at increased risk of poor pregnancy outcomes. The public health impact of maternal alcohol-use disorders on fetal outcomes is significant. [ABSTRACT FROM AUTHOR]

The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (http://www.ichr.uwa.edu.au/alcoholandpregnancy). The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe trends in mode of delivery, to identify significant factors which affected mode of delivery, and to describe how these factors and their impact have changed over time. DESIGN: Total population birth cohort. SETTING: Western Australia 1984-2003. PARTICIPANTS: The analysis was restricted to all singleton infants delivered at 37-42 weeks of gestation with a cephalic presentation (n = 432,327). METHODS: Logistic regression analyses were undertaken to estimate significant independent risk factors separately for elective and emergency caesarean sections compared with vaginal delivery (spontaneous and instrumental), adjusting for potential confounding variables. MAIN OUTCOME MEASURES: Trends in mode of delivery, demographic factors, and pregnancy and delivery complications. Estimated likelihood of elective caesarean section compared with vaginal delivery and emergency caesarean section compared with vaginal delivery. RESULTS: Between 1984-88 and 1999-2003, the likelihood of women having an elective caesarean section increased by a factor of 2.35 times (95% CI 2.28-2.42) and the likelihood of an emergency caesarean section increased 1.89 times (95% CI 1.83-1.96). These caesarean section rate increases remained even after adjustment for their strong associations with many sociodemographic factors, obstetric risk factors, and obstetric complications. Rates of caesarean section were higher in older mothers, especially those older than 40 years of age (elective caesarean section, OR 5.42 [95% CI 4.88-6.01]; emergency caesarean section, OR 2.67 [95% CI 2.39-2.97]), and in nulliparous women (elective caesarean section, OR 1.54 [95% CI 1.47-1.61]; emergency caesarean section, OR 3.61 [95% CI 3.47-3.76]). CONCLUSIONS: Our data show significant changes in mode of delivery in Western Australia from 1984-2003, with an increasing trend in both elective and emergency caesarean section rates that do not appear to be explained by increased risk or indication. [ABSTRACT FROM AUTHOR]

Objective: Engagement with secondary mental health services after an emergency department presentation with suicidal behaviours may be an important strategy for reducing the risk of repeat attempts. Our aim was to examine secondary mental health service contact following a presentation to emergency department with suicidal behaviours., Methods: A systematic review of papers published between 2000 and 2020 was undertaken. This identified 56 papers relating to 47 primary studies. Data were extracted and summarised separately by age group: (1) young people, (2) older adults and (3) adults and studies with participants of 'all ages'., Results: Studies in young people ( n  = 13) showed, on average, 44.8% were referred and 33.7% had contact with secondary mental health services within 4 weeks of emergency department discharge. In comparison, in adult/all ages studies ( n  = 34), on average, 27.1% were referred to and 26.2% had mental health service contact within 4 weeks. Only three studies presented data on contact with mental health services for older adults, and proportions ranged from 49.0% to 86.0%., Conclusion: This review highlights poor utilisation of secondary mental health service following emergency department presentation for suicidal behaviours, and further research is needed to identify the reasons for this. Crucially, this information could assist in the allocation of resources to facilitate the timely implementation of suicide prevention services.

Topological magnetic monopoles (TMMs), also known as hedgehogs or Bloch points, are three-dimensional (3D) non-local spin textures that are robust to thermal and quantum fluctuations due to the topology protection 1-4 . Although TMMs have been observed in skyrmion lattices 1,5 , spinor Bose-Einstein condensates 6,7 , chiral magnets 8 , vortex rings 2,9 and vortex cores 10 , it has been difficult to directly measure the 3D magnetization vector field of TMMs and probe their interactions at the nanoscale. Here we report the creation of 138 stable TMMs at the specific sites of a ferromagnetic meta-lattice at room temperature. We further develop soft X-ray vector ptycho-tomography to determine the magnetization vector and emergent magnetic field of the TMMs with a 3D spatial resolution of 10 nm. This spatial resolution is comparable to the magnetic exchange length of transition metals 11 , enabling us to probe monopole-monopole interactions. We find that the TMM and anti-TMM pairs are separated by 18.3 ± 1.6 nm, while the TMM and TMM, and anti-TMM and anti-TMM pairs are stabilized at comparatively longer distances of 36.1 ± 2.4 nm and 43.1 ± 2.0 nm, respectively. We also observe virtual TMMs created by magnetic voids in the meta-lattice. This work demonstrates that ferromagnetic meta-lattices could be used as a platform to create and investigate the interactions and dynamics of TMMs. Furthermore, we expect that soft X-ray vector ptycho-tomography can be broadly applied to quantitatively image 3D vector fields in magnetic and anisotropic materials at the nanoscale., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

We report the development of deep-learning coherent electron diffractive imaging at subangstrom resolution using convolutional neural networks (CNNs) trained with only simulated data. We experimentally demonstrate this method by applying the trained CNNs to recover the phase images from electron diffraction patterns of twisted hexagonal boron nitride, monolayer graphene, and a gold nanoparticle with comparable quality to those reconstructed by a conventional ptychographic algorithm. Fourier ring correlation between the CNN and ptychographic images indicates the achievement of a resolution in the range of 0.70 and 0.55 Å. We further develop CNNs to recover the probe function from the experimental data. The ability to replace iterative algorithms with CNNs and perform real-time atomic imaging from coherent diffraction patterns is expected to find applications in the physical and biological sciences.

Electron ptychography is a 4-D STEM phase-contrast imaging technique with applications to light-element and beam-sensitive materials. Although the electron dose (electrons incident per unit area on the sample) is the primary figure of merit for imaging beam-sensitive materials, it is also necessary to consider the contrast transfer properties of the imaging technique. Here, we explore the contrast transfer properties of electron ptychography. The contrast transfer of focused-probe, non-iterative electron ptychography using the single-side-band (SSB) method is demonstrated experimentally. The band-pass nature of the phase-contrast transfer function (PCTF) for SSB ptychography places strict limitations on the probe convergence semi-angles required to resolve specific sample features with high contrast. The PCTF of the extended ptychographic iterative engine (ePIE) is broader than that for SSB ptychography, although when both high and low spatial frequencies are transferred, band-pass filtering is required to remove image artefacts. Normalisation of the transfer function with respect to the noise level shows that the transfer window is increased while avoiding noise amplification. Avoiding algorithms containing deconvolution steps may also increase the dose-efficiency of ptychographic phase reconstructions., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Hybrid organic-inorganic perovskites have high potential as materials for solar energy applications, but their microscopic properties are still not well understood. Atomic-resolution scanning transmission electron microscopy has provided invaluable insights for many crystalline solar cell materials, and we used this method to successfully image formamidinium lead triiodide [CH(NH 2 ) 2 PbI 3 ] thin films with a low dose of electron irradiation. Such images reveal a highly ordered atomic arrangement of sharp grain boundaries and coherent perovskite/PbI 2 interfaces, with a striking absence of long-range disorder in the crystal. We found that beam-induced degradation of the perovskite leads to an initial loss of formamidinium [CH(NH 2 ) 2 + ] ions, leaving behind a partially unoccupied perovskite lattice, which explains the unusual regenerative properties of these materials. We further observed aligned point defects and climb-dissociated dislocations. Our findings thus provide an atomic-level understanding of technologically important lead halide perovskites., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

Single atom detection is of key importance to solving a wide range of scientific and technological problems. The strong interaction of electrons with matter makes transmission electron microscopy one of the most promising techniques. In particular, aberration correction using scanning transmission electron microscopy has made a significant step forward toward detecting single atoms. However, to overcome radiation damage, related to the use of high-energy electrons, the incoming electron dose should be kept low enough. This results in images exhibiting a low signal-to-noise ratio and extremely weak contrast, especially for light-element nanomaterials. To overcome this problem, a combination of physics-based model fitting and the use of a model-order selection method is proposed, enabling one to detect single atoms with high reliability.

Team-based care can go a long way toward improving patient outcomes. This review--with accompanying tips and resource lists--can help.

Background: Fetal alcohol spectrum disorder (FASD) is known to be under-recognised in Australia. The use of standard methods to identify when to refer individuals who may have FASD for specialist assessment could help improve the identification of this disorder. The purpose of this study was to develop referral criteria for use in Australia., Method: An online survey about FASD screening and diagnosis in Australia, which included 23 statements describing criteria for referral for fetal alcohol syndrome (FAS) and FASD based on published recommendations for referral in North America, was sent to 139 health professionals who had expertise or involvement in FASD screening or diagnosis. Survey findings and published criteria for referral were subsequently reviewed by a panel of 14 investigators at a consensus development workshop where criteria for referral were developed., Results: Among the 139 health professionals who were sent the survey, 103 (74%) responded, and 90 (65%) responded to the statements on criteria for referral. Over 80% of respondents agreed that referral for specialist evaluation should occur when there is evidence of significant prenatal alcohol exposure, defined as 7 or more standard drinks per week and at least 3 standard drinks on any one day, and more than 70% agreed with 13 of the 16 statements that described criteria for referral other than prenatal alcohol exposure. Workshop participants recommended five independent criteria for referral: confirmed significant prenatal alcohol exposure; microcephaly and confirmed prenatal alcohol exposure; 2 or more significant central nervous system (CNS) abnormalities and confirmed prenatal alcohol exposure; 3 characteristic FAS facial anomalies; and 1 characteristic FAS facial anomaly, growth deficit and 1 or more CNS abnormalities., Conclusion: Referral criteria recommended for use in Australia are similar to those recommended in North America. There is a need to develop resources to raise awareness of these criteria among health professionals and evaluate their feasibility, acceptability and capacity to improve the identification of FASD in Australia.

Background: The teratogenic effects of maternal alcohol consumption during pregnancy include anomalies of craniofacial structures derived from the cranial neural crest cells. The presence of specific craniofacial anomalies contributes to the diagnosis of fetal alcohol spectrum disorders. Cleft lip and palate [orofacial clefts (OFCs)], also derived from the cranial neural crest cells, are common congenital anomalies, but their relationship with prenatal alcohol consumption is unknown., Methods: To evaluate the association between maternal consumption of alcohol during pregnancy and the occurrence of OFCs in infants, we conducted a systematic review and meta-analyses of published studies. We examined the associations between any alcohol consumption, binge level drinking, and heavy and moderate levels of consumption vs. no or low levels of consumption., Results: After screening 737 publications, we identified 33 studies (23 case-control and 10 cohort studies). There was considerable heterogeneity in individual study design, quality measures and study results. Findings from random effects meta-analyses suggest no relationship between prenatal alcohol consumption and the occurrence of OFCs {pooled odds ratios for any alcohol intake and binge level drinking respectively: cleft lip with or without cleft palate 1.00 [95% confidence interval (CI) 0.86, 1.16] from 18,349 participants in 13 studies, 1.04 [95% CI 0.87, 1.24] [8763 individuals, 4 studies]; cleft palate only 1.05 [95% CI 0.92, 1.21] [21,459 individuals, 17 studies], 0.94 [95% CI 0.74, 1.21] [7730 participants, 4 studies]}., Conclusions: While we found no association between alcohol consumption during pregnancy and OFCs in infants, the influence of study design, particularly in relation to alcohol exposure measurement and OFC ascertainment cannot be ignored., (© 2014 John Wiley & Sons Ltd.)

Background: Fetal alcohol spectrum disorders (FASD) are underdiagnosed in Australia, and health professionals have endorsed the need for national guidelines for diagnosis. The aim of this study was to develop consensus recommendations for the diagnosis of FASD in Australia., Methods: A panel of 13 health professionals, researchers, and consumer and community representatives with relevant expertise attended a 2-day consensus development workshop to review evidence on the screening and diagnosis of FASD obtained from a systematic literature review, a national survey of health professionals and community group discussions. The nominal group technique and facilitated discussion were used to review the evidence on screening and diagnosis, and to develop consensus recommendations for the diagnosis of FASD in Australia., Results: The use of population-based screening for FASD was not recommended. However, there was consensus support for the development of standard criteria for referral for specialist diagnostic assessment. Participants developed consensus recommendations for diagnostic categories, criteria and assessment methods, based on the adaption of elements from both the University of Washington 4-Digit Diagnostic Code and the Canadian guidelines for FASD diagnosis. Panel members also recommended the development of resources to: facilitate consistency in referral and diagnostic practices, including comprehensive clinical guidelines and assessment instruments; and to support individuals undergoing assessment and their parents or carers., Conclusions: These consensus recommendations provide a foundation for the development of guidelines and other resources to promote consistency in the diagnosis of FASD in Australia. Guidelines for diagnosis will require review and evaluation in the Australian context prior to national implementation as well as periodic review to incorporate new knowledge.

Objective: This study examines the relationships between the dose, pattern, and timing of prenatal alcohol exposure and achievement in reading, writing, spelling, and numeracy in children aged 8 to 9 years., Methods: Data from a randomly selected, population-based birth cohort of infants born to non-Indigenous women in Western Australia between 1995 and 1997 (n = 4714) (Randomly Ascertained Sample of Children born in Australia's Largest State Study cohort) were linked to the Western Australian Midwives' Notification System and the Western Australian Literacy and Numeracy Assessment statewide education testing program. The records for 86% (n = 4056) of the cohort were successfully linked with education records when the children were aged 8 to 9 years. The associations between prenatal alcohol exposure and achievement of national benchmarks in school numeracy, reading, spelling, and writing tests and nonattendance for the tests was examined. Logistic regression was used to generate adjusted odds ratios (aOR) and 95% confidence intervals (CI), adjusting for potential confounding factors. The referent group included children of mothers who previously drank alcohol but who abstained during pregnancy., Results: Children were twice as likely not to achieve the benchmark for reading after heavy prenatal alcohol exposure during the first trimester (aOR 2.26; 95% CI 1.10-4.65) and for writing when exposed to occasional binge drinking in late pregnancy (aOR 2.35; 95% CI 1.04-5.43). Low-moderate prenatal alcohol exposure was not associated with academic underachievement., Conclusions: The type of learning problems expressed depends on the dose, pattern, and timing of prenatal alcohol exposure.

Objective: To investigate the relationship between maternal alcohol-use disorder and dental hospital admissions in children up to 5 years of age., Study Design: Mothers with an International Classification of Diseases, 9th revision/10th revision alcohol-related diagnosis, a proxy for alcohol-use disorder, were identified through the Western Australian data-linkage system. Exposed mothers were frequency-matched by maternal age, Aboriginal status, and child's birth year to randomly selected comparison mothers without an alcohol diagnosis. Linkage with the Midwives Notification System (1983-2002) identified all births of these mothers; "exposed" (non-Aboriginal, n = 11,171; Aboriginal, n = 8145) and comparison cohorts (non-Aboriginal, n = 32,508; Aboriginal, n = 16,719). Dental hospital admissions were identified through linkage with Hospital Morbidity Data (1983-2007) (3.2% exposed; 3.0% comparison) and cases of fetal alcohol syndrome (n = 84) through linkage with the Western Australian Register of Developmental Anomalies. ORs and 95% CIs for having a dental admission (International Classification of Diseases, 9th revision: 520-529; International Classification of Diseases, 10th revision: K0-K14.9) were generated by the use of generalized estimating equations, which we adjusted for potential confounding factors (aOR)., Results: Children of mothers with an alcohol-related diagnosis had increased adjusted odds of gingivitis and periodontal diseases (aOR 1.67; 95% CI 1.12-2.51) and "other" diseases of the lip and oral mucosa (aOR 1.56; 95% CI 1.21-2.01). Diseases of the salivary glands were increased only in Aboriginal children of mothers with an alcohol-related diagnosis (aOR 2.65; 95% CI 1.09-6.44). Children diagnosed with fetal alcohol syndrome had increased ORs of any dental admission (aOR 2.58; 95% CI 1.30-5.11)., Conclusions: Maternal alcohol-use disorder was associated with dental admissions related to disorders of the soft tissues, but questions remain regarding perinatal influences on dental admissions and disease., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Background: Australia's commitment to consumer and community participation in health and medical research has grown over the past decade. Participatory research models of engagement are the most empowering for consumers., Methods: As part of a project to develop a diagnostic instrument for fetal alcohol spectrum disorders (FASD) in Australia (FASD Project), the Australian FASD Collaboration (Collaboration), including a consumer advocate and two consumer representatives, was established. On completion of the FASD Project an on-line survey of Collaboration members was conducted to assess their views on consumer involvement. Women in the community were also invited to participate in Community Conversations to discuss real life situations regarding communications with health professionals about alcohol and pregnancy. Community Conversation feedback was analysed qualitatively and attendees were surveyed about their views of the Community Conversation process., Results: The on-line survey was completed by 12 members of the Collaboration (71%). Consumer and community participation was considered important and essential, worked well, and was integral to the success of the project. The 32 women attending the Community Conversations generated 500 statements that made reference to prevention, how information and messages are delivered, and appropriate support for women. Nearly all the attendees at the Community Conversations (93%) believed that they had an opportunity to put forward their ideas and 96% viewed the Community Conversations as a positive experience., Conclusions: The successful involvement of consumers and the community in the FASD Project can be attributed to active consumer and community participation, which included continued involvement throughout the project, funding of participation activities, and an understanding of the various contributions by the Collaboration members.

Background: This study explores the potential of data linkage to investigate the proportion of birth defects classified as alcohol-related (ARBD) by the Institutes of Medicine (IOM) that are attributable to maternal alcohol-use disorder., Methods: Maternal alcohol-use disorder was identified using International Classification of Diseases (9th and 10th revision) codes for alcohol-related diagnoses recorded on record-linked Western Australian health, mental health, and/or drug and alcohol datasets 1983 to 2007. Children of these mothers (n=23,859) were compared with a randomly selected cohort of children born to mothers without an alcohol diagnosis, frequency-matched by maternal age, Aboriginal status, and child's birth year (n=61,370). Birth defects were identified through linkage with the Western Australian Register of Developmental Anomalies and defects with chromosomal causes were excluded. Associations between overall and individual IOM-designated ARBD and a maternal alcohol-related diagnosis recorded "during pregnancy" or "any" diagnosis (before/during/after pregnancy) was assessed using multivariate logistic regression to generate odds ratios and 95% confidence intervals. Population-attributable fractions were calculated for significant results using total population numbers., Results: There was a significant association between maternal alcohol-related diagnoses recorded during pregnancy and ARBD (adjusted odds ratio, 3.14; 95% confidence interval, 2.49-3.96), with an attributable fraction of 0.57%. "Any" maternal alcohol diagnosis demonstrated a higher attributable fraction for ARBD (1.53%), with the highest attributable fractions for microcephaly (7.31%), ptosis (3.75%), atrial septal defect (2.86%), and conotruncal heart defects (2.01%)., Conclusion: Research using linked, population-based administrative health data has the potential to advance knowledge of ARBD. Routine collection and recording of alcohol use during pregnancy for all pregnant women is required and would enhance this methodology. Birth Defects Research (Part A) 97:497-504, 2013. © 2013 Wiley Periodicals, Inc., (Copyright © 2013 Wiley Periodicals, Inc.)

Multiple myeloma (MM) is a systemic malignancy of plasma cells often characterized by sternal, rib, or back pain. This article describes how a patient who had chest pain for more than one month was mistakenly diagnosed with reflux esophagitis. Healthcare providers should be mindful of MM when determining the source of unidentified chest pain in patients.

Background: Improvements in the rate of infant mortality (death in first year of life) have not occurred in recent years. This study investigates the association between maternal alcohol-use disorder and sudden infant death syndrome (SIDS) and infant mortality not classified as SIDS using linked, population-based health and mortality data., Methods: Exposed mothers were identified through the presence of an International Classification of Diseases 9/10 alcohol diagnosis, a proxy for alcohol-use disorder, recorded on health, mental health, and/or drug and alcohol datasets (1983-2005). Comparison mothers without an alcohol diagnosis were frequency matched to exposed mothers on maternal age within maternal race and year of birth of their children. All offspring with their birth recorded on the Midwives Notification System compose the exposed (n = 21 841) and comparison (n = 56 054) cohorts. Cases of SIDS (n = 303) and infant mortality excluding SIDS (n = 598) were identified through linkage with the Western Australian Mortality Register. Analyses were conducted by using Cox regression and results presented as adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs)., Results: The highest risk of SIDS occurred when a maternal alcohol diagnosis was recorded during pregnancy (aHR 6.92, 95% CI 4.02-11.90) or within 1 year postpregnancy (aHR 8.61, 95% CI 5.04-14.69). An alcohol diagnosis recorded during pregnancy more than doubled the risk of infant deaths (excluding SIDS) (aHR 2.35, 95% CI 1.45-3.83). Maternal alcohol-use disorder is attributable for at least 16.41% (95% CI 9.73%-23.69%) of SIDS and 3.40% (95% CI 2.28%-4.67%) of infant deaths not classified as SIDS., Conclusions: Maternal alcohol-use disorder is a significant risk factor for SIDS and infant mortality excluding SIDS.

Background: There is little reliable information on the prevalence of fetal alcohol spectrum disorders (FASD) in Australia and no coordinated national approach to facilitate case detection. The aim of this study was to identify health professionals' perceptions about screening for FASD in Australia., Method: A modified Delphi process was used to assess perceptions of the need for, and the process of, screening for FASD in Australia. We recruited a panel of 130 Australian health professionals with experience or expertise in FASD screening or diagnosis. A systematic review of the literature was used to develop Likert statements on screening coverage, components and assessment methods which were administered using an online survey over two survey rounds., Results: Of the panel members surveyed, 95 (73%) responded to the questions on screening in the first survey round and, of these, 81 (85%) responded to the second round. Following two rounds there was consensus agreement on the need for targeted screening at birth (76%) and in childhood (84%). Participants did not reach consensus agreement on the need for universal screening at birth (55%) or in childhood (40%). Support for targeted screening was linked to perceived constraints on service provision and the need to examine the performance, costs and benefits of screening.For targeted screening of high risk groups, we found highest agreement for siblings of known cases of FASD (96%) and children of mothers attending alcohol treatment services (93%). Participants agreed that screening for FASD primarily requires assessment of prenatal alcohol exposure at birth (86%) and in childhood (88%), and that a checklist is needed to identify the components of screening and criteria for referral at birth (84%) and in childhood (90%)., Conclusions: There is an agreed need for targeted but not universal screening for FASD in Australia, and sufficient consensus among health professionals to warrant development and evaluation of standardised methods for targeted screening and referral in the Australian context. Participants emphasised the need for locally-appropriate, evidence-based approaches to facilitate case detection, and the importance of ensuring that screening and referral programs are supported by adequate diagnostic and management capacity.

Most policies and guidelines recommend that women abstain from alcohol during pregnancy. This can be difficult to achieve in developed nations where the majority of women consume alcohol and almost half of pregnancies are unplanned, leading to many pregnancies being exposed to alcohol prior to pregnancy awareness. Concerns have been raised that abstinence policies may lead women in this situation to terminate their pregnancy out of fear that they have harmed their baby; however, the evidence is limited. A recent study found that while few women reported alcohol as the reason for seeking an abortion, in almost all cases where alcohol was the reason, the women were either binge drinking or reported alcohol-related problems and the pregnancy was unplanned.

Objective: To evaluate health professionals' agreement with components of published diagnostic criteria for fetal alcohol spectrum disorders (FASD) in order to guide the development of standard diagnostic guidelines for Australia., Design: A modified Delphi process was used to assess agreement among health professionals with expertise or experience in FASD screening or diagnosis. An online survey, which included 36 Likert statements on diagnostic methods, was administered over two survey rounds. For fetal alcohol syndrome (FAS), health professionals were presented with concepts from the Institute of Medicine (IOM), University of Washington (UW), Centers for Disease Control (CDC), revised IOM and Canadian diagnostic criteria. For partial FAS (PFAS), alcohol-related neurodevelopmental disorder (ARND), and alcohol-related birth defects (ARBD), concepts based on the IOM and the Canadian diagnostic criteria were compared., Setting/participants: 130 Australian and 9 international health professionals., Results: Of 139 health professionals invited to complete the survey, 103 (74.1%) responded, and 74 (53.2%) completed one or more questions on diagnostic criteria. We found consensus agreement among participants on the diagnostic criteria for FAS, with the UW criteria most commonly endorsed when compared with all other published criteria for FAS. When health professionals were presented with concepts based on the Canadian and IOM diagnostic criteria, we found consensus agreement but no clear preference for either the Canadian or IOM criteria for the diagnosis of PFAS, and no consensus agreement on diagnostic criteria for ARND. We also found no consensus on the IOM diagnostic criteria for ARBD., Conclusions: Participants indicated clear support for use of the UW diagnostic criteria for FAS in Australia. These findings should be used to develop guidelines to facilitate improved awareness of, and address identified gaps in the infrastructure for, FASD diagnosis in Australia.

Background: Despite the availability of five guidelines for the diagnosis of fetal alcohol spectrum disorders (FASD), there is no national endorsement for their use in diagnosis in Australia. In this study we aimed to describe health professionals' perceptions about the adoption of existing guidelines for the diagnosis of FASD in Australia and identify implications for the development of national guidelines., Methods: We surveyed 130 Australian and 9 international health professionals with expertise or involvement in the screening or diagnosis of FASD. An online questionnaire was used to evaluate participants' familiarity with and use of five existing diagnostic guidelines for FASD, and to assess their perceptions about the adoption of these guidelines in Australia., Results: Of the 139 participants surveyed, 84 Australian and 8 international health professionals (66.2%) responded to the questions on existing diagnostic guidelines. Participants most frequently reported using the University of Washington 4-Digit Diagnostic Code (27.2%) and the Canadian guidelines (18.5%) for diagnosis. These two guidelines were also most frequently recommended for adoption in Australia: 32.5% of the 40 participants who were familiar with the University of Washington 4-Digit Diagnostic Code recommended adoption of this guideline in Australia, and 30.8% of the 26 participants who were familiar with the Canadian guidelines recommended adoption of this guideline in Australia. However, for the majority of guidelines examined, most participants were unsure whether they should be adopted in Australia. The adoption of existing guidelines in Australia was perceived to be limited by: their lack of evidence base, including the appropriateness of established reference standards for the Australian population; their complexity; the need for training and support to use the guidelines; and the lack of an interdisciplinary and interagency model to support service delivery in Australia., Conclusions: Participants indicated some support for the adoption of the University of Washington or Canadian guidelines for FASD diagnosis; however, concerns were raised about the adoption of these diagnostic guidelines in their current form. Australian diagnostic guidelines will require evaluation to establish their validity in the Australian context, and a comprehensive implementation model is needed to facilitate improved diagnostic capacity in Australia.

Issues: The lack of consensus about whether low to moderate levels of prenatal alcohol exposure are a risk factor for fetal development has generated considerable debate about what advice policies and guidelines should provide., Approach: This paper reviews the evidence from systematic reviews and meta-analyses examining the risk from low and moderate levels of prenatal alcohol exposure, along with the results of articles published 2009-2010, after the reviews., Key Findings: The reported significant effects from low levels of prenatal alcohol exposure are likely due to methodological issues such as confounding and/or misclassification of exposure or outcome and there is no strong research evidence of fetal effects from low levels of alcohol exposure. However, harm is well-documented with heavy exposure and moderate levels of exposure, 30-40 g per occasion and no more than 70 g per week, have been demonstrated to increase the risk of child behaviour problems., Implications: With such a small margin before there is increased risk to the fetus, it would be morally and ethically unacceptable for policies and guidelines to condone consumption of alcohol during pregnancy. Not all women will follow this advice and some women will inadvertently consume alcohol prior to pregnancy awareness requiring non-judgmental counselling and the provision of rational advice about the likelihood of risk to the fetus., Conclusions: The policy advice that 'the safest choice for pregnant women is to abstain from alcohol during pregnancy' should be maintained. However, the abstinence message needs to be presented in a balanced and rational manner to prevent unintended negative consequences., (© 2011 Australasian Professional Society on Alcohol and other Drugs.)

Aim: The aim of this study was to investigate the association between heavy maternal alcohol consumption and pre- peri- and postneonatally acquired cerebral palsy (CP)., Method: The records of all mothers with an International Classification of Diseases, revision 9 or 10 (ICD-9/-10) alcohol-related diagnostic code, indicating heavy alcohol consumption, recorded on population-based health, mental health, and drug and alcohol data sets from 1983 to 2007, and their children were identified through the Western Australian Data-linkage System. This 'exposed' cohort was frequency matched with mothers without an alcohol-related diagnosis and their offspring (comparison group). Cases of CP were identified through linkage with the Western Australia CP Register. Analyses were undertaken using multivariate logistic regression., Results: There were 23 573 live births in the exposed group (58.6% non-Aboriginal; 41.4% Aboriginal) and 292 cases of CP. The odds of pre/perinatally acquired CP were elevated for children of non-Aboriginal mothers with an alcohol-related diagnosis recorded during pregnancy (adjusted odds ratio 3.32; 95% confidence interval [CI] 1.30-8.48) and for Aboriginal children when an alcohol-related diagnosis was recorded up to 12 months before the mother's pregnancy (adjusted odds ratio 2.49; 95% CI 0.99-6.25). Increased odds of postneonatally acquired CP following any alcohol-related diagnosis were found for non-Aboriginal children (adjusted odds ratio 7.92; 95% CI 2.23-28.14)., Interpretation: These results suggest that heavy maternal alcohol consumption is a direct cause of pre/perinatally acquired CP, and an indirect cause of postneonatally acquired CP, in non-Aboriginal children. The lack of an association for Aboriginal children requires further investigation but may be due to under ascertainment of alcohol use disorders during pregnancy and other aetiological pathways., (© The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.)

Background: This study was conducted to evaluate the steady-state blood concentrations and potential accumulation of levonorgestrel (LNG) and ethinyl estradiol (EE) administered for up to 84 days and EE alone for 7 additional days as an extended-regimen 91-day oral contraceptive (OC)., Study Design: An open-label, single-site study was conducted in 30 healthy female volunteers. Subjects received daily doses of 0.15 mg LNG/0.03 mg EE for 84 consecutive days followed by 0.03 mg EE alone for 7 days. Pharmacokinetic (PK) monitoring was conducted on Days 1, 21, 84 and 91., Results: The observed plasma concentrations of LNG after 84 days and of EE after 84 and 91 days were comparable to the steady-state concentrations observed at 21 days. Pharmacokinetic parameters over the 24-h dosing period were similar at all time points measured after achieving steady-state plasma concentrations., Conclusion: This study demonstrated that an extended-regimen OC providing 84 days of LNG/EE and 7 days of EE alone has a PK profile similar to a 28-day conventional OC regimen and does not result in any additional accumulation of these hormones., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: When examining the association between prenatal alcohol exposure and fetal effects, the timing and intensity of exposure have been ignored in epidemiological studies. The effect of using dose, pattern and timing of consumption ("composite" method) was investigated in this study, to examine the association between prenatal alcohol exposure and fetal effects., Methods: The composite method resulted in six categories of exposure (abstinent, low, moderate, binge

Objective: The goal was to examine the associations between dose, pattern, and timing of prenatal alcohol exposure (PAE) and birth defects., Methods: Data from a randomly selected, population-based cohort of nonindigenous women who gave birth to a live infant in Western Australia (WA) between 1995 and 1997 (N=4714) were linked to WA Midwives Notification System and WA Birth Defects Registry data. We assessed the associations of PAE before pregnancy, in the first trimester, and in late pregnancy with any birth defect and with birth defects classified as alcohol-related birth defects (ARBDs) by the Institute of Medicine (IOM), by using logistic regression., Results: The prevalence of birth defects classified as ARBDs by the IOM was low. Compared with abstinence, heavy PAE in the first trimester was associated with increased odds of birth defects classified as ARBDs (adjusted odds ratio: 4.6 [95% confidence interval: 1.5-14.3]), with similar findings after validation through bootstrap analysis. There was no association between low or moderate PAE and birth defects., Conclusions: A fourfold increased risk of birth defects classified as ARBDs was observed after heavy PAE in the first trimester. Many individual birth defects included in the IOM classification for ARBDs either were not present in this cohort or were not associated with PAE. Large, population-based studies are needed to strengthen the evidence base for ARBDs.

Objective: To investigate the relationship between prenatal alcohol exposure and fetal growth and preterm birth and to estimate the effect of dose and timing of alcohol exposure in pregnancy., Design: A population-based cohort study linked to birth information on the Western Australian Midwives Notification System., Setting: Western Australia., Population: A 10% random sample of births restricted to nonindigenous women who had delivered a singleton infant (n= 4719) in 1995-1997., Methods: The impact of alcohol consumption in pregnancy on fetal growth (small-for-gestational-age [SGA] and large-for-gestational-age infants [LGA]) and preterm birth (<37 weeks of gestation) was assessed using multivariate logistic regression analysis and adjusting for confounding factors., Main Outcome Measures: Odds ratios and 95% CI, attributable risk, and population attributable risk were calculated., Results: The percentage of SGA infants and preterm birth increased with higher levels of prenatal alcohol exposure; however, the association between alcohol intake and SGA infants was attenuated after adjustment for maternal smoking. Low levels of prenatal alcohol were not associated with preterm birth; however, binge drinking resulted in a nonsignificant increase in odds. Preterm birth was associated with moderate and higher levels of prenatal alcohol consumption for the group of women who ceased drinking before the second trimester. This group of women was significantly more likely to deliver a preterm infant than women who abstained from alcohol (adjusted OR 1.73 [95% CI 1.01-3.14])., Conclusions: Alcohol intake at higher levels, particularly heavy and binge drinking patterns, is associated with increased risk of preterm birth even when drinking is ceased before the second trimester. This finding, however, is based on small numbers and needs further investigation. Dose and timing of prenatal alcohol exposure appears to affect preterm delivery and should be considered in future research and health education.

There has been a trend over the past two decades in some Western countries for women to delay childbearing, a factor associated with an increased risk of perinatal mortality (stillbirth and neonatal death). While the rates of stillbirth and neonatal mortality have improved in some countries, it has not been established whether maternal age remains a risk factor for perinatal mortality in Australia. The Western Australian Maternal and Child Health Research Database (MCHRDB) was used to examine the effect of maternal age on perinatal death in the periods 1984-93 and 1994-2003 after adjustment for parity and sociodemographic factors. Stillbirths and neonatal deaths were analysed separately. The crude rate of stillbirth has shown little change over the 20 years examined remaining at around 7.5 per 1000 total births, while the rate of neonatal death has decreased steadily from 5.4 per 1000 livebirths in 1984 to 2.0 in 2003. Older maternal age remains a risk factor for stillbirth but the relative risk has declined. After adjustment for parity and sociodemographic factors the relative risk of stillbirth for a woman aged over 40 years (compared with a woman aged 25-29 years) decreased from 2.6 in the period 1984-93, to 1.9 in the period 1994-2003. The increased risk of stillbirth associated with teenage mothers was fully explained by sociodemographic factors in both time periods. No increased risk of neonatal death was evident in the recent period 1994-2003 for teenage or older mothers after adjustment for parity and sociodemographic factors. In spite of some improvements over the past 20 years, women 30 years of age and older continue to be at increased risk of stillbirth. The risk of neonatal death is no longer associated with increased maternal age; however, the small number of cases in the older maternal age groups may be a result of the increased prevalence of antenatal screening and terminations for birth defects.

It is well accepted that heavy alcohol consumption during pregnancy is a risk factor for fetal alcohol spectrum disorder, but research findings for exposure to low to moderate alcohol levels during pregnancy are equivocal, allowing a range of interpretations. The 2001 guideline from the National Health and Medical Research Council (NHMRC) for low-risk drinking for "women who are pregnant or might soon become pregnant" recommends fewer than seven standard drinks per week, and no more than two standard drinks on any one day. This position has polarised health professional and consumer opinion in Australia. The NHMRC guidelines on alcohol are scheduled for review in 2007. We surveyed the alcohol and pregnancy policies and clinical practice guidelines of Australia and six other English-speaking countries to identify current policy. Documents were obtained through Internet searches and direct contact with the relevant organisations. The policies and guidelines varied both across and within countries, and the NHMRC guideline, while not universally supported in Australia, is in step with the policies of the United Kingdom and Canada. Research is needed to elucidate the true association between low to moderate alcohol consumption and fetal harm, the impact of different policies on rates of maternal alcohol consumption during pregnancy, and any untoward outcomes of an abstinence message, to inform and underpin future policy development in Australia.

Study Objective: Prospective assessment of serum homocysteine level in relation to risk of coronary heart disease (CHD) and stroke., Design: Case-cohort study with 17 years follow up., Methods: Homocysteine was measured from stored serum. Proportional hazards regression models were used to obtain adjusted hazard ratios., Results: There was no significant overall relationship between homocysteine and cardiovascular disease after controlling for known confounders. For women, removal of creatinine from the multivariate model resulted in a significant relationship., Conclusions: These results provide little support for a significant independent relationship between level of homocysteine and risk of CHD or stroke in men and women with no evidence of pre-existing cardiovascular disease.