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Prevalence of fetal alcohol spectrum disorder and its relationship with levels and patterns of alcohol consumption: a scoping review
(BMJ, 2026-05-04)
Ana Cristina Castro-Avila
;
Veronica Mary Dale
;
Holly Essex
;
Susan Golder
;
Laura Jefferson
<jats:sec> <jats:title>Objective</jats:title> <jats:p>To explore prevalence estimates of fetal alcohol spectrum disorder (FASD) in high-income countries and the relationships between levels and patterns of alcohol consumption during pregnancy and FASD.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Two scoping reviews of observational studies. We searched Medline, EMBASE, Maternity and Infant Care, and the Incidence and Prevalence Database until June 2024. Two reviewers screened studies independently using predefined criteria to address our two questions and extracted data on study design, diagnostic criteria, methods of collecting drinking history and details about levels and drinking patterns.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>We identified 41 relevant studies. Most were conducted in the Americas region (n=15) and had a cross-sectional design (n=26). The US Institute for Medicine diagnostic criteria were most frequently used for case ascertainment (n=22). Prevalence ranged from 5.8 (95% CI 4.6 to 7.1) to 170 000 (95% CI 161 000 to 178 000) per 1 000 000 general population. Estimates of associations between drinking levels/patterns and having a child diagnosed with FASD varied substantially. The lowest OR (95% CI) was 1.8 (0.3 to 12.2) for women who drank 1–1.9 drinks per drinking day compared with no alcohol and the highest was 61 (18.9 to 195.5) for women who drank any amount of alcohol during pregnancy compared with women who did not drink at all.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>FASD prevalence estimates in high-income countries and the risk of different levels and drinking patterns varied widely due to the use of different diagnostic criteria, sampling and alcohol consumption collection methods. Improving alcohol consumption collection methods will help enhance diagnostic certainty and the identification of at-risk groups.</jats:p> </jats:sec>
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Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic’s first wave
(2021)
CASTRO AVILA, ANA CRISTINA
;
Laura Jefferson
;
Veronica Dale
;
Karen Bloor
<jats:sec><jats:title>Objectives</jats:title><jats:p>To identify follow-up services planned for patients with COVID-19 discharged from intensive care unit (ICU) and to explore the views of ICU staff and general practitioners (GPs) regarding these patients’ future needs and care coordination.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This is a sequential mixed-methods study using online surveys and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey data were descriptively analysed.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>GP surgeries and acute National Health Service Trusts in the UK.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>GPs and clinicians leading care for patients discharged from ICU.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcomes</jats:title><jats:p>Usual follow-up practice after ICU discharge, changes in follow-up during the pandemic, and GP awareness of follow-up and support needs of patients discharged from ICU.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals and whether or not these were functioning during the pandemic. Eighty per cent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic and over half modifying their provision (usually to provide the service remotely). Common themes relating to barriers to provision of follow-up were funding complexities, remit and expertise, and communication between ICU and community services. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community and lack of clarity about who was responsible for referrals and follow-up.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for patients with COVID-19, but for all those discharged from ICU.</jats:p></jats:sec>
1Scopus© Citations 26 1
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The effect of external inspections on safety in acute hospitals in the National Health Service in England: A controlled interrupted time-series analysis
(2019)
Karen Bloor
;
Carl Thompson
;
CASTRO AVILA, ANA CRISTINA
<jats:sec><jats:title>Objectives</jats:title><jats:p> To evaluate the effect of Care Quality Commission external inspections of acute trusts on adverse event rates in the English National Health Service. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Interrupted time-series analysis including all acute NHS trusts in England ( n = 155) using two control groups (new versus historical inspection regime and trusts not inspected). Multilevel random-coefficient modelling of (1) rates of falls with harm and (2) pressure ulcers, from April 2012 to June 2016, was undertaken using the new, resource-intensive regime of Care Quality Commission inspections as an intervention. Data used in the model included dates and type of inspection, patient safety indicators, demographic characteristics and financial risk of hospitals. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> In one year, Care Quality Commission inspected 66 acute trusts (42% of all English trusts) using their new regime and 46 (30%) using their previous one. Prior to inspections being announced, rates of falls with harm and pressure ulcers were improving in both intervention and control hospitals. The announcement of an inspection did not affect either indicator. After inspections, rates of falls with harm improved more slowly, and pressure ulcer rates no longer improved for trusts inspected using both regimes. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Neither form of external inspection was associated with positive, clinically significant effects on adverse event rates. Any improvement happening before the announced Care Quality Commission inspections slowed after the inspection. </jats:p></jats:sec>
11 1Scopus© Citations 18

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