Tesis sobre el tema "Alcohol control"

Research on self-control suggests that people do not do as well at self-control after they have already exerted self-control on something else. Despite the obvious importance of self-control in drinking behavior, few studies have examined alcohol consumption as an outcome measure in the context of self-control depletion and the potential role of cognitive processes in the self-control to drinking relationship remains largely unexplored. Although it is widely agreed that alcohol expectancies play an important role in one's decision to drink, no study has examined the role of expectancies in self-control's influence on drinking. This study addresses this important gap in the research by testing whether positive expectancies for alcohol influence the relationship between self-control depletion and placebo alcohol consumption in the laboratory. Results offer support for the resource model of self-control depletion in the context of drinking decisions; participants in the depleted self-control condition drank more placebo alcohol despite being reminded to be ready for an upcoming memory task. Hypotheses of conditional and indirect effects consistent with a process model of self-control were not supported. Using nonparametric analytic techniques, patterns in the data emerged suggestive of conditional indirect effects, though they appear to be very small in scale. Findings support the further exploration of the primary hypotheses, given the consideration of current limitations.

Alcohol is an important economic and cultural commodity. It also represents a significant public health problem. Alcohol is the third greatest risk factor for the global disease burden even though half of the global population abstain. Currently alcohol control strategies are inadequate and unable to combat the health, social and economic problems caused by a legal drug that has become more widely available, more affordable and promoted aggressively. This thesis considers how alcohol control policy is governed, developed and implemented at global, European, UK and Scottish policy levels with specific focus on the role of the alcohol industry in this area. Contemporary modes of governance are increasingly characterised by a multi-agency partnership approach where unelected stakeholders, including corporate partners, contribute to the development and implementation of policy and of action out with policy. The research investigates the role of the alcohol industry within discourses and action in efforts to reduce alcohol related harm. It aims to identify alcohol industry action at global, European, UK and Scottish levels of authority in order to offer an overview of the extent of action and in turn its influence on policy discourses. The research provides an analysis of the alcohol industry as a political operator. The alcohol industry engages with, and in some respects is, a stakeholder active within public health policy circles in relation to alcohol control. This engagement spans science, research, corporate social responsibility, philanthropy, lobbying and direct engagement within official policy circles. The thesis uses the alcohol industry as a case study that highlights a need for research on how influence is wielded by corporate interests within policy circles. There is acknowledgement in various theoretical accounts on governance that changing modes of governance have resulted in the creation of a space for non-state actors within policy circles. However, thereafter, the role of corporate actors is habitually underestimated and even overlooked all together. The argument presented here is that the role of powerful economic interests is rapidly gaining significance as a factor in policy making. This must be explored further in order to ascertain the extent of the influence and the ways in which economic actors exert influence. Methodologically the research examines policy documents, and industry communications as well as adopting an investigative approach to the strategies and agendas of a variety of policy stakeholders. The outcome is a narrative derived from a synthesis of existing sources that explores the area of alcohol control policy which focuses on the involvement of corporate stakeholders with a clear conflict of interest within the process of developing health policy in relation to alcohol. The results indicate that the influence of corporate actors represents a significant and growing threat to the development and implementation of effective evidence based alcohol control policy. Overall the research is intended to make a contribution to academic and public debates on governance and to support public health efforts to reduce alcohol related harm. It attempts to explore the accumulation of corporate action over multiple levels of authority and to describe and evaluate the effects of this accumulative action on public health policy in relation to alcohol.

Highly organised and differentiated neural circuits form and unite to link the cortex with the basal ganglia and thalamus to mediate movement, cognition and behaviour. Previous assertions that the basal ganglia primarily acted to filter cortical information to facilitate motor outputs only have since given way to an understanding of the basal ganglia as a relay and gating structure with functionally and structurally segregated inputs, functions and outputs. Thus, cortical – basal ganglia circuits can be segregated into three broadly separable functional domains mediating motor (primary and supplementary motor cortex (SMA) and putamen), cognitive (dorsolateral prefrontal cortex (dlPFC) and caudate), and limbic (ventromedial prefrontal cortex and ventral striatum (VS)) processes. In addition, cognitive and behavioural programs that pass through the cortical – basal ganglia circuitry can be subject to filtering by the subthalamic nucleus (STN), which receives direct projections from the cortex. This work first demonstrated the functional organisation of segregated intrinsic cortical – basal ganglia circuits in humans, alongside a detailed map of functional subzones within STN, a small and technically inaccessible midbrain structure. The behavioural relevance of the defined cortical – basal ganglia circuits was investigated by examining the cognitive constructs of impulsivity and compulsivity. Waiting impulsivity, a tendency towards rapid premature responses that has been associated with compulsive drug use, was associated with connectivity between limbic regions including subgenual anterior cingulate cortex, VS and STN. However, motor impulsivity, in the form of stopping ability, was associated with motoric regions including pre-SMA and STN. Compulsivity was captured as deficits in: reversal learning, implicating lateral orbitofrontal cortex; attentional shifting, implicating dlPFC; and habit learning, implicating SMA. Neural circuit changes were also examined in individuals with alcohol dependence and binge drinkers. Waiting impulsivity was elevated in both groups and the functional connectivity, microstructural integrity and anatomical connectivity of the neural circuit underlying waiting impulsivity were associated with problematic drinking behaviours in both groups. Together, this work establishes that discrete functional subzones of small subcortical regions can be differentiated in humans and that their behavioural correlates can be similarly mapped. The definition of intrinsic network architecture underlying a particular behaviour and the demonstration its disturbance in psychiatric groups will crucially inform the development of future diagnostic and therapeutic models.

Selective attention towards alcohol-related cues (i.e., “attentional bias”) is thought to reflect increased incentive motivational value of alcohol and alcohol cues acquired through a history of heavy alcohol use, and as such attentional bias is considered to be a clinically relevant factor contributing to alcohol use disorders. This dissertation consists of two studies that investigated specific mechanisms through which attentional bias might serve to promote alcohol abuse. Study 1 compared magnitude of attentional bias in heavy (n = 20) and light (n = 20) drinkers following placebo and two doses of alcohol (0.45 g/kg and 0.65 g/kg). Heavy drinkers displayed significantly greater attentional bias than did moderate drinkers following placebo. However, heavy drinkers displayed a dose-dependent decrease in response to alcohol. Individual differences in attentional bias under placebo were associated with both self-reported and laboratory alcohol consumption, yet bias following alcohol administration did not predict either measure of consumption. These findings suggest that attentional bias is strongest before a drinking episode begins, and as such might be most influential in terms of initiation of alcohol consumption. Study 2 addressed theoretical accounts regarding potential reciprocal interactions between attentional bias and inhibitory control that might promote excessive alcohol consumption. Fifty drinkers performed a measure of attentional bias and a novel task that measures the degree to which alcohol-related stimuli can increase behavioral activation and reduce the ability to inhibit inappropriate responses. As hypothesized, inhibitory failures were significantly greater following alcohol images compared to neutral images. Further, heightened attentional bias was associated with greater response activation following alcohol images. These findings suggest that alcohol stimuli serve to disrupt mechanisms of behavioral control, and that heightened attentional bias is associated with greater disruption of control mechanisms following alcohol images. Taken together, these studies provide strong evidence of an association between attentional bias in sober individuals and alcohol consumption, suggesting a pronounced role of attentional bias in initiation of consumption. Further, findings show that attention to alcohol cues can serve to disrupt mechanisms of inhibitory control that might be necessary to regulate drinking behavior, suggesting a potential means through which attentional bias might promote consumption.

The influence of a primarily Public form of self-awareness and of Private and Public Self-Consciousness on drunken physical aggression and complex reaction-time were examined. Two forms of the balanced-placebo design were employed. Results indicated that each form of self-focus played a significant role in the determination of various aspects of drunken comportment. Consumption of alcohol did not eliminate self-aware behavior on the measures employed. Public Self-Consciousness acted to increase drunken impairment. A modified form of the balanced-placebo design proved superior to the standard version for use with moderately high doses (1.32 ml/kg) of alcohol on a measure of subjective intoxication. The implications for the literature on self-focus and drunken comportment are discussed.

Thesis (Ph. D.)--University of California, San Diego, and San Diego State University, 2009.
Title from first page of PDF file (viewed May 8, 2009). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references (p. 67-79).

This dissertation models the dynamics of alcohol use in the Russian Federation with an emphasis on identifying policy implications most likely to be effective at controlling alcohol use. Utilizing data from The Russian Longitudinal Monitoring Survey, models of alcohol consumption are estimated using both myopic and rational specifications via ordinary least squares, fixed effects two stage least squares and, the focus of this study, two-step system generalized method of moments. Alcohol consumption is studied both as a composite good and as a distinct beverage category (wine, beer, and hard liquor). Furthermore, equations stratified by gender and rural status are included to better identify effects specific to relevant subgroups of the sample. Strong evidence of myopic addiction in both the overall sample and the stratified subgroups are identified. Even so, alcohol does seem to follow the law of demand within the myopic specification indicating that consumers will still react to changes in price. No evidence for rational addiction is found in either the complete sample or its subgroups. Results from the sample subgroups (male/female, urban/rural) were consistent with the overall pattern observed in the full sample, but differed in magnitude. This would suggest that, although alcohol consumption in individuals is affected by similar factors, regardless of gender or geography, the extent to which these individuals are affected differs. This reality would lend credence to "targeted" public health interventions for specific subgroups of individuals, rather than a one size fits all approach.

There is growing evidence that acute changes in fundamental mechanisms of impulse control contribute to the transition from social drinking to abusive drinking. One component of impulsivity concerns the ability to inhibit maladaptive behaviors (i.e., inhibitory control). Inhibitory mechanisms are reliably shown to be sensitive to the impairing effects of alcohol, and studies have begun to show that this impairment fails to recover at the same speed as other aspects of behavior. However, the degree to which inhibitory control develops tolerance to alcohol has only been examined under limited conditions. This dissertation consists of three studies examining contexts in which tolerance has been observed for a host of prototypic behaviors, and will compare the degree to which it fails to develop for inhibitory control. Study 1 examined the rate of recovery for inhibitory control compared with other behaviors as blood alcohol concentrations (BACs) declined to zero following a dose of alcohol in 24 social drinkers. Results revealed prolonged alcohol impairment of inhibitory control along the BAC curve, even as BACs approached zero. By contrast, behaviors including reaction time and motor coordination began to show recovery markedly faster, as BACs were still significantly elevated. Study 2 examined the degree to which recent drinking patterns predict acute alcohol impairment from alcohol in a group of 52 drinkers. Recent, heavy consumption predicted less impairment of motor coordination, but bore no relationship to the magnitude of impairment of inhibitory control. Study 3 examined whether increasing the stimulus strength of environmental cues signaling the need to inhibit behavior could reduce alcohol impairment of inhibitory control in 56 participants. Results showed that increasing stimuli strength reduced alcohol impairment of behavioral activation, but actually increased inhibitory failures. Taken together, the findings contribute to the growing body of evidence suggesting that inhibitory control is especially vulnerable to the impairing effects of alcohol compared with other behaviors. Indeed, these studies systematically assessed the pharmacokinetic and environmental factors that contribute to tolerance, indicating that inhibition is disrupted in circumstances under which response activation is unimpaired. The findings have important implications for understanding the behaviorally-disruptive effects of alcohol.

This thesis uses data from Kenya to contribute to the literature on tobacco and alcohol control policies in low and middle-income countries. The thesis uses the two most recent household and budget surveys (2005/6 and 2015/16), to examine some of the effects of the tobacco and alcohol control policies that were implemented in Kenya between 2005 and 2015. Chapter 2 considers the impact of consumption and taxation of tobacco and alcohol on household spending patterns. An instrumental variable approach is used in the estimation of the difference in spending patterns, between tobacco-consuming (alcohol-consuming) households and households that do not consume tobacco (alcohol). Following the precedent of some other studies, the adult sex ratio is used as an instrumental variable for the tobacco and alcohol consumption status of households. However, the adult sex ratio may not meet the exclusion restriction. In order to address this concern, I change the specification of the instrumental variable and relax the exclusion restriction. As a result, the upper and lower bounds of the difference in expenditure shares between households that consumed tobacco (alcohol) and the households that did not consume tobacco (alcohol) are estimated. A natural experiment involving tobacco and alcohol taxes occurred during the data collection period of one of the household surveys: the excise tax on tobacco and alcohol was increased during the data collection phase. A matched difference-in-differences (MDID) technique is used to estimate the implication of a tobacco (alcohol) tax increase on household spending patterns. The pseudo-panel generated from MDID also provided a new way of controlling for possible endogeneity arising from time-invariant unobservable variables. Therefore, MDID is used as a new approach, for comparing household spending patterns of tobacco-consuming (alcohol-consuming) households with those of households that do not consume tobacco (alcohol). The price and non-price tobacco-control policies that were implemented between 2005/6 and 2015/16 contributed to a decrease in household tobacco use prevalence. However, alcohol-control policies implemented over the same period did not successfully reduce the overall prevalence of alcohol consumption among Kenyan households. Tobacco- and alcohol-consuming households were found to spend less on education, energy, rent, healthcare, and food items. MDID results confirmed that tobacco and alcohol consuming households had lower expenditure shares on items necessary for human capital development. The increase in tobacco taxes did not have an impact on household spending patterns among tobacco-consuming households. However, an increase in taxes on alcohol led to further crowding out of expenditure on fruits. Chapter 3 uses the risk of child malnutrition in Kenya, to examine the effectiveness of tobacco and alcohol control policies, in reducing tobacco and alcohol consumption prevalence among vulnerable households. Past studies in this literature did not explicitly control for cluster/village level factors that may affect child nutrition. A multilevel/mixed effects logit and general equations estimation logit model are used to estimate the difference in the risk of child malnutrition, between households that consumed tobacco and alcohol and those that did not consume the two goods. The two models account for the possibility of correlation in nutritional outcomes for children living in the same cluster/village. The two methods also allowed for the inclusion of contextual effects that could inform public health policy in Kenya. In 2005/6 the odds of long-term child malnutrition were higher for children living in tobacco and alcohol consuming households in rural Kenya. The tobacco and alcohol control policies implemented between 2005/6 and 2015/16 were more effective in reducing tobacco and alcohol consumption prevalence among the poorest rural households. As a result, the decrease in child malnutrition prevalence was greater among households that consumed tobacco and alcohol. In 2015/16 the risk of child malnutrition in tobacco and alcohol consuming households was similar to that of non-consuming households. The results from chapter 3 indicate that tobacco and alcohol control policies that were implemented in Kenya over the ten-year period, contributed to the reduction in consumption of the two goods among the poorest rural households. Therefore, very poor households invested resources, which could have been used for tobacco/alcohol consumption, on human capital development. Chapter 2 and chapter 3 provide evidence on some of the opportunity costs associated with tobacco/alcohol consumption as well as potential benefits that may arise from controlling consumption of the two goods. Subsequently, Chapter 4 focuses on the price elasticity of demand for tobacco and alcohol products. Tax-induced price increases is one of the most effective policy tools for controlling the demand for the two goods. The effectiveness of price policy in controlling demand for tobacco and alcohol may be hindered by among other things, the consumption of informally produced alcohol and noncigarette tobacco products as well as other stimulants. Majority of the relatively few studies done on African countries were on South Africa and most of them estimated the price elasticity of demand for cigarettes and formally produced alcohol products. Further, I am not aware of any peer-reviewed study that has estimated the price elasticity of demand for alcohol and tobacco products in Kenya. Household survey data is used to estimate the own-price and expenditure elasticities (as proxies for income elasticities) of demand for tobacco and alcohol products in Kenya. The responsiveness of the demand for informally produced alcohol as well as non-cigarette tobacco products to changes in prices of cigarettes and formally produced beers is also estimated. This thesis also estimates the responsiveness of demand for khat to changes in the price of cigarettes and formally produced beers. Khat is a stimulant mostly consumed in Arabia and the Horn of Africa. One of the concerns about the use of taxes as a measure to control tobacco and alcohol consumption is the possible regressive nature of tobacco and alcohol taxes. Therefore, chapter 4 also examines the impact of price and non-price tobacco- and alcohol-control policies on the regressivity/progressivity of household tobacco and alcohol burdens (budget shares). Tobacco-control policies implemented between 2005/6 and 2015/16, contributed to a reduction in the regressivity of household tobacco budget shares. The changing profile of tobacco consuming households as well as economic growth over the period may have also contributed to the increase in the estimated price elasticity of demand for cigarettes. Over the ten-year period, the estimated price elasticity of demand for cigarettes increased from -0.63 to -0.42. Khat and snuff tobacco were found to be complements for cigarettes. Khat and informally produced spirits were found to be substitutes for formally produced beers. Further, the demand for formally produced beers was found to be price elastic. The alcohol-control policies that were implemented over the ten-year period, contributed to a reduction in the regressivity of overall alcohol budget shares. However, over the ten-year period, there was a rapid increase in demand for spirits in Kenya.

Excessive college student drinking is a complex problem associated with a range of consequences including deaths, injuries, damage, health risks, legal difficulties, and academic problems. State governing boards, trustees and executives have enacted policies aimed at reducing the negative effects of excessive drinking. This study examined influences on university staff members responsible for implementation of alcohol-control policies. Deeper understanding of factors influencing alcohol-control policy implementation may help leaders improve policy making, implementation and attainment of policy objectives.

This mixed methods study utilized a sequential transformative mixed methods strategy with a quantitative survey, sequenced first, informing the prioritized qualitative multiple case study. Research was conducted at two public universities selected from a single state. In the quantitative phase students (n=1,252) completed a survey measuring student support for 33 alcohol-control measures. Staff (n=27) responsible for policy implementation completed a survey estimating student support for alcohol-control measures. Survey data informed development of the case study interview protocol. In the qualitative phase ten interviews were conducted at each case study site.

The study’s theoretical and conceptual model was based upon Pressman and Wildavsky’s (1973) implementation framework and Kotter’s (1996) eight-stage process for leading change. Findings from the quantitative phase of the study revealed strong levels of support for alcohol-control policies at both campuses while staff members generally underestimated student support for alcohol-control policies. The key findings that emerged after coding case study data included the influences of: (a) executive leadership; (b) leadership transitions and policy saliency; (c) cognition and sensemaking; and, (d) anchoring changes in culture. Student support for alcohol-control policies was found to have no direct influence on staff members responsible for implementation of alcohol control policies.

Both self-control and disinhibition (an aspect of sensation seeking) are associated with alcohol use. Self-control is negatively related to alcohol use while disinhibition is positively related to alcohol use. However it is unknown whether disinhibition and self-control each predict unique variance in alcohol use. Objective: The objective was to test for independent and joint effects of disinhibition and self-control on alcohol use. Methods: College-enrolled young adults (n = 259; 198 = female) participated in a longitudinal study where questionnaires were administered at each of 2 time points, separated by 3 weeks. Questionnaires assessed disinhibition, self-control, heavy episodic drinking (HED), social weekend drinking (SWD) and demographic information. Results: Hierarchical linear regression analyses revealed the presence of a statistically significant interaction between self-control and disinhibition predicting both HED (β = -.14, p < .01, sr = -.13) and SWD (β = -.10, p < .05, sr = -.09). The nature of the interaction was such that disinhibition was a positive predictor of alcohol use when self-control was low, but not when self-control was high. Conclusions: Results suggest that when both disinhibition and self-control are considered simultaneously, self-control moderates the relationship between disinhibition and alcohol use.

There are now in Britain some 200,00 homes with a drug-using parent, and this figure does not include the homes with an alcohol-dependent parent. These levels of substance-use seem set to increase, particularly among women of childbearing age. Research so far conducted indicates that women with substance problems are more reluctant than men to come forward for help, and this is especially the case if the women are mothers. Thus the study of the lives of substance-using mothers is an important area of concern, pragmatically in terms of social policy and sociologically in terms of studying a little-known, marginalised and vulnerable population. Despite this importance, little research has been conducted to date on the everyday experiences of substance-using mothers. This thesis addresses this gap in knowledge by researching the lives of forty-eight women with substance-dependency problems, using a grounded-theory approach to analyse data gathered with the aid of a range of research instruments, including a series of semi-structured interviews. The research respondents were interviewed about their childhood experiences, the context of their daily lives as mothers and substance-users, their relationships with their children, and their attitudes and perceptions towards their substance-use. The thesis argued that, in the everyday lives of substance-using mothers, a key narrative is that of taking and losing control, as the women struggle to maintain their family-lives in the face of disruptive forces. The women hold to traditional views of motherhood, and find themselves reluctant non-conformists to this ideal, as they share, together with other mothers under patriarchy, a sense of powerless responsibility for the wellbeing of their children. Substance-using mothers, it is argued, are an example of a conceptual category of 'problematic mothers' in that their failure to cope and protect their children effectively reveals some otherwise-hidden dimensions of normative motherhood.

Previous research has shown that alcohol abuse may cause a deficit in frontal lobe functioning, specifically, areas of the frontal lobe that are related to executive function. Additionally, problems with executive function have been related to increased difficulty in managing cravings to addictive substances. The current study explored the relationship between alcohol use and performance on measures of executive functioning in a sample of 121 traditional college students. Students were given 5 measures of executive function designed to explore mental set shifting, updating, inhibition, sustained attention, and planning. These measures were used to examine the relationship between executive function and craving as measured by the Obsessive Compulsive Drinking Scale. Levels of alcohol use were also examined using the Alcohol Use Disorders Identification Test in relation to executive function performance and family history of alcohol abuse.

Orientador: Flávio Vasconcelos da Silva
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia Química
Made available in DSpace on 2018-08-18T14:35:21Z (GMT). No. of bitstreams: 1 Rousselet_GeorgesRoger_D.pdf: 11864400 bytes, checksum: e7540876b96b62538dc7486d5c1ddca5 (MD5) Previous issue date: 2011
Resumo: Nos anos da década de 80 ocorreu uma considerável expansão nos incentivos à produção de biocombustíveis, em especial o etanol, com o advento do Pró-Álcool. Esta expansão trouxe consigo a necessidade de se realizar diversos estudos relacionados à melhoria dos processos de produção. Para as usinas com destilarias anexas foi um benefício apreciável, já que se fabricava açúcar de alta qualidade, mandando-se para a destilaria além do melaço e de caldo misto das moendas, produtos intermediários da fabricação do açúcar como mel rico, mel pobre e caldo do filtro; sobrecarregava a fermentação, mas automação desembaraçava todo o sistema de produção do álcool. Entretanto, nas destilarias autônomas instaladas em regiões sem tradição canavieira, não havendo continuidade na disponibilidade de matéria prima, a automação era prejudicada. Na indústria sucroalcooleira, a teoria e a aplicação de controle têm uma interrelação profunda com sistemas de informação e processos de fabricação. Todavia, chegou-se a um estágio em que o desenvolvimento de metodologia e análise matemática, com precisão, deste processo tornou-se tarefa árdua ou até impossível. Estas características ratificam a importância de um adequado dimensionamento e seleção de equipamentos e sistemas para condições de operação pré-definidas. Tendo em vista a importância da automação (instrumentação e controle) nestes sistemas, foram realizadas, neste trabalho, uma análise da evolução do sistema de automação no ramo sucroalcooleiro e a proposta de um sistema de automação que atenda às necessidades de manutenção das variáveis de processo visando uma maior eficiência na coleta de dados e análise das condições de operação. Com os resultados pretende-se abrir um canal de discussão amplo sobre a aplicação desta importante tecnologia
Abstract: With the advent of the Pro-alcohol Program (Pró-Álcool) in the 1980s, considerable expansion of biofuel production incentives occurred, particularly those related to ethanol. This expansion led to a demand for various studies focused on improvement in production processes. It was highly beneficial for plants joined to the distilleries, since high-quality sugar was produced and intermediate products of the sugar manufacturing process such as rich molasses, poor molasses and filtered cane juice, in addition to molasses and mixed cane juice from the mills were delivered to the distillery. Furthermore, fermentation was saturated and ethanol production was maximized by automation. However, automation was damaged in the autonomous distilleries constructed in areas that were not traditional for sugarcane processing and when raw material is not continuously available. In the sugar and ethanol industry, the theory and application of control have a profound interrelation with information systems and manufacturing processes. Nevertheless, a stage was reached when the development of accurate methodology and mathematical analysis of this process became an arduous or even impossible task. These characteristics corroborate the importance of an adequate dimensioning and selection of equipment and systems for predetermined operating conditions. Owing to the importance of automation (instrumentation and control) of these systems, analysis of progress in the automation system in the sugar and ethanol field was performed in this study. Furthermore, an automation system that is capable of meeting requirements for maintenance of processing variables was also proposed to achieve a greater efficiency in data collection and analysis of operating conditions. With the results of the present study, a broad channel of discussion about the application of this important technology may be established
Doutorado
Sistemas de Processos Quimicos e Informatica
Doutor em Engenharia Química

Dissertation (PhD)--Stellenbosch University, 2003.
ENGLISH ABSTRACT: Introduction: Fetal alcohol syndrome (FAS) consists of multi-system abnormalities and is caused by the excessive intake of alcohol during pregnancy. The teratogenic effect of alcohol on the human fetus has now been established beyond reasonable doubt and FAS is the most important human teratogenic condition known today. The syndrome, first described by Lemoine in1968 in the French literature and in the English literature by Jones and Smith in 1973, has since been corroborated by numerous animal and human studies. This study has grown out of several epidemiological, prenatal and infant studies in areas of the Western Cape that are currently being undertaken by the Foundation for Alcohol Related Research (FARR). Preliminary data from studies in Wellington have confirmed that a significant proportion of school-entry children have FAS. The prevalence ofF AS in this community exceeds that for Down syndrome by a factor of30 times. The frequency ofFAS in high-risk populations of the Western Cape is the highest reported anywhere in the world. With this background, and the paucity of FAS literature related to dentistry, the aim of this study was to determine the craniofacial and oral manifestations ofF AS in a sample of school-going children in the Western Cape. Methodology: This study is a descriptive, case-control, cross-sectional study using a random cluster sampling method. On the day of examination, children were weighed, and their height and head circumference were measured. They then had photographs and radiographs taken, followed by an oral examination. For each child, the following information was recorded on the data capture sheet: date of birth, gender, head circumference, weight and height, enamel opacities, dental fluorosis, plaque index, gingival bleeding index, dentition status, oral mucosal lesions and dentofacial anomalies. Results: The total sample of90 children with diagnosed FAS and 90 controls, were matched for age, gender and social class. There were no significant age differences between the two groups (p=0.3363) and the mean ages were 8.9 and 9.1 for the FAS and control groups respectively. Head circumference (HC) differed significantly between the two groups (pAFRIKAANSE OPSOMMING: Fetale alkoholsindroom (FAS) bestaan uit multisisteem abnormaliteite en word veroorsaak deur oormatige inname van alkohol tydens swangerskap. Die teratogeniese uitwerking van alkoholop die menslike fetus word nie meer betwyfel nie en FAS is die belangrikste menslike teratogeniese toestand tans bekend. Die sindroom, soos aanvanklik deur Jones en Smith in 1973 beskryf, is sedertdien deur vele studies op mens en dier bevestig. Hierdie studie het gegroei uit vele epidemiologiese-, prenatale- en kleuterstudies in dele van die Weskaap wat tans onderneem word deur die Stigting vir Alkoholverwante Navorsing. Voorlopige data van die studies in Wellington bevestig dat 'n betekenisvolle deel van skoolbeginners FAS het. Die prevalensie van FAS in hierdie gemeenskap oortref dié van Down se sindroom met 'n faktor van 30. Die frekwensie van FAS in die Weskaap is die hoogste wat in die wêreld gerapporteer is. Met hierdie agtergrond, en die skaarste aan FAS literatuur wat op tandheelkunde betrekking het, was die doel van hierdie studie om die kraniofasiale en mondmanifestasies van fetale alkoholsindroom in 'n monster van skoolkinders in die Weskaap te ondersoek. Metodologie: Hierdie studie was 'n beskrywende, gevallebeheerde deursneestudie waarin 'n lukrake gebondelde monstermetode gebruik is. Op die dag van die ondersoek is die kinders geweeg en hulle lengte en kopomtrek bepaal. Hierna is foto's en x-straalopnames geneem, gevolg deur 'n mondondersoek. Die volgende inligting is vir elke kind aangeteken: geboortedatum, geslag, kopomtrek, massa en lengte, glasuur-opasiteite, tandfluorose, plaakindeks, gingivale bloedingsindeks, gebitstatus, mukosale letsels en dentofasiale anomalieë. Resultate: Die totale monster, bestaande uit 90 kinders met gediagnoseerde fetale alkoholsindroom en 90 bypassende kontroles, is vergelyk ten opsigte van ouderdom, geslag en sosiale klas. Daar was geen betekenisvolle ouderdomsverskille tussen die twee groepe nie (p- =0.3363). Kopomtrek het betekenisvol tussen die twee groepe verskil (p<0.0001), en die drie fotografiese diagnostiese afmetings is almal beïnvloed deur kopomtrek. Die prevalensie van glasuur-opasiteite tussen die FAS- en kontrolegroep was nie betekenisvol nie en het rondom 15% vir beide gewissel. Die opasiteite is hoofsaaklik gesien in maksillêre sentrale snytande en mandibulêre eerste molare. Meer as driekwart van beide groepe het plaak getoon, en byna tweederdes het gingivale bloeding met sondering gehad. Die gevallegroep het statisties betekenisvol meer (p