Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

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The effects from prenatal alcohol exposure have been found to cause a range of congenital physical and cognitive abnormalities (Chasnoff, Wells, Telford, Schmidt, & Messer, 2010; Kable & Coles, 2004a). The neurological impairments associated with the effects from prenatal alcohol exposure often cause learning problems, most notably in mathematics (Kable & Coles, 2004a; Howell et al., 2006). Studies have indicated that when provided instructional interventions in mathematics, children affected by prenatal alcohol exposure made gains in learning. However, the studies did not provide specifics as to how children with FAS construct the understanding of a skill or concept (Kable, Coles, & Taddeo, 2007; Coles, Kable, & Taddeo, 2009). This study contributes to the literature by examining how children affected by prenatal alcohol exposure learn the concept of equivalence through their use of gestures in contrast to their learning outcomes. Previous studies have shown that children’s use of gestures while learning mathematics assist with the integration of verbal and visual stimuli, support concept formation, and facilitate flexible encoding of problems (Goldin-Meadow, Cook, & Mitchell, 2009; McNeil & Alibali, 2004). The results from this study indicated that children in the Alcohol Exposed group showed little to no learning after the intervention as compared to a control group matched by age and IQ. The study showed that children affected by prenatal alcohol exposure used fewer conceptual gestures while learning equivalence as compared to a control group. According to the gesture analysis, the children in the Alcohol Exposed group mentally represented the concept of equivalence as a series of isolated steps or procedures. The procedural representation was not transitioned into a flexible conceptual format and applied to solve different problem types accurately (McNeil & Alibali, 2004). Future studies need to investigate whether teaching children affected by prenatal alcohol exposure to gesture during mathematics instruction would be effective to increase concept formation, accurate encoding, and learning mathematics / Inclusive Education / D. Ed. (Inclusive Education)

Thesis (M Social Work)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Fetal alcohol spectrum disorders (FASD) is caused by maternal drinking during pregnancy. Pre-natal drinking has a range of deleterious effects including physical, mental and behavioural consequences for the affected child. Although FASD is completely preventable, it is irreversible with consequences that last into adulthood. The range of effects of FASD forms a spectrum with fully developed FAS on the one end and no effects on the other end of the spectrum. The Western Cape has one of the highest recorded rates of FAS in the world. This seriously affects almost all systems in society and strains the already overburdened educational-, health-, social- and judicial systems. For this reason preventing FASD is of the utmost importance and requires a comprehensive approach on multiple levels. This study explores and describes FASD prevention services in the Bonnievale, Robertson, Ashton and Montagu-areas – a wine-producing area in the Western Cape. Available FASD prevention services on all levels of prevention, the focus-areas of the different prevention activities, collaboration and co-ordination between the role-players and obstacles in delivering prevention services, was examined. By adopting an ecological approach, FASD prevention services could be investigated on multiple levels. This study used a combination of quantitative and qualitative research. An exploratory design and a purposive sampling method were used. Participants were interviewed individually and with the help of a semi-structured questionnaire. The findings of the empirical investigation show that, although prevention efforts are applied on the universal, selective and indicated levels of prevention, a lack of formal prevention efforts that are actively pursued - especially on the level of indicated prevention - exists. This is aggravated by the absence of formal co-ordination of services and structured systems of referrals. NGO‟s and government departments are, as a result, not clear about their respective roles and responsibilities and women with the highest risk for having a child with FAS, therefore, fall through the cracks of the system. This happens partly because social workers are often perceived as the only agents for social change in the community. According to the ecological approach all levels (micro, meso and macro) of organizations in the social environment should work together for change by repeating prevention messages on the different levels and thereby reinforcing it. In the study area, however, most FAS prevention services were on the micro-level with few on the meso-level and virtually none on macro-level. Participants identified a lack of co-ordination, unplanned families, a lack of resources, a lack of training and training material and low levels of education as obstacles in service delivery. Recommendations resulting from the study indicate that FAS prevention will benefit from structured, formal programs on all levels of prevention. This will require non-government organizations and government departments to co-ordinate services and to develop a formal system of referral amongst the role-players. Training of personnel in clinics, NGO‟s, government departments and volunteers, as well as the development of training material targeted at people on different levels of education, should receive attention. It is, in conclusion, recommended that community organizations and structures such as churches, places of business, farmer‟s associations and liquor outlets are actively involved in the prevention of FASD. / AFRIKAANSE OPSOMMING: Fetale Alkohol Spektrum Afwykings (FASA) word veroorsaak deur alkoholgebruik tydens swangerskap. Alkoholgebruik tydens swangerskap het „n reeks skadelike effekte, insluitend fisiese, psigiese en gedragsafwykings in die geaffekteerde kind. Alhoewel FASA heeltemal voorkombaar is, is dit onomkeerbaar en duur die gevolge daarvan voort in volwassenheid. Die reeks effekte van FASA vorm „n spektrum met volledig ontwikkelde FAS aan die een kant en geen effekte nie aan die ander kant van die spektrum. Die Wes-Kaap het een van die hoogste aangetekende voorkomssyfers van FAS in die wêreld. Dit affekteer feitlik alle sisteme in die samelewing en plaas nog meer druk op die reeds oorlaaide opvoedkundige-, gesondheids-, maatskaplike- en regssisteme. Om hierdie rede is die voorkoming van FASA van uiterste belang en word „n omvattende benadering op veelvuldige vlakke vereis. Hierdie studie ondersoek en beskryf FASA voorkomingsdienste in die Bonnievale-, Robertson-, Ashton- en Montagu-area – „n wynproduserende streek in die Wes-Kaap. Die beskikbaarheid van FASA voorkomingsdienste op alle vlakke van voorkoming, die fokus-areas van die verskillende voorkomingsaktiwiteite, samewerking en koördinering van dienste tussen die rolspelers, sowel as struikelblokke in voorkomingsdienste, is ondersoek. Deur die ekologiese benadering aan te neem, kon FASA voorkomingsdienste op veelvuldige vlakke ondersoek word. Die studie kombineer kwantitatiewe en kwalitatiewe navorsing. Die ontwerp van die studie is verkennend en daar is „n doelbewuste steekproef gedoen. Indivuduele onderhoude met deelnemers is met behulp van semi-gestruktureeerde vraelyste gevoer. Die bevindinge van die empiriese ondersoek toon dat, alhoewel voorkomingspogings aangewend word op die universele, selektiewe en indikatiewe voorkomingsvlakke, daar 'n gebrek bestaan aan formele voorkomingspogings wat aktief nagestreef word, veral op die indikatiewe vlak. Dit word vererger deur die afwesigheid van formele koördinering van dienste en gestruktureerde verwysingsisteme. Nie-regeringsorganisasies en staatsdepartemente het gevolglik nie duidelikheid oor hul onderskeie rolle en verantwoordelikhede nie. Die gevolg hiervan is dat vroue met die hoogste risiko om geboorte te skenk aan kinders met FAS, deur die krake in die sisteem val. Dit geskied deels omdat maatskaplike werkers dikwels gesien word as die enigste agente vir maatskaplike verandering in die gemeenskap. Volgens die ekologiese benadering behoort alle vlakke (mikro, meso en makro) van organisasie in die sosiale omgewing saam te werk om verandering teweeg te bring deurdat voorkomingsboodskappe op die verskillende vlakke te herhaal en sodoende te versterk word. In die studie-area is die meeste voorkomingsdienste egter op mikro-vlak gelewer met min op meso-vlak en feilik geen op makro-vlak nie. Deelnemers aan die studie het „n gebrek aan koördinasie van dienste, onbeplande gesinne, „n gebrek aan hulpbronne, „n gebrek aan opleiding en opleidingsmateriaal en lae vlakke van geletterdheid geïdentifiseer as struikelblokke in dienslewering. Aanbevelings wat uit die studie voortvloei, dui aan dat FASA voorkomingsdienste sal baat vind by gestruktureerde, formele programme op alle vlakke van voorkoming. Dit sal vereis dat nie-regeringsorganisasies en staatdepartemente hul dienste koördineer en „n formele verwysingstelsel tussen die verskillende rolspelers ontwikkel. Opleiding van personeel in klinieke, NRO‟s, staatsdepartemente en vrywilligers, sowel as die ontwikkeling van opleidingsmateriaal wat persone op verskillende vlakke van opvoeding teiken, behoort aandag te geniet. Dit word laastens ook aanbeveel dat gemeenskapsorganisasies en strukture byvoorbeeld kerke, besighede, boere-verenigings en verkoopspunte vir alkohol, aktief betrek word by die voorkoming van FASA.

Thesis (MEdPsych (Educational Psychology))--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: Fetal Alcohol Spectrum Disorder, which is the most common cause of mental and learning disabilities in the world, is totally preventable. Fetal Alcohol Spectrum Disorder is not a genetic or inherited condition; however, it is permanent and reduces human potential. There is no cure or treatment. Fetal Alcohol Spectrum Disorder does not distinguish between race, class or culture and can affect children from all socio-economic groups. It is however more prevalent amongst poor, uneducated, uninformed and marginalised (minority groups) or aboriginal communities due to a variety of historical, sociopolitical and economic reasons. Fetal Alcohol Spectrum Disorder has become a public health problem in South Africa in provinces like the Western and Northern Cape (winegrowing areas), where substantial research has been conducted and where alcohol abuse can be traced back to the ‘dop’ system. The highest documented prevalence of Fetal Alcohol Spectrum Disorder in the world has been identified in these provinces amongst a marginalised group of people classified in South Africa as ‘coloured’. A substantial amount of research has been conducted on the characteristics, manifestation and prevalence of Fetal Alcohol Spectrum Disorder in South Africa, but no research has yet been done to ascertain educators’ knowledge of and attitude to learners with Fetal Alcohol Spectrum Disorder. In view of the high prevalence of Fetal Alcohol Spectrum Disorder in South Africa, and the possibility that many of the learners with learning and behavioural problems in our schools could be victims of Fetal Alcohol Spectrum Disorder (also known as a ‘hidden disability’) I concentrated my research on schools situated in low socio-economic areas on the Cape Flats where poverty and unemployment are high and shebeens are plentiful. Through this research I firstly wished to establish how much knowledge educators have of Fetal Alcohol Spectrum Disorder and what their attitudes are toward learners manifesting the disorder. Secondly, my aim was to ascertain to what extent educators are able to support and identify these learners. Qualitative research methods and an interpretive constructivist paradigm were used to conduct the study. Data was primarily collected through the use of interviews, focus group discussions, observations and a research journal. Nine participants, from three different low socio-economic schools (one from each educational phase) on the Cape Flats, were involved. Themes that emerged from the data were analysed and recorded through the constant comparative method. They are discussed together with the research findings. This study revealed important issues pertaining to educators’ knowledge of Fetal Alcohol Spectrum Disorder and whether they are able to assist learners presenting with this disorder in mainstream education in South Africa. A number of recommendations are made for further research in this field. / AFRIKAANSE OPSOMMING: Fetale Alkohol Spektrumsindroom, wat as die algemeenste oorsaak van verstandelike en leergestremdhede in die wêreld beskou word, is ʼn sindroom wat voorkom kan word. Die sindroom is nie geneties of oorerflik nie, maar die skade is permanent omdat daar geen behandeling en teenmiddel is nie. Dit het gevolglik ʼn negatiewe impak op menslike vermoëns. Fetale Alkohol Spektrumsindroom kan kinders van alle sosioekonomiese groepe affekteer en alhoewel dit nie kultuur-, ras- of klasgebonde is nie, is dit oorwegend ʼn algemene verskynsel onder groepe met ʼn lae opvoedingspeil, diegene wat oningelig en gemarginaliseer is (minderheidsgroepe) of dié wat as inboorlinggemeenskappe bekend staan, wat toegeskryf kan word aan verskeie historiese, sosio-politieke en ekonomiese redes. Fetale Alkohol Spektrumsindroom is tans ʼn openbare gesondheidsprobleem in Suid-Afrika, veral in die wynstreke van die Wes- en Noord-Kaap. Omvattende navorsing is al in genoemde provinsies gedoen waar alkoholmisbruik ʼn lang aanloop het en verbind word met die dopstelsel. Die Wes-Kaap en Noord-Kaap is alombekend as provinsies met die hoogste voorkomsyfer van Fetale Alkohol Spektrumsindroom FASD in die wêreld, veral onder ʼn gemarginaliseerde groep mense wat as die kleurlinge’ bekend staan. Alhoewel omvattende navorsing oor die karaktereienskappe, manifestasies en voorkoms van Fetale Alkohol Spektrumsindroom in Suid-Afrika reeds gedoen is, kon geen navorsing gevind word wat die kennis van opvoeders en hul en houdings jeens leerders met Fetale Alkohol Spektrumsindroom probeer vasstel nie. As die hoë voorkoms van Fetale Alkohol Spektrumsindroom in ag geneem word, asook die moontlikheid dat baie leerders in ons skole leer- en gedragsprobleme manifesteer, kan daar waarskynlik slagoffers van Fetale Alkohol Spektrumsindroom wees en wie se gestremdhede dus ‘onsigbaar’ is. My navorsing fokus daarom hoofsaaklik op skole in die lae sosio-ekonomiese areas van die Kaapse Vlakte, waar armoede en werkloosheid hoogty vier en waar daar ʼn hoë voorkoms van onwettige drankwinkels (‘sjebiens’) is. My primêre doel met hierdie navorsing was om die kennis van onderwysers oor Fetale Alkohol Spektrumsindroom te bepaal en om die houding van opvoeders jeens leerders wat met kenmerke van hierdie sindroom vas te stel. Ek wou ook vasstel tot welke mate opvoeders bevoeg om is leerders met Fetale Alkohol Spektrumsindroom te identifiseer en te ondersteun. Kwalitatiewe navorsingsmetodes en ʼn interpretatiewe konstruktivistiese paradigma is in die studie gebruik. Data is primêr ingesamel met behulp van onderhoude, fokusgroep-besprekings, observasies en ʼn navorsingsjoernaal. Nege deelnemers verbonde aan drie verskillende skole met lae sosio-ekonomiese vlakke (een opvoeder van elke opvoedingsfase), op die Kaapse Vlakte was by die studie betrokke. Temas wat blootgelê is deur die data is ontleed en by wyse van die konstante vergelykende metode opgeneem. Hulle word saam met die navorsingsbevindings bespreek. Die navorsing toon belangrike aspekte van opvoeders se kennis van Fetale Alkohol Spektrumsindroom. Dit bevraagteken ook of hoofstroom-opvoeders in staat is om leerders met Fetale Alkohol Spektrumsindroom te ondersteun. Voortspruitend uit die bevindings word aanbevelings gemaak vir verdere ondersoeke op hierdie gebied.

This institutional ethnography relies on observations, interviews, and textual analyses to explore the experiences of mothers and children who attend a women-centered agency in Vancouver, Canada where a hot lunch, child care in the emergency daycare, and participation in group activities are vital forms of support. Mothers who come to the centre have many concerns related to their need for safe housing, a sustainable income, adequate food, child care, and support. And like mothers anywhere, they have concerns about their children. While many of the children, the majority of them First Nations, have never had a diagnostic assessment for fetal alcohol syndrome (FAS) or for the relatively new umbrella category, ‘fetal alcohol spectrum disorder’ (FASD), a number of the mothers were concerned or even knew that their children had FAS. This thesis asks – how does it happen that mothers have come to know their children in this way? The study critically examines how FASD knowledge and practices actually work in the setting and what they accomplish. My analysis traces how ruling practices for constructing and managing ‘problem’ mothers and children coordinate work activities for identifying children deemed to be ‘at risk’ for FASD. In their efforts to help their children and improve their opportunities for a better life, mothers become willing participants in group activities where they learn how to attach the relevancies of the FASD discourse to their children’s bodies or behaviours. They also gain instruction which helps them to confess their responsibility for children’s problems. While maternal alcohol use as the cause of FASD is contested in literature and in some work sites it is, in this setting, taken as a fact. This study discovers how institutional work processes involving government, medicine, and education actually shape and re-write women’s and children’s experiences into forms of knowledge that make mothers and children institutionally actionable. It is only by exposing the relations of power organizing mothers’ work that it may be possible to re-direct attention to mothers’ and children’s embodied concerns and relieve mothers of the overwhelming responsibility for which they are held and hold themselves to be accountable. / Graduate

The effects from prenatal alcohol exposure have been found to cause a range of congenital physical and cognitive abnormalities (Chasnoff, Wells, Telford, Schmidt, & Messer, 2010; Kable & Coles, 2004a). The neurological impairments associated with the effects from prenatal alcohol exposure often cause learning problems, most notably in mathematics (Kable & Coles, 2004a; Howell et al., 2006). Studies have indicated that when provided instructional interventions in mathematics, children affected by prenatal alcohol exposure made gains in learning. However, the studies did not provide specifics as to how children with FAS construct the understanding of a skill or concept (Kable, Coles, & Taddeo, 2007; Coles, Kable, & Taddeo, 2009). This study contributes to the literature by examining how children affected by prenatal alcohol exposure learn the concept of equivalence through their use of gestures in contrast to their learning outcomes. Previous studies have shown that children’s use of gestures while learning mathematics assist with the integration of verbal and visual stimuli, support concept formation, and facilitate flexible encoding of problems (Goldin-Meadow, Cook, & Mitchell, 2009; McNeil & Alibali, 2004). The results from this study indicated that children in the Alcohol Exposed group showed little to no learning after the intervention as compared to a control group matched by age and IQ. The study showed that children affected by prenatal alcohol exposure used fewer conceptual gestures while learning equivalence as compared to a control group. According to the gesture analysis, the children in the Alcohol Exposed group mentally represented the concept of equivalence as a series of isolated steps or procedures. The procedural representation was not transitioned into a flexible conceptual format and applied to solve different problem types accurately (McNeil & Alibali, 2004). Future studies need to investigate whether teaching children affected by prenatal alcohol exposure to gesture during mathematics instruction would be effective to increase concept formation, accurate encoding, and learning mathematics / Inclusive Education / D. Ed. (Inclusive Education)

Maternal diet can have a great impact on the health and development of the fetus. Poor fetal nutrition has been linked to the development of a set of conditions in later life, such as coronary heart disease, type 2 diabetes and hypertension, while restricted growth can result in hypogylcemia, hypocalcemia, hypothermia, polycythemia, hyperbilirubinemia and cerebral palsy. High alcohol consumption during pregnancy can result in Fetal Alcohol Syndrome, a condition that can cause growth retardation, lowered intelligence and craniofacial defects. Current biometric assessment of the fetus involves size-based measures which may not accurately portray the state of fetal development, since they cannot differentiate cases of small-but-healthy or large-but-unhealthy fetuses. This thesis aims to outline a set of more appropriate measures of accurately capturing the state of fetal development. Specifically, soft tissue area and liver volume measurement are examined, followed by facial shape characterisation. A number of tools are presented which aim to allow clinicians to achieve accurate segmentations of these landmark regions. These are modifications on the Live Wire algorithm, an interactive segmentation method in which the user places a number of anchor points and a minimum cost path is calculated between the previous anchor point and the cursor. This focuses on giving the clinician intuitive control over the exact position of the segmented contour. These modifications are FA-S Live Wire, which utilises Feature Asymmetry and a weak shape constraint, ASP Live Wire, which is a 3D expansion of Live Wire, and FA-O Live Wire, which uses Feature Asymmtery and Local Orientation to guide the segmentation process. These have been designed with each of the specific biometric landmarks in mind. Finally, a method of characterising fetal face shape is proposed, using a combination of the segmentation methods described here and a simple shape model with a parameterised b-spline meshing approach to facial surface representation.

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