A randomized trial was conducted to test the efficacy and sufficiency of parent-child interaction therapy (PCIT) in preventing re-reports of physical abuse among abusive parents. Physically abusive parents (N=110) were randomly assigned to one of three intervention conditions: (a) PCIT, (b) PCIT plus individualized enhanced services, or (c) a standard community-based parenting group. Participants had multiple past child welfare reports, severe parent-to-child violence, low household income, and significant levels of depression, substance abuse, and antisocial behavior. At a median follow-up of 850 days, 19% of parents assigned to PCIT had a re-report for physical abuse compared with 49% of parents assigned to the standard community group. Additional enhanced services did not improve the efficacy of PCIT. The relative superiority of PCIT was mediated by greater reduction in negative parent-child interactions, consistent with the PCIT change model.

Aims Alcohol-exposed pregnancies (AEP) are the direct cause of Fetal Alcohol Spectrum Disorders (FASD). This study examines drinking patterns among pregnant and non-pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world. Design Cross-sectional survey. Setting 7 public women’s clinics in two locations: St. Petersburg (SPB) and the Nizhny Novgorod region (NNR). Participants 648 pregnant and non-pregnant childbearing age women. Measurements A face-to-face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition. Findings 89% of non-pregnant women reported consuming alcohol and 65% reported binge drinking in the past three months. 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at-risk for AEP. There was a significant decline in drinking after pregnancy identification. 20% of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive. Conclusions Russian women substantially reduce drinking after pregnancy recognition compared to pre-pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The preconception period presents a risk window and, therefore, a prevention opportunity.

Children and adolescents affected by prenatal exposure to alcohol who have brain damage that is manifested in functional impairments of neurocognition, self-regulation, and adaptive functioning may most appropriately be diagnosed with neurobehavioral disorder associated with prenatal exposure. This Special Article outlines clinical implications and guidelines for pediatric medical home clinicians to identify, diagnose, and refer children regarding neurobehavioral disorder associated with prenatal exposure. Emphasis is given to reported or observable behaviors that can be identified as part of care in pediatric medical homes, differential diagnosis, and potential comorbidities. In addition, brief guidance is provided on the management of affected children in the pediatric medical home. Finally, suggestions are given for obtaining prenatal history of in utero exposure to alcohol for the pediatric patient.

BackgroundAlcohol consumption during pregnancy can result in a range of adverse pregnancy outcomes including Fetal Alcohol Spectrum Disorders (FASD). Risky drinking among Russian women constitutes a significant risk for alcohol-exposed pregnancies (AEP). Russian women report that obstetrics and gynecology (OB/GYN) physicians are the most important source of information about alcohol consumption during pregnancy and developing effective prevention interventions by OB/GYNs is indicated. This is the first study focused on implementation of an AEP prevention intervention at women’s clinics in Russia.MethodThe paper describes the intervention protocol and addresses questions about the feasibility of a brief FASD prevention intervention delivered by OB/GYNs at women’s clinics in Russia. Brief physician intervention guidelines and two evidence-based FASD prevention interventions were utilized to design a brief dual-focused physician intervention (DFBPI) appropriate to Russian OB/GYN care. The questions answered were whether trained OB/GYN physicians could deliver DFBPI during women’s routine clinic visits, whether they maintained skills over time in clinical settings, and which specific intervention components were better maintained. Data were collected as part of a larger study aimed at evaluating effectiveness of DFBPI in reducing AEP risk in non-pregnant women. Methods of monitoring the intervention delivery included fidelity check lists (FCL) with the key components of the intervention completed by physicians and patients and live and audio taped observations of intervention sessions. Physicians (N = 23) and women (N = 372) independently completed FCL, and 78 audiotapes were coded.ResultsThe differences between women’s and physicians’ reports on individual items were not significant. Although the majority of physician and patient reports were consistent (N = 305), a discrepancy existed between the reports in 57 cases. Women reported more intervention components missing compared to physicians (p < 0.001). Discussing barriers was the most difficult component for physicians to implement, and OB/GYN demonstrated difficulties in discussing contraception methods.ConclusionsThe results supported the feasibility of the DFBPI in Russia. OB/GYN physicians trained in the DFBPI, monitored, and supported were able to implement and maintain skills during the study. In addition to the alcohol focus, DFBPI training needs to have a sufficient component to improve physicians’ skills in discussing contraception use.

Fetal alcohol syndrome is a severe outcome of alcohol use during pregnancy, and the rates may be higher in countries with greater use of alcohol. To obtain information from Russian physicians (N = 23), women (N = 23), and male partners (N = 5), focus groups were conducted with 51 participants in St. Petersburg, Russia. The main objective was to determine the participants' knowledge, attitudes, and behavior related to drinking during pregnancy. Data were analyzed using ATLAS-ti 5.0. The results will be used to develop a survey of Russian professionals and women leading to FAS prevention programming. The study's limitations are described.

Background Drinking patterns among Russian women indicate substantial risk for alcohol-exposed pregnancies. Data about women’s knowledge and attitudes related to alcohol consumption during pregnancy and the extent to which women’s knowledge and attitudes affect their alcohol use remain limited. Objectives To describe Russian women’s knowledge and attitudes and assess whether women’s knowledge and attitudes were associated with their risky drinking. Methods Cross-sectional survey. Women of childbearing age (n=648) were recruited at women’s health clinics and asked about their alcohol consumption, pregnancy status, attitudes, and knowledge about effects of alcohol and Fetal Alcohol Syndrome (FAS). Results Women exhibited misconceptions and 40% believed or were uncertain whether alcohol consumption during pregnancy was acceptable. Although 34% had heard of FAS, only 8% possessed accurate knowledge. Knowledge was associated with alcohol consumption among pregnant women, but there was no association between knowledge and risky drinking in non-pregnant women, including those who were at risk for an unplanned pregnancy or were trying to conceive. Attitudes were strongly associated with risky drinking by non-pregnant women across levels of knowledge about FAS and any alcohol use by pregnant women. Conclusions Russian women had limited knowledge and misconceptions about effects of alcohol on fetus, and risky alcohol consumption was strongly associated with women’s attitudes and knowledge. The study provides strong evidence to support continuing public health education about effects of alcohol use during pregnancy. Correcting specific misconceptions and targeting the preconceptional period in health communications are necessary to reduce at-risk drinking and the risk for alcohol-exposed pregnancies.

This article examines the historical evolution of the development of social policy toward street children in Russia and makes recommendations for prevention. The historical examination begins with the Soviet period, when statistics on social problems were not publicly known. It continues through the post-Soviet period when there was an emerging awareness about the increasing number of abused, abandoned children and children living on the streets. Etiological factors, such as child maltreatment and parental substance abuse, are then discussed. Based on these etiological factors, the article then proposes a model in which existing institutions and professionals are supported in facilitating an integrated system of primary, secondary and tertiary prevention. This includes improving child protection services and interventions to prevent children leaving their homes, early identification of children who are becoming involved in street life and a continuum of care for children who cannot return home.

BackgroundFew studies have examined the effects of low‐dose alcohol consumption on the “lipid peroxidation‐antioxidant defense” (LPO‐AOD) system of mothers and infants, and on infant growth and development. This study examined effects of alcohol consumption on the LPO‐AOD system of pregnant women and newborns and infant development.MethodsA total of 209 pregnant women were recruited for this prospective study at the first prenatal visit and followed until delivery: 112 consumed alcohol and 97 reported no alcohol use during pregnancy. Infants were evaluated at birth, and at 6 and 12 months of age. The study controlled for the confounding effect of maternal smoking.ResultsBiomarkers of lipid peroxidation, for example, thiobarbituric acid reactants, were higher and the activity of the antioxidant defense system was lower in drinkers and their infants. Higher rates of pathological conditions and slower postnatal growth were observed among infants who were prenatally exposed to alcohol. Low‐dose alcohol use and tobacco smoking were associated with lower postnatal infant growth trajectories, resulting in restricted growth at 6 and 12 months among infants born to mothers who drank or smoked during pregnancy. Alcohol had a broad effect on the infant and maternal LPO‐AOD system, while the effect of smoking was limited in this study to maternal glutathione peroxidase.ConclusionsSmall amounts of alcohol consumed during pregnancy are associated with dysfunction of the LPO‐AOD system and development of oxidative stress in women and their children. Identification and preventive interventions are needed for pregnant women who use alcohol in any amount.