Talk:Broken/Draft\x3aWikiJournal of Medicine/Fetal alcohol spectrum disorder

Peer review

Conflicts of interest: None declared.

This article on fetal alcohol spectrum disorders (FASD) provides a concise summary of the condition, with discussion about etiology, epidemiology, prevention, and a brief mention about treatment. References are appropriately used, and the cited sources appear to be authoritative and reliable. A few revisions are suggested, which would strengthen the review article and make it suitable for publication.

Many of the suggestions fall in the domain of style, with changes to make the vocabulary more specific and suited for health care professionals.

Paragraph one:
”whose mother drank alcohol during pregnancy.” -> “consumed” may be a better word here
”an abnormal appearance,” -> the characteristic facies of FAS are described well in the photograph (figure), but this should be also referenced in the text.
“small head” -> “microcephaly” is a better term
“are involve in high risk sexual activity” —> should read “involved”

Paragraph two:
“Surveys from the United states, have found” -> comma is extraneous and should be omitted
“10% of pregnant women have drank in the last month” -> again, "consumed" would be a better word for this phrase
“an older mother” -> “advanced maternal age” is more professional-sounding
“directly and indrectly affects a developing baby” -> “fetus” is the correct term before delivery
“Diagnosis is based on a person’s signs and symptoms” -> may be helpful to emphasize that FASD is a clinical diagnosis (as opposed to one based on laboratory or imaging investigations)

Paragraph three:
An additional few sentences on treatment may be helpful and strengthen this review article. Some helpful resources can be obtained from the American Academy of Pediatrics:
1. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Algorithm-for-Evaluation.aspx
2. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/Management.aspx

The article should include a sentence about appropriate referrals for primary care practitioners to make (e.g. pediatric neurologist, developmental pediatrics, and/or neuropsychologist).

The article should clearly state that there are no medications specifically approved to treat FASD, but that some prescription medications are sometimes prescribed to help manage symptoms.

Paragraph four:
This paragraph describes the epidemiology of FASD, and should be inserted between paragraph 1 and 2.

“affect between 2% and 5% of people” -> according to the cited reference, this appears to be an upper limit. I would suggest qualifying this statement with “affect up to 2% and 5% of people”
“The lifetime cost of an individual with FAS were estimated to be” -> should read “lifetime costs” to keep sentence plural to be consistent with the verb “were”

Dtsang (discuss • contribs) 00:33, 8 September 2015 (UTC)

Peer Review 2

Conflicts of Interest : None declared

The article in fetal alcohol spectrum disorder provides a brief review of the topic and touches almost all aspects of the condition. Apart from some pedagogical changes (using consumd instead of drank ) it might be good if the author considers the following points :

The opening paragraph mostly relies on a single fact sheet from CDC , which is a reliable source . However the paragraph is a bit "hazy" in the sense by mixing various types in this spectrum disorder. It might be good to move the types of the spectrum in the later paragraph with more clarity and clear distinction and move some aetiology (covered in second paragraph here). The authors highlight that there is no safe amount to drink during pregnancy, which though scientifically right and the right advice to give to expectant mothers it is often not a pragmatic option for some mothers. The NHS in UK (http://www.nhs.uk/conditions/pregnancy-and-baby/pages/alcohol-medicines-drugs-pregnant.aspx#close ) as for example recommends that one can at a maximum go for 1 to 2 units of alcohol once a week to minimize the risk to the baby. It is also important to highlight that alcohol it is more harmful in the first trimester when in can even lead to miscarriage . Epilepsy and cerebral palsy has also been linked to FASD in some studies.Might be good to highlight these. I am not sure how reliable the data on high risk sexual behavior for FASD is considering a multitude of factors which might lead to this kind of behavior (and this is epidemiologically very tough to differentiate).

It might be good if the article also highlights a sentence on the embryological basis of the disease viz that the baby liver is one of the last organs to develop and hence incapable of metabolising alcohol.

Diagnoses of FASD is essentially a clinical diagnoses with ruling out of various other abnormalities seen in pediatric cases including congenital and neurodevelopmental anomalies of other aetiology. Authors might reference the American Academy of Pediatrics Toolkit for this purpose : https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/fetal-alcohol-spectrum-disorders-toolkit/Pages/The-Toolkit.aspx The toolkit also mentions some evidence based interventions and medication etc .

Screening for FASD is an important tool and deserves a mention.

The terminal paragraph on burden of disease and economic costs does not provide a global perspective and esp of LMIC nations where increases consumption of alcohol in women is an emerging trend. It might be good to have a world view. Data from Canada , UK, some other Europen nations, Australia and Russia is available (in addition to ones mentioned in article). A good collection of many such articles is available here : http://www.nofas-uk.org/PDF/FAF%2013%20%20final.pdf

--Drsoumyadeepb (discuss • contribs) 21:49, 12 September 2015 (UTC)

Rejection (for now)

This article had been awaiting replies and/or amendments of the peer review comments for too long now, so I now have to decide to reject this article. If the author wants to renew the processing, I think we can use the same peer reviews again and get to an editorial board decision quite fast. Mikael Häggström (discuss • contribs) 19:12, 1 March 2017 (UTC)