Background This paper examines the degree of agreement among simple dichotomous self-report, validated screening results, and biochemical screening results of prenatal alcohol and other drug use among pregnant women. Method Secondary analysis was conducted on a cohort of pregnant women 16 years or older, presenting for prenatal care in the greater Cape Town, South Africa. Dichotomous verbal screening is a standard of care, and pregnant patients reporting alcohol and other drug use in dichotomous verbal screenings were asked to engage in (...) screening using the Alcohol Smoking and Substance Involvement Screening Test and urinalysis. Results Significant agreements between dichotomous and ASSIST scores were observed. A higher rate of self-reported alcohol use was detected, relative to urine screening with a predictive value of 34.9; while underreporting of illicit substance use was observed with an overall predictive value of 50.0. Conclusion Dichotomous verbal screening was considered valid after comparison with the ASSIST; however, combined use with urine screenings can be recommended especially for identifying illicit substance use in order to accurately detect alcohol and other drug use in pregnancy, so that women can be identified and referred for appropriate interventions where needed. (shrink)

Dr McShane’s discussion paper drew my attention to the theme of fragmentation. There is the fragmentation in our sense of our known worlds brought about by the relentless explosion of change in our collective knowledge and the related life styles which it necessitates. There is also the fragmentation in our sense of ourselves which will be our present concern. Alasdair Macintyre poses the question, how do actions and conversations add up or cohere in the unity of a human life? Translating (...) MacIntyre’s question we can ask: how might questions, insights, formulations, judgements, and decisions add up, cohere, and shape the form and identity of the self in time? It is a question which I believe students of Lonergan need to address. (shrink)