Health Care Provider Knowledge and Practices Regarding Folic Acid, United States, 2002–2003

Objective: To assess health care providers (HCP) knowledge and practices regarding folic acid (FA) use for neural tube defect (NTD) prevention. Methods: Two identical surveys were conducted among 611 obstetricians/gynecologists (OB/GYNs) and family/general physicians (FAM/GENs) (2002), and 500 physician assistants (PAs), nurse practitioners (NPs), certified nurse midwives (CNMs), and registered nurses (2003) to ascertain knowledge and practices regarding FA. For analysis, T-tests, univariate and multivariate logistic regression modeling were used. Results: Universally, providers knew that FA prevents birth defects. Over 88% knew when a woman should start taking folic acid for the prevention of NTDs; and over 85% knew FA supplementation beyond what is available in the diet is necessary. However, only half knew that 50% of all pregnancies in the United States are unplanned. Women heard information about multivitamins or FA most often during well woman visits in obstetrical/gynecology (ob/gyn) practice settings (65%), and about 50% of the time during well woman visits in family/general (fam/gen) practice settings and 50% of the time at gynecology visits (both settings). Among all providers, 42% did not know the correct FA dosage (400 μg daily). HCPs taking multivitamins were more than twice as likely to recommend multivitamins to their patients (Odds Ratio [OR] 2.27 95%, Confidence Interval [CI] 1.75–2.94). HCPs with lower income clients (OR 1.49, CI 1.22–1.81) and HCPs with practices having more than 10% minorities (OR 1.46, CI 1.11–1.92) were more likely to recommend supplements. NPs in ob/gyn settings were most likely and FAM/GENs were least likely to recommend supplements (OR 3.06, CL 1.36–6.90 and OR 0.64, CL 0.45–0.90 respectively). Conclusions: Knowledge about birth defects and the necessity of supplemental FA was high. Increasing knowledge about unintended pregnancy rates and correct dosages of FA is needed. The strongest predictor for recommending the use of FA supplements was whether the provider took a multivitamin

Delivery-related knowledge of mothers of NICU infants compared with well-baby-nursery infants

Objective: The objective of this study was to compare the knowledge of mothers of newborns in a neonatal intensive care unit (NICU) and well-baby nursery (WBN) regarding their understanding of term gestation, delivery mode safety, and elective late preterm delivery. Methods: Mothers of newborns admitted to either an NICU (n = 88) or a WBN (n = 145) were surveyed (March 2008-September 2010). Results: Of all mothers, regardless of infant location, 7% were unable to define term gestation, 33% were unaware that scheduling delivery at 35-36 weeks is not advisable, and 30% lacked the knowledge that cesareans are not safer than vaginal deliveries. Multivariate regression models show that socioeconomic and demographic factors underlie many knowledge gaps, and surprisingly, models confirmed that the site (NICU versus WBN) of the infant was not a significant factor related to maternal knowledge. Conclusion: This study revealed gaps in mothers\u27 understanding of the medical implications of premature delivery even though most mothers knew the correct length of term gestation. Unexpectedly, NICU mothers who had a child with significant illness and who encountered multiple health care providers did not have improved understanding of perinatal risks. We conclude that all women need to be educated on the significance of the mode and the timing of delivery

Sudden infant death syndrome: Effect of breast and formula feeding on frontal cortex and brainstem lipid levels

MethodologyDocosahexaenoic acid levels were measured by gas chromatography in samples of frontal lobe and brainstem taken from 28 and 26 infants, respectively, who had died of sudden infant death syndrome (SIDS).ResultsSignificantly higher levels of docosahexaenoic acid were present in the frontal lobe tissues derived from the 13 breast fed infants (age range = 3.3-36.3 weeks; mean 15.9 +/- 11.3 weeks) compared to the 15 formula fed infants (age range = 6.9-47.7 weeks; mean 19.3 +/- 10.6 weeks); mean (+/- s.d.) levels were 8.5 +/- 1.1% and 7.6 +/- 0.8% of total fatty acids (P = 0.019). There was, however, no significant difference in brainstem docosahexaenoic acid levels between breast and formula fed infants.ConclusionsGiven these variable findings, further investigation of the relationship between dietary fatty acid intake and cerebral lipid levels may help to clarify whether different modes of feeding have a role in the pathogenesis of SIDS

Indirect taxation and tax incidence under nonlinear pricing

Nonlinear pricing schemes, Indirect taxation, D42, D82, H21,