Recent Advances of Microfluidic Platform for Cell Based Non-Invasive Prenatal Diagnosis.

The purpose of the present review is to try to highlight recent advances in the application of microfluidic technology on non-invasive prenatal diagnosis (NIPD). The immunoaffinity based microfluidic technology is the most common approach for NIPD, followed by size-based microfluidic methods. Immunoaffinity microfluidic methods can enrich and isolate circulating fetal extravillous trophoblasts (fEVTs) or fetal nucleated red blood cells (fnRBCs) for NIPD by using specific antibodies, but size-based microfluidic systems are only applied to isolate fEVTs. Most studies based on the immunoaffinity microfluidic system gave good results. Enough fetal cells were obtained for chromosomal and/or genetic analysis in all blood samples. However, the results from studies using size-based microfluidic systems for NIPD are less than ideal. In conclusion, recent advances in microfluidic devices make the immunoaffinity based microfluidic system potentially a powerful tool for cell-based NIPD. However, more clinical validation is needed.

Isolation of TTF-1 Positive Circulating Tumor Cells for Single-Cell Sequencing by Using an Automatic Platform Based on Microfluidic Devices.

Single-cell sequencing provides promising information in tumor evolution and heterogeneity. Even with the recent advances in circulating tumor cell (CTC) technologies, it remains a big challenge to precisely and effectively isolate CTCs for downstream analysis. The Cell RevealTM system integrates an automatic CTC enrichment and staining machine, an AI-assisted automatic CTC scanning and identification system, and an automatic cell picking machine for CTC isolation. H1975 cell line was used for the spiking test. The identification of CTCs and the isolation of target CTCs for genetic sequencing were performed from the peripheral blood of three cancer patients, including two with lung cancer and one with both lung cancer and thyroid cancer. The spiking test revealed a mean recovery rate of 81.81% even with extremely low spiking cell counts with a linear relationship between the spiked cell counts and the recovered cell counts (Y = 0.7241 × X + 19.76, R2 = 0.9984). The three cancer patients had significantly higher TTF-1+ CTCs than healthy volunteers. All target CTCs were successfully isolated by the Cell Picker machine for a subsequent genetic analysis. Six tumor-associated mutations in four genes were detected. The present study reveals the Cell RevealTM platform can precisely identify and isolate target CTCs and then successfully perform single-cell sequencing by using commercially available genetic devices.

Circulating tumor cells as a "real-time liquid biopsy": Recent advances and the application in ovarian cancer.

Even with the latest advances in technology, the treatment of ovarian cancer remains a big challenge because it is typically diagnosed at advanced stage, is prone to early relapse in spite of aggressive treatment and has an extremely poor prognosis. Circulating tumor cells (CTCs) can be used as a non-invasive "real-time liquid biopsy", which has shown the value of diagnosis, assessment of prognosis and chemoresistance, and detection of small residual tumors on ovarian cancer. This review article provides an overview on recent research on CTCs in ovarian cancer, with special focus on the clinical application of CTC tests.

Application of Artificial Intelligence in the Establishment of an Association Model between Metabolic Syndrome, TCM Constitution, and the Guidance of Medicated Diet Care.

BACKGROUND: This study conducted exploratory research using artificial intelligence methods. The main purpose of this study is to establish an association model between metabolic syndrome and the TCM (traditional Chinese medicine) constitution using the characteristics of individual physical examination data and to provide guidance for medicated diet care. METHODS: Basic demographic and laboratory data were collected from a regional hospital health examination database in northern Taiwan, and artificial intelligence algorithms, such as logistic regression, Bayesian network, and decision tree, were used to analyze and construct the association model between metabolic syndrome and the TCM constitution. Findings. It was found that the phlegm-dampness constitution (90.6%) accounts for the majority of TCM constitution classifications with a high risk of metabolic syndrome, and high cholesterol, blood glucose, and waist circumference were statistically significantly correlated with the phlegm-dampness constitution. This study also found that the age of patients with metabolic syndrome has been advanced, and shift work is one of the risk indicators. Therefore, based on the association model between metabolic syndrome and TCM constitution, in the future, metabolic syndrome can be predicted through the syndrome differentiation of the TCM constitution, and relevant medicated diet care schemes can be recommended for improvement. CONCLUSION: In order to increase the public's knowledge and methods for mitigating metabolic syndrome, in the future, nursing staff can provide nonprescription medicated diet-related nursing guidance information via the prediction and assessment of the TCM constitution.

An Automatic Platform Based on Nanostructured Microfluidic Chip for Isolating and Identification of Circulating Tumor Cells.

Circulating tumor cell (CTC) test is currently used as a biomarker in cancer treatment. Unfortunately, the poor reproducibility and limited sensitivity with the CTC detection have limited its potential impact on clinical application. A reliable automated CTC detection system is therefore needed. We have designed an automated microfluidic chip-based CTC detection system and hypothesize this novel system can reliably detect CTC from clinical specimens. SKOV3 ovarian cancer cell line was used first to test the reliability of our system. Ten healthy volunteers, 5 patients with benign ovarian tumors, and 8 patients with epithelial ovarian cancer (EOC) were recruited to validate the CTC capturing efficacy in the peripheral blood. The capture rates for spiking test in SKOV3 cells were 48.3% and 89.6% by using anti-EpCAM antibody alone and a combination of anti-EpCAM antibody and anti-N-cadherin antibody, respectively. The system was sensitive to detection of low cell count and showed a linear relationship with the cell counts in our test range. The sensitivity and specificity were 62.5% and 100% when CTC was used as a biomarker for EOC. Our results demonstrated that this automatic CTC platform has a high capture rate and is feasible for detection of CTCs in EOC.

Mindfulness-based programme on the psychological health of pregnant women.

PROBLEM: Preparation of psychological well-being is an important component of antenatal education for childbirth, but few courses focus on this component. BACKGROUND: The psychosocial health of pregnant women is known to affect perinatal outcomes. Psychosocial stress in women has been associated with increased obstetric interventions and has been shown to affect the health of both mother and child. AIM: To explore the efficacy of an eight-week Mindfulness-Based Childbirth and Parenting programme on reducing prenatal stress, depression, mindfulness, and childbirth self-efficacy. METHODS: In this prospective and randomized controlled trial study, 104 women between 13 and 28 weeks gestation were enrolled and assigned randomly into two groups. Participants in the experimental group received mindfulness-based programme and practice-at-home with audio recordings. The comparison group received traditional education classes. Psychological health was assessed at baseline, post-intervention, and 36-week gestation. FINDINGS: Significant differences were seen in both groups in terms of changes over time in stress, depression, childbirth self-efficacy, and mindfulness, as compared with baseline. In gestation week 36, stress scores were slightly higher and childbirth self-efficacy and mindfulness scores were lower for both groups, but all scores were relatively better in the experimental than in the comparison group. CONCLUSIONS: Perinatal mental health problems affect mothers, their infants, and society. The eight-week mindfulness programme effectively reduced self-perceived stress and depression and increased childbirth self-efficacy and mindfulness. Future research is needed to explore the potential benefits, mechanisms, and effects on maternal and infant birth outcomes of mindfulness.

Sleep quality at 3 months postpartum considering maternal age: A comparative study.

BACKGROUND: Poor sleep quality is related to old age among the general population, but few studies have focused on postpartum women of advanced maternal age. The present study aimed to describe and compare sleep quality between women younger or older than 35 years of age at 3 months postpartum, and to examine the related factors. METHODS: A cross-sectional survey was conducted with 160 postpartum women who had given birth at a teaching hospital in Taiwan. The participants were assigned to two groups according to age (≥35 years, n=80; and 20-34 years, n=80). Sleep quality was measured using the Pittsburgh Sleep Quality Index with a cut-off score of 5. RESULTS: The prevalence of poor sleep quality at 3 months postpartum was higher in older mothers (61.6%) than in younger mothers (38.4%, p<0.01). Multiple logistic regression revealed that poor sleep quality was positively correlated with the severity of postpartum physical symptoms, lack of exercise, and room-sharing with infants. After adjustment for those variables, older mothers were three times more likely to have poor sleep quality than younger mothers (odds ratio=3.08; 95% confidence interval 1.52-6.23). CONCLUSION: Health care providers should pay attention to sleep problems among postpartum women, especially mothers of advanced maternal age. In particular, health care providers should evaluate sleep quality among postpartum women, instruct them not to share the bed with their infants at night, perform exercise, and manage their postpartum physical symptoms to improve the sleep quality.

Noninvasive prenatal diagnosis of fetal aneuploidy by circulating fetal nucleated red blood cells and extravillous trophoblasts using silicon-based nanostructured microfluidics.

BACKGROUND: Noninvasive prenatal testing (NIPT) based on cell-free DNA in maternal circulation has been accepted worldwide by the clinical community since 2011 but limitations, such as maternal malignancy and fetoplacental mosaicism, preclude its full replacement of invasive prenatal diagnosis. We present a novel silicon-based nanostructured microfluidics platform named as "Cell Reveal™" to demonstrate the feasibility of capturing circulating fetal nucleated red blood cells (fnRBC) and extravillous cytotrophoblasts (EVT) for cell-based noninvasive prenatal diagnosis (cbNIPD). METHODS: The "Cell Reveal™" system is a silicon-based, nanostructured microfluidics using immunoaffinity to capture the trophoblasts and the nucleated RBC (nRBC) with specific antibodies. The automated computer analysis software was used to identify the targeted cells through additional immunostaining of the corresponding antigens. The identified cells were retrieved for whole genome amplification for subsequent investigations by micromanipulation in one microchip, and left in situ for subsequent fluorescence in situ hybridization (FISH) in another microchip. When validation, bloods from pregnant women (n = 24) at gestational age 11-13+6 weeks were enrolled. When verification, bloods from pregnant women (n = 5) receiving chorionic villus sampling or amniocentesis at gestation age 11+4-21 weeks with an aneuploid or euploid fetus were enrolled, followed by genetic analyses using FISH, short tandem repeat (STR) analyses, array comparative genomic hybridization, and next generation sequencing, in which the laboratory is blind to the fetal genetic complement. RESULTS: The numbers of captured targeted cells were 1-44 nRBC/2 ml and 1-32 EVT/2 ml in the validation group. The genetic investigations performed in the verification group confirmed the captured cells to be fetal origin. In every 8 ml of the maternal blood being blindly tested, both fnRBC and EVT were always captured. The numbers of captured fetal cells were 14-22 fnRBC/4 ml and 1-44 EVT/4 ml of maternal blood. CONCLUSIONS: This report is one of the first few to verify the capture of fnRBC in addition to EVT. The scalability of our automated system made us one step closer toward the goal of in vitro diagnostics.

Increased postpartum maternal complications after cesarean section compared with vaginal delivery in 225 304 Taiwanese women.

OBJECTIVE: To compare the short-term maternal postpartum complications associated with cesarean section (CS), vaginal delivery (VD), repeated CS and vaginal birth after cesarean section (VBAC) in a large national sample. METHODS: This was a population-based study of the Taiwan National Health Insurance Research Database (NHIRD). Outcomes include post-discharge (2 weeks) urinary tract infection (p-UTI), complications of obstetrical surgical wounds (p-wound) and postpartum hemorrhage (p-hemorrhage). A logistic regression model with generalized estimating equations were utilized, and adjustments were made for maternal and hospital characteristics. RESULTS: The incidence of p-UTI was 0.79%. CS was associated with a significantly higher risk of p-UTI compared with VD (odds ratio [OR] 1.14; 95% confidence interval [CI], 1.003-1.29). The incidence of p-wound was 4.07%. CS and repeated CS were associated with a higher risk of p-wound compared with VD (OR 1.68; 95% CI, 1.28-2.21 and OR 1.64; 95% CI, 1.22-2.20, respectively). Age, maternal diseases and hospital and obstetrician volumes were associated with patient outcomes. CONCLUSIONS: Women with a delivery mode of CS have a higher risk of p-UTI and p-wound than women with VD. Maternal characteristics and hospital and obstetrician volumes may also influence postpartum outcomes.

[The Design Requirements for an E-Health Management Platform: Addressing the Needs of Adolescent Girls at High Risk of Metabolic Syndrome].

BACKGROUND: The rising prevalence of metabolic syndrome among adolescents has not been effectively addressed by current campus-based health promotions. Using the Internet in these promotions may help health professionals achieve better healthcare management. PURPOSE: The purpose of the present study was to explore the design requirements of an e-health management platform from the subjective perspective of adolescent girls who were at a high risk of metabolic syndrome. The findings may provide a reference for designing nursing interventions that more effectively promote healthly lifestyle habits to adolescents. METHODS: This qualitative study employed a snowball approach and used a semi-structured interview guide to collect data. A total of 20 Taiwanese adolescent females who were at a high risk of metabolic syndrome, aged 16-20 years, able to speak Mandarin or Taiwanese, and willing to participate and to have their sessions tape-recorded were enrolled as participants and engaged individually in in-depth interviews. The constant comparative method was used to inductively analyze the interview data. RESULTS: Five main themes related to the e-health management platform emerged from the data. These themes included: an attractive and user-friendly website interface, access to reliable information and resources, provision of tailored health information, access to peer support, and self-monitoring and learning tools. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings highlight the key design needs of an e-Health management platform from the perspective of adolescent girls who are at a high risk of metabolic syndrome. The identified themes may be addressed in future revisions / developments of these platforms in order to better address the needs of this vulnerable population and to effectively reduce the incidence of metabolic syndrome. The authors hope that the results of the present study may be used to provide better healthcare and support for adolescent girls with metabolic syndrome.

Postdischarge rehospitalization and in-hospital mortality among Taiwanese women with hip fracture.

OBJECTIVES: To explore the factors concerning postdischarge rehospitalization and in-hospital mortality among Taiwanese women older than 50 years with hip fracture. MATERIALS AND METHODS: The National Health Insurance database from 2000 to 2006 was used to identity relevant cases. Women inpatients aged over 50 years with new-onset hip fracture in 2003 were identified. We analyzed the factors affecting postdischarge rehospitalization and in-hospital mortality. RESULTS: In 2003, there were 9467 new-onset hip fracture inpatients claimed among Taiwanese women aged over 50 years. The 3-year cumulative rates of rehospitalization after discharge and in-hospital mortality rate were 11.01% (1043) and 7.10% (672), respectively. The factors determined to be related to rehospitalization were patient age, hospital level, length of stay of the initial hospitalization due to hip fracture, and Charlson comorbidity index (CCI) score. The factors determined to be related to in-hospital mortality were age, urbanization level of region where patients were insured, hospital level, length of stay of the initial hospitalization due to hip fracture, and CCI score. CONCLUSION: Characteristics of women aged over 50 years with hip fracture remain an important issue based on high rehospitalization and in-hospital mortality rates. We have identified related risk factors that may be helpful in treating hip fracture among this population segment.

The struggle against fat: weight loss experiences of overweight adolescent girls in Taiwan.

BACKGROUND: Weight loss is an important health issue for overweight girls. Understanding their subjective feelings and experiences regarding weight loss may help healthcare professionals and hospitals develop an appropriate intervention for this population. However, there have been few studies done on the subjective weight loss experiences of overweight adolescent girls. PURPOSE: This study developed a descriptive theory framework to elicit the weight loss experiences of overweight adolescent girls in Taiwan. METHODS: This qualitative study used grounded theory to conduct in-depth interviews with 20 overweight adolescent girls aged 16-20 years. Data were analyzed using the constant comparative method. RESULTS: "Struggle against fat" was the core theme that described and guided the process of weight loss for participants. During this process, "obesity as a stigma" was identified as the antecedent condition with the subcategories: being teased, being blamed, being bullied, and lack of personal attractiveness. Participants struggled to practice a new lifestyle while continuing their previous lifestyle during the weight loss process. This process was categorized as "trying dieting shortcuts," "self-sabotage," "confronting weakness," and "adhere to a new life." During this process, some participants adhered to a new life by perceiving peer/family support, using incentive slogans, and sharing experiences. Finally, participants either continued to maintain their new lifestyle and gradually lost weight or resumed their previous lifestyle and regained weight by entering into a vicious cycle of combating fat through dieting shortcuts while practicing self-sabotage. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Weight loss is a difficult issue for most overweight and obese adolescent girls. Health providers should better understand adolescent psychology to provide this population with effective incentives to modify their lifestyles for health purposes. It is crucial that healthcare providers be good coaches to guide and positively support these girls in their struggle against fat.

An Internet-based health management platform may effectively reduce the risk factors of metabolic syndrome among career women.

OBJECTIVES: The purpose of this study is to target career women with metabolic syndrome (Mets) risk factors and investigate the effectiveness of using a health management platform (HMP) to improve health behavior and reduce Mets risk factors. METHODS: This study adopted the structure of a randomized control trial, and targeted full-time career women aged ≥ 20 years, who possessed Mets risk factors. Intervention was performed via an Internet-based HMP, and changes in health behavior 1.5 months and 3 months after intervention and Mets risk factors 3 months after intervention were analyzed. RESULTS: A total of 66 career women participated in this study. At 3 months, the HMP group displayed better results than the control group in terms of waist circumference, fasting glucose, and the mean number of Mets components. In terms of the group and time interaction analysis on health behavior, the HMP group only displayed significantly better results in exercise scores than the control group at 1.5 months. CONCLUSION: The application of an Internet-based tailored HMP can facilitate an effective improvement in Mets components of career women with Mets risk factors.

Sleep Quality among Female Hospital Staff Nurses.

Purpose. To investigate sleep quality of hospital staff nurses, both by subjective questionnaire and objective measures. Methods. Female staff nurses at a regional teaching hospital in Northern Taiwan were recruited. The Chinese version of the pittsburgh sleep quality index (C-PSQI) was used to assess subjective sleep quality, and an electrocardiogram-based cardiopulmonary coupling (CPC) technique was used to analyze objective sleep stability. Work stress was assessed using questionnaire on medical worker's stress. Results. A total of 156 staff nurses completed the study. Among the staff nurses, 75.8% (117) had a PSQI score of ≥5 and 39.8% had an inadequate stable sleep ratio on subjective measures. Nurses with a high school or lower educational degree had a much higher risk of sleep disturbance when compared to nurses with a college or higher level degree. Conclusions. Both subjective and objective measures demonstrated that poor sleep quality is a common health problem among hospital staff nurses. More studies are warranted on this important issue to discover possible factors and therefore to develop a systemic strategy to cope with the problem.

Effects of standardized phytoestrogen on Taiwanese menopausal women.

OBJECTIVE: To investigate the effects of standardized soy extract on climacteric symptoms, lipid profiles, bone markers, and serum isoflavone concentration in healthy Taiwanese postmenopausal women. MATERIALS AND METHODS: A multicenter, open-labeled, randomized, prospective, comparative study design was used. A total of 130 outpatients who had undergone natural menopause were randomly administered either 70 mg or 35 mg soy extract daily for 24 weeks. RESULTS: The evidence suggests that the soy extract treatment that was administered to both groups for 1 month could help reduce climacteric scores (reductions of 19.66% [p<0.01] and 18.85% [p<0.01] in the 35 mg and 70 mg groups compared with baseline, respectively), and the efficacy was more potent after 6 months of treatment. Soy isoflavone significantly reduced the total cholesterol (reductions of 4.50% [p<0.01] and 3.06% [p<0.05] in the 35 mg and 70 mg groups, respectively) and low density lipoprotein cholesterol levels (reductions of 4.67% [p<0.05] and 5.09% [p<0.05] in the 35 mg and 70 mg groups, respectively) in patients with total cholesterol > 200 mg/dL after 6 months of treatment. In patients with high bone turnover (urinary deoxypyridinoline/creatinine > 7.4 nM/mM), soy extract treatment reduced the deoxypyridinoline/creatinine level by 10.53% (p<0.05) and 11.58% (p<0.05) in the 35 mg and 70 mg groups, respectively. Serum levels of isoflavone increased in both groups after 6 months of treatment. CONCLUSION: Soy extract is highly efficacious at relieving menopausal symptoms and demonstrates a positive effect on the cardiovascular system and skeleton.

Risk factors for blood transfusion in singleton pregnancy deliveries in Taiwan.

OBJECTIVE: To investigate risk factors for blood transfusion in pregnancy. METHODS: In a population-based study, data from all women with singleton pregnancies (n=225 304) admitted for delivery in Taiwanese hospitals in 2002 were obtained from the National Health Insurance claims database. To identify risk factors for blood transfusion, a logistic regression model with generalized estimating equation was used to calculate the adjusted odds ratio (OR) and 95% confidence intervals (CI) for characteristics of the pregnant women, hospitals, clinics, and obstetricians. RESULTS: The incidence of blood transfusion was 1.43%. Cesarean delivery, vaginal birth after cesarean (VBAC), and repeat cesarean delivery had higher rates of blood transfusion than vaginal delivery, with an OR of 7.2 (95% CI, 6.38-8.02), 4.2 (95% CI, 2.52-6.87), and 5.9 (95% CI, 5.06-6.80), respectively. Other risk factors included extremes of age; pregnancies complicated by prepartum hemorrhage, placenta previa, pre-eclampsia, eclampsia, anemia, or systemic lupus erythematosus; and obstetricians with low or mid-to-low numbers of deliveries. CONCLUSION: The study has identified risk factors for blood transfusion in pregnancy on the basis of a nationwide database and provides useful information for obstetric practice. For women with a history of cesarean delivery, vaginal delivery might be considered owing to its lower incidence of transfusion.

Doing the best to control: the experiences of Taiwanese women with lower urinary tract symptoms.

BACKGROUND: In Taiwan, most women with lower urinary tract symptoms live quietly with their symptoms without seeking medical help. These women's voices have not been heard or investigated. OBJECTIVES: The purpose of this study was to generate descriptive theory on the basis of the lived experiences of Taiwanese women with lower urinary tract symptoms. METHODS: A qualitative study on the basis of grounded theory was used. Sixteen Taiwanese women with lower urinary tract symptoms aged 41-75 years participated in in-depth interviews. The data were analyzed using the constant comparative method. RESULTS: "Doing the best to control" was the core category for describing the process of women who used their own unique ways of controlling urination problems. During the process, "Irritating urination problems" was the term identified as the antecedent condition. The woman would then begin the process of "doing the best to control," which would be marked by action and interaction among four categories: (a) self-limited activities, (b) modify daily life, (c) always looking for the toilet while outdoors, and (d) feeling stress and uneasiness. After this phase, some women would begin "seeking medical help," "trying to practice a helpful lifestyle," or both. However, a few women just "did nothing, just living with it." DISCUSSION: Women do their best to improve self-control of their urination problems. However, stress and uneasiness permeate the process and overshadow their lives.

Sleep quality, fatigue, and related factors among perimenopausal women in Taipei City.

BACKGROUND: Sleep disturbances and fatigue are two of the most common complaints in perimenopausal women. PURPOSE: The purpose of this study was to explore sleep quality, fatigue, and related factors among perimenopausal women. METHODS: A cross-sectional correlation survey was conducted. Data were collected through purposive sampling conducted from January to April 2008 at gynecological clinics and perimenopausal support groups in Taipei City. Informed consent was obtained from patients. RESULTS: Eighty-five women with a mean age of 52.73 years were recruited. The total score for sleep quality was 7.71 ± 4.66, and 62.4% of women were identified as poor sleepers. The mean score of perimenopausal fatigue was 3.02 ± 2.41, indicating mild fatigue. Results showed that the quality of sleep among perimenopausal women was significantly affected by factors including long-term drug use, hormone and/or nutritional supplement consumption, perimenopausal status, and tendency toward anxiety and/or depression (t = 5.43, p < .01; t = -3.15, p < .01; t = -3.33, p < .001; F = 4.33, p < .05; F = 20.20 and 12.73, p < .001.). Fatigue and perimenopausal disturbances were related to sleep quality (r = .63 and .61, p < .01), and 43% of sleep quality variance was explained by fatigue and depression. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: It is crucial to assess sleep quality in perimenopausal women who complain of fatigue and/or depression. In addition, health providers should integrate assessments of factors of significant influence on the sleep quality of perimenopausal women (e.g., fatigue; long-term drug, hormone, and/or nutritional supplements use; menopausal status, and tendency toward anxiety and/or depression).

Awareness and use of folic acid among pregnant women in Taipei.

OBJECTIVE: Periconceptional use of folic acid may effectively reduce the risk of fetal neural tube defects. The objective of the present study was to evaluate the awareness and use of folic acid during periconceptional period in Taiwan. MATERIALS AND METHODS: A cross-sectional study was performed at Taiwan Adventist Hospital between March 2008 and December 2008. Data were obtained using a questionnaire from 275 women between 10-12 weeks of gestation. RESULTS: About 90% of women reported having ever heard of folic acid, but only 15.6% of women used folic acid before their pregnancy. There was no significant relationship between awareness and use of folic acid and variant sociodemographic factors. Only 41% of women (78/191) understood the recommended dose of folic acid. About 86% of women (170/197) reported they could identify natural folate-rich food and most of them stated green leaf vegetables as the most important natural source of folic acid. CONCLUSION: Only a small proportion of women have used folic acid before their pregnancies. A public health policy or strategy to increase the preconceptional use of folic acid is needed in Taiwan.

A hospital-based therapeutic lifestyle program for women with metabolic syndrome.

OBJECTIVE: The aim of the present study is to evaluate the effect of a hospital-based therapeutic lifestyle program on women with metabolic syndrome (MetS). MATERIALS AND METHODS: We conducted a therapeutic lifestyle program for women with MetS. They all received a low calorie, balanced diet and participated in a regular aerobic exercise program for 8 weeks. Anthropometric indices, blood pressure, and biochemical data were collected. A paired t test was used for statistical analysis. A p value of less than 0.05 was considered statistically significant. RESULTS: Forty-four women took part in the program. All the components of MetS had decreased significantly by the end of the program and 25% of women no longer had MetS at the end of the program. CONCLUSION: The therapeutic lifestyle program with diet control and regular exercise improves most markers of MetS except for levels of high density lipoprotein cholesterol. Therapeutic lifestyle intervention may be the best way of reducing the risk of cardiovascular disease in women with MetS.