A comprehensive evaluation of food fortification with folic acid for the primary prevention of neural tube defects.

BACKGROUND: Periconceptional use of vitamin supplements containing folic acid reduces the risk of a neural tube defect (NTD). In November 1998, food fortification with folic acid was mandated in Canada, as a public health strategy to increase the folic acid intake of all women of childbearing age. We undertook a comprehensive population based study in Newfoundland to assess the benefits and possible adverse effects of this intervention. METHODS: This study was carried out in women aged 19-44 years and in seniors from November 1997 to March 1998, and from November 2000 to March 2001. The evaluation was comprised of four components: I) Determination of rates of NTDs; II) Dietary assessment; III) Blood analysis; IV) Assessment of knowledge and use of folic acid supplements. RESULTS: The annual rates of NTDs in Newfoundland varied greatly between 1976 and 1997, with a mean rate of 3.40 per 1,000 births. There was no significant change in the average rates between 1991-93 and 1994-97 (relative risk [RR] 1.01, 95% confidence interval [CI] 0.76-1.34). The rates of NTDs fell by 78% (95% CI 65%-86%) after the implementation of folic acid fortification, from an average of 4.36 per 1,000 births during 1991-1997 to 0.96 per 1,000 births during 1998-2001 (RR 0.22, 95% CI 0.14-0.35). The average dietary intake of folic acid due to fortification was 70 µg/day in women aged 19-44 years and 74 µg/day in seniors. There were significant increases in serum and RBC folate levels for women and seniors after mandatory fortification. Among seniors, there were no significant changes in indices typical of vitamin B12 deficiencies, and no evidence of improved folate status masking haematological manifestations of vitamin B12 deficiency. The proportion of women aged 19-44 years taking a vitamin supplement containing folic acid increased from 17% to 28%. CONCLUSIONS: Based on these findings, mandatory food fortification in Canada should continue at the current levels. Public education regarding folic acid supplement use by women of childbearing age should also continue.

A cluster randomized trial of a sex education programme in Belize, Central America.

BACKGROUND: Concerns about adverse consequences of early childbearing and risk of sexually transmitted diseases (STD) have renewed interest in the sexual behaviour of adolescents in developing countries, where they represent a large proportion of the population and are at highest risk. To date, little is known about the sexual knowledge of adolescents in developing countries. This study's primary objective was to evaluate the effectiveness of a responsible sexuality education programme (RSP) in changing knowledge associated with sex and sexuality; secondary objectives were to evaluate changes in attitudes and behavioural intent. METHODS: A cluster randomized design randomizing high school classes in Belize City. Subjects were 13-19 years old. RESULTS: Seven schools in Belize City were selected; 8 classrooms were randomized to the intervention arm and 11 classrooms to the control arm (N = 399). The intervention was associated with two more correct answers on the post-test (difference score was 2.22 points, 95% CI = 0.53, 3.91) after adjusting for gender and previous sexual experience. After controlling for gender and previous sexual experience, the intervention was associated with no change in the attitudes (0.06, 95% CI: -2.89, 2.82) or behavioural intent domains (0.84, 95% CI: -1.12, 2.46). CONCLUSIONS: Greater changes in knowledge were observed in the intervention group than in the control group following the intervention. Changes were not observed for the attitude or behavioural intent domains. These results and the results of similar studies may be used to further improve sex education programmes as it is imperative that students have access to the information necessary to make informed decisions regarding their sexual health.

The influence of prevalence and policy on the likelihood that a physician will offer HIV screening in pregnancy.

OBJECTIVE: To determine the extent to which provincial recommendations, reported regional prevalence rates and perceived local prevalence rates of HIV in pregnancy influence a physician's decision to routinely offer prenatal screening for HIV. DESIGN AND METHODS: A random sample of 5,052 family physicians and obstetricians were surveyed by mail. Logistic regression was used to explore the relationships among the variables of interest. RESULTS: The response rate was 61%. Of these, 69.2% provided prenatal care and were included in the analysis. Physicians were more likely to routinely offer HIV testing if they practiced in provinces with recommendations that supported the universal offer of a test (O.R. = 5.80), independent of living in a region with an estimated prevalence rate exceeding 5/10,000 (O.R. = 1.76), or the perception that the infection rate in their practice justified universal counselling of pregnant women (O.R. = 10.41). CONCLUSIONS: Provincial recommendations supporting universal HIV testing in pregnancy are reflected in physician practice.