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      Knowledge on preconceptional folic acid supplementation and intention to seek for preconception care among men and women in an urban city: a population-based cross-sectional study

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          Abstract

          Background

          To study the knowledge of a large city population on preconception folic acid supplementation and intention to seek for preconception care within an urban perinatal health program.

          Methods

          Cross-sectional surveys run in Rotterdam, the Netherlands, in 2007 and annually from 2009 to 2014. A random sample of residents aged between 16 and 85 years was taken each year from the municipal population register. Bivariate analysis, interaction analysis, trend analysis and logistic regression were performed.

          Results

          Knowledge on preconceptional folic acid supplementation significantly improved (+20 %) between 2007 and 2009, and the intention to consult a GP or midwife in the preconception period significantly increased (+53 %) from 2007 to 2012. Logistic regression analyses showed that low socio-economic status was significantly associated with low preconceptional folic acid knowledge, but with higher intention to seek out preconception care. An interaction effect was found between educational level and ethnicity, showing that the higher the educational level the lower the gap of level of knowledge between the different ethnic groups.

          Conclusion

          Despite campaigns about folic acid supplementation knowledge on this supplement remains low. The intention amongst men and women to seek out preconception care is still insufficient. Structural interventions to increase and maintain awareness on folic acid supplementation, especially among high-risk groups, are needed.

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          Most cited references28

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          Effects and safety of periconceptional folate supplementation for preventing birth defects.

          It has been reported that neural tube defects can be prevented with periconceptional folic acid supplementation. The effects of different doses, forms and schemes of folate supplementation for the prevention of other birth defects and maternal and infant outcomes are unclear. This review updates and expands a previous Cochrane Review assessing the effects of periconceptional supplementation with folic acid to reduce neural tube defects (NTDs). We examined whether folate supplementation before and during early pregnancy can reduce neural tube and other birth defects (including cleft palate) without causing adverse outcomes for mothers or babies. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010). Additionally, we searched the international clinical trials registry platform and contacted relevant organisations to identify ongoing and unpublished studies. We included all randomised or quasi-randomised trials evaluating the effect of periconceptional folate supplementation alone, or in combination with other vitamins and minerals, in women independent of age and parity. We assessed trials for methodological quality using the standard Cochrane criteria. Two authors independently assessed the trials for inclusion, one author extracted data and a second checked for accuracy. Five trials involving 6105 women (1949 with a history of a pregnancy affected by a NTD and 4156 with no history of NTDs) were included. Overall, the results are consistent in showing a protective effect of daily folic acid supplementation (alone or in combination with other vitamins and minerals) in preventing NTDs compared with no interventions/placebo or vitamins and minerals without folic acid (risk ratio (RR) 0.28, 95% confidence interval (CI) 0.15 to 0.52). Only one study assessed the incidence of NTDs and the effect was not statistically significant (RR 0.08, 95% CI 0.00 to 1.33) although no events were found in the group that received folic acid. Folic acid had a significant protective effect for reoccurrence (RR 0.32, 95% CI 0.17 to 0.60). There is no statistically significant evidence of any effects on prevention of cleft palate, cleft lip, congenital cardiovascular defects, miscarriages or any other birth defects. There were no included trials assessing the effects of this intervention on maternal blood folate or anaemia at term.We found no evidence of short-term side effects. Folic acid, alone or in combination with vitamins and minerals, prevents NTDs but does not have a clear effect on other birth defects.
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            Judging nudging: can nudging improve population health?

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              Differential beliefs, perceived social influences, and self-efficacy expectations among smokers in various motivational phases.

              The ASE model, an integration of social psychological models, states that motivational phases and the transition from one phase to another can be predicted by behavioral determinants. The goal of the present study was to replicate the so-called O pattern that was found in earlier Dutch studies. In four cross-sectional studies (N = 918, N = 354, N = 225, N = 317), smokers filled in a questionnaire based on the ASE model, while the motivational phase question was based on the stage definitions from the Transtheoretical model. Precontemplating smokers perceived fewer advantages of quitting than contemplators. Precontemplators encountered less support for quitting than contemplators. Contemplators reported lower self-efficacy expectations than those in preparation, while this group had lower self-efficacy expectations than respondents in action. Ex-smokers in maintenance reported fewer disadvantages of quitting than those in action. Since changes in cognitive determinants are thought to mediate transitions in motivational phases, the results can be used to tailor health education messages to the needs of smokers in the various motivational phases. The results suggest that smokers in precontemplation would benefit most from information about the pros of quitting and from obtaining support for quitting. Smokers in contemplation and preparation may benefit most from self-efficacy-enhancing information. Copyright 1998 American Health Foundation and Academic Press.
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                Author and article information

                Contributors
                +31 10 7030430 , s.temel@erasmusmc.nl
                o.erdem@Rotterdam.nl
                ajj.voorham@Rotterdam.nl
                g.bonsel@erasmusmc.nl
                e.a.p.steegers@erasmusmc.nl
                denktas@euc.eur.nl
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                18 December 2015
                18 December 2015
                2015
                : 15
                : 340
                Affiliations
                [ ]Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Westzeedijk 118, Room Wk-221, 3016 AH Rotterdam, The Netherlands
                [ ]Municipal Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
                [ ]Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
                Article
                774
                10.1186/s12884-015-0774-y
                4684618
                26684337
                d581119f-8cf3-4064-b834-affe55dc0584
                © Temel et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 April 2015
                : 4 December 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Obstetrics & Gynecology
                preconception care,folic acid,intention,health professional,knowledge
                Obstetrics & Gynecology
                preconception care, folic acid, intention, health professional, knowledge

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