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Kancherla V, Black RE. Historical perspective on folic acid and challenges in estimating global prevalence of neural tube defects. Ann N Y Acad Sci 2019. [PMID: 29532513 DOI: 10.1111/nyas.13601] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Neural tube defects (NTD) are major congenital malformations affecting births worldwide. NTD are associated with life-long disability, significant medical care costs, and child mortality. Their prevalence varies worldwide. We conducted a review of published literature and surveillance systems to examine challenges in estimating an overall global prevalence estimate for NTD. Our review showed that most low- and middle-income countries do not track NTD and indicate a high prevalence of these malformations where data are available. Challenges in global NTD prevalence estimation include (1) quality of surveillance methods, (2) existing risk factors (including geographic or socioeconomic factors, availability and use of folic acid, and racial-ethnic and genetic factors), and (3) limitations in education and access to care. We recommend population-based surveillance systems tracking all pregnancy outcomes and major risk factors. Countries should invest in sustainable, multisource surveillance systems, in parallel to folic acid interventions, for gaining a more accurate knowledge of global prevalence of NTD than we currently have. Such efforts will assist in both global prevention of NTD and periodic evaluation of folic acid interventions for NTD reduction. Global NTD prevalence data can drive political will and accelerate the implementation and evaluation of NTD prevention programs.
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia
| | - Robert E Black
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
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Centeno Tablante E, Pachón H, Guetterman HM, Finkelstein JL. Fortification of wheat and maize flour with folic acid for population health outcomes. Cochrane Database Syst Rev 2019; 7:CD012150. [PMID: 31257574 PMCID: PMC6599881 DOI: 10.1002/14651858.cd012150.pub2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Folate is a B-vitamin required for DNA synthesis, methylation, and cellular division. Wheat and maize (corn) flour are staple crops consumed widely throughout the world and have been fortified with folic acid in over 80 countries to prevent neural tube defects. Folic acid fortification may be an effective strategy to improve folate status and other health outcomes in the overall population. OBJECTIVES To evaluate the health benefits and safety of folic acid fortification of wheat and maize flour (i.e. alone or in combination with other micronutrients) on folate status and health outcomes in the overall population, compared to wheat or maize flour without folic acid (or no intervention). SEARCH METHODS We searched the following databases in March and May 2018: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and MEDLINE In Process, Embase, CINAHL, Web of Science (SSCI, SCI), BIOSIS, Popline, Bibliomap, TRoPHI, ASSIA, IBECS, SCIELO, Global Index Medicus-AFRO and EMRO, LILACS, PAHO, WHOLIS, WPRO, IMSEAR, IndMED, and Native Health Research Database. We searched the International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing or planned studies in June 2018, and contacted authors for further information. SELECTION CRITERIA We included randomised controlled trials (RCTs), with randomisation at the individual or cluster level. We also included non-RCTs and prospective observational studies with a control group; these studies were not included in meta-analyses, although their characteristics and findings were described. Interventions included wheat or maize flour fortified with folic acid (i.e. alone or in combination with other micronutrients), compared to unfortified flour (or no intervention). Participants were individuals over two years of age (including pregnant and lactating women), from any country. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias. MAIN RESULTS We included 10 studies: four provided data for quantitative analyses (437 participants); five studies were randomised trials (1182 participants); three studies were non-RCTs (1181 participants, 8037 live births); two studies were interrupted time series (ITS) studies (1 study population of 2,242,438, 1 study unreported). Six studies were conducted in upper-middle-income countries (China, Mexico, South Africa), one study was conducted in a lower-middle-income country (Bangladesh), and three studies were conducted in a high-income country (Canada). Seven studies examined wheat flour fortified with folic acid alone or with other micronutrients. Three studies included maize flour fortified with folic acid alone or with other micronutrients. The duration of interventions ranged from two weeks to 36 months, and the ITS studies included postfortification periods of up to seven years. Most studies had unclear risk of bias for randomisation, blinding, and reporting, and low/unclear risk of bias for attrition and contamination.Neural tube defects: none of the included RCTs reported neural tube defects as an outcome. In one non-RCT, wheat flour fortified with folic acid and other micronutrients was associated with significantly lower occurrence of total neural tube defects, spina bifida, and encephalocoele, but not anencephaly, compared to unfortified flour (total neural tube defects risk ratio (RR) 0.32, 95% confidence interval (CI) 0.21 to 0.48; 1 study, 8037 births; low-certainty evidence).Folate status: pregnant women who received folic acid-fortified maize porridge had significantly higher erythrocyte folate concentrations (mean difference (MD) 238.90 nmol/L, 95% CI 149.40 to 328.40); 1 study, 38 participants; very low-certainty evidence) and higher plasma folate (MD 14.98 nmol/L, 95% CI 9.63 to 20.33; 1 study, 38 participants; very low-certainty evidence), compared to no intervention. Women of reproductive age consuming maize flour fortified with folic acid and other micronutrients did not have higher erythrocyte folate (MD -61.80 nmol/L, 95% CI -152.98 to 29.38; 1 study, 35 participants; very low-certainty evidence) or plasma folate (MD 0.00 nmol/L, 95% CI -0.00 to 0.00; 1 study, 35 participants; very low-certainty evidence) concentrations, compared to women consuming unfortified maize flour. Adults consuming folic acid-fortified wheat flour bread rolls had higher erythrocyte folate (MD 0.66 nmol/L, 95% CI 0.13 to 1.19; 1 study, 30 participants; very low-certainty evidence) and plasma folate (MD 27.00 nmol/L, 95% CI 15.63 to 38.37; 1 study, 30 participants; very low-certainty evidence), versus unfortified flour. In two non-RCTs, serum folate concentrations were significantly higher among women who consumed flour fortified with folic acid and other micronutrients compared to women who consumed unfortified flour (MD 2.92 nmol/L, 95% CI 1.99 to 3.85; 2 studies, 657 participants; very low-certainty evidence).Haemoglobin or anaemia: in a cluster-randomised trial among children, there were no significant effects of fortified wheat flour flatbread on haemoglobin concentrations (MD 0.00 nmol/L, 95% CI -2.08 to 2.08; 1 study, 334 participants; low-certainty evidence) or anaemia (RR 1.07, 95% CI 0.74 to 1.55; 1 study, 334 participants; low-certainty evidence), compared to unfortified wheat flour flatbread. AUTHORS' CONCLUSIONS Fortification of wheat flour with folic acid may reduce the risk of neural tube defects; however, this outcome was only reported in one non-RCT. Fortification of wheat or maize flour with folic acid (i.e. alone or with other micronutrients) may increase erythrocyte and serum/plasma folate concentrations. Evidence is limited for the effects of folic acid-fortified wheat or maize flour on haemoglobin levels or anaemia. The effects of folic acid fortification of wheat or maize flour on other primary outcomes assessed in this review is not known. No studies reported on the occurrence of adverse effects. Limitations of this review were the small number of studies and participants, limitations in study design, and low-certainty of evidence due to how included studies were designed and reported.
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Affiliation(s)
| | - Helena Pachón
- Food Fortification Initiative & Emory University1518 Clifton Rd NE, Room 2049AtlantaGeorgiaUSA
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Saing S, Haywood P, van der Linden N, Manipis K, Meshcheriakova E, Goodall S. Real-World Cost Effectiveness of Mandatory Folic Acid Fortification of Bread-Making Flour in Australia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:243-254. [PMID: 30617458 DOI: 10.1007/s40258-018-00454-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND In 2009, mandatory folic acid fortification of bread-making flour was introduced in Australia to reduce the birth prevalence of preventable neural tube defects (NTDs) such as spina bifida. Before the introduction of the policy, modelling predicted a reduction of 14-49 NTDs each year. OBJECTIVE Using real-world data, this study provides the first ex-post evaluation of the cost effectiveness of mandatory folic acid fortification of bread-making flour in Australia. METHODS We developed a decision tree model to compare different fortification strategies and used registry data to quantify the change in NTD rates due to the policy. We adopted a societal perspective that included costs to industry and government as well as healthcare and broader societal costs. RESULTS We found 32 fewer NTDs per year in the post-mandatory folic acid fortification period. Mandatory folic acid fortification improved health outcomes and was highly cost effective because of the low intervention cost. The policy demonstrated improved equity in outcomes, particularly in birth prevalence of NTDs in births from teenage and indigenous mothers. CONCLUSIONS This study calculated the value of mandatory folic acid fortification using real-world registry data and demonstrated that the attained benefit was comparable to the modelled expected benefits. Mandatory folic acid fortification (in addition to policies including advice on supplementation and education) improved equity in certain populations and was effective and highly cost effective for the Australian population.
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Affiliation(s)
- Sopany Saing
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Phil Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Naomi van der Linden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Kathleen Manipis
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Elena Meshcheriakova
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
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Grosse SD, Pike J, Soelaeman R, Tilford JM. Quantifying Family Spillover Effects in Economic Evaluations: Measurement and Valuation of Informal Care Time. PHARMACOECONOMICS 2019; 37:461-473. [PMID: 30953263 PMCID: PMC6529092 DOI: 10.1007/s40273-019-00782-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Spillover effects on the welfare of family members may refer to caregiver health effects, informal care time costs, or both. This review focuses on methods that have been used to measure and value informal care time and makes suggestions for their appropriate use in cost-of-illness and cost-effectiveness analyses. It highlights the importance of methods to value informal care time that are independent of caregiver health effects in order to minimize double counting of spillover effects. Although the concept of including caregiver time costs in economic evaluations is not new, relatively few societal perspective cost-effectiveness analyses have included informal care, with the exception of dementia. This is due in part to challenges in measuring and valuing time costs. Analysts can collect information on time spent in informal care or can assess its impact in displacing other time use, notably time in paid employment. A key challenge is to ensure appropriate comparison groups that do not require informal care to be able to correctly estimate attributable informal care time or foregone market work. To value informal care time, analysts can use estimates of hourly earnings in either opportunity cost or replacement cost approaches. Researchers have used widely varying estimates of hourly earnings. Alternatively, stated-preference methods (i.e. contingent valuation, conjoint analysis) can be used to value the effect of informal care on utility, but this can entail double counting with health effects. Lack of consensus and standardization of methods makes it difficult to compare estimates of informal care costs.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS E-87, Atlanta, GA, 30341, USA.
| | - Jamison Pike
- Immunization Services Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rieza Soelaeman
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS E-87, Atlanta, GA, 30341, USA
| | - J Mick Tilford
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Alnaami IM, Alayad EG. Review on myelomeningocele management and its current status in Saudi Arabia. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2019; 24:5-10. [PMID: 30842393 PMCID: PMC8015532 DOI: 10.17712/nsj.2019.1.20180169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Major approaches have emerged in the field of myelomeningocele (MMC) management. The prevalence of MMC in Kingdom of Saudi Arabia is 0.44-1.46/1000 births. Nine point seven percent of pregnant Saudi women take folic acid before conception; MMC is estimated to result in 1,417,500 Saudi Riyals (SAR) in lifetime costs per patient. Abortion should be performed cautiously in Muslim countries; another option may be the intrauterine foetal surgical repair of MMC, which has better neuromotor outcomes and reduces the need for ventriculoperitoneal shunt, albeit with a higher risk of obstetric complications. Seven years after intrauterine foetal surgery emerged, there is a need to establish this service in Kingdom of Saudi Arabia. A multidisciplinary approach is required for MMC patients; surgical closure should be carried out within 72 hours after birth to reduce the risk of infection. Advancing MMC care allows patients to survive to adulthood, and action must be taken to improve the quality of MMC care in Kingdom of Saudi Arabia.
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Affiliation(s)
- Ibrahim M Alnaami
- Department of Neurosurgery, Asir Central Hospital, Abha, Kingdom of Saudi Arabia. E-mail:
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Inouye BM, Jiang R, Alkazemi MH, Wang HHS, Wolf S, Pomann GM, Tejwani R, Wiener JS, Purves JT, Routh JC. Hospital and ED charges for spina bifida care in the United States between 2006 and 2014: Over $2 billion annually. Disabil Health J 2019; 12:431-436. [PMID: 30711573 DOI: 10.1016/j.dhjo.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/21/2018] [Accepted: 01/14/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND More children with spina bifida (SB) are surviving into adulthood. Unfortunately, little data exist regarding the economic implications of modern SB care. OBJECTIVE We examined economic data from two national databases to estimate the annual nationwide hospital and emergency charges of SB from 2006-14. METHODS We analyzed the 2006-2014 Nationwide Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS). SB patients were defined using ICD-9-CM codes. Demographic and charge data were obtained from each database. Multiple imputation was used to estimate missing data (1.6% for NIS and 22% in NEDS). The principal outcomes were mean, median, and total charges for encounters each year. RESULTS There were 725,646 encounters for individuals with SB between 2006 and 2014. The average age of captured SB patients who were admitted to a hospital or seen in an ER was 29 years. In 2014, the median charge for inpatient encounters was $31,071 (IQR: $15,947, $63,063) and for ER encounters was $2407.02 (IQR: $1321.91, $4211.35). In total, the sum of charges from all SB-related admissions in 2014 was $1,862,016,217 (95% CI: $1.69 billion, $2.03 billion), while the sum of charges of all SB-related ER encounters in 2014 was $176,843,522 (95% CI: $158 million, $196 million). There was a steady increase in charges over the study period. CONCLUSION Charges for SB-related inpatient and emergency care in the US in 2014 was in excess of $2 billion in contrast to $1.2 billion in 2006, after adjusting for inflation; this is an impressively high figure for a relatively small number of patients.
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Affiliation(s)
- Brian M Inouye
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Ruiyang Jiang
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - M Hassan Alkazemi
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Hsin-Hsiao S Wang
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Steven Wolf
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
| | - Gina-Maria Pomann
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
| | - Rohit Tejwani
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John S Wiener
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - J Todd Purves
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
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Wong EC, Rose CE, Flores AL, Yeung LF. Trends in Multivitamin Use Among Women of Reproductive Age: United States, 2006-2016. J Womens Health (Larchmt) 2019; 28:37-45. [PMID: 30620242 DOI: 10.1089/jwh.2018.7075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Women of reproductive age can consume 0.4 milligrams of folic acid daily to reduce the risk of a neural tube defect (NTD)-affected pregnancy. Multivitamins (MVs) are one source of folic acid. MATERIALS AND METHODS Using HealthStyles survey data (n = 9268), we assessed change in prevalence of MV use during 2006-2016 among women by age (18-24, 25-34, and 35-44 years), race/ethnicity (non-Hispanic [NH] white, NH black, Hispanic), and pregnancy status (trying to get pregnant, not pregnant nor trying to get pregnant, and pregnant) using log-binomial regression. RESULTS Daily MV consumption decreased overall from 32.7% to 23.6% during 2006-2016 for women aged 18-44 years (p for trend <0.001). Age-specific decreases were seen in women aged 25-34 years (2006: 34.1%; 2016: 23.7%; p < 0.001) and 35-44 years (2006: 37.3%; 2016: 27.1%; p < 0.001). Decreases in daily MV intake were found among NH whites (2006: 35.4%; 2016: 24.9%; p < 0.001) and Hispanics (2006: 30.6%; 2016: 22.1%; p < 0.001), but remained unchanged among NH blacks (2006: 23.7%; 2016: 21.8%; p = 0.87). Daily MV intake remained unchanged for women trying to get pregnant (2006: 40.2%; 2012: 38.3%; p = 0.19), decreased for women not pregnant nor trying to get pregnant (2006: 31.3%; 2012: 21.3%; p < 0.001), and fluctuated for pregnant women (2006: 53.8%; 2012: 71.0%; p = 0.21). Prevalence of no MV consumption increased significantly across all age and race/ethnicity groups. CONCLUSIONS Overall MV intake decreased for the past decade and varied by age, race/ethnicity, and pregnancy status. Innovative messaging and targeted interventions for increasing folic acid intake are needed to reduce NTDs.
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Affiliation(s)
- Eugene C Wong
- 1 Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.,2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles E Rose
- 2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alina L Flores
- 2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lorraine F Yeung
- 2 National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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da Rosa EB, Silveira DB, Correia JD, Grapiglia CG, de Moraes SAG, Nunes MR, Zen TD, Oliveira CA, Correia EPE, Alcay CT, Lisboa ML, da Cunha AC, Zen PRG, Rosa RFM. Periconceptional folic acid supplementation in Southern Brazil: Why are not we doing it right? Am J Med Genet A 2018; 179:20-28. [PMID: 30569628 DOI: 10.1002/ajmg.a.60699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 09/28/2018] [Accepted: 10/29/2018] [Indexed: 11/06/2022]
Abstract
Several countries, as Brazil, have public policies for periconceptional folic acid supplementation (FAS) in order to prevent unfavorable outcomes. Our aim was to evaluate the FAS situation in a public reference hospital from Southern Brazil. This study included all mothers who had children born at the Hospital Materno Infantil Presidente Vargas, RS, Brazil, in a 1-year period. Data collection was conducted through interviews with application of a clinical protocol and analysis of the patients' records. FAS was defined as the use of folic acid in any period of the periconceptional period, irrespective of the duration and amount. We also classified those mothers who correctly followed the national recommendation proposed by the Health Ministry of Brazil. The sample consisted of 765 mothers evaluated soon after childbirth. Their ages ranged from 12 to 45 years (mean 25.2 years). The overall level of FAS was 51.5%, and the use according to the national recommendation occurred in only 1.6%. Factors associated with non-FAS consisted of lower maternal age (p = .009) and maternal schooling (p = .023), higher number of pregnancies (p = .003), fewer prenatal visits (p = .050) and later prenatal care onset (p = .037). Periconceptional FAS in our midst seems to be very far from the ideal goal. Susceptible groups appeared to be mothers who were younger, less educated, multiparous, and had inadequate prenatal care. We believe that efforts of education and awareness should be especially targeted for these groups. These recommendations should also be strengthened among those who prescribe the FAS.
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Affiliation(s)
- Ernani B da Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | - Daniélle B Silveira
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | - Jamile D Correia
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil
| | | | | | | | - Tatiana D Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Pharmacy, Faculdade de Ciências da Saúde, Centro Universitário Ritter dos Reis - UniRitter, Porto Alegre, Brazil
| | - Ceres A Oliveira
- Institute of Education and Research, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Cristiane T Alcay
- Nursing Service, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil
| | - Marli L Lisboa
- Nursing Service, Hospital Materno Infantil Presidente Vargas (HMIPV), Porto Alegre, Brazil.,Fetal Medicine, HMIPV, Porto Alegre, Brazil
| | | | - Paulo R G Zen
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Clinical Genetics, UFCSPA and Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Rafael F M Rosa
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), RS, Brazil.,Clinical Genetics, UFCSPA and Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
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Kancherla V, Wagh K, Johnson Q, Oakley GP. A 2017 global update on folic acid-preventable spina bifida and anencephaly. Birth Defects Res 2018; 110:1139-1147. [DOI: 10.1002/bdr2.1366] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/14/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Vijaya Kancherla
- Center for Spina Bifida Prevention, Department of Epidemiology; Rollins School of Public Health of Emory University; Atlanta Georgia
| | - Kaustubh Wagh
- Hubert Department of Global Health; Rollins School of Public Health of Emory University; Atlanta Georgia
| | | | - Godfrey P. Oakley
- Center for Spina Bifida Prevention, Department of Epidemiology; Rollins School of Public Health of Emory University; Atlanta Georgia
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Wang H, Zhao S, Finnell RH, George T, Cooney AJ. Generation of integration-free induced pluripotent stem cells from a patient with spina bifida. Stem Cell Res 2018; 31:27-30. [DOI: 10.1016/j.scr.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/24/2018] [Accepted: 05/15/2018] [Indexed: 10/16/2022] Open
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Kakavandi NR, Hasanvand A, Ghazi-Khansari M, Sezavar AH, Nabizadeh H, Parohan M. Maternal dietary nitrate intake and risk of neural tube defects: A systematic review and dose-response meta-analysis. Food Chem Toxicol 2018; 118:287-293. [DOI: 10.1016/j.fct.2018.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/09/2018] [Accepted: 05/11/2018] [Indexed: 12/20/2022]
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Carias C, Chesson HW, Grosse SD, Li R, Meltzer MI, Miller GF, Murphy LB, Nurmagambetov TA, Pike JJ, Whitham HK. Recommendations of the Second Panel on Cost Effectiveness in Health and Medicine: A Reference, Not a Rule Book. Am J Prev Med 2018; 54:600-602. [PMID: 29338958 PMCID: PMC6038124 DOI: 10.1016/j.amepre.2017.11.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/06/2017] [Accepted: 11/30/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Cristina Carias
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia.
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Rui Li
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Gabrielle F Miller
- Division of Analysis, Research and Practice Integration, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
| | - Louise B Murphy
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Tursynbek A Nurmagambetov
- Division of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC, Atlanta, Georgia
| | - Jamison J Pike
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia
| | - Hilary K Whitham
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia
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Mukhtar A, Kramer MR, Oakley GP, Kancherla V. Race and ethnicity and preconception folic acid supplement use among pregnant women in Georgia, PRAMS 2009 to 2011. Birth Defects Res 2018; 109:38-48. [PMID: 27905191 DOI: 10.1002/bdra.23597] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/11/2016] [Accepted: 10/24/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND The United States Public Health Service recommends that all women of reproductive age consume 400 μg of folic acid daily to prevent major neural tube defects. Hispanics have the highest prevalence of neural tube defects compared with other race/ethnic groups. We studied prevalence of preconception folic acid supplement use, and its association with race/ethnicity among pregnant women in Georgia. METHODS Using state-wide population-based data from 2009 to 2011 Georgia Pregnancy Risk Assessment Monitoring System, we examined the prevalence of preconception folic acid supplement use among pregnant women aged 18 to 45 years. We conducted multivariable logistic regression and estimated adjusted odds ratios and 95% confidence intervals to examine the association between race/ethnicity and supplemental folic acid use among study participants. RESULTS Overall, 25% of all participants reported taking folic acid supplements daily before conception. Only 21% of Hispanic women reported preconception folic acid supplement use. Hispanic women were twice as likely to not take folic acid supplements (adjusted odds ratio = 2.15; 95% confidence interval, 1.35-3.40) compared with non-Hispanic whites, after controlling for maternal age, parity, pregnancy intention, knowledge that folic acid prevents birth defects, and preconception smoking and exercise. CONCLUSION Hispanics are a growing population in the United States with an expected 14 million women of child-bearing age by 2020, and the prevalence of preconception folic acid supplement use is low in this group with a high risk of neural tube defects. Promotion of voluntarily fortified corn masa flour can lower neural tube defects in Hispanics. Mandatory corn masa fortification will be a more effective public health policy.Birth Defects Research 109:38-48, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ayesha Mukhtar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Michael R Kramer
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Godfrey P Oakley
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.,Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.,Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
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64
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Sahakyan V, Duelen R, Tam WL, Roberts SJ, Grosemans H, Berckmans P, Ceccarelli G, Pelizzo G, Broccoli V, Deprest J, Luyten FP, Verfaillie CM, Sampaolesi M. Folic Acid Exposure Rescues Spina Bifida Aperta Phenotypes in Human Induced Pluripotent Stem Cell Model. Sci Rep 2018; 8:2942. [PMID: 29440666 PMCID: PMC5811493 DOI: 10.1038/s41598-018-21103-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 01/30/2018] [Indexed: 12/30/2022] Open
Abstract
Neural tube defects (NTDs) are severe congenital abnormalities, caused by failed closure of neural tube during early embryonic development. Periconceptional folic acid (FA) supplementation greatly reduces the risk of NTDs. However, the molecular mechanisms behind NTDs and the preventive role of FA remain unclear. Here, we use human induced pluripotent stem cells (iPSCs) derived from fetuses with spina bifida aperta (SBA) to study the pathophysiology of NTDs and explore the effects of FA exposure. We report that FA exposure in SBA model is necessary for the proper formation and maturation of neural tube structures and robust differentiation of mesodermal derivatives. Additionally, we show that the folate antagonist methotrexate dramatically affects the formation of neural tube structures and FA partially reverts this aberrant phenotype. In conclusion, we present a novel model for human NTDs and provide evidence that it is a powerful tool to investigate the molecular mechanisms underlying NTDs, test drugs for therapeutic approaches.
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Affiliation(s)
- Vardine Sahakyan
- Translational Cardiomyology Laboratory, Stem Cell Biology and Embryology Unit, Stem Cell Institute, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Robin Duelen
- Translational Cardiomyology Laboratory, Stem Cell Biology and Embryology Unit, Stem Cell Institute, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Wai Long Tam
- Tissue Engineering Laboratory, Skeletal Biology and Engineering Research Center, and Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
| | - Scott J Roberts
- Tissue Engineering Laboratory, Skeletal Biology and Engineering Research Center, and Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
- Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, The Royal National Orthopaedic Hospital, London, UK
| | - Hanne Grosemans
- Translational Cardiomyology Laboratory, Stem Cell Biology and Embryology Unit, Stem Cell Institute, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Pieter Berckmans
- Stem Cell Institute and Stem Cell Biology and Embryology Unit, Department Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Gabriele Ceccarelli
- Human Anatomy Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Department, Istituto Mediterraneo di Eccellenza Pediatrica (ISMEP), Children's Hospital "G di Cristina", Palermo, Italy
| | - Vania Broccoli
- Stem Cell and Neurogenesis Unit, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
- CNR-Institute of Neuroscience, Milan, Italy
| | - Jan Deprest
- Department of Obstetrics and Gynecology, Division Woman and Child, Fetal Medicine Unit, University Hospitals KU Leuven, Leuven, Belgium
- Institute for Women's Health (IWH), University College London, London, United Kingdom
| | - Frank P Luyten
- Tissue Engineering Laboratory, Skeletal Biology and Engineering Research Center, and Prometheus, Division of Skeletal Tissue Engineering, KU Leuven, Leuven, Belgium
| | - Catherine M Verfaillie
- Stem Cell Institute and Stem Cell Biology and Embryology Unit, Department Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Maurilio Sampaolesi
- Translational Cardiomyology Laboratory, Stem Cell Biology and Embryology Unit, Stem Cell Institute, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
- Human Anatomy Unit, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
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65
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Hoddinott J. The investment case for folic acid fortification in developing countries. Ann N Y Acad Sci 2018; 1414:72-81. [PMID: 29363765 PMCID: PMC5887927 DOI: 10.1111/nyas.13527] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/19/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022]
Abstract
There is compelling evidence that neural tube defects can be prevented through mandatory folic acid fortification. Why, then, is an investment case needed? At the core of the answer to this question is the notion that governments and individuals have limited resources for which there are many competing claims. An investment case compares the costs and benefits of folic acid fortification relative to alternative life-saving investments and informs estimates of the financing required for implementation. Our best estimate is that the cost per death averted through mandatory folic acid fortification is $957 and the cost per disability-adjusted life year is $14.90. Both compare favorably to recommended life-saving interventions, such as the rotavirus vaccine and insecticide-treated bed nets. Thus, there is a strong economic argument for mandatory folic acid fortification. Further improvements to these estimates will require better data on the costs of implementing fortification and on the costs of improving compliance where regulations are already in place.
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Affiliation(s)
- John Hoddinott
- Division of Nutritional Sciences and Charles H. Dyson School of Applied Economics and ManagementCornell UniversityIthacaNew York
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66
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Flores AL, Cordero AM, Dunn M, Sniezek JE, Arce MA, Crider KS, Tinker S, Pellegrini C, Carreón R, Estrada J, Struwe S, Boyle C. Adding folic acid to corn Masa flour: Partnering to improve pregnancy outcomes and reduce health disparities. Prev Med 2018; 106:26-30. [PMID: 29128408 PMCID: PMC5912337 DOI: 10.1016/j.ypmed.2017.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/19/2017] [Accepted: 11/01/2017] [Indexed: 11/24/2022]
Abstract
Although strides have been made in preventing neural tube defects (NTDs), Hispanic women remain more likely to have a baby born with an NTD and less likely to know the benefits of, or consume, folic acid than women of other race/ethnic groups. In 1998, the U.S. Food and Drug Administration (FDA) mandated that all enriched cereal grain products be fortified with folic acid; however, corn masa flour (CMF), used to make many corn products that are a diet staple of many Hispanic groups, was not included under this regulation. In 2006, a Working Group began a collaboration to address this disparity by pursuing a petition to FDA to allow folic acid to be added voluntarily to CMF. The petition process was a monumental effort that required collaboration and commitment by partners representing the affected population, manufacturers, scientists, and others. The petition was approved in 2016 and folic acid is now added to CMF products, with expected results of more women achieving the recommended daily folic acid intake, more infants born per year without an NTD, and millions of dollars in direct medical expenditures averted. This 10-year public-private partnership brought together diverse groups that traditionally have different goals. The Working Group continues to work toward ensuring that fortified CMF products are available to the consumer, with the end goal of achieving a reduction in NTD-affected pregnancies.
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Affiliation(s)
- Alina L Flores
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Amy M Cordero
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael Dunn
- Brigham Young University, Department of Nutrition, Dietetics, and Food Science, Provo, UT, USA
| | - Joseph E Sniezek
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Miguel A Arce
- Gruma Corporation, Technology Division, Monterrey, Mexico
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Rita Carreón
- UnidosUS (formerly National Council of La Raza), Washington, D.C., USA
| | | | - Sara Struwe
- Spina Bifida Association, Arlington, VA, USA
| | - Coleen Boyle
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
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67
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Grosse SD. How Economic Findings Can Inform Prevention Research in Cardiovascular Disease. Am J Prev Med 2017; 53:S118-S120. [PMID: 29153112 PMCID: PMC6033324 DOI: 10.1016/j.amepre.2017.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 07/21/2017] [Accepted: 08/08/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
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68
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Kancherla V, Oakley GP. Total prevention of folic acid-preventable spina bifida and anencephaly would reduce child mortality in India: Implications in achieving Target 3.2 of the Sustainable Development Goals. Birth Defects Res 2017; 110:421-428. [PMID: 29195033 DOI: 10.1002/bdr2.1175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 10/04/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND The potential to reduce child mortality by preventing folic acid-preventable spina bifida and anencephaly (FAP SBA) is inadequately appreciated. To quantify possible reduction in FAP SBA-associated child mortality in low- and middle-income countries, we conducted an analysis to demonstrate in India, a country with more than 25 million births and 1.2 million under-five deaths each year, the decrease in neonatal, infant, and under-five mortality that would occur through total prevention of FAP SBA. METHODS We estimated the percent reductions in neonatal, infant, and under-five mortality that would have occurred in India in 2015 had all of FAP SBA been prevented. We also estimated the contributions of these reductions toward India's Sustainable Development Goals on child mortality indicators. We considered the overall prevalence of spina bifida and anencephaly in India as 5 per 1,000 live births, of which 90% were preventable with effective folic acid intervention. RESULTS In the year 2015, folic acid interventions would have prevented about 116,070 cases of FAP SBA and 101,565 under-five deaths associated with FAP SBA. Prevention of FAP SBA would have reduced annually, neonatal, infant, and under-five mortality by 10.2%, 8.9%, and 8.3%, respectively. These reductions would have contributed 18.5% and 17.2% to the reductions in neonatal and under-five mortality, respectively, needed by India to achieve its 2030 Sustainable Developmental Goal Target 3.2 addressing preventable child mortality. CONCLUSIONS Total prevention of FAP SBA clearly has a significant potential for immediate reductions in neonatal, infant, and under-five mortality in India, and similarly other countries.
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Affiliation(s)
- Vijaya Kancherla
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Godfrey P Oakley
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
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69
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Prenatal folic acid use associated with decreased risk of myelomeningocele: A case-control study offers further support for folic acid fortification in Bangladesh. PLoS One 2017; 12:e0188726. [PMID: 29190654 PMCID: PMC5708673 DOI: 10.1371/journal.pone.0188726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 11/13/2017] [Indexed: 11/19/2022] Open
Abstract
Neural tube defects contribute to severe morbidity and mortality in children and adults; however, they are largely preventable through maternal intake of folic acid before and during early pregnancy. We examined the association between maternal prenatal folic acid supplement intake and risk of myelomeningocele (a severe and common type of neural tube defect) in the offspring. We performed secondary analysis using data from a case-control study conducted at Dhaka Community Hospital, Bangladesh between April and November of 2013. Cases and controls included children with and without myelomeningocele, respectively, and their mothers. Cases were identified from local hospitals and rural health clinics served by Dhaka Community Hospital. Controls were selected from pregnancy registries located in the same region as the cases, and matched (1:1) to cases by age and sex. Myelomeningocele in the offspring was confirmed by a pediatrician with expertise in classifying neural tube defects. Maternal prenatal folic acid supplement intake was the main exposure of interest. We estimated crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression analysis. There were 53 pairs of matched cases and controls in our study. Overall, 51% of case mothers reported using folic acid supplements during pregnancy compared to 72% of control mothers (p = 0.03). Median plasma folate concentrations at the time of study visit were 2.79 ng/mL and 2.86 ng/mL among case and control mothers, respectively (p = 0.85). Maternal prenatal folic acid use significantly decreased the odds of myelomeningocele in the offspring (unadjusted OR = 0.42, 95% CI = 0.18–0.96). The association was slightly attenuated after adjusting for maternal age at the time of pregnancy (adjusted OR = 0.43, 95% CI = 0.18–1.02). Our study confirms the protective association between maternal prenatal folic acid supplement use and myelomeningocele among children born in Bangladesh. Our findings point to an overall low folic acid supplement use and low plasma folate concentrations among women of reproductive age in Bangladesh. Mandatory fortification of staple foods with folic acid can address low folate status among women of child-bearing age, and prevent child morbidity and mortality associated with myelomeningocele in Bangladesh.
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70
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Au KS, Findley TO, Northrup H. Finding the genetic mechanisms of folate deficiency and neural tube defects-Leaving no stone unturned. Am J Med Genet A 2017; 173:3042-3057. [PMID: 28944587 PMCID: PMC5650505 DOI: 10.1002/ajmg.a.38478] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 08/11/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
Neural tube defects (NTDs) occur secondary to failed closure of the neural tube between the third and fourth weeks of gestation. The worldwide incidence ranges from 0.3 to 200 per 10,000 births with the United States of American NTD incidence at around 3-6.3 per 10,000 dependent on race and socioeconomic background. Human NTD incidence has fallen by 35-50% in North America due to mandatory folic acid fortification of enriched cereal grain products since 1998. The US Food and Drug Administration has approved the folic acid fortification of corn masa flour with the goal to further reduce the incidence of NTDs, especially among individuals who are Hispanic. However, the genetic mechanisms determining who will benefit most from folate enrichment of the diet remains unclear despite volumes of literature published on studies of association of genes with functions related to folate metabolism and risk of human NTDs. The advances in omics technologies provides hypothesis-free tools to interrogate every single gene within the genome of NTD affected individuals to discover pathogenic variants and methylation targets throughout the affected genome. By identifying genes with expression regulated by presence of folate through transcriptome profiling studies, the genetic mechanisms leading to human NTDs due to folate deficiency may begin to be more efficiently revealed.
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Affiliation(s)
- KS Au
- Division of Medical Genetics, Department of Pediatrics, University of Texas Health Science Houston – McGovern Medical School, Houston, TX
| | - TO Findley
- Division of Neonatology, Department of Pediatrics, University of Texas Health Science Houston – McGovern Medical School, Houston, TX
| | - H Northrup
- Division of Medical Genetics, Department of Pediatrics, University of Texas Health Science Houston – McGovern Medical School, Houston, TX
- Shriners Hospitals for Children - Houston, Houston, TX
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71
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Arth A, Kancherla V, Pachón H, Zimmerman S, Johnson Q, Oakley GP. A 2015 global update on folic acid-preventable spina bifida and anencephaly. ACTA ACUST UNITED AC 2017; 106:520-9. [PMID: 27418029 DOI: 10.1002/bdra.23529] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/14/2016] [Accepted: 04/27/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Spina bifida and anencephaly are two major neural tube defects. They contribute substantially to perinatal, neonatal, infant, and under-five mortality and life-long disability. To monitor the progress toward the total prevention of folic acid-preventable spina bifida and anencephaly (FAP SBA), we examined their global status in 2015. METHODS Based on existing data, we modeled the proportion of FAP SBA that are prevented in the year 2015 through mandatory folic acid fortification globally. We included only those countries with mandatory fortification that added at least 1.0 ppm folic acid as a fortificant to wheat and maize flour, and had complete information on coverage. Our model assumed mandatory folic acid fortification at 200 μg/day is fully protective against FAP SBA, and reduces the rate of spina bifida and anencephaly to a minimum of 0.5 per 1000 births. RESULTS Our estimates show that, in 2015, 13.2% (35,500 of approximately 268,700 global cases) of FAP SBA were prevented in 58 countries through mandatory folic acid fortification of wheat and maize flour. Most countries in Europe, Africa, and Asia were not implementing mandatory fortification with folic acid. CONCLUSION Knowledge that folic acid prevents spina bifida and anencephaly has existed for 25 years, yet only a small fraction of FAP SBA is being prevented worldwide. Several countries still have 5- to 20-fold epidemics of FAP SBA. Implementation of mandatory fortification with folic acid offers governments a proven and rapid way to prevent FAP SBA-associated disability and mortality, and to help achieve health-related Sustainable Development Goals. Birth Defects Research (Part A) 106:520-529, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Annelise Arth
- Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Vijaya Kancherla
- Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Helena Pachón
- Food Fortification Initiative, Atlanta, Georgia.,Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | | | | | - Godfrey P Oakley
- Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia
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72
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Methotrexate and Valproic Acid Affect Early Neurogenesis of Human Amniotic Fluid Stem Cells from Myelomeningocele. Stem Cells Int 2017; 2017:6101609. [PMID: 29056972 PMCID: PMC5615990 DOI: 10.1155/2017/6101609] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 07/18/2017] [Accepted: 08/01/2017] [Indexed: 11/18/2022] Open
Abstract
Myelomeningocele (MMC) is a severe type of neural tube defect (NTD), in which the backbone and spinal canal do not close completely during early embryonic development. This condition results in serious morbidity and increased mortality after birth. Folic acid significantly reduces, and conversely, folate antagonist methotrexate (MTX) and valproic acid (VPA) increase the occurrence of NTDs, including MMC. How these pharmacological agents exactly influence the early neurulation process is still largely unclear. Here, we characterized human amniotic fluid-derived stem cells (AFSCs) from prenatally diagnosed MMC and observed an effect of MTX and VPA administration on the early neural differentiation process. We found that MMC-derived AFSCs highly expressed early neural and radial glial genes that were negatively affected by MTX and VPA exposure. In conclusion, we setup a human cell model of MMC to study early neurogenesis and for drug screening purposes. We also proposed the detection of early neural gene expression in AFSCs as an additional MMC diagnostic tool.
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73
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Kagawa Y, Hiraoka M, Kageyama M, Kontai Y, Yurimoto M, Nishijima C, Sakamoto K. Medical cost savings in Sakado City and worldwide achieved by preventing disease by folic acid fortification. Congenit Anom (Kyoto) 2017; 57:157-165. [PMID: 28185308 PMCID: PMC5600128 DOI: 10.1111/cga.12215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/05/2017] [Accepted: 02/07/2017] [Indexed: 01/01/2023]
Abstract
The introduction of mandatory fortification of grains with folate in 1998 in the United States resulted in 767 fewer spina bifida cases annually and a cost saving of $603 million per year. However, far more significant medical cost savings result from preventing common diseases, including myocardial infarction, stroke, dementia and osteoporosis. A cost-effectiveness analysis showed a gain of 266 649 quality-adjusted life-years and $3.6 billion saved annually, mainly due to the reduction of cardiac infarction. The recommended folate intake in Japan is 240 μg/day whereas it is 400 μg/day internationally. Our Sakado Folate Project targeted individuals with genetic polymorphism of methylenetetrahydrofolate reductase or with hyperhomocysteinemia. Using, for example, folate-fortified rice, resulted in an increase in serum folate and a decrease in serum homocysteine in the participants, and reduced medical costs were achieved by decreasing myocardial infarction, stroke, dementia and fracture. Due to the small population of Sakado City (approximately 101 000) and small number of births (693) in 2015, a decrease in spina bifida could not be confirmed but there was a significant decrease in the number of very low birthweight infants. The genome notification of subjects was effective in motivating intake of folate, but the increase in serum folate (from 17.4 to 22.5 nmol/L, 129%) was less than that observed following compulsory folic acid fortification of cereals in the USA (from 12.1 to 30.2 nmol/L, 149.6%). Mandatory folic acid fortification is cheap in decreasing medical costs and is thus recommended in Japan.
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Affiliation(s)
- Yasuo Kagawa
- Department of Medical Chemistry, Kagawa Nutrition University, Sakado City, Japan
| | - Mami Hiraoka
- Shukutoku University, College of Nursing and Nutrition, School of Nutrition, Chiba City, Japan
| | - Mitsuyo Kageyama
- Yamanashi Gakuin University Faculty of Health and Nutrition, Kofu City, Japan
| | - Yoshiko Kontai
- University of Niigata Prefecture Faculty of Human Life Studies Department of Health and Nutrition, Niigata City, Japan
| | | | - Chiharu Nishijima
- Department of Medical Chemistry, Kagawa Nutrition University, Sakado City, Japan
| | - Kaori Sakamoto
- Department of Medical Chemistry, Kagawa Nutrition University, Sakado City, Japan
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74
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Kancherla V, Walani SR, Weakland AP, Bauwens L, Oakley GP, Warf BC. Scorecard for spina bifida research, prevention, and policy - A development process. Prev Med 2017; 99:13-20. [PMID: 28189808 DOI: 10.1016/j.ypmed.2017.01.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/19/2017] [Accepted: 01/31/2017] [Indexed: 01/09/2023]
Abstract
Spina bifida is a serious and largely preventable neural tube birth defect and an important cause of mortality and lifelong disability. The People and Organizations United for Spina Bifida and Hydrocephalus (PUSH!) Global Alliance was formed in 2014 to provide a common platform for various organizations worldwide to raise the visibility of spina bifida and hydrocephalus. In its formative phase, the alliance recognized that in order to accelerate surveillance, prevention, and care for these conditions, there was a need to provide an evidence-based assessment of how nations are performing in specific areas. In this paper, we describe the impetus for, and the process of, developing country-level scorecards for spina bifida surveillance, prevention and care. The PUSH! Executive Committee formulated a comprehensive list of six actionable indicators measuring availability of published studies on population-based folate studies; surveillance of prevalence and mortality; prevention-based policies; access to care; and quality of life associated with spina bifida. Rubrics were developed to score each country on the aforementioned indicators. Country scores were pooled across each indicator and the composite scores ranged between zero and three if there was a need for improvement, four and five if they were in good standing, or six for an excellent status. The scorecard included country-specific recommendations assimilated from the literature and published guidelines to aid policy makers in accelerating surveillance and prevention, and improving the care and quality of life indicators. For comparison, country-level scorecards were grouped by WHO-regions. Score cards were made available publicly through the website "www.pu-sh.org".
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Affiliation(s)
- Vijaya Kancherla
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
| | | | | | - Lieven Bauwens
- International Federation for Spina Bifida and Hydrocephalus, Brussels, Belgium
| | - Godfrey P Oakley
- Center for Spina Bifida Prevention, Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
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75
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Bae S, Kamynina E, Farinola AF, Caudill MA, Stover PJ, Cassano PA, Berry R, Peña-Rosas JP. Provision of folic acid for reducing arsenic toxicity in arsenic-exposed children and adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Sajin Bae
- Cornell University; Division of Nutritional Sciences; 324 Savage Hall 244 Garden Avenue Ithaca NY USA 14853
| | - Elena Kamynina
- Cornell University; Division of Nutritional Sciences; 324 Savage Hall 244 Garden Avenue Ithaca NY USA 14853
| | - Adetutu F Farinola
- University of Ibadan; Faculty of Public Health, Department of Human Nutrition and Dietetics; Seat of Wisdom Chapel Ibadan Oyo State Nigeria 200282
| | - Marie A Caudill
- Cornell University; Division of Nutritional Sciences; 324 Savage Hall 244 Garden Avenue Ithaca NY USA 14853
| | - Patrick J Stover
- Cornell University; Division of Nutritional Sciences; 324 Savage Hall 244 Garden Avenue Ithaca NY USA 14853
| | - Patricia A Cassano
- Cornell University; Division of Nutritional Sciences; 324 Savage Hall 244 Garden Avenue Ithaca NY USA 14853
| | - Robert Berry
- Independent cosultant; 1376 N Decatur Rd NE Atlanta Georgia USA 30306
| | - Juan Pablo Peña-Rosas
- World Health Organization; Evidence and Programme Guidance, Department of Nutrition for Health and Development; 20 Avenue Appia Geneva GE Switzerland 1211
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76
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Cost and Cost-Effectiveness Assessments of Newborn Screening for Critical Congenital Heart Disease Using Pulse Oximetry: A Review. Int J Neonatal Screen 2017; 3:34. [PMID: 29376140 PMCID: PMC5784211 DOI: 10.3390/ijns3040034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Screening newborns for critical congenital heart disease (CCHD) using pulse oximetry is recommended to allow for the prompt diagnosis and prevention of life-threatening crises. The present review summarizes and critiques six previously published estimates of the costs or cost-effectiveness of CCHD screening from the United Kingdom, United States, and China. Several elements that affect CCHD screening costs were assessed in varying numbers of studies, including screening staff time, instrumentation, and consumables, as well as costs of diagnosis and treatment. A previous US study that used conservative assumptions suggested that CCHD screening is likely to be considered cost-effective from the healthcare sector perspective. Newly available estimates of avoided infant CCHD deaths in several US states that implemented mandatory CCHD screening policies during 2011-2013 suggest a substantially larger reduction in deaths than was projected in the previous US cost-effectiveness analysis. Taking into account these new estimates, we estimate that cost per life-year gained could be as low as USD 12,000. However, that estimate does not take into account future costs of health care and education for surviving children with CCHD nor the costs incurred by health departments to support and monitor CCHD screening policies and programs.
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77
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Dunn A, Grosse SD, Zuvekas SH. Adjusting Health Expenditures for Inflation: A Review of Measures for Health Services Research in the United States. Health Serv Res 2016; 53:175-196. [PMID: 27873305 DOI: 10.1111/1475-6773.12612] [Citation(s) in RCA: 323] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To provide guidance on selecting the most appropriate price index for adjusting health expenditures or costs for inflation. DATA SOURCES Major price index series produced by federal statistical agencies. STUDY DESIGN We compare the key characteristics of each index and develop suggestions on specific indexes to use in many common situations and general guidance in others. DATA COLLECTION/EXTRACTION METHODS Price series and methodological documentation were downloaded from federal websites and supplemented with literature scans. PRINCIPAL FINDINGS The gross domestic product implicit price deflator or the overall Personal Consumption Expenditures (PCE) index is preferable to the Consumer Price Index (CPI-U) to adjust for general inflation, in most cases. The Personal Health Care (PHC) index or the PCE health-by-function index is generally preferred to adjust total medical expenditures for inflation. The CPI medical care index is preferred for the adjustment of consumer out-of-pocket expenditures for inflation. A new, experimental disease-specific Medical Care Expenditure Index is now available to adjust payments for disease treatment episodes. CONCLUSIONS There is no single gold standard for adjusting health expenditures for inflation. Our discussion of best practices can help researchers select the index best suited to their study.
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Affiliation(s)
- Abe Dunn
- Bureau of Economic Analysis, Washington, DC
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Samuel H Zuvekas
- Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD
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78
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Garcia-Casal MN, Peña-Rosas JP, Mclean M, De-Regil LM, Zamora G. Fortification of condiments with micronutrients in public health: from proof of concept to scaling up. Ann N Y Acad Sci 2016; 1379:38-47. [PMID: 27508517 DOI: 10.1111/nyas.13185] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/22/2016] [Accepted: 06/24/2016] [Indexed: 01/19/2023]
Abstract
Fortification of condiments or seasonings may be useful for delivering micronutrients if they are consumed consistently by most of the population, as occurs in many countries. The World Health Organization, in collaboration with the Micronutrient Initiative and the Sackler Institute for Nutrition Science at the New York Academy of Sciences, convened a technical consultation on "Fortification of Condiments and Seasonings with Vitamins and Minerals in Public Health: from Proof of Concept to Scaling Up" to review the role of condiments and seasonings in improving micronutrient status, as constituents of regular diets and patterns of production and consumption worldwide. The consultation covered aspects related to implementation, monitoring, evaluation, and legal frameworks of fortification programs, as well as food safety and policy coherence for condiment fortification in the context of other public health strategies. This paper introduces the background and rationale of the technical consultation, synopsizes the presentations, and provides a summary of the main considerations proposed by the working groups.
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Affiliation(s)
- Maria Nieves Garcia-Casal
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland.
| | - Juan Pablo Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Mireille Mclean
- The Sackler Institute for Nutrition Science, The New York Academy of Sciences, New York, New York
| | | | - Gerardo Zamora
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
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79
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Teutsch SM, Glied S, Roy K. Strengthening the Use of Economics in Informing U.S. Public Health Policy. Am J Prev Med 2016; 50:S1-S3. [PMID: 27102852 PMCID: PMC8456754 DOI: 10.1016/j.amepre.2016.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 01/19/2016] [Accepted: 02/05/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Steven M Teutsch
- Public Health Institute, Oakland, California; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California; Fielding School of Public Health, University of California, Los Angeles, California
| | - Sherry Glied
- Robert F. Wagner Graduate School of Public Service, New York University, New York, New York
| | - Kakoli Roy
- Policy Research, Analysis, and Development Office, Office of the Associate Director for Policy, CDC, Atlanta, Georgia.
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