human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Since the publication of r and omised trials showing firm evidence of prevention of neural tube defects with periconceptional folic acid , there have been population health promotion programmes to encourage women to take folic acid supplements , and the introduction of voluntary fortification of some foods with folic acid in Australia . In order to evaluate these two strategies , we collected data by self-administered question naire from a r and om sample of recently pregnant women in Western Australia between September 1997 and March 2000 .  Response to health promotion was measured in three ways : ( 1 ) knowledge of the association between periconceptional folate and prevention of spina bifida ( the ' correct message ' ) ; ( 2 ) use of periconceptional vitamin supplements of folic acid daily in the periconceptional period ; and ( 3 ) daily folate intake from fortified foods in the 6 months before pregnancy . We examined the relationship of maternal demographic and behavioural characteristics with these three measures . Overall , 62.3 % of women were aware of the correct message before pregnancy , 28.5 % reported taking 200 microg or more of folic acid from supplements daily in the periconceptional period and 56.6 % of women obtained 100 microg or more of folic acid from fortified foods . Women who first became aware of the correct message during pregnancy or who were unaware of the correct message before or during pregnancy were more likely than women aware before pregnancy to be younger , having their first pregnancy , be single or in a de facto relationship , have no tertiary education , and be a public patient . Similar associations were seen for women taking either no folic acid or < 200 microg of folic acid in supplements daily in the periconceptional period . There were no significant associations between these demographic variables and amount of folate obtained from fortified foods . Women who were unaware of the correct message and did not take folic acid supplements were more likely to have smoked , not to have engaged in exercise , and not to have planned their pregnancy , whereas there was no association with these behavioural characteristics and intake of folate from fortified foods . These results indicate that health promotion strategies have not reached all segments of the target population equally , but there is no such disparity with folate-fortified foods , and they suggest that m and atory fortification of a staple food is likely to reach all women regardless of demographic and behavioural characteristics , and hence provide improved opportunity for prevention of neural tube defects in Australia BACKGROUND Pre-conception counselling has the potential to reduce pregnancy complications and congenital disorders . The timing of counselling , before conception , is crucial to maximize the benefit . As many couples are unaware of their risk status and the fact that the first period of pregnancy is crucial , they do not seek information before pregnancy occurs . To reach couples with timely information , it seems that a health care worker needs to take the initiative . In The Netherl and s , the GP is in an ideal position to offer pre-conception counselling . OBJECTIVE The aim of this study was to determine the interest of women aged 18 - 40 in pre-conception counselling  if this is offered to them by their own GP . METHOD A cohort of women ( n = 1206 ) received a personal letter from their own GP with an offer of pre-conception counselling . The women were requested to fill in a reply form , indicating if they were interested , might be interested ( if they decided to become pregnant ) or were not interested in an invitation for pre-conception counselling . When interested , they were asked to give an indication as to when they were planning a pregnancy . Women who were not interested were requested to give a reason . RESULTS Almost 70 % of the women returned the reply form . Up to the age of 29 years , at least 80 % of the respondents were interested or might be interested should they decide to have children . Most women , especially the younger women , do not know exactly when they wish to become pregnant . Regardless of age , > 70 % of the respondents were interested . Only 11 % of the respondents indicated specifically that they were not interested in advice . CONCLUSION Women are interested in GP-initiated pre-conception counselling . Further research is needed to assess the effect of programmed and systematic pre-conception counselling , offered by GPs , on pregnancy outcome and the health of the children . A r and omized controlled trial to assess these effects currently is being conducted at the Department of General Practice in Leiden OBJECTIVES To assess women 's concerns when interviewed about the association between  folate and neural tube defects ( NTDs ) and to determine how this is affected by time , being folate aware , having seen folate promotional material or being pregnant . DESIGN As part of a community r and omized trial outcomes evaluation , independent cross-sectional follow-up surveys were carried out in 1997 and 2000 . SETTING AND PARTICIPANTS Six local government areas in the state of Victoria , Australia ; 2431 women aged between 15 and 44 years . MAIN VARIABLES STUDIED Whether or not women knew of the association between folate and NTDs ( i.e. were folate aware ) , whether or not women had been concerned by seeing folate/NTD information and if an interview about folate and NTDs had raised any concerns for them . RESULTS In the 1997 survey , 36 % of women said that the interview had raised concerns and this decreased to 26 % in 2000 . Women who were folate aware were significantly less likely to have raised concerns than women who were not folate aware ( OR(adj ) = 0.38 , 95 % CI 0.24 - 0.60 ) . In general , women who had seen promotional material were less likely to feel concern about the interview than those who had not , although this varied with whether or not the promotional material had raised concerns . These effects were greater in women who were pregnant . CONCLUSIONS Women had increased concerns having seen folate promotional material and after being interviewed about it . These results are consistent with the proposition that an initial emotional response to sensitive health information is part of an adaptive response appropriate to the process of health-related behaviour change OBJECTIVE To study the knowledge , attitude and practice of pregnant women regarding  periconceptional folic acid ( FA ) intake . DESIGN Question naire-based prospect i ve study . SETTING Antenatal clinic of a District General Hospital . SUBJECTS Three-hundred pregnant women in an antenatal clinic . RESULTS Nearly all ( 298/300 ) had heard of FA . A majority ( 275/300 , 91 % ) knew that FA could prevent neural tube defects , and married women those with higher education those of Social Classes 1 - 3 and women over 30 years of age were more likely to be thus aware . Knowledge about the correct timing of FA intake was seen in 76 % and was more likely in those with higher education married women and women age over 30 years Intake of FA  in the periconceptional period was seen in 134/300 ( 44.6 % ) women and was most likely in the married , Social Classes 1 - 3 , women with higher education ( all P<0.001 ) , non-smokers women with a planned pregnancy and women aged 30 years and over CONCLUSIONS The knowledge of the correct timing of FA intake was present in only 76 % . Less than half ( 44.6 % ) had taken FA in the periconceptional period , and this was far more common in the more ' privileged ' classes . Low socio-economic status , age less than 30 years , lower educational status and unplanned pregnancy were high risk factors for not taking FA . The challenge to the medical profession for targeting this group can not be over-emphasised OBJECTIVE To estimate folate intake and knowledge in women of childbearing age , in relation to risk of neural tube defects . SUBJECTS/ SETTING One hundred forty-eight women ( aged 18 to 45 years ) in the Vancouver area of British Columbia , Canada . DESIGN Using an interviewer-administered survey , we examined women for folate knowledge and the relation of folate knowledge to intake in a r and om sample . Contribution of folate from food , fortified grain products , and supplements was assessed by vali date d semiquantitative food frequency question naire . STATISTICAL ANALYSIS PERFORMED Descriptive statistics , t tests , Chi;(2 ) , Pearson correlation analysis . RESULTS Mean daily folate intake from food , fortified foods , and supplementation was 812+/-710 Dietary Folate Equivalents (DFE)/day . Fortification of bread and grain products contributed 104+/-68 microg synthetic folic acid (SFA)/day ( equal to 174+/-114 DFE ) , and supplements contributed 205+/-388 microg SFA/day . Although 86 % of women met the Estimated Average Requirement ( 320 DFE/day ) for folate , only 26 % met the recommendation ( 400 microg SFA/day ) for women capable of becoming pregnant . Most ( 95 % ) of the women had heard of folate , but only 25 % knew that it could prevent birth defects . One-fourth of the women had good or very good knowledge of folate-rich foods . However , folate knowledge was not related to its intake . The most common sources of folate information were magazines/newspapers , doctors , and television/radio . Lack of awareness of the importance of folate was the most common reason given for choosing not to use folic acid supplements before pregnancy . However , 78 % of the women indicated that , with knowledge of the benefits of folate , they would use supplemental folic acid daily to reduce the risk of birth defects . APPLICATIONS/ CONCLUSIONS Educational strategies are required to increase folate awareness among women and to promote the benefits of periconceptional folic acid supplementation . Targeting physicians to educate women on the importance of folate could be a potentially successful route . Summary .¶ Objectives : The periconceptional intake of 0.4 mg folic acid is recommended in many countries to prevent neural tube defects . This paper describes the poor implementation of corresponding guidelines in Germany , the effectiveness of an intervention-based on providing adequate information and the problems associated with the implementation.¶ Methods : Two cross sectional studies investigated knowledge , attitude , and behaviour of r and omly sample d gynaecologists ( n = 24/27 ) , pharmacists ( n = 21/21 ) , and women in childbed ( n = 131/118 ) before and after the information campaign.¶ Results : Before the intervention , 3.8 % of the women implemented  folic-acid-prophylaxis  compared with 9.3 % afterwards ( p = n.s . ) . The awareness of the prophylaxis before pregnancy correlated with socio-economic status and rose from 28 % ( before ) to 42 % after intervention ( p<0.05 ) . Before the intervention , 38 % of the gynaecologists and 38 % of the pharmacists recommended the prophylaxis compared with 74 % ( p<0.05 ) and 43 % ( p = n.s . ) afterwards.¶ Conclusions : The effect of the intervention was small . To improve the situation , fortification of specially selected and labelled food should be considered . An accompanying nation-wide information campaign should focus on women with lower socio-economic status Objectives : To determine the changes since 1996 in knowledge of folate for the prevention of neural tube defects ( NTDs ) among women of child‐bearing age and measure the residual effect of an earlier consumer‐directed information campaign Objective To assess obstetrician-gynecologists ' knowledge of and clinical practice concerning folate . Methods We mailed surveys on nutrition during pregnancy to the 230 ACOG Fellows who are members of the Collaborative Ambulatory Research Network and to a r and om sample of 800 Fellows who are not members of the Network . Our results focus on questions concerning folate . Results We analyzed 488 surveys ( a 47.4 % response rate ) . Approximately two thirds of respondents screen their pregnant patients for folate  intake . Fewer ( 53 % ) screen their nonpregnant patients of childbearing age . Those who screened their patients for folate intake were more likely to counsel pregnant patients about diet . They also were more likely to believe that nutritional counseling would improve pregnancy outcomes ( 70.0 % versus 56.5 % ) and overall patient health ( 77.5 % versus 66.5 % ) . Most Fellows were aware that macrocytic anemia was a manifestation of folate deficiency ( 90.4 % ) and that folic acid supplementation during preconception and the early prenatal period helps protect against neural tube defects ( 96.5 % ) . They were aware that alcoholics ( 91.4 % ) , smokers ( 61.3 % ) , and lactating women ( 53.5 % ) are at increased risk of folate deficiency . They were less aware of other consequences of low folate intake , such as increased serum homocysteine ( 20.3 % ) . Respondents who screen their pregnant patients for folate intake correctly answered more of the knowledge questions about folate than physicians who do not screen . Conclusion Obstetrician-gynecologists are generally aware of the link between folate intake and neural tube defects , but are less aware of other aspects of folate metabolism BACKGROUND A preconception care program has the potential to assist women who want to become pregnant by advising these women about risk factors , healthy lifestyles , and assessing readiness for pregnancy . We conducted a r and omized controlled trial to determine whether comprehensive preconception risk assessment at the time of a negative pregnancy test followed by referral to primary care services is effective in initiating treatment for women with preconception risk factors . METHODS One hundred seventy women were offered preconception risk assessment following a negative pregnancy test . Women were 
    Output:
    
agent
There were factors that are particularly associated with lower rates of use of folic acid supplements .
One of the most important of these is the link with unintended pregnancy , followed by age , socio-economic and ethnic group .
Integrated campaigns can increase the use of folic acid supplements to some extent .
Research trials indicated that : ( i ) printed re sources and the mass media used in isolation are not effective in the longer term ; and ( ii ) health-care-based initiatives can be effective and are more likely to be successful if they include making supplements easily available .
Campaigns and interventions have the potential to exacerbate socio-economic inequalities in folic acid use .
However , even high- quality campaigns that increase use result in under half of women in the target group taking supplements
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Since the publication of r and omised trials showing firm evidence of prevention of neural tube defects with periconceptional folic acid , there have been population health promotion programmes to encourage women to take folic acid supplements , and the introduction of voluntary fortification of some foods with folic acid in Australia . In order to evaluate these two strategies , we collected data by self-administered question naire from a r and om sample of recently pregnant women in Western Australia between September 1997 and March 2000 .  Response to health promotion was measured in three ways : ( 1 ) knowledge of the association between periconceptional folate and prevention of spina bifida ( the ' correct message ' ) ; ( 2 ) use of periconceptional vitamin supplements of folic acid daily in the periconceptional period ; and ( 3 ) daily folate intake from fortified foods in the 6 months before pregnancy . We examined the relationship of maternal demographic and behavioural characteristics with these three measures . Overall , 62.3 % of women were aware of the correct message before pregnancy , 28.5 % reported taking 200 microg or more of folic acid from supplements daily in the periconceptional period and 56.6 % of women obtained 100 microg or more of folic acid from fortified foods . Women who first became aware of the correct message during pregnancy or who were unaware of the correct message before or during pregnancy were more likely than women aware before pregnancy to be younger , having their first pregnancy , be single or in a de facto relationship , have no tertiary education , and be a public patient . Similar associations were seen for women taking either no folic acid or < 200 microg of folic acid in supplements daily in the periconceptional period . There were no significant associations between these demographic variables and amount of folate obtained from fortified foods . Women who were unaware of the correct message and did not take folic acid supplements were more likely to have smoked , not to have engaged in exercise , and not to have planned their pregnancy , whereas there was no association with these behavioural characteristics and intake of folate from fortified foods . These results indicate that health promotion strategies have not reached all segments of the target population equally , but there is no such disparity with folate-fortified foods , and they suggest that m and atory fortification of a staple food is likely to reach all women regardless of demographic and behavioural characteristics , and hence provide improved opportunity for prevention of neural tube defects in Australia BACKGROUND Pre-conception counselling has the potential to reduce pregnancy complications and congenital disorders . The timing of counselling , before conception , is crucial to maximize the benefit . As many couples are unaware of their risk status and the fact that the first period of pregnancy is crucial , they do not seek information before pregnancy occurs . To reach couples with timely information , it seems that a health care worker needs to take the initiative . In The Netherl and s , the GP is in an ideal position to offer pre-conception counselling . OBJECTIVE The aim of this study was to determine the interest of women aged 18 - 40 in pre-conception counselling  if this is offered to them by their own GP . METHOD A cohort of women ( n = 1206 ) received a personal letter from their own GP with an offer of pre-conception counselling . The women were requested to fill in a reply form , indicating if they were interested , might be interested ( if they decided to become pregnant ) or were not interested in an invitation for pre-conception counselling . When interested , they were asked to give an indication as to when they were planning a pregnancy . Women who were not interested were requested to give a reason . RESULTS Almost 70 % of the women returned the reply form . Up to the age of 29 years , at least 80 % of the respondents were interested or might be interested should they decide to have children . Most women , especially the younger women , do not know exactly when they wish to become pregnant . Regardless of age , > 70 % of the respondents were interested . Only 11 % of the respondents indicated specifically that they were not interested in advice . CONCLUSION Women are interested in GP-initiated pre-conception counselling . Further research is needed to assess the effect of programmed and systematic pre-conception counselling , offered by GPs , on pregnancy outcome and the health of the children . A r and omized controlled trial to assess these effects currently is being conducted at the Department of General Practice in Leiden OBJECTIVES To assess women 's concerns when interviewed about the association between  folate and neural tube defects ( NTDs ) and to determine how this is affected by time , being folate aware , having seen folate promotional material or being pregnant . DESIGN As part of a community r and omized trial outcomes evaluation , independent cross-sectional follow-up surveys were carried out in 1997 and 2000 . SETTING AND PARTICIPANTS Six local government areas in the state of Victoria , Australia ; 2431 women aged between 15 and 44 years . MAIN VARIABLES STUDIED Whether or not women knew of the association between folate and NTDs ( i.e. were folate aware ) , whether or not women had been concerned by seeing folate/NTD information and if an interview about folate and NTDs had raised any concerns for them . RESULTS In the 1997 survey , 36 % of women said that the interview had raised concerns and this decreased to 26 % in 2000 . Women who were folate aware were significantly less likely to have raised concerns than women who were not folate aware ( OR(adj ) = 0.38 , 95 % CI 0.24 - 0.60 ) . In general , women who had seen promotional material were less likely to feel concern about the interview than those who had not , although this varied with whether or not the promotional material had raised concerns . These effects were greater in women who were pregnant . CONCLUSIONS Women had increased concerns having seen folate promotional material and after being interviewed about it . These results are consistent with the proposition that an initial emotional response to sensitive health information is part of an adaptive response appropriate to the process of health-related behaviour change OBJECTIVE To study the knowledge , attitude and practice of pregnant women regarding  periconceptional folic acid ( FA ) intake . DESIGN Question naire-based prospect i ve study . SETTING Antenatal clinic of a District General Hospital . SUBJECTS Three-hundred pregnant women in an antenatal clinic . RESULTS Nearly all ( 298/300 ) had heard of FA . A majority ( 275/300 , 91 % ) knew that FA could prevent neural tube defects , and married women those with higher education those of Social Classes 1 - 3 and women over 30 years of age were more likely to be thus aware . Knowledge about the correct timing of FA intake was seen in 76 % and was more likely in those with higher education married women and women age over 30 years Intake of FA  in the periconceptional period was seen in 134/300 ( 44.6 % ) women and was most likely in the married , Social Classes 1 - 3 , women with higher education ( all P<0.001 ) , non-smokers women with a planned pregnancy and women aged 30 years and over CONCLUSIONS The knowledge of the correct timing of FA intake was present in only 76 % . Less than half ( 44.6 % ) had taken FA in the periconceptional period , and this was far more common in the more ' privileged ' classes . Low socio-economic status , age less than 30 years , lower educational status and unplanned pregnancy were high risk factors for not taking FA . The challenge to the medical profession for targeting this group can not be over-emphasised OBJECTIVE To estimate folate intake and knowledge in women of childbearing age , in relation to risk of neural tube defects . SUBJECTS/ SETTING One hundred forty-eight women ( aged 18 to 45 years ) in the Vancouver area of British Columbia , Canada . DESIGN Using an interviewer-administered survey , we examined women for folate knowledge and the relation of folate knowledge to intake in a r and om sample . Contribution of folate from food , fortified grain products , and supplements was assessed by vali date d semiquantitative food frequency question naire . STATISTICAL ANALYSIS PERFORMED Descriptive statistics , t tests , Chi;(2 ) , Pearson correlation analysis . RESULTS Mean daily folate intake from food , fortified foods , and supplementation was 812+/-710 Dietary Folate Equivalents (DFE)/day . Fortification of bread and grain products contributed 104+/-68 microg synthetic folic acid (SFA)/day ( equal to 174+/-114 DFE ) , and supplements contributed 205+/-388 microg SFA/day . Although 86 % of women met the Estimated Average Requirement ( 320 DFE/day ) for folate , only 26 % met the recommendation ( 400 microg SFA/day ) for women capable of becoming pregnant . Most ( 95 % ) of the women had heard of folate , but only 25 % knew that it could prevent birth defects . One-fourth of the women had good or very good knowledge of folate-rich foods . However , folate knowledge was not related to its intake . The most common sources of folate information were magazines/newspapers , doctors , and television/radio . Lack of awareness of the importance of folate was the most common reason given for choosing not to use folic acid supplements before pregnancy . However , 78 % of the women indicated that , with knowledge of the benefits of folate , they would use supplemental folic acid daily to reduce the risk of birth defects . APPLICATIONS/ CONCLUSIONS Educational strategies are required to increase folate awareness among women and to promote the benefits of periconceptional folic acid supplementation . Targeting physicians to educate women on the importance of folate could be a potentially successful route . Summary .¶ Objectives : The periconceptional intake of 0.4 mg folic acid is recommended in many countries to prevent neural tube defects . This paper describes the poor implementation of corresponding guidelines in Germany , the effectiveness of an intervention-based on providing adequate information and the problems associated with the implementation.¶ Methods : Two cross sectional studies investigated knowledge , attitude , and behaviour of r and omly sample d gynaecologists ( n = 24/27 ) , pharmacists ( n = 21/21 ) , and women in childbed ( n = 131/118 ) before and after the information campaign.¶ Results : Before the intervention , 3.8 % of the women implemented  folic-acid-prophylaxis  compared with 9.3 % afterwards ( p = n.s . ) . The awareness of the prophylaxis before pregnancy correlated with socio-economic status and rose from 28 % ( before ) to 42 % after intervention ( p<0.05 ) . Before the intervention , 38 % of the gynaecologists and 38 % of the pharmacists recommended the prophylaxis compared with 74 % ( p<0.05 ) and 43 % ( p = n.s . ) afterwards.¶ Conclusions : The effect of the intervention was small . To improve the situation , fortification of specially selected and labelled food should be considered . An accompanying nation-wide information campaign should focus on women with lower socio-economic status Objectives : To determine the changes since 1996 in knowledge of folate for the prevention of neural tube defects ( NTDs ) among women of child‐bearing age and measure the residual effect of an earlier consumer‐directed information campaign Objective To assess obstetrician-gynecologists ' knowledge of and clinical practice concerning folate . Methods We mailed surveys on nutrition during pregnancy to the 230 ACOG Fellows who are members of the Collaborative Ambulatory Research Network and to a r and om sample of 800 Fellows who are not members of the Network . Our results focus on questions concerning folate . Results We analyzed 488 surveys ( a 47.4 % response rate ) . Approximately two thirds of respondents screen their pregnant patients for folate  intake . Fewer ( 53 % ) screen their nonpregnant patients of childbearing age . Those who screened their patients for folate intake were more likely to counsel pregnant patients about diet . They also were more likely to believe that nutritional counseling would improve pregnancy outcomes ( 70.0 % versus 56.5 % ) and overall patient health ( 77.5 % versus 66.5 % ) . Most Fellows were aware that macrocytic anemia was a manifestation of folate deficiency ( 90.4 % ) and that folic acid supplementation during preconception and the early prenatal period helps protect against neural tube defects ( 96.5 % ) . They were aware that alcoholics ( 91.4 % ) , smokers ( 61.3 % ) , and lactating women ( 53.5 % ) are at increased risk of folate deficiency . They were less aware of other consequences of low folate intake , such as increased serum homocysteine ( 20.3 % ) . Respondents who screen their pregnant patients for folate intake correctly answered more of the knowledge questions about folate than physicians who do not screen . Conclusion Obstetrician-gynecologists are generally aware of the link between folate intake and neural tube defects , but are less aware of other aspects of folate metabolism BACKGROUND A preconception care program has the potential to assist women who want to become pregnant by advising these women about risk factors , healthy lifestyles , and assessing readiness for pregnancy . We conducted a r and omized controlled trial to determine whether comprehensive preconception risk assessment at the time of a negative pregnancy test followed by referral to primary care services is effective in initiating treatment for women with preconception risk factors . METHODS One hundred seventy women were offered preconception risk assessment following a negative pregnancy test . Women were 
    Output:
    