Shlobin Nathan A, Roach Jordan T, Kancherla Vijaya, Caceres Adrian, Ocal Eylem, Ghotme Kemel A, Lam Sandi, Park Kee B, Rosseau Gail, Blount Jeffrey P, Boop Frederick A
1Division of Pediatric Neurosurgery, Lurie Children's Hospital, Chicago, Illinois.
2Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Neurosurg Pediatr. 2022 Nov 4;31(1):8-15. doi: 10.3171/2022.9.PEDS22188. Print 2023 Jan 1.
The global neurosurgery movement arose at the crossroads of unmet neurosurgical needs and public health to address the global burden of neurosurgical disease. The case of folic acid fortification (FAF) of staple foods for the prevention of spina bifida and anencephaly (SBA) represents an example of a new neurosurgical paradigm focused on public health intervention in addition to the treatment of individual cases. The Global Alliance for the Prevention of Spina Bifida-F (GAPSBiF), a multidisciplinary coalition of neurosurgeons, pediatricians, geneticists, epidemiologists, food scientists, and fortification policy experts, was formed to advocate for FAF of staple foods worldwide. This paper serves as a review of the work of GAPSBiF thus far in advocating for universal FAF of commonly consumed staple foods to equitably prevent SBA caused by folic acid insufficiency.
A narrative review was performed using the PubMed and Google Scholar databases.
In this review, the authors describe the impact of SBA on patients, caregivers, and health systems, as well as characterize the multifaceted requirements for proper spina bifida care, including multidisciplinary clinics and the transition of care, while highlighting the role of neurosurgeons. Then they discuss prevention policy approaches, including supplementation, fortification, and hybrid efforts with folic acid. Next, they use the example of FAF of staple foods as a model for neurosurgeons' involvement in global public health through clinical practice, research, education and training, and advocacy. Last, they describe mechanisms for involvement in the above initiatives as a potential academic tenure track, including institutional partnerships, organized neurosurgery, neurosurgical expert groups, nongovernmental organizations, national or international governments, and multidisciplinary coalitions.
The role of neurosurgeons in caring for children with spina bifida extends beyond treating patients in clinical practice and includes research, education and training, and advocacy initiatives to promote context-specific, evidence-based initiatives to public health problems. Promoting and championing FAF serves as an example of the far-reaching, impactful role that neurosurgeons worldwide may play at the intersection of neurosurgery and public health.
全球神经外科运动兴起于未满足的神经外科需求与公共卫生的交叉点，以应对神经外科疾病的全球负担。主食叶酸强化（FAF）预防脊柱裂和无脑畸形（SBA）的案例代表了一种新的神经外科范式，该范式除了治疗个体病例外，还侧重于公共卫生干预。全球预防脊柱裂 -F 联盟（GAPSBiF）由神经外科医生、儿科医生、遗传学家、流行病学家、食品科学家和强化政策专家组成的多学科联盟，旨在倡导全球范围内主食的叶酸强化。本文旨在回顾 GAPSBiF 迄今为止在倡导普遍对常见主食进行叶酸强化以公平预防叶酸缺乏导致的 SBA 方面所做的工作。
使用 PubMed 和谷歌学术数据库进行叙述性综述。
在本综述中，作者描述了 SBA 对患者、护理人员和卫生系统的影响，并阐述了脊柱裂适当护理的多方面要求，包括多学科诊所和护理过渡，同时强调了神经外科医生的作用。然后他们讨论了预防政策方法，包括补充、强化以及叶酸的混合措施。接下来，他们以主食叶酸强化为例，说明神经外科医生如何通过临床实践、研究、教育和培训以及宣传参与全球公共卫生。最后，他们描述了参与上述倡议作为潜在学术任期途径的机制，包括机构伙伴关系、有组织的神经外科、神经外科专家组、非政府组织、国家或国际政府以及多学科联盟。
神经外科医生在照顾脊柱裂儿童方面的作用不仅限于临床实践中治疗患者，还包括研究、教育和培训以及宣传倡议，以促进针对公共卫生问题的因地制宜、基于证据的倡议。推广和支持主食叶酸强化是全球神经外科医生在神经外科与公共卫生交叉领域可能发挥的深远、有影响力作用的一个例子。
