Homologous recombination deficiency (HRD) status predicts response to standard neoadjuvant chemotherapy in patients with triple-negative or BRCA1/2 mutation-associated breast cancer.

PURPOSE: Defects in the homologous recombination (HR) DNA repair pathway sensitize tumors to therapeutics that target this pathway. A significant proportion of triple-negative breast cancers (TNBC) carry HR defects. The HRD assay is highly associated with sensitivity to neoadjuvant platinum-based chemotherapy in TNBC. Standard chemotherapy consists of some combination of an anthracycline, cyclophosphamide, and taxane. This study assesses the association of HR deficiency status with response to standard neoadjuvant chemotherapy in TNBC or BRCA1/2 mutation-associated breast cancer. METHODS: Tumor samples were retrospectively obtained from 45 TNBC patients and 2 BRCA1/2 mutant, hormone receptor-positive/HER2-negative breast cancer patients who received anthracycline- and/or taxane-based neoadjuvant chemotherapy at Stanford University or Cedars-Sinai Medical Centers. The HRD score and tumor BRCA1/2 mutation status were determined from baseline tumor biopsies. HR deficient tumors were those with a HRD score of ≥ 42 or a tumor BRCA1/2 mutation. Response was categorized by the residual cancer burden (RCB) index. RESULTS: HR deficient patients were more likely to achieve a pathologic complete response (pCR) compared with non-deficient patients (OR 13.06, CI 1.52-11.241, p = 0.0028). Among BRCA1/2 mutation wild-type patients, HR deficient patients were more likely to achieve a pCR (OR 16, 95% CI 1.65-160.41, p = 0.0041) compared with HR non-deficient patients. Further, HRD scores were highly concordant pre- and post-therapy (Spearman correlation > 99%). CONCLUSIONS: HR deficiency status is significantly associated with response to standard neoadjuvant chemotherapy in TNBC. This observation is consistent with the mechanisms of action of doxorubicin and cyclophosphamide as DNA damaging agents.

Tumor BRCA1 Reversion Mutation Arising during Neoadjuvant Platinum-Based Chemotherapy in Triple-Negative Breast Cancer Is Associated with Therapy Resistance.

Purpose: In germline BRCA1 or BRCA2 (BRCA1/2) mutation carriers, restoration of tumor BRCA1/2 function by a secondary mutation is recognized as a mechanism of resistance to platinum and PARP inhibitors, primarily in ovarian cancer. We evaluated this mechanism of resistance in newly diagnosed patients with BRCA1/2-mutant breast cancer with poor response to neoadjuvant platinum-based therapy.Experimental Design: PrECOG 0105 was a phase II neoadjuvant study of gemcitabine, carboplatin, and iniparib in patients with stage I-IIIA triple-negative or BRCA1/2 mutation-associated breast cancer (n = 80). All patients underwent comprehensive BRCA1/2 genotyping. For mutation carriers with moderate or extensive residual disease after neoadjuvant therapy, BRCA1/2 status was resequenced in the residual surgical breast tumor tissue.Results: Nineteen patients had a deleterious germline BRCA1/2 mutation, and four had moderate residual disease at surgery. BRCA1/2 sequencing of residual tissue was performed on three patients. These patients had BRCA1 1479delAG, 3374insGA, and W1712X mutations, respectively, with LOH at these loci in the pretreatment tumors. In the first case, a new BRCA1 mutation was detected in the residual disease. This resulted in a 14-amino acid deletion and restoration of the BRCA1 reading frame. A local relapse biopsy 4 months later revealed the identical reversion mutation, and the patient subsequently died from metastatic breast cancer.Conclusions: We report a BRCA1 reversion mutation in a patient newly diagnosed with triple-negative breast cancer that developed over 18 weeks of platinum-based neoadjuvant therapy. This was associated with poor therapy response, early relapse, and death. Clin Cancer Res; 23(13); 3365-70. ©2017 AACR.

Phase II Study of Gemcitabine, Carboplatin, and Iniparib As Neoadjuvant Therapy for Triple-Negative and BRCA1/2 Mutation-Associated Breast Cancer With Assessment of a Tumor-Based Measure of Genomic Instability: PrECOG 0105.

PURPOSE: This study was designed to assess efficacy, safety, and predictors of response to iniparib in combination with gemcitabine and carboplatin in early-stage triple-negative and BRCA1/2 mutation-associated breast cancer. PATIENTS AND METHODS: This single-arm phase II study enrolled patients with stage I to IIIA (T ≥ 1 cm) estrogen receptor-negative (≤ 5%), progesterone receptor-negative (≤ 5%), and human epidermal growth factor receptor 2-negative or BRCA1/2 mutation-associated breast cancer. Neoadjuvant gemcitabine (1,000 mg/m(2) intravenously [IV] on days 1 and 8), carboplatin (area under curve of 2 IV on days 1 and 8), and iniparib (5.6 mg/kg IV on days 1, 4, 8, and 11) were administered every 21 days for four cycles, until the protocol was amended to six cycles. The primary end point was pathologic complete response (no invasive carcinoma in breast or axilla). All patients underwent comprehensive BRCA1/2 genotyping, and homologous recombination deficiency was assessed by loss of heterozygosity (HRD-LOH) in pretreatment core breast biopsies. RESULTS: Among 80 patients, median age was 48 years; 19 patients (24%) had germline BRCA1 or BRCA2 mutations; clinical stage was I (13%), IIA (36%), IIB (36%), and IIIA (15%). Overall pathologic complete response rate in the intent-to-treat population (n = 80) was 36% (90% CI, 27 to 46). Mean HRD-LOH scores were higher in responders compared with nonresponders (P = .02) and remained significant when BRCA1/2 germline mutations carriers were excluded (P = .021). CONCLUSION: Preoperative combination of gemcitabine, carboplatin, and iniparib is active in the treatment of early-stage triple-negative and BRCA1/2 mutation-associated breast cancer. The HRD-LOH assay was able to identify patients with sporadic triple-negative breast cancer lacking a BRCA1/2 mutation, but with an elevated HRD-LOH score, who achieved a favorable pathologic response. Confirmatory controlled trials are warranted.

[Taiwan occupational health nursing: practices, policies and future trends].

The steady evolution of domestic industries and the continued expansion of the workforce have outdated Taiwan's traditional model of occupational health nursing, which focuses on preventing work-related diseases and ensuring workplace safety. Professional-competency evaluations, now widely used within the medical and other professional communities to confirm that individuals have mastered relevant knowledge and skills, are a fixture in service quality management and related strategies. Occupational health nurses have a critical role in promoting and ensuring the quality of occupational-health related services. A multifaceted strategy is needed to update the domestic model of occupational health nursing. This strategy should include: 1) Set professional standards and create standard teaching materials for national occupational health nurses; 2) Enhance the professional efficacy of nurses in this field; 3) Survey the relevant role functions and education/training needs of occupational health nurses; 4) Develop relevant elective courses; and 5) Format courses/curricula for e-learning and for multimedia platforms. Furthermore, after implementation of this strategy, the model should be evaluated in terms of the knowledge and skills acquired by occupational health nurses. It is hoped that by reflecting local needs and experiences this new model will update the field of occupational health nursing to meet the needs of the current and future workplace in Taiwan and increase nursing knowledge and skills in order to foster and sustain healthy workplace environments.

Use of herbal dietary supplement si-wu-tang and health-related quality of life in postpartum women: a population-based correlational study.

Objective. The aim of the study was to explore the association between women's use of herbal dietary supplement Si-Wu-Tang during the postpartum period and their health-related quality of life. Methods. This is a population-based correlational study. We used multistage, stratified, systematic sampling to recruit 24,200 pairs of postpartum women and newborns from the Taiwan National Birth Registry in 2005. A structured questionnaire was successfully administered to 87.8% of the sampled population. Trained interviewers performed home interviews 6 months after the women's deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the quality of life of the women along with the frequency of Si-Wu-Tang use. Results. Si-Wu-Tang use after delivery improved women's score for bodily pain and also improved their score for mental health when used more than 10 times. In addition, there were increases in general health and vitality scores in the group who continuously used Si-Wu-Tang more than 10 times after using Sheng-Hua-Tang. Conclusion. Use of Si-Wu-Tang after delivery may be associated with women's health-related quality of life especially for those who previously used Sheng-Hua-Tang. These results are exploratory and need to be replicated.

Probiotic supplement use among young children in Taiwan: a prospective cohort study.

OBJECTIVES: The objective of this study is to provide details on probiotic supplement use among young children in Taiwan. PARTICIPANTS AND METHODS: This study is based on the Taiwan Birth Cohort Study database. We used questionnaires to collect information on probiotic supplement use among young children from birth to 18 months of age, while also considering their demographic characteristics and other covariates. Low-birth-weight infants, preterm infants, those with birth defects, and those with caregivers who returned incomplete questionnaires were excluded. The final valid sample comprised 16,991 cases. RESULTS: Approximately half the children received probiotic supplements before the age of 18 months. Only 6.3% of the children received probiotic supplements during the two periods of birth to 6 months and 7 to 18 months. Firstborn children, native mothers, mothers with higher educational levels, higher family income, and parents who lead healthy lifestyles were positively related to probiotic supplement use among children. Young children who were breastfed, with eczema, or with gastrointestinal tract problems were significantly positively associated with probiotic supplement use. CONCLUSION: The findings show that probiotic supplement usage among young children is associated with a more socially advantaged circumstance and certain child health factors, such as eczema, diarrhea, and constipation. Parents might use probiotic supplements for prevention or treatment of child diseases. The findings of this research could serve as a baseline for future studies, and provide insight into probiotic supplement use behavior for health professionals caring for infants and young children.

Synthesis, structure and oxygen-sensing properties of iridium(III)-containing coordination polymers with different cations.

Four iridium(III)-containing coordination polymers 1-4 using Ir(ppy)(2)(H(2)dcbpy)PF(6) (L-H(2), ppy = 2-phenylpyridine, H(2)dcbpy = 4,4'-dicarboxy-2,2'-bipyridine) as the bridging ligand, [ZnL(2)]·3DMF·5H(2)O (1), [CdL(2)(H(2)O)(2)]·3DMF·6H(2)O (2), [CoL(2)(H(2)O)(2)]·2DMF·8H(2)O (3) and [NiL(2)(H(2)O)(2)]·3DMF·6H(2)O (4), have been synthesized and structurally characterized. The emissions from 1-4 are ascribed to a metal-to-ligand charge transfer transition (MLCT). The absolute emission quantum yields for 1-4 in single crystals were measured in air to be 0.274, 0.193, 0.001 and 0.002, respectively. The noteworthy oxygen-sensing properties of 1-4 as well as L-H(2) in a single crystal were also evaluated. The Stern-Volmer quenching constant, K(SV) values, of 1-4 and L-H(2) can be deduced to be 0.834, 2.820, 1.328, 1.111 and 2.476, respectively. The results show promising K(SV) values (e.g.2) that are competitive or even larger than those of many known Ir-complexes. Moreover, the short response time (e.g. compound 2) and recovery times toward oxygen of 1-4 have been measured in their single crystal forms. The reversibility experiments for 1-4 were carried out for seven repeated cycles. As a result, >75% recovery of intensity for 1 and 2 on each cycle demonstrates a high degree of reproducibility during the sensing process. It should be noted that iridium(III)-containing coordination polymers with high emission intensity and notable oxygen sensing properties are obscure, especially in the single crystal form. This, in combination with its fine reversibility, leads to success in single crystal oxygen recognition based on photoluminescence imaging. The detection limit could be 0.50% for gaseous oxygen. Moreover, the temperature effect of compound 2 in a single crystal upon application as an oxygen sensor was expected.

Dietary supplement intake by 6-month-old Taiwanese infants.

OBJECTIVES: The objective of the present study was to investigate the types of dietary supplements administered to healthy 6-month-old infants and to identify the factors influencing the use of such supplements. SUBJECTS AND METHODS: The present study was based on the Taiwan Birth Cohort Study database. Questionnaires were used to collect information on the use of dietary supplements from birth, infant feeding practices, and other covariates at 6 months of age. We excluded low-birth-weight, preterm babies, and those whose caregivers returned incomplete questionnaires, leaving a sample size of 18,658. Multiple logistic regression was used to determine the characteristics capable of predicting the use of supplements in this population. A total of 34.9% of infants were fed dietary supplements from birth. RESULTS: The most common types of supplements administered to infants were probiotics, calcium, and multivitamin/mineral supplements. Formula feeding, earlier weaning, and earlier complementary feeding were positively related to the use of several supplements. CONCLUSIONS: The present study demonstrates that the use of pediatric dietary supplements is relatively common among infants in Taiwan, even in the earliest stages of life. For infants whose diet is adequate, no need exists for dietary supplements, and excessive intake can adversely influence health. Communication between health professionals and child caregivers should be promoted to increase understanding of infant feeding, as well as the safety and efficacy of dietary supplements.

Duration of breast feeding and risk of developmental delay in Taiwanese children: a nationwide birth cohort study.

The purpose of this study was to examine the relationship between duration of breast feeding and four developmental domains: gross motor, fine motor, language, and personal/social skills. This study included 14,621 infants from birth to 18 months of age. In the Taiwan Birth Cohort Study, four developmental screening items adapted from the Denver Development Screening Test were most appropriate for children aged 15 to 18 months. The proportion of young children who had mastered specific milestones increased consistently with longer duration of breast feeding. The adjusted odds ratios of the risk of developmental delay for the longest duration of breast feeding vs. never breast-fed were 0.69 [95% confidence interval (CI) 0.57, 0.83] for gross motor, 0.64 [95% CI 0.53, 0.77] for fine motor, 0.74 [95% CI 0.60, 0.91] for language, and 0.76 [95% CI 0.64, 0.90] for personal/social skills. Regardless of when the mothers returned to work, duration of breast feeding was found to have an inverse association with developmental delay in young children. The protection against developmental delays remained significant for those children who were breast-fed for more than 6 months. Children who were breast-fed for longer than 6 months had a lower risk of developmental delay than those who were never breast-fed. These data support the hypothesis that duration of breast feeding is positively related to young children's neurodevelopment.

A new coordination polymer exhibiting unique 2D hydrogen-bonded (H2O)16 ring formation and water-dependent luminescence properties.

A new coordination polymer, [Zn(dpe)(bdc)]·4H(2)O (ZndB; dpe=1,2-bis(4-pyridyl)ethane, bdc(2-)=dianion of benzenedicarboxylic acid), which possesses a 3D metal-organic framework (MOF) has been synthesized and structurally characterized. This 3D MOF is constructed by the assembly of helical channels filled with guest water molecules in both inner and outer regions of the channel. The resulting network also creates a 2D water layer containing hydrogen-bonded (H(2)O)(16) rings as the basic building units. Thermogravimetric and powder X-ray diffraction measurements of ZndB revealed a two-step weight loss of water molecules with a reversible water adsorption/desorption process in the inner channel for the first stage, and irreversible water desorption in the outer channel for the second stage. This spongelike property is manifested by the excimer emission originating from interaction between dpe (π*) and the other dpe (π) of the proximal helical channel, which is highly sensitive to the environmental perturbation. Powder X-ray analyses reveal that the dehydration process induces the readjustment of dpe π-π stacking distance/orientation, which results in dramatic luminescence changes from dim pale blue (λ(em)≈470 nm) upon hydration to bright white-light generation (broad, λ(em)≈500-550 nm) upon water depletion, accompanied by a ≈100-fold increase in the emission intensity.

Favorable neonatal outcomes among immigrants in Taiwan: evidence of healthy immigrant mother effect.

BACKGROUND: Although racial/ethnic disparities in neonatal and infant health are well known, positive associations between migration and perinatal health exist among immigrant mothers in western countries. There are unique marriage migration, East Asia culture, universal national health insurance system, and adequate social support in Taiwan that may differ from the situation in western countries. We aimed to assess the neonatal outcomes among live births to married immigrant mothers in recent years in Taiwan. METHODS: We conducted a population-based analysis among all the live births in Taiwan during the period 1998-2003 to assess neonatal outcomes, including incidence of low birth weight and preterm birth and of early and late neonatal mortality, according to maternal nationality. Logistic regression was used to estimate the odds ratios (ORs) associated with low birth weight and preterm birth, and Cox proportional hazards were used to estimate the relative risks (RRs) associated with mortality in the neonatal period. RESULTS: There were a total of 1,405,931 single live births, including 6.6% born to immigrant mothers and 93.4% born to Taiwanese mothers. Disparities existed among the intercultural couples, including paternal age, parental educational level, and residential distribution. Fewer low birth weight and fewer preterm babies were born to immigrant mothers than to Taiwanese mothers. In addition, babies born to immigrant mothers had lower early neonatal and neonatal mortalities than those born to Taiwanese mothers. There were lower risks of having a low birth weight (adjusted OR [AOR] 0.73, 95% confidence interval [CI] 0.70-0.75) or preterm (AOR 0.72, 95% CI 0.69-0.74) baby and lower hazard ratios (HRs) of having an early neonatal death (adjusted HR [AHR] 0.68, 95% CI 0.56-0.82) or neonatal death (AHR 0.74, 95% CI 0.64-0.87) in babies born to immigrant mothers. There is a gradual increase in the risks of adverse neonatal outcomes associated with increases in length of residence. CONCLUSIONS: Evidence of a healthy immigrant mother effect on neonatal health is clear. Despite lower parental education, advancing paternal age, and spatial distribution disparity, babies born to married immigrant mothers in Taiwan had favorable neonatal outcomes.

Infant feeding practices and physician diagnosed atopic dermatitis: a prospective cohort study in Taiwan.

It is common to recommend breastfeeding and a delayed introduction of solids to prevent atopic dermatitis (AD). However, the scientific evidence for this is inconclusive. The aim of this study was to explore the effect of breastfeeding and solids on AD, when taking account of reverse causality. This on-going birth cohort study was designed to sample 24,200 representative post-partum women and their babies from the Taiwan National Birth Registration database. Using two home interviews at 6 and 18 months after birth, with structured questionnaires about diet and physician's diagnosis of AD by parental reports, a total of 20,172 pairs (83.4%) were reviewed completely. Considering reverse causality, we excluded 2399 children with AD in the first 6 months of life and 18,733 were finally recruited. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health. After adjustment for potential confounders, the overall results showed that the increased duration of breastfeeding seemed to increase the risk of AD at 18 months in children. However, no significant effect was found for the delayed introduction of solids on the risk of AD. There is no evidence of a protective effect of prolonged breastfeeding and a delayed introduction of solids against AD among children at age 18 months, and may even be a risk factor of AD.

Is infant feeding pattern associated with father's quality of life?

The aim of this study was to compare the health-related quality of life of fathers under different infant feeding type scenarios. The Medical Outcomes Study 36-item Short-Form was used to measure the health-related quality of life of 1,699 fathers, and the scores were used to look for associations with different infant feeding methods. Multivariable linear regression analysis was used to explore the contribution of the other potential related factors on fathers' quality of life. After controlling for confounding factors, fathers whose infants were ever being breast-fed reported lower scores than fathers whose infants were bottle-fed. Except for the infant feeding pattern, having a job, higher family income, and being the major caregiver were positively related to the father's quality of life. Fathers may not benefit during breast-feeding process. Because fathers' involvement plays an important role in the success of breast-feeding, the development of interventions that enable fathers to support their breast-feeding partner is very important.

Women's perceptions of their husband's drinking behavior as a risk factor of their health-related quality of life in the postpartum period.

PURPOSE: The objective of this study is to investigate the association between women's perceptions of their husband's drinking behavior and their health-related quality of life (HRQOL) in the postpartum period. METHODS: We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. A structured questionnaire to assess lifestyle risk behaviors and HRQOL was successfully administered to 87.8% of the sampled population. Subjects undertook a home interview 6 months after their deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the HRQOL of the wives, and the scores were used to look for associations with their perceptions of husband's alcohol-drinking behavior. RESULTS: After controlling for the potential confounders, wives' scores on all SF-36 scales except the PF scale were inversely associated with the frequency of their husbands' alcohol drinking. Moreover, the MCS measure was also inversely associated with in the frequency of their husbands' alcohol drinking but the PCS did not show any association. CONCLUSIONS: Our study adds evidence supporting the negative association between of husbands' alcohol drinking and their wives' health as measured by the SF-36 HRQOL, especially for mental health.

Working hours and risk of gestational hypertension and pre-eclampsia.

BACKGROUND: The potential impact of employment on maternal health, particularly in relation to gestational hypertension and pre-eclampsia, has been subject to research. However, there is limited evidence on associations between shift work and long working hours on the incidence of these conditions. AIMS: To evaluate potential associations between maternal shift work and long working hours during pregnancy and gestational hypertension or pre-eclampsia. METHODS: Multistage stratified systematic sampling was used to recruit 24 200 post-partum women from the Taiwan national birth registration database in 2005. Subjects underwent home interview 6 months after their deliveries by structured questionnaire to obtain characteristics of maternal employment and potential confounders. Diagnosis of gestational hypertension and pre-eclampsia was obtained from the birth registration. RESULTS: There was no association between employment status and gestational hypertension or pre-eclampsia. Also, no significant association between gestational hypertension or pre-eclampsia and maternal shift work or long working hours during pregnancy was found in all or primiparous women. CONCLUSIONS: There was no convincing evidence that maternal shift work or long working hours had a higher risk of gestational hypertension or pre-eclampsia. However, further research is warranted to confirm these negative findings.

Use of Sheng-Hua-Tang and health-related quality of life in postpartum women: a population-based cohort study in Taiwan.

BACKGROUND: Although Sheng-Hua-Tang (comprising Radix Angelicae Sinensis, Ligustici Rhizoma, Semen Persicae, Zingiberis Rhizoma and Glycyrrhizae Radix) use during the postpartum has been popular in Chinese communities over a long period, its benefits have not been evaluated in terms of its effects on the health-related quality of life of postpartum women. OBJECTIVES: This study aims to explore the relation between different patterns of Sheng-Hua-Tang use and the health-related quality of life in postpartum women. DESIGN: A longitudinal birth cohort follow-up study. SETTINGS AND PARTICIPANTS: We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. A structured questionnaire was successfully administered to 87.8% of the sampled population. METHODS: Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. The Medical Outcomes Study 36-item Short-Form (SF-36) was used to measure the quality of life of the women with different patterns of Sheng-Hua-Tang use. RESULTS: Compared with those who never used after delivery, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang within 1 month only but decreased in those who continuously used within 1 month and later. In addition, the scores of role limitations due to physical health and emotional problems significantly increased in women who used Sheng-Hua-Tang regardless of the frequency. CONCLUSIONS: Sheng-Hua-Tang use during the first month of the postpartum period may have a positive effect on women's health-related quality of life especially in terms of role limitations due to physical health and emotional problems. However, continuous use after the first month of the postpartum period might have a negative effect on women's quality of life. Further studies are needed to replicate the results and elucidate the causal relations.

Maternal return to work and breastfeeding: a population-based cohort study.

BACKGROUND: In recent decades there has been a marked rise in the participation of women with infants in the labour market, while there has been a decline in the prevalence rate of breastfeeding. OBJECTIVE: To explore the relationship between maternal return to work and breastfeeding. DESIGN: An on-going prospective longitudinal study. SETTING AND PARTICIPANTS: Multistage stratified systematic sampling was designed to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Participating women underwent two home interviews at 6 and 18 months after giving birth, following structured questionnaires. A total of 21,248 and 20,172 women were interviewed, and the completed interview rate was thus 87.8% and 83.4% at 6 and 18 months, respectively. All study participants provided informed consent as approved by the Ethics Review Board of the National Taiwan College of Public Health. RESULTS: The overall prevalence of initial breastfeeding was 83.7%. Postpartum women returning to work less than or equal to 1 month had the lowest initiation of breastfeeding rate (77.5%), but had a higher prevalence of breastfeeding duration less than or equal to 1 month (34.9%) than the overall population (26.8%). Overall 67.9%, 39.4%, 25.4%, and 12.7% mothers who started breastfeeding still breastfed their infants at the age of 1, 3, 6 and 12 months, respectively. Women with maternal leave of less than or equal to 6 months ceased breastfeeding earlier than those with maternal leave beyond 6 months and those who did not return to work up to 18 months after birth. After adjustment for potential confounders, odds ratios of initial breastfeeding seemed no different, except those for postpartum women who returned to work less than or equal to 1 month and those who did not return to work. Mothers returning to work within 1 year after giving birth were significantly earlier in weaning than those without return to work. CONCLUSION: In our study, an early maternal return to work, especial within 6 months after giving birth, was a barrier to the initiation and continuation of breastfeeding. Thus, a comprehensive strategy is required to encourage the practice of breastfeeding in working women from pregnancy to the return to work, and nurses should work to promote breastfeeding in the different occasion.

Chinese herbal medicine use in Taiwan during pregnancy and the postpartum period: a population-based cohort study.

BACKGROUND: Using Chinese herbal medicines during pregnancy and postpartum is common in the Chinese community. OBJECTIVE: The purpose of this current study is to explore the use of Chinese herbal medicines by women during pregnancy and postpartum in Taiwan. DESIGN: It is an on-going prospective longitudinal study design. SETTING AND PARTICIPANTS: We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. A structured questionnaire was successfully administered to 87.8% of the sampled population. RESULTS: At least one Chinese herbal medicine was used by 33.6% and 87.7% of the interviewed subjects during pregnancy and the postpartum period, respectively. An-Tai-Yin, Pearl powder, and Huanglian were the most commonly used during pregnancy, while Shen-Hua-Tang and Suz-Wu-Tang were the most commonly used by postpartum women. Pregnant women aged 20-34, with high education, threatened abortion, chronic disease, and primipara appeared to use more Chinese herbal medicines than others in the sample. Postpartum women with high education, primipara, normal spontaneous delivery, and breastfeeding were found to use more Chinese herbal medicines; but women with pregnancy-related illness used less. CONCLUSIONS: Chinese herbal medicines are frequently used by women during pregnancy and the postpartum period in Taiwan and those with high education and primipara used more such herbs. Due to limited safety information on these herbs, we would advise caution regarding their use either during pregnancy or postpartum breastfeeding period. Moreover, it is important for nurses/midwifes enquiring about such habits, and providing the adequate education to women during prenatal and postpartum care to prevent potential side effects.

Risk factors on the menstrual cycle of healthy Taiwanese college nursing students.

BACKGROUND: The purpose of this study was to explore risk factors, including age at menarche, body mass index (BMI), psychiatric stress and physical exercise on the menstrual cycle of healthy Taiwanese college nursing students. METHODS: We conducted a cross-sectional survey involving 1300 female college students in the nursing curriculum between December 2002 and March 2003. We provided a structured questionnaire for each student. Information on the women's demographics, lifestyles and reproductive history related to menstrual cycle characteristics was requested. A total of 1095 healthy students were included in the analysis. A logistic regression was used to estimate the odds ratios for each of the menstrual cycle characteristics. RESULTS: We found that age at menarche, BMI and psychiatric stress were associated with menstrual cycle characteristics in healthy college nursing students. In addition to menarche at the age of 14 years or later, obesity and psychological stress, menarche before 12 years of age was an important risk factor for menstrual dysfunction. Moreover, obese students had the highest risk of having a longer cycle and cycle irregularity. CONCLUSIONS: Early menarche might be related to menstrual dysfunction in addition to late menarche, obesity and psychological stress. Moreover, obese students are at the highest risks for longer cycles and cycle irregularity.