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.

The learning effectiveness of nursing students using online testing as an assistant tool: a cluster randomized controlled trial.

With the rapid development of the Internet, online testing is becoming more widely-used in education. The purpose of this study is to explore the learning effectiveness of nursing students using online testing as an assistant tool. The participants were 146 junior college nursing students aged 19 to 20 taking the community health nursing course. With a class as the unit, three classes were randomized and allocated to one experimental group and two control groups. Two structured questionnaires were used to obtain the basic data, and the groups' examination results were also collected. The results of this study showed that before the intervention, there were no significant differences between the experimental and two control groups. After the intervention and adjusting for potential confounders, the score of midterm test in the experimental group was significantly better than those of the control groups. Over half of the students felt that answering 21 to 30 questions in 31 to 60 min for one unit of testing were appropriate. The results of this study showed that online testing is feasible for use as an assistant tool for learning. However, the positive effects of this approach appeared to be short- rather than long-term, and thus more studies are required in future.

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.

[A discourse on female nurse job stress and reproductive hazards].

The negative effects of job stress on female reproduction have been receiving greater attention due to rapidly falling fertility rates in recent years. Nurses represent the greatest number of workers in the healthcare system. Nearly all are female and most are of reproductive age. Over half of nurses perceive nursing as a high-pressure occupation, making job stress an important issue. Long-term job stress affects mental and reproductive health. The International Nursing Association's advocacy of high quality, positive medical environments in 2007 highlighted the importance of improving workplace quality. This article reviews references and discusses job stress and its relationship to reproductive hazards for female nurses. We hope it provides valuable information and encourages government and related organizations to improve the medical working environment, recognize job stress in a timely manner, and provide health promotion strategies to reduce reproductive hazards and promote nurse health.

Maternal psychosocial factors around delivery, and the behavior of 2-year-old children.

BACKGROUND: The objectives of the present study were to explore whether maternal psychosocial factors, mental health and work stress around delivery, are related to the behavior of 2-year-old children. METHODS: In a prospective cohort study design, pregnant women attending the National Taiwan University Hospital for delivery and post-partum care from April 2004 to January 2005 were recruited and their children were observed at 24 months. A total of 186 mother-term-born child dyads completed the measurement. The five-item Mental Health Index (MHI-5) self-report data of maternal psychosocial factors were selected from the Taiwanese version of the short form 36 (SF-36). The Child Behavior Checklist for age 1½-5 (CBCL/1½-5) was completed by the parents when the child was 2 years old. RESULTS: The mean score of mental health around delivery was 68.11. The proportion of mothers with work stress seldom and always was 61.8% and 24.7%, respectively. The mean of the total CBCL score, and internalizing, externalizing behavior and sleep problems scores was 45.95, 11.89, 15.59 and 4.23, respectively. After adjusting for the potential confounders, maternal work stress around delivery was found to have a significant effect on the total CBCL and externalizing, attention and aggressive, behavioral problems of 2-year old children. Maternal mental health around delivery, however, did not show significant effects on child behavior. CONCLUSIONS: Work stress around delivery seems to aggravate children's externalizing behavior problems at 2 years old. It is therefore important to improve the psychosocial health and reduce the stress of pregnant women.

Maternal psychosocial factors around delivery on development of 2-year-old children: A prospective cohort study.

AIM: To explore whether maternal psychosocial factors around delivery are related to development of 2-year-old children. METHODS: Pregnant women going to the hospital for delivery were recruited, and their children were observed at 24 months. A total of 186 mother-child dyads completed the measurement. Self-report data of maternal psychosocial factors around delivery were selected from the Taiwanese version of the short-form 36. The Comprehensive Developmental Inventory for Infants and Toddlers was completed by interviewers and the main care givers for the child at 2 years old. RESULTS: Using the multiple linear regression analysis and adjusting for potential confounders, maternal vitality around delivery was found to have a significantly positive relationship with the whole Comprehensive Developmental Inventory for Infants and Toddlers (P = 0.005) and self-help development (P = 0.001), but work stress had a significantly negative relationship with motor development (seldom, P = 0.050; always, P = 0.048). CONCLUSIONS: Maternal vitality around delivery was beneficial to a child's self-help development, while work stress seemed to be an adverse effect on child's motor development in later life. It is important to improve the psychosocial health of pregnant women.

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.

[An overview of maternal and child health policies in various countries].

Healthy mothers and children are essential to maintaining and expanding national prosperity. This article reviews maternal and child health policies in several countries, including the United States, Canada, United Kingdom, Norway, Denmark, Japan, Singapore, and Republic of Korea. Comparing and considering the policy experiences of different countries can provide references for designing and revising women's and children's health care policies in Taiwan. Secondary data used in this study were retrieved from a variety of resources including websites of the World Health Organization and various national governments, official publications, and articles related to women's and children's health. The life cycles of women and children embraces differing needs at different stages (e.g., preconception, pregnancy, postpartum, newborn, infant, and young adulthood). To meet these needs, a broad spectrum of policies offers different levels of coverage. Strengthened cooperation among agencies and with nongovernmental organizations is needed to achieve goals. This review showed that countries with greater achievements in women's and children's health focus on families and manage effective cooperation between departments to execute policies. The successes of such policies may be referenced by Taiwanese policymakers and government officials.

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.

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.

[Preconception care].

Healthy mothers and children are the hope and dream of every country. Evidence shows that promoting health in women and couples before pregnancy can promote the health of their offspring. Hence, comprehensive healthcare for women should start before pregnancy (i.e., preconception care). Such represents an effective strategy to lessen adverse maternal and infant health outcomes. The Centers for Disease Control and Prevention (CDC) in the United States established in 2004 a working group to convene conferences addressing preconception care issues, which has since held two summit conferences (in 2005 and 2007) to develop recommendations and guidelines for improving preconception health and care. A new consensus on reproductive health promotion and protection as emerged. Preconception care, the primary preventive approach for women of reproductive age, works to identify and modify biomedical, behavioral, and social risks through preventive and management interventions. No national policy for preconception care currently exists in Taiwan. Hence, it is important to coordinate different resources related to preconception care available through schools, workplaces, outpatient service centers, families and the community in order to establish a uniform national policy and intervention programs that will further enhance the health of women and children in Taiwan.

The combined effect of employment status and transcultural marriage on breast feeding: a population-based survey in Taiwan.

In recent decades there has been a marked rise in both the labour market participation of women with infants and transcultural marriage in Taiwan. The objectives of this study were to explore the combined effect of employment status and transcultural marriage on the prevalence and factors relating to initiation and continuation of breast feeding in Taiwan. We used multistage stratified systematic sampling to recruit 2048 postpartum women from the Taiwan National Birth Registration database for the period November to December 2003. They were interviewed at home within 6 months of delivery using a structured questionnaire; 87% of the sampled population completed the interview. We used logistic regression analysis to estimate the odds ratio (OR) of breast-feeding initiation and Cox regression (survival) analysis to predict continued breast feeding. The prevalences of initial breast feeding for employed Taiwanese mothers, unemployed Taiwanese mothers, employed foreign-born mothers and unemployed foreign-born mothers were 84.4%, 83.7%, 79.1% and 79.7%, respectively. Among the four groups of mothers who initiated breast feeding, 12.9%, 27.2%, 14.7% and 39.7% of their infants, respectively, were still breast feeding at the age of 6 months. Factors associated with initiation of breast feeding were high maternal education (OR 3.80; 95% confidence interval [CI] 1.81, 7.98) and normal spontaneous delivery (OR 1.36; 95% CI 1.04, 1.78). The main reason for not breast feeding in 52% of the mothers was insufficient or no milk. There existed a combined effect of employment status and transcultural marriage on the continuation of breast feeding. Employed Taiwanese mothers were earlier than others at weaning. Unemployed foreign-born mothers breast fed the longest [hazard ratio (HR) 0.54; 95% CI 0.42, 0.70]. Other factors related to late weaning were high maternal education (HR 0.67; 95% CI 0.47, 0.96), older maternal age (HR 0.76; 95% CI 0.61, 0.94), mother sleeping with baby at night (HR 0.68; 95% CI 0.59, 0.78), and no supplemental baby food before the age of 6 months (HR 0.78; 95% CI 0.68, 0.90). The initiation of breast feeding was high but it decreased dramatically after the postpartum period in Taiwan. There was a significant combined effect of employment status and transcultural marriage on the continuation of breast feeding. Employment is a persistent barrier to continued breast feeding.

Chinese herbal medicines used in pregnancy: a population-based survey in Taiwan.

PURPOSE: To explore the use (prevalence and related factors) of Chinese herbal medicines used by pregnant women. METHODS: We used multistage stratified systematic sampling to recruit 2048 postpartum women from the Taiwan national birth register between November and December 2003. Subjects underwent a home interview 6 months after their deliveries. A structured questionnaire was successfully applied to 87% of the sampled population. RESULTS: At least one Chinese herbal medicine was used during pregnancy by 24.1% of the interviewed subjects. Pregnant women with threatened abortion appeared to use more Chinese herbal medicines than other pregnant women. CONCLUSION: Chinese herbal medicines are frequently used by pregnant women in Taiwan and are very frequently used by those with a threatened abortion.

Herbal medicines used during the first trimester and major congenital malformations: an analysis of data from a pregnancy cohort study.

BACKGROUND: Major congenital malformations place a considerable burden on the affected child, the family and society. Any kind of medicine used during pregnancy might have a harmful impact; therefore, such practice has raised concerns. The objective of the current study was to explore the relationship between the use of herbal medicines by pregnant women during the first trimester of pregnancy and the risk of major congenital malformation in their live born infants. METHODS: This was a cross-sectional analysis of data from a prospective pregnancy cohort, which was established between 1984 and 1987. To assemble the cohort, pregnant women of >or=26 weeks of gestation who came to the Taipei Municipal Maternal and Child Hospital in Taiwan for prenatal care were enrolled in the study and interviewed using a structured questionnaire. Detailed information, including herbal medicine use during different periods of pregnancy, was obtained during the interview. Past medical history, current obstetric data and details on conventional medicines used during pregnancy were abstracted from medical records. Data on birth weight, gestational duration and characteristics of live born infants were gathered from the Taiwan national birth register. Congenital malformation information was obtained from multiple sources: the newborn examination record (1984-7); the national death register (1984-2003); and Taiwan National Health Insurance data (1996-2000). Multiple logistic regression was used to estimate the odds ratio [OR] of major congenital malformation by herbal medicines used during the first trimester. RESULTS: A total of 14,551 live births were analysed. After adjustment for confounding factors, taking huanglian during the first trimester of pregnancy was found to be associated with increased risk of congenital malformations of the nervous system (adjusted OR 8.62, 95% CI 2.54, 29.24). An-Tai-Yin was associated with an increased risk of congenital malformations of the musculoskeletal and connective tissues (adjusted OR 1.61, 95% CI 1.10, 2.36) and the eye (adjusted OR 7.30, 95% CI 1.47, 36.18). CONCLUSION: We found evidence for a possible link between the use of specific herbal medicines during the first trimester of pregnancy and increased risks of specific groups of congenital malformations. We could not investigate whether the adverse effects were related to direct toxicity from the herbal medicines, or were from misuse, contamination or uncontrolled confounding. Nonetheless, we would advise caution regarding use of herbal medicines during pregnancy, and we suggest that further investigation of these findings is warranted.

Use of Coptidis Rhizoma and foetal growth: a follow-up study of 9,895 pregnancies.

PURPOSE: To explore the effect of Coptidis Rhizoma on foetal growth in pregnancy. METHODS: During 1985-1987, each pregnant woman with 26 or more weeks of gestation who came to the Taipei Municipal Maternal and Child Hospital for prenatal care was enrolled and interviewed by three trained interviewers using structured questionnaires to obtain detailed information including the herbal medicines used during pregnancy. Medical histories of diabetes, hypertension, antepartum haemorrhage and medicines used during pregnancy were abstracted from medical records of mothers'. Data of birth weight, gestational duration and characteristics of infants were gathered from the Taiwan national birth registration. A total of 9,895 singleton livebirths were analysed. The variables related to foetal growth included two dichotomous measures: low birth weight (LBW) and small for gestational age (SGA); and one continuous measure: birth weight. Potential risk factors associated with these outcomes were investigated using multiple logistic and linear regression models. RESULTS: After adjustment, pregnant women taking Coptidis Rhizoma during pregnancy had no significantly adverse effect on foetal growth. There was a non-significantly slightly decreased mean of birth weight and increased risk of LBW and SGA babies if the frequency of using Coptidis Rhizoma was more than 56 times. CONCLUSIONS: The usual usage of Coptidis Rhizoma during pregnancy seemed not to increase the adverse risk on foetal growth. Future observations for use of longer than 56 times or a higher cumulated dose were needed to clarify the safety.