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Background Although policies have been implemented to improve a breastfeeding-friendly environment, few studies have examined the effectiveness of these policies in Taiwan. We examined progress in breastfeeding environmental factors from 2008 through 2011 in Taiwan and their association with continuing exclusive and any breastfeeding until 6 months postpartum. Methods This study was a secondary data analysis, using four cross-sectional and national surveys of 1,453-12,410 postpartum women in the years 2008 through 2011. Data were collected by telephone interviews, using structured questionnaires with randomly selected postpartum women who gave birth in the indicated years. Results were weighted to enhance representativeness. Logistic regression was used to compute adjusted odds ratios for the use of breastfeeding-friendly services on breastfeeding continuation. Results The rates of breastfeeding at 6 months postpartum generally increased from 2008 to 2011, despite a drop in 2010. The use of breastfeeding-friendly environmental factors, including breastfeeding rooms in public places or workplaces, breastfeeding consultation phone lines/websites, breastfeeding volunteers, and delivery in baby-friendly hospitals, increased from 2008 to 2011. However, the percentage of women participating in breastfeeding support groups decreased during that period. After controlling for maternal characteristics, use of each of the breastfeeding-friendly environmental factors was significantly and positively associated with continuing breastfeeding until 6 months postpartum. The adjusted odds ratios for breastfeeding-friendly environmental factors ranged from 1.15 to 5.04. Conclusions The breastfeeding-friendly environment and long-term breastfeeding rates in Taiwan improved from 2008 to 2011, supporting the effectiveness of policy and public health efforts. [ABSTRACT FROM AUTHOR]

Purpose. Although Shi Quan Da Bu Tang (SQDBT) has been used to treat cancer patients clinically, very few studies evaluating the effectiveness of SQDBT using objective indicators have been published. The study objectives were to examine the effectiveness of SQDBT for alleviating hematotoxicity, as indicated by white blood cell (WBC) counts and hemoglobin (Hb) levels, among patients with breast carcinoma receiving chemotherapy. Methods. The authors identified patients with breast carcinoma who received chemotherapy in a teaching hospital in Taipei in 2008 through a chart review process. Only patients with initial WBC counts of <4000/µL were included. The case group was composed of 47 chemotherapy courses treated with SQDBT, whereas the comparison group included 257 courses without SQDBT. The complete blood count test was done before start of a chemotherapy course and 1 week after chemotherapeutic drugs were given. Results. Age, cancer stage, cancer status, use of granulocyte colony-stimulating factor, and chemotherapy drugs were controlled in the model. Patients who took SQDBT had significantly increased WBC counts, especially neutrophils, and Hb after chemotherapy (adjusted β = 1202.51, 95% confidence interval [CI] 440.45-1964.57 for WBC; β = 834.83, 95% CI = 197.35-1472.31 for neutrophils; β = 0.34, 95% CI = 0.05-0.63 for Hb). There were no significant differences in tumor markers CEA and CA153 between patients given SQDBT or not after chemotherapy. Conclusion. SQDBT is effective in alleviating hematotoxicity among patients with breast carcinoma receiving chemotherapy, without affecting the presentation of tumor markers in the short term. More study is needed to determine long-term outcomes such as recurrence and survival. [ABSTRACT FROM PUBLISHER]

This cohort study assessed the structural relationships among social support, acculturation, and postpartum depressive symptoms experienced by marriage-based immigrant mothers in Taiwan. Data were collected at 1 and 6 months postpartum from 203 immigrant mothers married to Taiwanese men in Taipei, Taiwan. The structural equation modeling results showed that social support and postpartum depression were directly and negatively related. Higher social support and lower depression at 1 month postpartum were related to a positive social attitude (i.e., accepting attitude toward mainstream society). Social attitude was a moderator of the relationship between depression at 1 month and social support at 6 months postpartum, where a positive social attitude decreased the negative effect of depression at 1 month on social support at 6 months. Social support in the early postpartum period not only directly decreased postpartum depression, but also indirectly decreased postpartum depression through improving social attitude. [ABSTRACT FROM AUTHOR]

Associations between breastfeeding intention, duration and post‐natal depression (PND) have been shown in pre‐COVID‐19 studies. However, studies during COVID‐19 have not examined the associations between breastfeeding intention, breastfeeding practices, and PND in an international sample of post‐natal women, taking into consideration COVID‐19 related factors. This is the first study to address this gap as both PND and breastfeeding may be affected by COVID‐19, and have important long‐term effects on women's and infant's health. A cross‐sectional internet‐based survey was conducted with 3253 post‐natal women from five countries: Brazil, South Korea, Taiwan, Thailand, and the United Kingdom from July to November 2021. The results showed that women who intended to breastfeed during pregnancy had lower odds of having PND than women who did not intend to. Women who had no breastfeeding intention but actually breastfed had greater odds (AOR 1.75) of having PND than women who intended to breastfeed and actually breastfed. While there was no statistical significance in expressed breast milk feeding in multivariable logistic regression models, women who had shorter duration of breastfeeding directly on breast than they planned had greater odds (AOR 1.58) of having PND than those who breastfed longer than they planned even after adjusting for covariates including COVID‐19‐related variables. These findings suggested the importance of working with women on their breastfeeding intention. Tailored support is required to ensure women's breastfeeding needs are met and at the same time care for maternal mental health during and beyond the pandemic. Key messages: This study identified independent associations of breastfeeding intention and actual breastfeeding practices with PND after adjustment for COVID‐19‐related covariates.Although women who intended to breastfeed during pregnancy were less likely to have PND, those who did not intend to breastfeed but did breastfeed were more likely to have PND than those who intended to breastfeed and breastfed.Women with shorter (vs. longer) than planned duration of breastfeeding on breast were more likely to have PND.Health care providers and policymakers should ensure tailored support is available for women's infant feeding plans and mental health. [ABSTRACT FROM AUTHOR]

Objectives: American Institute of Medicine (IOM) recommends different ranges of gestational weight gain (GWG) based on pre-pregnancy body mass index (BMI). In Taiwan, IOM guidelines are implemented concurrently with the local recommendation for GWG (10–14 kg). This study compared between the two sets of guidelines in relation to adverse perinatal outcomes. Methods: We analyzed 31,653 primiparas with singletons from 2011 to 2016 annual National Breastfeeding Surveys. Logistic regressions for preterm birth, small for gestational age (SGA), large for gestational age (LGA), cesarean section and excessive postpartum weight retention (EPWR) were fitted separately for GWG categorized according to IOM and Taiwan ranges. Areas under the receiver–operator curves (AUC) and the predicted probabilities for each outcome were compared in each BMI group. Results: AUC for both guidelines ranged within 0.51–0.73. Compared to Taiwan recommendation, IOM ranges showed lower probabilities of SGA for underweight (0.11–0.15 versus 0.14–0.18), of LGA for obese (0.12–0.15 versus 0.15–0.18), of EPWR for overweight (0.19–0.30 versus 0.27–0.39), and obese (0.15–0.22 versus 0.25–0.36); and higher probabilities of EPWR for underweight (0.17–0.33 versus 0.14–0.22). Conclusions for practice: Discriminative performance of IOM and Taiwan recommendations was poor for the five adverse birth outcomes, and no preference for either set of recommendations could be inferred from our results. In the absence of specific GWG guidelines, health care workers may provide inconsistent information to their patients. Future research is needed to explore optimal GWG ranges that can reliably predict locally relevant perinatal outcomes for mother and child. [ABSTRACT FROM AUTHOR]

Introduction: Marriage-based immigrant women are increasing around the world. Although bi-dimensional acculturation is important for immigrant women's health, the existing scales have mainly been developed for immigrant women in Western countries and hence some items may not be suitable for Asian contexts. Thus, we developed and evaluated the Bidimensional Acculturation Scale for Marriage-Based Immigrant Women (BAS-MBIW) in Taiwan. Methods: The BAS-MBIW was developed based on a literature review and clinical observations. Bi-dimensional acculturation involves "adaptation to host culture (acculturation)" and "maintenance of heritage culture (enculturation)." The initial scale included two 24-item subscales. The validation samples were 310 marriage-based immigrant women who were pregnant for at least twelve weeks in Taiwan. The BAS-MBIW was assessed and modified by experts. Data analyses included factor analysis, Pearson's correlation, and Cronbach's alpha coefficient. Results: Expert reviews and factor analysis indicated that the scale had acceptable content and construct validity. The validated scale includes two 19-item subscales, encompassing six domains: language, media, food preference, cultural heritage, social interaction, and shopping and merchandise preference, with good internal consistencies (Cronbach's alpha coefficient is 0.88 for acculturation and 0.83 for enculturation). Acculturation was positively related to local language ability and duration of immigration but negatively related to age at immigration, stress, and depression; whereas enculturation was positively related to age at immigration, stress, and depression but negatively related to duration of immigration, indicating convergent validity. Conclusions: The BAS-MBIW offers reliable and valid assessments of pregnant immigrant women's level of acculturation and enculturation in Taiwan. The BAS-MBIW could be used to assess bi-dimensional acculturation among marriage-based immigrant women. [ABSTRACT FROM AUTHOR]

Background: Isoniazid resistant tuberculosis is the most prevalent type of resistance in Swaziland and over two-thirds of the isoniazid resistant tuberculosis patients are tuberculosis and human immunodeficiency virus co-infected. The study aimed to determine risk factors associated with isoniazid resistant tuberculosis among human immunodeficiency virus positive patients in Swaziland.Methods: This was a case-control study conducted in nine healthcare facilities across Swaziland. Cases were patients with isoniazid resistant tuberculosis (including 78 patients with isoniazid mono-resistant tuberculosis, 42 with polydrug-resistant tuberculosis, and 77 with multidrug-resistant tuberculosis). Controls were presumed drug-susceptible tuberculosis patients (n = 203). Multinomial logistic regression was used to determine related factors.Results: The median time lag from diagnosis to tuberculosis treatment initiation was 50 days for isoniazid mono or poly drug-resistant tuberculosis, 17 days for multidrug-resistant tuberculosis compared to 1 day for drug-susceptible tuberculosis patients. History of previous tuberculosis treatment was positively associated with either isoniazid mono or poly drug-resistant tuberculosis (OR = 7.91, 95% CI: 4.14-15.11) and multidrug-resistant tuberculosis (OR = 12.20, 95% CI: 6.07-24.54). Isoniazid mono or poly resistant tuberculosis patients were more likely to be from rural areas (OR = 2.05, 95% CI: 1.23-3.32) and current heavy alcohol drinkers compared to the drug-susceptible tuberculosis group. Multi drug-resistant tuberculosis patients were more likely to be non-adherent to tuberculosis treatment compared to drug-susceptible tuberculosis group (OR = 3.01, 95% CI: 1.56-5.82).Conclusion: To prevent and control isoniazid resistant tuberculosis among HIV-positive patients in Swaziland, the tuberculosis program should strengthen the use of rapid diagnostic tests, detect resistance early, promptly initiate supervised tuberculosis treatment and decentralize quality tuberculosis services to the rural areas. Adherence to tuberculosis treatment should be improved. [ABSTRACT FROM AUTHOR]

An introduction is presented that discussed issues on topics improving healthcare quality and patient outcomes, focuses different learning objectives for students at different grade levels and innovation and new discoveries, curriculum development and evidence-based quality improvement.

This study compared symptom severity, symptom interference and use of complementary and alternative medicine (CAM) between cancer survivors after curative treatment and individuals who did not have cancer. Factors associated with CAM use among cancer survivors were examined. A cross‐sectional survey was conducted of 146 cancer survivors (77 breast and 69 colorectal cancer survivors who had completed conventional treatment 1–5 years previously and were cancer‐free) from a hospital's cancer registration system (survivor group), and 161 healthy individuals without cancer (comparison group). The two groups were frequency‐matched for sex and age. Findings indicated higher use of CAM in the survivor group (54.1%) than the comparison group (36.6%). There were no significant differences in overall symptom severity and interference between the two groups. Multivariate logistic regression showed that prior use of CAM (OR = 5.14, 95% CI: 2.34–10.69) and higher symptom interference (OR = 1.04, 95% CI: 1.001–1.08) were positively related to CAM use in the survivor group. The survivors did not have higher symptom severity and symptom interference with daily life, but were more likely to use CAM than the comparison group. Medical staff should discuss symptom interference and use of CAM with cancer survivors to guide them in the appropriate use of CAM. [ABSTRACT FROM AUTHOR]

Many studies have reported positive contributions of health promotion on the health behavior of nursing staff working in hospitals, including the maintenance of a regular healthy diet, engagement in physical activity, performance of routine screening practices, and participation in a health examination. Despite being considered a role model for healthy lifestyles, little is known about the effect of health-promoting hospital settings on nursing staff. The aim of this study was to perform a nationwide, hospital-based, cross-sectional, survey comparing health practices between full-time nurses of health-promoting hospitals and those of non-health-promoting hospitals in Taiwan. We conducted a nationwide, hospital-based, cross-sectional, survey in 100 hospitals from May to July 2011 using a questionnaire as the measurement tool. Nurses aged between 18 and 65 years from certified health-promoting hospitals (n = 14,769) were compared with nurses in non-health-promoting hospitals (n = 11,242). A multiple logistic regression model was conducted to estimate the effect of certified HPH status on the likelihood of performing health behavior, receiving general physical examination, undergoing cancer screening, and participating in hospital-based health-promoting activities. All nurses of HPH hospitals were more likely to perform physical activity, practice cancer screening, receive at least one general physical examination in the past 3 years, and had a higher chance of participating in at least one hospital-based health-promoting activity in the past year (particularly weight-control groups and sports-related clubs) than those of non-HPH hospitals. This study suggests the effectiveness of implementing health promotion on the health behavior of full-time nursing staff in hospitals. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to develop an osteoporosis prevention program based on the Health Belief Model. This study found that the prevention program improved osteoporosis preventive behaviors among women in Taiwan. Health professionals could use this model to plan and evaluate their osteoporosis prevention programs. [Copyright &y& Elsevier]

Purpose/objectives To determine the prevalence of workplace violence and explore the role of hospital organizational characteristics and health promotion efforts in reducing hospital violence among nurses in Taiwan. Design Cross-sectional survey. Setting One hundred hospitals across Taiwan. Sample The final sample in our study comprised responses from 26,979 nurses. Methods The data were obtained from a nationwide hospital survey, Physical and Mental Health and Safety Needs in Full-Time Health Care Staff , which was developed and conducted by the Bureau of Health Promotion, Taiwan, in 2011. Main research variables The main dependent variable was whether nurses had experienced violence within the past year. Physical violence, threatened or intimidated personal safety, verbal violence or sexual harassment were all included. Findings Of the 26,979 nurses, 13,392 nurses (49.6%) had experienced at least one episode of any type of violence in the past year; 5150 nurses (19.1%) had been exposed to physical violence, and 12,491 nurses (46.3%) had been exposed to non-physical violence. The prevalence of having experienced any violence varied widely and ranged from the highest (55.5%) in an emergency room or intensive care unit to the lowest (28.3%) among those aged 55–65 years. After adjusting for other characteristics, younger nurses were significantly more likely to be exposed to any violent threat. Nurses working in public hospitals had a significantly higher risk of workplace violence than those working in private hospitals. Significant variations were also observed among work units. Although nurses working in a certified health promoting hospital (HPH) did not have a lower risk of workplace violence, those working in an outstanding HPH had a significantly lower risk of workplace violence. A similar pattern was observed for non-physical violence. Conclusions Workplace violence is a major challenge to workplace safety for nurses in hospitals. This large scale nurse survey identified individual, work and hospital characteristics associated with workplace violence among hospital nurses. Preventive efforts in reducing hospital violence shall be targeted these high risk groups and settings. Implications for nursing This nationwide nurse survey assisted us in more clearly understanding the scope of the hospital violence facing nurses and identifying critical risk factors. The findings not only identified the most common locations of violence in hospitals but also suggested that extensive investments and efforts by hospitals in health promotion are crucial. [ABSTRACT FROM AUTHOR]

Background: Nurses are faced with varying job stressors depending on their positions and duties. Few previous studies have compared job stress and related chronic conditions among different nursing positions. The objectives were to compare job stressors among clinical registered nurses, nurse practitioners, and head nurses and explore the impact of job stressors and stress level on hyperlipidemia, hyperglycemia, and hypertension. Methods: Secondary data extracted from a survey of health-care workers conducted from May to July 2014 across 113 hospitals in Taiwan was used. This analysis included 17,152 clinical registered nurses, 1438 nurse practitioners, and 2406 head nurses. Socio-demographic characteristics, job stressors, stress levels, and hyperlipidemia, hyperglycemia, and hypertension variables were extracted. Results: Perceived stressors differed among clinical registered nurses, nurse practitioners, and head nurses, but overall stress level did not. Nurse practitioners and head nurses showed significantly higher prevalence of hyperlipidemia, hyperglycemia, and hypertension than clinical registered nurses. Higher stress levels, age, body mass index, work hours, and caring for family members were positively associated with hyperlipidemia, hyperglycemia, and hypertension. After adjustment for these variables, risk of hyperlipidemia, hyperglycemia, and hypertension did not differ across the nursing positions. Conclusions: Although stressors vary by different nursing positions, overall stress level does not. Hyperlipidemia, hyperglycemia, and hypertension are related to stress level, age, body mass index, weekly working hours, and caring for family members. Hence, alleviating job stress and avoiding long working hours are likely to reduce the risk of hyperlipidemia, hyperglycemia, and hypertension in nurses. [ABSTRACT FROM AUTHOR]

Families of children with developmental delay (DD) need to adapt to the child's disability and make use of family strengths to maximize the child's developmental potential. Family resilience (FR) is the level of capacity of a family to rebound from adversity. The purpose of this study was to develop the Mandarin Chinese version of the Family Resilience Assessment Scale (FRAS) and to examine the psychometric properties of the scale among families of children with DD in Taiwan. Independent translations, back-translations, and committee reviews were performed. A total of 502 primary caregivers of children with DD in Taipei were recruited as validation samples. Item analysis demonstrated that the critical ratio values of all 54 items were >3 (p < 0.001), except for one item, which was dropped from further analysis. Confirmatory factor analysis on the 53-item FRAS supported the original six-factor structure: family communication and problem solving, utilizing social and economic resources, maintaining a positive outlook, family connectedness, family spirituality, and ability to make meaning of adversity. Families that were good in "maintaining good interactive relationships" and "using effective coping strategies" had higher mean scores on the FRAS than their counterparts. The scale exhibited good internal consistency (Cronbach's alphas were 0.96 for the overall scale and 0.68-0.96 for subscales) and test-retest reliability at a 2-week interval (intra-class correlation coefficient = 0.88). The study confirmed that the Mandarin Chinese version of the FRAS is a reliable and valid instrument to assess FR in families of children with DD in Taiwan. [ABSTRACT FROM AUTHOR]

Infertility treatment experiences may accumulate and influence postpartum psychological well-being among women with infertility. However, the association between infertility treatment experiences and postpartum depressive symptoms remained unclear. This cross-sectional survey aimed to describe depressive symptom scores of 180 women, who conceived while undergoing infertility treatment, at 2–6 months after childbirth, and to explore factors, including infertility history and treatment experiences, associated with postpartum depressive symptoms. Data were collected via telephone interviews and patient record reviews. Postpartum depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, with a cutoff score of 10. The prevalence of postpartum depressive symptoms was 34.4 %. Higher perceived stress levels after childbirth than before undergoing infertility treatment, a duration of infertility diagnosis longer than three years, maternal age >35 years, pregnancy conceived through in vitro fertilization (IVF), and experiencing all three lines of infertility treatment, namely ovarian stimulation, intrauterine insemination, and IVF, were associated with a higher risk of postpartum depressive symptoms. Breastfeeding, social support, and baby sex in line with stated preference were negatively associated with postpartum depressive symptoms. There were no significant interactions between the variables. The women's infertility history and treatment experiences were found to have influenced their postpartum depressive symptoms, especially among women who had a long duration of infertility, conceived through IVF, and had received all lines of infertility treatment. [ABSTRACT FROM AUTHOR]

Background Women who undergo cesarean birth might have an increased risk for poor mental health after childbirth, possibly because of maternal and neonatal physical problems, low parental confidence, and decreased levels of oxytocin. However, this relationship remains controversial and requires further examination. The study aimed to examine the effect of cesarean birth on postpartum stress, anxiety, and depression. Methods This nationwide population-based cohort study was conducted using the Taiwan National Health Insurance Database. A total of 12 619 women who underwent cesarean birth and 12 619 control women who underwent vaginal birth were matched by propensity score based on age, socioeconomic status, residential urbanicity, antepartum comorbidity, and index year of delivery. We compared the incidence of stress, anxiety, and depression during the first postpartum year between cesarean and comparison groups by calculating incidence rate ratios ( IRRs). Results The cesarean group showed a significantly higher risk for stress symptoms ( IRR 1.4 [95% confidence interval {CI} 1.02-1.92]), but not anxiety ( IRR 1.14 [95% CI 0.95-1.38]) or depression ( IRR 1.32 [95% CI 0.94-1.87]), although the IRRs were also greater than one. The cesarean group had a significantly higher risk of any of the above-listed three disorders than the comparison group (incidence 27.6 vs 23.4 per 1000 person-years; IRR 1.18 [95% CI 1.01-1.38]). Conclusions Cesarean birth was associated with an increased risk of postpartum stress symptoms. Health professionals should avoid unnecessary cesarean birth, pay attention to women who deliver by cesarean, and intervene appropriately in an attempt to improve mental health among postpartum women. [ABSTRACT FROM AUTHOR]

Background Needlestick and sharps injuries are prevalent work-related injuries among nurses. Safety devices prevent only one-quarter of related injuries. More studies of modifiable risk factors are needed. Objectives To examine whether long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan. Design Cross-sectional survey. Settings/participants This analysis included 19,386 full-time bedside nurses working in 104 hospitals across Taiwan. Methods Participants filled out an anonymous questionnaire from July to September 2014. Chronic insomnia, needlestick injuries, and sharps injuries during the past year were each measured by a yes/no question. Multivariate logistic regression models were applied to examine the effects of long work hours and chronic insomnia on needlestick and sharps injuries, given with control for sex, marital status, educational level, age, years of practice, work unit, and hospital level in the model. Results More than 70% of study nurses worked long hours during the previous week (>50 h: 27.5%; 41–50 h: 43.2%), and 15.5% of nurses reported chronic insomnia. The percentage of sharps injuries (38.8%) was higher than that for needlestick injuries (22.4%) during the previous year among nurses. After adjusting for potential confounders, logistic regression yielded significant results showing that those who worked 41 to 50 h per week, >50 h per week, and had chronic insomnia were 1.17 times (95% C.I. = 1.04–1.32), 1.51 times (95% C.I. = 1.32–1.72), and 1.45 times (95% C.I. = 1.25–1.68) more likely to experience needlestick injuries, and 1.29 times (95% C.I. = 1.17–1.42), 1.37 times (95% C.I. = 1.23–1.53), and 1.56 times (95% C.I. = 1.37–1.77) more likely to experience sharps injuries, respectively, than those who worked fewer hours and did not have insomnia. Conclusions This nationwide nurse survey showed that high rates of needlestick and sharps injuries persist in hospital nurses in Taiwan. The common problems of long work hours and chronic insomnia increase the risk of these injuries. We suggest that hospital managers follow regulations on work hours and optimize shift schedules for nurses to decrease related injuries. [ABSTRACT FROM AUTHOR]

Children and adolescents tend to lose weight, which may be associated with misperceptions of weight. Previous studies have emphasized establishing correlations between eating disorders and an overestimated perception of body weight, but few studies have focused on an underestimated perception of body weight. The objective of this study was to explore the relationship between misperceptions of body weight and weight-related risk factors, such as eating disorders, inactivity, and unhealthy behaviors, among overweight children who underestimated their body weight. We conducted a cross-sectional, descriptive study between December 1, 2006 and February 15, 2007. A total of 29,313 children and adolescents studying in grades 4-12 were enrolled in this nationwide, cross-sectional survey, and they were asked to complete questionnaires. A multivariate logistic regression using maximum likelihood estimates was used. The prevalence of body weight misperception was 43.2% (26.4% overestimation and 16.8% underestimation). Factors associated with the underestimated perception of weight among overweight children were parental obesity, dietary control for weight loss, breakfast consumption, self-induced vomiting as a weight control strategy, fried food consumption, engaging in vigorous physical activities, and sleeping for >8 hours per day (odds ratios=0.86, 0.42, 0.88, 1.37, 1.13, 1.11, and 1.17, respectively). In conclusion, the early establishment of an accurate perception of body weight may mitigate unhealthy behaviors. [ABSTRACT FROM AUTHOR]

Study Question: Is the mode of conception (natural, subfertility and non-IVF, and IVF) associated with the risk of Type 1 diabetes mellitus among offspring?, Summary Answer: The risk of Type 1 diabetes in offspring does not differ among natural, subfertility and non-IVF, and IVF conceptions., What Is Known Already: Evidence has shown that children born through IVF have an increased risk of impaired metabolic function., Study Design, Size, Duration: A population-based, nested case-control study was carried out, including 769 children with and 3110 children without Type 1 diabetes mellitus within the prospective cohort of 2 228 073 eligible parent-child triads between 1 January 2004 and 31 December 2017., Participants/materials, Setting, Methods: Using registry data from Taiwan, the mode of conception was divided into three categories: natural conception, subfertility, and non-IVF (indicating infertility diagnosis but no IVF-facilitated conception), and IVF conception. The diagnosis of Type 1 diabetes mellitus was determined according to the International Classification of Diseases, 9th or 10th Revision, Clinical Modification. Each case was matched to four controls randomly selected after matching for child age and sex, residential township, and calendar date of Type 1 diabetes mellitus occurrence., Main Results and the Role of Chance: Based on 14.3 million person-years of follow-up (median, 10 years), the incidence rates of Type 1 diabetes were 5.33, 5.61, and 4.74 per 100 000 person-years for natural, subfertility and non-IVF, and IVF conceptions, respectively. Compared with natural conception, no significant differences in the risk of Type 1 diabetes were observed for subfertility and non-IVF conception (adjusted odds ratio, 1.04 [95% CI, 0.85-1.27]) and IVF conception (adjusted odds ratio, 1.00 [95% CI, 0.50-2.03]). In addition, there were no significant differences in the risk of Type 1 diabetes according to infertility source (male/female/both) and embryo type (fresh/frozen)., Limitations, Reasons for Caution: Although the population-level data from Taiwanese registries was used, a limited number of exposed cases was included. We showed risk of Type 1 diabetes was not associated with infertility source or embryo type; however, caution with interpretation is required owing to the limited number of exposed events after the stratification. The exclusion criterion regarding parents' history of diabetes mellitus was only applicable after 1997, and this might have caused residual confounding., Wider Implications of the Findings: It has been reported that children born to parents who conceived through IVF had worse metabolic profiles than those who conceived naturally. Considering the findings of the present and previous studies, poor metabolic profiles may not be sufficient to develop Type 1 diabetes mellitus during childhood., Study Funding/competing Interest(s): This study was supported by grants from Shin Kong Wu Ho-Su Memorial Hospital (No. 109GB006-1). The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. The authors have no competing interests to disclose., Trial Registration Number: N/A., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Globally, there has been little growth in vaccination coverage, with countries in the Horn of Africa having the lowest vaccination rates. This study investigated factors associated with vaccination status among children under five years old in Somaliland. The 2020 Somaliland Demographic and Health Survey surveyed women aged 15-49 years from randomly selected households. This multilevel analysis included 2673 primary caregivers of children under five. Only 34% of children were ever vaccinated. Childhood vaccination coverage was positively associated with high-budget regions, high healthcare facility density, and children older than 23 months. Vaccination coverage was greater for urban and rural residents than for nomadic people. Children whose mothers could read part of one sentence or one complete sentence were more likely to be vaccinated than illiterate mothers. Children whose mothers received antenatal care (ANC) once, two to three times, or four times or more were more likely to be vaccinated than those whose mothers received no ANC. Childhood vaccination coverage in Somaliland is low. Promoting maternal ANC visits and increasing women's literacy may enhance vaccination coverage. Funds should be allocated to areas with low resources, particularly for nomadic people, to boost vaccination uptake.