Jinhee Park

Breast cancer risk factors in Korean women: a literature review

AIM To compile a complete list of risk factors from the Korean breast cancer studies to obtain relevant predictor information essential in developing a predictive model for breast cancer. BACKGROUND Breast cancer is the most commonly diagnosed female cancer in Korea. However, the breast cancer-screening rate in Korea is relatively low compared with that in other countries. In order to promote early health screening, there is a need to identify those individuals who are most likely to develop breast cancer by using an accurate predictive model. METHODS Thirty-four breast cancer studies were selected from MEDLINE and two Korean literature databases. Two researchers summarized the risk factors and their effects in each article using a checklist. FINDINGS Most of the studies were case-control studies conducted after 2000. In 34 articles, a total of 84 risk factors for breast cancer in Korean women were identified; of these, 58 factors were determined as statistically significant factors. The factors identified most often were body mass index, menarche, menopause, family history, pregnancy and delivery, breastfeeding, alcohol use, smoking habits, diet, education and use of oral contraceptives. None of 34 studies looked at stress as a risk factor of which influence on cancer has been reported in other populations. CONCLUSION The next steps will be to construct a questionnaire consisting of relevant variables based on these study results and to develop a predictive model. This would be used to encourage those Koreans who are more likely to develop breast cancer to have early check-ups.

Factors associated with feeding progression in extremely preterm infants.

BackgroundAmong infants born prematurely, competence at oral feeding is necessary for growth and hospital discharge. Extremely preterm (EP) infants (28 weeks of gestational age [GA]) are at risk for a variety of medical complications, which can limit the infant’s capacity to develop oral feeding competence. ObjectiveThis study examined feeding progression by assessing timing of acquisition of five early feeding milestones among EP infants and the impact of immaturity and medical complications. DesignA chart review was conducted for 94 EP infants who participated in a larger longitudinal randomized study. Feeding progression was defined as infants’ postmenstrual age (PMA) at five milestones: first enteral feeding, full enteral feeding, first oral feeding, half oral feeding, and full oral feeding. GA at birth and five medical complications (neurological risk, bronchopulmonary dysplasia, necrotizing enterocolitis, patent ductus arteriosus, and gastroesophageal reflux disease) were used as potential factors influencing the feeding progression. Linear mixed models were used to examine feeding progression across the milestones and contributions of GA at birth and five medical complications on the progression, after controlling for milk type as a covariate. ResultEP infants gradually achieved feeding milestones; however, the attainment of the feeding milestones slowed significantly for infants with younger GA at birth and the presence of medical complications, including neurological risk, bronchopulmonary dysplasia, necrotizing enterocolitis, and patent ductus arteriosus but not gastroesophageal reflux disease. Milk type was a significant covariate for all analyses, suggesting that infants fed with breast milk achieved each of five milestones earlier than formula-fed infants. DiscussionImproved understanding of the timing of essential feeding milestones among EP infants and the contribution of specific medical conditions to the acquisition of these milestones may allow for more targeted care to support feeding skill development.

Efficacy of semielevated side-lying positioning during bottle-feeding of very preterm infants: a pilot study.

Very preterm (VP, ⩽30 wk gestational age) infants are at risk for impaired lung function, which significantly limits their ability to eat. A semielevated side-lying (ESL) position is a feeding strategy that may improve oral feeding by supporting breathing during feeding. The study evaluated the efficacy of the ESL position compared with the semielevated supine (ESU) position on physiological stability and feeding performance of bottle-fed VP infants. Using a within-subject crossover design, 6 VP infants were bottle-fed twice on 1 day, in both the ESL and ESU positions in a random order. Physiological stability (heart rate, oxygen saturation [SaO2], and respiratory characteristics) and feeding performance (percent intake, proficiency, efficiency, and duration of feeding) were measured before and/or during feeding. Very preterm infants fed in the ESL position demonstrated significantly less variation in heart rate, less severe and fewer decreases in heart rate, respiratory rate that was closer to the prefeeding state, shorter and more regular intervals between breaths, and briefer feeding-related apneic events. No significant differences for SaO2 or feeding performance were found. The findings indicate that the ESL position may support better regulation of breathing during feeding, thereby allowing VP infants to better maintain physiological stability throughout feeding.

Assessment Tools for Evaluation of Oral Feeding in Infants Younger Than 6 Months.

Background:Feeding difficulty is common in infants younger than 6 months. Identification of infants in need of specialized treatment is critical to ensure appropriate nutrition and feeding skill development. Valid and reliable assessment tools help clinicians objectively evaluate feeding. Purpose:To identify and evaluate assessment tools available for clinical assessment of bottle- and breastfeeding in infants younger than 6 months. Methods/Search Strategy:CINAHL, HaPI, PubMed, and Web of Science were searched for “infant feeding” and “assessment tool.” The literature (n = 237) was reviewed for relevant assessment tools. A secondary search was conducted in CINAHL and PubMed for additional literature on identified tools. Findings/Results:Eighteen assessment tools met inclusion criteria. Of these, 7 were excluded because of limited available literature or because they were intended for use with a specific diagnosis or in research only. There are 11 assessment tools available for clinical practice. Only 2 of these were intended for bottle-feeding. All 11 indicated that they were appropriate for use with breastfeeding. None of the available tools have adequate psychometric development and testing. Implications for Practice:All of the tools should be used with caution. The Early Feeding Skills Assessment and Bristol Breastfeeding Assessment Tool had the most supportive psychometric development and testing. Implications for Research:Feeding assessment tools need to be developed and tested to guide optimal clinical care of infants from birth through 6 months. A tool that assesses both bottle- and breastfeeding would allow for consistent assessment across feeding methods.

The Pediatric Eating Assessment Tool: Factor Structure and Psychometric Properties

Objectives: The Pediatric Eating Assessment Tool (PediEAT) is a parent-report instrument developed to assess symptoms of feeding problems in children aged 6 months to 7 years. The purpose of this study was to identify the factor structure of the PediEAT and test its psychometric properties, including internal consistency reliability, temporal stability, and construct validity. Methods: Participants included 567 parents of children aged 6 months to 7 years. Fifty-four percent of the sample had parent report of a diagnosed feeding problem or feeding concerns. Exploratory factor-analysis techniques were used to remove redundant or non-endorsed items and identify the factor structure of the instrument. Construct validity was examined with 466 parents completing the Mealtime Behavior Questionnaire as a criterion standard. Known-groups validation was used to compare PediEAT scores between children with and without diagnosed feeding problems. Temporal stability of the PediEAT was examined with 97 parents repeating the PediEAT after 2 weeks. Results: Principal components factor analysis with varimax rotation supported a 4-factor model accounting for 39.4% of the total variance. The 4 subscales (Physiologic Symptoms, Problematic Mealtime Behaviors, Selective/Restrictive Eating, Oral Processing) demonstrated acceptable internal consistencies (coefficient alphas: 0.92, 0.91, 0.83, 0.83; respectively). Construct validity was supported in 2 ways. The PediEAT correlated with the Mealtime Behavior Questionnaire (r = 0.77, P < 0.001) and total score and subscale scores were significantly different between children with and without diagnosed feeding problem (P < 0.001). Temporal stability was demonstrated through test-retest reliability (r = 0.95, P < 0.001). Conclusions: Strong psychometric properties support the use of the PediEAT in research and clinical practice.

Milk Flow Rates From Bottle Nipples Used for Feeding Infants Who Are Hospitalized

PURPOSE This study tested the milk flow rates and variability in flow of currently available nipples used for bottle-feeding infants who are hospitalized. METHOD Clinicians in 3 countries were surveyed regarding nipples available to them for feeding infants who are hospitalized. Twenty-nine nipple types were identified, and 10 nipples of each type were tested by measuring the amount of infant formula expressed in 1 min using a breast pump. Mean milk flow rate (mL/min) and coefficient of variation were used to compare nipples within brand and within category (i.e., Slow, Standard, Premature). RESULTS Flow rates varied widely between nipples, ranging from 2.10 mL/min for the Enfamil Cross-Cut to 85.34 mL/min for the Dr. Browns Y-Cut Standard Neck. Variability of flow rates among nipples of the same type ranged from a coefficient of variation of 0.05 for Dr. Browns Level 1 Standard- and Wide-Neck to 0.42 for the Enfamil Cross-Cut. Mean coefficient of variation by brand ranged from 0.08 for Dr. Browns to 0.36 for Bionix. CONCLUSIONS Milk flow is an easily manipulated variable that may contribute to the degree of physiologic instability experienced by infants who are medically fragile during oral feeding. This study provides clinicians with information to guide appropriate selection of bottle nipples for feeding infants who are hospitalized.

Implications of systematic review for breast cancer prediction.

Highly accurate and predictive models are essential components to promote early breast cancer screening in primary care or home care settings. This study was conducted to demonstrate how the relevant variable selection process influenced the predictive performance of the model to identify individuals at high risk for breast cancer. As such, as a strategy to increase the predictive performance of the models, a systematic review of previously published articles was conducted to select important risk factors for breast cancer. Through the systematic literature review and the application of variable selection methods, 13 final risk factors were identified. Logistic regression and naive Bayes predictive modeling techniques were used. Both models had higher predictive performances than previously developed models. It is believed that the systematic literature review process contributed to the identification of relevant variables and increased the predictive performance of the models. This study also implies that the naive Bayes was equivalent to and could be preferred over logistic regression.

Implementing co-regulated feeding with mothers of preterm infants

Purpose:The purpose of this study is to describe implementation of the Co-Regulated Feeding Intervention (CoReg), when provided by mothers and guided by intervention nurses trained in methods of guided participation (GP). Co-regulated feeding intervention aims to prevent stress during feeding and ease the challenge very preterm (VP) infants experience coordinating breathing and swallowing during the early months. Guided participation is a participatory learning method to guide the complex learning required for mothers. Study Design and Methods:Sixteen mothers of 17 VP infants participated. Each mother received a median of five intervention sessions during the infants transition to oral feeding. Intervention field notes, audio recordings of the sessions, and video recordings of the nurse-guided feedings were reviewed, organized, and content analyzed to evaluate implementation. Results:The co-regulated feeding intervention was well received by mothers; enrollment, participation, and retention rates were high. Most mothers chose to spread out the intervention sessions across the transition period. Scheduling sessions was the greatest barrier. Mothers had competing demands and infant readiness to eat could not be predicted. The top five issues identified as needing attention by the mother or nurse included reading cues, coregulating breathing, providing motoric stability, regulating milk flow, and providing rest periods. Main GP strategies included joint attention with the mother to the dyads feeding challenges, auditory assessment of breathing and swallowing, and reflection with planning for future feedings using video playback. Clinical Implications:Nurse presence while mothers feed affords rich opportunities to guide coregulated, cue-based feeding. Co-regulated feeding intervention would be enhanced if mothers are guided by the bedside nurse.

FIRST, DO NO HARM: A Response to "Oral Alimentation in Neonatal and Adult Populations Requiring High-Flow Oxygen via Nasal Cannula".

A recent paper [1] has proposed that the use of respiratory support delivered via high-flow nasal cannula (HFNC) does not have a direct impact on the safety of oral (PO, per os) feeding. As a group of NICU clinicians and researchers, we are writing to express our concern about the design and conclusions presented in this study. Specifically, the article does not present sufficient data for the NICU sample studied to support their conclusions in relation to this population (as detailed below). We believe that this could potentially place vulnerable infants at risk of unsafe feeding practices. Within the NICU environment, HFNC is used as an intervention for many infants with pulmonary disease. Common clinical benefits of HFNC support in infants identified in the literature include a ‘CPAP’ effect (i.e., delivering positive pressure that stents open the airway), providing anatomic O2 reservoirs in the pharynx and allowing rinsing of pharyngeal dead space [2, 3]. To swallow safely, the bolus needs to be contained in the oral cavity prior to the swallow, and the laryngeal vestibule needs to close (deglutition apnea) as the bolus moves through the pharynx, to ensure transport to the esophagus and not into the larynx or lower airway. To swallow safely during breastfeeding and bottle feeding, the precise timing of the suck-swallow-breath sequence needs to be maintained over every one of the swallows that occur in quick succession for minutes at a time while the infant is latched and suckling at the breast or bottle. We are not aware of any objective data using instrumental assessment that show that the presence of HFNC does not (a) impair swallow function during infant suckle feeding or (b) increase aspiration risk in NICU infants (many of whom are at heightened risk for aspiration from their underlying lung disease in itself). The Leder et al. paper [1] does not provide any such data but appears to encourage the practice of allowing (at least some) infants who are dependent on HFNC to feed PO. Of note, the authors report that 34 % (17/50) of infants on HFNC were deemed ‘safe’ to PO feed by MD/RN staff (although it appears that all continued to require tube feeds, indicating that they were not fully functional PO feeders, and is not clear how ‘safety’ was monitored). On examination of the information presented, it is apparent that none of the infants included in this study had a direct feeding evaluation (either formal clinical assessment or instrumental assessment) to confirm the safety of PO feeding. The authors report on their initial criteria for determining readiness to consider trying PO feeds, but make no mention of direct feeding evaluation and no & Pamela Dodrill PDodrill@partners.org

Age-based norm-reference values for the Child Oral and Motor Proficiency Scale

To determine reference values for the Child Oral and Motor Proficiency Scale (ChOMPS) based on healthy, typically developing and typically eating children between six months and seven years old.