Mapping patterns of complementary and alternative medicine use in cancer: An explorative cross-sectional study of individuals with reported positive "exceptional" experiences

<p>Abstract</p> <p>Background</p> <p>While the use of complementary and alternative medicine (CAM) among cancer patients is common and widespread, levels of commitment to CAM vary. "Committed" CAM use is important to investigate, as it may be associated with elevated risks and benefits, and may affect use of biomedically-oriented health care (BHC). Multiple methodological approaches were used to explore and map patterns of CAM use among individuals postulated to be committed users, voluntarily reporting exceptional experiences associated with CAM use after cancer diagnosis.</p> <p>Method</p> <p>The verbatim transcripts of thirty-eight unstructured interviews were analyzed in two steps. First, manifest content analysis was used to elucidate and map participants' use of CAM, based on the National Center for Complementary Medicine (NCCAM)'s classification system. Second, patterns of CAM use were explored statistically using principal component analysis.</p> <p>Findings</p> <p>The 38 participants reported using a total of 274 specific CAM (median = 4) consisting of 148 different therapeutic modalities. Most reported therapies could be categorized using the NCCAM taxonomy (n = 224). However, a significant number of CAM therapies were not consistent with this categorization (n = 50); consequently, we introduced two additional categories: <it>Spiritual/health literature </it>and <it>Treatment centers</it>. The two factors explaining the largest proportion of variation in CAM usage patterns were a) number of CAM modalities used and b) a category preference for <it>Energy therapies </it>over the categories <it>Alternative Medical Systems </it>and <it>Treatment centers </it>or vice versa.</p> <p>Discussion</p> <p>We found considerable heterogeneity in patterns of CAM use. By analyzing users' own descriptions of CAM in relation to the most commonly used predefined professional taxonomy, this study highlights discrepancies between user and professional conceptualizations of CAM not previously addressed. Beyond variations in users' reports of CAM, our findings indicate some patterns in CAM usage related to number of therapies used and preference for different CAM categories.</p

Women´s encounters with biomedical technology in the realm of cervical cancer screening

As a form of biomedical technology, the Papanicolaou (Pap) smear has been described as the most widely used and established cane er- screening tool in the world. In Sweden, Pap smear technology triggered what is today an established secondary preventive intervention directed towards 'healthy' women to detect those at risk for developing cervical cancer, a potentially fatal disease, as well as those with the disease. Sweden has been described as one of the countries where mortality in cervical cancer has decreased due to a well-organised screening programme. Cervical cancer screening (CCS) encompasses a broad spectrum of phenomena that ranges from the cellular level to populations of 'healthy' women and various professional groups and academic disciplines thus perform, study, and regulate CCS. The overall aim of this thesis is to explore and describe how women create meaning in the encounter with biomedical technology at various sites associated with population based cervical cancer screening (PCCS) with focus on health, normality and risk for disease. Multi-sited ethnography was used to conceive of PCCS as one field of inquiry although performed at and dispersed among multiple sites. The cytodiagnosticians, who assess the Pap smears and do not meet the women in the target population, have a central but understudied role in CCS. For the women whose cells have been examined, deviations on the level of cells have to be rendered meaningful in regard to their own health and illness, despite a lack of experientially matching symptoms. The thesis is composed of a methodological and theoretical paper (Paper I) and three empirical studies (Papers II, III and IV), conducted in conjunction with a large-scale multi disciplinary project investigating PCCS from "lay" and "professional" perspectives through a series of studies. In Paper I the role of the research assistant in multidisciplinary team research, conducting interviews on sensitive topics, and the notion of informed consent in institutional sites, are among the issues highlighted and problematised. Paper II is based on interviews with women at three screening venues chosen for demographic variation. The modified phenomenographic analysis highlights four qualitatively different ways of reasoning about attendance and the Pap smear, with only one similar to the biomedical rationale for screening with focus on attending for the test/results. Some shared themes are also described, e.g. the notion of early detection of disease and familiarity with biomedical technology and controls of the 'healthy' body. Paper III is based on one year of fieldwork conducted at two cytology laboratories. The manuscript is an ethnographic description of the personnel's daily work and analysis of the Pap smears. The personnel's work and skills with enhancing the cytology sample's trajectory; assessing and classifying normal cytology, and; detecting and marking abnormal cells are analysed and described focussing on order and disorder, classification, visual knowledge and biomedical technology. By assessing and classifying normal cytology, differentiating between normal and abnormal cells and suggesting classifications of the grades of abnormal cells, the cytodiagnosticians partake in creating order among cells. In Paper IV a phenomenological hermeneutical method was used as a strategy to explore and describe how women experience receiving notification on abnormal Pap test results through the PCCS. Women's experiences in receiving abnormal Pap smear test results are presented in two themes: Pap smear for routine and recurrent confirmation of health, and ambiguous communication about Pap smear results. The themes are discussed as an unintentional transition from health to liminality, as the women expected the Pap smear to confirm health, but instead neither health nor disease was confirmed or excluded. Thus, the discovery of abnormal cells did not create order for the women, as disorder had generally not been experienced. The thesis discussion synthesises similarities and differences in and between the studies e.g. in regard to the notion of early detection of disease and the role of routinisation. These similarities and differences are discussed in relation to current research, discourses and policy documents on CCS in general and PCCS in particular

From 'silent' to 'heard': Professional mediation, manipulation and women's experiences of their body after an abnormal Pap smear

While there is a large body of research on cervical cancer screening, fewer studies address the experiences of women receiving abnormal Pap smear results after routine screening. Those studies highlighting such experiences tend to concentrate on resulting psychosocial distress, with an absence in the literature about women's experiences of their bodies during medical follow-up for dysplasia, and no studies were found that explore such experiences over time. In this article, we focus on bodily experiences over time during medical follow-up of an abnormal Pap smear among a group of women in Sweden. This qualitative analysis is based on interview data from a total of 30 women, and with in-depth analysis of the content of 34 transcribed interviews with nine women who were followed longitudinally. We found that medical follow-up involved an experience of both "having" and "being" a body, which changed over time. Women described a process that ranged from having a cervix that was neither felt, 'heard', nor seen, to having a body that became known to them first indirectly through professional mediation and later through direct experience after professional manipulation. The conceptualization of bodily boundaries appeared to change, e.g. through visualization of the previously unfamiliar cervix, pain, vaginal discharge, and bleeding, as well as linkages to the bodies of women in their extended families through the generations. Thus, bodily experiences appear to be an intrinsic part of medical follow-up of an abnormal Pap smear through which health, disease, and risks in the past, present, and future were reconceptualised.Sweden Cervical cancer screening Prevention Body

Complement gene variants in relation to autoantibodies to beta cell specific antigens and type 1 diabetes in the TEDDY Study

A total of 15 SNPs within complement genes and present on the ImmunoChip were analyzed in The Environmental Determinants of Diabetes in the Young (TEDDY) study. A total of 5474 subjects were followed from three months of age until islet autoimmunity (IA: n = 413) and the subsequent onset of type 1 diabetes (n = 115) for a median of 73 months (IQR 54-91). Three SNPs within ITGAM were nominally associated (p < 0.05) with IA: rs1143678 [Hazard ratio; HR 0.80; 95% CI 0.66-0.98; p = 0.032], rs1143683 [HR 0.80; 95% CI 0.65-0.98; p = 0.030] and rs4597342 [HR 1.16; 95% CI 1.01-1.32; p = 0.041]. When type 1 diabetes was the outcome, in DR3/4 subjects, there was nominal significance for two SNPs: rs17615 in CD21 [HR 1.52; 95% CI 1.05-2.20; p = 0.025] and rs4844573 in C4BPA [HR 0.63; 95% CI 0.43-0.92; p = 0.017]. Among DR4/4 subjects, rs2230199 in C3 was significantly associated [HR 3.20; 95% CI 1.75-5.85; p = 0.0002, uncorrected] a significance that withstood Bonferroni correction since it was less than 0.000833 (0.05/60) in the HLA-specific analyses. SNPs within the complement genes may contribute to IA, the first step to type 1 diabetes, with at least one SNP in C3 significantly associated with clinically diagnosed type 1 diabetes