Use of Self-Care and Practitioner-Based Forms of Complementary and Alternative Medicine before and after a Diagnosis of Breast Cancer

Purpose. We examine factors associated with self-care, use of practitioner-based complementary and alternative medicine (CAM), and their timing in a cohort of women with breast cancer. Methods. Study participants were women with breast cancer who participated in the Long Island Breast Cancer Study Project. Self-care is defined as the use of multivitamins, single vitamins, botanicals, other dietary supplements, mind-body practices, special diets, support groups, and prayer. Within each modality, study participants were categorized as continuous users (before and after diagnosis), starters (only after diagnosis), quitters (only before diagnosis), or never users. Multivariable logistic regression was used for the main analyses. Results. Of 764 women who provided complete data, 513 (67.2%) initiated a new form of self-care following breast cancer diagnosis. The most popular modalities were those that are ingestible, and they were commonly used in combination. The strongest predictor of continuous use of one type of self-care was continuous use of other types of self-care. Healthy behaviors, including high fruit/vegetable intake and exercise, were more strongly associated with continuously using self-care than starting self-care after diagnosis. Conclusions. Breast cancer diagnosis was associated with subsequent behavioral changes, and the majority of women undertook new forms of self-care after diagnosis. Few women discontinued use of modalities they used prior to diagnosis

Latent class analysis suggests four distinct classes of complementary medicine users among women with breast cancer

Background: Breast cancer patients commonly report using >1 form of complementary and alternative medicine (CAM). However, few studies have attempted to analyze predictors and outcomes of multiple CAM modalities. We sought to group breast cancer patients by clusters of type and intensity of complementary and alternative medicine (CAM) use following diagnosis. Methods: Detailed CAM use following breast cancer diagnosis was assessed in 2002–2003 among 764 female residents of Long Island, New York diagnosed with breast cancer in 1996–1997. Latent class analysis (LCA) was applied to CAM modalities while taking into account frequency and intensities. Results: Four distinct latent classes of CAM use emerged: 1) “Low-dose supplement users” (40 %), who used only common nutritional supplements; 2) “Vitamin/mineral supplement users” (39 %), using an abundance of supplements in addition to other practices; 3) “Mind-body medicine users” (12 %), with near-universal use of supplements, mind-body medicine techniques, and massage; and 4) “Multi-modality high-dose users” (9 %), who were highly likely to use nearly all types of CAM. Predictors of membership in classes with substantial CAM use included younger age, more education, higher income, Jewish religion, ideal body mass index, higher fruit and vegetable intake, higher levels of physical activity, receipt of adjuvant chemotherapy, and prior use of oral contraceptives. Conclusions: LCA identified important subgroups of breast cancer patients characterized by varying degrees of complementary therapy use. Further research should explore the reproducibility of these classes and investigate the association between latent class membership and breast cancer outcomes

Discourses of diversity, equality and inclusion: Trenchant formulations or transient fashions?

Using bibliometric analysis of published work, we examine the discursive trends, patterns and implications of three different anti-discrimination solutions (equality, diversity and inclusion) over a 40-year period from 1970 to 2010. The findings reveal that the anti-discrimination discourses are consistent with management fashions, in terms of both their trends and the rhetorical strategies used by proponents to establish the dominance of their favoured approach, particularly by denigrating previous approaches. Practitioner-facing academics play a key role in the process by giving shape, exposure and credibility to the anti-discrimination solutions, but not in creating them. Only by breaking free of the oppositional discursive patterns can the debate move on to anti-discrimination solutions that attempt to blend together equality, diversity and inclusion

Postdiagnosis Change in Bodyweight and Survival After Breast Cancer Diagnosis

Weight gain after diagnosis is common among women with breast cancer, yet results have been inconsistent among the few studies examining its effects on survival

Characteristics of patients with venous thromboembolism and atrial fibrillation in Venezuela

<p>Abstract</p> <p>Background</p> <p>Studies describing venous thromboembolic event (VTEE) and atrial fibrillation (AF) in South American populations are limited. The aim of this cross-sectional study was to describe the characteristics of Venezuelan patients admitted and treated for these conditions.</p> <p>Methods</p> <p>A retrospective medical record review of 1397 consecutive patients admitted to three private hospitals or clinics between January 2000 and December 2005 was performed. Data was collected on demographics, anthropometrics, hospital visit, comorbidities and treatment.</p> <p>Results</p> <p>Among 401 VTEE and 996 AF patients, men were more likely to have AF (58%) while more women experienced a VTEE (58%). Most patients were admitted via the emergency room (87%) and had only one event during the study period (83%). Common comorbidities included hypertension (46%), heart failure (17%), diabetes (12%) and congestive heart failure (11%). Characteristics of Venezuelan patients with VTEE and AF are similar to that reported in the literature for other populations.</p> <p>Conclusions</p> <p>These results provide background characteristics for future studies assessing risk factors for AF and VTEE in South American populations.</p

Prevalence and predictors of antioxidant supplement use during breast cancer treatment: The Long Island Breast Cancer Study Project

Although many patients take antioxidant dietary supplements during breast cancer treatment, the benefits of such supplementation are unproven. We analyzed the prevalence of and factors associated with antioxidant supplement use during breast cancer treatment among women who participated in the Long Island Breast Cancer Study Project

Post-diagnosis physical activity and survival after breast cancer diagnosis: the Long Island Breast Cancer Study

Physical activity (PA) is associated with physiological responses thought to beneficially affect survival after breast cancer diagnosis, yet few studies have considered the entire survivorship experience. Effects of post-diagnosis activity on survival were examined in a cohort of 1,423 women diagnosed with in situ or invasive breast cancer in 1996–1997. Subjects were interviewed soon after diagnosis and again after approximately 5 years to assess breast cancer-related factors, including recreational PA before and after diagnosis. Date and cause of death through 2009 were determined from the National Death Index. Adjusted estimates were obtained using proportional hazards regression and a selection model to account for missing data. Survival was improved among women who were highly active after diagnosis (>9.0 MET h/week) compared to inactive women (0 MET h/week) for all-cause [hazard ratio (HR) (95 % credible interval): 0.33 (0.22, 0.48)] and breast cancer-specific mortality [HR: 0.27 (0.15, 0.46)]. The association of PA with overall mortality appeared stronger in the first 2 years after diagnosis [HR: 0.14 (0.03, 0.44)] compared to 2+ years since diagnosis [HR: 0.37 (0.25, 0.55)]. These findings show that postdiagnosis PA is associated with improved survival among women with breast cancer

Polycyclic aromatic hydrocarbon–DNA adducts and survival among women with breast cancer

Polycyclic aromatic hydrocarbons (PAH) are mammary carcinogens in animal studies, and a few epidemiologic studies have suggested a link between elevated levels of PAH-DNA adducts and breast cancer incidence. An association between PAH-DNA adducts and survival among breast cancer cases has not been previously reported. We conducted a survival analysis among women with newly diagnosed invasive breast cancer between 1996 and 1997, enrolled in the Long Island Breast Cancer Study Project. DNA was isolated from blood samples that were obtained from cases shortly after diagnosis and before treatment, and assayed for PAH-DNA adducts using an ELISA. Among the 722 cases with PAH-DNA adduct measurements, 97 deaths (13.4%) from all causes and 54 deaths (7.5%) due to breast cancer were reported to the National Death Index (NDI) by December 31, 2002. Using Cox proportional hazards models and controlling for age at diagnosis, we did not find evidence that all-cause mortality (hazard ratio (HR) = 0.88; 95% confidence interval (CI): 0.57–1.37), or breast cancer mortality (HR = 1.20; 95% CI: 0.63–2.28) was strongly associated with detectable PAH-DNA adduct levels compared with non-detectable adducts; additionally, no dose-response association was observed. Among a subgroup with treatment data (n=520), adducts were associated with over a two-fold higher mortality among those receiving radiation, but mortality for adducts was reduced among hormone therapy users. Results from this large population-based study do not provide strong support for an association between detectable PAH-DNA adducts and survival among women with breast cancer, except perhaps among those receiving radiation treatment

Collaborative innovation: A viable alternative to market-competition and organizational entrepreneurship

There are growing pressures for the public sector to be more innovative but considerable disagreement about how to achieve it. This paper uses institutional and organizational analysis to compare three major but different public innovation strategies. The paper commences by confronting the myth that the market-driven private sector is more innovative than the public sector by showing that both sectors have a number of barriers as well as drivers of innovation, some of which are similar while others are sector-specific. The paper then systematically analyses the three strategies for innovation. These are: New Public Management which emphasises market competition; the neo-Weberian state which emphasises organizational entrepreneurship; and collaborative governance which emphasises multi-actor engagement across organizations in the private, public and non-profit sectors. The article concludes that the choice between different strategies for enhancing public innovation is contingent rather than absolute. Some contingencies for each strategy are outlined

Therapeutic targeting of cathepsin C::from pathophysiology to treatment

Cathepsin C (CatC) is a highly conserved tetrameric lysosomal cysteine dipeptidyl aminopeptidase. The best characterized physiological function of CatC is the activation of pro-inflammatory granule-associated serine proteases. These proteases are synthesized as inactive zymogens containing an N-terminal pro-dipeptide, which maintains the zymogen in its inactive conformation and prevents premature activation, which is potentially toxic to the cell. The activation of serine protease zymogens occurs through cleavage of the N-terminal dipeptide by CatC during cell maturation in the bone marrow. In vivo data suggest that pharmacological inhibition of pro-inflammatory serine proteases would suppress or attenuate deleterious effects of inflammatory/auto-immune disorders mediated by these proteases. The pathological deficiency in CatC is associated with Papillon-Lefèvre syndrome. The patients however do not present marked immunodeficiency despite the absence of active serine proteases in immune defense cells. Hence, the transitory pharmacological blockade of CatC activity in the precursor cells of the bone marrow may represent an attractive therapeutic strategy to regulate activity of serine proteases in inflammatory and immunologic conditions. A variety of CatC inhibitors have been developed both by pharmaceutical companies and academic investigators, some of which are currently being employed and evaluated in preclinical/clinical trials