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BACKGROUND: The bioavailability of isoflavones in children after soy exposure is uncertain. OBJECTIVE: We aimed to compare isoflavone patterns in infants exposed to isoflavone-containing breast milk (BF), in tofu-fed (TF) infants, and in mothers consuming a soy beverage. DESIGN: Eighteen nursing mothers who were not feeding soy foods to their infants consumed one daily serving of a soy protein beverage for 2-4 d and collected their own milk and urine and infant urine. Plasma was collected from infants if venous blood draws were ordered by pediatricians. Blood and urine were collected from additional children after they consumed tofu. Isoflavones were measured by liquid chromatography-mass spectrometry. RESULTS: In 7 subjects, isoflavone values increased significantly from baseline after mothers ate soy: in maternal urine (x +/- SEM) from 18.4 +/- 13.0 to 135.1 +/- 26.0 nmol/mg creatinine, in breast milk from 5.1 +/- 2.2 to 70.7 +/- 19.2 nmol/L, and in infant urine from 29.8 +/- 11.6 to 111.6 +/- 18.9 nmol/mg creatinine. The mean isoflavone concentration in plasma obtained from 11 BF infants was 19.7 +/- 13.2 nmol/L. TF infants had much higher mean isoflavone values (urine, 229 +/- 129 nmol/mg creatinine; plasma, 1049 +/- 403 nmol/L). Statistically significant correlations were observed between the types of fluids investigated within mothers, between mothers and infants, and within infants. Urinary isoflavone excretion per hour adjusted for dose per body weight was 81% lower for BF infants and 24% higher for TF infants than for their mothers after eating soy. CONCLUSIONS: More isoflavones appear in children than in adults after adjustment for isoflavone intake. Systemic isoflavone exposure in infants can be determined by urinary analysis.

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CONTEXT: In addition to seeking conventional treatment from physicians, cancer patients will often use religious and spiritual resources (RSR) and complementary and alternative medicine (CAM). Patients' beliefs about the relationships among RSR, CAM, and conventional treatments may reflect belief systems not readily apparent to physicians. OBJECTIVE: 1) Identify the RSR used and explore themes in beliefs regarding RSR, CAM, and conventional treatment. 2) Investigate the nature of the relationships among RSR, CAM, and conventional treatment in the lives of cancer patients. DESIGN: Cancer patients in Hawaii were recruited from a group who had previously completed a questionnaire on CAM use. In-depth interviews were conducted with a selected subset of survey participants. PARTICIPANTS: 143 cancer patients were interviewed 2 to 3 years following diagnosis. RESULTS: Participants reported using a variety of RSR, including personal faith, individual (self) prayer, relationship/dialog with God, prayers from fellow church members and others, counseling from pastor/priest or leader of faith, reading the bible, attending religious services, meditation, finding and spending time at locations of spiritual energy (i.e., churches, specific geographical locations, or certain natural settings), and help or counseling by ancestor(s). They also expressed beliefs that RSR, CAM, and conventional treatment have both shared and distinct purposes. RSR themes included providing treatment or cure, supporting treatment or cure, and being part of life. CAM themes included providing treatment or cure, supporting treatment or cure, preventing cancer and recurrence, substitution for conventional treatment, and as a last resort. Participants believed the purposes of conventional treatment were to fight/cure cancer and to improve quality of life. CONCLUSIONS: RSR, CAM, and conventional treatment served both spiritual and physical purposes. When participants perceived a relationship between RSR, CAM, and conventional treatment, it reflected shared spiritual and physical purposes. Such associations were especially strong when RSR, CAM, and conventional treatment shared the common goals of providing treatment or cure and/or supporting treatment or cure. Perceptions of shared purpose were individual to each participant, with religious congruence and life history playing a role in beliefs about the relationship between RSR and CAM. Such beliefs can affect issues of control, spiritual well-being, coping, depression, decision-making, and possibly health outcomes in cancer patients. Therefore, they should be addressed by clinicians in discussions with their patients.

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This study examined patterns in the use of health information among Caucasian, Japanese, and non-Japanese Asian Pacific Islander cancer patients in Hawaii and explored the relation of ethnicity and educational level to choices of health information sources. Information from 140 cancer patients, most of whom were users of complementary and alternative medicine (CAM), was analyzed using correspondence analysis. Three clusters of health information pertinent to the three ethnic groups emerged from the data. The results of this study revealed that Caucasian patients preferred objective, scientific, and updated information obtained through medical journals or newsletters from research institutions, telephone information services, and the internet. Japanese patients relied on media and commercial sources including television, newspapers, books, magazines and CAM providers. Non-Japanese Asians and Pacific Islanders used information sources involving person-to-person communication with their physicians, social groups, and other cancer patients. A higher educational level was closely related to a cluster of health information stressing objective, scientific and updated information, while a lower educational level was associated with interpersonally communicated information. The three ethnicity-specific patterns of health information use remained relatively stable at different educational levels, implying that the effect of patients' ethnicity overrides their educational level in shaping their choices of health information. The results of this study indicate the importance of recognizing cancer patients' culturally developed world views when understanding their health information-seeking behavior. For medical practice, these findings indicate the need for healthcare providers to assist cancer patients to obtain accurate health information in a culturally sensitive way.

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The aim of this paper is to identify barriers to communication between physicians and cancer patients regarding complementary and alternative medicine (CAM) by exploring the perspectives of patients. In face of the recent popularity of CAM use among cancer patients, the lack of communication is a serious problem. A number of CAM therapies may interfere with conventional treatments and thus impact patients' well-being and chances of survival. In addition, lack of communication is problematic in the health care context because the development of openness and trust between health care providers and clients is contingent upon effective interpersonal communication. We conducted semi-structured interviews with 143 cancer patients to explore their experiences with CAM use. Using a qualitative research method, we examined interview data from 93 CAM users who provided sufficient information about communication issues. As a result, three themes emerged describing barriers to unsuccessful communication as perceived from the patient's point of view: physicians' indifference or opposition toward CAM use, physicians' emphasis on scientific evidence, and patients' anticipation of a negative response from their physician. Increasing education about CAM and regular assessment of CAM use may help physicians to be more aware of their patients' CAM use. As a result, physicians may provide patients with information on risks and benefits of CAM use and refer patients to other services that may address unmet needs. Given a difference in epistemiologic beliefs about cancer and its treatment, the challenge is to find a common ground for an open discussion in which physicians consider that scientific evidence is not all that counts in the life of an individual facing a serious disease.

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