The Kaiser Permanente Northern California research program on genes, environment, and health (RPGEH) pregnancy cohort: study design, methodology and baseline characteristics.

BACKGROUND: Exposures during the prenatal period may have lasting effects on maternal and child health outcomes. To better understand the effects of the in utero environment on children's short- and long-term health, large representative pregnancy cohorts with comprehensive information on a broad range of environmental influences (including biological and behavioral) and the ability to link to prenatal, child and maternal health outcomes are needed. The Research Program on Genes, Environment and Health (RPGEH) pregnancy cohort at Kaiser Permanente Northern California (KPNC) was established to create a resource for conducting research to better understand factors influencing women's and children's health. Recruitment is integrated into routine clinical prenatal care at KPNC, an integrated health care delivery system. We detail the study design, data collection, and methodologies for establishing this cohort. We also describe the baseline characteristics and the cohort's representativeness of the underlying pregnant population in KPNC. METHODS: While recruitment is ongoing, as of October 2014, the RPGEH pregnancy cohort included 16,977 pregnancies (53 % from racial and ethnic minorities). RPGEH pregnancy cohort participants consented to have blood samples obtained in the first trimester (mean gestational age 9.1 weeks ± 4.2 SD) and second trimester (mean gestational age 18.1 weeks ± 5.5 SD) to be stored for future use. Women were invited to complete a questionnaire on health history and lifestyle. Information on women's clinical and health assessments before, during and after pregnancy and women and children's health outcomes are available in the health system's electronic health records, which also allows long-term follow-up. DISCUSSION: This large, racially- and ethnically-diverse cohort of pregnancies with prenatal biospecimens and clinical data is a valuable resource for future studies on in utero environmental exposures and maternal and child perinatal and long term health outcomes. The baseline characteristics of RPGEH Pregnancy Cohort demonstrate that it is highly representative of the underlying population living in the broader community in Northern California.

Use of alternative medicine by children with cancer in Washington state.

BACKGROUND: Use of alternative medicine is widespread among adult cancer patients, but considerably less is known about the use of these therapies by pediatric cancer patients. Our objective was to investigate the distribution and patterns of alternative medicine use by children diagnosed with cancer in Washington State. METHODS: Pediatric cancer patients (< or =18 years) with first primary neoplasms were identified from the Cancer Surveillance System of western Washington. Telephone interviews were conducted with parents of 75 patients to obtain data on the prevalence and types of alternative medicine used, satisfaction with conventional and alternative medicine, motivations for use of alternative medicine, adverse effects, and costs. RESULTS: Seventy-three percent of patients used at least one alternative treatment or therapy. Twenty-one percent of patients consulted an alternative provider (e.g., acupuncturist, naturopathic doctor), and insurance companies covered 75% of these costs. Twenty-eight percent used high-dose dietary supplements such as vitamins C or E, and 35% used herbal preparations. Although use of alternative medicine was associated with parental dissatisfaction with their child's physician (P = 0.02), no patient used alternative medicine as a substitute for standard medical care. Most patients used alternative medicine to cope with disease symptoms or the side effects of the medical treatments. CONCLUSIONS: Pediatric oncology patients use alternative treatments as adjuncts to conventional care. Both researchers and health care providers should remain informed about the benefits and adverse effects of alternative therapies in order to discuss treatment options with patients and their families and to monitor treatment efficacy.