Push or pull? : The relationship between quality of care and use of complementary and alternative medicine among patients with lung cancer in Sweden

Little is known about relationships between quality of care (QoC) and use of complementary and alternative medicine (CAM) among patients with lung cancer (LC). Purpose: This study examines CAM-use among patients with LC in Sweden, associations between QoC and CAM-use among these patients, and reported aspects of LC-care perceived as particularly positive and negative by patients, as well as suggestions for improving QoC. Methods: Survey data from 94 patient members of the Swedish LC patient organization about CAM-use and QoC as measured by the instrument “Quality from the patient’s perspective” were analyzed. Results: Fifty (53%) LC-patients used CAM, with 40 of the CAM-users reporting that CAM helped them. The most common CAMs used were dietary supplements and natural remedies, followed by prayer. Significantly more patients reported using prayer and meditation for cure than was the case for other types of CAM used. Less than half the CAM-users reported having spoken with staff from the biomedical health care system about their CAM-use. Patients provided numerous suggestions for improving LC-care in a variety of areas, aiming at a more effective and cohesive care trajectory. No differences in QoC were found between CAM-users and non-CAM-users, but differences in CAM-use i.e. type of CAM, reasons for using CAM, and CAM-provider consulted could be associated with different experiences of care. Conclusions: It is important to recognize that CAM-users are not a homogeneous group but might seek different types of CAMs and CAM-providers in different situations depending on experiences of care.

Attitudes towards the minority variety Caló in the south of Spain : a sociolinguistic study

Caló is a variety spoken by the Spanish Calé (i.e. the Roma). It belongs to a group of languages referred to as “Para-Romani”, characterized by Romani vocabulary, but largely non-Romani morphology, phonology and syntax, in the case of Caló deriving from Spanish. According to previous research carried out – with focus on the vocabulary and the grammar of this variety – Caló is on its way to extinction. However, there is an expressed interest in reintroducing a form called “Romanó-Caló”. Attitudes play an important role in minority language maintenance as well as in order for a revitalization project to be successful. The aim of this study is to measure the attitudes that both Calé and non-Calé have towards Caló and Caló speakers, a type of study never carried out in the past. The methods applied are both direct and indirect. In total, 231 informants listened to different recordings of voices acting as either a “Spanish speaking person” or a “Caló speaking person”, a technique referred to as ‘matched guise’, answering questions related to the voices on attitude scales. Furthermore, 182 of the informants rated their agreement or disagreement to positive and negative items towards Caló and its speakers on a Likert scale. The results of the analysis indicate that the attitudes differ towards Caló and Caló speakers, depending on the informant’s (a) ethnicity (b) contact with Caló as well as with Caló speakers, and (c) gender. It is those who – in their own opinion – belong to the ethnic group Calé, as well as those who claim that they have some contact with the variety and its speakers, who show positive attitudes in both parts of the study. The women also show more positive attitudes than the men. It is also possible to note positive attitudes towards the variety and its speakers among the subjects with a high level of knowledge of Caló words, as well as among those with the highest willingness to use Caló. These observations suggest that a revitalization project of the variety Caló has a clear chance of being successful.

Role of dietary fats in modulating cardiometabolic risk during moderate weight gain : a randomized double-blind overfeeding trial (LIPOGAIN study)

BACKGROUND: Whether the type of dietary fat could alter cardiometabolic responses to a hypercaloric diet is unknown. In addition, subclinical cardiometabolic consequences of moderate weight gain require further study. METHODS AND RESULTS: In a 7-week, double-blind, parallel-group, randomized controlled trial, 39 healthy, lean individuals (mean age of 27±4) consumed muffins (51% of energy [%E] from fat and 44%E refined carbohydrates) providing 750 kcal/day added to their habitual diets. All muffins had identical contents, except for type of fat; sunflower oil rich in polyunsaturated fatty acids (PUFA diet) or palm oil rich in saturated fatty acids (SFA diet). Despite comparable weight gain in the 2 groups, total: high-density lipoprotein (HDL) cholesterol, low-density lipoprotein:HDL cholesterol, and apolipoprotein B:AI ratios decreased during the PUFA versus the SFA diet (-0.37±0.59 versus +0.07±0.29, -0.31±0.49 versus +0.05±0.28, and -0.07±0.11 versus +0.01±0.07, P=0.003, P=0.007, and P=0.01 for between-group differences), whereas no significant differences were observed for other cardiometabolic risk markers. In the whole group (ie, independently of fat type), body weight increased (+2.2%, P<0.001) together with increased plasma proinsulin (+21%, P=0.007), insulin (+17%, P=0.003), proprotein convertase subtilisin/kexin type 9, (+9%, P=0.008) fibroblast growth factor-21 (+31%, P=0.04), endothelial markers vascular cell adhesion molecule-1, intercellular adhesion molecule-1, and E-selectin (+9, +5, and +10%, respectively, P<0.01 for all), whereas nonesterified fatty acids decreased (-28%, P=0.001). CONCLUSIONS: Excess energy from PUFA versus SFA reduces atherogenic lipoproteins. Modest weight gain in young individuals induces hyperproinsulinemia and increases biomarkers of endothelial dysfunction, effects that may be partly outweighed by the lipid-lowering effects of PUFA. CLINICAL TRIAL REGISTRATION URL: http://ClinicalTrials.gov. Unique identifier: NCT01427140.