Window of the World: Sino-African Encounters through Copies and Simulations.

Located in the manufacturing hub of Shenzhen is Window of the World: a Chinese theme park that features miniature copies of heritage sites from around the world. The individuals living within this constructed simulation are imported from diverse countries. They come to work as performers, animating the different cultural pavilions. As such, the transnationalism made possible by this park provides a window through which we can observe cultural interactivity, as well as the ways in which culture is constructed and re-presented. This article examines some of the processes of cultural encounters through copies of commodified cultural heritage. It also sheds light on the ways in which Kung Fu movies circulating in Africa have inspired the imaginations of young people, revealing cultural feedback loops that provide openings for new contact. Grounded in ethnographic research, the findings here are based on interviews with Kenyan and South African contract workers at this theme park. This article explores young people's pursuits of new opportunities of identity-formation and self-representation, as well as economic stability and forward mobility.

Prevalence of Zinc Deficiency in Cardiac Surgery Patients.

BACKGROUND: The aim of this study was to define the status of preoperative zinc levels in patients with heart disease presenting for cardiac surgery and to identify any predictors for and any clinical consequences of low zinc levels. METHODS: Adult patients presenting for elective surgery, either coronary artery bypass graft surgery and/or valve replacement, provided a fasting blood sample on the day of admission for surgery. Plasma and erythrocyte zinc levels were analysed and the levels correlated with the patient's characteristics and clinical outcomes. RESULTS: Of 56 patients 53% (n=30) had abnormally low plasma zinc levels (<12µmol/L) and 5.5% (n=3) had abnormally low erythrocyte zinc levels (<160µmol/L), indicative of deficiency. There were significant associations between lower plasma zinc levels and the presence of hypertension (p=0.02), hypercholesteraemia (p=0.02) and higher body mass index (BMI) (p=0.034) but no effect on major postoperative clinical outcomes. CONCLUSIONS: This small study shows that zinc deficiency is common in cardiac surgery patients, especially in the presence of hypertension, hypercholesterolaemia or obesity. The effects of zinc deficiency in cardiac surgery need to be further investigated.

An interpretive review of consensus statements on clinical guideline development and their application in the field of traditional and complementary medicine.

BACKGROUND: Despite ongoing consumer demand and an emerging scientific evidence-base for traditional and complementary medicine (T&CM), there remains a paucity of reliable information in standard clinical guidelines about their use. Often T&CM interventions are not mentioned, or the recommendations arising from these guidelines are unhelpful to end-users (i.e. patients, practitioners and policy makers). Insufficient evidence of efficacy may be a contributing factor; however, often informative recommendations could still be made by drawing on relevant information from other avenues. In light of this, the aim of this research was to review national and internationally endorsed consensus statements for clinical guideline developers, and to interpret how to apply these methods when making recommendations regarding the use of T&CM. METHOD: The critical interpretive review method was used to identify and appraise relevant consensus statements published between 1995 and 2015. The statements were identified using a purposive sampling technique until data saturation was reached. The most recent edition of a statement was included in the analysis. The content, scope and themes of the statements were compared and interpreted within the context of the T&CM setting; including history, regulation, use, emerging scientific evidence-base and existing guidelines. RESULTS: Eight consensus statements were included in the interpretive review. Searching stopped at this stage as no new major themes were identified. The five themes relevant to the challenges of developing T&CM guidelines were: (1) framing the question; (2) the limitations of using an evidence hierarchy; (3) strategies for dealing with insufficient, high quality evidence; (4) the importance of qualifying a recommendation; and (5) the need for structured consensus development. CONCLUSION: Evidence regarding safety, efficacy and cost effectiveness are not the only information required to make recommendations for clinical guidelines. Modifying factors such as burden of disease, magnitude of effect, current use, demand, equity and ease of integration should also be considered. Uptake of the recommendations arising from this review are expected to result in the development of higher quality clinical guidelines that offer greater assistance to those seeking answers about the appropriate use of T&CM.

Complementary medicine use by people living with HIV in Australia - a national survey.

Little is known about the use of complementary medicines by people living with HIV in Australia since the advent of more effective combination antiretroviral therapy. We conducted an anonymous survey of 1211 adult patients receiving combination antiretroviral therapy from one of eight specialist HIV clinics across Australia, aiming to identify the current patterns of use of ingestible complementary medicines. Data collected included reasons for use, information sources and rates of disclosure of use of complementary medicines to medical practitioners and pharmacists. Ingestible complementary medicine was used by up to 53% of the 1037 patients returning a survey. Complementary medicine was commonly used for general health, to boost immune function and, to a lesser extent, to address co-morbidities. Disclosure of complementary medicines use to doctors was far higher than to pharmacists. Given the potential for interactions, pharmacists should be more aware of patients' complementary medicines use.

A quality dietary supplement: before you start and after it's marketed--a conference report.

Consumers worldwide are turning to dietary supplements as one part of their personal goal to lead healthier and more active lives. In truth, the quality of life now supersedes the length of life as no one would trade living to one hundred (the last forty with compromised physical abilities and decreased mental acuity) for 80 years of travel, time with family, and intellectual pursuits. If there is the possibility of preventing a disease or debilitating condition through efficient lifestyle changes (additions, subtractions, modifications) and to also avoid the costly and escalating medical and pharmaceutical treatments that accompany having the disease/condition, then a sensible individual would focus on their overall health and wellness…proactively, instead of reactively. However, an important caveat is that over-regulation or inappropriate application of current regulations can increase the price of dietary supplements and nutritional products and thus cause underutilization of the potentially beneficial physiological attributes of these products. Conversely, strict adherence to regulatory guidelines could result in safer dietary supplements and fewer adverse reactions requiring medical attention. If new regulations or stricter interpretation/application of existing regulations result in certain dietary supplements being taken off the market, will continued demand create a completely unregulated, underground economy that will create unforeseen problems? More research should be supported by government agencies to determine the effectiveness of dietary supplements, nutritional products and complementary medicine in reducing personal and societal medical costs and further contribution to the overall health of the population.

Clinical Oncology Society of Australia position statement on the use of complementary and alternative medicine by cancer patients.

Health professionals involved in the clinical management of cancer are becoming increasingly aware that their patients use complementary and alternative medicine (CAM). As cancer incidence and survival rates increase, use of CAM is also likely to increase. This paper outlines the position of the Clinical Oncology Society of Australia (COSA) on the use of CAM by cancer patients and provides guidance for health professionals involved with the treatment of cancer patients who are using or wish to use CAM. Key definitions and common communication scenarios are presented along with evidence-based recommended steps for health professionals when discussing CAM use. COSA encourages health professionals to focus on open discussion with their patients regarding CAM, to become familiar with reputable resources for CAM information, to discuss with patients the concept of evidence-based medicine, to recognize limitations to their knowledge of CAM and seek further advice when necessary, and to be respectful of the patients' right to autonomy.

Prevalence of vitamin D deficiency prior to cardiothoracic surgery.

BACKGROUND: Vitamin D deficiency is one of the most common chronic medical conditions in the world and also prevalent in Australia. A growing body of evidence suggests that low vitamin D also has adverse effects on cardiovascular health, including coronary risk factors and adverse cardiovascular outcomes such as myocardial infarction, cardiac failure and stroke. There is some evidence suggesting that a greater proportion of people with cardiovascular disease have low vitamin D compared to the general population. We examined the prevalence of vitamin D deficiency and insufficiency in elective cardiothoracic surgical patients presenting to the Alfred Hospital in Melbourne, Australia and compared this to recent Victorian statistics for people of the same age group. METHODS: Consecutive adult elective cardiothoracic surgical patients listed for either coronary artery bypass graft surgery or heart valve repair or replacement surgery attending The Alfred Hospital, Melbourne between July 2011 and October 2012 were invited to participate. This ensured that patients were enrolled over all four seasons. Fasting serum samples were taken on the day of surgery, immediately after admission. Eighty volunteers participated in the study. Of the group, 40% were due to have coronary artery bypass graft surgery, 35% valve surgery and 25% a combination of the two; 74% reported having hypertension, 69% hyperlipidaemia, 26% diabetes and 39% had a BMI >30 kg/m(2). RESULTS: Test results revealed that 92.5% of patients had Vitamin D levels < 75 nmol/L, 67.5% had levels < 60 nmol/L, 52.5% had levels between 30-59 nmol/L and 15% had levels < 30 nmol/L. Inadequate vitamin D levels were found in 80% of obese patients (BMI > 30 kg/m(2)) compared to 59% of non-obese patients. CONCLUSIONS: Based on our small screening study, a substantial proportion of elective cardiothoracic surgical patients have less than optimal serum vitamin D3 levels prior to surgery. We found two-thirds of patients had serum vitamin D levels below 60 nmol/L, placing them at higher risk of falls. This finding is of concern as these patients would have received multiple consultations with various medical practitioners prior to hospital admission and yet their inadequate vitamin D status remained. Failing to identify patients with low vitamin D and correcting it with supplementation places older adults at unnecessary risk, especially of falls, which are associated with a high risk of mortality. In an ageing population with CVD, vitamin D status needs to be assessed and any inadequacy corrected. Whether low vitamin D status prior to cardiac surgery affects post-surgery outcomes, is another issue which deserves future investigation.

Reduction in urinary organophosphate pesticide metabolites in adults after a week-long organic diet.

BACKGROUND: Conventional food production commonly uses organophosphate (OP) pesticides, which can have negative health effects, while organic food is deemed healthier because it is produced without these pesticides. Studies suggest that organic food consumption may significantly reduce OP pesticide exposure in children who have relatively higher pesticide exposure than adults due to their different diets, body weight, behaviour and less efficient metabolism. OBJECTIVES: A prospective, randomised, crossover study was conducted to determine if an organic food diet reduces organophosphate exposure in adults. METHODS: Thirteen participants were randomly allocated to consume a diet of at least 80% organic or conventional food for 7 days and then crossed over to the alternate diet. Urinary levels of six dialkylphosphate metabolites were analysed in first-morning voids collected on day 8 of each phase using GC-MS/MS with detection limits of 0.11-0.51 µg/L. RESULTS: The mean total DAP results in the organic phase were 89% lower than in the conventional phase (M=0.032 [SD=0.038] and 0.294 [SD=0.435] respectively, p=0.013). For total dimethyl DAPs there was a 96% reduction (M=0.011 [SD=0.023] and 0.252 [SD=0.403] respectively, p=0.005). Mean total diethyl DAP levels in the organic phase were half those of the conventional phase (M=0.021 [SD=0.020] and 0.042 [SD=0.038] respectively), yet the wide variability and small sample size meant the difference was not statistically significant. CONCLUSIONS: The consumption of an organic diet for one week significantly reduced OP pesticide exposure in adults. Larger scale studies in different populations are required to confirm these findings and investigate their clinical relevance.

Oxidative stress in surgery in an ageing population: pathophysiology and therapy.

Reactive oxygen species (ROS) play an important role in the regulation of normal cellular function. When ROS are produced in excess they can have detrimental effects, a state known as oxidative stress. Thus ROS play both physiological and pathophysiological roles in the body. In clinical practice oxidative stress and its counterpart, antioxidant capacity can be measured and can guide remedial therapy. Oxidative stress can have a negative impact in all forms of major surgery including cardiac surgery, general surgery, trauma surgery, orthopedic surgery and plastic surgery; this is particularly marked in an ageing population. Many different therapies to reduce oxidative stress in surgery have been tried with variable results. We conclude that in surgical patients the assessment of oxidative stress, improvement of the understanding of its role, both positive and negative, and devising appropriate therapies represent fruitful fields for future research.

Massage therapy for cardiac surgery patients--a randomized trial.

OBJECTIVES: To determine whether massage significantly reduces anxiety, pain, and muscular tension and enhances relaxation compared with an equivalent period of rest time after cardiac surgery. The feasibility of delivering the treatment, effects on heart rate, blood pressure, and respiratory rate, and patient satisfaction were also assessed. METHODS: Elective cardiac surgery patients were randomized to receive massage or rest time at 2 points after surgery. Visual analog scales were used to measure pain, anxiety, relaxation, muscular tension, and satisfaction. Heart rate, respiratory rate, and blood pressure were measured before and after treatment. Focus groups and feedback were used to collect qualitative data about clinical significance and feasibility. RESULTS: A total of 152 patients (99% response rate) participated. Massage therapy produced a significantly greater reduction in pain (P = .001), anxiety (P < .0001), and muscular tension (P = .002) and increases in relaxation (P < .0001) and satisfaction (P = .016) compared to the rest time. No significant differences were seen for heart rate, respiratory rate, and blood pressure. Pain was significantly reduced after massage on day 3 or 4 (P < .0001) and day 5 or 6 (P = .003). The control group experienced no significant change at either time. Anxiety (P < .0001) and muscular tension (P < .0001) were also significantly reduced in the massage group at both points. Relaxation was significantly improved on day 3 or 4 for both groups (massage, P < .0001; rest time, P = .006), but only massage was effective on day 5 or 6 (P < .0001). Nurses and physiotherapists observed patient improvements and helped facilitate delivery of the treatment by the massage therapists on the ward. CONCLUSIONS: Massage therapy significantly reduced the pain, anxiety, and muscular tension and improves relaxation and satisfaction after cardiac surgery.

Characteristics and consumption patterns of Australian organic consumers.

BACKGROUND: Increasingly, Australians are choosing to consume organically produced food, but only a small percentage consume organic food exclusively, and there is little information in the scientific literature that describes their actual level of intake. In order to provide a more meaningful description of Australian organic consumers the 'Organic Consumption Survey' and 'Organic Food Intake Survey' were conducted online in 2010. The aims were to provide information about the characteristics of regular organic consumers and quantify levels of organic consumption. RESULTS: The majority of participants (n = 318) were female (80.3%), 25-55 years old (80.3%), living in urban areas (61.2%), born in Australia (68.9%) and were in a healthy weight range (55.5%). Organic fruit and vegetables had the highest uptake by organic consumers and meat products the lowest. The majority of participants consumed at least 65% organic food in their diet, including 35% certified organic food. CONCLUSION: A better understanding of organic consumers may help to serve the long-term interests of the organic industry and other stakeholders of food marketing. Clearer definitions of organic consumers may also inform research evaluating the purported health benefits of organic foods.

The prevalence and experience of Australian naturopaths and Western herbalists working within community pharmacies.

BACKGROUND: Naturopaths and Western herbal medicine (WHM) practitioners were surveyed to identify their extent, experience and roles within the community pharmacy setting and to explore their attitudes to integration of complementary medicine (CM) practitioners within the pharmacy setting. METHOD: Practising naturopaths and WHM practitioners were invited to participate in an anonymous, self-administered, on-line survey. Participants were recruited using the mailing lists and websites of CM manufacturers and professional associations. RESULTS: 479 practitioners participated. 24% of respondents (n=111) reported they had worked in community pharmacy, three-quarters for less than 5 years. Whilst in this role 74% conducted specialist CMs sales, 62% short customer consultations, 52% long consultations in a private room and 51% staff education. This was generally described as a positive learning experience and many appreciated the opportunity to utilise their specialist knowledge in the service of both customers and pharmacy staff. 14% (n=15) did not enjoy the experience of working in pharmacy at all and suggested pharmacist attitude largely influenced whether the experience was positive or not. Few practitioners were satisfied with the remuneration received. 44% of the total sample provided comment on the issue of integration into pharmacy, with the main concern being the perceived incommensurate paradigms of practice between pharmacy and naturopathy. Of the total sample, 38% reported that they would consider working as a practitioner in retail pharmacy in future. CONCLUSIONS: The level of integration of CM into pharmacy is extending beyond the mere stocking of supplements. Naturopaths and Western Herbalists are becoming utilised in pharmacies.

Physical conditioning and mental stress reduction--a randomised trial in patients undergoing cardiac surgery.

BACKGROUND: Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery. This study involving cardiac surgery patients was primarily aimed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting. Secondary aims were to evaluate the effect of these programs on quality of life (QOL), rates of postoperative atrial fibrillation (AF) and length of stay (LOS) in hospital. METHODS: Elective patients scheduled for coronary artery bypass graft and/or valve surgery at a public hospital in Melbourne, Australia were enrolled. Patients were randomized to receive either holistic therapy (HT) or usual care (UC). HT consisted of a series of light physical exercise sessions together with a mental stress reduction program administered in an outpatient setting for the first two weeks after placement on the waiting list for surgery. A self-administered SF-36 questionnaire was used to measure QOL and hospital records to collect data on LOS and rate of postoperative AF. RESULTS: The study population comprised 117 patients of whom 60 received HT and 57 received UC. Both programs were able to be delivered within the hospital setting but ongoing therapy beyond the two week duration of the program was not carried out due to long waiting periods and insufficient resources. HT, as delivered in this study, compared to UC did not result in significant changes in QOL, LOS or AF incidence. CONCLUSIONS: Preoperative holistic therapy can be delivered in the hospital setting, although two weeks is insufficient to provide benefits beyond usual care on QOL, LOS or postoperative AF. Further research is now required to determine whether a similar program of longer duration, or targeted to high risk patients can provide measurable benefits. TRIAL REGISTRATION: This trial was conducted as part of a larger study and according to the principles contained in the CONSORT statement 2001.

Use of complementary medicines by cardiac surgery patients; undisclosed and undetected.

BACKGROUND: Some complementary medicines (CMs) confer benefits in people with cardiovascular disease, yet they also pose risks such as drug interactions and haemorrhage. OBJECTIVES: To determine cardiac surgery patients' perioperative use of CMs, disclosure about their use and interest in hospitals providing access to complementary therapies. METHOD: An anonymous survey of 205 elective cardiac surgery inpatients at Cabrini Hospital, Victoria. RESULTS: Of the 161 respondents (78% response rate), 51% took CMs and 92% took prescription medicines in the two weeks before admission. Of those taking CMs, 42% intended to continue this use in hospital. Medical doctors were the main prescribers and 25% of patients were taking fish oils and 25% multivitamins. Use was not significantly associated with gender, education or income. In hospital, the main reason for non-disclosure about CM use was not being asked. Of those asked about their use, 52% reported being asked by a nurse, 12% a surgeon, 12% a pharmacist and 8% an anaesthetist. Most (85%) of the total sample would consider using complementary therapies if offered by hospitals. CONCLUSIONS: CMs are used by cardiac surgery patients but communication with surgeons and anaesthetists is poor. There is substantial patient interest in hospital-based complementary therapies.

Adverse reactions to complementary medicines: the Australian pharmacy experience.

OBJECTIVES: The primary aim was to determine the prevalence of adverse reactions to over-the-counter complementary medicines and their severity, as described by consumers. Secondary aims were to identify consumers' reporting behaviours and understanding of the AUST L designation on product labels. METHODS: An anonymous, self-administered survey was completed by randomly selected pharmacy customers at 60 community pharmacy locations between August 2008 and February 2009. KEY FINDINGS: Of the 1121 survey participants (response rate 62%), 72% had used a complementary medicine product in the previous 12 months, and 7% of this group (n = 55) reported having experienced an adverse reaction at some time. Of these, 71% described the reaction as mild and not requiring treatment, 22% as moderate and/or requiring advice from a healthcare professional and 7% (n = 4) described it as severe and requiring hospitalisation. If they were to report the reaction, it was most commonly to a medical practitioner. Most (88%) of complementary medicine consumers had never noticed the term 'AUST L'. CONCLUSIONS: Complementary medicines are widely used by pharmacy customers. Adverse reactions to these products are under-reported to healthcare authorities. Most adverse reactions are mild and serious reactions are rare. Customers have little awareness of the designation AUST L.

Perceptions, use and attitudes of pharmacy customers on complementary medicines and pharmacy practice.

BACKGROUND: Complementary medicines (CMs) are popular amongst Australians and community pharmacy is a major supplier of these products. This study explores pharmacy customer use, attitudes and perceptions of complementary medicines, and their expectations of pharmacists as they relate to these products. METHODS: Pharmacy customers randomly selected from sixty large and small, metropolitan and rural pharmacies in three Australian states completed an anonymous, self administered questionnaire that had been pre-tested and validated. RESULTS: 1,121 customers participated (response rate 62%). 72% had used CMs within the previous 12 months, 61% used prescription medicines daily and 43% had used both concomitantly. Multivitamins, fish oils, vitamin C, glucosamine and probiotics were the five most popular CMs. 72% of people using CMs rated their products as 'very effective' or 'effective enough'. CMs were as frequently used by customers aged 60 years or older as younger customers (69% vs. 72%) although the pattern of use shifted with older age. Most customers (92%) thought pharmacists should provide safety information about CMs, 90% thought they should routinely check for interactions, 87% thought they should recommend effective CMs, 78% thought CMs should be recorded in customer's medication profile and 58% thought pharmacies stocking CMs should also employ a complementary medicine practitioner. Of those using CMs, 93% thought it important for pharmacists to be knowledgeable about CMs and 48% felt their pharmacist provides useful information about CMs. CONCLUSIONS: CMs are widely used by pharmacy customers of all ages who want pharmacists to be more involved in providing advice about these products.