This Reflective Topical Autobiography (RTA) aimed to reflect on and recount my own actual life stories and the life lessons learned, in order to identify patterns, trends and insights from my life and to offer these insights to others. My objectives were to promote personal empowerment as a tool for fulfilling individual potential, and to heal and be healed, by taking personal responsibility and making choices that enhance the individual and thus the collective consciousness.The research questions I posed to myself to assist in reflecting on and recounting my life stories were: What are the key stories of my life? What life lessons have I learned from my experiences? What are the patterns, trends and insights from my life? How can I offer these insights to other people? The RTA activities included writing personal stories, reflecting on my life patterns, trends and insights, and using photographs and a DVD production, to illustrate the main ideas and events.The research process allowed me to move from being reactive to reflective and to answer the research questions. Some of my life lessons learned from my experiences are that: one person can make a difference; lack of money is not lack of personal power; and nothing is impossible. My life patterns and trends include having a high-energy lifestyle, living without fear, learning to deal with disappointments, keeping life records, taking responsibility for action, and creating a morphic field. This RTA also offers insights to other people, with whom they resonate.It became apparent to me, in the process of documenting my personal journey in this RTA, that by suspending judgement and keeping an open mind and open heart, I am able to attune to what I call ‘Divine Intelligence’. It is a deep cellular knowing, that we are all connected. In 32 years of my own development, I have witnessed quantum leaps in the disciplines of science, spirit, ancient wisdom and health, which are acknowledged in the academies of the world. There is a new way of seeing and thinking, which is about a future based on these holistic principles of interconnectedness. It is the contention of this RTA that thoughts and intentions are the tools for personal and global change.

Crude foliar extracts of sixty species from six subfamilies of Australian Lamiaceae were screened by whole organism contact toxicity on the polyphagous mite Tetranychus urticae Koch (Acari: Tetranychidae). In addition, cytotoxicity assessments against insect cell lines from Spodoptera frugiperda J.E.Smith (Lepidoptera : Noctuidae) and Drosophila melanogaster Meigen (Diptera: Drosophilidae) were also made. The findings indicated that the Spodoptera cell line was more susceptible to extracts than the Drosophila cell line and no direct correlation was observed between the two screening methods. However, several interesting relationships were identified. Extracts from sub-families Ajugoideae, Scutellarioideae, Chloanthoideae, Viticoideae and Nepetoideae showed acaricidal activity, whilst only those from Ajugoideae and Nepetoideae displayed potent cytotoxic effects. A range of activities was observed for the 25 species of Plectranthus, 14 of which showed moderate to high contact toxicity against T. urticae. Overall, least promising bioactivity was observed for extracts from the plant subfamily Prostantheroideae, which showed little contact toxicity or cytotoxicity for the 18 extracts studied. Greatest cytotoxicity was observed from a methanol extract of leaf material of Glossocarya calcicola Domin. Bioassay guided fractionation led to the discovery of three novel clerodane diterpenes, which were not present in the stems or at all in the closely related species G. hemiderma. Compound 1 was characterised as (rel)-10âH-trans-12î-(2-methylbut-2(E)-enoyl)-1â-(isobutanoyl)-6á,13î-dihydroxyclerodan-4(20),8(18)-dien-7,15-dione-15,16-oxide, to which the trivial name calcicolin-A was assigned. The other two compounds had the same skeletal structure and C-12 substituent but in compound 2 (calcicolin-B), the C-1 esterifying group became 2-methylbut-2(E)-enoic acid and in 3 (calcicolin-C) it became 2-methylbutanoic acid. Although insect antifeeding activity was not observed for G. calcicola, cytotoxicity against insect and human carcinoma cell lines was detected. Greatest acaricidal activity was observed for Plectranthus diversus S.T.Blake when topically applied (LC50 = 0.25% (w/v)). The major compound present in the extract of P. diversus was identified as the known compound 7á,18-dihydroxy-isopimara-8(14),15-diene. These findings were of chemotaxonomic significance as this is the first known occurrence of a pimarane diterpene in Plectranthus, a genus characterised by abietane diterpenes. A number of abietanes were isolated and identified in this study, though none of which were novel. Promising cytotoxicity was observed from P. fasciculatus P.I.Forst., which was attributed to coleon U, a known abietane diterpene with cytotoxic activity. Other species of Plectranthus showed potential acaricidal activity as a crude extract in particular P. graveolens R.Br. (LC50 = 0.76% (w/v)). Bioassay guided fractionation did reveal some interesting behavioural effects on mites but in general the fractions were less toxic than the whole extract. The hexane-soluble components of the methanol extract were extremely effective against mites and while the mode of action was not fully understood, it is possible that a smothering effect could be the cause. A potted plant trial was also carried out for this species to determine the effects of crude extract. At time = 112 h post treatment, a concentration response in mite mortality was observed. The control and 0.5% (w/v) treatment were not significantly different to one another but had significantly larger numbers of mites than the 1.0 and 1.5% (w/v) treatment. These results showed that the crude methanol extract of Plectranthus graveolens showed acaricidal efficacy against Tetranychus urticae in a leaf disc and a potted plant trial at concentrations of 1% (w/v) or above with no phytotoxic effects. The repellency and antifeeding effects of some plant extracts were evaluated against Plutella xylostella L. (Lepidoptera: Plutellidae) in a choice and no-choice bioassay. The most outstanding results were observed for Ajuga australis L. against both second and third instar larvae. The active constituents were present as minor compounds, thus detailed spectroscopic analysis was not adequately performed. However, the compounds were believed to be known clerodane diterpenes that have been previously isolated from this and other species of Ajuga.

The importance of spirituality in relation to mental well-being and physical health is currently well regarded in the academic literature. Therefore spiritual care is now considered an important aspect of holistic healing practices. However, research is showing that most health care providers do not feel competent or confident in this area of care. In this thesis I explore how spiritual care is understood and experienced by practitioners in aged and palliative care in a regional area on the coast of New South Wales. The 26 participants, whose insights and experiences are depicted in this thesis, were very happy to be involved in this qualitative research project, because they felt that they now had the opportunity to explore spirituality and spiritual care.The participants in this research describe spiritual care as involving doing in the form of religious practices, such as praying or bible readings and non-religious activities that were seen as spiritual such as talking about dying, touching people or reminiscing. Additionally, they also commented about spiritual care as a special way of being with clients, which involved qualities and attitudes that were clearly felt or recognized by the participants as special. Not necessarily labeled as spiritual care, this special way of being was described as not being separate, but being an integral part of the daily acts of caring such as feeding a patient or preparing them for a bath. Participants found it often difficult to elaborate on what made such an interaction spiritual or how to describe the quality of these interactions as there seemed to be no familiar language to share the experiences of spirituality and spiritual care. Additionally, participants commented quite regularly that, although spiritual care was seen as important, there were many factors that inhibited these practices. In reflecting on these issues I put forward that, although the practitioners in this research are familiar with spiritual care, the most important contribution to encouraging health care providers to feel more confident is to continue conversations about spiritual care to increase competency in a non-denominational spiritual discourse in aged and palliative care.

This Reflective Topical Autobiography (RTA) aimed to reflect on and recount my own actual life stories and the life lessons learned, in order to identify patterns, trends and insights from my life and to offer these insights to others. My objectives were to promote personal empowerment as a tool for fulfilling individual potential, and to heal and be healed, by taking personal responsibility and making choices that enhance the individual and thus the collective consciousness.The research questions I posed to myself to assist in reflecting on and recounting my life stories were: What are the key stories of my life? What life lessons have I learned from my experiences? What are the patterns, trends and insights from my life? How can I offer these insights to other people? The RTA activities included writing personal stories, reflecting on my life patterns, trends and insights, and using photographs and a DVD production, to illustrate the main ideas and events.The research process allowed me to move from being reactive to reflective and to answer the research questions. Some of my life lessons learned from my experiences are that: one person can make a difference; lack of money is not lack of personal power; and nothing is impossible. My life patterns and trends include having a high-energy lifestyle, living without fear, learning to deal with disappointments, keeping life records, taking responsibility for action, and creating a morphic field. This RTA also offers insights to other people, with whom they resonate.It became apparent to me, in the process of documenting my personal journey in this RTA, that by suspending judgement and keeping an open mind and open heart, I am able to attune to what I call ‘Divine Intelligence’. It is a deep cellular knowing, that we are all connected. In 32 years of my own development, I have witnessed quantum leaps in the disciplines of science, spirit, ancient wisdom and health, which are acknowledged in the academies of the world. There is a new way of seeing and thinking, which is about a future based on these holistic principles of interconnectedness. It is the contention of this RTA that thoughts and intentions are the tools for personal and global change.

Prediabetes, a condition in which glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes, affects approximately 37% of adults in the United States and is a major public health concern. Extensive research has evaluated the association between physical activity (PA) and type 2 diabetes; however, few studies have examined the association between PA and prediabetes. Therefore, we evaluated the association between PA (including leisure time, occupational and total) and prediabetes status among adults, stratified by gender, using multinomial logistic regression models fit to serial cross-sectional 2007-2014 National Health and Nutrition Examination Survey data. After adjusting for age, race, body mass index, smoking status, family history of hypertension and education, results suggest that the association between leisure time [moderate PA: 0.98 (95% CI: 0.80–1.21); tertile 3: 1.05 (95% CI: 0.75–1.49)] and total PA [tertile 1: 1.15, (95% CI: 0.96–1.38); tertile 2: 1.00, (95% CI: 0.79–1.27); tertile 3: 0.96, (0.77–1.20)] and undiagnosed prediabetes and was not statistically significant among women. However, compared to women who engaged in no occupational PA, engaging in the highest tertile was statistically significantly associated with lower odds of undiagnosed prediabetes [tertile 3: 0.75, (95% CI: 0.58–0.97)]. Compared to men who engaged in no leisure time PA, men engaging in the highest tertile of leisure time PA had a statistically significant lower odds of undiagnosed prediabetes [Tertile 3: 0.79, ( 0.65–0.98)]. Compared to men who did not engage in any PA, men engaging in any PA did not have a statistically significant decrease in odds of undiagnosed prediabetes [tertile 1: 0.90, (0.71–1.16); Tertile 2: 0.93, (0.74–1.18); Tertile 3: 0.99, (0.80–1.21)]. Overall, our results show that for both men and women, there was a general lack of association between leisure-time, occupational, and total physical activity and prediabetes status in adjusted analyses.

HEALTH CARE PROVIDERS OF COMPLEMENTARY MEDICINE Charles University, Faculty of Pharmacy in Hradec Králové Department of Social and Clinical Pharmacy Student: Ema Sopková Tutor: PharmDr. Jitka Pokladníková, PhD. Introduction: The interest and use of complementary and alternative medicine (CAM) is constantly expanding. Despite the increased prevalence of the use of CAM in the Czech Republic, no common approach to regulation or general legislation of KAM has been adopted so far. At present, there is a lack of view of this issue on the part of KAM therapists in the Czech Republic. Aim: To determine the attitudes of CAM therapists to the regulation of CAM according to the criteria of evaluation of regulation, which are based on the requirements for health professionals. The secondary objective was to determine the influence of socio-demographic characteristics on the attitudes of CAM therapists. Methods: The cross-sectional prospective observational study was carried out using an online anonymous questionnaire survey in the period from March 29, 2021 to April 18, 2021. The questionnaire was sent to registered associations of complementary medicine therapists in the Czech Republic, selected in the public register of subjects. Data were collected over a three-week period, during which respondents were...

Currently, little is known about patients' perceptions and beliefs in discussing complementary and alternative medicine (CAM) with their conventional medical (CM) doctor. The purpose of this descriptive research was to show whether CAM-using patients have an interest in discussing CAM treatments with their CM doctor for comprehensive care as described by the health belief model (HBM) constructs of perceived susceptibility, perceived seriousness, and perceived benefits of taking action. A sample of 165 participants age 18 or older from 2 chiropractic clinics in the midwestern United States completed a Likert-scaled survey. The data were analyzed using descriptive statistics and multiple regression to determine if there is a relationship between the variables of the need for a CAM discussion with a CM as the outcome using HBM constructs as the independent variables. The primary findings from this study were that (a) the participants were interested in discussing CAM with their physicians, with the majority of the participants stating that they discussed CAM either often (33.5%) or always (29.3%); and (b) perceived susceptibility, perceived seriousness, and perceived benefits of taking action were not predictive of a CAM discussion. Future studies should be conducted to (a) examine samples with varying demographic characteristics to assess the generalizability of the current findings; and (b) to include additional predictors of CAM discussions from the HBM such as barriers, cues to action, and self-efficacy. The results of this study add to the limited literature on CAM usage and may prompt future research. Implications for positive social change include understanding patient interest in discussing CAM which can help improve the overall quality of patient service.

Integrative medicine (IM) has organized as a new area of specialization in mainstream healthcare. The development of IM is widely attributed to popular demand for the range of therapies known collectively as Complementary and Alternative Medicine (CAM). During the 1990's the rate of acceptance of CAM accelerated among consumers, professions, financing and education. The Medical Expenditure Panel Survey (MEPS) measured CAM utilization and professional service provision during the years 1996 and 1998, but never since. These surveys were unique because they specifically inquired as to whether CAM was provided by a physician, among other types of professionals. This dissertation defines early integrative medicine (MDCAM) as CAM therapies provided by physicians. Because the MDCAM subpopulation is small, MEPS surveys for 1996 and 1998 were combined (N=39,314) to improve statistical power. The theoretical approach employed Abbott's (1988) theory of a system of professions, in which MDCAM represents a professional strategy of client differentiation through the social boundary mechanism of borrowing (Tilly, 2004) specific CAM therapies to satisfy consumer demand. The utility of the theory of a system of professions is discussed for its ability to decouple conceptual-level claims from observable workplace-level behaviors. Nearly one million Americans received CAM therapies from their physicians during the period, and this professional behavior was found in every region of the country. Services provided by physicians included spiritual healing, massage and acupuncture; national population prevalence estimates are provided. This is meaningful because physicians, at the time, were at risk for disciplinary action for providing CAM. The MDCAM subpopulation was similar to those who used both conventional and CAM services from other professional sources (BOTH), however, MDCAM reported much higher prescription medication use. The demographic profile of MDCAM was more similar to those who consume health care services frequently, compared to infrequent consumers. The MDCAM group is distinguished from those who use BOTH by increased utilization of the following services: nutritional advice, biofeedback and meditation. MDCAM is characterized by diagnoses of chronic illness. MDCAM recipients used mainstream medicine, yet employed disease management services offered by the CAM domain.

People with diabetes mellitus are more likely to die from cardiovascular causes than those without diabetes, and modifiable risk factors, such as hyperglycaemia, dyslipidaemia and hypertension can be targeted in intervention programs to decrease this risk. In addition to tertiary care for patients with diabetes, there is a need for simple programs to be implemented in the community that allow the benefits of improved metabolic and blood pressure control to be realised more widely. Pharmaceutical care comprises the detection, prevention and solution of drug-related problems in a quantifiable form, so that outcomes of care can be easily reviewed and monitored. Previous studies of pharmaceutical care programs in patients with diabetes do not provide conclusive evidence of the benefit of pharmaceutical care. The aim of this research was to evaluate the impact of the provision of pharmaceutical care to patients with diabetes mellitus in an Australian context. In order to develop a pharmaceutical care program, the characteristics of an Australian cohort of patients with diabetes were reviewed. The Fremantle Diabetes Study (FDS), was a community-based prospective observational study of diabetes care, control and complications in a postcode-defined region of 120 097 people surrounding the port city of Fremantle in Western Australia. It was intended that the FDS annual reviews would provide important local information in order to design and implement a prospective pharmaceutical care program. A pilot pharmaceutical care program was subsequently developed for use in a diabetes outpatient clinic. This program was then modified for use in a community-based sample of type 2 diabetes mellitus patients, drawn from the FDS cohort. / Demographic parameters, including ethnicity and treatment details, were reviewed at study entry for the full FDS cohort and then over time for a subset of patients that returned for four subsequent annual assessments. Insulin use was more common in patients of Southern European origin compared with the Anglo-Celt group irrespective of the level of glycaemia, at baseline. This difference persisted during subsequent follow-up but was not associated with improved glycaemic control. These findings demonstrated that there are important ethnic differences in the management of patients with type 2 diabetes mellitus. The pilot pharmaceutical care program was carried out in high-risk diabetes mellitus patients attending a hospital outpatient clinic. The patients had poor glycaemic control, dyslipidaemia, hypertension and/or were on three or more prescription medications. In the pharmaceutical care arm, a clinical pharmacist reviewed and monitored all aspects of the patients' drug therapy in collaboration with other health care professionals at six weekly intervals for six months. The control patients received usual outpatient care. Seventy-three patients were recruited into the study, of whom 48 (66%) were randomised to receive pharmaceutical care. One in six patients was taking complementary medicines. The pharmaceutical care program provided patients with important medication information that resulted in changes to drug therapy. However, the six-month program did not lead to an improvement in glycaemic control. The next phase of the study adapted the pilot hospital-based pharmaceutical care program to a community-based setting. / Two hundred and two type 2 diabetes mellitus FDS patients were recruited, of whom 101 (50%) were randomised to the pharmaceutical care program, and all were followed for 12-months. There were significant reductions in risk factors associated with coronary heart disease in the case but not the control group over time, specifically glycaemic control, lipid levels, and blood pressure. Glycosylated haemoglobin fell from 7.5% to 7.0% (P<0.0001), total cholesterol fell from 5 mmol/L to 4.6 mmol/L (P<0.0001), systolic blood pressure fell from 158 mmHg to 143 mmHg (P<0.0001) and diastolic blood pressure fell from 77mmHg to 71mmHg (P<0.0001). Multiple linear regression analysis confirmed that pharmaceutical care program involvement was an independent predictor of benefit after adjustment for key variables. The 10-year coronary heart disease risk for patients without a previous coronary event was reduced by 4.6% over the 12-month study period in the pharmaceutical care group (P<0.0001), while there was no change in the controls (P=0.23). This phase of the study showed that medium-term individualised pharmaceutical care reduced vascular risk factors in a community-based cohort of patients with diabetes and that provision of a multifactorial intervention can improve health outcomes in type 2 diabetes mellitus. As part of the pharmaceutical care program, a high level of complementary medicine use was found. As a result, a study of complementary medicine use was undertaken in 351 patients from the FDS. A convenience sample of FDS patients was interviewed regarding their use of complementary medicines. A literature search was conducted to assess the potential impact of these medicines on diabetes, concomitant medications or diabetes-related co-morbidities. / Eighty-three of 351 (23.6%) patients with diabetes had consumed at least one complementary medicine in the previous year and 42% (77/183) of the products potentially necessitated additional patient monitoring or could be considered potentially inappropriate for a diabetic patient. The data indicated the need for patient disclosure of complementary medicine use and adequate monitoring for complementary medicine-related adverse events, as part of the pharmaceutical care process. The pharmaceutical care model was established to provide a framework by which drug use could be improved to enhance patients' clinical and health-related quality of life outcomes. For the present study, a straightforward pharmaceutical care program was adapted from a hospital setting to a community setting, where the principal requirement was a clinical pharmacist who had completed a self-directed diabetes-training program. In this context, clinically relevant parameters improved over the course of the study period. Pharmaceutical care programs such as this can begin the process of translating the findings of large and expensive clinical trials into standard clinical practice.

Combining the use of alternative and complementary therapies and orthodox medicine is an increasing phenomenon. This thesis examines the implications of mixing and matching plural healing modalities against a backdrop of patient and practitioner responsibilities. From an anthropological perspective, the predominant use of qualitative methodology is an integral part of this research project. Central to this study is the views of a variety of participant categories - patients who use both alternative and orthodox healing methods; non-medical alternative and complementary practitioners; medical doctors who integrate orthodox and CAM therapies into their daily practise; and orthodox general practitioners. Interviews with these participants took place over an eighteen-month timeframe and involved face-to-face interviews, telephone interviews, and focus group research. Social constructionist theory, which forms part of the compendium of interpretive theoretical approaches adopted under the medical anthropology paradigm, has been used in order to expose the beliefs patients and practitioners hold about their own responsibilities, and those of the other participant categories. This study reveals a palimpsest of complex, contradictory and competing discourses in relation to patient and practitioner expectations and responsibilities. One important finding relates to the significance of neo-liberal and individualistic ideologies. This thesis concludes that the rhetoric from complementary and alternative practitioners, and their integrative colleagues, is heavily imbued with ideas about self-responsibility, particularly in relation to patient lifestyle choices and therapeutic compliance. Patients and orthodox general practitioners share some of these views but in general adopt a more collective approach to health care responsibilities. While patients are prepared to accept some responsibility for their illnesses and health keeping practises, they express strong reliance towards the orthodox health model as well as those doctors who practise integrative medicine. However the same cannot be said of their attitudes towards CAM modalities where considerable ambivalence is evident towards both practitioners and the therapies themselves. The role of the state, and its responsibilities for the structure of the health care system in New Zealand, is also clearly influential in the construction of belief systems. This is especially so because the rhetoric underlying neo-liberal and individualistic discourses now permeates the direction of health policies. Increasing levels of surveillance, both at bureaucratic and individual levels, also attests to the influence of neo-liberalism and individualism. This study exposes the tensions between the rhetoric of self-responsibility and the lived experiences of patients and health practitioners, which in many cases is more collective in its focus than is initially apparent.