The Prevalence of Natural Health Product Use in Patients with Acute Cardiovascular Disease

Background: Natural health products (NHP) use may have implications with respect to adverse effects, drug interactions and adherence yet the prevalence of NHP use by patients with acute cardiovascular disease and the best method to ascertain this information is unknown. Objective: To identify the best method to ascertain information on NHP, and the prevalence of use in a population with acute cardiovascular disease. Methods: Structured interviews were conducted with a convenience sample of consecutive patients admitted with acute cardiovascular disease to the University of Alberta Hospital during January 2009. NHP use was explored using structured and open-ended questions based on Health Canada’s definition of NHP. The medical record was reviewed, and documentation of NHP use by physicians, nurses, and pharmacists, compared against the gold-standard structured interview. Results: 88 patients were interviewed (mean age 62 years, standard deviation [SD 14]; 80 % male; 41 % admitted for acute coronary syndromes). Common co-morbidities included hypertension (59%), diabetes (26%) and renal impairment (19%). NHP use was common (78 % of patients) and 75 % of NHP users reported daily use. The category of NHP most commonly used was vitamins and minerals (73%) followed by herbal products (20%), traditional medicines including Chines

Use of biological based therapy in patients with cardiovascular diseases in a university-hospital in New York City

BACKGROUND: The use of complementary and alternative products including Biological Based Therapy (BBT) has increased among patients with various medical illnesses and conditions. The studies assessing the prevalence of BBT use among patients with cardiovascular diseases are limited. Therefore, an evaluation of BBT in this patient population would be beneficial. This was a survey designed to determine the effects of demographics on the use of Biological Based Therapy (BBT) in patients with cardiovascular diseases. The objective of this study was to determine the effect of the education level on the use of BBT in cardiovascular patients. This survey also assessed the perceptions of users regarding the safety/efficacy of BBT, types of BBT used and potential BBT-drug interactions. METHOD: The survey instrument was designed to assess the findings. Patients were interviewed from February 2001 to December 2002. 198 inpatients with cardiovascular diseases (94 BBT users and 104 non-users) in a university hospital were included in the study. RESULTS: Users had a significantly higher level of education than non-users (college graduate: 28 [30%] versus 12 [12%], p = 0.003). Top 10 BBT products used were vitamin E [41(43.6%)], vitamin C [30(31.9%)], multivitamins [24(25.5%)], calcium [19(20.2%)], vitamin B complex [17(18.1%)], fish oil [12(12.8%)], coenzyme Q10 [11(11.7%)], glucosamine [10(10.6%)], magnesium [8(8.5%)] and vitamin D [6(6.4%)]. Sixty percent of users' physicians knew of the BBT use. Compared to non-users, users believed BBT to be safer (p < 0.001) and more effective (p < 0.001) than prescription drugs. Forty-two potential drug-BBT interactions were identified. CONCLUSION: Incidence of use of BBT in cardiovascular patients is high (47.5%), as is the risk of potential drug interaction. Health care providers need to monitor BBT use in patients with cardiovascular diseases

Should the Law Governing Maritime Areas in the Arctic Adapt to Changing Climatic Circumstances?

The legal regime of the Arctic maritime areas has for a long time remained on the backburner of international norm creating activities. This can primarily be explained by the inhospitable climate which created natural barriers for human activities and imposed limits on the usefulness of the available technology.At present, however, climate change seems to be responsible for a marked heating up, not only of the mere physical environment of the Arctic, but also of the political tensions concerning the exact legal regime to be applied in the region.This chapter provides a close examination of the present-day legal status of the Arctic. Since almost all territorial claims have been settled in the area, the present contribution will only focus on the Arctic water areas with a special emphasis on navigation. Starting from what seems to have finally become a generally accepted legal cornerstone for appreciating the legal status of these waters, namely the 1982 United Nations Convention on the Law of the Sea, the chapter will first examine how climate change impacts on this legal regime. Subsequently, the vulnerability as well as the adaptive capacity of the 1982 Convention will be examined. Before drawing some conclusions, ways and means will be looked at for this existing legal system to better meet the new challenges that climate change poses for Arctic waters

Search and Rescue at Sea: Do New Challenges Require New Rules?

Search and rescue at sea (SAR) has been always carried out under principles of customary law of the sea obliging vessels and states to help persons whose ships are in distress at sea. International treaties define more detailed conditions and obligations to provide adequate SAR. The rationale of all these principles and rules, as well as of the associated duties affecting the obliged persons/states to carry out and organize SAR activities, was that of increasing safety at sea and taking care of seafarers and fishermen (or passengers onboard vessels) who were at sea mainly for the purpose of work. The safety of ships has increased enormously in recent decades. Therefore the number of classical SAR operations has become a minimal fraction of those actually carried out to rescue, for example, leisure yachts, migrants and cruise ship tourists that venture into dangerous waters (including the Arctic) in pursuit of adventure. Thus, the original SAR rationale has drastically changed. We need to consider whether the obligations set at the international level for rescuers and affected states should be updated to deal with current rescue missions. To deal with the migration problem in the Mediterranean, the normal SAR schemes \u2013 while not being abandoned \u2013 have been largely supplemented by other forms of international cooperation. This chapter investigates these new forms of cooperation and presents some proposals for updating the SAR international regime to meet the new challenges posed by persons venturing to sea. The Author wishes to thank Chiara Cellerino and Lorenzo Schiano di Pepe for valuable comments on the draft of this paper. Neither of them is, however, even partly responsible for any remaining mistake or inaccuracy