Awareness Of Healthcare Providers Research Articles

Awareness of Bacterial Resistance to Antibiotics among Healthcare Providers in Sana’a City, Yemen

Objectives: To assess the awareness of healthcare providers in Sana’a city of the most frequently antibiotic-resistant bacterial isolates encountered in clinical settings, the factors associated with the emergence of such resistance and the strategies to counteract antibiotic resistance. Methods: This cross-sectional study included 416 healthcare providers; namely, 167 physicians, 61 pharmacists and 188 nurses, from four public and two private hospitals in Sana’a. Data about demographics, awareness of the most frequently isolated antibiotic-resistant bacteria in clinical settings, the factors possibly associated with such resistance and the best strategies to counteract antibiotic resistance were collected using a pre-designed questionnaire. Data were then analyzed using suitable statistical tests. Results: The majority of healthcare providers were aware of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa as the two most frequently encountered bacterial species in clinical practice, with non-statistically significant differences in the awareness level among physicians, pharmacists and nurses. However, a statistically significant difference was found among healthcare providers regarding their awareness of the most possible factors contributing to antibiotic resistance. In this regard, pharmacists were significantly more aware of the contribution of the extensive use of newer generations of antibiotics (P = 0.030), inappropriate prescribing of antibiotics (P = 0.010) and use of antibiotics without prescription (P = 0.045) to the emergence and spread of antibiotic resistance than physicians and nurses. On the other hand, physicians and nurses were significantly more aware of the role of reducing the length of hospital stay (P = 0.005), limiting the use of medical instrumentation (P = 0.036), use of narrow-spectrum antibiotics (P = 0.005), surveillance for antibiotic resistance (P = 0.004), development of infection control policies and procedures (P <0.001) and consultation with infectious disease specialists (P = 0.010) as key strategies to minimize the emergence of antibiotic-resistant bacteria compared to pharmacists. Moreover, nurses showed significantly higher awareness of the use of narrow-spectrum antibiotics (P = 0.005) and surveillance of antibiotic resistance (P = 0.003) as key strategies to reduce the emergence and spread of antibiotic resistance. Conclusions: There is a discrepancy in the awareness of Yemeni healthcare providers’ of the most frequently encountered antibiotic-resistant bacteria in clinical practice, the factors possibly contributing to such resistance and the key strategies to counteract it. Therefore, continuing medical education of physicians, pharmacists and nurses is recommended to keep them updated on antibiotic resistance and the best strategies and approaches to its containment. In addition, there is a need for the development of infectious disease protocols for hospitals to optimize the selection and treatment with antibiotics, to reduce side effects and costs and to minimize the development of antibiotic resistance.

Survey of Obstetrician-gynecologists in the United States About Trichomoniasis, 2016.

Trichomoniasis is the most prevalent nonviral sexually transmitted infection (STI) in the United States. It can present with vaginitis in women and urethritis in men, but is most often asymptomatic or occurs with minimal symptoms. It is associated with other STIs, adverse pregnancy outcomes and pelvic inflammatory disease. For these reasons, health care provider awareness of trichomoniasis is of public health importance. To assess practitioner knowledge, attitudes, and practices concerning trichomoniasis management, the American College of Obstetricians and Gynecologists conducted an online survey in 2016 of its members, and we analyzed results from 230 respondents. We note discrepancies between practice and recommendations among surveyed providers: a minority of respondents routinely screen human immunodeficiency virus (HIV)-positive patients for trichomoniasis (10.7%, "most of the time"; 95% confidence interval [CI], 6.7-15.8; 33.0%, "always"; 95% CI, 26.5%-40.0%), treat trichomoniasis in HIV-positive patients with the recommended dose of metronidazole 500 mg twice a day for 7 days (25.8%; 95% CI, 20.0%-32.3%), or retest patients diagnosed with trichomoniasis 3 months after treatment (9.6%; 95% CI, 6.1%-14.3%). Only 29.0% (95% CI, 23.0%-35.5%) retreat with metronidazole 500 mg twice a day for 7 days in patients who have failed prior treatment. Screening for and treatment of trichomoniasis in HIV-positive patients, and retesting and retreatment for trichomoniasis in the general population appear to be suboptimal. Continuing education for providers is needed for this common but "neglected" STI.

The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review.

This systematic review explored associations between smoking and health outcomes involving the musculoskeletal system. AMSTAR criteria were followed. A comprehensive search of PubMed, Web of Science, and Science Direct returned 243 articles meeting inclusion criteria. A majority of studies found smoking has negative effects on the musculoskeletal system. In research on bones, smoking was associated with lower BMD, increased fracture risk, periodontitis, alveolar bone loss, and dental implant failure. In research on joints, smoking was associated with increased joint disease activity, poor functional outcomes, and poor therapeutic response. There was also evidence of adverse effects on muscles, tendons, cartilage, and ligaments. There were few studies on the musculoskeletal health outcomes of secondhand smoke, smoking cessation, or other modes of smoking, such as waterpipes or electronic cigarettes. This review found evidence that suggests tobacco smoking has negative effects on the health outcomes of the musculoskeletal system. There is a need for further research to understand mechanisms of action for the effects of smoking on the musculoskeletal system and to increase awareness of healthcare providers and community members of the adverse effects of smoking on the musculoskeletal system.

Experiences of being screened for intimate partner violence during pregnancy: a qualitative study of women in Japan

BackgroundIntimate partner violence (IPV) is physical, sexual or psychological violence by a current or former intimate partner. IPV threatens women’s health, and during pregnancy women are more vulnerable to violence. Therefore, IPV screening has been recommended during antenatal care; however, health care providers have expressed concern about the negative impact on women and therefore have been reluctant in conducting IPV screening. Consequently our objective was to investigate pregnant women’s experiences of reading and completing an IPV screening questionnaire.MethodsSemi-structured interviews were conducted with postpartum women who had received IPV screening during pregnancy to investigate their experiences using the IVP Violence Against Women Screen (VAWS). Qualitative data were analyzed based on content analysis.ResultsA total of 43 women participated in this study. There were eight (18.6%) women positive for IPV screening during pregnancy. Content analysis for all participants revealed three themes: necessity, acceptability and optimality. ‘Necessity’ referred to benefits for women from IPV screening, and was supported by three categories: ‘redefining the relationship’, ‘promoting IPV awareness’ and ‘opportunity to initiate support’. ‘Acceptability’ of IPV screening was also supported by three categories: ‘comfortable’, ‘quickly completed’ and ‘difficulty’. ‘Optimality’ meant IPV screening during pregnancy was appropriate timing for women who had been screened as either positive or negative.ConclusionsThe majority of women, including women experiencing IPV, had positive responses to IPV screening during pregnancy. Future diffusion of IPV screening requires safe environments for IPV screening and improved awareness of health care providers towards IPV.

PSS4 - Epidemiology Of Hyperhidrosis in the United States: A Systematic Literature Review

Hyperhidrosis is a medical condition characterized by excess sweating beyond what is physiologically required to maintain normal thermoregulation, with some evidence to suggest genetic etiology and transmission. This study assessed the epidemiology of hyperhidrosis in the US. A systematic literature search was conducted using PubMed/MEDLINE and Scopus databases and applying PICOS criteria to define scope of the search: population (patient-reported or diagnosed hyperhidrosis), outcomes (incidence, prevalence), and study type (observational). Studies conducted in the US and published in English between January 1, 2000 and January 7, 2018 were included. Epidemiological data were summarized; other included study outcomes such as population characteristics and burden of disease were reported narratively. The search yielded 897 articles eligible for title screening: 50 were retained for abstract review, of which 11 required full-text review against PICOS criteria. Five studies met all inclusion criteria, 3 of which were conducted in samples considered representative of the US population, and the remaining 2 in sub-populations (children and lower-limb amputees). Results were stratified by body area in 2 studies, with axillary hyperhidrosis being the most commonly affected (50.8%–65%). Sufferer-reported prevalence of hyperhidrosis (3 studies) ranged from 2.8% (overall US population) to 12.6% (lower-limb amputees), while diagnosed prevalence ranged from 0.10% (children) to 0.35% (US population). Over half of those surveyed indicated that sweating impacts confidence, is very embarrassing, causes anxiety, and is burdensome to cope with; however, only 38%-51% of those surveyed had discussed their symptoms with their health provider. Those asked about possible interventions for sweating felt that most interventions were not helpful or only mildly helpful. Few epidemiological studies of hyperhidrosis have been conducted. Sufferer-reported prevalence is substantially higher than diagnosed prevalence. Additional research is warranted to further understand prevalence of hyperhidrosis and increase health care provider awareness of this condition.

A survey on the knowledge, attitudes and practices of physicians towards pharmacovigilance in Jordanian health centres.

Knowledge, attitudes and practices of health care professionals towards pharmacovigilance are strongly associated with reporting adverse drug reactions, as proven by a number of studies. This study aims to evaluate the levels of knowledge, attitudes and practices towards pharmacovigilance among physicians working at health centres of the Jordanian Ministry of Health. This took the form of a cross-sectional survey. Questionnaires were distributed by the researcher and research assistant to the physicians. Twenty primary and comprehensive health centres were covered. The study included 106 physicians. Poor knowledge and practices were observed (mean knowledge score of 1.5±1.2 out of five, and mean practice score of 5.5±1.8 out of 15), while a high level of positive attitudes was observed (mean attitude score of 9.3±1.3 out of 10). Half of the physicians were aware that monitoring adverse drug reactions in Jordan is carried out by the Jordan Pharmacovigilance Centre. The majority of physicians (95.2%) mentioned that they rarely or never used the adverse drug reactions reporting form in Jordan. It is clear that there is a need to initiate educational activities and intervention programmes to raise the awareness of health care providers in Jordan regarding pharmacovigilance.

An Analysis of the Inclusion of Medications Considered Potentially Inappropriate in Older Adults in Chemotherapy Templates for Hematologic Malignancies: One Recommendation for All?

There remains a paucity of data regarding the use of potentially inappropriate medications (PIMs) in the supportive management of older adults undergoing chemotherapy. Raising awareness among healthcare providers regarding the frequency of their use and potential toxicities may help to minimize the risks to patients. The aim of this study was to evaluate the frequency of six specific classes of medications considered PIMs by the American Geriatrics Society Beers Criteria that are commonly included in the National Comprehensive Cancer Network (NCCN) chemotherapy order templates for hematologic malignancies. The six PIMs evaluated are first-generation antihistamines, benzodiazepines, corticosteroids, H2-receptor antagonists, metoclopramide, and antipsychotics. A total of 311 unique chemotherapy order templates published online by the NCCN for the treatment of hematologic malignancies were reviewed to determine the frequency that these six specific PIMs were recommended for supportive care. Approximately 45% of the NCCN chemotherapy templates for hematologic malignancies specifically recommended the use of at least one of the six PIMs examined. The remainder of the templates evaluated referred exclusively to the NCCN Guidelines® on Oncology for Antiemesis, which also included the use of at least one of the six PIMs evaluated. These findings demonstrate that PIMs are frequently used as supportive therapy in the treatment of hematologic malignancies. Increasing healthcare provider awareness of their potential side effects may minimize the risks associated with their use in older adults with hematologic malignancies undergoing chemotherapy.

Redressing the Red Dress: Rethinking the Campaign.

Since 2002, female cardiovascular mortality has significantly decreased. According to the Centers for Disease Control and Prevention Wonder Search Database, 491 713 American women died of cardiovascular disease in 2002 compared with 399 028 in 2014. This improvement has been attributed in part to the joint efforts of the National Heart, Lung, and Blood Institute and the Heart Truth campaign, the American Heart Association and the Go Red for Women Campaign, WomenHeart, the campaign of the National Coalition for Women with Heart Disease, and the Women’s Heart Alliance, along with many partners, who joined efforts to increase the awareness of heart disease in women. As with all epidemiological findings, it is a challenge to tease out which factors have led to the improvements in cardiovascular outcomes in women. Understanding what worked and what did not will guide the development and implementation of future campaigns aimed at further reducing cardiovascular mortality. Data from surveys suggest that awareness about heart disease has significantly increased, with larger increases in whites than in Latinos and blacks.1 Women are more likely to be aware that heart disease is the number 1 killer of women, yet percentages remain suboptimal (≈55%). Although the Go Red and Red Dress campaigns targeted women between 40 and 60 years of age, increased awareness in healthcare providers due to the …

Ethiopian women's perspectives on antenatal care and iron-folic acid supplementation: Insights for translating global antenatal calcium guidelines into practice.

After decades of global response to iron-deficiency anemia, lessons learned from antenatal iron-folic acid (IFA) supplementation can inform new micronutrient supplementation efforts. The World Health Organization recommends calcium supplementation for the prevention of preeclampsia; however, little is documented on how to design programs to integrate calcium into the standard of care. Twenty interviews with pregnant women and 22 interviews with health providers and volunteers in two districts in Ethiopia were conducted to examine how barriers and facilitators to antenatal care, IFA supplementation, and initial reactions to calcium supplements and regimen might influence adherence and inform future programs. Women viewed supplementation positively but cited lack of information on benefits and risks, forgetfulness, and inconsistent IFA supply as challenges. Though knowledge and awareness of anemia and IFA supplements were widespread, preeclampsia was mostly unknown. Some symptoms of preeclampsia were viewed as normal in pregnancy, making it difficult to convey risk to motivate supplement use. Some women viewed co-consumption of IFA and calcium as potentially harmful and were confused regarding the simultaneous risks of anemia and hypertension, understood as "low" and "high" blood levels in pregnancy. However, most said they would take both IFA and calcium supplements if provided with supplements and counseling on purpose and benefits. Strategies such as social support from families, stronger community-based counseling, and increased health care provider and community awareness of preeclampsia are critical for women to understand the benefits of supplementation and resolve confusion caused by current descriptors used for anemia and hypertension.

ACOG Committee Opinion No. 727: Cascade Testing: Testing Women for Known Hereditary Genetic Mutations Associated With Cancer.

"Cascade testing" refers to the performance of genetic counseling and testing in blood relatives of individuals who have been identified with specific genetic mutations. Testing protocols and other interventions may save lives and improve health and quality of life for these family members. Obstetrician-gynecologists should know who is eligible for cascade testing and should use all available resources to ensure that cascade testing is offered and occurs in a timely manner. Despite the clear health benefits for specific populations and individuals, obstetrician-gynecologists should be aware of the potential barriers to cascade testing and should know which options can help patients overcome those barriers. Such barriers, however, may be overcome with health care provider awareness and participation in local and state initiatives to improve implementation of cascade testing. Resources (available within federal and state agencies, professional societies, and in advocacy and community groups) are critical to the successful implementation of cascade testing. This Committee Opinion focuses specifically on cascade testing and the role of the obstetrician-gynecologist in clinical and public health efforts to increase identification of women with hereditary cancer syndromes.

ACOG Committee Opinion No. 727 Summary: Cascade Testing: Testing Women For Known Hereditary Genetic Mutations Associated With Cancer.

"Cascade testing" refers to the performance of genetic counseling and testing in blood relatives of individuals who have been identified with specific genetic mutations. Testing protocols and other interventions may save lives and improve health and quality of life for these family members. Obstetrician-gynecologists should know who is eligible for cascade testing and should use all available resources to ensure that cascade testing is offered and occurs in a timely manner. Despite the clear health benefits for specific populations and individuals, obstetrician-gynecologists should be aware of the potential barriers to cascade testing and should know which options can help patients overcome those barriers. Such barriers, however, may be overcome with health care provider awareness and participation in local and state initiatives to improve implementation of cascade testing. Resources (available within federal and state agencies, professional societies, and in advocacy and community groups) are critical to the successful implementation of cascade testing. This Committee Opinion focuses specifically on cascade testing and the role of the obstetrician-gynecologist in clinical and public health efforts to increase identification of women with hereditary cancer syndromes.

Gynecologic Bleeding Complications in Postmenarchal Female Adolescents Receiving Antithrombotic Medications.

The prevalence, clinical features, and management of gynecologic bleeding complications and health care provider awareness of these in postmenarchal adolescents receiving antithrombotic medications has rarely been addressed in the literature. We sought to address these issues in a review of our experience in a pediatric tertiary care center. A retrospective chart review was conducted with institutional review board approval from 2004 to 2014, on eligible postmenarchal adolescents receiving antithrombotic medications. Descriptive statistics were used. Sixty-eight adolescents received antithrombotic medications (thromboembolism in 67 of 68; 99%; cardiac causes in 4 of 68; 6%), which included enoxaparin, warfarin, unfractionated heparin, alteplase, fondaparinux, and aspirin. Heavy menstrual bleeding (HMB) screening questions were documented by treating hematologists in 52 of 68 patients (76%; 95% confidence interval, 65%-86%). Adolescent gynecology consult was requested for 25 of 68 patients (37%). After antithrombotic medications were started, 13 of 68 (19%) developed HMB. Anemia was found in 43% of patients tested (18 of 42); 50% (9 of 18) and 78% patients (14 of 18) received packed red blood cell transfusion and iron therapy, respectively. Five patients (5 of 68; 7%) developed hemorrhagic ovarian cysts, 40% (2 of 5) were treated with surgery, 16% (1 of 5) received transfusions, and 100% (5 of 5) received or continued progesterone-only therapy with no recurrence. Adolescents receiving antithrombotic medications are at risk of developing gynecologic bleeding complications, which can result in anemia, hospitalization, transfusions, or surgery. Provider awareness/screening of HMB as a bleeding complication of antithrombotic medications is less than optimal. Future prospective studies in adolescents receiving antithrombotic medications are needed to better evaluate provider awareness and the prevalence of gynecologic bleeding complications, which can lead to effective management.

Healthcare providers’ attitude and knowledge regarding medication use in breastfeeding women: a Jordanian national questionnaire study

Medication use among women who have recently given birth is unavoidable in some situations. The aim of this study was to assess the attitude and knowledge of healthcare providers (HCPs) in Jordan about the safe use of medications during breastfeeding. The data were collected from HCPs in maternal and children care centres and hospitals from April 2015 to January 2016, using a self-administered questionnaire. A total of 904 HCPs (79.3%) were enrolled in the study. Half of the participants followed the World Health Organisation’s and American Academy of Pediatrics’ recommendations. The awareness of HCPs regarding these recommendations was lower among nurses (OR 0.212, 95%CI 0.132–0.338, p < .001) and pharmacists (OR 0.476, 95%CI 0.297–0.763, p = .002) than physicians. The majority of participants (80%) had low level of knowledge and nurses were more likely to have low knowledge than physicians (OR 0.099, 95%CI 0.050–0.197, p < .001). Professional continuous education programmes were highly encouraged.Impact statementWhat is already known on this subject: Use of medications among women who have recently given birth is unavoidable in some situations and most of them are safe to be given during breastfeeding.What the results of this study add: Healthcare providers in Jordan have variable attitudes regarding the safety of medication use during breastfeeding. The majority of healthcare providers have a low level of knowledge regarding the safe use of medication during breastfeeding. Nurses are more likely to have low knowledge as compared to physicians.Implications for clinical practice: Healthcare providers should be encouraged to seek information regarding compatibility of medication use during breastfeeding from reliable sources. Professional continuing education programmes concerning the safety of medication use during breastfeeding period are needed to target all involved HCPs. More attention should be directed toward medical schools’ curricula to widen the knowledge of medication use and focus on practice-based clinical experience.

A survey on pediatric brain death and on organ transplantation: how did the law amendment change the awareness of pediatric healthcare providers?

In Japanese society taking a cautious attitude towards organ transplantation, we investigate how amendment of the Organ Transplant Law which legalized brain death (BD) determination criteria changed the awareness concerning BD and organ transplantation of pediatric healthcare providers. The questionnaire survey adopted the bearer method and was sent to members of the Japanese Society of Emergency Pediatrics (JSEP). In both the surveys of 2008 and 2016, the same item "Questionnaire survey on BD and organ transplant" was disseminated. We compared the responses of the two surveys. Statistical analysis was performed using chi-square test. Significance was observed when p value was less than 0.05. Comparison of the results of the two surveys in this study showed a change in awareness of BD/organ transplantation held by pediatric healthcare providers in Japan. It was suggested that Japanese pediatric healthcare providers tend to explain to the family that it is BD with incomplete diagnosis of BD. In the 2016 survey, there is an increase in the response "There is experience of children diagnosed with BD" and it might be due to the effect of the amendment of the law (p=0.0038). In July 2010, the "Amendment of the Organ Transplant Law" became effective, and it became possible to provide organs with family member consent even if the intention of the patient to provide organs was unknown. Since this amendment made it possible to provide children under 15years of age with BD donors, we assumed that there was a change in awareness concerning BD determination and organ transplantation for pediatric healthcare providers.

Raising awareness of health care providers about MERSCoV infection in public hospitals in Mecca, Saudi Arabia

It is important that health care workers have good knowledge, attitudes and practices (KAP) towards MERS-CoV, especially in Mecca because of the MERS-CoV threat during hajj and umrah. This study aimed to assess KAP of health care providers in public hospitals in Mecca about MERS-CoV infection and evaluate the effectiveness of a health education intervention to improve KAP. KAP was assessed among 281 participants using a self-administered questionnaire who then underwent the health education intervention using a combination of methods. After 3 months, 188 participants responded to the post-intervention evaluation. Significant post-intervention improvement was found in the median scores for knowledge (P < 0.001), attitude (P = 0.022) and cumulative KAP (P < 0.001); scores improved irrespective of age group and gender. Practice scores did not improve significantly, although reported practices were good before the intervention. The positive effects of the intervention support efforts to continuously implement health education interventions for health care providers in Mecca.

Current state of pharmacovigilance in the Arab and Eastern Mediterranean region: results of a 2015 survey.

This study describes the current state of pharmacovigilance systems in Arab and Eastern Mediterranean countries. A descriptive cross-sectional study was conducted between May and September 2015. Data were gathered from a standardized online survey sent to pharmacovigilance leadership identified as the official national contact for the WHO Programme for International Drug Monitoring. In countries with no specified pharmacovigilance programme or leadership, Ministry of Health officers responsible for drug safety policies were invited to participate in the survey. The survey measured three domains of pharmacovigilance performance using indicators that were defined and assigned scores a priori: 10 structural, 10 process, and seven impact indicators. Total scores were assigned to each domain of indicators, and countries were compared depending on their total performance score. Complete responses were received from 20 countries (of 24 total), representing an 83% response rate. Approximately 20% (n=4) of respondents reported not having any pharmacovigilance programme in their country. In total, across the three primary pharmacovigilance performance domains, the mean score for the 20 countries in the survey was 28.9 [standard deviation(SD): 13.8] with a range from 4 to 48 (maximum possible score: 48). In the structural performance domain, which assessed the existence of key pharmacovigilance structures, systems and policies in each country, the mean score among respondents was 13.1 (SD: 5.7) and the scores ranged from 2 to 19 (maximum possible score: 19). In the process performance domain, which assessed the constellation of activities undertaken by pharmacovigilance programmes (including the collection, collation, analysis and evaluation of adverse drug event reports), the mean score among respondent countries was 9.1 (SD: 5.4) and the scores ranged from 0 to 17 (maximum possible score: 17). Finally, in the impact domain, which measured the scope of national efforts at promoting risk minimization and increasing awareness in use of potentially unsafe pharmaceutical products, the mean score was 6.8 (SD: 3.6) and scores ranged from 0 to 12 (maximum possible score: 12). The findings suggest wide disparities in pharmacovigilance systems in the region, underscoring the need for a multistakeholder effort in bolstering programme development and the necessity to build collaboration regionally and internationally to enhance capacity, improve public and healthcare provider awareness and assist in the development of pharmacovigilance systems still in their nascent stage.

Domperidone for Lactation: What Health Care Providers Need to Know.

This commentary serves to raise health care provider awareness about the regulatory status and available evidence regarding domperidone for insufficient lactation. Breastfeeding provides significant health benefits for mothers and infants, and insufficient milk production remains the most common reason for early weaning. Domperidone, a dopamine receptor antagonist that may increase milk production, is not approved for any human use in the United States. It is approved in some countries for certain gastrointestinal disorders, but is not approved in any country for lactation enhancement. Domperidone is associated with serious cardiac arrhythmias. The U.S. Food and Drug Administration (FDA) issued an import alert in 2004, updated in 2012, explaining that the importation of domperidone is illegal with limited exceptions, including when imported pursuant to an investigational new drug application. The FDA also issued a public safety warning regarding the use of domperidone for lactation. Nonetheless, domperidone is sometimes being obtained illegally and used in attempts to increase milk production in lactating mothers. There is limited quality evidence for the effectiveness of domperidone for lactation enhancement. In contrast, considerable information exists on domperidone's cardiac risks including QT prolongation, torsades de pointes, and sudden cardiac death, including among lactating women. In light of limited efficacy data that do not offset safety concerns from a public health perspective, we continue to caution against using domperidone for lactation enhancement. Research and drug development are needed to address the significant unmet medical need for lactation disorders.

A Novel Public Health Approach to Measuring Tobacco Cessation Needs Among Cancer Survivors in Alaska.

Cancer survivors who continue to smoke have poorer response to treatment, higher risk for future cancers and lower survival rates than those who quit tobacco after diagnosis. Despite the increased risk for negative health outcomes, tobacco use among Alaskan cancer survivors is 19%, among the highest in the nation. To characterize and address tobacco cessation needs among cancer survivors who called a quit line for help in quitting tobacco, Alaska's Comprehensive Cancer Control program initiated a novel partnership with the state's Tobacco Quit Line. Alaska's Tobacco Quit Line, a state-funded resource that provides confidential coaching, support, and nicotine replacement therapies for Alaskan adults who wish to quit using tobacco, was used to collect demographic characteristics, health behaviors, cessation referral methods and other information on users. From September 2013- December 2014, the Alaska Quit Line included questions about previous cancer status and other chronic conditions to assess this information from cancer survivors who continue to use tobacco. Alaska's Tobacco Quit Line interviewed 3,141 smokers, 129 (4%) of whom were previously diagnosed with cancer. Most cancer survivors who called in to the quit line were female (72%), older than 50 years of age (65%), white (67%), and smoked cigarettes (95%). Cancer survivors reported a higher prevalence of asthma, COPD and heart disease than the non-cancer cohort. Approximately 34% of cancer survivors were referred to the quit line by a health care provider. This report illustrates the need for health care provider awareness of persistent tobacco use among cancer survivors in Alaska. It also provides a sound methodologic design for assessing ongoing tobacco cessation needs among cancer survivors who call a quit line. This survey methodology can be adapted by other public health programs to address needs and increase healthy behaviors among individuals with chronic disease.

Misdiagnosed Frontal_Transethmoidal Meningoencephalocele : Case Report

To enhance awareness of healthcare providers for any baby comes with persistence unilateral nasal obstruction, and take care for him. Methods: A report of rare case for a child presented with an internal nasal mass with maternal history of folic acid deficiency Results: The diagnosis of transethmoidal encephalocele was confirmed by a computed tomography (CT) and magnetic resonance imaging(MRI). Craniotomy excision and duroplasty, assisted with endonasal endoscopic excision and repair of skull base defect by middle turbinate graft were done. Nasal tissue was taken for Histological examination which confirmed the diagnosis of an encephalocele within the nasal cavity. The patient had recovered with complete healing of grafts with no recurrence and follow up CT after 6 months was normal. Conclusion: The general physicians and pediatricians must put in consideration any baby with unilateral persistence nasal obstruction which can be frontal-transethmoidal meningocele +/- encephalocele . Taking folic acid or food rich of folate during pregnancy can help in reduction of neural tube defects prevalence. Radiological imaging (CT +/- MRI) study should be done for every Pediatric case presenting with an intranasal mass before any surgical intervention or an invasive intranasal procedure.

Do Thai Physicians Recommend Seasonal Influenza Vaccines to Pregnant Women? A Cross-Sectional Survey of Physicians' Perspectives and Practices in Thailand.

BackgroundPhysicians play a major role in influencing acceptance and uptake of vaccines. However, little is known about physicians’ perspectives on influenza vaccination of pregnant women in Thailand, for whom vaccine coverage is estimated at <1%.MethodIn 2013, a self-administered questionnaire on physicians’ perceptions, attitudes and practices related to influenza vaccination for pregnant women was distributed to 1,134 hospitals with an antenatal care clinic (ANC) in Thailand. At each hospital, one physician working at the ANC completed the survey. Predictors of routine recommendation of influenza vaccine were analyzed utilizing log-binomial regression.ResultsA total of 580 (51%) complete responses were received from physicians practicing at ANCs. A favorable attitude towards vaccination was expressed by 436 (75%) physicians, however only 142 (25%) reported routinely recommending influenza vaccine to pregnant women in their current practice. Physicians were more likely to recommend influenza vaccine routinely when they had more than three years of practice (prevalence ratio [PR] 1.9, 95% CI 1.2–2.3), had treated pregnant women for influenza (PR 1.8, 95% CI 1.3–2.7), perceived the influenza vaccine to be effective (moderate level: PR 1.6, 95% CI 1.1–2.4; high level: PR 1.9, 95% CI 1.3–2.9) and were aware of the Ministry of Public Health’s (MOPH) recommendation of influenza vaccination in pregnancy (PR 1.3, 95% CI 1.1–1.7). Vaccine not being available, perception that policy was ambiguous and lack of awareness of MOPH recommendations were the most commonly cited barriers to routine recommendation of influenza vaccine.ConclusionDespite a national policy to vaccinate pregnant women for influenza, only 25% of Thai physicians working in ANCs routinely recommend vaccination. Strategies are needed to increase vaccine availability and free vaccine services, address clinician concerns over vaccine effectiveness and expand healthcare provider awareness of MOPH recommendations.