Physician Advice Research Articles

Influencia de la artroplastia total de cadera y el consejo médico en la actividad deportiva realizada después de la intervención

Background and objectivesThere are no randomized prospective studies that evaluate sports activity after total hip arthroplasty (THA). The objective of this study is to assess the level and type of sports activity in patients undergoing THA and to assess the recommendations given by physicians. Materials and methodsWe performed a descriptive study that analyzes 46 patients (the average age was 41 years, range 37 – 48) under 50 years of age who underwent THA (58 hips) in our center. The average follow-up was 7.5 (1 - 11) years. Age, sex, sports activity according to the UCLA scale, sports activities practiced before and after the intervention, complications and recommendations given by doctors were evaluated. ResultsThe average time to resume sport activity after the surgery was 5 (3-10) months. There were no differences in the UCLA scale before and after the operation (P> 0.05). The most practiced sport before the surgery was swimming (17%). The 31% of patients did not receive advice from their physician and the 65.2% were dissuaded from playing sports after ATC. The recommended sports were swimming (44%) and the static bicycle (17.5%), correlating with the most practiced sports after the operation. ConclusionThe patients modified their sport activity after having undergone a total hip arthroplasty. The surgery and the physician's advice were the ones that influenced the choice of the sports activity performed after being operated on.

Risk Factors for Self-stigma among Incarcerated Women with Alcohol Use Disorder.

Alcohol use disorder (AUD) is a highly stigmatized condition, often associated with negative stereotypes such as being morally weak, incompetent, unpredictable, and aggressive. People with AUD are at risk of experiencing self-stigma, a social-cognitive experience in which people think others hold negative stereotypes about them, expect to be treated unfairly, and/or believe that negative stereotypes are personally accurate. Women in the criminal justice system with AUD in particular are at risk of experiencing self-stigma due to intersecting sources of disadvantage. Given that self-stigma can lead to treatment avoidance and dropout, it is important to understand risk factors for self-stigma to inform prevention and intervention efforts in the justice system. Incarcerated women with AUD (n=185) completed measures of alcohol self-stigma as well as a variety of theoretically relevant risk factors including sociodemographics, baseline levels of stress and depression, and alcohol-related factors (i.e., length of drinking history, frequency/amount of use, consequences of use, physician advice to stop, belief that legal involvement is related to alcohol use, alcohol-related charges, self-efficacy to quit, readiness for treatment, pressures to enter treatment, factors that influence treatment) and other stigmatized conditions (drug use, exchanging sex, and homelessness). Results showed that experiencing more consequences of alcohol use, pressures to enter treatment, and perceived stress were associated with internalized stigma and anticipated/enacted stigma. This study begins to identify which incarcerated women with AUD are most at risk of experiencing self-stigma that may interfere with alcohol treatment.

Prejudice against higher‐weight health providers: Implications for patients and providers

AbstractHigher‐weight health providers may face prejudice, which may affect the health provider and the patient alike. In a series of five studies, we sought to experimentally determine the extent of weight prejudice against health providers as well as boundary conditions for the effects. In all studies, participants evaluated the profile of a potential health provider, which contained each study's manipulation. They subsequently rated their likelihood of selecting the provider, their perceived legitimacy of the provider, and how likely they would be to follow the provider's advice. We found that higher‐weight professionals were evaluated more negatively than lower weight professionals in Study 1. Focusing only on health professionals in Study 2, we found that higher‐weight health professionals were evaluated more negatively than lower weight professionals, especially when the health professional's specialty was relevant to weight (i.e., nutrition vs. allergies). This did not depend on gender of the health provider (Study 3). In Study 4, we found that imagined patient risk for heart disease did not moderate the effect of provider weight on prejudiced attitudes, and the effect did not change when providing participants with credible purported physician advice (Study 5). Taken together, these studies provide evidence that weight prejudice against higher‐weight health providers exists, especially in medical contexts related to weight. Not only are there implications for higher‐weight health providers, but also there are implications for patients as well. Thus, prejudice against higher‐weight health providers could constitute an important health issue.

Women's Gendered Experiences of Traumatic Brain Injury.

Despite recognizing that women have worse outcomes after traumatic brain injury (TBI), little is known about how gender influences their experiences of this critical injury. Past research has been dominated by androcentrism and quantitative approaches, leaving the lived experience of women with TBI insufficiently examined. To gain insight into their experiences, this qualitative study interviewed 19 Canadian women with mild and moderate-to-severe TBIs. Applying a thematic analysis, we discerned three themes: Gender prevails considers choosing to do gender over complying with physician advice; Consequences of TBI impeding performativity explores how women frame themselves as terrible people for being unable to do gender post-TBI; and Perceptions of receiving care looks at gendered caregiving expectations. These results broadly align with research on how doing gender influences recovery and health outcomes. We discuss the implications of our findings for knowledge translation, future research on women's TBI recovery, and clinical practice.

Analysis of motivation to quit smoking in patients with chronic obstructive pulmonary diseases

Тobacco smoking is a leading risk factor for chronic ob-structive pulmonary disease (COPD) progression, it also decreases the therapeutic efficacy for bronchial asthma patients. The goal of the study was to analyse the rea-sons for smoking cessation and develop brief physician's advice for smoking cessation. Маterials and methods.156 COPD patients (grades 2 and 3), age ranging from 51 tо 75 years (110 males and 46 females), and 157 bron-chial asthma (BА) patients, of medium severity, age ran-ging from 20 tо 69 years (67 males and 90 females) have been studied. The control group included 100 smokers (20–68 years of age), with no acute diseases or respiratory symptoms throughout the study. Inclusion criteria: smo-king 10 or more cigarettes a day for no less than 3 years. A questionnaire was used to evaluate nicotine depen dence (Fagerstrom test), and motivation to abandon tobacco smoking (ТS). Results. The majority of COPD patients had high degree of nicotine dependence (ND) = 6.7±0.4 score, with controls' level of 5.2±0.5, р<0.05 (similar levels both for males and females). Patients with asthma more often had medium and low degree ND. The majority of smo-king patients were highly motivated to smoking ces-sation, however, the maximum scores were shown by COPD patients in 23% of cases (practically even between males and females) and only in 10% of BA cases, mainly due to females not being ready to abandon TS (with max-imum scores only in 2% of cases). The main reasons for smoking quit were health maintenance, costs decrease, desire to stop being dependent on cigarettes, and tak-ing care of children's health. Conclusion. Health care providers when consulting the patients have to take into account the main reasons for stopping tobacco smoking, viz. health and cost-cutting concerns.

Factors Affecting Patient Compliance to Physician Advice among Lebanese Internet Users

Factors Affecting Patient Compliance to Physician Advice among Lebanese Internet Users

Who will buy a continuous positive airway pressure machine if diagnosed as obstructive sleep apnea? Do the patients follow physician's advice?

Who will buy a continuous positive airway pressure machine if diagnosed as obstructive sleep apnea? Do the patients follow physician's advice?

Treatment Decision Making in AML: Factors of Importance to Clinicians, AML Patients and Their Family

Treatment Decision Making in AML: Factors of Importance to Clinicians, AML Patients and Their Family

Parents' Perceptions of Infant Crying: A Possible Path to Preventing Abusive Head Trauma.

Infant crying can lead to parental frustration and is the most common trigger for abusive head trauma (AHT). We used qualitative methodology with an activating stimulus (an audiotape of an infant crying) to prime the participants to engage in open dialogue for the purpose of understanding their perceptions of infant crying and its association with AHT, with the aim that information from these interviews and the impact of hearing the activating stimulus could be used to inform interventions to prevent AHT that would resonate with parents. We conducted 25 initial qualitative interviews and 16 subsequent interviews with mothers and fathers of newborns. Before the initial interview, parents listened to a 1-minute audio clip of a crying infant, followed by a preventive message regarding AHT. The transcribed data were analyzed, and themes were developed using the constant comparative method of grounded theory. Data collection and analysis continued past the point of thematic saturation. Four themes emerged from the initial interviews: 1) previous experience is helpful to manage infant crying, 2) babies cry for a reason, 3) shaking an infant is incomprehensible to parents, and 4) the role of safety planning to manage frustration with crying. Analysis of the subsequent interviews revealed 2 additional themes: 1) use of supports for infant crying (eg, technology and physician advice) and 2) effects of the audio clip on caregiving practices. Previous experiences and beliefs about crying affect parents' perceptions of infant crying and AHT. After discharge, parents reported using technology for information and support and thinking about the audio clip when caring for their infant. These experiences, beliefs, and practices may aid in shaping effective prevention strategies to prevent AHT.

Physicians advice, parental practice and adherence to doctor\u2019s advice: an original survey on infant feeding

Background: Despite several years of guidance on infant feeding, there has been only a slight change in consumer compliance. Therefore, this study aimed to analyse parents feeding practices, explore physicians’ advice about infant feeding and subsequent parent’s adherence to advice.MethodsA multicentric cross-sectional qualitative and descriptive self-report online study was conducted in volunteers to participate in the study.ResultsFifty-four physicians (paediatricians and general practitioners) and 600 parents of infants were recruited. Of the infants, 20.2% presented at inclusion with at least one type of functional gastrointestinal disorder. The breastfeeding prevalence was quite low (37.3%). The main initial deviance from guidelines said they observed in infant feeding was the early use of cow’s milk. More than two-thirds of infants older than 8 months were drinking cow’s milk. The introduction of solid foods was globally in line with recommendations. Most physicians gave advice about the different aspects of infant feeding but were seeking more information, as did the parents. A discrepancy between the physicians’ statements and the parents’ perceptions was observed. However the majority (95.4%) of parents reported that they followed totally or partially the advice received, especially by abandoning subsequently the use of cow’s milk in favour of a formula. The main reason for not adhering to the advice was that they did not consider it suitable for their infant and they preferred to rely on their feelings or recommendations from familiars.ConclusionsThis survey provides good insights into parents’ infant feeding practices together with the advice given by their doctor. The gap between practices and current guidelines is notable only for breast-feeding and use of formula. Despite several guidelines professionals and parents seek nutrition information. It highlights the need to deliver consistent, relevant, and less confusing messages about infant feeding.

Barriers to Exercise in Type 2 DM Patients: An Institutional Cross-Sectional Descriptive Study

Background: The benefits of regular exercise are well recognized in type 2 diabetes subjects. However, a substantial proportion of patients don’t exercise at all. We aimed to enumerate the barriers to exercise in Type 2 Diabetes Mellitus (T2DM) patients and factors associated with these barriers. Methodology: We conducted a cross-sectional study of successive type 2 diabetes patients attending routine out-patient diabetes clinics in five tertiary care hospitals in Kolkata, India from 1st April,2017 to 31st March 2018. All patients who matched our study eligibility criteria were interviewed by diabetes care providers using a structured questionnaire modeled after a systematic review of similar studies but tuned to regional preferences. Besides demographic details, patient particulars and laboratory investigations, the questionnaire included 2 direct questions on possible barriers to exercise. The questions were grouped into five categories viz. environmental (4 questions), behavioral (9 questions), occupational (2 questions), physical inability (7 questions) and medical reason (1 question). Patients’ who didn’t meet the ADA-EASD recommended exercise (at least 150 minutes moderate intensity aerobic physical activity viz. brisk walking at 3-4 km-hr) were classified as non-exercisers. Results: The present study included a total of 1061 patients of which 617 were males versus 444 females. 636 (59.9%) were not doing physical activity as per current international standards. A substantial higher proportion of females (68.9%) did not exercised as compared to males (53.5%), which is statistically significantly higher, p<0.001. Insulin usage was found to be significantly associated to hamper exercise (p=0.017), physical activity being 8% lower (34.5% in insulin users versus 42.5% in non-insulin users). Male gender (OR-1.877, 95% CI=1.217-2.894, p=0.004) and doctor’s prior advice for exercise (OR-3.397, 95% CI=2.035-5.671, p<0.001) were found as significant predictors for increased physical activity. Conclusion: This study elaborates the need for awareness regarding possible barriers when counseling T2DM patients. Exercise remains one of the cheapest pillars of DM management, the benefits of which extend beyond glycemic control. However, as this study illustrates about 60% of patients with T2DM do not carry out the recommended exercise. This study also highlights the importance of physician advice regarding exercise. Behavioural causes seem to be the commonest barrier to exercise and hence strategies to target the same needs to be thought of.

Mortality in children with severe acute malnutrition

Malnutrition is a major contributor to the global disease burden, accounting for more than one-third of child deaths worldwide. Severe Acute Malnutrition is a disease that is an underlying condition in many under five admissions in the study area of Hiwot Fana Specialized University Hospital, Harare and in Ethiopia as a whole. The main objective of the study is to identify the prevalent cause of mortality in Severe Acute Malnutrition, among children aged 6-59 months, admitted to Hiwot Fana Specialized University Hospital, Pediatric ward, Nutrition Rehabilitation Unit from 2013 to 2015. Which will be key to help improve the management protocol so as to see better outcomes in the patients in the study area, or at the very least to be a stepping stone to and point out the need for further analytical studies on the topic. The study was a retrospective, descriptive cross-sectional study which was conducted to identify the prevalent causes of mortality in patients aged 6-59 months admitted to Hiwot Fana Specialized University Hospital, Nutrition Rehabilitation Unit over the period of 2013-2015. The study reveals that the case recovery rate of the study area is 36% with the rate of patients who have disappeared or had left against physician's advice being a whapping 61.9%. The mortality rate weez was found to be 2.1% with the mortality sex ratio of Male: Female 1.6:1. The commonest complication that appears to related with mortality in Severe Acute Malnutrition was diarrheal disease (Acute Gastroenteritis) being present in 14 of the 15 deaths in the study period. The study concludes that the Case Fatality Rate of the study area, even though very low, the high rate of disappearance and yet a comparatively low rate of recovery brings to question the general quality of care in the facility. More to this the commonest complication associated with mortality being a preventable and manageable one i.e. AGE calls for Vigilance in the management of such patients.

Smoking Cessation among Female and Male Veterans before and after a Randomized Trial of Proactive Outreach.

Introduction:Female veterans smoke cigarettes at high rates compared with both male veterans and nonveteran women. Proactive outreach (PRO) to smokers may reduce gender disparities in cessation care. The objectives of this study were to compare baseline experiences with VA smoking cessation care for men and women and to assess for gender differences in response to a PRO intervention.Methods:We conducted a post hoc subgroup analysis of a pragmatic, multisite randomized, controlled trial comparing PRO with usual care (UC). Baseline experiences included physician advice to quit, satisfaction with care, and past-year treatment use. At the 1-year follow-up, treatment use, quit attempts, and 6-month prolonged abstinence for women and men randomized to PRO versus UC were compared using logistic regression.Results:Baseline and follow-up surveys were returned by 138 women and 2,516 men. At baseline, women were less likely than men to report being very or somewhat satisfied with the process of obtaining smoking cessation medications in the VA (47% of women vs. 62% of men), but no less likely to report having used cessation medications from the VA in the past year (39% of women vs. 34% of men). After the intervention, phone counseling and combined therapy increased among both women and men in PRO as compared with UC. At the 1-year follow-up, men in PRO were significantly more likely to report prolonged abstinence than those in UC (odds ratio, 1.65; 95% CI, 1.28–2.14); results for women were in the same direction but not statistically significant (odds ratio, 1.39; 95% CI, 0.48–3.99).Conclusions:Satisfaction with cessation care in VA remains low. PRO to smokers was associated with an increased use of cessation therapies, and increased odds of achieving prolonged abstinence. A subgroup analysis by gender did not reveal significant differences in the treatment effect.

National Trends in Cessation Counseling, Prescription Medication Use, and Associated Costs Among US Adult Cigarette Smokers

Cigarette smoking is the leading cause of preventable disease and death in the United States. When used separately or in combination, smoking cessation counseling and cessation medications have been associated with increased cessation rates. To present trends in self-reported receipt of physician advice to quit smoking and in use of prescription smoking cessation medication along with their associated expenditures among a nationally representative sample of active adult smokers in the United States. This repeated cross-sectional study of US adults aged 18 years or older was conducted from July 5, 2018, through August 15, 2018. Data were collected between January 1, 2006, and December 31, 2015, from the Medical Expenditure Panel Survey, an annual US survey of individuals and families, health care personnel, and employers. Participants (n = 29 106) were noninstitutionalized civilians who were randomly drawn from the respondents of the previous year's National Health Interview Survey. Multivariable logistic regression models were used to examine the associations between sociodemographic factors and receipt of physician cessation advice and use of cessation prescription medication. A 2-part econometric model was used to assess health care expenditures. Trends in self-reported receipt of physician advice to quit and uptake of prescription smoking cessation medications with associated total and out-of-pocket expenditures. The study sample consisted of 29 106 participants, with a mean (SD) age of 57 (10) years and a composition of 13 670 women (47.0%). The results were weighted to provide estimates for 31.2 million active adult cigarette smokers. The proportion of smokers who reported receiving physician advice to quit increased from 60.2% (95% CI, 58.5%-62.0%) in 2006 to 2007 to 64.9% (95% CI, 62.8%-66.9%) in 2014 to 2015, with a P for trend = .001. The odds of receiving physician cessation advice was statistically significantly higher in women (odds ratio [OR], 1.50; 95% CI, 1.39-1.59) and lower among uninsured participants (OR, 0.58; 95% CI, 0.52-0.65). Overall, prescription smoking cessation medication use decreased with a corresponding reduction in total expenditures from $146 million (out-of-pocket cost, $46 million) in 2006 to 2007 to $73 million (out-of-pocket cost, $9 million) in 2014 to 2015. Male (odds ratio [OR], 0.78; 95% CI, 0.66-0.91), uninsured (OR, 0.58; 95% CI, 0.41-0.83), and racial/ethnic minority (African American: OR, 0.51 [95% CI, 0.38-0.69]; Asian: OR, 0.31 [95% CI, 0.10-0.93]; Hispanic: OR, 0.53 [95% CI, 0.36-0.78]) participants were less likely to use prescription smoking cessation medications. The lower rates of delivery of physician advice to quit smoking and the lower uptake of known prescription smoking cessation medications among men, younger adults, uninsured individuals, racial/ethnic minority groups, and those without smoking-associated comorbidities may be associated with the higher smoking rates among these subgroups despite an all-time low prevalence of smoking in the United States; this finding calls for a more targeted implementation of smoking cessation guidelines.

Participation in thrill-seeking activities by patients with hypertrophic cardiomyopathy: Individual preferences, adverse events and physician attitude

Thrill-seeking activities are a favorite pastime for people of all ages. Patients with hypertrophic cardiomyopathy (HCM) are often barred from participation on the basis of danger for arrhythmias. Our aim was to collect information regarding the safety of thrill-seeking activities for HCM patients. An anonymous online survey invited adult HCM patients to report participation in 11 activities (rollercoaster riding, jet skiing, rafting, bungee jumping, rappelling, paragliding, kayaking/canoeing, motor racing, snowboarding, BASE jumping and skydiving) before and after HCM diagnosis, along with major (ICD shock, syncope) or minor (nausea, dizziness, palpitations, chest pain) adverse events related to participation, and relevant physician advice. Six hundred forty-seven HCM patients completed the survey, with 571 (88.2%) reporting participation in ≥1 TSAs (participant age 50.85 ± 14.21, 56.6% female, 8143 post-diagnosis participations). At time of survey, 457 participants (70.6%) were ICD-carriers or had ≥1 risk factor for sudden cardiac death. Nine (1.5%) participants reported a major event during or immediately after (60 minutes) of surveyed activity. Minor adverse events were reported by 181 participants (31.6%). In addition, 8 participants reported a major adverse event >60 minutes later but within the same day. Regarding physician advice, of the 213 responders (32.9%) receiving specific advice, 56 (26.2%) were told safety data is absent with no definitive recommendation, while 24 (11.2%) and 93 (43.6%) were told TSAs were respectively safe or dangerous. In this cohort, participation in thrill-seeking activities rarely caused major adverse events. This information can be used for shared-decision making between providers and patients.

Research on the standardized training mode of clinical medical talents based on clinical pathway

ObjectiveTo study the effect of clinical pathway on the ability of standardized treatment of patients for medical students.Methods450 undergraduates were divided into group A and group B, Group A was the traditional practice group, group B was the clinical pathway teaching group. 225 students in each group. group A students according to the traditional practice teaching method, finished the ward round and case discussion with their teachers, consulted the attending physician's advice for their patients. On that basis, tried to give the simulation of the doctor's advice after choosing the same disease but different patients, recording their history, according to their own understanding; Group B students studied the clinical pathway in advance, based on the method of Group A, followed the clinical pathway, combined with their own understanding, tried to give the simulation of the doctor's advice. Two high qualificated experts inspected the completeness and correctness of the simulation of the doctor's advice giving by group A and group B students. At the same time , students' confidence in independent treatment of same disease were assessed by themselves.Resultsthe integrity of students' medical advice in group A and group B was 85.68±3.10 vs 92.05±2.96‐P<0.01; The correctness was 86.55±3.88 vs 95.59±4.31‐P<0.01; The degree of confidence in the treatment of the doctor's order was 75.19±6.90 vs 90.45±5.65‐P<0.01.ConclusionThe students in the clinical pathway‐teaching group are better than the traditional teaching group students in the confidence, the integrity and the correctness of the doctor's orders.Support or Funding InformationThis project is supported by the teaching reform program of shanxi higher education (No. 2013‐ 033), The project of "131" leading talents of shanxi higher education, the education reform project of postgraduate students in Shanxi Province (No. 2017‐027), the education reform project of shanxi medical university, the National Natural Science Foundation Youth Fund (30600637). China Postdoctral Foundation(2014M561207)‐Shanxi Scholarship Council of ChinaThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Shimbi Dhanya (pulses) as Ayurvedic food supplement for calcium deficiency

Ahara (food) is an important tool in Ayurveda. Ahara itself acts as an Aushadha (medicine). Shimbidhanya Varga (pulses) in daily diet has an important role in maintaining strength of Asthi Dhatu. Asthi Dhatu can be anatomically correlated to bones and teeth of body, 98% of bones composed of calcium. So calcium deficiency may directly proportional to Asthi Dhatu Kshaya. Shimbi Dhanya Varga (pulses) is rich in Proteins, Calcium, Phospherus and Magnesium. Mudga (green gram), Masha (black gram), Soya Bean etc. are coming under Shimbi Dhanya Varga has 124mg, 154mg, 240mg of calcium content respectively per 100gm. It will satisfy RDA of calcium in diet. Among Indian population aged 30 to 60 years had low calcium with high prevalence of osteopenia (52%) and osteoporosis (29%). This made the community to use of calcium tablets with or without physicians advice. So incomplete absorption, high cost and later side effects affects community health. So promote and educate useful ways of intake of calcium to human body just through daily diet and made it part of community health care programmes.

Cancer-Related Internet Use and Its Association With Patient Decision Making and Trust in Physicians Among Patients in an Early Drug Development Clinic: A Questionnaire-Based Cross-Sectional Observational Study.

BackgroundThe role of cancer-related internet use on the patient-physician relationship has not been adequately explored among patients who are cancer-related internet users (CIUs) in early-phase clinical trial clinics.ObjectiveWe examined the association between cancer-related internet use and the patient-physician relationship and decision making among CIUs in an early drug development clinic.MethodsOf 291 Phase I clinic patients who completed a questionnaire on internet use, 179 were CIUs. Generations were defined by the year of patient’s birth: “millennials” (after 1990) and “Generation X/Y” (1965-1990) grouped as “Millennials or Generation X/Y”; “Baby Boomers” (1946-1964); and “Greatest or Silent Generation” (1945 and earlier). Statistical analyses included the Wilcoxon matched-pairs signed-rank test and the Mann-Whitney U test.ResultsCIUs were 52% (94/179) female, 44% (78/179) were older than 60 years, and 60% (108/179) had household incomes exceeding US $60,000. The sources of information on cancer and clinical trials included physicians (171/179, 96%), the internet (159/179, 89%), and other clinical trial personnel (121/179, 68%). For the overall sample and each generation, the median values for trust in referring and Phase I clinical trial physicians among early drug development clinic CIUs were 5 on a 0-5 scale, with 5 indicating “complete trust.” CIUs’ trust in their referring (5) and phase 1 (5) physicians was higher than CIUs’ trust in Web-based cancer-related information (3; P<.001 for both). CIUs who reported visiting the National Cancer Institute (NCI) website, NCI.org, to learn about cancer reported higher levels of trust in Web-based cancer-related information than CIUs who did not use the NCI website (P=.02). Approximately half of CIUs discussed internet information with their doctor. Only 14% (23/165) of CIUs had asked their physician to recommend cancer-related websites, and 24% (35/144) of CIUs reported at least occasional conflict between their physician’s advice and Web-based information.ConclusionsDespite the plethora of websites related to cancer and cancer clinical trials, patients in early-phase clinical trial settings trust their physicians more than Web-based information. Cancer-related organizations should provide regularly updated links to trustworthy websites with cancer and clinical trial information for patients and providers and educate providers on reliable cancer websites so that they can better direct their patients to appropriate internet content.

Meningococcal C vaccine coverage in France in infants, children, and adolescents

ObjectivesMeningococcal C (MenC) vaccination was introduced in the French vaccination calendar in 2010 to reduce the incidence of invasive meningococcal C disease (IMDC), mainly through herd immunity. The Vaccinoscopie survey helps follow vaccination coverage rates (VCRs) of children. MethodsThis annual survey is based on a self-administered online questionnaire. In 2017, 4500 mothers of children completed the questionnaire and reported all vaccinations recorded in their child's health record. ResultsMenC vaccination was deemed indispensable or useful by 77% to 84% of mothers. The main barrier mentioned by mothers considering the vaccination useless/not very useful, was fear of adverse effects. VCR was estimated at 77% among 24-35-month-old infants, 79% among 6-year-old children, and 50% among 14-15-year-old adolescents. VCR strongly varied depending on the physician's advice for vaccination and on the type of follow-up. Six months after publication of the new French vaccine calendar in April 2017, with a MenC vaccine recommendation for all 5-month-old infants, 43% of infants had received a dose at 6 months of age. ConclusionsVCRs are insufficient to reach herd immunity. Between 2011 and 2017 more than 100 deaths could have been avoided in France if optimal VCRs had been achieved. Faced with this vaccine strategy failure, the new vaccine recommendation at 5 months of age seems well-accepted. This recommendation and the implementation of infant mandatory vaccination in 2018 should have a major impact on IMD C incidence in this age group.

A hospital-based cross-sectional study on yoga and meditation in patients of hypertension in Western India

Background: Yoga and meditation hold promise as a non-pharmacological management of hypertension as they have shown to lower blood pressure. This study aimed at (1) assessing the awareness about benefits of yoga and meditation in hypertension among patients and finding its socio-demographic correlates, (2) estimating the practice of yoga and meditation in hypertensives, its pattern and impact on blood pressure control.Methods: This cross-sectional study was conducted on 400 hypertensive patients. Statistical association was tested with chi square and independent t tests.Results: It was observed that only 9% respondents were aware of the benefits of yoga and meditation in hypertension while 12.8% practised the same. On probing it was found that these 3.8% practised yoga and meditation only because their physician had advised them to do so without even knowing their benefits. This points out the importance of physician advice which can be even more effective if pros and cons are properly explained. People who were aware of the benefits were 51.9 times more likely to practise them (p&lt;0.001). Highly significant association was observed between awareness regarding lifestyle modifications like yoga and meditation and gender, socioeconomic status, education and locality (urban non-slum/urban slum/rural).Conclusions: The complementary use of non-pharmacological treatment or lifestyle modifications like yoga and meditation can go a long way to lower blood pressure and such options need to be provided by the health care providers and the gap in awareness elicited in our study needs to be addressed.