***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Disease prevention and health promotion are important tasks in the daily practice of all general practitioners ( GPs ) . The objective of this study was to explore the knowledge and attitudes of European GPs in implementing evidence -based health promotion and disease prevention recommendations in primary care , to describe GPs ' perceived barriers to implementing these recommendations and to assess how GPs ' own health behaviors affect their work with their patients . METHODS A postal multinational survey was carried out from June to December 2000 in a r and om sample of GPs listed from national colleges of each country . RESULTS Eleven European countries participated in the study , giving a total of 2082 GPs . Although GPs believe they should advise preventive and health promotion activities , in practice , they are less likely to do so . About 56.02 % of the GPs answered that carrying-out prevention and health promotion activities are difficult . The two most important barriers reported were heavy workload/lack of time and no reimbursement . Associations between personal health behaviour and attitudes to health promotion or activities in prevention were found . GPs who smoked felt less effective in helping patients to reduce tobacco consumption than non-smoking GPs ( 39.34 % versus 48.18 % , P < 0.01 ) . GPs who exercised felt that they were more effective in helping patients to practice regular physical exercise than sedentary GPs ( 59.14 % versus 49.70 % , P < 0.01 ) . CONCLUSIONS Significant gaps between GP 's knowledge and practice s persist in the use of evidence -based recommendations for health promotion and disease prevention in primary care INTRODUCTION Smoking cessation counseling by health professionals is an effective approach to increase cessation rates among smokers . To guide the development of training and educational interventions , we surveyed six health professional groups including general practitioners ( GPs ) , pharmacists , dentists , dental hygienists , nurses , and respiratory therapists , in order to describe current practice s and identify the correlates of smoking cessation counseling . METHODS Self-administered question naires were mailed to 500 persons r and omly selected from the membership lists of active licensed professionals in each health professional group in Québec . RESULTS Response proportions ranged from 52 % ( nurses ) to 70 % ( dental hygienists ) . Compared with other groups , GPs and pharmacists undertook more counseling with patients ready to quit . GPs and respiratory therapists undertook more counseling with patients not ready to quit . Three factors emerged consistently across most groups as positively associated with counseling , including the belief that counseling is the role of health professionals , perceived self-efficacy to engage in effective counseling , and knowledge of community cessation re sources . DISCUSSION The correlates of cessation counseling are similar across health professional groups . Interventions that address beliefs that cessation counseling is the role of health professionals , self-efficacy to provide effective counseling , and knowledge of community re sources may result in improved cessation counseling practice s among health professionals Over the years we have been working to develop , test , and implement tobacco control interventions as a part of routine care within Kaiser Permanente . Most of our work has been in Kaiser Permanente 's northwest division , based in Portl and , Oregon , but we have also implemented similar approaches in several other divisions , including Ohio , Hawaii , and Georgia . I will first describe our general approach , which we call the TRAC model ( “ tobacco reduction , assessment , and care ” ) , and then share both our progress and some very real difficulties we have encountered in trying to implement the program throughout the health care system . The rationale for delivering brief tobacco intervention during routine care is familiar to those who work in cessation.1 Tobacco remains the most important cause of preventable disease . We know that most smokers see clinicians frequently , and that these visits create teachable moments when patients are receptive to advice and intervention . When we routinely ignore these intervention opportunities , we are , in effect , failing our patients . Indeed , meta-analyses from the Agency for Health Care Policy and Research ( AHCPR ) clinical guideline 2 show that brief advice and support lead to modest but consistent long term effects on smoking cessation . We also know that brief tobacco interventions are among the most cost effective of all medical care procedures we routinely offer.3 4 It is for these reasons that the Health Plan Employer Data Information Set ( HEDIS ) and other quality monitoring groups are holding health care systems accountable for addressing tobacco during clinical care . For me , however , the most important reasons to offer cessation advice and assistance are that our patients want , need , and expect this kind of support . How are we doing as a nation in delivering cessation advice during medical care visits ? Figure 1 displays time trend data 5 from the National Household BACKGROUND China has the most smokers among the world 's nations . Physicians play a key role in smoking cessation , but little is known about Chinese physicians and smoking . METHODS This 2004 clustered r and omized survey of 3552 hospital-based physicians from six Chinese cities measured smoking attitudes , knowledge , personal behavior , and cessation practice s for patients . Descriptive statistics and multivariate analysis of factors associated with asking about or advising against smoking were conducted in 2005 and 2006 . RESULTS  Smoking prevalence was 23 % among all Chinese physicians , 41 % for men and 1 % for women . Only 30 % report good implementation of smoke-free workplace policies and 37 % of current smokers have smoked in front of their patients . Although 64 % usually advise smokers to quit , only 48 % usually ask about smoking status , and 29 % believe most smokers will follow their cessation advice . Less than 7 % set quit date s or use pharmacotherapy when helping smokers quit . Although 95 % and 89 % , respectively , know that active or passive smoking causes lung cancer , only 66 % and 53 % , respectively , know that active or passive smoking causes heart disease . Physicians were significantly more likely to ask about or advise against smoking if they believed that counseling about health harms helps smokers quit and that most smokers would follow smoking-cessation advice . CONCLUSIONS Physician smoking cessation , smoke-free workplaces , and education on smoking-cessation techniques need to be increased among Chinese physicians . Strengthening counseling skills may result in more Chinese physicians helping smoking patients to quit . These improvements can help reduce the Chinese and worldwide health burden from smoking OBJECTIVE To investigate the smoking habits and associated risk factors among Greek physicians . STUDY DESIGN Cross-sectional survey of a r and omly selected sample of Greek physicians . METHODS A national sample of 1284 physicians ( 718 men , 566 women ) participated in the study , which was conducted between September 2003 and June 2005 . Data were collected through an anonymous self-completed question naire . Logistic regression  was used to analyse the influence of different factors on the probability of a physician being a current or former smoker . RESULTS Overall , 38.6 % of the physicians ( 40 % of men ; 37 % of women ) currently smoked , 13.8 % were former smokers , and 47.6 % had never smoked . Eighty-three per cent of smokers reported starting smoking before the age of 25 years , with half of them during medical school ( aged 19 - 24 years ) . Multivariate analyses revealed that physicians who were male , unmarried , divorced or widowed , surgeons or anaesthetists , and residents were more likely to be current smokers . Former smokers were more likely to be older , male and born in a rural area . Moreover , the odds of being a current or former smoker were significantly higher among physicians with a history of parents who smoked . The proportion of physicians who reported counselling  patients ( often or always ) to stop smoking  was lower among current smokers compared with those who never smoked or those who were former smokers ( 74.4 % vs. 85.3 % vs. 84.7 % , P<0.0001 ) . CONCLUSIONS The prevalence of smoking among Greek physicians is exceedingly high and similar to that of the general population . More effective interventions that reduce smoking in the medical community should be implemented immediately so that physicians will be better able to fulfil their function as role models for the general population BACKGROUND While cardiologists are very active in the prevention of cardiovascular disease , their attitudes towards patients ' smoking habits are poorly studied . AIMS In a nationwide French survey , we assessed cardiologists ' levels of knowledge and management of smoking cessation . METHODS We sent out a question naire to a r and om sample of 1000 cardiologists . RESULTS A total of 371cardiologists agreed to participate in the survey ; 8.1 % were current smokers and 32.4 % were past smokers . Most classified smoking cessation as the top priority for patients with coronary artery disease ( 56.5 % ) and peripheral arterial disease ( 88.5 % ) . Cardiologists routinely assessed active and passive smoking in 96.2 % and 43 % of their patients , respectively . Only 29.2 % considered themselves well informed about  smoking-cessation management .  While 39.9 % declared they knew about the minimal counselling 7.3 % described it correctly . Only 17.5 % used the Fagerström question naire . Smoking cessation was advised systematic ally by 85 % but only 5.4 % of cardiologists followed up their patients specifically on this issue . They referred smokers to either their general practitioner or to smoking-cessation centres and /or quitlines in 16.0 % and 67.0 % of cases , respectively ; 31.8 % never referred their patients to a smoking-cessation centre , and 25 % declared being unaware of any such centre in their area . Cardiologists who smoked were less likely to ask about patients ' smoking status than non-smokers ( 90 % vs 98.2 % , p=0.039 ) . Similarly , they were more passive in offering  smoking-cessation counselling ( 23 % vs 7 % , p=0.011 ) , and referred less frequently their patients to a smoking-cessation centre ( 37 % vs 64 % , p=0.028 ) . CONCLUSION French cardiologists are rarely involved in the management of smoking cessation . Their own smoking status influences their attitudes towards the management of smoking cessation CONTEXT The World Health Organization has advocated that physicians should not smoke cigarettes and surveys on this issue should be conducted among medical professionals . However , no nationally representative surveys of smoking among physicians in Japan have been reported . OBJECTIVES To estimate the nationwide prevalence of smoking and determine the attitudes toward smoking among Japanese physicians . DESIGN , SETTING , AND PARTICIPANTS Descriptive study in which anonymous question naires were mailed to 4500 r and omly selected physician members of the Japan Medical Association in the year 2000 , which represents 63 % of all Japanese physicians ; 3771 ( 84 % ) respondents were included in the analysis . MAIN OUTCOME MEASURES Smoking prevalence among physicians , history of smoking , and attitudes toward smoking . RESULTS The prevalence of cigarette smoking among physicians was 27.1 % for men and 6.8 % for women , about half the age-adjusted prevalences among the general Japanese population . Smoking prevalence was higher among male physicians in Japan than those in the United States ( 3%-10 % ) and the United Kingdom ( 4%-5 % ) . Smoking prevalence differed by age , with the highest prevalence among male past smokers aged 70 years or older ( 51.8 % ; 95 % confidence interval [ CI ] , 47.4%-56.2 % ) . Among male current smokers , the highest rates were for those aged 40 to 49 years ( 31 % ; 95 % CI , 27.5%-34.5 % ) ; rates for female past smokers were highest among those aged 50 to 59 years ( 10.7 % ; 95 % CI , 6.6%-14.8 % ) and for female current smokers were highest among those aged 70 years or older ( 8.2 % ; 95 % CI , 4.8%-11.6 % ) . Nonsmoking physicians had more unfavorable views toward smoking and were more active in encouraging patients not to smoke than those physicians who smoked . CONCLUSION Smoking cessation programs should be introduced among Japanese physicians to reduce the number of smoking physicians . Also , a continuing education program should be instituted to motivate physicians about their role in society OBJECTIVES Several countries have followed the US example in publishing national guidelines on smoking cessation interventions . Gauging responses to these guidelines can provide important lessons for future implementation and revision internationally . This study sought to assess General Practitioners ' ( GPs ' ) views on recently published English smoking cessation guidelines that form the foundation of the UK National Health Service 's smoking cessation strategy . DESIGN Postal survey in which GPs were asked to judge the appropriateness , effectiveness and practicability of key recommendations for primary care in recent national smoking cessation guidelines . SETTING General practice , Engl and and Wales . SUBJECTS R and om national sample of GPs ; 236 GPs completed the question naire ; effective response rate : 62 % . RESULTS Only 16 % of GPs accepted that all the recommendations in the guidelines were appropriate ; 43 % accepted that it was appropriate to check the smoking status of known smokers when they visit the surgery and only 30 % thought it was practicable to advise smokers to stop at every opportunity . However , 77 % of GP 
    Output:
    
However , high levels of heterogeneity were found that were not explained by the meta-regression .
Smoking status of doctors may affect their delivery of smoking cessation treatments to patients , with smokers being less likely than non-smokers or ex-smokers to advise and counsel their patients to quit but more likely to refer them to smoking cessation programmes