eMedinewS4th February 2014, Tuesday

Dr K K AggarwalPadma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at
www.facebook.com/Dr KKAggarwal

Long–term Air Pollution Ups Risk of CVD: European Study

A large meta-analysis of 11 cohorts in five European countries suggests that long-term exposure to air pollution is a cardiovascular risk factor(1). The findings, from the European Study of Cohorts for Air Pollution Effects (ESCAPE), were published online January 21, 2014 in BMJ.

People who live in polluted areas for a long period have a greater risk of having a first heart attack, said Giulia Cesaroni at Lazio Regional Health Service, Rome, Italy.

According to the recent report on the Global Burden of Disease, particulate air pollution is estimated to cause 3.1 million deaths each year worldwide, reports Medscape.

In the European Union, the current annual limit for fine particulate matter with a diameter of <2.5 μm (PM2.5) is 25 μg/m3, which is more than twice as high as the acceptable level in the US, at 12 μg/m3.

ESCAPE included 100 166 participants who were enrolled in cohorts in Finland, Sweden, Denmark, Germany, and Italy from 1997 to 2007 and had no previous coronary events at baseline. During a mean follow–up of 11.5 years, 5157 participants had an incident acute coronary event.

The researchers found that a 5–μg/m3 increase in annual exposure to fine (PM 2.5) particulate matter was associated with a 13% increased risk of coronary events, and a 10–μg/m3 increase in annual exposure to coarse (PM 10) particulate matter was associated with a 12% increased risk of coronary events.

Significant cardiac effects were also discernible for exposure levels only slightly above the 10–μg/m3 World Health Organization (WHO) air–quality guideline" for fine particles.

Nearly 90% of the world’s population is exposed to levels of air pollution that exceed this recommended maximum threshold.

A study showed that in Beijing, levels of fine particles in the air were more than 10 times as high as this over a five–year period(3).

There is a need to call for more efforts to reduce other known cardiovascular risk factors, such as smoking, in highly polluted areas.

In addition, "people with or at risk of cardiovascular disease who live in highly polluted areas also warrant more aggressive use of primary and secondary preventive therapies, including antiplatelet agents, lipid–lowering agents, and treatments for hypertension or diabetes, all known to prevent cardiovascular events.


  1. Cesaroni G, Forastiere F, Stafoggia M, et al. Long term exposure to ambient air pollution and incidence of acute coronary events: Prospective cohort study and meta–analysis in 11 European cohorts from the ESCAPE Project.BMJ 2014:DOI:10.1136/bmj.f7412.
  2. Brauer M and Mancini GBJ. Where there’s smoke… BMJ 2014;DOI:10.1136/bmj.g40.
  3. Guo Y, Li S, Tian Z, et al. The burden of air pollution on years of life lost in Beijing, China, 2004–08: Retrospective regression analysis of daily deaths. BMJ 2013;347:f7139.
Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

cpr 10 mantra
VIP’s on CPR 10 Mantra Video
Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

What is charity?

sprritual blog

Some time back after returning from a free health check–up camp, I met a processor of Cardiology from Lucknow and started boasting that I saw 100 patients free today. He said do not get excited. Charity is a positive, but still not the absolute positive, unless it is done without any motive or done secretly. He said that you were honored on the stage; you got blessings from the patients and people talked about you in positive sense. It was an investment in the long run and not an absolute charity. When you serve, never be honored on the stage by the people to whom you are serving. If you get that then it is like give and take. The purpose of life should be to help others without any expectations.

Understanding helping others

When you help others, it should not end up in harming somebody else even though your help is unconditional. If you end up in promoting no.2 by superseding another deserving senior person, this is not a help as the person to whom you are helping will give you one blessing but the person to whom you have harmed will give you 10 curses. Ultimately you end up with minus 8 points. Helping other means that it should give happiness to you, to the persons you have helped and also to others to whom you have not helped.

Helping always pays

The difference between American and Indian models is that Indians always think of now and do not invest in future. Americans always plans for the future. When we help somebody, we want that the same person should expect you by helping you when you are in need in a shorter run. But charity does not believe in that. Your job is to help others and negate your negative past karmas. You never know, may be decades later you get a help from a person to whom you helped decades earlier. Help should never be linked to returns.

cardiology news

Testing For Gossip

In ancient Greece, Socrates was reputed to hold knowledge in high esteem. One day an acquaintance met the great philosopher and said, "Do you know what I just heard about your friend?"

"Hold on a minute", Socrates replied. "Before telling me anything I’d like you to pass a little test. It’s called the Triple Filter Test." "Triple filter?"

"That’s right", Socrates continued. "Before you talk to me about my friend, it might be a good idea to take a moment and filter what you’re going to say. That’s why I call it the triple filter test. The first filter is Truth. Have you made absolutely sure that what you are about to tell me is true?"

"No," the man said, "Actually I just heard about it and …" "All right", said Socrates. "So you don’t really know if it’s true or not. Now let’s try the second filter, the filter of Goodness. Is what you are about to tell me about my friend something good?”

"No, on the contrary" "So", Socrates continued, "you want to tell me something bad about him, but you’re not certain it’s true. You may still pass the test though, because there’s one filter left: The filter of Usefulness. Is what you want to tell me about my friend going to be useful to me?"

"No, not really" "Well", concluded Socrates, "if what you want to tell me is neither true nor good nor even useful, why tell it to me at all?"

News Around The Globe

6th International Conference "Recent Advances in Cardiovascular Sciences" 31st January &1st February, 2014

Dr. Robert Roberts, M.D., FRCPC, MACC, FAHA, FCAHS, LLD (Hon.), FRSC
President and CEO, University of Ottawa Heart Institute, Canada
Professor of Medicine, University of Ottawa, Director, Ruddy Canadian Cardiovascular Genetics Centre Ontario, Canada

Dr. Robert Roberts is the President and CEO of the University of Ottawa Heart Institute (UOHI) since 2004 and the founding Director of The Ruddy Canadian Cardiovascular Genetics Centre. Under Dr. Roberts leadership, the UOHI has achieved world recognition being ranked by SIR SCHIMAGO in the top 2% of research institutions worldwide. Dr. Roberts has had a distinguished and prolific international career as a Cardiologist, Educator and Scientist and has held several international leadership roles. Dr. Roberts continues to lecture around the world on his research. He developed the MBCK Test which was used as the gold standard to diagnose heart attacks for the past three decades, followed by the discovery of several genes responsible for heart disease, including the first gene for heart attacks and is co–discoverer of more than 30 genes associated with heart attacks, since his return to Canada. In recognition of his scientific contributions, published in over 860 scientific articles and text books, Dr. Roberts has received several prestigious awards, including Fellow of the Royal Society of Canada, Distinguished Scientist Award from the American College of Cardiology (1998); Canadian Cardiovascular Society Research Achievement Award (2012); McLaughlin Medal from the Royal Society of Canada (2008); Albrecht Fleckenstein Memorial Award from the International Academy of Cardiology (2008); Distinguished Fellowship Award from the International Academy of Cardiology (2012); Citation for Highly Cited Researcher from ISI Thomson Scientific (2002); Dalhousie University, Doctor of Laws honoris causa (2012); First Prize: International Film Festival, NY for video on ""Unlocking the Secrets of the Heart", (1992). As one of the founders of molecular cardiology, Dr. Roberts is recognized as a leader in the research and practice of cardiology worldwide.

Topic: Genetics: A Glimpse of Medicine in the Future

Coronary Artery Disease (CAD), the number one killer in the world, is in large part preventable, with 30 to 40% reduction by treating known risk factors. About 50% of risk for CAD is due to genetic predisposition, thus comprehensive prevention requires treating known and genetic risk. In 2005, we discovered the first genetic risk factor (9p21), and currently a total of 50 genetic risk variants. Several features common to these genetic risk factors have important therapeutic implications for the prevention and treatment of coronary artery disease. It was quite surprising to find that 35 of these genetic risk variants do not mediate their risk for CAD through known risk factors such as cholesterol or blood pressure. Secondly, most of the genetic risk variants are extremely common, occurring in more than half the population. Analysis of the frequency of these genetic risk variants in cases and controls show that the combination of a number of variants is responsible for genetic risk rather than a single variant. Based on our initial analysis, the average number of variants in cases and controls is about 17 per individual. The separation between overall increased risks is most appreciated in individuals who have 20 or 30 of these genetic variants. Lastly, these genetic variants acting through novel pathways will provide new targets for development of specific therapy. This has already materialized in the development of an antibody inhibiting PCSK9, associated with decreased plasma cholesterol levels and decreased morbidity and mortality. Discovery of the molecular pathways for these new independent genetic variants promises to be an insightful and fruitful exploration.

Padma Bhushan Prof. Nirmal Kumar Ganguly, M.D Former Director General (ICMR), Distinguished Biotechnology Research Professor, National Institute of Immunology, New Delhi

Cardiovascular Diseases – Indian Scenario

Cardiovascular diseases (CVD) forms a major share of the deaths and disability adjusted life years (DALYs) lost in India. Importantly, mortality and morbidity due to coronary heart disease and stroke are on the rise. Moreover, ischemic heart disease is likely to be the highest cause of disease burden by 2020. There are a number of modifiable and non-modifiable risk factors for CVD. A number of research initiatives to tackle the disease have been initiated in India, including the “polypill”. Other interventions such as tobacco control, as well as integrated national program to prevent and control CVD and diabetes are ongoing. The INTERHEART Study as well as intricate risk factors such as the cardiac biomarkers will also be highlighted in the talk. Some recent reports of CVD and risk factors in men and women; and recent advancements in tobacco control, and hypertension programs in schools and in the north-east will be discussed. The challenges to tackle the problem of CVDs are enormous and these will also be indicated. Strengthening of various surveillance systems, including the integrated disease surveillance programme (IDSP) will be touched upon. The talk will conclude with a discussion on issues of financial assistance for health expenditure in India, highlighting various health insurance schemes.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

eMedinewS e–gifts to our readers

This is the age of smartphones. To improve usability and readability, eMedinewS has launched a mobile app of the newsletter for its readers. You can now also view eMedinewS on your smart phones or iPads.

The eMedinewS app is now available for free  emedinewsdownload.

The various icons for downloading are provided on the top of the newsletter. Choose the icon that is compatible with your device, whether emedinewsiPhone, emedinewsAndroid, emedinewsBlackberry, emedinewsiPad, emedinewsDesktop/Windows phone or emedinewsGSM
Click on the icon ‘e’ from the mail and download to install the app to the home screen of your mobile phone, iPad or Desktop. After you finish downloading, you will see an icon ‘e’ on the home screen of your device. That’s it.

Now you don’t need to type the address of the website in your web browser or log in to your email account every day to read the newsletter. Just click on the app and begin reading.

Rabies News (Dr. A K Gupta)

Can the animal bite wounds be cauterized?

Cauterizing the wound is not advisable as it leaves a very bad scar and also does not confer any additional advantage over washing the wound with water and soap. It amounts to malpractice and the doctor can be sued for compensation under COPRA.

cardiology news

OTC drug does not mean it can be taken without a doctor’s advice

An over–the–counter antacid is often used to relieve mild cases of heartburn or acid reflux. Though they are available without a doctor’s prescription they should be taken only under a doctor’s advice.

As per American Academy of Family Physicians

  • There are different types of antacids that work in different ways.
  • One should talk to the doctor before taking an antacid.
  • To manage an ulcer, an antacid may need to be taken in conjunction with an antibiotic.
  • If one needs more calcium to help strengthen bones, one should prefer an antacid that contains calcium carbonate.
  • In some, antacids may have minor side effects such as nausea, headache, diarrhea or constipation.
  • One should read the label carefully to make sure that one is not allergic to any of the ingredients.
  • People with kidney disease may not be able to take all types of antacids.
  • An antacid may interact with other medications.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • The American Heart Association/American Stroke Association (AHA/ASA) has issued a statement on risk adjustment of ischemic stroke outcomes for comparing hospital performance. Published online in Stroke on January 23, the authors state that: "There are a number of important methodological challenges in undertaking risk–adjusted outcome comparisons to assess the quality of stroke care in different hospitals. It is important for stakeholders to recognize these challenges and for there to be a concerted approach to improving the methods for quality assessment and improvement."
  • One in four patients who underwent recent diagnostic catheterizations in 18 New York state hospitals to detect suspected CAD were not appropriate candidates for this procedure, based on new criteria. In a study, among the patients who had undergone inappropriate diagnostic catheterization, 57% had no chest pain, no previous stress test, and a low to intermediate Framingham global CAD risk score. The study was published online January 28, 2014 in Circulation: Cardiovascular Interventions.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Researchers have come up with an innovative way to raise awareness about stroke warning signs among youngsters — playing a video game that’s designed to motivate learning. A new study published online January 29 in Stroke showed that children who played the Stroke Hero video game knew more about stroke symptoms and what to do in a stroke emergency, and that kids tested 7 weeks later picked up further stroke knowledge. According to the authors, a stroke video game may be an innovative method for improving and sustaining actionable stroke knowledge among young children.
  • The American Academy of Pediatrics (AAP), in collaboration with the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices, the American Academy of Family Practice, and the American College of Obstetricians and Gynecologists, has published a revision of immunization schedules for infants, children, and teenagers for 2014. The revised immunization schedule appears in the February 2014 issue of Pediatrics.
cardiology news

Total CPR since 1st November 2012 – 86083 trained

Media advocacy through Web Media

web mediawebmedia webmedia
press release

Dr K K Aggarwal to Receive DST National Award for Outstanding Efforts in Science & Technology Communication in General

Dr K K Aggarwal President Heart care Foundation of India will be awarded National Award for Outstanding Efforts in Science & Technology Communication in general for the year 2013. The award consists of Rs. 2 lakhs, a memento and a citation. The award will be presented on Feb 28 at DST Auditorium as part of National Science Day Celebrations.

Dr Aggarwal is also recipient of two other National Awards Padma Shri and Dr B C Roy National Award and will be the first Doctor in the country to have received these three National Awards.
The award is given by the National Council for Science & Technology Communication, an Apex Body of the Government of India under the Department of Science & Technology. The council instituted national awards to stimulate, encourage and recognize outstanding efforts in the area of science popularization and communication in 1987.

The award is presented to an individual or an institution for outstanding work in communication of science and technology and or promoting of scientific temper which had the widest impact in the country during the past five years.

Dr Aggarwal also Senior Consultant Physician and Cardiologist has immensely contributed to the Society in Science and Technology Communication as a Clinician, Writer, Anchor, Trainer, Conceptualizer, Advisor, Researcher and Scientific Health Communicator.

Many of his low–cost science awareness modules have been recognized by the Government of India by releasing postal commemorative stamps (Run for the Heart 1991 Rs 1 Postal Stamp, Perfect Health Mela 1993 Rs 6.50 Postal Stamp and First Mega Telemedicine Camp 2012 Cancellation Stamp).
He was the Delhi Coordinator for Year of Scientific Awareness in 2004 and successfully launched and used folk artists as Sutradhars for creating scientific awareness on adolescence health and nutrition.
He has developed over 1000 preventive one liner scientific health messages for general public and provided scientific training to over 63400 people on Hands–only CPR for revival after sudden death.

His efforts in Scientific Health Awareness have also won him many prestigious National and International Awards like CMAAO IMA Oration, DMA Swasthya Ratna, Delhi Medical Association Sunder Lal Roopwati Memorial Award , Dr Mungelar National IMA Award etc.

Dr Aggarwal is frequently quoted by electronic and print media with over 15,000 quotes. He has anchored many TV shows like over 26 episodes of "Take Care" for DD India and the currently on air "Health Wealth" on Zee Media.

Awardee List

  1. National Award for Outstanding Efforts in Science & Technology Communication in general (Category–A): Individual Dr K K Aggarwal, Institution: Society of Pollution & Environment Conservation Scientists.
  2. National Award for Outstanding Efforts in Science & Technology Communication through Print Media including Books and Magazines (Category–B): Dr. Oum Prakash Sharma Dy Director, IGNOU; Shri Hemant Achyut Lagvankar; Shri Bhabesh Mahanta and Dr. N. Rajagopalan.
  3. National Award for Outstanding Efforts in Science & Technology Popularization among Children (Category–C): Shri Jaswinder Singh and Dr. Kailash Chandra Goswami.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 86083 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

emedipicstoday emedipics

CPR 10 Utsav 15th December 2013, Talkatora Stadium

press release

AHA – ACS update

vedio of day

today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

As a part of space–research program, a physiologist was asked to investigate the effect of flight–induced stress on blood pressure. Accordingly, the blood pressures of the cosmonauts were to be measured twice: once before the take–off, and once after the spacecraft entered the designated orbit around the earth. For a proper comparison, the pre–flight blood pressure should be recorded in:

1. The lying down position.
2. The sitting position.
3. The standing position.
4. Any position, as long as the post–flight recording is made in the same position.

Yesterday’s Mind Teaser: A 31 year old female patient complaints of bilateral impairment of hearing for the past 5 years. On examination, tympanic membrane is normal and audiogram shows a bilateral conductive deafness. Impedance audiometry shows as type of curve and acoustic reflexes are absent. All constitute part of treatment, except:

1. Hearing aid.
2. Stapedectomy.
3. Sodium fluoride.
4. Gentamicin.

Answer for yesterday’s Mind Teaser: 4. Gentamicin.

Correct answers received from: Dr. Vishal D Wahane, Abhay Naik, Dr B K Agarwal, Muthumperumal Thirumalpillai, Dr.Raghavendra Jayesh, Prabha Sanghi, Dr Jainendra Upadhyay, DR.A.K.GAJJAR, Dr. P. C. Das, Dr Pankaj Agarwal, Dr.Jayashree Sen & Dr.Bitaan Sen

Answer for 1st February Mind Teaser: 4. Calcaneum.

Correct answers received from: Dr.Jayashree Sen & Dr.Bitaan Sen

Send your answer to ijcp12@gmail.com

medicolegal update

Click on the image to enlarge

medical querymedical query

medicolegal update
medicolegal update

Women Gossip

A lot of ladies used to sit together every evening in a park and talk non stop. One day they were sitting very very quietly. A gentleman who would walk past the noisy group every day was surprised to see them all so quiet. He inquired about this to which they replied, "You see, today we are ALL present, so we don't know who to gossip about."

TEACHER: George, go to the map and find North America.
GEORGE: Here it is!
TEACHER: Correct. Now, class, who discovered America?
CLASS: George!

medicolegal update

Click on the image to enlarge

medicolegal updatemedicolegal update

medicolegal update

Situation: A patient with rheumatic arthritis was not given penicillin prophylaxis, and subsequently developed another attack.
Reaction: Oh my God! Why was the prophylaxis not started?
Lesson: Make sure that one administers secondary prophylaxis in the setting of suspected post streptococcal reactive arthritis for up to one year after the onset of symptoms. Evidence of valvular disease after one year should prompt continued prophylaxis; otherwise, antibiotic prophylaxis may be discontinued.

medicolegal update

Success seems to be largely a matter of hanging on after others have let go. William Feather

medicolegal update

Dr KK Aggarwal: Kidney stone of less than 5mm size needs no treatment http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: Happiness can be woven into every aspect of life once you make new choices http://bit.ly/15QdVeB #Health

medicolegal update
  1. It has been almost two weeks since IMA Sr. Vice–president, Dr. K.K. Aggarwal, was requested to provide the letter that IMA sent to WMA in support of Dr. Ketan Desai. Although Dr. Aggarwal sent me a brief response (to my personal email) providing the contact of IMA secretary general urging to write to him which I promptly did, there is absolutely no further response from anyone in IMA till now. It seems Dr. Aggarwal and other top IMA leaders are all in a deep slumber. But why? After all, this forum is basically for and by Indian doctors. Does Dr. Aggarwal feel that his silence is going to raise IMA’s credibility (whatever is left) in the eyes of other honest and impartial doctors? Dr. Kunal Saha (in one of the doctors group)

    Dr KK replies: IMA correspondence is done by the Honorary Secretary General. I was not in office last year. I do not understand why anyone should approach the IMA through me for any IMA issues of last year. I have already clarified my stand in yesterday’s editorial. The copy of the request by Dr Saha was forwarded by me to the IMA the same day.
  2. Dear Dr KK: I remember clearly that you initiated unsolicited discussion with me on phone and later in Delhi during our workshop suggesting that Ketan Desai is not guilty and all cases have been dropped against him and I like any Indian should feel proud with his president status of World Medical Council. I evaded the discussion in view of facts lacking on my end to debate with you. However, questions by Kunal and the conspiracy exposed by him regarding the role IMA is playing warrants an explanation of truth you still understand on your end now again. Kindly mail your understanding with the way you have the facts given by Kunal now and bring truth to limelight again and make Indian doctors feel proud that the current vice president of IMA carries the guts to speak the truth with evidence and facts. Best wishes: Vivek Chhabra (wrote in one of the yahoo groups of doctors)

    Dr K K replies: I am still of the opinion based on yesterday’s editorial written by me that Dr Desai has no charge sheet against him in Lucknow case and all proceedings have been stayed by Supreme Court in Delhi Case. Any one has a right to interpret this in their own way; but eMedinewS’ stand is that one is honest unless proved convicted. If he was corrupt then the CBI would not have closed the DA case and discharged him of the other 27 cases.

eMedinewS Special

1. IJCP’s ejournals (This may take a few minutes to open)

2. eMedinewS audio PPT (This may take a few minutes to download)

3. eMedinewS audio lectures (This may take a few minutes to open)

4. eMedinewS ebooks (This may take a few minutes to open)

Our Contributors

Dr Veena Aggarwal, Dr Arpan Gandhi, Dr Aru Handa, Dr Ashish Verma, Dr A K Gupta, Dr Brahm Vasudev, Dr GM Singh, Dr Jitendra Ingole, Dr Kaberi Banerjee (banerjee.kaberi@gmail.com), Dr Monica Vasudev, Dr MC Gupta, Dr Neelam Mohan (drneelam@yahoo.com), Dr Navin Dang, Dr Pawan Gupta(drpawangupta2006@yahoo.com), Dr Parveen Bhatia, (bhatiaglobal@gmail.com), Dr Prabha Sanghi, Dr Prachi Garg, Rajat Bhatnagar (http://www.isfdistribution.com), Dr. Rajiv Parakh, Dr Sudhir Gupta, Prof.(Dr).C V Raghuveer

medicolegal update

Our Sites

media advocacy