***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 Overuse of antibiotics for children 's upper respiratory infections is widespread and contributes to the emergence of antibiotic-resistant bacteria . OBJECTIVE To assess changes in knowledge and awareness regarding antibiotic resistance and appropriate antibiotic use after community-wide educational interventions to reduce inappropriate antibiotic use . DESIGN Baseline survey conducted during June through July 1997 and postintervention survey of baseline participants during June through August 1998 . SETTING Communities in northern Wisconsin . PARTICIPANTS Parents of 729 r and omly selected children < 4 years of age were called until 215 in each of the intervention and control areas were reached . Of the 430 baseline participants , 365 ( 85 % ) participated in the postintervention survey . INTERVENTION Parent-oriented activities included distribution of material s and presentations . Physician-oriented activities included formal presentations and small group meetings . OUTCOME MEASURE Change in awareness about antibiotic resistance and knowledge about antibiotic indications . RESULTS A higher proportion of parents in the intervention area ( 53 % ) were exposed to 2 or more local educational messages , compared with the control area ( 23 % ) . From the baseline to the postintervention survey , the percentage of parents with a high degree of antibiotic resistance awareness increased more in the intervention area ( 58 % to 73 % ) than in the control area ( 60 % to 65 % ) . In the intervention area , there was also a larger increase in knowledge regarding appropriate indications for antibiotic use , compared with the control area . The proportion of parents who expected an antibiotic for their child and did not receive one declined in the intervention area ( 14 % to 9 % ) , while it increased in the control area ( 7 % to 10 % ) . In addition , the percentage of parents in the intervention area who brought their child to another physician because they did not receive an antibiotic decreased ( 5 % to 2 % ) , while it increased in the control area ( 2 % to 4 % ) . CONCLUSION Parental knowledge and awareness about antibiotic indications and antibiotic resistance can be changed with educational interventions directed at parents and clinicians INTRODUCTION Communication campaigns are incorporating tobacco constituent messaging to reach smokers , yet there is a dearth of research on how such messages should be constructed or will be received by smokers . METHODS In a 2 × 2 × 2 experiment , we manipulated three cigarette constituent message components : ( 1 ) the toxic constituent of tobacco ( arsenic vs. lead ) with a corresponding health effect , ( 2 ) the presence or absence of an evocative image , and ( 3 ) the source of the message ( FDA vs. no source ) . We recruited smokers ( N = 1669 , 55.4 % women ) via an online platform  and r and omized them to one of the eight message conditions . Participants viewed the message and rated its believability and perceived effectiveness , the credibility of the message source , and action expectancies ( ie , likelihood of seeking additional information and help with quitting as a result of seeing the message ) . RESULTS We found significant main effects of image , constituent , and source on outcomes . The use of arsenic as the constituent , the presence of an evocative image , and the FDA as the source increased the believability , source credibility , and perceived effectiveness of the tobacco constituent health message . CONCLUSIONS Multiple elements of a constituent message , including type of constituent , imagery , and message source , impact their reception among smokers . Specifically , communication campaigns targeting smokers that utilize arsenic as the tobacco constituent , visual imagery , and the FDA logo may be particularly effective in changing key outcomes that are associated with subsequent attitude and behavioral changes . IMPLICATION S This article describes how components of communication campaigns about cigarette constituents are perceived . Multiple elements of a tobacco constituent message , including type of constituent , image , and message source may influence the reception of messages among current smokers . Communication campaigns targeting smokers that utilize arsenic as the tobacco constituent , visual imagery , and the FDA logo may be particularly effective in changing key outcomes among smokers . The effects of such campaigns should be examined , as well as the mechanisms through which such campaigns affect change Background A global antimicrobial resistance ( AMR ) awareness intervention targeting the general public has been prioritized . Objectives To evaluate the effectiveness of interventions that aim to change AMR awareness and subsequent stewardship behaviours amongst the public . Methods Five data bases were search ed between 2000 and 2016 for interventions to change the public 's AMR awareness and /or antimicrobial stewardship behaviours . Study design s meeting the Cochrane Effective Practice and Organization of Care ( EPOC ) criteria , non-controlled before- and -after studies and prospect i ve cohort studies were considered eligible . Participants recruited from healthcare setting s and studies measuring stewardship behaviours of healthcare professionals were excluded .  Quality of studies was assessed using EPOC risk of bias criteria . Data were extracted and synthesized narratively . Registration : PROSPERO international prospect i ve register of systematic review s ( PROSPERO 2016 : CRD42016050343 ) . Results Twenty studies were included in the review with nine meeting the EPOC criteria . The overall risk of bias was high . Nineteen studies were conducted in high-income countries .  Mass media interventions were most common ( n = 7 ) , followed by school-based ( n = 6 ) and printed material interventions ( n = 6 ) . Seventeen studies demonstrated a significant effect on changing knowledge , attitudes or the public 's antimicrobial stewardship behaviours . Analysis showed that interventions targeting schoolchildren and parents have notable potential , but for the general public the picture is less clear . Conclusions Our work provides an in-depth examination of the effectiveness of AMR interventions for the public . However , the studies were heterogeneous and the quality of evidence was poor . Well- design ed , experimental studies on behavioural outcomes of such interventions are required Objective Observational research suggests that placing graphic images on cigarette warning labels can reduce smoking rates , but field studies lack experimental control . Our primary objective was to determine the psychological processes set in motion by naturalistic exposure to graphic vs. text-only warnings in a r and omized clinical trial involving exposure to modified cigarette packs over a 4-week period . Theories of graphic-warning impact were tested by examining affect toward smoking , credibility of warning information , risk perceptions , quit intentions , warning label memory , and smoking risk knowledge . Methods Adults who smoked between 5 and 40 cigarettes daily ( N = 293 ; mean age = 33.7 ) , did not have a contra-indicated medical condition , and did not intend to quit were recruited from Philadelphia , PA and Columbus , OH . Smokers were r and omly assigned to receive their own br and of cigarettes for four weeks in one of three warning conditions : text only , graphic images plus text , or graphic images with elaborated text . Results Data from 244 participants who completed the trial were analyzed in structural-equation models . The presence of graphic images ( compared to text-only ) caused more negative affect toward smoking , a process that indirectly influenced risk perceptions and quit intentions ( e.g. , image->negative affect->risk perception->quit intention ) . Negative affect from graphic images also enhanced warning credibility including through increased scrutiny of the warnings , a process that also indirectly affected risk perceptions and quit intentions ( e.g. , image->negative affect->risk scrutiny->warning credibility->risk perception->quit intention ) . Unexpectedly , elaborated text reduced warning credibility . Finally , graphic warnings increased warning-information recall and indirectly increased smoking-risk knowledge at the end of the trial and one month later . Conclusions In the first naturalistic clinical trial conducted , graphic warning labels are more effective than text-only warnings in encouraging smokers to consider quitting and in educating them about smoking ’s risks . Negative affective reactions to smoking , thinking about risks , and perceptions of credibility are mediators of their impact . Trial Registration Clinical trials.gov The aim of this article is to further knowledge of the explanatory processes of narrative persuasion in the field of health communication , using data obtained in a research study of entertainment-education based on audiovisual fiction . Participating in the study were 208 young persons between the ages of 14 and 20 , r and omly distributed to three different groups . Each of the groups was exposed to a different episode of the Colombian television series Revelados , desde todas las posiciones . The results showed that greater identification with the main character of the episode transmitting a prevention message was associated with greater cognitive elaboration , which in turn led to more favorable attitudes toward the topics addressed . However , counterarguing was not observed to play a significant mediating role . The findings of this study allow us to conclude that getting people to think and reflect can help persuade them , which suggests that narrative persuasion models and dual models of rhetorical persuasion can be compatible in certain context s , such as when messages are design ed in such a way that characters make explicit arguments that endorse a prosocial message through dialogues Objectives To test the hypothesis that a multifaceted , local public campaign could be feasible and influence antibiotic prescribing for out patients . Design Community level , controlled , non-r and omised trial . Setting Provinces of Modena and Parma in Emilia-Romagna , northern Italy , November 2011 to February 2012 . Population 1 150 000 residents of Modena and Parma ( intervention group ) and 3 250 000 residents in provinces in the same region but where no campaign had been implemented ( control group ) . Interventions Campaign material s ( mainly posters , brochures , and advertisements on local media , plus a newsletter on local antibiotic resistance targeted at doctors and pharmacists ) . General practitioners and paediatricians in the intervention area participated in design ing the campaign messages . Main outcomes measures Primary outcome was the average change in prescribing rates of antibiotics for outpatient in five months , measured as defined daily doses per 1000 inhabitants/day , using health districts as the unit of analysis . Results Antibiotic prescribing was reduced in the intervention area compared with control area ( −4.3 % , 95 % confidence interval −7.1 % to −1.5 % ) . This result was robust to “ sensitivity analysis ” modifying the baseline period from two months ( main analysis ) to one month . A higher decrease was observed for penicillins resistant to β lactamase and a lower decrease for penicillins susceptible to β lactamase , consistent with the content of the newsletter on antibiotic resistance directed at health professionals . The decrease in expenditure on antibiotics was not statistically significant in a district level analysis with a two month baseline period ( main analysis ) , but was statistically significant in sensitivity analyses using either a one month baseline period or a more powered doctor level analysis . Knowledge and attitudes of the target population about the correct use of antibiotics did not differ between the intervention and control areas . Conclusions A local low cost information campaign targeted at citizens , combined with a newsletter on local antibiotic resistance targeted at doctors and pharmacists , was associated with significantly decreased total rates of antibiotic prescribing but did not affect the population ’s knowledge and attitudes about antibiotic resistance . Trial registration Clinical Trials.gov NCT01604096 Context : Large-scale strategies are needed to reduce overuse of antibiotics in US communities . Objectives : To evaluate the impact of a mass media campaign—“Get Smart Colorado”—on public exposure to campaign , antibiotic use , and office visit rates . Design : Nonr and omized controlled trial . Setting : Two metropolitan communities in Colorado , United States . Subjects : The general public , managed care enrollees , and physicians residing in the mass media ( 2.2 million persons ) and comparison ( 0.53 million persons ) communities . Intervention : The campaign consisting of paid outdoor advertising , earned media and physician advocacy ran between November 2002 and February 2003 . Principal Measures : Antibiotics dispensed per 1000 persons or managed care enrollees , and the proportion of office visits receiving antibiotics measured during 10 to 12 months before and after the campaign . Results : After the mass media campaign , there was a 3.8 % net decrease in retail pharmacy antibiotic dispenses per 1000 persons ( P = 0.30 ) and an 8.8 % net decrease in managed care-associated antibiotic dispenses per 1000 members ( P = 0.03 ) in the mass media community . Most of the decline occurred among pediatric members , and corresponded with a decline in pediatric office visit rates . There was no change in the office visit prescription rates among pediatric or adult managed care members , nor in visit rates for complications of acute respiratory tract infections . Conclusions : A low-cost mass media campaign was associated with a reduction in antibiotic use in the community , and seems to be mediated through decreases in office visits rates among children . The campaign seems to be cost-saving BACKGROUND Parent education is an integral component to promoting judicious antibiotic use . Opportunities to educate parents directly are limited . Child care providers are in a position to relay information to parents . METHODS A group-r and omized trial assessed the impact of a child care center staff intervention on parental knowledge and attitudes regarding appropriate antibiotic use  . A 9-point knowledge score and 3 attitude items were measured . RESULTS Surveys were returned by 151 ( 51 % ) of 298 intervention center parents and 150 ( 42 % ) of 361 control center parents . Intervention center respondents were significantly more likely than control center respondents to be college graduates , non-Hispanic white , and insured . Among college graduates , the median knowledge score was 7.0 at intervention centers and 
    Output:
    
The study demonstrates how affect is a present but tacit communication strategy of antimicrobial stewardship interventions but has not - to date - been adequately theorized or explicitly considered in the intervention design process .
Certain affective features were explored in relation to the effectiveness of antimicrobial resistance interventions and warrant further investigation .
Key desirable behavioural changes are decreased patient dem and s for antibiotics , use of them for targeted purpose s alone , and compliance with prescribed dosing .