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Antibiotic resistance is an emerging global public health threat. One of the main drivers of this threat is the inappropriate use of antibiotics. In Sri Lanka, antibiotic consumption is increasing, but little is known locally about how patients perceive antibiotics. We conducted a qualitative study to gain a better understanding of the knowledge, perceptions, and attitudes of patients regarding antibiotics and antibiotic resistance. Semi-structured interviews involving 18 patients with lower respiratory tract infection (LRTI) admitted to a large, public tertiary care hospital in southern Sri Lanka were conducted. Interviews were analyzed to identify themes regarding the patients' knowledge of LRTI etiology and treatment, perceptions and attitudes toward LRTI treatment, including antibiotics, and patient-physician communication. Most patients mentioned multiple care visits and the use of multiple pharmaceuticals prior to admission. Patients sought a quick resolution to their ailments and frequently visited several private physicians to obtain a satisfying answer. Self-medication was also common. Patients reused prescriptions for antibiotics, kept antibiotics for later use after prematurely stopping their course of treatment, and bought over-the-counter antibiotics. Patients' knowledge of disease etiology and antibiotics was poor. Only a few patients were aware of antibiotic resistance. Despite the desire to receive more information regarding disease and treatment, patient-provider communication was limited and mainly confined to prescription instructions. This qualitative study performed in Sri Lanka suggests that inappropriate use of antibiotics is a multifactorial problem. To improve antibiotic use, a multifactorial approach that includes educating the public, increasing awareness among physicians, and implementing systems-level changes to restrict access to antibiotics is urgently needed.

Importance: Physicians may be important sources of sexuality information and preventive services, and one-on-one confidential time during health maintenance visits is recommended to allow discussions of sexual development, behavior, and risk reduction. However, little is known about the occurrence and characteristics of physician-adolescent discussions about sexuality., Objective: To examine predictors of time spent discussing sexuality, level of adolescent participation, and physician and patient characteristics associated with sexuality discussions during health maintenance visits by early and middle adolescents., Design, Setting, and Participants: Observational study of audio-recorded conversations between 253 adolescents (mean age, 14.3 years; 53% female; 40% white; 47% African American) and 49 physicians (82% pediatricians; 84% white; 65% female; mean age, 40.9 years; mean [SD] duration in practice, 11.8 [8.7] years) coded for sexuality content at 11 clinics (3 academic and 8 community-based practices) located throughout the Raleigh/Durham, North Carolina, area., Main Outcomes and Measures: Total time per visit during which sexuality issues were discussed. RESULTS One hundred sixty-five (65%) of all visits had some sexual content within it. The average time of sexuality talk was 36 seconds (35% 0 seconds; 30% 1-35 seconds; and 35% ≥ 36 seconds). Ordinal logistic regression (outcome of duration: 0, 1-35, or ≥ 36 seconds), adjusted for clustering of patients within physicians, found that female patients (odds ratio [OR] = 2.58; 95% CI, 1.53-4.36), older patients (OR = 1.37; 95% CI, 1.13-1.65), conversations with explicit confidentiality discussions (OR = 4.33; 95% CI, 2.58-7.28), African American adolescents (OR = 1.58; 95% CI, 1.01-2.48), and longer overall visit (OR = 1.07; 95% CI, 1.03-1.11) were associated with more sexuality talk, and Asian physicians were associated with less sexuality talk (OR = 0.13; 95% CI, 0.08-0.20). In addition, the same significant associations between adolescent, physician, and visit characteristics were significantly associated with greater adolescent participation., Conclusions and Relevance: Our study may be the first to directly observe sexuality talk between physicians and adolescents. We found that one-third of all adolescents had annual visits without any mention of sexuality issues; when sexuality talk occurred, it was brief. Research is needed to identify successful strategies physicians can use to engage adolescents in discussions about sexuality to help promote healthy sexual development and decision making., Trial Registration: clinicaltrials.gov Identifier: NCT01040975.

The adverse health effects of tobacco and alcohol are well known. Alcohol consumption is increasing in Sri Lanka, but few population studies have been conducted. The objective of this study was to document tobacco and alcohol consumption levels among adults in southern Sri Lanka and to identify the main reasons for using or refraining from alcohol and tobacco products. Tobacco and alcohol use within Sri Lanka is relatively common, particularly among adult males. Reasons given for smoking and drinking frequently relate to social and image-based motivators. Women may be especially susceptible to the influence of peer pressure in social situations. Public health efforts should consider the use of demographic-specific anti-tobacco and anti-alcohol messages, as the motivators driving behavior appear to differ across gender and age groups.

Background: The reproductive health status of China's low-income urban women is believed to be poor. Therefore, understanding their reproductive history and needs and improving services provision is very important. However, few studies have been done to assess reproductive health status, knowledge and needs in this low-income population. The purpose of this study is to broadly assess reproductive and family planning history, knowledge and health needs among low income urban women with an aim to informing health services interventions., Methods: 1642 low-income women age 18-49 from Haidian district, Beijing were selected. All were interviewed via a standardized questionnaire in 2006., Results: Most women reported at least one pregnancy and delivery (97.7%, 98.3%). Deliveries in hospitals (97.3%) by medical personnel (98.5%) were commonplace, as was receipt of antenatal care (86.0%). Nearly half had at least one abortion, with most (56.0%) performed in district hospitals, by physicians (95.6%), and paid for out-of-pocket (64.4%). Almost all (97.4%) used contraception, typically IUDs or condoms. Reproductive knowledge was limited. Health needs emphasized by the participants included popularizing reproductive health information, being able to discuss their reproductive health concerns, free reproductive health insurance, examination and treatment., Conclusion: Among poor urban women in Beijing, antenatal care and contraceptive use were common. However, abortions were also common. Knowledge about reproductive health was limited. There is a need for better reproductive health education, free medical care and social support.

Objective: The purpose of this study was to capture and describe knowledge, attitudes, and beliefs about tuberculosis (TB) among persons at high risk for TB infection., Methods: We conducted 11 focus groups in 3 different populations at high risk for TB infection: Spanish-speaking immigrants, homeless shelter residents, and persons attending a drug/alcohol rehabilitation center. A standardized list of open-ended questions was used to guide discussion. Using grounded theory, transcripts of the focus group sessions were reviewed by 4 independent reviewers to identify emergent themes., Findings: Participants (N = 52) generally understood that TB is an infectious disease that frequently affects the lungs and can be fatal if untreated. They also knew that a skin test can be used to diagnose TB. However, participants frequently had incorrect beliefs regarding the cause, transmission, and treatment of TB. Many participants thought that TB is transmitted in the same fashion as other infectious diseases such as human immunodeficiency virus or aquired immune deficiency syndrome (HIV/AIDS). A general sentiment of fear and aversion toward persons ill with TB was expressed., Limitations: Focus groups were a convenience sample and subjects were not necessarily representative of the underlying populations., Conclusions: Tuberculosis knowledge among high-risk populations is suboptimal, and false beliefs regarding transmission and treatment were common in this study. Knowledge regarding transmission of other infectious diseases such as HIV/AIDS was frequently translated into incorrect knowledge regarding TB. Stigma continues to be a barrier to TB diagnosis and treatment.

Setting: North Carolina, USA., Objective: To understand physicians' knowledge and attitudes toward the treatment of young children with latent tuberculosis infection (LTBI) in a low-incidence region., Design: Cross-sectional survey of 525 pediatricians and 525 family practitioners in North Carolina., Results: Of 1050 surveys mailed, 149 (14%) were returned. In the previous year, 96% of responding physicians had treated children who had emigrated from a tuberculosis (TB) endemic country. During the last 2 years, 84% of physicians had not diagnosed any young children with TB disease, and 46% had not treated any young children with LTBI. Most (83%) physicians routinely placed tuberculin skin tests (TSTs), and 26% reported placing > 10 TSTs per month. Experience in treating children with LTBI was the only predictor of TB knowledge. Physicians were particularly confused about two issues: 1) TST among bacille Calmette-Guérin (BCG) vaccinated children and 2) treatment of young children with recent exposure to an adult with infectious TB., Conclusions: Knowledge of important issues related to management of LTBI in children aged < 5 years was limited among physicians in an area with relatively low TB incidence. Creative methods must be developed to help physicians in low-incidence areas to appropriately diagnose and treat LTBI among young children.

Objective: We compared the opinions, knowledge, and attitudes of final-year medical, physiotherapy, occupational therapy, nursing, and pharmacy students about complementary/alternative medicine (CAM)., Methods: A cross-sectional study questionnaire (n = 442) was administered on site at the University of Western Ontario and the University of Toronto to fourth-year health professions students. Outcome measures were self-reported knowledge, attitude, and perceived usefulness of CAM therapies, the perceived importance of scientific inquiry for the acceptance of CAM, and educational exposure to the topic., Results: Educational exposure to CAM was correlated with the perceived usefulness of CAM. Medical students reported the least amount of education about CAM and viewed CAM therapies as less useful than did their health professions student peers. Medical students and pharmacy students were more likely than the other health professions students to view traditional scientific forms of evidence as necessary before accepting CAM therapies., Conclusions: Perceptions differed among the different health professions student groups about the usefulness of CAM therapies and the kind of evidence needed before they should be incorporated into standard care. This may have important implications for multidisciplinary care.

Objective: To determine the prevalence of neonatal circumcision immediately following delisting of the procedure in Ontario and to examine parents' knowledge, attitudes, and behaviours regarding circumcision., Design: Cross-sectional survey., Setting: Perinatal tertiary care centre in southwestern Ontario., Participants: Of the 151 mothers approached, three were excluded because they did not speak English and two declined participation; 112 of 146 mothers of healthy male newborns responded for a response rate of 77%., Main Outcome Measures: Circumcision status of infant and parents' knowledge, attitudes, and behaviour., Results: The circumcision rate before delisting had been 56.2%; in the months immediately after, the rate was 59.8% (95% confidence interval was 51%, 69%). Mothers of infants in the outcome groups did not differ significantly in any demographic feature other than education, where the group deciding against circumcision reported higher education levels (Wilcoxon nonparametic two-sample test: zeta = 2.29, P = 0.02). Mothers who chose circumcision listed medical (59%) and sociocultural considerations (40%) a most important to their decision. Father's circumcision status was strongly associated with the infant's (chi 2[df 1] = 25.13, P = 0.0001). Although 74% discussed circumcision with their family physicians, many parents were not well informed about risks or benefits. Anesthetic use during circumcision was reported by 29%, but 48% did not know whether any had been used., Conclusions: The prevalence of neonatal circumcision did not change after delisting. Informed consent was often lacking. Sociocultural issues are important to some parents and need to be addressed in the consultation process.