To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To describe national antibiotic prescribing for acute gastroenteritis (AGE).
We included visits with diagnoses for bacterial and viral gastrointestinal infections from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS; 2006–2015) and the IBM Watson 2014 MarketScan Commercial Claims and Encounters Database. For NAMCS/NHAMCS, we calculated annual percentage estimates and 99% confidence intervals (CIs) of visits with antibiotics prescribed; sample sizes were too small to calculate estimates by pathogen. For MarketScan, we used Poisson regression to calculate the percentage of visits with antibiotics prescribed and 95% CIs, including by pathogen.
We included 10,210 NAMCS/NHAMCS AGE visits; an estimated 13.3% (99% CI, 11.2%–15.4%) resulted in antibiotic prescriptions, most frequently fluoroquinolones (28.7%; 99% CI, 21.1%–36.3%), nitroimidazoles (20.2%; 99% CI, 14.0%–26.4%), and penicillins (18.9%; 99% CI, 11.6%–26.2%). In NAMCS/NHAMCS, antibiotic prescribing was least frequent in emergency departments (10.8%; 99% CI, 9.5%–12.1%). Among 1,868,465 MarketScan AGE visits, antibiotics were prescribed for 13.8% (95% CI, 13.7%−13.8%), most commonly for Yersinia (46.7%; 95% CI, 21.4%–71.9%), Campylobacter (44.8%; 95% CI, 41.5%–48.1%), Shigella (39.7%; 95% CI, 35.9%–43.6%), typhoid or paratyphoid fever (32.7%; (95% CI, 27.2%–38.3%), and nontyphoidal Salmonella (31.7%; 95% CI, 29.5%–33.9%). Antibiotics were prescribed for 12.3% (95% CI, 11.7%–13.0%) of visits for viral gastroenteritis.
Overall, ∼13% of AGE visits resulted in antibiotic prescriptions. Antibiotics were unnecessarily prescribed for viral gastroenteritis and some bacterial infections for which antibiotics are not recommended. Antibiotic stewardship assessments and interventions for AGE are needed in ambulatory settings.
Much of the psychosocial care people receive after major incidents and disasters is informal and is provided by families, friends, peer groups and wider social networks. Terrorist attacks have increased in recent years. Therefore, there is a need to better understand and facilitate the informal social support given to survivors.
We addressed three questions. First, what is the nature of any informal support-seeking and provision for people who experienced the 2017 Manchester Arena terrorist attack? Second, who provided support, and what makes it helpful? Third, to what extent do support groups based on shared experience of the attack operate as springboards to recovery?
Semi-structured interviews were carried out with a purposive sample of 18 physically non-injured survivors of the Manchester Arena bombing, registered at the NHS Manchester Resilience Hub. Interview transcripts were thematically analysed.
Participants often felt constrained from sharing their feelings with friends and families, who were perceived as unable to understand their experiences. They described a variety of forms of helpful informal social support, including social validation, which was a feature of support provided by others based on shared experience. For many participants, accessing groups based on shared experience was an important factor in their coping and recovery, and was a springboard to personal growth.
We recommend that people who respond to survivors’ psychosocial and mental healthcare needs after emergencies and major incidents should facilitate interventions for survivors and their social networks that maximise the benefits of shared experience and social validation.
Two commonly linked harmful practices that negatively impact the health of girls and women in sub-Saharan Africa, and threaten their development and quality of life, are female genital mutilation and girl-child marriage. The central focus of the study was to investigate the association between female genital mutilation and girl-child marriage in sub-Saharan Africa. Data from the most recent Demographic and Health Surveys of twelve sub-Sahara African countries were pooled. A total of 14,748 women aged 20–24 were included in the study. A multilevel logistic regression analysis was employed, with reported adjusted odds ratios (aORs) and associated 95% confidence intervals (CIs). The overall prevalence of FGM in the twelve countries was 52.19%, with the highest prevalence in Guinea (97.17%). The overall prevalence of girl-child marriage in the twelve countries was 57.96%, with the highest prevalence in Chad (78.06%). Women who had never experienced female genital mutilation were less likely to experience girl-child marriage (aOR=0.76, CI=0.71–0.82) compared with those who had ever experienced female genital mutilation. Age 24 (aOR=0.47, CI=0.43–0.52), secondary/higher level of education (aOR=0.31, CI=0.28–0.35), richest wealth quintile (aOR=0.56, CI=0.47–0.66), exposure to mass media (aOR=0.81, CI=0.74–0.88) medium community literacy level (aOR=0.63, CI=0.57–0.69) and low community socioeconomic status (aOR=0.67, CI=0.49–0.92) were found to be protective against girl-child marriage. The findings reveal that female genital mutilation is associated with girl-child marriage in sub-Saharan Africa. The continued practice will adversely affect the reproductive health outcomes of girls in the sub-region. Policies aimed at eliminating female genital mutilation and girl-child marriage should focus on compulsory basic education, poverty alleviation and increasing access to mass media. Further, campaigns should cover more communities with lower literacy levels and medium socioeconomic status.
Distress after major incidents is widespread among survivors. The great majority do not meet the criteria for mental health disorders and rely on psychosocial care provided by their informal networks and official response services. There is a need to better understand their experiences of distress and psychosocial care needs.
The aims of our study were to enhance understanding of the experience of distress among people present at the Manchester Arena bombing in 2017, identify their experiences of psychosocial care after the incident and learn how to better deliver and target effective psychosocial care following major incidents.
We conducted a thematic analysis of semi-structured interviews with 18 physically non-injured survivors of the Manchester Arena attack, who registered with the NHS Manchester Resilience Hub.
Distress was ubiquitous, with long-lasting health and social consequences. Initial reluctance to seek help from services was also common. Early and open access to authoritative sources of information and emotional support, and organised events for survivors, were viewed as helpful interventions. Inappropriate forms of psychosocial and mental healthcare were common and potent stressors that affected coping and recovery.
This paper extends our understanding of how people react to major events. Provision for the large group of people who are distressed and require psychosocial care may be inadequate after many incidents. There is a substantial agenda for developing awareness of people's needs for psychosocial interventions, and training practitioners to deliver them. The findings have substantial implications for policy and service design.
This chapter tells the largely untold story of the political economy of international drug regulation in the 1950s. It will tell the story of producer country efforts, led by Turkey, Iran and India, to agree an international quota system for opium and thus to divide up the licit global market. It examines the simultaneous efforts to suppress the global illicit market and minimise the numbers of producers to a small select few who would enjoy an enforced oligopoly. It highlights the quiet diplomatic pressure placed on countries viewed as epicentres of the global trade and a conscious ignorance of strategically important states – for example the US State Department refusing to criticise French Indochina and Mexico. Further, it tells the story of Harry Anslinger’s efforts to incorrectly portray Communist China as the world’s leading narcostate. It concludes with a look at the breakdown of multilateralism over the 1953 Opium Protocol, a treaty which few accepted but was rammed through by the US and some select allies. It was this Protocol which ultimately galvanised moderates and producer states around the need for a Single Convention to roll back the excesses of the 1953 Protocol.
To describe the cumulative seroprevalence of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antibodies during the coronavirus disease 2019 (COVID-19) pandemic among employees of a large pediatric healthcare system.
Design, setting, and participants:
Prospective observational cohort study open to adult employees at the Children’s Hospital of Philadelphia, conducted April 20–December 17, 2020.
Employees were recruited starting with high-risk exposure groups, utilizing e-mails, flyers, and announcements at virtual town hall meetings. At baseline, 1 month, 2 months, and 6 months, participants reported occupational and community exposures and gave a blood sample for SARS-CoV-2 antibody measurement by enzyme-linked immunosorbent assays (ELISAs). A post hoc Cox proportional hazards regression model was performed to identify factors associated with increased risk for seropositivity.
In total, 1,740 employees were enrolled. At 6 months, the cumulative seroprevalence was 5.3%, which was below estimated community point seroprevalence. Seroprevalence was 5.8% among employees who provided direct care and was 3.4% among employees who did not perform direct patient care. Most participants who were seropositive at baseline remained positive at follow-up assessments. In a post hoc analysis, direct patient care (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.03–3.68), Black race (HR, 2.70; 95% CI, 1.24–5.87), and exposure to a confirmed case in a nonhealthcare setting (HR, 4.32; 95% CI, 2.71–6.88) were associated with statistically significant increased risk for seropositivity.
Employee SARS-CoV-2 seroprevalence rates remained below the point-prevalence rates of the surrounding community. Provision of direct patient care, Black race, and exposure to a confirmed case in a nonhealthcare setting conferred increased risk. These data can inform occupational protection measures to maximize protection of employees within the workplace during future COVID-19 waves or other epidemics.
The division between internalist and externalist perspectives has dominated many areas of philosophy over the last few decades. In broadest terms, the issue is how best to individuate or otherwise categorize properties of agents that bear upon them being rational, perceiving, acting creatures. Are the properties internal to the agent, to the exclusion of external factors, or are they essentially involving of properties and things external to the agents? In the philosophy of language, the relevant properties pertain to general linguistic competence, and so we may ask if language itself (appropriately understood) is an internal property of speaker-hearers, or, say, if a word’s meaning is essentially world involving. Only a cursory survey of internalism in the philosophy of language would be possible in the space available; the chapter’s ambition, instead, is to offer something of a rapprochement.
This chapter outlines the early development of UN CND and how it progressed towards its first new international treaty in 1948. Emerging from the tense post-war negotiations the key uncertainties for CND were: how it would operate in practice; how it would fit into broader UN and geopolitical streams; and whether it would function as a talking-shop or, as per the US vision, a tool to enforce regulations and publicly bludgeon member states as needed. The first three meetings of CND in 1946– 1948 would be pivotal. The first two served to sound out the political context within which CND would operate and how the structures would function in practice. Following this, a major political push occurred around the Third Session, first concluding a new Protocol and then spring boarding into discussions on a new production limitation convention and even advocating a new ‘single convention’ to unify all previous drug treaties.
This introduces the topic of multilateral drug control, its contemporary relevance and the areas under examination within the book. It highlights the key themes grouped by three overarching focuses: historical, contemporary-legal and international relations theory. It examines the major debates under way in UN drug control and their direct relation to the historical-legal regulatory discussion encapsulated within the book. It outline existing historiography on international drug control and examines more recent developments. It points to continuing gaps in historiography, international relations, legal and policy literature which this book will fill. In particular it highlights the extensive literature on international legal fragmentation and its relevance for drug control debates. It offers an overview of regime theory and international relations approaches, suggesting a new and emerging framework based on evaluating drug control as a ‘regime complex’ in a similar lineage to climate change and intellectual property regimes, which will be covered in a more breadth in the Conclusion.
At the outbreak of War in 1939 the drug control system stood as a mixture of contradictions and uncertainty. On the one side were the strict control advocates, led by the United States. On the other side were producing states, agrarian countries whose economic, cultural and political systems were entwined with the very drugs the system sought to limit. In the middle were the old colonial powers, recognised the role opium played within many their colonies. The outbreak of war would fundamentally reshape international drug control. Moreover, it was driven by US-led bilateral efforts, utilising its wartime leverage, while other states were confined to rear-guard defensive actions. The reshaping of control during wartime was in many ways the result of aggressive wartime diplomatic manoeuvring by Harry Anslinger and key members of the Washington drug control lobby. The most radical wartime departure occurred in 1943 when Britain and Holland promised to adopt a policy of total prohibition of opium smoking and monopolies in many of their colonial territories. This shift, enabled Anslinger to bring new pressure to bear on the traditionally recalcitrant states such as Iran and Afghanistan to impose stricter controls and prohibitions.
This chapter examines the legal legal of the Single Convention and its successor treaties. The passage of the Single Convention represented a high-water mark in the international regulatory system. While it contained little in terms of innovation, it streamlined the complex array of drug treaties, while moving the terrain of control forward marginally. It essentially solidified an economic regulatory framework for a global licit commodity market in certain essential medicines. To enforce this market it mandated certain action around controlling and prohibiting non-medical production and manufacturing. Key questions around dealing with ‘addiction’ and suppressing non-medical consumption were left largely unanswered. The US may have lost the battle around the Single Convention and control of the system in the 1960s but they would enter the 1970s ready to refight many of these battles, beginning with the declaration of the ‘war of drugs’ and an aggressive new round of bilateral drug diplomacy. Ultimately the ‘war on drugs’ was not an inevitable outgrowth of these documents, but instead represented a specific set of interpretations, bureaucratic and normative trajectories and member state implementations.
This chapter charts the occasionally tense inter- and intra-governmental infighting surrounding the creation of the UN drug control system. It highlights the key institutional, legal and geopolitical issues as well as foundational member state divisions over market control, regulatory reach and legal enforcement capabilities. The deep regulatory and oversight structures of the League treaty system were transferred wholesale, with no formal wartime interruption. However, reconstruction of the political apparatus proved a much more contested issue. Strict control advocates in the US pushed the creation of a more uniform, stringent and enforcement-oriented system. The majority of states, however, simply aimed for conservatism and continuity with the League drug apparatus. They were supported in this aim by the US State Department which sought to minimise areas of disagreement within the fledgling UN organisation. Drug control was far from a strategic or geopolitical post-war priority and entrenched interests among producing states and colonial powers remained. Astride the enormous economic, social and political challenges facing the post-war world, a consensus-oriented system appeared the path of least resistance for most, including the US State Department.