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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.
Since assuming power after the 1994 genocide, President Paul Kagame and his political party, the Rwandan Patriotic Front, have struggled to unite Rwanda’s citizens using, among other initiatives, a simplified version of Rwandan history to diminish the ethnic tensions that made the 1994 genocide possible. As a result, Rwanda’s history has become highly politicized, with vastly divergent versions of the nation’s past narrated in private settings, where it is more politically appropriate for Rwandans to share their experiences. This paper focuses on divergent representations of Rwandan monarchical figures – often unnamed – whom the narrators imbue with values according to their individual political affiliations, lived experiences, and identity. These narratives are indicative of the broader ways that modern Rwandans narrate their experiences of history in response to Rwanda’s current official history, as well as previous official histories. Careful analysis reveals much about the current political climate in post-genocide Rwanda: most notably, that Rwandans continue to see their nation’s past through vastly different lenses, demonstrating the enormous challenges facing the Rwandan government as it seeks to reconcile its population using current methods. It also highlights the ongoing need on the part of historians to approach contemporary sources critically, informed by sources produced and debated in the pre-genocide period.
Clozapine has become a widely used drug in therapyresistant schizophrenia and, increasingly, in the levodopa-induced dyskinesias and the psychoses of chronic Parkinson's disease. We report the case of a 43 year old male patient who developed a reversible encephalopathy associated with clozapine therapy.