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The Canadian Nosocomial Infection Surveillance Program conducted point-prevalence surveys in acute-care hospitals in 2002, 2009, and 2017 to identify trends in antimicrobial use.
Eligible inpatients were identified from a 24-hour period in February of each survey year. Patients were eligible (1) if they were admitted for ≥48 hours or (2) if they had been admitted to the hospital within a month. Chart reviews were conducted. We calculated the prevalence of antimicrobial use as follows: patients receiving ≥1 antimicrobial during survey period per number of patients surveyed × 100%.
In each survey, 28−47 hospitals participated. In 2002, 2,460 (36.5%; 95% CI, 35.3%−37.6%) of 6,747 surveyed patients received ≥1 antimicrobial. In 2009, 3,566 (40.1%, 95% CI, 39.0%−41.1%) of 8,902 patients received ≥1 antimicrobial. In 2017, 3,936 (39.6%, 95% CI, 38.7%−40.6%) of 9,929 patients received ≥1 antimicrobial. Among patients who received ≥1 antimicrobial, penicillin use increased 36.8% between 2002 and 2017, and third-generation cephalosporin use increased from 13.9% to 18.1% (P < .0001). Between 2002 and 2017, fluoroquinolone use decreased from 25.7% to 16.3% (P < .0001) and clindamycin use decreased from 25.7% to 16.3% (P < .0001) among patients who received ≥1 antimicrobial. Aminoglycoside use decreased from 8.8% to 2.4% (P < .0001) and metronidazole use decreased from 18.1% to 9.4% (P < .0001). Carbapenem use increased from 3.9% in 2002 to 6.1% in 2009 (P < .0001) and increased by 4.8% between 2009 and 2017 (P = .60).
The prevalence of antimicrobial use increased between 2002 and 2009 and then stabilized between 2009 and 2017. These data provide important information for antimicrobial stewardship programs.
Two different projections of world population for the years 1980 and 2000, viz. the United Nations Medium Variant Projection and Current Fertility Projection, are considered. Both show large increases in world population. When the more developed regions and the less developed regions are considered separately, the major part of the growth is seen to be concentrated in the less developed regions.
The changes in total population expected in the next 40 years (1960–2000) are seen to be very different from changes which have taken place in the last 40 years.
The question of the conditions that must prevail before fundamentalist religion can play a significant part in politics has loomed large in recent years with the resurgence of Islamic fundamentalism in the Middle East. Protestant fundamentalism has drawn somewhat less attention, except for the case of the new Christian right in America. Nowhere in the contemporary world are the politics of conservative Protestantism more clearly visible than in Northern Ireland. Therefore, in this essay we seek to explain why Protestant fundamentalism has achieved such prominence and success in Ulster in recent years. First, we present a comparative analysis of conservative Protestant politics in the English-speaking world. Second, we offer an historically informed analysis of the rise of Ulster's most successful fundamentalist politician, the Reverend Ian Paisley.