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Association of Antibiotic Duration and Outcomes among NICU Infants with Invasive Staphylococcus aureus Infections
- Areej Bukhari, Ibukunoluwa Akinboyo, Kanecia Zimmerman, Danny Benjamin, Veeral Tolia, Rachel Greenberg
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- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue S1 / July 2021
- Published online by Cambridge University Press:
- 29 July 2021, pp. s27-s28
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Background:Staphylococcus aureus is the second-leading cause of late-onset sepsis among infants in US neonatal intensive care units (NICUs). Management of S. aureus bacteremia and meningitis in infants varies widely due to the lack of standardized guidelines. We examined the association between initial antibiotic duration and recurrent S. aureus infection or death among NICU infants with S. aureus bacteremia and/or meningitis. Methods: We conducted a retrospective cohort study of infants in Pediatrix Medical Group NICUs from 1997 to 2018 with first episode of S. aureus bacteremia and/or meningitis, identified as having at least 1 blood or cerebrospinal fluid (CSF) culture growing only S. aureus at any point during their NICU stay. Excluded infants were those not started on antistaphylococcal therapy within 2 days of positive culture, those with had endocarditis or osteomyelitis, or those who died or were discharged during or up to 1 day after antibiotic cessation. Antibiotic cessation was defined as last day of antibiotic given if followed by at least 3 days without antibiotics. Multivariable logistic regression was used to analyze the association between antibiotic duration categorized as <14 or ≥14 days) and recurrent SA infection (within 12 weeks of antibiotic cessation, prior to hospital discharge), or death (within 7 days of antibiotic cessation and at discharge). Results: Of 4,086 infants included, 3,991 (98%) had S. aureus bacteremia only and 95 (2%) had meningitis ± bacteremia. Of those with bacteremia only, 2,017 (50.5%), and 17 (18%) of those with meningitis received <14 days antibiotics (Figure 1). Longer antibiotic duration was associated with lower gestational age, methicillin-resistance, severe illness and bacteremia duration of ≥4 days (Table 1). There was a significant association between <14 days antibiotics and recurrent infection (p = 0.04) and 7-day mortality (p = 0.02) in the meningitis cohort. Infants with SA bacteremia who received ≥14 days antibiotics had reduced odds of recurrent SA infection (OR 0.24, 95% CI 0.18-0.32) and death (OR 0.33, 95% CI 0.25-0.44), adjusting for post-natal age, gestational age, sex, methicillin-resistance, severe illness and duration of bacteremia (Table 2). Conclusions: In the largest study thus far examining antibiotic duration among hospitalized infants with S. aureus bacteremia and/or meningitis, ≥14 days antibiotics was associated with decreased odds of recurrent infection or death. Further studies are needed to define the optimal treatment duration and identify clinical factors distinguishing infants able to safely receive a shorter antibiotic duration.
Funding: No
Disclosures: None
Figure 1.
Table 1. Table 2.
Dedication
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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6 - Industry and Occupation
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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Summary
Agriculture represents 10% of the European Union total GDP, and it plays an essential role in the European culture and environmental protection. Indeed, agriculture occupies a great part of the territory and helps maintain the lifestyle and economy of many rural areas.
Food and Water Watch Europe, 2014
By making the area of countries proportional to their agricultural workforce, this map shows the spatial distribution of the total estimated economically active population across Europe who are working in agriculture. Turkey has by far the largest number, followed by Romania, Poland, France and Italy. In relative terms, the largest share of workers in agriculture in any one nation state as a proportion of each country’s total economically active population is in Albania (48.0%), followed by Romania (31.6%), Turkey (25.5%) and Kosovo (23.6%). The smallest percentages are in Sweden, the United Kingdom, Malta and Germany (all below 2%).
Europe needs its real economy now more than ever to underpin the recovery of economic growth and jobs and it needs to reindustrialise for the 21st century. Immediate action should contribute to revert the current downward trend and to promote the re-industrialisation of Europe. Currently industry accounts for about 16% of EU GDP. Therefore, the European Commission has set its goal that industry’s share of GDP should be around 20% by 2020.
European Commission, 2014a
There are an estimated 69 million people in Europe working in industry. This category is mainly made up of people involved in manufacturing. About 15% of the industrial workforce of Europe are in Germany, Europe’s leading industrial power. About 10% are in Italy and another 10% in France. In relative terms, the country with the largest number working in industry as a proportion of its total economically active population is the Czech Republic (38.6%), followed by Bulgaria (35.2%) and Slovenia (35.0%), all former communist countries. The smallest percentage of a country’s workers employed in industry is in Andorra (4.7%).
At first glance this map looks very similar to the next map showing people working in service occupations. However, there are differences: for example, the number of workers in the industrial sector is larger in Turkey and smaller in the UK compared with those in services.
9 - Economics
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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According to data from the World Bank, the total gross domestic product (GDP) of all the countries mapped in this atlas in 2012 was 18 trillion and 673 billion US dollars, which is approximately one quarter of the estimated total GDP of the world. The total GDP of a country is equal to the market value of the goods and services produced by all sectors of that country’s economy in a year. To allow comparison outside of Europe, GDP per person (per capita) is usually recorded in US dollars.
Germany has the largest GDP, followed by France, the United Kingdom, Italy and Spain. However, Monaco has the highest GDP per capita (US$163,026), followed by Liechtenstein (134,617), Luxembourg (107,476), Norway (99,558), Switzerland (79,052), Denmark (56,210) and Sweden (55,244). The lowest values are found in Kosovo (3,453), Albania (4,148), Bosnia and Herzegovina (4,446), FYR Macedonia (4,589), Serbia (5,189), Montenegro (6,183), Bulgaria (6,986) and Romania (7,942). Note that these are not average annual personal income figures. However, in countries where income inequalities are lower, and where shareholders and very rich people take fewer profits, the figure for GDP per capita is closer to that of the average personal income.
This map shows the absolute increases in gross domestic product since the economic crisis started in 2007/08. The figures have all been converted to what are called ‘constant 2005 US dollars’ to eliminate any distortions due to inflation. There are 23 countries that experienced an absolute increase over the period to 2012. These were mostly in central Europe, with Germany, Turkey and Poland standing out. However, in relative terms the largest increase is observed in Kosovo, with its GDP growing by 25% between 2007 and 2012, followed by Albania (20%), Poland (18%), Turkey (16%) and Slovakia (10%). It is also worth noting that the economies of Switzerland, Norway and Sweden did not shrink overall during this period of massive economic slump.
The cartographic technique used to create these cartograms does not shrink away completely countries that should not be shown as the distortions created would be too severe. They would appear to be like black holes sucking in parts of the continent (see Chapter 1).
Acknowledgements
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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12 - Policy
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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Where does the European Union get its money from‚ and how does it spend it? With an annual budget of over €122bn, the EU is an economic power in its own right, more significant than many countries. So, how do those finances break down?
Rogers, 2012b
As noted in the above quote, the European Union can be seen as an economic power in its own right. However, it is also important to highlight that the total EU budget is very small when compared with the sum of all the national budgets of member states. In 2011 the total EU budget was €140 billion, whereas the total budget of all EU member states was €6,300 billion – 50 times bigger (European Commission, 2014c).
This chapter focuses on current EU member states (at the time of compiling the data for the atlas) and explores the distribution of EU policy and in particular the geographical distribution of the EU budget. The EU budget aims to promote the policy priorities agreed by all member states through a multi-annual spending plan known as the ‘Financial Framework’, which specifies the EU expenditure over a fixed period for specified categories. The last financial framework covered the period 2007–13 and ensured a certain planning security for the main areas of the common political goals of the EU. At the time of writing, tense negotiations are under way for the forthcoming Multiannual Financial Framework 2014–20.
The contributions to the EU budget by each country are based on economic power: each EU member state contributes to the budget a percentage of its value added tax (VAT) receipts and 1% of its gross national income (GNI). But because of various rebates the EU’s overall budget represents approximately 1% of the gross national income of all member states.
The graph here shows the total payments and contributions by country. It demonstrates one other, often less discussed, aspect of the EU: that although some of the wealthier countries pay quite large sums into the EU budget (depending on their GDP) they also receive quite large payments from it. For example, the largest contributors, such as France, Germany and the United Kingdom, are also those in receipt of the largest payments from the EU budget.
References
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2 - Identity and Culture
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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Article 2 Right to life
1. Everyone has the right to life.
2. No one shall be condemned to the death penalty, or executed.
Charter of Fundamental Rights of the European Union, 2007/C 303/01
The protection of human rights and, most importantly, of the right not to be executed, is considered to be one of Europe’s principal contemporary values. It is one of the key ‘Copenhagen criteria’ that needs to be met before any country can be considered as a potential member of the European Union.
According to the latest data from the European Values Survey, on a scale of 1 (never) to 10 (always), 45% of all Europeans answered ‘never’ when asked if they agree with the death penalty; just 8% answered ‘always’.
It’s possible that where the memory of executions is recent, or continues to be kept alive, opposition to the idea of execution being reintroduced is strongest. The largest number opposed to the idea is observed in Kosovo (87%), followed by Malta (68%), Turkey (67%), Italy (63%) and Bosnia and Herzegovina (60%). Countries where the fewest people say the death penalty should never be reintroduced include the Czech Republic (15%), Lithuania (21%), Latvia (21%), Hungary (22%), Estonia (24%) and the United Kingdom (25%).
The Convention on the Future of Europe’s deliberations over the EU Constitution has thrown into relief the role of religion in defining ‘Europeanness’ … The debate over whether Christianity should be seen as constitutive of European identity has been framed by wider concerns about collective identities and memories in Europe.
Schlesinger and Foret, 2006, p 59
There have long been debates about the importance of religion in shaping European identity – in particular of Christianity, Islam and Judaism, which are often described as the ‘great religions of the West’. But how important is religion in the life of Europeans?
According to the most recent data from the European Values Survey, 27% of all Europeans consider religion to be very important and another 27% as ‘quite important’, whereas for 22% it is ‘not at all important’.
In Turkey, 80% of the surveyed population believe that religion is very important in their lives, followed by Cyprus (59%), Malta (59%) and Romania (55%). The smallest percentages are observed in Estonia (5%), the Czech Republic (6.3%), Germany (7.8%) and Sweden (8.3%).
Appendix: Sources of Data
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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Contents
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5 - Employment
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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The participation of women in the labour market in the European Union has been growing steadily in recent years, and their increasing participation is seen as a key factor in achieving the goals of the European Employment Strategy and the Europe 2020 Strategy. At policy level, it is recognised that the economic success of Member States depends on women being able to reach their full potential. The Commission’s focus in this area is on ensuring that women have the opportunity to work when they want and that they can balance work with other family responsibilities.
Eurofound, 2012
This map shows the spatial distribution of the economically active female population – that is, women who are in work or who are looking for work – across Europe in 2010. The highest absolute number is in Germany, followed by the United Kingdom, France, Italy and Spain. However, in relative terms Estonia and Lithuania have the largest proportions of economically active females as a share of the total economically active population (49.4% and 49.3% respectively), followed by Latvia (48.8%), Finland (47.8%) and France (47.5%). It is interesting to note that in the former USSR, the active female population was typically very high. In contrast, the lowest percentages are observed in Turkey (26.6%) and Malta (33.5%).
This map is based on the most recent data from Eurostat and the World Bank. It shows the total numbers of unemployed people as they were distributed across Europe in 2012. The estimated total number for the whole of Europe at that time was 29,817,744, and it has risen since then. Nearly one fifth of this number live in Spain, which is the country with the highest absolute number of unemployed residents in Europe. In relative terms, the highest percentage is observed in Kosovo, a very poor country, where an estimated 45% of the economically active population are unemployed. The second highest estimated unemployment rate is in FYR Macedonia (31%), followed by Bosnia and Herzegovina (27%), Spain (25%) and Greece (24%). The countries with the lowest unemployment rates (all below 5%) are Austria, Switzerland, Norway, San Marino, Monaco, Liechtenstein and Andorra, which are among the richest countries in Europe. It is interesting to note that most of Europe’s people are not as free to move and settle in some of these high employment countries as they are to move to other parts of Europe.
10 - Environment
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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Carbon dioxide levels in the atmosphere have broken through a symbolic mark. Daily measurements of CO2 at a US government agency lab on Hawaii have topped 400 parts per million for the first time ... The last time CO2 was regularly above 400ppm was three to five million years ago – before modern humans existed.
BBC News, 2013c
According to the latest data from the World Bank, the estimated carbon dioxide (CO2) emissions produced by the burning of fossil fuels and the manufacture of cement in all countries mapped in this atlas was 4,101,932 kilotonnes (kt) in 2009. The largest share of this (about a fifth) was produced by Germany, followed by the United Kingdom (11.57%) and Italy (9.77%). However, when taking the total population of each state into account, Luxembourg has the highest level of emissions (20.3 metric tonnes per capita), followed by the Czech Republic and the Netherlands (10.3), while the lowest levels are observed in Albania (0.9), Turkey (3.9), Hungary, Croatia and Montenegro (each 4.9). The estimated level of world emissions of carbon dioxide is 4.7 metric tonnes per capita, while in the European Union it is 7.2 metric tonnes per capita.
Only in Albania and Turkey are emissions found to be lower than the global average. Lower levels of pollution are found only in areas where there is both very little highly polluting industry and where individual levels of material consumption are lower. Across all of Europe there is now an aim to reduce carbon dioxide pollution.
The levels of gases in the atmosphere that drive global warming increased to a record high in 2012. According to the World Meteorological Organization (WMO), atmospheric CO2 grew more rapidly last year than its average rise over the past decade. Concentrations of methane and nitrous oxide also broke previous records. Thanks to carbon dioxide and these other gases, the WMO says the warming effect on our climate has increased by almost a third since 1990.
McGrath, 2013
This map shows the estimated emissions from agricultural biomass burning, industrial activities and livestock management across Europe. According to data from the World Bank, these were estimated to be approximately 324,884.90 kt of carbon dioxide equivalent. Germany has the largest volume (13% of the total), followed by France, Turkey, Poland and the United Kingdom.
7 - Health
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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The EU has an enviably high life expectancy. In 2007, life expectancy at birth stood at 79 years in the EU compared to an average global expectancy of only 67 (UN). Outside Europe, only 6 countries in the world (Japan, Australia, Israel, Canada, New Zealand and Singapore) have a higher life expectancy.
European Commission, 2010, p 73
It is worth noting that the United States of America does not feature in the list in the quote above. This map and the next show the life expectancy at birth for females and males by region. The northeast Spanish region Comunidad Foral de Navarra has the highest female life expectancy at birth (86 years), followed by the French regions Rhône-Alpes (85.9),
Poitou-Charentes (85.8) and Île de France (85.8), and the Italian region Marche (85.7). On the other hand, the Bulgarian region Yugoiztochen has the lowest female life expectancy at birth (75.8). Other regions at the bottom end of the range include Bulgaria’s Severozapaden (76.1) and Severoiztochen (76.3), and Romanian regions Nord-Vest (76.1) and Vest (76.3).
Women appear to live longer in southern Europe than women in the north. However, this pattern will be influenced by the migration of many elderly people across international borders and towards the sunshine of the south.
The highest male life expectancy at birth is found in the Italian regions Marche (80.1) and Provincia Autonoma Bolzano/Bozen (79.8), followed by the UK regions Dorset and Somerset (79.7) and Berkshire, Buckinghamshire and Oxfordshire (79.7), and Italy’s Umbria (79.6) and Toscana (79.6). The lowest life expectancy values are observed in the Baltic countries (mapped here as single NUTS 2 regions) Lithuania (64.8), Latvia (65.8) and Estonia (67.2), and also in the Hungarian regions
Észak-Magyarország (67.4) and Észak-Alföld (68.4). Men appear to live longer in Western Europe than those in the East. Again migration since birth clearly plays a part – not just the migration of men who tend to do better in life further West, but also possibly the much higher migration rates of young women from the East, leaving more men behind.
The health of men without female partners tends to be worse (but the reverse does not, in general, apply).
1 - Introduction
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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A NEW WAY OF LOOKING AT EUROPE
The EU has delivered half a century of peace, stability, and prosperity, helped raise living standards and launched a single European currency, the euro and is progressively building a single Europe-wide market in which people, goods, services, and capital move among Member States as freely as within one country.
European Commission, 2012a
This is one of the declarations made on the European Union (EU) official website. The motto of the EU – the largest, most populous, political union of separate countries in the world – is ‘United in diversity’, signifying the intentions and efforts of Europeans to work together for peace and prosperity, while at the same time highlighting the idea that the many different cultures, traditions and languages of Europe are a key asset, benefit and legacy.
The EU website suggests that the history of the EU can be divided into six major periods as follows:
• 1945–59: A peaceful Europe – the beginnings of cooperation
• 1960s: The ‘Swinging Sixties’ – a period of economic growth
• 1970s: A growing Community – the first Enlargement
• 1980s: The changing face of Europe – the fall of the Berlin Wall
• 1990s: A Europe without frontiers
• 2000s: A decade of further expansion
(European Commission, 2012b)
However, at this stage it cannot be predicted how the current, seventh (2010s) decade might be labelled. In the aftermath of the financial crisis, will it be known as the decade of ever-closer union and pan-European identity, salvation and solidarity? Or will it be the decade of austerity and the revival of old divisions, national stereotypes and hatred? Will it be the decade of sustainability, ‘green growth’ and social cohesion? Or will it be the decade of rising mass poverty, gross inequality, social exclusion and environmental degradation? On one hand there have been some optimistic signs, including a recent report by the European Commission suggesting a reduction in health inequalities between European regions and, in particular, a narrowing of gaps in life expectancy and infant mortality (European Commission, 2013a). However, there are also suggestions, from evidence such as that presented in a recent Red Cross report, that ‘Europe is sinking into a protracted period of deepening poverty, mass unemployment, social exclusion, greater inequality, and collective despair as a result of austerity policies adopted in response to the debt and currency crisis of the past four years’ (Traynor, 2013).
Glossary of Terms and Abbreviations
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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3 - Demographics
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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“In all EU member states, the proportion of older people has increased in recent decades, because of a combination of low fertility and longer life expectancy. However, there are some variations between countries and time periods in the contributions of these factors.”
Rechel et al, 2013, p 1312
This diagram, known as a population pyramid, shows the distribution of the 503 million men and women in the European Union by different age groups. The shape of this diagram is often described as a ‘constrictive pyramid’, which is typical of developed societies with low fertility and mortality rates and with relatively older populations. The population aged 15–65 years is 335 million, whereas nearly one fifth of the total population is over 65 years old. There are only 78 million children aged 0–15. The male:female ratio in the EU is 0.95.
It is interesting to compare the population pyramid for the whole of the EU with similar diagrams for separate countries in Europe. Most member state pyramids look similar to that of the EU. However, the pyramids for Albania and to a lesser extent Turkey have a more ‘pyramid-like’ shape, suggesting either relatively higher outmigration rates in the recent past and/or a lower life expectancy. Fertility in these countries is not much higher than the EU average. On the other hand, Germany, the Netherlands and Andorra seem to have higher than average elderly populations.
Also of interest is the fact that Andorra has the highest male:female ratio, while Latvia, Lithuania and Estonia have the lowest ratios.
It is possible to explore the geographical dimension of the data presented in the population pyramids above, by examining them at the regional level. This map is a cartogram highlighting areas with the greatest geographical concentrations of populations of traditional working age (15–65 years) across European regions.
The lowest percentage of working age population (as a proportion of the total population in the region) is 55%, and it is observed in the region of Mardin, one of the oldest settled areas in the world, in southeast Turkey. The highest percentage is 74%, in Inner London. There are also very high rates in Poland, the Slovak Republic and Croatia. Here there are fewer elderly people and fewer children. Within Turkey, rates are high where people have migrated westwards.
4 - Education
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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This map is based on Eurostat population data and a dataset created by Barro and Lee (2013) to analyse educational attainment across the world between 1950 and 2010. The dataset uses UNESCO’s International Standard Classification of Education (ISCED), which is one of the most suitable for comparisons of ‘education statistics and indicators across countries on the basis of uniform and internationally-agreed definition’ (Barro and Lee, 2013, p 185). Educational comparisons are never ideal, but some are better than others. The meaning of ‘no school’ can range from arrived from outside Europe having never been to school, to hardly ever attended school, which will be the case for many older people, through to attended school but achieved so little that in terms of educational benefit it is as if the person never went.
Using the data for the latest year (2010), the map shows the distribution of the estimated numbers of people aged 15 years and over in Europe who have had no formal schooling. The total number is nearly 19 million, representing 3.7% of all Europe’s population aged 15 and over living in the countries mapped in this atlas. The highest numbers of people who have had no schooling are in Turkey, followed by Italy, Germany and the United Kingdom. However, it is interesting, and surprising, to see that the highest percentage is observed in Switzerland (11.7%). This is followed by Turkey (10.5%), Portugal (10.1%), Cyprus (10.0%) and Luxembourg (6.2%). On the other hand, the lowest percentages are observed in the Czech Republic (0.1%), Denmark (0.14%), Estonia (0.2%) and Norway (0.2%).
Around one in seven children leave school or training early and this has an impact on individuals, society and economies ... Early leavers from education and training and tertiary educational attainment are headline indicators for the Europe 2020 strategy.
European Commission, 2013c
This map uses data from the same study conducted by Barro and Lee (2013) as was used for the map on the previous page. The total estimated number of people across Europe who have, at most, primary education is 106 million people, representing about 21% of all residents aged 15 and over. The highest number is in Turkey, the second highest in the United Kingdom and third highest in Italy.
8 - Politics
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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The spirit of democracy is not a mechanical thing to be adjusted by abolition of forms. It requires change of the heart.
Mahatma Gandhi (Bombay Sarvodaya Mandal/Gandhi Book Centre, 2014)
Preserving democratic governance and human rights is considered to be one of the key contemporary values of Europe. It is also one of the key ‘Copenhagen criteria’ that needs to be met before any country can be considered as a potential member of the European Union. According to the 2008 European Values Survey, only a very small fraction of Europeans said they ‘disagreed strongly’ when asked if democracy is the best political system. This map shows their geographical distribution. Kosovo has the largest percentage of population strongly disagreeing with this statement. However, the value for Kosovo is only 4.5%, followed by Bulgaria (3.1%).
People disagreeing strongly with the statement that democracy is the best political system may, of course, believe that there is a better system that no one has invented yet, and that what many countries currently have is not the best there could ever be. Alternatively they may think that what is called a democratic system is, in fact, easily manipulated by a few ‘special interests’ with access to money, the media and politicians. This group may also include people who can remember, or have been told stories about, less democratic times in their own country when they thought the area was better run than it is today. It is notable that in Italy and Greece in 2008, very few people were strongly opposed to democracy.
At 57, the thrice-married motherof- three has long been a ubiquitous presence on the political landscape of Greece, a defining figure who began as the iconic ‘voice of the Polytechnic’ during the 1973 students’ revolt against the military dictatorship … Damanaki, who would spend seven months in prison after the regime crushed the rebellion, still bears the scars of that time. Memories of days spent in solitary confinement in a darkened cell at Athens’s notorious military police headquarters return to haunt her.
Smith, 2010, on Maria Damanaki, European Commissioner for Maritime Affairs and Fisheries
According to the 2008 European Values Survey, an estimated 2% of all respondents believe that the army ruling the country would be a very good political system. This map shows their geographical distribution.
The Social Atlas of Europe
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- 15 April 2023
- Print publication:
- 25 June 2014
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This is the first human geography social atlas of Europe to consider the European economy, culture, history and human and physical geography as a single land mass and a more unified European people. It provides an accessible overview of Europe and a human geography contribution to debates about a wide range of topics.
Frontmatter
- Dimitris Ballas, University of Sheffield, Danny Dorling, University of Oxford, Benjamin Hennig, University of Oxford
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- Book:
- The Social Atlas of Europe
- Published by:
- Bristol University Press
- Published online:
- 15 April 2023
- Print publication:
- 25 June 2014, pp i-ii
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- Chapter
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