Antibiotic Self-Medication and Antibiotic Resistance: Multilevel Regression Analysis of Repeat Cross-Sectional Survey Data in Europe

Antibiotic resistance is a global public health issue with several anthropogenic drivers, including antibiotic consumption. Recent studies have highlighted that the relationship between antibiotic consumption and antibiotic resistance is contextualised by a variety of socioeconomic, cultural, and governance-related drivers of consumption behaviour and contagion that have been underexamined. A potential complication for research and policy is that measures of antibiotic consumption are often reliant on prescribing or sales data which may not easily take into account the dynamics of community consumption that include self-medication; for example, the preservation and use of leftover medication or the obtaining of antibiotics without a prescription. This study uses repeated cross-sectional survey data to fulfil two core aims: firstly, to examine the individual-level and national-contextual determinants of self-medication among antibiotic consumers in European countries, and secondly, to examine the relationship between self-medication behaviour and antibiotic resistance at the national level. This study is particularly novel in its application of a multilevel modelling specification that includes individual-level factors with both time-variant and persistent national characteristics to examine antibiotic consumption behaviours. The key findings of the study are that survey respondents in countries with persistently higher levels of inequality, burdens of out-of-pocket health expenditure, and corruption have an increased probability of self-medicating with antibiotics. The study also highlights that overall levels of antibiotic consumption and antibiotic self-medication do not correlate and are associated heterogeneously with changes in different pathogen/antibiotic pairs. In summary, the study emphasises that antibiotic stewardship and antibiotic resistance, whilst related by biological mechanisms, are also inherently social issues. Attempts to improve antibiotic stewardship and address the challenge of antibiotic resistance should also attend to structural challenges that underlie challenges to antibiotic stewardship in the community, such as the effects of inequality and reduced access to healthcare services

Identity, enactment and entrepreneurship engagement in a declining place

We examine entrepreneurship practice and identity work in a rural small town in New Zealand. Once prosperous, the town suffered economically and socially as old industries closed. Recently the town was rejuvenated, largely because of Linda's entrepreneurial activities. Our findings demonstrated conflict between her entrepreneurial identity and local sense of place. We theorize Linda's entrepreneurial identity in her business practice; where she experienced controversy, despite economic success. We argue that a complete understanding of identity and entrepreneurship practices requires attention to social and spatial processes, not just economic processes

Patterns and trends in entrepreneurial network literature: 1993-2003

This paper reflects the increasing interest in entrepreneurial networking. Indeed Monsted (1995) suggests that networking is now a vogue concept in the entrepreneurship field. The popularity of the network theme has resulted in an increasing number of publications. Our study is an attempt to first quantify the growth in network research, as indicated by published papers. It then attempts to provide a guide to developments in network publications

The protean entrepreneur: the entrepreneurial process as fitting self and circumstance.

This paper is an ethnographic study of rural entrepreneurship. It explores the relationship between small business and the rural environment and is intended to contribute to the development of entrepreneurial theory. The major findings are that the entrepreneurial process is the creation and extraction of value from the environment, but that the background of the entrepreneur configures the idiosyncratic entrepreneurial process. The key to understanding this is argued to be the entrepreneurs perception of value, so that entrepreneurship is argued to be protean in that it takes its shape from the dynamics of the individual fitting themselves into their perception of the socio-economic context. Thus the entrepreneurs approach to business can be understood in terms of their values and in this study, the entrepreneurial business is shaped and formed from these same values

Enacted metaphor: the theatricality of the entrepreneurial process.

The article proposes the value of theatricality as an additional conceptual tool to aid analysis and understanding of the entrepreneurial process. It explores the application of dramatism and dramaturgy and argues that such application is a useful addition to our repertoire. In particular, the ideas of spanning the boundaries of space and time and of truth and fiction, and the liminality of entrepreneurship lend themselves to such theatrical analysis. This allows a fuller appreciation of the entrepreneurial act in the duality of the concepts of the world as stage and the world as staged. The metaphors of theatricality offer an alternative medium for understanding

The Arcadian Enterprise : an enquiry into the nature and conditions of rural small business

This thesis is a study of rural entrepreneurship which attempts to understand what it is that rural entrepreneurs do within the rural context. Our understanding of entrepreneurship is fragmentary, often narrowly focused and discipline bound. Entrepreneurial theory lacks even a limiting definition of the phenomenon. As Bartlett 1988 claims, it is an intellectual onion; if you keep peeling off the layers you are left with nothing and come away in tears. This seems to suggest that entrepreneurship is a process rather than an entity. Furthermore, a major focus of entrepreneurial research has been the entrepreneur as an individual, yet paradoxically, entrepreneurship is essentially a social act. Accordingly the central argument of this thesis is that in order to understand the entrepreneur we must place entrepreneurial action in its social context, we must study the process of entrepreneurship. This study therefore endeavours to investigate the actions of the entrepreneur in one context, rurality. Consequently this study is a detailed examination of a rural environment and the interrelationships of this environment and entrepreneurs. Its purpose is to try to establish the nature of the relationships between rurality and to specify the conditions of the entrepreneurial process

The economic reification of entrepreneurship: re-engaging with the social.

Growth and development at personal, firm and national levels are all, quite properly, attributed to entrepreneurship. However, the importance of these entrepreneurial outcomes has shaped how we perceive entrepreneurs and the entrepreneurial concept. The significance of these positive outcomes seems to imply that entrepreneurship is primarily an economic function. In consequence throughout history, the words 'entrepreneur', 'entrepreneurial' and 'entrepreneurship' have been associated with specific economic roles and phenomena (Hebert and Link 1982). Van Praag and Versloot (2007) go so far as to claim that almost without exception, academic studies on entrepreneurship are motivated by the economic benefits of entrepreneurship. In short, our perceptions of entrepreneurship have become functionalist. Economics has won the battle for theoretical hegemony in academia and society as a whole and such dominance becomes stronger every year (Ferraro et al, 2005). At the very least, as Minniti and L{acute}evesque (2008) claim, many aspects of entrepreneurship and its implications have been studied taking the lens of neoclassical economics. The problem is that this functionalist lens is narrow. Its necessary reductionism doesn't permit us to see enough of, or to take into account, the fine grain of context and circumstance, nor of the non-mechanistic behaviour, the sentient and the emotional entrepreneurial practices that characterise entrepreneurship. This is surprising, because entrepreneurship is always about novelty and newness, doing things differently and creating change. The qualities of context and idiosyncratic human behaviour are the very qualities that may provide this very novelty that makes things entrepreneurial. By confining entrepreneurship in an economic paradigm, our understanding is at risk of a procrustean trimming, a reductionism that offers poor explanatory justice. It also fails to give due explanatory weight to how entrepreneurship emerges from social and economic interactions (Anderson et al, 2012). Consequently, I want to argue that the economists focus on outcomes means that economic 'explanation' has overwhelmed 'understanding' (Anderson, 2014). The economistic dominance of enquiries about what causes entrepreneurship are explanations of enterprise that have served us well in explaining aspects such as innovation. But they serve us poorly in understanding how such processes emerge

Conceptualising entrepreneurship as economic 'explanation' and the consequent loss of 'understanding'.

This paper examines how entrepreneurship has become conceptualised as an economic phenomenon. We explain how the outcomes, the admirable results of entrepreneurship, have led to this position. An understandable concern for the economic benefits from enterprise, and the appeal of measurability, has led to a focus on explaining entrepreneurship. This has been matched by a relative neglect of examining the processes that would help us to understand entrepreneurship. Explanations of entrepreneurship best fit a systems view, where entrepreneurship is a mechanism for adjustment to change, as for example in Kirznerian alertness. But such a view cannot take full account of how entrepreneurship produces change. In homogenising entrepreneurship's idiosyncratic nature, we miss the nuanced understanding of how the entrepreneurial self fits into context to create, as well as employ, change. The instrumentality of explanation obscures the subjectivity of entrepreneurial practices

Entrepreneurship and networked collaboration: synergetic innovation, knowledge and uncertainty.

This conceptual paper examines the nature of entrepreneurship in innovation processes in time of crisis. Crisis is a time of heightened uncertainty, manifested as increased ambiguity about what knowledge is available yet necessary for innovation. It is argued here that connecting this diverse knowledge is essential for innovation and that this is a key entrepreneurial process. Whilst this point is established in the literature, there is perhaps a gap in understanding how such knowledge is entrepreneurially applied. In systems-based views of innovation there seems to be an assumption that knowledge synthesis just happens as a natural occurrence. Reviewing and synthesising disparate literatures, this paper argues that stocks of knowledge are not, in themselves, sufficient to produce innovation. Instead, entrepreneurial agency is required to collaborate, connect and to combine these knowledge stocks to produce innovation. The paper contributes to understanding and theory by demonstrating how and why this 'social' connecting is a critical element of the entrepreneurial role and a crucial part of innovation