6 research outputs found

    Outpatient antibiotic use attributable to viral acute lower respiratory tract infections during the cold season in France, 2010-2017

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    International audienceAntibiotic stewardship requires clear insight into antibiotic overuse and the syndromes that lead to prescription. The aim of this study was to estimate the proportion of antibiotic prescriptions attributable to acute lower respiratory tract infections (LRTIs) during the cold season. Using individual data from the French National Health Insurance (NHI) database, weekly time series were constructed of outpatient antibiotic (beta-lactams and macrolides) prescriptions between January 2010 and December 2017. Time series were also constructed of tenth edition of the International Classification of Diseases (ICD-10) discharge diagnoses from a national network of emergency departments (EDs), stratified by specific syndromes (pneumonia, bronchitis, bronchiolitis and influenza-like illness). The number of outpatient antibiotic prescriptions attributable to these syndromes during the cold season in France was modeled and estimated for the entire population, young children (≤5 years) and the elderly (≥75 years). LRTIs accounted for 40% (95% confidence interval [95% CI]: 29, 52) of outpatient antibiotic use during the cold season for the entire population, including 23% (95% CI: 13, 33) and 17% (95% CI: 13, 22) for bacterial and viral infections, respectively. In children and the elderly, viral LRTIs were the reason for 38% (95% CI: 31, 46) and 20% (95% CI: 16, 25) of outpatient antibiotic use, respectively (with bronchiolitis accountable for half of use in young children). In the entire population and in children, respectively, outpatient antibiotic overuse attributable to viral LRTIs was estimated to be 289 (95% CI: 221, 374) and 1588 (95% CI: 1295, 1922) prescriptions per 100 000 inhabitants per week. These results highlight the major role of viral infections in driving antibiotic prescriptions, particularly in young children

    Association of Pneumococcal Conjugate Vaccine Coverage With Pneumococcal Meningitis: An Analysis of French Administrative Areas, 2001–2016

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    International audienceGeographic variations of invasive pneumococcal disease incidence and serotype distributions were observed after pneumococcal conjugate vaccine introduction at regional levels and among French administrative areas. The variations could be related to regional vaccine coverage (VC) variations that might have direct consequences for vaccination-policy impact on invasive pneumococcal disease, particularly pneumococcal meningitis (PM) incidence. We assessed vaccine impact from 2001 to 2016 in France by estimating the contribution of regional VC differences to variations of annual local PM incidence. Using a mixed-effect Poisson model, we showed that, despite some variations of VC among administrative areas, vaccine impact on vaccine-serotype PM was homogeneously confirmed among administrative areas. Compared with the prevaccine era, the cumulative VC impact on vaccine serotypes led, in 2016, to PM reductions ranging among regions from 87% (25th percentile) to 91% (75th percentile) for 7-valent pneumococcal conjugate vaccine serotypes and from 58% to 63% for the 6 additional 13-valent pneumococcal conjugate vaccine serotypes. Nonvaccine-serotype PM increases from the prevaccine era ranged among areas from 98% to 127%. By taking into account the cumulative impact of growing VC and VC differences, our analyses confirmed high vaccine impact on vaccine-serotype PM case rates and suggest that VC variations cannot explain PM administrative area differences

    Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis

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    International audienceAbstractBackgroundPneumococcal meningitis (PM) is a major invasive pneumococcal disease. Two pneumococcal conjugate vaccines (PCVs) have been introduced in France: PCV7 was recommended in 2003 and replaced in 2010 by PCV13, which has six additional serotypes. The impact of introducing those vaccines on the evolution of PM case numbers and serotype distributions in France from 2001 to 2014 is assessed herein.MethodsData on 5166 Streptococcus pneumoniae strains isolated from cerebrospinal fluid between 2001 and 2014 in the 22 regions of France were obtained from the National Reference Center for Pneumococci. The effects of the different vaccination campaigns were estimated using time series analyses through autoregressive moving-average models with exogenous variables (“flu-like” syndromes incidence) and intervention functions. Intervention functions used 11 dummy variables representing each post vaccine epidemiological period. The evolution of serotype distributions was assessed for the entire population and the two most exposed age groups ( 64 years old).ResultsFor the first time since PCV7 introduction in 2003, total PM cases decreased significantly after starting PCV13 use: –7.1 (95% CI, –10.85 to –3.35) cases per month during 2013–2014, and was confirmed in children  64 years old (–2.0; 95% CI, –3.36 to –0.57). During 2012–2014, different non-vaccine serotypes emerged: 12F, 24F in the entire population and children, 6C in the elderly; serotypes 3 and 19F persisted in the entire population.ConclusionsUnlike other European countries, the total PM cases in France declined only after introduction of PCV13. This suggests that vaccine pressure alone does not explain pneumococcal epidemiological changes and that other factors could play a role. Serotype distribution had changed substantially compared to the pre-vaccine era, as in other European countries, but very differently from the US. A highly reactive surveillance system is thus necessary not only to monitor evolutions due to vaccine pressure and to verify the local serotypic appropriateness of new higher-valent pneumococcal vaccines, but also to recognise and prevent unexpected changes due to other internal or external factors

    Trade Linkages and the Trade Matrices in the OECD Interlink Model

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    This paper provides a mainly graphical summary of the trade matrices underlying the OECD’s international macroeconomic model Interlink. In doing so it gives a snapshot of the geographical nature of global trading relationships, in particular between individual OECD countries and the main non-OECD regions, distinguishing trade in manufactures non-manufactures and non-factor services. It also serves more broadly as a 'ready reckoner' guide to the sensitivity of shocks that are transmitted through trade. The sources and methods used to construct the matrices are also described in annexes ... Les relations commerciales et les matrices de commerce dans le modele interlink de l'OCDE Ce document résume sous forme principalement graphique les matrices de commerce qui sont à la base d'INTERLINK, le modèle macroéconomique international de l'OCDE. Ce faisant, il donne un instantané du caractère géographique des relations globales de commerce, en particulier entre les pays individuels membres de l'OCDE et les principales régions non-OCDE, en distinguant commerce de produits manufacturés, non-manufacturés et services hors revenus d'investissement. Ce document sert aussi plus généralement comme guide "prêt-à-l'emploi" de la sensibilité aux chocs transmis par le commerce. Les sources et méthodes utilisées à la construction des matrices sont aussi décrites en annexe ...trade, trade matrices, International macroeconomic model, marchés financiers internationaux

    Modelling Manufacturing Export Volumes Equations: A System Estimation Approach

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    International trade is a principle transmission mechanism by which developments in one country can have repercussions in others and how it is modelled is an important part of any multi-country model. This paper describes recent estimation work carried out by the OECD, which respecifies and updates the equations which determine manufactures export volumes in the OECD INTERLINK model. An important feature of this estimation work is that the relevant equations are estimated as a consistent system, allowing data acceptable parameter restrictions to be imposed across countries. For a number of countries and regions allowance is also made for the possible influence of supply-side factors on market share performance over and above that explained by changes in price competitiveness, using non-linear trend variables. The paper reports both estimation results and the simulation properties of the equations both in isolation and as part of corresponding country models and the fully linked ... Le commerce international est un mécanisme de transmission essentiel par lequel l'évolution de la situation dans un pays peut avoir des répercussions sur les autres pays, et la façon dont il est modélisé joue un rôle important dans tout modèle multinational. Ce document décrit le travail d'estimation récemment entrepris par l'OCDE qui modifie les specifications et met à jour les équations qui déterminent les volumes d'exportation de produits manufacturés dans le modèle INTERLINK de l'OCDE. Une caractéristique importante de ce travail est que les équations concernées sont estimées de façon à former un système cohérent, permettant de contraindre les coefficients à être identiques entre pays, lorsque les tests économétriques le justifient. Pour un certain nombre de pays et de régions, l'utilisation d'une tendance non linéaire permet aussi d'expliquer l'évolution de leurs parts de marchés par l'influence possible de facteurs d'offre, outre les effets dûs à l'évolution de leur ...trade, exports, forecasting and simulation

    The New OECD International Trade Model

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    This paper provides a detailed description of recent research to re-estimate and re-specify the international trade volume and price equations that are used in the OECD Economics Department to analyse international trade developments. New panel data estimates of the factors affecting export performance, import penetration and exchange rate pass-through into trade prices are reported for both OECD and non-OECD economies. The model set out has already been used successfully to monitor the global consistency of the international trade projections in the Economic Outlook. Le nouveau modèle du commerce international de l'OCDE Cette étude présente de façon détaillée la respecification et la réestimation des équations de commerce extérieur (prix et volumes) qui sont utilisées par le Département des Affaires Économiques de l'OCDE pour analyser les développements du commerce mondial. L'impact des facteurs influençant la performance à l'exportation, le taux de pénétration des importations et l'effet du taux de change sur les prix du commerce extérieur des zones OCDE et non OCDE est estimé par le biais de données de panel. Le model présenté a déjà été mis en oeuvre avec succès pour assurer la cohérence globale des prévisions des flux commerciaux publiées dans les Perspectives Économiques de l'OCDE.international trade prices, forecasting model, international trade volumes, volumes du commerce extérieur, modèle de prévision, prix du commerce extérieur