Competition reduces rent extraction in private-sector firms. In this article, we empirically assess whether it similarly disciplines politicians by evaluating local-level governments' performance in ...Flanders. The results indicate that electoral competition - measured via the number of parties competing in elections - significantly positively affects the productive efficiency of municipal policy. Intertemporal competition - measured as the volatility of election outcomes over time - has a similar, but weaker, positive effect. These beneficial effects are mitigated by the fact that competition may lead to more fragmented governments, which is shown to work against their productive efficiency. Overall, though, the beneficial effects outweigh the unfavourable ones in our sample.
In national elections the results tend to become more 'nationalized': a homogeneous party offer all over the territory, less variation in the results per constituency & more homogeneous electoral ...swings. This article investigates whether this nationalization can also be witnessed at local elections. It focuses on two indicators: the party offer & the voting behavior. The party offer is the presence of the national parties on the local ballot paper, while the voting behavior looks at patterns of homogeneity across the municipalities. The answer to the question of nationalization is mixed. The Flemish & Walloon local elections display the same long-term trend as the national elections, but they keep their own local character. The heterogeneity of the local party offer clearly demonstrates the local specificity of the local elections, & consequently the voting behavior also differs from the voting behavior at national elections. We also find that the local elections in Wallonia are less nationalized than in Flanders. Although the local character of the local elections remains important, the newer parties -- Ecolo & Groen! -- show until 2000 a clear trend towards nationalization. Especially the extreme right Vlaams Belang shows positive scores on all indicators of nationalization since its first local appearance in 1982. Tables, Figures. Adapted from the source document.
To characterize differences between Herpes Simplex virus encephalitis and Varicella-Zoster virus encephalitis (HSVE and VZVE) and other aetiologies of infectious encephalitis (IE), and to investigate ...the impact of time-to-aciclovir (ACV) start, ACV dose and duration on outcome.
We compared 132 HSVE, 65 VZVE and 297 other IE enrolled in a prospective cohort (ENCEIF). We estimated associations between time-to-ACV start, dose or duration and outcome through adjusted odds ratio (aOR) using logistic regression analysis.
Prevalence of immunodepression differed among aetiologies: 15/65 (23%) for VZVE, 13/132 (10%) for HSVE and 30/297 (10%) for other IE (p <0.05), as was presence of seizure at admission: 27/132 (20%) for HSVE, 4/65 (6%) for VZVE and 43/297 (14%) for other IE (p <0.05). Poor outcome at hospital discharge (Glasgow outcome scale ≤3) differed among the three groups: 40/127 (31%) for HSVE, 12/65 (18%) for VZVE and 38/290 (13%) for other IE (p <0.05). Time-to-ACV start was associated with outcome in HSVE (aOR 3.61 1.25–10.40), but not in VZVE (aOR 0.84 0.18–3.85). Increased ACV dose was not associated with outcome among HSVE (aOR 1.25 0.44–3.64) nor VZVE (aOR 1.16 0.24–5.73).
HSVE and VZVE are distinct in clinical presentation, outcome and prognostic factors. The impact of early ACV initiation was more apparent for HSVE than for VZVE; however, this could be because of VZVE’s smaller sample size and lower outcome rate leading to low statistical power or because of potential distinct IE pathophysiology.
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To assess prescribers' experiences and opinions regarding antimicrobial stewardship programme (ASP) activities.
A cross-sectional paper-based survey was conducted among prescribers in 27 out of 35 ...randomly selected large hospitals in France.
All 27 investigated hospitals (20 non-university public, 4 university-affiliated and 3 private hospitals) had an ASP and an appointed antibiotic advisor (AA), with a median of 0.9 full-time equivalents per 1000 acute-care beds (IQR 0-1.4). Of the 1963 distributed questionnaires, 920 were completed (46.9%). Respondents were mainly attending physicians (658/918, 71.7%) and medical specialists (532/868, 61.3%). Prescribers identified two main ASP objectives: to limit the spread of resistance (710/913, 77.8%) and to improve patient care and prognosis (695/913, 76.1%). The presence of an AA constituted a core element of ASP (96.2% agreement between answers of ASP leader and respondents). Respondents acknowledged an AA's usefulness especially on therapeutic issues, i.e. choosing appropriate antibiotic (agreement 84.7%) or adapting treatment (89.6%), but less so on diagnostic issues (31.4%). Very few respondents reported unsolicited counselling and post-prescription controls. Three-quarters of prescribers identified local guidelines (692/918, 75.4%). Prescribers did not approve of measures counteracting their autonomy, i.e. automatic stop orders (agreement 23.4%) or pre-approval by AAs (28.8%). They agreed more with educational interventions (73.0%) and clinical staff meetings (70.0%).
Prescribers perceived ASP mainly through its 'on-demand' counselling activities. They preferred measures that did not challenge their clinical autonomy. High levels of antibiotic consumption in French hospitals bring into question the effectiveness of such an approach. However, limited ASP staffing and resources may preclude extended activities.
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