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Background

Effectiveness estimates from observational studies on ticagrelor use in routine clinical care are conflicting, with some contrary to the results of the pivotal randomized controlled trial of ticagrelor in acute coronary syndrome. The aim of this study was to estimate the effect of implementing and using ticagrelor in routine clinical care in patients with myocardial infarction using a natural experimental approach.

Methods and Results

This is a retrospective cohort study including patients hospitalized for myocardial infarction in Sweden between 2009 and 2015. The study exploited differences in the timing and speed of ticagrelor implementation between treatment centers as a source of random treatment assignment. The effect of implementing and using ticagrelor was estimated based on the admitting center's likelihood of treating patients with ticagrelor, measured as the proportion of patients treated in the 90 days before patient admission. The main outcome was 12‐month mortality. The study included 109 955 patients, of whom 30 773 were treated with ticagrelor. Being admitted to a treatment center with higher past ticagrelor use was associated with a reduction in 12‐month mortality (2.5 percentage points for 100% versus 0% past use [95% CI, 0.2–4.8]). The results are in line with the findings from the ticagrelor pivotal trial.

Conclusions

Using a natural experiment, this study finds that the implementation and use of ticagrelor in routine clinical care has reduced 12‐month mortality in patients admitted to the hospital with myocardial infarction in Sweden and supports the external validity of randomized evidence on ticagrelor effectiveness.

We study the effects of introducing a performance-based promotion program for teachers in Sweden. The pro-gram intended to make the teaching profession more attractive by raising wages for skilled teachers and taking advantage of teachers' professional competence. Our results show that: (i) high-wage teachers are more likely to be promoted; (ii) the stipulated wage increase has full pass-through onto wages for promoted teachers; (iii) schools with promotions have lower teacher separations and an improved pool of teachers. These results suggest that performance-based promotions could be an important tool for raising teacher quality.

Det hävdas ofta att storasyskon skulle vara mer ansvarsfyllda, eller att småsyskon skulle vara mer kreativa. Hur man påverkas av platsen i syskonskaran har också gett upphov till en omfattande forskningslitteratur. En stor del av forskningen präglas emellertid av små urval och otillräcklig information om familjen. I den här artikeln presenteras resultaten från våra egna studier av syskonordningens betydelse för individers hälsa och personlighet. Vi diskuterar även möjliga mekanismer bakom syskonordningseffekter och vilka data som krävs för att kunna fastställa trovärdiga orsakssamband. 

INTRODUCTION: Nepal Perinatal Quality Improvement Project (NePeriQIP) intends to scale up a quality improvement (QI) intervention for perinatal care according to WHO/National guidelines in hospitals of Nepal using the existing health system structures. The intervention builds on previous research on the implementation of Helping Babies Breathe-quality improvement cycle in a tertiary healthcare setting in Nepal. The objective of this study is to evaluate the effect of this scaled-up intervention on perinatal health outcomes.

METHODS/DESIGN: Cluster-randomised controlled trial using a stepped wedged design with 3 months delay between wedges will be conducted in 12 public hospitals with a total annual delivery rate of 60 000. Each wedge will consist of 3 hospitals. Impact will be evaluated on intrapartum-related mortality (primary outcome), overall neonatal mortality and morbidity and health worker's performance on neonatal care (secondary outcomes). A process evaluation and a cost-effectiveness analysis will be performed to understand the functionality of the intervention and to further guide health system investments will also be performed.

DISCUSSION: In contexts where resources are limited, there is a need to find scalable and sustainable implementation strategies for improved care delivery. The proposed study will add to the scarce evidence base on how to scale up interventions within existing health systems. If successful, the NePeriQIP model can provide a replicable solution in similar settings where support and investment from the health system is poor, and national governments have made a global pledge to reduce perinatal mortality.

TRIAL REGISTRATION NUMBER: ISRCTN30829654.

We study the intergenerational transmission of cognitive and noncognitive abilities using population data and correct for measurement error in abilities using two sets of instruments. The results show that previous estimates are biased downward and that once measurement error is corrected for, the correlation in noncognitive ability is close to that of cognitive ability. By considering both parents, intergenerational ability correlations account for a substantial portion of the sibling correlation. Using adoptees, we find that the social impact of maternal abilities is more important than paternal abilities. Children's educational attainment and labor market outcomes are strongly related to parents' cognitive and noncognitive abilities.

We document a substantial decline in cognitive and social interactive abilities and in GPAs among entering teachers. Then, using matched student-teacher data, we find that teacher abilities have a negligible impact on average student achievement This finding hides interesting heterogeneities. In particular, an increase in teachers' cognitive (social) abilities increases (reduces) the achievement gap between high- and low-aptitude students. Teacher cognitive and social abilities further appear to be complements. We also find strong positive effects of male teachers' GPAs that are uniform across students, but similar effects are not found for female teachers' GPAs.

In many countries welfare services that traditionally have been provided by the public sector are being contracted out to private providers. But are private contractors better at providing these services? We use a randomized experiment to empirically assess the effectiveness of contracting out employment services to private placement agencies. Our results show that unemployed at private placement agencies have a closer interaction with their case worker than unemployed at the Public Employment Service (PES); e.g., they receive more assistance in improving their job search technology. We do not find any overall difference in the chances of finding employment between private placement agencies and the PES, but this hides important heterogeneities across different types of unemployed. In particular, private providers are better at providing employment services to immigrants, whereas they may be worse for adolescents. Any effects tend to fade away over time. 

Aim:  To investigate the association between perinatal risk factors and neonatal complications and early oculo-motor development in very preterm infants.

Methods:  Perinatal risk factors were identified, and the potential association with early oculo-motor development was evaluated by measuring smooth pursuit eye movements (SP) at 2 and 4 months' corrected age (CA) in a population of very preterm infants born in Uppsala County 2004-2007 (n = 113).

Results:  Among the 15 tested factors, eight showed significant association in univariate analysis with lower levels of SP at 4 months' CA, namely administration of prenatal corticosteroids, gestational age, birthweight, bronchopulmonary dysplasia, retinopathy of prematurity, periventricular leukomalacia, intraventricular haemorrhage >grade 2, and persistent ductus arteriosus. At 2 months' CA, only retinopathy of prematurity >stage 2 was associated with lower levels of SP. When all factors significant in the univariate tests were included in multiple regressions aimed to assess each factor's independent relation to SP, periventricular leukomalacia was the only significant independent factor. When adding 2-5 of the significant factors using multiple regression analysis, the levels of SP became lower.

Conclusion:  Perinatal risk factors were associated with lower levels of SP. This could be interpreted as delayed or disturbed development of normal oculomotor ability.

We examine the demand for wines in Sweden using five years ofweekly data on sales, advertising, and expert reviews. The effect of afavorable review peaks in the week after publication with an increasein demand of 6 percent, and the effect remains significant for morethan 20 weeks. We find small demand-enhancing effects of neutralreviews and no evidence of important negative effects from unfavorablereviews. Restrictions on the state-owned monopoly retailer andthe exogenous timing of a subset of the reviews support a causalinterpretation of the effects of reviews on demand.

In many countries welfare services that traditionally have been provided by the public sector are being contracted out to private providers. But are private contractors better at providing these services? We use a randomized experiment to empirically assess the effectiveness of contracting out employment services to private placement agencies. Our results show that unemployed at private placement agencies have a closer interaction with their case worker than unemployed at the Public Employment Service (PES); e.g., they receive more assistance in improving their job search technology. We do not find any overall difference in the chances of finding employment between private placement agencies and the PES, but this hides important heterogeneities across different types of unemployed. In particular, private providers are better at providing employment services to immigrants, whereas they may be worse for adolescents. Any effects tend to fade away over time.