Do smoke-free laws affect revenues in pubs and restaurants?

In the debate about laws regulating smoking in restaurants and pubs, there has been some controversy as to whether smoke-free laws would reduce revenues in the hospitality industry. Norway presents an interesting case for three reasons. First, it was among the first countries to implement smoke-free laws, so it is possible to assess the long-term effects. Second, it has a cold climate so if there is a negative effect on revenue one would expect to find it in Norway. Third, the data from Norway are detailed enough to distinguish between revenue from pubs and restaurants. Autoregressive integrated moving average (ARIMA) intervention analysis of bi-monthly observations of revenues in restaurants and pubs show that the law did not have a statistically significant long-term effect on revenue in restaurants or on restaurant revenue as a share of personal consumption. Similar analysis for pubs shows that there was no significant long-run effect on pub revenue

Smoking behaviors before and after implementation of a smoke-free legislation in Guangzhou, China

BACKGROUND: According to the partial smoke-free legislation implemented on 1 September 2010 in Guangzhou, China, smoke-free did not cover all indoor areas. Some places have a full smoking ban (100 % smoke-free), other places have a partial smoking ban, and homes have no ban. This study aimed to compare the smoking behaviors before and after implementation of a smoke-free legislation. METHOD: A repeated cross-sectional survey was conducted on smoking-related behaviors with a total of 4,900 respondents before, and 5,135 respondents after the legislation was instituted. For each wave of the survey, a three-stage stratified sampling process was used to obtain a representative sample. Pearson’s Chi-square test was used to determine differences of smoking prevalence and quit ratio between the two samples. Logistic regression models were used to examine the associations of a smoke-free legislation with smoking behaviors. RESULTS: The overall daily smoking rate declined significantly from 20.8 % to 18.2 % (p < 0.05), especially among those aged 15–24 years. The quit ratios increased significantly (from 14.5 % to 17.9 %), but remained low among 15–44 year olds. The overall self-reported smoking behaviors in locations with a full smoking ban decreased significantly from 36.4 % to 24.3 % with the greater drops occurring in cultural venues, public transport vehicles, and government offices. Smoking in places with partial smoking bans remained high (89.6 % vs. 90.4 %), although a slight decrease was observed in some of these areas. The implementation of a smoke-free legislation did not lead to more smoking in homes (91.0 % vs 89.4 %), but smoking in homes remained high. CONCLUSIONS: These findings highlight the urgent need for a comprehensive smoke-free legislation covering all public places in Guangzhou, simultaneously educational interventions and campaigns promoting voluntary changes in home smoking need to occur

European Regional Differences in All-Cause Mortality and Length of Stay for Patients with Hip Fracture

Background: Today’s healthcare systems face challenges involving rising need and demand for healthcare as well as concerns about cost containment, misuse of medical services and unwarranted variations in medical practices. Given the stretched budgets for healthcare, there is a need to improve healthcare performance and to make competent use of limited resources. To support organisations in improving performance, benchmarking is a valuable tool for several reasons. First, it is an effective substitute for competition in the public sector. Second, through benchmarking, performance differences between organisations in various measures are revealed, and for those performing less optimally, possible improvement areas may be discovered. Third, benchmarking is useful for evaluating the impact of healthcare reforms on performance. Coupled with big data from patient registers and other administrative registers, benchmarking thus can offer opportunities for finding ideal structures in the provision and financing of healthcare. Aim: The overall aim of this thesis was to show how benchmarking can be applied to assess healthcare performance with the use of register data. Methods: The four studies included in the thesis were based on two comprehensive patientlevel datasets, with data obtained from multiple registers. Study I applied international benchmarking, with the performance for the surgical treatment of hip fractures being assessed between and within seven European countries. Regression analyses were used to explore associations between age- and sex-adjusted mortality rates and length of stay (LOS) and selected country- and region-level variables. In Studies II–IV, a national perspective was considered in the assessment of the performance of elective hip replacement surgery in Sweden. In Study II, the orthopaedic departments’ productivity development between 2005 and 2012 was measured by the Malmquist Productivity Indices. The indices were further decomposed into changes in efficiency and technology. In Studies III and IV, a quasi-experimental research design was applied to assess the effects of a healthcare reform involving competition and financial incentives introduced in the capital region in 2009. In both studies, difference-in-difference analysis was used to estimate the causal effects on LOS and various measures of subjective and objective quality. In Study III, the difference-in-difference analyses were also stratified by hospital type to examine whether the reform had heterogenous effects across hospital types. In Study IV, an entropy balancing algorithm was further applied to make the intervention and control groups comparable. Findings: Study I revealed marked differences in age- and sex-adjusted LOS and mortality rates for hip fracture patients, across and within included countries. Variations were found to be associated with the availability of national clinical guidelines, the share of males in the region and country-specific effects. In Study II, differences in the development of productivity, efficiency and technology in the provision of hip replacement surgery across and within the orthopaedic departments were revealed. The overall results indicated a slight positive productivity development over the study period, which was primarily due to catch-up effects (improvements in efficiency), rather than changes in technology. The findings from Study III indicated that the reform led to the LOS of the surgical admission not decreasing at the same rate as before, and to reduction of the adverse event rate within 90 days following surgery. These effects were driven mainly by university and central hospitals. Furthermore, the reform brought no changes in patient satisfaction with the outcome of the surgery (Study III and Study IV) or gains in various patient-reported outcome measures at oneand six-year follow-ups (Study IV). Conclusions: The thesis has demonstrated how benchmarking can be applied to assess healthcare performance with the use of register data, with the four studies contributing with various perspectives and measurements at different levels of healthcare systems. First, the thesis has exemplified how performance measurement can be applied to identify and analyse performance gaps. Considerable variations in the performance of orthopaedic care between and within units of analysis were revealed at the departmental and international levels. This implies that there is room for improvement and that stakeholders should learn from best practices. Second, the thesis has demonstrated how benchmarking can be useful in the assessment of healthcare reforms. The findings indicated that the studied reform reduced the adverse event rate, led to LOS not decreasing at the same rate as before and had no effect on patient-reported outcome measures. These findings contribute to the general knowledge about the effects of market elements and financial incentives and can be used to inform decisionmaking. Future perspectives should focus on how this information can and should be used in practice to change organisations’ behaviour and to improve healthcare performance

Decreased aminoacylation of mutant tRNAs in MELAS but not in MERRF patients

Mutations in human mitochondrial tRNA genes are associated with a number of multisystemic disorders. Using an assay that combines tRNA oxidation and circularization we have determined the relative amounts and states of aminoacylation of mutant and wild-type tRNAs in tissue samples from patients with MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, stroke-like episodes) and MERRF syndrome (myoclonus epilepsy with ragged red fibers), respectively. In most, but not all, biopsies from MELAS patients carrying the A3243G substitution in the mitochondrial tRNA(Leu(UUR)) gene, the mutant tRNA is under-represented among processed and/or aminoacylated tRNAs. In contrast, in biopsies from MERRF patients harboring the A8344G substitution in the tRNA(Lys) gene neither the relative abundance nor the aminoacylation of the mutated tRNA is affected. Thus, whereas the A3243G mutation may contribute to the pathogenesis of MELAS by reducing the amount of aminoacylated tRNA(Leu), the A8344G mutation does not affect tRNA(Lys) function in the same way