Promising measures to reduce the mortality in Russia: an analytical review

The purpose of the study was to identify promising measures to reduce mortality in Russia. Methods used included analysis of systematic reviews from PubMed, Web of Science, Scopus, and Google Scholar. Results. Many reasonable measures for reducing mortality in Russia include promoting healthy behaviour (tobacco control, alcohol control, support for healthy diet, physical activity) and preventing death due to external causes. It is necessary to increase the effectiveness of disease management, including arterial hypertension, hypercholesterolemia, diabetes mellitus, cardiovascular accidents, hepatitis C, HIV. This could require intensifying digital transformation of health care, implementing modern teamwork approaches to the patient’s treatment and follow-up with greater involvement of nurses and other personnel. In terms of screening, it is essential to expand coverage and introduce modern, effective screening methods for colorectal cancer, cervical cancer, and neonatal screening. It is necessary to expand vaccination against Covid-19, vaccination of the elderly from Pneumococcus, and adolescents from HPV. Prevention of mortality from external causes should include sets of measures targeted at the prevention of suicides, traffic accidents, fires, drownings, etc., in addition to alcohol control measures. Finally, increasing health care financing, including medication provision, can bring additional years of life. Conclusions. Russia has significant potential to implement new measures to reduce the mortality rate.

Cardiovascular diseases mortality and alcohol control policy in Lithuania: exploring a possible link

Background Lithuania possesses one of the highest alcohol per capita consumption and has previously implemented alcohol control policies to reduce the alcohol-attributable burden. The aim of this study was to investigate Lithuanian cardiovascular disease (CVD) mortality rate trends between 2001 and 2018 and to explore a possible link between CVD mortality rate and alcohol control policy implementation. Methods Lithuanian population mortality and alcohol consumption data for 2001–2018 were obtained from Statistics Lithuania and The State Register of Death Cases and Their Causes, Institute of Hygiene. Sex-specific CVD mortality rates were directly standardized to the European standard population by five-year age groups and categorized according to the ICD-10 codes for all CVDs (I00-I99), ischemic heart disease (IHD) (I20-I25), cerebrovascular diseases (I60-I69) and alcoholic cardiomyopathy (ACM) (I42.6). Joinpoint regression analyses were performed to identify points of inflection to explore their alignment with five selected alcohol policy enactments. Results Overall, the 2001–2018 yearly mortality rates for all CVDs significantly decreased on average by − 1.6% (95% CI -2.0, − 1.2%) among men and − 2.1% (95% CI -2.5, − 1.8%) among women. Yearly changes in all CVDs, IHD, cerebrovascular diseases and ACM mortality rates were insignificant prior to their respective critical year points in 2006, 2005, 2008 and 2007, but significantly decreased afterwards by an average of − 2.4% (95% CI -2.7, − 2.0%), − 1.6% (95% CI -2.1, − 1.1%), − 1.2% (95 CI -1.7, − 0.6%) and − 4.5% (95% CI -7.3, − 1.6%) among men, and by − 2.7% (95% CI -3.0, − 2.3%), − 2.0% (95% CI -2.6, − 1.4%), − 1.8% (95% CI 2.4, − 1.3%) and − 6.6% (95% CI -10.7, − 2.2%) among women, respectively. The changes in the mortality rate trends for all CVDs, IHD, cerebrovascular diseases and especially ACM coincided with alcohol policies enacted on the January 1, 2008, January 1, 2009, April 1, 2014 and March 1, 2017. Conclusions Yearly mortality rates for all CVDs, IHD, cerebrovascular diseases and ACM have declined in Lithuania between 2001 and 2018, and declining trends were more prominent in women than in men. Among the ICD-10 CVD categories investigated, the points of inflection identified for the ACM mortality rate trend coincided best with the selected alcohol policy enactment dates.

Evaluating the Impact of Alcohol Control Interventions on Suicide Mortality Rates

Introduction & Objective: Given that the impact of regulatory and public policy initiatives cannot usually be tested through traditional randomized controlled trial designs, well-selected, -designed, and -analyzed natural experiments are the method of choice when examining the effects of such enactments on a variety of outcomes. The classic methodology for such evaluations is interrupted time-series (ITS) analysis, which is considered as one of the quasi-experimental designs that use both pre- and post-policy data without randomization. This study tests the impact of alcohol control interventions implemented in different period of times on suicide mortality rates among people 25-74 years of age using ITS. Methods: We mainly use the generalized additive mixed model (GAMM) to capture trend and seasonality in suicide mortality rates while controlling for unemployment rates, financial crisis during 2007-2008, and legal alcohol consumption records. Given the notable differences in alcohol consumption and suicide mortality between males and females, all analyses are conducted gender-specifically. Results: The ITS shows that the intervention introduced in 2017 has a significant effect on reducing suicide mortality rates for males between 25 and 74. Following the implementation of the intervention, suicide mortality rates decreased by 23.8% (95% CI: 10.2% - 35.4%) on average. Conclusion: The alcohol control intervention that strictly increased the excise tax on alcohol products has been shown to have a strong impact on reducing suicide mortality rates among male adults 25-74 years of age. ITS analyses are one of the strongest evaluative designs and allow a more detailed assessment of the longitudinal impact of an intervention than may be possible with a randomized control trial.

Barriers to the Implementation of Alcohol Policies in Jayapura City

Background: Basic Health Research (RISKESDAS) in 2018 found as many as 15 provinces out of 35 provinces had a prevalence of alcohol consumption above the national prevalence, and Papua was reportedly in the top 15 of the prevalence of high alcohol consumption (alcohol) as much as 4.6%. Objective: To describe the obstacles to the implementation of local government policies in curbing the circulation of alcohol in Jayapura City. Method: This is a descriptive study using a qualitative single instrumental case study design in Jayapura City from May to September 2020. Purposive sampling technique was employed to determine participants who consisted of an integrated team of alcohol control and supervision (n =6). Data collection was using in-depth interviews and non-participant observation. Result: Communication between the integrated team was not optimal. National Food and Drug Agency (BPOM) had not routinely conducted sample tests as the majority of traditional alcoholic beverages sold in shops such as local liquors were illegal. The division of duties and responsibilities by the integrated team was good, but the execution in the field was not as agreed upon. There were alcohol traders who have not applied for licenses to sell alcohol because the process to get license permits was too complicated. The content of Perda No.8 of 2014 weakened the police because they could not give punishment like Satpol PP, however, Satpol PP did not have an investigating team. Conclusion: The lack of commitment from the control and supervision team of alcohol circulation in carrying out their duties. The resources involved were lacking. Coordination among the integrated teams was not going well thus the division of tasks and authorities with implementation actions in the field did not work according to the policy enforce in Jayapura City. Evaluation of work programs by policy implementers could be carried out to increase the success of implementation.

Alcohol and Cancer: Epidemiology and Biological Mechanisms

Approximately 4% of cancers worldwide are caused by alcohol consumption. Drinking alcohol increases the risk of several cancer types, including cancers of the upper aerodigestive tract, liver, colorectum, and breast. In this review, we summarise the epidemiological evidence on alcohol and cancer risk and the mechanistic evidence of alcohol-mediated carcinogenesis. There are several mechanistic pathways by which the consumption of alcohol, as ethanol, is known to cause cancer, though some are still not fully understood. Ethanol’s metabolite acetaldehyde can cause DNA damage and block DNA synthesis and repair, whilst both ethanol and acetaldehyde can disrupt DNA methylation. Ethanol can also induce inflammation and oxidative stress leading to lipid peroxidation and further DNA damage. One-carbon metabolism and folate levels are also impaired by ethanol. Other known mechanisms are discussed. Further understanding of the carcinogenic properties of alcohol and its metabolites will inform future research, but there is already a need for comprehensive alcohol control and cancer prevention strategies to reduce the burden of cancer attributable to alcohol.

Assessing alcohol consumption patterns in Jinja and Masindi districts

BackgroundUganda National Association of Community and Occupational Health (UNACOH) implemented a workplace and community based alcohol control intervention in the districts of Masindi and Jinja in Uganda where alcohol is highly consumed. UNACOH therefore conducted an end-of year evaluation with a main focus on two of the project’ anticipated outcomes. These include:1) Reduced risky alcohol consumption patterns among the communities in the project area especially among vulnerable and high risk groups (elderly, youth, women, commercial motorcyclists and fisher folk) by 2021 and 2) Legal restrictions on density of alcohol outlets, accessibility to minors and availability are in place in Masindi and Jinja district by 2021 .The main objective was therefore to assess alcohol consumption patterns among drinkers, perceptions about community awareness of alcohol control regulations and their perceived effectiveness in the project area (Masindi and Jinja) in the year 2020.MethodsThis was a cross-sectional evaluation conducted among 310 respondents in selected villages within the intervention Sub Counties of the Districts in the project area. These included; These included Karujubu Division,Miirya and Pakanyi Sub Counties in Masindi District, and Bugembe Town Council,Walukuba- Masese Division and Budondo Sub County in Jinja District. The primary outcomes were; reduced risky alcohol consumption patterns among the communities and presence of legal restrictions on density of alcohol outlets, accessibility to minors and availability. Quantitative data were entered and cleaned using Epi-data version 4.6.0.2 analyzed using STATA version 12.0. Descriptive analysis was used to generate information on the alcohol consumption patterns.Results Findings indicated that majority drinkers were male (71.34%) with only 0.93% below the age of 18 years. Spirits were the commonest type of alcohol consumed (40.78%). Risky alcohol consumptions were reported by nearly half (48.71%) of the drinkers. Male drinkers (81.88%) and those in Jinja (58.97%) reported significantly higher alcohol consumption in comparison with female drinkers (18.12%) and those in Masindi (38.31%) respectively. (χ2 =15.74 and p value of 0.000 and χ2=13.24 and p = 0.000).ConclusionVariation in risky alcohol consumption between the project areas could be attributed to differences in implementation of alcohol control regulations. In some project areas, communities were aware of alcohol control regulations and thought these had been beneficial in reducing alcohol related harm. Risky consumption among drinkers remained relatively high. If these negative trends are not reversed they could significantly increase the non-communicable disease burden including mental health.