Background and aims
Alcohol use has been identified as a major risk factor for burden of mortality and disease, particularly for countries in eastern Europe. During the past two decades, several countries in this region have implemented effective alcohol policy measures to combat this burden. The aim of the current study was to measure the association between Lithuania's alcohol control policies and adult all‐cause mortality.
Design
Interrupted time–series methodology by means of general additive models.
Setting
Lithuania.
Participants
Adult population of Lithuania, aged 20 years and older.
Measurements
Alcohol control policies were ascertained via a document review of relevant legislation materials. Policy effects were evaluated as follows: (1) slope changes in periods of legislative (non‐)activity with regard to alcohol control policy (analysis 1); (2) level changes of three interventions following recommendations of the World Health Organization (analysis 2); and (3) level changes of seven interventions judged a priori by an international panel of experts (analysis 3). Mortality was measured by sex‐stratified and total monthly age‐standardized rates of all‐cause mortality for the adult population.
Findings
During the period 2001–18, effective alcohol control policy measures were implemented on several occasions, and in those years the all‐cause mortality rate declined by approximately 3.2% more than in years without such policies. In particular, the implementation of increased taxation in 2017 was associated with reduced mortality over and above the general trend for men and in total for all analyses, which amounted to 1452 deaths avoided (95% confidence interval = −166 to –2739) in the year following the implementation of the policy.
Conclusions
Alcohol control policies in Lithuania appear to have reduced the overall adult all‐cause mortality over and above secular trends.
Aims
To study the impact of alcohol control policy measures (i.e. increases in taxation, restrictions on availability, including minimum purchasing age regulations, legislation on drink driving and advertisement bans) on alcohol‐related traffic harm in Lithuania between January 2004 and February 2019.
Design
Analyses of trend data on the proportion of alcohol‐related collisions and crashes, injury and mortality, adjusting for secular trends, seasonality, periods of alcohol control measure implementation and economic development. Generalized additive mixed models were used. Multiple sensitivity analyses were conducted.
Setting
Lithuania.
Cases
Monthly number of alcohol‐related cases of traffic collisions and crashes, injuries and deaths.
Interventions and comparators
Periods of time during which new alcohol control measures were implemented and/or augmented compared to periods when they were not.
Measurements
Monthly data for 2004 to 2019 from routine statistics of the Lithuanian Road Police Service.
Findings
All indicators decreased consistently and significantly after the implementation of alcohol control measures, including increased taxation, reduction of availability and a ban on advertisement, starting in 2014. On average, each implemented policy measure permanently reduced the proportion of alcohol‐attributable crashes by 0.55% [95% confidence interval (CI) = 0.21–0.90%; P = 0.002], the proportion of alcohol‐attributable injuries by 0.60% (95% CI = 0.24–0.97%; P = 0.001) and the proportion of alcohol‐attributable deaths by 0.13% (95% CI = 0.10–0.15%; P < 0.001).
Conclusions
Alcohol control policy measures, including measures to reduce overall level of alcohol consumption, were associated with a marked decrease in alcohol‐related traffic harm.
Background and Aims
The relationship between alcohol consumption and cirrhosis is well established. Policies that can influence population‐level use of alcohol should, in turn, impact cirrhosis. We examined the effect of population‐level alcohol control policies on cirrhosis mortality rates in Lithuania – a high‐income European Union country with high levels of alcohol consumption.
Methods
Age‐standardized, monthly liver mortality data (deaths per 100,000 adults, aged 15+) from Lithuania were analysed from 2001 to 2018 (n = 216 months) while controlling for economic confounders (gross domestic product and inflation). An interrupted time‐series analysis was conducted to estimate the effect of three alcohol control policies implemented in 2008, 2017 and 2018 and the number of cirrhosis deaths averted.
Results
There was a significant effect of the 2008 (P < .0001) and 2017 (P = .0003) alcohol control policies but a null effect of the 2018 policy (P = .40). Following the 2008 policy, the cirrhosis mortality rate dropped from 4.93 to 3.41 (95% CI: 3.02‐3.80) deaths per 100,000 adults, which equated to 493 deaths averted. Further, we found that following the 2017 policy, the mortality rate dropped from 2.85 to 2.01 (95% CI: 1.50‐2.52) deaths per 100,000 adults, corresponding to 245 deaths averted.
Conclusions
Our findings support the hypothesis that alcohol control policies can have a significant, immediate effect on cirrhosis mortality. These policy measures are cost‐effective and aid in reducing the burden of liver disease.
We present the first case of severe cardiotoxicity of carbon monoxide leading to myocardial rupture and fatal outcome. 83-year-old woman was hospitalized 4 hours after the fire in her house with no respiratory or cardiac symptoms. After two days, she has suffered sudden collapse leading to cardiac arrest. Postmortem examination revealed intramural haemorrhage with myocardial rupture at the apex of the left ventricle. Minimal stenosis was noted in the proximal coronary arteries with no evidence of distal occlusion or any other long-standing heart disease. This case supports recommendations for targeted cardiovascular investigations in cases of CO poisoning.
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