AIM - This paper assesses alcohol policies and interventions in Finland and the Canadian province of Ontario, using the policy options and interventions recommended in WHO's Global strategy to reduce the harmful use of alcohol (2010).

DATA & METHODS - The information and data are based on archival sources, surveys, legislative and government documents, and published papers. The paper assesses both jurisdictions on 10 areas in the WHO document and their sub-topics: 1. leadership, 2. health services response, 3. community action, 4. drinking and driving policies and countermeasures, 5. availability of alcohol, 6. marketing of alcoholic beverages, 7. pricing policies, 8. reducing the negative consequences of drinking and alcohol intoxication, 9. reducing the public health impact of illicit alcohol and informally produced alcohol, and 10. monitoring and surveillance.

RESULTS - Ontario had several recent noteworthy developments in line with WHO recommendations: health services response, controls of drinking and driving, pricing policies, reducing the negative consequences of drinking and intoxication, and monitoring and surveillance. Finland has emphasised pricing policies in recent years, and there have also been significant developments in community action, controls of drinking and driving, alcohol advertising, and monitoring and surveillance.

CONCLUSIONS - Challenges and opportunities for strengthening the policy responses are noted, as well as topics for future research.

BACKGROUND: Given the recent international debates about the effectiveness and appropriate age setpoints for legislated minimum legal drinking ages (MLDAs), the current study estimates the impact of Canadian MLDAs on mortality among young adults. Currently, the MLDA is 18 years in Alberta, Manitoba and Quebec, and 19 years in the rest of Canada.

METHODS: Using a regression-discontinuity approach, we estimated the impacts of the MLDAs on mortality from 1980 to 2009 among 16- to 22-year-olds in Canada.

RESULTS: In provinces with an MLDA of 18 years, young men slightly older than the MLDA had significant and abrupt increases in all-cause mortality (14.2%, p=0.002), primarily due to deaths from a broad class of injuries [excluding motor vehicle accidents (MVAs)] (16.2%, p=0.008), as well as fatalities due to MVAs (12.7%, p=0.038). In provinces/territories with an MLDA of 19 years, significant jumps appeared immediately after the MLDA among males in all-cause mortality (7.2%, p=0.003), including injuries from external causes (10.4%, p<0.001) and MVAs (15.3%, p<0.001). Among females, there were some increases in mortality following the MLDA, but these jumps were statistically non-significant.

CONCLUSIONS: Canadian drinking-age legislation has a powerful impact on youth mortality. Given that removal of MLDA restrictions was associated with sharp upturns in fatalities among young men, the MLDA likely reduces population-level mortality among male youth under the constraints of drinking-age legislation. Alcohol-control policies should target the transition across the MLDA as a pronounced period of mortality risk, especially among males.

06 May 2014 In Liver Disease

INTRODUCTION AND AIMS: Alcohol is an established risk factor for liver cirrhosis. It remains unclear, however, whether this relationship follows a continuous dose-response pattern or has a threshold. Also, the influences of sex and end-point (i.e. mortality vs. morbidity) on the association are not known. To address these questions and to provide a quantitative assessment of the association between alcohol intake and risk of liver cirrhosis, we conducted a systematic review and meta-analysis of cohort and case-control studies.

DESIGN AND METHODS: Studies were identified by a literature search of Ovid MEDLINE, EMBASE, Web of Science, CINAHL, PsychINFO, ETOH and Google Scholar from January 1980 to January 2008 and by searching the references of retrieved articles. Studies were included if quantifiable information on risk and related confidence intervals with respect to at least three different levels of average alcohol intake were reported. Both categorical and continuous meta-analytic techniques were used to model the dose-response relationship.

RESULTS: Seventeen studies met the inclusion criteria. We found some indications for threshold effects. Alcohol consumption had a significantly larger impact on mortality of liver cirrhosis compared with morbidity. Also, the same amount of average consumption was related to a higher risk of liver cirrhosis in women than in men.

DISCUSSION AND CONCLUSIONS: Overall, end-point was an important source of heterogeneity among study results. This result has important implications not only for studies in which the burden of disease attributable to alcohol consumption is estimated, but also for prevention.

06 May 2014 In General Health




BACKGROUND: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the burden of disease attributable to mental and substance use disorders in terms of disability-adjusted life years (DALYs), years of life lost to premature mortality (YLLs), and years lived with disability (YLDs). METHODS: For each of the 20 mental and substance use disorders included in GBD 2010, we systematically reviewed epidemiological data and used a Bayesian meta-regression tool, DisMod-MR, to model prevalence by age, sex, country, region, and year. We obtained disability weights from representative community surveys and an internet-based survey to calculate YLDs. We calculated premature mortality as YLLs from cause of death estimates for 1980-2010 for 20 age groups, both sexes, and 187 countries. We derived DALYs from the sum of YLDs and YLLs. We adjusted burden estimates for comorbidity and present them with 95% uncertainty intervals. FINDINGS: In 2010, mental and substance use disorders accounted for 183.9 million DALYs (95% UI 153.5 million-216.7 million), or 7.4% (6.2-8.6) of all DALYs worldwide. Such disorders accounted for 8.6 million YLLs (6.5 million-12.1 million; 0.5% [0.4-0.7] of all YLLs) and 175.3 million YLDs (144.5 million-207.8 million; 22.9% [18.6-27.2] of all YLDs). Mental and substance use disorders were the leading cause of YLDs worldwide. Depressive disorders accounted for 40.5% (31.7-49.2) of DALYs caused by mental and substance use disorders, with anxiety disorders accounting for 14.6% (11.2-18.4), illicit drug use disorders for 10.9% (8.9-13.2), alcohol use disorders for 9.6% (7.7-11.8), schizophrenia for 7.4% (5.0-9.8), bipolar disorder for 7.0% (4.4-10.3), pervasive developmental disorders for 4.2% (3.2-5.3), childhood behavioural disorders for 3.4% (2.2-4.7), and eating disorders for 1.2% (0.9-1.5). DALYs varied by age and sex, with the highest proportion of total DALYs occurring in people aged 10-29 years. The burden of mental and substance use disorders increased by 37.6% between 1990 and 2010, which for most disorders was driven by population growth and ageing. INTERPRETATION: Despite the apparently small contribution of YLLs-with deaths in people with mental disorders coded to the physical cause of death and suicide coded to the category of injuries under self-harm-our findings show the striking and growing challenge that these disorders pose for health systems in developed and developing regions. In view of the magnitude of their contribution, improvement in population health is only possible if countries make the prevention and treatment of mental and substance use disorders a public health priority.




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