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Introduction: Major alcohol control policy measures in the Baltic countries and Poland have been shown to reduce alcohol per capita consumption (APC), 100% alcohol-attributable and all-cause mortality. This publication aims to estimate the effects of taxation increases and availability restrictions separately. Material and methods: Data were obtained from the statistical offices of the countries included except for alcohol consumption data, which were taken from the WHO for comparability reasons. Various types of regression analyses were conducted on time-series data using generalized additive mixed models. Results: On average, taxation increases were associated with decreases in APC (-0.89 litres (l); 95% CI: -1.35 l, -0.43 l) and all-cause mortality (-1.3%; 95% CI: -2.4%, -0.17%) among males. Given the average number of deaths in the four countries, the 1.3% reduction in the male mortality rate corresponds to 93 deaths postponed in Estonia, 166 in Latvia, 239 in Lithuania, and 2,606 in Poland, using the 2019 populations of the respective countries as the reference points. For 100% alcohol-attributable mortality, there were significant associations with availability restrictions for males (-12.1%; 95% CI: -17.8%, -6.4%) and females (-8.5%; 95% CI: -16.3%, -0.7%), as well as with taxation for females (-9.06%; 95% CI: -14.02%, -3.83%). All other associations were in the hypothesized direction but did not reach statistical significance. Conclusions: Different effects were found for taxation increases and availability restrictions. The former works via reducing the level of consumption, and thereby reduces all-cause mortality, while the latter seems to work more specifically on reducing heavy drinking occasions and consequently in particular on decreasing 100% alcohol-attributable mortality. Both alcohol control policies important to reduce consumption and alcohol-attributable mortality. However, they produce partly different outcomes, and thus should be implemented depending on the epidemiological profile and the desired effects. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

In Lithuania, cytological screening of cervical cancer (CC) is largely opportunistic. Absence of standardized systematic invitation practice might be the reason for low participation rates. The study aimed to assess the cost-effectiveness of systematic invitation approach in CC screening programme from the perspective of a healthcare provider. A decision tree was used to compare an opportunistic invitation by a family doctor, a personal postal invitation letter with appointment time and place, and a personal postal invitation letter with appointment time and place with one reminder letter. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) per one additionally screened woman and per one additional abnormal Pap smear test detected. The ICER of one personal postal invitation letter was €9.67 per one additionally screened woman and €55.21 per one additional abnormal Pap smear test detected in comparison with the current screening practice. The ICER of a personal invitation letter with an additional reminder letter compared to one invitation letter was €13.47 and €86.88 respectively. Conclusions: A personal invitation letter approach is more effective in increasing the participation rate in CC screening and the number of detected abnormal Pap smears; however, it incurs additional expenses compared with current invitation practice.