Implementation Of Control Policies Research Articles

A cross domain access control model for medical consortium based on DBSCAN and penalty function

BackgroundGraded diagnosis and treatment, referral, and expert consultations between medical institutions all require cross domain access to patient medical information to support doctors’ treatment decisions, leading to an increase in cross domain access among various medical institutions within the medical consortium. However, patient medical information is sensitive and private, and it is essential to control doctors’ cross domain access to reduce the risk of leakage. Access control is a continuous and long-term process, and it first requires verification of the legitimacy of user identities, while utilizing control policies for selection and management. After verifying user identity and access permissions, it is also necessary to monitor unauthorized operations. Therefore, the content of access control includes authentication, implementation of control policies, and security auditing. Unlike the existing focus on authentication and control strategy implementation in access control, this article focuses on the control based on access log security auditing for doctors who have obtained authorization to access medical resources. This paper designs a blockchain based doctor intelligent cross domain access log recording system, which is used to record, query and analyze the cross domain access behavior of doctors after authorization. Through DBSCAN clustering analysis of doctors’ cross domain access logs, we find the abnormal phenomenon of cross domain access, and build a penalty function to dynamically control doctors’ cross domain access process, so as to reduce the risk of Data breach. Finally, through comparative analysis and experiments, it is shown that the proposed cross domain access control model for medical consortia based on DBSCAN and penalty function has good control effect on the cross domain access behavior of doctors in various medical institutions of the medical consortia, and has certain feasibility for the cross domain access control of doctors.

Efektivitas Implementasi Kebijakan Pengendalian Pencemaran Udara di Indonesia

Air pollution is a significant environmental problem in Indonesia, affecting public health and environmental quality. Air pollution control policies have been implemented to address this issue. This study aims to evaluate the effectiveness of the implementation of air pollution control policies in Indonesia from an environmental law perspective and examine community participation in supporting the implementation of these policies. This study uses a juridical-normative method with a case study approach, namely Decision Number: 14 / PDT.G / LH / 2018 / PN.Gns. The results of the study are that this decision is a dispute between residents of Untoro Village, Trimurjo District, Central Lampung Regency and PD. Subur Jaya which is located in Untoro Village, Trimurjo District, Central Lampung Regency. This dispute occurred because of the pollution of PD. Subur Jaya rice factory waste which has disturbed local residents and caused air pollution. Analysis of the decision shows that although the air pollution control policy has been well formulated, its implementation faces various obstacles, such as lack of coordination between institutions, limited resources, and ineffective law enforcement. In addition, public participation in supporting this policy is still low, due to the lack of socialization and education regarding the importance of air pollution control. In conclusion, the implementation of air pollution control policies in Indonesia has not been fully effective from an environmental law perspective. Improved coordination between institutions, strengthened law enforcement, and increased public participation through more intensive socialization and education are needed to achieve better results in air pollution control in Indonesia.

A realist evaluation of the implementation of a national tobacco control program and policy in India.

There is a growing interest in studying and unpacking implementation of policies and programmes as it provides an opportunity to reduce the policy translation time lag taken for research findings to translate to policies and get implemented and understand why policies may fail. Realist evaluation is a theory-driven approach that embraces complexity and helps to identify the mechanisms generating the observed policy outcomes in given context. We aimed to study facilitators and barriers while implementing the Cigarettes and Other Tobacco Products Act, 2003 (COTPA) a comprehensive national tobacco control policy, and the National Tobacco Control Programme (NTCP), 2008 using realist evaluation. We developed an initial program theory (IPT) based on a realist literature review of tobacco control policies in Low- and Middle-Income Countries (LMICs). Three diverse states -Kerala, West Bengal, and Arunachal Pradesh- with varying degree of implementation of tobacco control law and program were chosen as case studies. Within the three selected states, we conducted in-depth interviews with 48 state and district-level stakeholders and undertook non-participant observations to refine the IPT. Following this, we organized two regional consultations covering stakeholders from 20 Indian states for a second iteration to further refine the program theory. A total of 300 Intervention-Context-Actor-Mechanism-Outcome (ICAMO) configurations were developed from the interview data, which were later synthesized into state-specific narrative program theories for Kerala, West Bengal and Arunachal Pradesh. We identified five mechanisms: collective action, felt accountability, individual motivation, fear, and prioritization that were (or were not) triggered leading to diverse implementation outcomes. We identified facilitators and barriers to implementing the COTPA and the NTCP, which have important research and practical implications for furthering the implementation of these policies as well as implementation research in India. In the future, researchers could build on the refined program theory proposed in this study to develop a middle-range theory to explain tobacco control policy implementation in India and other LMICs.

Unravelling habituation for COVID-19-related information: A panel data study in Japan.

This study examines people's habituation to COVID-19-related information over almost three years. Using publicly available data from 47 Japanese prefectures, I analyse how human mobility responded to COVID-19-related information, such as the number of COVID-19-infected cases, the declaration of a state of emergency (DSE), and several doses of vaccine using an interactive effects model, which is a type of panel data regression. The results show that Japanese citizens were generally fearful and cautious during the first wave of the unknown infection. As such, a 1% week-on-week increase in the number of infected cases results in a decrease in human mobility by 1.09-percentage-point (pp) week-on-week. However, they gradually became habituated to similar infection information during the subsequent waves, which is reflected in 0.71 pp and 0.29 pp decreases in human mobility in the second and third waves. Nevertheless, the level of habituation decreased in response to the different types of the infection, such as new variants in the fourth wave, with 0.50 pp decrease. By contrast, regarding the DSE, it is more plausible to consider that human mobility responds to varying requests rather than habituate them. Whereas a rapid vaccination program could alleviate people's concerns. I also find spatial spillovers of infection information on human mobility using a spatial weight matrix included in the regression model. However, there is no evidence of DSE or vaccination spatial spillovers, likely because both are valid only in one's own prefecture. The implementation of flexible human mobility control policies by closely monitoring human mobility can prevent excessive or insufficient mobility control requests. Such a flexible policy can efficiently suppress infection spread and prevent economic activity reduction more than necessary. These implications are useful for evidence-based policymaking during future pandemics.

Identifying enablers and barriers to the control of multidrug-resistant tuberculosis in Abia State, Nigeria: A qualitative study

ObjectiveDrug-resistant tuberculosis (TB) is a significant public health threat in high-burden TB countries, including Nigeria, constraining the achievement of End TB targets. Nonetheless, Nigeria's health system factors shaping the care of patients with multidrug-resistant tuberculosis (MDR-TB) are understudied. The study assessed the enablers and barriers to implementing MDR-TB care and treatment in Abia State, Nigeria. MethodsThis is a qualitative interview study adopting a phenomenological approach. We interviewed twelve participants comprising health workers and TB policymakers with roles in MDR-TB patient management at the national (n = 2) and state (n = 10) levels in May 2022. We used maximum variation sampling to purposively select participants based on their roles, availability, and consent. The data were analysed thematically. ResultsThe factors enhancing care for patients with MDR-TB include using a certificate of readiness, community involvement, donor financing, availability of treatment centre, effective facility-community linkage, treatment support, multidisciplinary care team, training service providers, availability of oral drugs, expansion of diagnostic facilities, data tool availability, review meetings, and data-focused supervision. In contrast, the factors constraining MDR-TB management are poor implementation of infection control policy, donor dependence, delayed initiation of treatment, poorly motivated health workers, health worker stigma, shortage of personal protective equipment, and role conflict in data management. ConclusionThe findings highlight critical health systems strengths and weaknesses in MDR-TB control. MDR-TB care policies must build on the enablers and address the barriers to strengthen the care for patients with MDR-TB.

A composite index of provincial alcohol control policy implementation capacity in Thailand

BackgroundThere is a well-published literature on the effectiveness and stringency of alcohol control policies, but not many studies focus on policy implementation, where policies transform into impact. The objective of this study is to create a composite index that measures the capacity for implementing effective alcohol control policies across all provinces in Thailand. MethodsBased on the international literature, we developed a list of key indicators for tracking the implementation of alcohol policies at the subnational level. To ensure these indicators were relevant to the Thai context, we obtained feedback from Thai experts. We collected primary data according to the developed indicators using questionnaires filled in by key informants at the implementing agencies and gathered secondary data at the provincial level. On this basis, we developed indices that reflect the status of alcohol control policy implementation. We then investigated the association between the indices and the prevalence and pattern of alcohol consumption and alcohol-related harms while adjusting for potential confounders using multiple linear regression and negative binomial regression, respectively. ResultsScores on the Provincial Alcohol Policy Implementation Capacity (PAPIC) Index ranged between 39 and 79. We found that each 1-point increase in PAPIC score was associated with a 1.98 % reduction in the quantity of alcohol consumed in grams per day (coefficient: −0.02; 95 %CI: −0.03, −0.00; p-value<0.05; e−0.02= 0.9802). We also found that for each 1-point increase in PAPIC score, the proportion of regular drinkers reduced by 0.30 per cent (coefficient: −0.30; 95 %CI: −0.55, −0.05; p-value<0.05). However, we did not find any association between the indices and alcohol-related harms. ConclusionThe level of implementation of alcohol control policy at the sub-national level is associated with alcohol consumption levels. The findings suggest the value of allocating resources to the implementation of alcohol control policy.

Wandering Behavior and SARS-CoV-2 Infection in Veterans Affairs Community Living Center Residents

ObjectiveWandering behavior in nursing home (NH) residents could increase risk of infection. The objective of this study was to assess the association of wandering behavior with SARS-CoV-2 infection in Veterans Affairs (VA) Community Living Center (CLC) residents. DesignRetrospective cohort study. Setting & ParticipantsVeterans residing in 133 VA CLCs. MethodsWe included residents with SARS-CoV-2 test from March 1, 2020 to December 31, 2020 from VA electronic medical records. We identified CLC residents with wandering on Minimum Data Set 3.0 assessments and compared them with residents without wandering. The outcome was SARS-CoV-2 infection, as tested for surveillance testing, in those with and without wandering. Generalized linear model with Poisson link adjusted for relevant covariates was used. ResultsResidents (n = 9995) were included in the analytic cohort mean, (SD) age 73.4 (10.7); 388 (3.9%) women. The mean (SD) activities of daily living score in the overall cohort was 13.6 (8.25). Wandering was noted in 379 (3.8%) (n = 379) of the cohort. The exposure groups differed in prior dementia (92.6% vs 62.1%, standardized mean difference [SMD] = 0.8) and psychoses (41.4% vs 28.1%, SMD = 0.3). Overall, 12.5% (n = 1248) tested positive for SARS-CoV-2 and more residents among the wandering group were SARS-CoV-2 positive as compared with those in the group without wandering (19% [n = 72] vs 12.2% [n = 1176], SMD = 0.19). Adjusting for covariates, residents with wandering had 34% higher relative risk for SARS-CoV-2 infection (adjusted relative risk, 1.34; 95% CI, 1.04–1.69). Conclusions and ImplicationsCLC residents with wandering had a higher risk of SARS-CoV-2 infection. This may inform implementation of infection control and isolation policies as NHs attempt to balance ethical concepts of resident autonomy, proportionality, equity, and utilitarianism.

Decoding hotline's information with text-mining: A protocol for improving tobacco control in Shanghai.

Tobacco consumption in China remains the primary cause of preventable mortality, with Shanghai being particularly affected by issues related to secondhand smoke exposure. This study explores the role of the public service hotline 12345, a grassroots initiative in Shanghai, in capturing public sentiment and assessing the effectiveness of anti-smoking regulations. Our research aims to accurately and deeply understand the implementation and feedback of smoking control policies: by identifying high-frequency points and prominent issues in smoking control work based on the smoking control work order data received by the health hotline 12320. The results of this study will assist government enforcement agencies in improving smoking monitoring and clarify the direction for improving smoking control measures. Text-mining techniques were employed to analyze a dataset comprising 78011 call sheets, all related to tobacco control and collected from the hotline between 1 January 2015 and 31 December 2019. This methodological approach aims to uncover prevalent themes and sentiments in the public discourse on smoking and its regulation, as reflected in the hotline interactions. Our study identified hotspots and the issues of greatest concern to citizens. Additionally, it provided recommendations to enforcement agencies to enhance their capabilities, optimize the allocation of human resources for smoking control monitoring, reduce enforcement costs and support for anti-smoking campaigns, thereby contributing to more effective tobacco control policies in the region.

Trust in Transit: External Migration Control and Migrants’ Perceptions of Humanitarian Borderwork in the Sahel

The Sahel region has become a focal point for externalisation policies seeking to prevent the onward travel of migrants bound for North Africa and Europe. In this context, humanitarian actors are increasingly called upon to implement migration control policies or to address migrants’ vulnerabilities during journeys characterised by ‘extended temporariness’. This paper builds upon the concepts of the humanitarian border and institutional trust to develop a typology of organisations and to explore how migrants in transit perceive these forms of humanitarian borderwork. By employing the concept of trust as an analytical prism to examine social navigation, risk-assessments and the felt externalisation of migration control, we argue that transit migrants’ mistrust in humanitarian organisations is a ripple effect of the externalisation process. This leads to cumulative ripples, such as protection gaps for individuals travelling from West to North Africa. The article compares two key locations for West African transit migration in Niger and Mali, exhibiting similar characteristics but differing in the extent and visibility of external migration-related programming. Through qualitative content analysis of interviews conducted with 90 transit migrants between 2020 and 2021, we identify the perceived involvement of organisations in migration control and the phase in the migration trajectory as key factors influencing (mis)trust in organisations. We further trace the effects of (mis)trust on migrant strategies, including exit, risk-acceptance, and self-protection. The results highlight the far-reaching impacts of different externalisation environments on migrant safety and strategies, as well as on the ability of humanitarian organisations to provide protection in vulnerable migration situations.

Foot and Mouth Disease Vaccine Matching and Post-Vaccination Assessment in Abu Dhabi, United Arab Emirates.

Despite the annual vaccination of livestock against foot and mouth disease (FMD) in the United Arab Emirates (UAE), outbreaks of the disease continue to be reported. The effective control of field outbreaks by vaccination requires that the vaccines used are antigenically matched to circulating field FMD viruses. In this study, a vaccine matching analysis was performed using the two-dimensional virus neutralization test (VNT) for three field isolates belonging to the O/ME-SA/PanAsia-2/ANT-10 and O/ME-SA/SA-2018 lineages collected from different FMD outbreaks that occurred within the Abu Dhabi Emirate in 2021 affecting Arabian oryx (Oryx leucoryx), goat, and sheep. In addition, post-vaccination antibodies in sheep and goats were measured using solid-phase competitive ELISA (SPCE) for FMDV serotypes A and O at five months after a single vaccine dose and a further 28 days later after a second dose of the FMD vaccine. An analysis of vaccine matching revealed that five out of the six vaccine strains tested were antigenically matched to the UAE field isolates, with r1-values ranging between 0.32 and 0.75. These results suggest that the vaccine strains (O-3039 and O1 Manisa) included in the FMD vaccine used in the Abu Dhabi Emirate are likely to provide protection against outbreaks caused by the circulating O/ME-SA/PanAsia-2/ANT-10 and O/ME-SA/SA-2018 lineages. All critical residues at site 1 and site 3 of VP1 were conserved in all isolates, although an analysis of the VP1-encoding sequences revealed 14-16 amino acid substitutions compared to the sequence of the O1 Manisa vaccine strain. This study also reports on the results of post-vaccination monitoring where the immunization coverage rates against FMDV serotypes A and O were 47% and 69% five months after the first dose of the FMD vaccine, and they were increased to 81 and 88%, respectively, 28 days after the second dose of the vaccine. These results reinforce the importance of using a second booster dose to maximize the impact of vaccination. In conclusion, the vaccine strains currently used in Abu Dhabi are antigenically matched to circulating field isolates from two serotype O clades (O/ME-SA/PanAsia-2/ANT-10 sublineage and O/ME-SA/SA-2018 lineage). The bi-annual vaccination schedule for FMD in the Abu Dhabi Emirate has the potential to establish a sufficient herd immunity, especially when complemented by additional biosecurity measures for comprehensive FMD control. These findings are pivotal for the successful implementation of the region's vaccination-based FMD control policy, showing that high vaccination coverage and the wide-spread use of booster doses in susceptible herds is required to achieve a high level of FMDV-specific antibodies in vaccinated animals.

The Effectiveness of Government Policy on MSMEs Through Empirical Data Analysis in Lampung

The purpose of this study is to develop a model of policy synchronization between the central government and local governments and to project strategic goals and objectives to be achieved, as well as future policy directions. The research method used is a quantitative research method with descriptive analysis techniques. The research locus is the Central Government and Banten Province. The research time is May–July 2021. The research stages include primary and secondary data collection, data processing, primary and secondary data analysis, and projection analysis for the years 2021–2025. Based on the results of the analysis, the population policy synchronization model between the central and local governments can be implemented by focusing on government regulations and population control frameworks. This finding is expected to be the basis for stakeholders in synchronizing policies at the regional center so that there are no policy differences between the center and the regions. Central and Regional Government policies must be in line so that it can facilitate the implementation of population control policies in the regions. Keywords: policy synchronization, population, central government, local government

Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study

ObjectiveTo assess the impact of tobacco control regulations and policy implementation on smoking cessation tendencies in cigarette users born between 1982 and 1991 in Chile.DesignLongitudinal cross-sectional study.SettingNational level.ParticipantsData from the...

PENGENDALIAN PENCEMARAN AIR UNTUK KESEHATAN LINGKUNGAN YANG LEBIH BAIK DI KABUPATEN SUMENEP

The progress in the industrial sector has the potential to produce waste that can pollute and damage the environment. Wastewater is a major problem because it can have a negative impact on the environment and public health. Water pollution occurs because business owners does not manage wastewater at Wastewater Treatment Plant (IPAL). This research aims to analyze the implementation of water pollution control policy especially that caused by the shrimp pond industry in Sumenep Regency and solving the problems. This research is a normative juridical research, legal science approach and primary data as the main data is obtained from various legal materials related to research supported also by secondary and tertiary data as additional data. The results showed that the implementation of Sumenep Regency Regent Regulation No. 1 of 2016 concerning Water Quality Management and Water Pollution Control has not been implemented properly. It is necessary to create policies to control industrial wastewater pollution by the preparation of Regional Regulations, which contain criminal and/or administrative sanctions, and also contain the obligation for every shrimp pond owner must be equipped with IPAL so it’s more effective to protecting the environment and disciplining the society.

Tobacco and nicotine control policy implementation survey in the Russian regions: EPOHA-RF 2

Tobacco and nicotine control policy implementation survey in the Russian regions: EPOHA-RF 2

Tobacco Control in Denmark - How the Ugly Duckling Turned into a Swan.

The implementation of tobacco control policies has been a neglected topic in tobacco research. A comprehensive Tobacco Action Plan including plain packaging, point-of-sale display ban, a ban on characterizing flavours (in products other than cigarettes), a strengthening of the promotion and marketing ban, a ban on the sale of novel nicotine products to minors, smoke-and nicotine-free-school hours in all schools with minors, and a significant increase in tobacco tax, was adopted in Denmark in 2019. Eleven people involved or very close to the advocacy process were invited, two did not respond and nine attended our research centre. We used the Nominal Group Technique, a consensus method, to identify the most important driving factors for passing the Tobacco Action Plan. The round-robin identified 39 driving factors merged into 13 in the clarification phase. In the ranking phase, participants agreed on seven factors that they perceived have strongly influenced the political will to strengthen national tobacco control comprehensively. The most important factors were national data and evidence, a nationwide alliance with broad partnerships, a strict focus on young people, continuous media coverage, intensive lobbying by many different advocates, making it a community agenda - not a political one, and effective professional campaigns. Our findings agree with experiences from other countries that significantly improved tobacco control. The Danish strategy, including a nationwide alliance with broad partnerships, had a high influence on the political agenda. In this study, there was a consensus that seven factors strongly influenced the political will to comprehensively strengthen the national tobacco control in Denmark in a short time: national data and evidence; a nationwide alliance with broad partnerships; a strict focus on children and young people; continuous media coverage; intensive lobbying by many different advocates; making it a community agenda - not a political one, and effective professional campaigns. This is consistent with findings from other countries.

A cross sectional study on detection of COVID 19 antibodies in laboratory personnel at Osmania Medical College, Hyderabad

ABSTRACT Background: Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) associated with COVID-19 disease was first reported from Wuhan Hubei Province, China, in December 2019. Aim and Objective: The current study is aimed to evaluate seroprevalence of SARS-COV-2 antibodies in laboratory personnel working in association with COVID-19 diagnostic work. Methodology: A cross-sectional study was conducted between November 2020 and December 2020 to evluate seropositivity of COVID-19 in laboratory personnel by using COVID-19 IgG ELISA. Results: A total number of 91 laboratory personnel were included in the current study. Out of them, 45 (49.45%) were males, 46 (50.55%) were females. Out of 91 participants, 44 (48.35%) were doctors, 19 (20.8%) were Lab technicians, 13 (14.28%) were sample collection technicians, 7 (7.69%) were transport persons, 4 (4.39%) were research scientist, and 4 (4.39%) were data managers. Out of 91 samples, 25 were positive. Out of 44 doctors, 11 were positive contributing for (25%); out of 19 laboratory technicians, 5 were positive contributing for (26%); and out of 13 sample collection technicians, 5 were positive contributing for (38.46%). Conclusion: Seropositivity in asymptomatic individuals means that we need to be even more cautious in hospitals with masks, hand washing, and sanitization. Repeated serosurveys will help in the implementation of infection control policies in a systematic way, which in turn helps in protection of health care workers against COVID-19.

Unveiling global land fine- and coarse-mode aerosol dynamics from 2005 to 2020 using enhanced satellite-based monthly inversion data

Accurate fine-mode and coarse-mode aerosol knowledge is crucial for understanding their impacts on the climate and Earth's ecosystems. However, current satellite-based Fine-Mode Aerosol Optical Depth (FAOD) and Coarse-Mode Aerosol Optical Depth (CAOD) methods have drawbacks including inaccuracies, low spatial coverage, and limited temporal duration. To overcome these issues, we developed new global-scale FAOD and CAOD from 2005 to 2020 using a novel deep learning model capable of the synergistic retrieval of two aerosol sizes. After validation with the aerosol robotic network (AERONET) and sky radiometer network (SKYNET), the new monthly FAOD and CAOD showed significant improvements in accuracy and spatial coverage. From 2005 to 2020, the new data showed that China had the greatest decrease in FAOD and CAOD. In contrast, India and South Latin America had a significant increase in FAOD versus North Africa in CAOD. FAOD in the regions of Argentina, Paraguay, and Uruguay in South America have shown an upward trend. The results reveal that FAOD and CAOD display distinct patterns of change in the same regions, particularly on the west coast of the United States where FAOD is increasing, while CAOD is decreasing. Aside from the year 2020 due to the global COVID-19 pandemic, the analysis showed that although China has seen at least an +85% increase in energy consumption and urban expansion in 2019 compared to 2005 due to the needs of development and construction, the implementation of China's air pollution control policies has led to a significant decrease in FAOD (−46%) and CAOD (−65%) after 2013. This research enriches our comprehension of global fine and coarse aerosol patterns, additional investigations are needed to determine the potential global implications of these changes.

Vertical Profiles of Aerosols Induced by Dust, Smoke, and Fireworks in the Cold Region of Northeast China

Despite the long-term implementation of air pollution control policies in northeast China, severe haze pollution continues to occur frequently. With the adoption of a megacity (Changchun) in northeast China, we analysed the vertical characteristics of aerosols and the causes of aerosol pollution throughout the year using multisource data for providing recommendations for controlling pollution events (i.e., straw burning and fireworks). Based on a ground-based LiDAR, it was found that the extinction coefficient (EC) of aerosols at a height of 300 m in Changchun was highest in winter (0.44 km−1), followed by summer (0.28 km−1), with significant differences from those in warmer regions, such as the Yangtze River Delta. Therefore, it is recommended that air pollution control policies be differentiated between winter and summer. On Chinese New Year’s Eve in Changchun, the ignition of firecrackers during the day and night caused increases in the EC at a height of 500 m to 0.37 and 0.88 km−1, respectively. It is suggested that the regulation of firecracker ignition should be reduced during the day and strengthened at night. Based on the CALIPSO and backward trajectory analysis results, two events of dust–biomass-burning composite pollution were observed in March and April. In March, the primary aerosol component was dust from western Changchun, whereas in April, the main aerosol component was biomass-burning aerosols originating from northern and eastern Changchun. Hence, reducing the intensity of spring biomass burning can mitigate the occurrence of dust–biomass-burning composite pollution. These findings can provide emission policy suggestions for areas facing similar issues regarding biomass-burning transmission pollution and firework emissions.

Prevalence, regional patterns and socio-demographic factors associated with poly-tobacco use in India: A secondary data analysis.

Tobacco use is associated with early, intermediate and long-term complications throughout the life course. With an influx of newer products containing nicotine, poly-tobacco use is slowly emerging as a public health concern, that is defined as existing tobacco users currently using two or more tobacco or nicotine products. While many studies have investigated single use tobacco, there is a paucity of research on regional patterns and socio-demographic factors associated with poly-tobacco use in India. To assess prevalence of poly-tobacco use and determine the socio-demographic factors associated with poly-tobacco use in India. Data from the Global Adult Tobacco Survey 2 (GATS, 2016-17) was analysed, which included information on tobacco use among people aged >15 years. The pattern of current tobacco status was described using descriptive statistics. Multiple logistic regression models were estimated to determine factors associated with poly-tobacco use. The prevalence of poly-tobacco use in India was found to be 9.8%. Among the current tobacco users, the prevalence was 33%. Significant socio-demographic factors associated with poly-tobacco use included younger age, male gender, religion and backward caste. North-eastern region reported highest prevalence of poly-tobacco use in the country, followed by the central region. The number of poly-tobacco users in India is considerably high and a matter of concern, more so in north east and central regions of the country. There is a need to create awareness about dangerous effects of all types of tobacco products and strengthen implementation of tobacco control policies with special focus on regions with high burden.

Trends of alcohol-attributable deaths in Lithuania 2001–2021: epidemiology and policy conclusions

BackgroundLithuania, a Baltic country in the European Union, can be characterized by high alcohol consumption and attributable burden. The aim of this contribution is to estimate the mortality burden due to alcohol use for the past two decades based on different relative risk functions, identify trends, and analyse the associations of alcohol-attributable burden with alcohol control policies and life expectancy.MethodsThe standard methodology used by the World Health Organization for estimating alcohol-attributable mortality was employed to generate mortality rates for alcohol-attributable mortality, standardized for Lithuania’s 2021 population distribution. Joinpoint analysis, T-tests, correlations, and regression analyses including meta-regressions were used to describe trends and associations.ResultsAge-standardized alcohol-attributable mortality was high in Lithuania during the two decades between 2001 and 2021, irrespective of which relative risks were used for the estimates. Overall, there was a downward trend, mainly in males, which was associated with four years of intensive implementation of alcohol control policies in 2008, 2009, 2017, and 2018. For the remaining years, the rates of alcohol-attributable mortality were stagnant. Among males, the correlations between alcohol-attributable mortality and life expectancy were 0.90 and 0.76 for Russian and global relative risks respectively, and regression analyses indicated a significant association between changes in alcohol-attributable mortality and life expectancy, after controlling for gross domestic product.ConclusionsMale mortality and life expectancy in Lithuania were closely linked to alcohol-attributable mortality and markedly associated with strong alcohol control policies. Further implementation of such policies is predicted to lead to further improvements in life expectancy.