Impact of the WHO "best buys" for alcohol policy on consumption and health in the Baltic countries and Poland 2000-2020

Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time-series analyses suggest improved health, measured as reductions in all-cause and alcohol-attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol-attributable deaths. The natural experiment in this region of high-income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.

Policy disparities in response to COVID-19 between Singapore and China

Objective

The study analyzed the common points and discrepancies of COVID-19 control measures of the two countries in order to provide appropriate coping experiences for countries all over the world.

Method

This study examined the associations between the epidemic prevention and control policies adopted in the first 70 days after the outbreak and the number of confirmed cases in China and Singapore using the generalized linear model. Policy comparisons and disparities between the two countries were also discussed.

Results

The regression models show that factors influencing the cumulative number of confirmed cases in China: Locking down epicenter; activating Level One public health emergency response in all localities; the central government set up a leading group; classified management of “four categories of personnel”; launching makeshift hospitals; digital management for a matrix of urban communities; counterpart assistance. The following four factors were the key influencing factors of the cumulative confirmed cases in Singapore: The National Centre for Infectious Diseases screening center opens; border control measures; surveillance measures; Public Health Preparedness Clinics launched.

Conclusions

Through analyzing the key epidemic prevention and control policies of the two countries, we found that the following factors are critical to combat COVID-19: active case detection, early detection of patients, timely isolation, and treatment, and increasing of medical capabilities. Countries should choose appropriate response strategies with health equity in mind to ultimately control effectively the spread of COVID-19 worldwide.

Spatial scales in human movement between reservoirs of infection

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Simple, yet flexible, model of human movement patterns.

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Analytic formalism which can be used to derive important spatial scales.

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Introduces a novel drift–diffusion approximation for stochastic reservoirs.

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A new critical spatial scale predicted for helminth reservoirs of infection.

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The necessary data needed to test these predictions is outlined in detail.

The life cycle of parasitic organisms that are the cause of much morbidity in humans often depend on reservoirs of infection for transmission into their hosts. Understanding the daily, monthly and yearly movement patterns of individuals between reservoirs is therefore of great importance to implementers of control policies seeking to eliminate various parasitic diseases as a public health problem. This is due to the fact that the underlying spatial extent of the reservoir of infection, which drives transmission, can be strongly affected by inputs from external sources, i.e., individuals who are not spatially attributed to the region defined by the reservoir itself can still migrate and contribute to it. In order to study the importance of these effects, we build and examine a novel theoretical model of human movement between spatially-distributed focal points for infection clustered into regions defined as ‘reservoirs of infection’. Using our model, we vary the spatial scale of human moment defined around focal points and explicitly calculate how varying this definition can influence the temporal stability of the effective transmission dynamics – an effect which should strongly influence how control measures, e.g., mass drug administration (MDA), define evaluation units (EUs). Considering the helminth parasites as our main example, by varying the spatial scale of human movement, we demonstrate that a critical scale exists around infectious focal points at which the migration rate into their associated reservoir can be neglected for practical purposes. This scale varies by species and geographic region, but is generalisable as a concept to infectious reservoirs of varying spatial extents and shapes. Our model is designed to be applicable to a very general pattern of infectious disease transmission modified by the migration of infected individuals between clustered communities. In particular, it may be readily used to study the spatial structure of hosts for macroparasites with temporally stationary distributions of infectious focal point locations over the timescales of interest, which is viable for the soil-transmitted helminths and schistosomes. Additional developments will be necessary to consider diseases with moving reservoirs, such as vector-born filarial worm diseases.

Stochastic challenges to interrupting helminth transmission

Predicting the effect of different programmes designed to control both the morbidity induced by helminth infections and parasite transmission is greatly facilitated by the use of mathematical models of transmission and control impact. In such models, it is essential to account for the many sources of uncertainty - natural, or otherwise - to ensure robustness in prediction and to accurately depict variation around an expected outcome. In this paper, we investigate how well the standard deterministic models match the predictions made using individual-based stochastic simulations. We also explore how well concepts which derive from deterministic models, such as 'breakpoints' in transmission, apply in the stochastic world. Employing an individual-based stochastic model framework we also investigate how transmission and control are affected by the migration of infected people into a defined community. To give our study focus we consider the control of soil-transmitted helminths (STH) by mass drug administration (MDA), though our methodology is readily applicable to the other helminth species such as the schistosome parasites and the filarial worms. We show it is possible to theoretically define a 'stochastic breakpoint' where much noise surrounds the expected deterministic breakpoint. We also discuss the concept of the 'interruption of transmission' independent of the 'breakpoint' concept where analyses of model behaviour illustrate the current limitations of deterministic models to account for the 'fade-out' or transmission extinction behaviour in simulations. Our analysis of migration confirms a relationship between the critical infected human migration rate scale (i.e., order of magnitude) per unit of time and the death rate of infective stages that are released into the free-living environment. This relationship is shown to determine the likelihood that control activities aim at chemotherapeutic treatment of the human host will eliminate transmission. The development of a new stochastic simulation code for STH in the form of a publicly-available open-source python package which includes features to incorporate many population stratifications, different control interventions including mass drug administration (with defined frequency, coverage levels and compliance patterns) and inter-village human migration is also described.

Modeling and control of epidemics through testing policies

Testing is a crucial control mechanism in the beginning phase of an epidemic when the vaccines are not yet available. It enables the public health authority to detect and isolate the infected cases from the population, thereby limiting the disease transmission to susceptible people. However, despite the significance of testing in epidemic control, the recent literature on the subject lacks a control-theoretic perspective. In this paper, an epidemic model is proposed that incorporates the testing rate as a control input and differentiates the undetected infected from the detected infected cases, who are assumed to be removed from the disease spreading process in the population. After estimating the model on the data corresponding to the beginning phase of COVID-19 in France, two testing policies are proposed: the so-called best-effort strategy for testing (BEST) and constant optimal strategy for testing (COST). The BEST policy is a suppression strategy that provides a minimum testing rate that stops the growth of the epidemic when implemented. The COST policy, on the other hand, is a mitigation strategy that provides an optimal value of testing rate minimizing the peak value of the infected population when the total stockpile of tests is limited. Both testing policies are evaluated by their impact on the number of active intensive care unit (ICU) cases and the cumulative number of deaths for the COVID-19 case of France.

Mapping and comparing French people's positions regarding restrictive control policies: a pilot study

BACKGROUND

Public authorities resort to various control policies in order to curb the prevalence of unhealthy behaviors. As these policies can only succeed to the extent that people agree with them, this study mapped French people's positions regarding restrictive control policies in general.

METHOD

A sample of 344 adults (among them health professionals and lawyers) were presented with 54 vignettes depicting a control policy. Each vignette contained four pieces of information: the type of addictive behavior targeted (smoking, drinking, or gambling), the nature of preventive measures (e.g., information campaigns), the degree of regulative measures (e.g., prohibition to minors), and the severity of sanctions.

RESULTS

Through cluster analysis, eight qualitatively different positions were found: Never acceptable (9%), Weak or moderate regulation (5%), Moderate regulation associated with strong prevention (11%), Strong or moderate regulation (11%), Strong regulation in association with strong prevention (23%), Moderate sanctions in association with strong prevention and moderate regulation (9%), Severe sanctions (9%), and Always acceptable (9%). Some participants (14%) expressed no opinion at all.

CONCLUSION

French people's positions regarding control policies were extremely diverse. Regarding tobacco, however, one type of policy would likely be supported by a majority of people: Moderate regulation associated with at least a moderate level of prevention and low-level sanctions. Regarding alcohol, an acceptable position would be: Moderate regulation associated with at least a moderate level of prevention and high-level sanctions. Regarding gambling, an acceptable position would be: Strong regulation associated with at least a moderate level of prevention and low-level sanctions.

The 'breakpoint' of soil-transmitted helminths with infected human migration

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Novel analytic understanding of STH transmission dynamics near the breakpoint.

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New models of infected human migration are developed and analysed.

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An approximate Markovian process description is shown to describe migration well.

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Migration rates greater than the death rate of infectious stages are critical.

Building on past research, we here develop an analytic framework for describing the dynamics of the transmission of soil-transmitted helminth (STH) parasitic infections near the transmission breakpoint and equilibria of endemic infection and disease extinction, while allowing for perturbations in the infectious reservoir of the parasite within a defined location. This perturbation provides a model for the effect of infected human movement between villages with differing degrees of parasite control induced by mass drug administration (MDA). Analysing the dynamical behaviour around the unstable equilibrium, known as the transmission ‘breakpoint’, we illustrate how slowly-varying the dynamics are and develop an understanding of how discrete ‘pulses’ in the release of transmission stages (eggs or larvae, depending on the species of STH), due to infected human migration between villages, can lead to perturbations in the deterministic transmission dynamics. Such perturbations are found to have the potential to undermine targets for parasite elimination as a result of MDA and/or improvements in water and sanitation provision. We extend our analysis by developing a simple stochastic model and analytically investigate the uncertainty this induces in the dynamics. Where appropriate, all analytical results are supported by numerical analyses.

Particulate matter pollution over China and the effects of control policies

China is one of the regions with highest PM_2.5 concentration in the world. In this study, we review the spatio-temporal distribution of PM_2.5 mass concentration and components in China and the effect of control measures on PM_2.5 concentrations. Annual averaged PM_2.5 concentrations in Central-Eastern China reached over 100μgm^-3, in some regions even over 150μgm^-3. In 2013, only 4.1% of the cities attained the annual average standard of 35μgm^-3. Aitken mode particles tend to dominate the total particle number concentration. Depending on the location and time of the year, new particle formation (NPF) has been observed to take place between about 10 and 60% of the days. In most locations, NPF was less frequent at high PM mass loadings. The secondary inorganic particles (i.e., sulfate, nitrate and ammonium) ranked the highest fraction among the PM_2.5 species, followed by organic matters (OM), crustal species and element carbon (EC), which accounted for 6-50%, 15-51%, 5-41% and 2-12% of PM_2.5, respectively. In response to serious particulate matter pollution, China has taken aggressive steps to improve air quality in the last decade. As a result, the national emissions of primary PM_2.5, sulfur dioxide (SO₂), and nitrogen oxides (NO_X) have been decreasing since 2005, 2006, and 2011, respectively. The emission control policies implemented in the last decade could result in noticeable reduction in PM_2.5 concentrations, contributing to the decreasing PM_2.5 trends observed in Beijing, Shanghai, and Guangzhou. However, the control policies issued before 2010 are insufficient to improve PM_2.5 air quality notably in future. An optimal mix of energy-saving and end-of-pipe control measures should be implemented, more ambitious control policies for NMVOC and NH₃ should be enforced, and special control measures in winter should be applied. 40-70% emissions should be cut off to attain PM_2.5 standard.

Vehicular emissions in China in 2006 and 2010

Vehicular emissions in China in 2006 and 2010 were calculated at a high spatial resolution based on the data released by the National Bureau of Statistics, by taking the emission standards into consideration. China's vehicular emissions of carbon monoxide (CO), nitrogen oxides (NO_x), volatile organic compounds (VOCs), ammonia (NH₃), fine particulate matters (PM_2.5), inhalable particulate matters (PM₁₀), black carbon (BC), and organic carbon (OC) were 30,113.9, 4593.7, 6838.0, 20.9, 400.2, 430.5, 285.6, and 105.1Gg, respectively, in 2006 and 34,175.2, 5167.5, 7029.4, 74.0, 386.4, 417.1, 270.9, and 106.2Gg, respectively, in 2010. CO, VOCs, and NH₃ emissions were mainly from motorcycles and light-duty gasoline vehicles, whereas NO_X, PM_2.5, PM₁₀, and BC emissions were mainly from rural vehicles and heavy-duty diesel trucks. OC emissions were mainly from motorcycles and heavy-duty diesel trucks. Vehicles of pre-China I (vehicular emission standard of China before phase I) and China I (vehicular emission standard of China in phase I) were the primary contributors to all of the pollutant emissions except NH₃, which was mainly from China III and China IV gasoline vehicles. The total emissions of all the pollutants except NH₃ changed little from 2006 to 2010. This finding can be attributed to the implementation of strict emission standards and to improvements in oil quality.