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      Daily variations in ambulance calls for selected causes in Arkhangelsk, Russia: potential role of excessive alcohol consumption on weekends

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          Abstract

          Objective

          To assess daily variations in ambulance calls for cardiovascular diseases (CVDs), mental and behavioral disorders, and external causes in Arkhangelsk, Northwest Russia, in 2000–2008.

          Study design

          A population-based study.

          Methods

          Data about all ambulance calls during the years 2000–2008 were obtained from the Arkhangelsk ambulance station. Information about patient's gender, age, doctor's diagnosis according to International Classification of Diseases, 10th revision, and the date of call were recorded. Pearson's Chi-squared tests were used for comparing proportions of ambulance calls across the week for CVDs (I00-99), mental and behavioral disorders (F00-F99), and external causes (S00-T98, V01-Y98). The ratio of incidence of ambulance calls on Saturday, Sunday, and Monday versus the rest of week was also calculated.

          Results

          There is a significant daily variation (p < 0.001) in calls for CVDs in men and women aged 18–59 and women aged 60 years and older, with increased numbers of calls on weekends and Mondays varying between 2 and 3% excess calls. For mental and behavioral disorders, a similar pattern was found in the age group of 18–59 year-olds. Ratios for the number of calls during weekends and Mondays vs. the rest of the week were 1.05 (95% CI: 1.02–1.08) among women and 1.02 (95% CI: 1.00–1.05) among men. For external causes, a significant variation and an increase in ambulance calls during Saturdays, Sundays, and Mondays from 4 to 17% excess calls was observed for both age and gender groups.

          Conclusions

          The observed daily variations in ambulance calls with an increased number of calls on weekends and Mondays for CVDs, mental and behavioral disorders, and external causes may be associated with excessive alcohol consumption on the weekends. Further research using data on individual levels of alcohol consumption are warranted.

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          Most cited references35

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          Alcohol and Russian mortality: a continuing crisis.

          Russia remains in the grip of a mortality crisis in which alcohol plays a central role. In 2007, male life expectancy at birth was 61 years, while for females it was 74 years. Alcohol is implicated particularly in deaths among working-age men. To review the current state of knowledge about the contribution of alcohol to the continuing very high mortality seen among Russian adults Conservative estimates attribute 31-43% of deaths among working-age men to alcohol. This latter estimate would imply a minimum of 170 000 excess deaths due to hazardous alcohol consumption in Russia per year. Men drink appreciably more than women in Russia. Hazardous drinking is most prevalent among people with low levels of education and those who are economically disadvantaged, partly because some of the available sources of ethanol are very cheap and easy to obtain. The best estimates available suggest that per capita consumption among adults is 15-18 litres of pure ethanol per year. However, reliable estimation of the total volume of alcohol consumed per capita in Russia is very difficult because of the diversity of sources of ethanol that are available, for many of which data do not exist. These include both illegal spirits, as well as legal non-beverage alcohols (such as medicinal tinctures). In 2006 regulations were introduced aimed at reducing the production and sale of non-beverage alcohols that are commonly drunk. These appear to have been only partially successful. There is convincing evidence that alcohol plays an important role in explaining high mortality in Russia, in particular among working age men. However, there remain important uncertainties about the precise scale of the problem and about the health effects of the distinctive pattern of alcohol consumption that is prevalent in Russia today. While there is a need for further research, enough is known to justify the development of a comprehensive inter-sectoral alcohol control strategy. The recent fall in life expectancy in Russia should give a renewed urgency to attempts to move the policy agenda forward. © 2009 The Authors. Journal compilation © 2009 Society for the Study of Addiction.
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            Does drinking pattern modify the effect of alcohol on the risk of coronary heart disease? Evidence from a meta-analysis.

            To evaluate the strength of the evidence provided by epidemiological literature investigating drinking pattern as effect modifier of alcohol intake on the risk of coronary heart disease (CHD). Meta-analysis of observational studies. Medline, citation tracking, from 1966 to 2006. Original studies investigating the amount of alcohol intake, combined with the frequency of alcohol consumption and/or pattern of alcohol drinking affecting the risk of CHD were extracted. Among them, cohort and case-control studies reporting sufficient data to perform statistical analyses and using people who abstained from alcohol as the reference were included. Six (4 cohort and 2 case-control) out of 118 studies reviewed met the inclusion criteria. Compared with those who abstained from alcohol, regular heavy drinkers and heavy irregular or binge drinkers showed significantly different pooled relative risks of 0.75 (95% confidence interval 0.64 to 0.89) and 1.10 (1.03 to 1.17) respectively. The dose-response relation between the amount of alcohol intake and CHD risk was significantly different in regular and irregular drinkers. A J-shaped curve, with nadir around 28 grams of alcohol per week, and last protective dose of 131 grams per week, was obtained including drinkers who consumed alcohol for 2 days a week or less. Conversely, in people who consumed alcohol for more than 2 days a week a significant protective effect was seen even when drinking high amounts of alcohol. This meta-analysis suggests that binge and heavy irregular drinking modify the favourable effect of alcohol intake on the CHD risk. However, this conclusion should be taken with caution because of the small number of studies considered.
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              The positive relationship between alcohol and heart disease in eastern Europe: potential physiological mechanisms.

              Research into the effect of alcohol on cardiovascular disease has indicated protective effects from moderate consumption. These observations, made in industrialized countries, have influenced policies on alcohol in countries where the situation may be quite different--specifically, where consumption is substantially higher or patterns of drinking are different. In central and eastern Europe and the former Soviet Union, a growing body of epidemiological research indicates a positive rather than negative association between alcohol consumption and cardiovascular deaths, especially sudden cardiac deaths. By means of a systematic review of published work, we examine whether there is a physiological basis for the observed association between alcohol and heart disease seen in eastern Europe, focusing on the effects of high levels of consumption and of irregular or binge drinking. In binge drinkers, cardioprotective changes in high-density lipoproteins are not seen, and adverse changes in low-density lipoproteins are acquired. Irregular drinking is associated with an increased risk of thrombosis, occurring after cessation of drinking. It predisposes both to histological changes in the myocardium and conducting system and to a reduction in the threshold for ventricular fibrillation. Measures of frequency as well as quantity of consumption should be included in epidemiological studies. Taken with the epidemiological evidence emerging from eastern Europe, these observations have important implications for estimates of the burden of disease attributable to alcohol.
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                Author and article information

                Journal
                Int J Circumpolar Health
                Int J Circumpolar Health
                IJCH
                International Journal of Circumpolar Health
                Co-Action Publishing
                1239-9736
                2242-3982
                01 November 2012
                2012
                : 71
                : 10.3402/ijch.v71i0.19124
                Affiliations
                [1 ]International School of Public Health, Northern State Medical University, Arkhangelsk, Russia
                [2 ]Department of International Public Health, Norwegian Institute of Public Health, Oslo, Norway
                [3 ]Institute of Community Medicine, University of Tromsø, Tromsø, Norway
                Author notes
                [* ] Andrej M. Grjibovski, Norwegian Institute of Public Health, Post box 4404 Nydalen, NO-0403 Oslo, Norway, Tel:+47 2107 8319, Fax:+47 2107 6513. Email: andrei.grjibovski@ 123456fhi.no
                Article
                19124
                10.3402/ijch.v71i0.19124
                3488112
                23130353
                ffd55784-4558-4292-9f90-f959369dc5c5
                © 2012 Sergei N. Drachev et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 July 2012
                : 25 September 2012
                : 07 October 2012
                Categories
                Original Research Article

                Medicine
                alcohol,russia,cardiovascular,ambulance,external causes,binge drinking
                Medicine
                alcohol, russia, cardiovascular, ambulance, external causes, binge drinking

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