Amenable mortality inequalities and their changes by place of residence during 1990-2019: the case of Lithuania.

OBJECTIVE: The aim of this study was to analyze inequalities of amenable mortality by place of residence and its changes in Lithuania during 1990-2019. STUDY DESIGN: A record-linked cohort study. METHODS: Information on deaths was obtained from Statistics Lithuania and the Institute of Hygiene. Mortality rates from amenable causes of death by urban and rural among men and women were calculated per 100,000 population and were standardized by age. Inequalities in mortality were assessed using rate differences. For the assessment of the trends of mortality and its inequalities during 1990-2019, joinpoint regression analysis was applied. RESULTS: During 1990-2019, amenable mortality of men and women in rural areas was higher compared to urban areas (P < 0.05). Changes in men's and women's mortality and its inequalities between rural and urban areas were characterized by three cut-off points (P < 0.05). However, not all the periods between the cut-off points were characterized by statistically significant changes in mortality. A reduction in amenable mortality was more evident in women, especially those living in rural areas. During 1990-2004 and in 2006, the differences in amenable mortality were greater among rural and urban women than among men. However, during 2013-2019, the differences were smaller (P < 0.05). Inequalities of men's mortality decreased during 1990-2001 and 2005-2012, and inequalities of women's mortality decreased during 1993-2006, 2006-2017, and 2017-2019 (P < 0.05). Inequalities of men's mortality decreased most rapidly during 2005-2012 (on average, by 10.24% per year), while inequalities of women's mortality decreased most rapidly during 2017-2019 (on average by 18.32% per year) (P < 0.05). CONCLUSION: During 1990-2019, inequalities and a decline of inequalities in amenable mortality among rural and urban men and women were identified in Lithuania. The amenable mortality of the residents of Lithuania remained high, changed unevenly, and no significant sharp decrease was observed. Further reduction of inequalities in amenable mortality between rural and urban inhabitants with a special focus on men remain the health policy challenges in Lithuania.

Long-term safety and efficacy of acotiamide in functional dyspepsia (postprandial distress syndrome)-results from the European phase 3 open-label safety trial.

BACKGROUNDS: Acotiamide is a novel acetylcholinesterase inhibitor for treatment of postprandial distress syndrome (PDS) symptoms of functional dyspepsia (FD). This European phase 3 open-label safety trial has been conducted to evaluate the long-term safety of acotiamide and explore the efficacy of acotiamide on PDS symptoms using the validated LPDS, quality of life using SF-36 and SF-NDI, and work productivity using WPAI. METHODS: FD-PDS patients (defined by ROME III criteria) aged ≥18 years with active PDS symptoms and without predominant overlapping symptoms of epigastric pain syndrome and related disorders were enrolled to receive 100 mg acotiamide three times daily for 1 year. Patients' safety profile and efficacy of acotiamide were monitored. KEY RESULTS: The majority of patients (81.6%) maintained exposure to acotiamide for >50 weeks, with a mean duration of 320.3 days. No specific clinically significant safety concerns have been shown, with no deaths, treatment-related severe/serious adverse events, or any clinically significant laboratory test results. Although being an open-label trial, acotiamide showed a change in severity larger than the minimum clinically important difference at weeks 1 and 2 for postprandial fullness and early satiation (meal-related symptoms), and showed improvement of quality of life and work productivity from the first measurement (at week 12) up to 1 year. CONCLUSIONS & INFERENCES: The long-term safety of acotiamide treatment was confirmed. A clinically important change for PDS symptoms, QoL, and work productivity was suggested; however a controlled trial is required to confirm this hypothetic efficacy of acotiamide. (NCT01973790).