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1.
  • Ahlm, Kristin, et al. (författare)
  • Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs a retrospective study, 1992-2009
  • 2013
  • Ingår i: BMC Public Health. - BioMed Central. - 1471-2458 .- 1471-2458. ; 13, s. 216
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Background</strong>: Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs.</p><p><strong>Methods</strong>: During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine.</p><p><strong>Results</strong>: During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p&lt;0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (&lt;= 18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p&lt;0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688/4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons.</p><p><strong>Conclusion</strong>: Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.</p>
2.
3.
  • Tjäderborn, Micaela, 1983- (författare)
  • Psychoactive prescription drug use disorders, misuse and abuse Pharmacoepidemiological aspects
  • 2016
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p><strong>Background:</strong> There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns.</p><p><strong>Aim:</strong> The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors.</p><p><strong>Methods:</strong> A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV).</p><p><strong>Results:</strong> In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug.</p><p><strong>Conclusions:</strong> This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.</p>
4.
  • Agahi, Neda, et al. (författare)
  • Alcohol consumption in very old age and its association with survival : A matter of health and physical function
  • 2016
  • Ingår i: Drug And Alcohol Dependence. - 0376-8716 .- 1879-0046. ; 159, s. 240-245
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old. Methods: Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n=863) collected in 2010/2011 were used. Mortality was analyzed unti12014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5-30 drinks/month) and heavy drinker (&gt;30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed. Results: Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant. Conclusions: The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.</p>
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5.
  • Agahi, Neda, et al. (författare)
  • Alcohol consumption in very old age and its association with survival: a matter of health and physical function
  • 2016
  • Ingår i: Drug And Alcohol Dependence. - Elsevier. - 0376-8716 .- 1879-0046. ; 159, s. 240-245
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background</p><p>Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old.</p><p>Methods</p><p>Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n = 863) collected in 2010/2011 were used. Mortality was analyzed until 2014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5–30 drinks/month) and heavy drinker (&gt;30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed.</p><p>Results</p><p>Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant.</p><p>Conclusions</p><p>The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to-moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.</p><h2>Graphical abstract</h2><p><img src="http://ars.els-cdn.com/content/image/1-s2.0-S0376871615018372-fx1.jpg" data-loaded="true" data-gabseid="1-s2.0-S0376871615018372-fx1.jpg" data-thumbeid="1-s2.0-S0376871615018372-fx1.sml" data-thumbheight="146" data-thumbwidth="219" data-fullheight="200" data-fullwidth="300" /></p>
6.
  • Agahi, Neda, et al. (författare)
  • Social integration and alcohol consumption among older people : A four-year follow-up of a Swedish national sample
  • 2019
  • Ingår i: Drug And Alcohol Dependence. - 0376-8716 .- 1879-0046. ; 196, s. 40-45
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Today's older people drink more alcohol than earlier cohorts of older people. Social integration has been identified as an important factor for older people's drinking, but the association is complex. This study investigates both high and low levels of social integration and their associations with longitudinal patterns of alcohol consumption among older women and men.</p><p>Methods: Longitudinal nationally representative data of older Swedish women and men aged over 65 - the Swedish Level of Living Survey (LNU) and Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) - from 2010/2011 and 2014 (n = 1048). Associations between social contacts and social activities at baseline and longitudinal patterns of drinking frequency were examined with multinomial logistic regression analyses.</p><p>Results: Men reported drinking alcohol more often than women, but the most common drinking frequency among both women and men was to drink monthly or less. Drinking habits were generally stable over time. People with high levels of social activity at baseline were more likely to have a stable daily or weekly drinking frequency or increased drinking frequency over the four-year follow-up period, particularly women. People with low levels of social contacts and/or social activities were less likely to have a stable daily or weekly drinking frequency, compared to people in the low and stable drinking frequency group.</p><p>Conclusions: Alcohol consumption is embedded in a social context, older people drink in social situations and social integration predicts continued drinking patterns.</p>
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7.
  • Dauber, Hanna, et al. (författare)
  • Older adults in treatment for alcohol use disorders : service utilisation, patient characteristics and treatment outcomes
  • 2018
  • Ingår i: Substance Abuse Treatment, Prevention, and Policy. - 1747-597X .- 1747-597X. ; 13
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Background</strong> In western countries demographic changes are leading to an ageing society. Consequently, the number of older adults with alcohol use disorders (AUDs) will rise and the demand of treatment is likely to increase. However, thus far not many older adults with an AUD are seeking treatment and little is known about the efficacy of treatment for older adults. The present study aimed at determining the proportion of older adults with an AUD in addiction treatment, particular characteristics and treatment outcomes of this clientele.</p><p><strong>Methods</strong> Using data of 10,860 patients with an AUD aged 60 and over that are documented within the national German addiction care system we conducted exploratory analyses with regard to prevalence, sociodemographic, disorder- and treatment-related variables.</p><p><strong>Results</strong> Overall, we found a low proportion of older patients in treatment due to AUDs, but highly positive treatment outcomes. With regard to sociodemographic and disorder-related characteristics, older females and late-onset patients in particular constitute a unique clientele.</p><p><strong>Conclusions</strong> The low service utilisation on the one hand but good treatment prognosis on the other emphasise the need to promote treatment seeking among older adults with AUDs. In this context, the special characteristics we found among older patients may contribute to better reach this population and to improve provisions of targeted treatment approaches.</p>
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8.
  • Philipson, A., et al. (författare)
  • Adolescent depression and subsequent earnings across early to middle adulthood: A 25-year longitudinal cohort study
  • 2020
  • Ingår i: Epidemiology and Psychiatric Sciences. - 2045-7979 .- 2045-7960. ; 29
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: The few available studies on early-onset depression and future earnings offer ambiguous findings, and potential sources of heterogeneity are poorly understood. We examined the differences in adult earnings of males and females with and without a history of depressive disorder in adolescence, with specific focuses on (1) future earnings in clinical subtypes of adolescent depression; (2) the growth and distribution of earnings over time within these subgroups and (3) the mediating role of subsequent depressive episodes occurring in early adulthood. Methods: Data were drawn from the Uppsala Longitudinal Adolescent Depression Study, a community-based cohort study initiated in Uppsala, Sweden, in the early 1990s. Comprehensive diagnostic assessments were conducted at age 16-17 and in follow-up interviews 15 years later, while consecutive data on earnings for the years 1996 to 2016 (ages 20-40) were drawn from population-based registries. The current study included participants with a history of persistent depressive disorder (PDD) (n = 175), episodic major depressive disorder (MDD) (n = 82), subthreshold depression (n = 64) or no depression (n = 218) in adolescence. The association of adolescent depression with earnings in adulthood was analysed using generalised estimating equations. Estimates were adjusted for major child and adolescent psychiatric comorbidities and parental socioeconomic status. The indirect (mediated) effect of depression in early adulthood (ages 19-30) on earnings in mid-adulthood (31-40) was estimated in mediation analysis. The study followed the 'STrengthening the Reporting of OBservational studies in Epidemiology' (STROBE) guidelines. Results: Earnings across early to middle adulthood were lower for participants with a history of a PDD in adolescence than for their non-depressed peers, with an adjusted ratio of mean earnings of 0.85 (0.77-0.95) for females and 0.76 (0.60-0.95) for males. The differences were consistent over time, and more pronounced in the lower percentiles of the earnings distributions. The association was partially mediated by recurrent depression in early adulthood (48% in total; 61% for females, 29% for males). No reduction in earnings was observed among participants with episodic MDD in adolescence, while results for subthreshold depression were inconclusive. Conclusions: Our findings suggest that future earnings of adolescents with depressive disorders are contingent on the duration and natural long-term course of early-onset depression, emphasising the need for timely and effective interventions to avoid loss of human capital.
9.
  • Ohlsson, Bodil (författare)
  • The role of smoking and alcohol behaviour in management of functional gastrointestinal disorders
  • 2017
  • Ingår i: Bailliere's Best Practice and Research in Clinical Gastroenterology. - Baillière Tindall. - 1521-6918. ; 31:5, s. 545-552
  • Forskningsöversikt (refereegranskat)abstract
    • Functional gastrointestinal disorders (FGIDs) are common disorders in the population. Lifestyle habits have been suspected to influence the presence and degree of symptoms, and many studies have examined the role of food components and physical activity on the disease development. The role of smoking and alcohol intake on FGID has been less thoroughly examined. This systematic literature review, of a large amount of studies from different countries around the world with different design and application of FGID criteria, shows that smoking seems to be associated with a significant 50% increased risk of FD for current compared with never smokers. The associations between smoking and other FGIDs are weak, if present at all. A moderate alcohol intake is not associated with FGIDs. On the other hand, a high alcohol intake may lead to development and aggravation of FGID symptoms, especially functional dyspepsia.
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10.
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