| 1. |
- Bäckström, Eric, et al.
(författare)
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Healthcare contacts regarding circulatory conditions among swedish patients in opioid substitution treatment, with and without on-site primary healthcare
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 18:9
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Tidskriftsartikel (refereegranskat)abstract
- Patients in Opioid Substitution Treatment (OST) have increased mortality and morbidity, with circulatory conditions suggested to be a contributing factor. Since OST patients tend to have unmet physical healthcare needs, a small-scale intervention providing on-site primary healthcare (PHC) in OST clinics was implemented in Malmö, Sweden in 2016. In this study, we assessed registered circulatory conditions and healthcare utilization in OST patients with and without use of on-site PHC. Patients from four OST clinics in Malmö, Sweden, were recruited to a survey study in 2017–2018. Medical records for the participants were retrieved for one year prior to study participation (n = 192), and examined for circulatory diagnoses, examinations and follow-ups. Patients with and without on-site PHC were compared through descriptive statistics and univariate analyses. Eighteen percent (n = 34) of the sample had 1≤ registered circulatory condition, and 6% (n = 12) attended any clinical physiology examination or follow-up, respectively. Among patients utilizing on-site PHC (n = 26), the numbers were 27% (n = 7) for circulatory diagnosis, 15% (n = 4) for examinations, and 12% (n = 3) for follow-up. OST patients seem underdiagnosed in regard to their circulatory health. On-site PHC might be a way to diagnose and treat circulatory conditions among OST patients, although further research is needed.
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| 2. |
- Dahlman, Disa, et al.
(författare)
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Attitudes towards hepatitis C and treatment willingness in injection drug users: a follow-up interview study.
- 2015
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Ingår i: Journal of Alcoholism & Drug Dependence. - : OMICS Publishing Group. - 2329-6488. ; 3:4, s. 4-4
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Many injection drug users are infected with hepatitis C virus (HCV), yet few are treated. With opiate maintenance treatment, expected life length increases, and the incitement increases to treat HCV in order to avoid long term complications. The aim of the present study was to investigate attitudes towards HCV and HCV treatment willingness among opiate-dependent injection drug users at Malmö needle exchange program, through interviews just before entering opiate maintenance treatment and after 6 months in opiate maintenance treatment. Heroin-dependent injection drug users were recruited from Malmö needle exchange program October 2011 – April 2013. They had a structured baseline interview (N=83), led by social workers. After 6 months, all patients who successfully entered opiate maintenance treatment and were still enrolled (N=56) had a follow-up interview. Correlations with treatment willingness were calculated using Pearson’s Chi-Square test. Change over time was determined by McNemar Test. A majority at both baseline and follow-up wanted more information about HCV, but HCV-positive subjects did not feel affected by their HCV status. No significant change in treatment willingness was found after 6 month in opiate maintenance treatment, neither were any factors significantly associated with treatment willingness found. We conclude that there is need for inclusion of more information about and easy referral to HCV therapy as part of opiate maintenance treatment.
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| 3. |
- Dahlman, Disa, et al.
(författare)
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Behavioral characteristics and injection practices associated with skin and soft tissue infections among people who inject drugs : A community-based observational study
- 2017
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Ingår i: Substance Abuse. - : Informa UK Limited. - 0889-7077 .- 1547-0164. ; 38:1, s. 105-112
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Tidskriftsartikel (refereegranskat)abstract
- Background: People who inject drugs (PWID) are at increased risk for bacterial skin and soft tissue infections (SSTIs). Although SSTIs pose significant health risks, little is known about their prevalence and characteristics in the population of PWID in the United States. This study investigates whether behavioral factors related to skin and equipment hygiene and tissue-damaging injection practices are associated with recent SSTIs among PWID. Methods: Active PWID were recruited using targeted sampling in San Francisco in 2011–2013. Interviewers collected information on behavioral risk factors of past-month self-reported SSTIs. Inferential analyses used multivariate logistic regression methods (i.e., generalized linear model) to characterize risk factors for past-month SSTIs. Results: The self-reported prevalence of lifetime, past-year, and past-month SSTI was 70%, 29%, and 11%, respectively. Several factors were significantly associated with past-month SSTIs in bivariate analysis, including injecting nonpowder drugs (odds ratio [OR] = 3.57; 95% confidence interval [CI] = 1.23, 10.35; P = .01), needle-licking before injection (OR = 3.36; 95% CI = 1.28, 8.81; P = .01), injecting with someone else's preused syringe/needle (OR = 7.97; 95% CI = 2.46, 25.83; P < .001), being injected by another person (OR = 2.63; 95% CI = 1.02, 6.78; P = .04), infrequent skin cleaning before injection (OR = 2.47; 95% CI = 1.00, 6.10; P = .04), and frequent injections (P = .02). In multivariate analysis, only syringe/needle sharing (adjusted OR = 6.38; 95% CI = 1.90, 21.46) remained statistically significant. Conclusion: SSTIs are common among PWID. These data highlight the importance of clinical and public health screening efforts to reduce SSTIs. Needle exchange programs may be good venues for SSTIs screening and treatment.
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| 4. |
- Dahlman, Disa, et al.
(författare)
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Both localized and systemic bacterial infections are predicted by injection drug use : A prospective follow-up study in Swedish criminal justice clients
- 2018
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:5
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Tidskriftsartikel (refereegranskat)abstract
- Background Both skin and soft tissue infections (SSTI) and systemic bacterial infections are common in people who inject drugs (PWID), but data on incidence and risk factors are lacking. We compared registered diagnoses for such infections in Swedish criminal justice clients with regard to injecting drug use. Methods Baseline interview data from the Swedish Prison and Probation Service on drug use in PWID and non-PWID with problematic alcohol use were linked to follow-up data from national Swedish registers on hospital diagnoses and/or death. Associations between drug use and later diagnosis of SSTI and systemic bacterial infection (septicemia or bacterial infection of the heart, bone/joints or central nervous system) were analyzed by Cox regression. Results Incidence rates of SSTI was 28.3 per 1,000 person-years for PWID (n = 2,444) and 10.0 for non-PWID with problematic alcohol use (n = 735). Incidence rates of systemic bacterial infection was 9.1 per 1,000 person-years for PWID and 2.7 per 1,000 person-years for non-PWID. Injection drug use was associated with a significantly increased risk of bacterial infections, for main drugs heroin (SSTI: Hazard ratio [HR] 2.45; systemic infection: HR 2.75), amphetamine (SSTI: HR 1.60; systemic infection: HR 2.19), and polysubstance use (SSTI: HR 1.92; systemic infection: HR 2.01). In relation to injection use of amphetamine and polysubstance use, PWID mainly using heroin had higher risk of SSTI. Conclusions Injection drug use predicted both SSTI and systemic bacterial infection, with a particularly high risk of SSTI in PWID mainly using heroin. The results imply the need for increased attention to bacterial infections among PWID, in terms of clinical management, prevention and research.
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| 5. |
- Dahlman, Disa, et al.
(författare)
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Cervical cancer among Swedish women with drug use disorders : A nationwide epidemiological study
- 2021
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Ingår i: Gynecologic Oncology. - : Elsevier BV. - 0090-8258. ; 160:3, s. 742-747
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Tidskriftsartikel (refereegranskat)abstract
- Background/Aim: Cervical cancer incidence and mortality has decreased after introduction of national screening in Sweden, but women with drug use disorders (DUD) are less likely to participate in screening programs. We aimed to investigate cervical cancer incidence and mortality among women with DUD compared to the general female population in Sweden. Methods: We conducted a cohort study based on Swedish national register data for the period January 1997–December 2015. Data was collected for 3,838,248 women aged 15–75 years of whom 50,858 had DUD. Adjusted hazard ratios (HRs) for incident and fatal cervical cancer were calculated for women with and without DUD using Cox regression analysis. Results: DUD was significantly associated with incident cervical cancer (HR = 1.39, 95% confidence interval [CI] 1.39–1.61), but not fatal cervical cancer (HR = 1.25, 95% CI: 0.91–1.71), after adjusting for age, educational attainment, social welfare, region of residence, marital status and HIV infection. Conclusion: Women with DUD were thus identified as a risk group for incident cervical cancer, which calls for attention from clinicians and policy makers. It is possible that non-attendance in cancer screening and other healthcare seeking barriers may affect the risk of incident cervical cancer among women with DUD but more research on this topic is needed.
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| 6. |
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| 7. |
- Dahlman, Disa, et al.
(författare)
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Drug use disorder and risk of incident and fatal breast cancer : a nationwide epidemiological study
- 2021
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Ingår i: Breast Cancer Research and Treatment. - : Springer Science and Business Media LLC. - 0167-6806 .- 1573-7217. ; 186:1, s. 199-207
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Breast cancer is one of the most common cancer forms in women and it is often detected by screening. However, women with drug use disorders (DUD) are less likely to be reached by screening programs. In this study, we aimed to investigate breast cancer incidence, mortality and stage at time of diagnosis among women with DUD compared to the general female population in Sweden. Methods: We performed a follow-up study based on Swedish national register data for the period January 1997–December 2015. The study was based on 3,838,248 women aged 15–75 years, of whom 50,858 were registered with DUD. Adjusted hazard ratios (HRs) for incident and fatal breast cancer, and cancer stage at time of diagnosis, were calculated for women with and without DUD using Cox regression analysis. Results: DUD was associated with incident breast cancer (HR 1.08, 95% confidence interval [CI] 1.02–1.14, p = 0.0069), fatal breast cancer (HR 1.60, 95% CI 1.42–1.82, p < 0.001), and stage IV breast cancer, i.e. metastasis at diagnosis (HR 2.06, 95% CI 1.44–2.95, p < 0.001). Conclusions: Women with DUD were identified as a risk group for incident, fatal and metastasized breast cancer, which calls for attention from clinicians and policy makers. Cancer screening attendance and other healthcare seeking barriers are likely to affect the risk increase among women who use drugs; however, more research is needed on the underlying mechanisms.
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| 8. |
- Dahlman, Disa, et al.
(författare)
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Drug use disorder and risk of incident and fatal prostate cancer among Swedish men : a nationwide epidemiological study
- 2022
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Ingår i: Cancer Causes and Control. - : Springer Science and Business Media LLC. - 0957-5243 .- 1573-7225. ; 33:2, s. 213-222
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide. Men with drug use disorders (DUD) may potentially be at high risk for prostate cancer mortality because of delayed diagnosis and/or undertreatment. In this study, we aimed to investigate prostate cancer incidence, mortality, and stage at time of diagnosis among men with DUD compared to the general male population in Sweden. Methods: We performed a follow-up study based on Swedish national register data for the period January 1997–December 2016. The study was based on 1,361,532 men aged 50–75 years at inclusion, of whom 9,259 were registered with DUD. Cox regression analysis was used to compute adjusted hazard ratios (HRs) for incident and fatal prostate cancer, and cancer stage at time of diagnosis, associated with DUD. Results: DUD was associated with a slightly increased risk of incident prostate cancer (HR: 1.07, 95% confidence interval [CI] 1.00–1.14, p = 0.048) and substantially higher risk of fatal prostate cancer (HR: 1.59, 95% CI 1.40–1.82, p < 0.001), adjusted for age, socioeconomic factors, and comorbidities related to tobacco smoking and alcohol use disorder. No association was found between DUD and prostate cancer stage at diagnosis. Conclusions: Men with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population. Our findings should raise attention among medical staff and decision-makers towards a disadvantaged group of men in need of easily accessible prostate cancer evaluation and treatment.
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| 9. |
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| 10. |
- Dahlman, Disa, et al.
(författare)
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Female Swedish backpackers in Vietnam: A hypotheses generating study on sexual health risks while travelling.
- 2013
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Ingår i: Travel Medicine and Infectious Disease. - : Elsevier BV. - 1873-0442 .- 1477-8939. ; 11:4, s. 243-249
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: According to previous studies, foreign travellers and backpackers are at increased risk of sexually transmitted infections (STI). Concurrently, STI incidence, especially Chlamydia, is increasing among young Swedes. Our objective was to investigate Swedish backpackers' own view of sexual health and risks while travelling, with the purpose to identify hypotheses for further, more extensive research. METHOD: In-depth semi-structured interviews were carried out in Vietnam with four Swedish women in their early twenties. The interviewees had been travelling throughout South East Asia for a period of at least two weeks. RESULTS: There were large differences between the respondents regarding perceived health risks in relation to food safety, STI, and alcohol and drug use; and to what extent their behaviour while travelling deviated from their normal one. In contrast, the interviewees shared a perceived lack of knowledge about sexual health abroad. CONCLUSIONS: The study identified six hypotheses and suggestions for preventive measures that could be analysed in future research. The study demonstrated that sexual behaviour as well as attitudes and norms were strongly linked to the individual level, rather than to the group of backpackers.
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