| 1. |
- Leifler, Emma, et al.
(författare)
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Social validity of social skills group training in school settings
- 2021
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Ingår i: INSAR (International Society for Autism Research), the 20 th Annual Meeting, 3-7 May, 2021, Virtual Conference.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Skolkontakt - Social Validity of Social Skills Training in School Settings Background: Social impairments are associated with Autism spectrum disorders (ASD). Individuals with ASD are at increased risk for mental disorders and are overrepresented among school absenteeism. Little is known about social skills group training for adolescents in naturalistic treatment settings. Furthermore, there is a lack of qualitative elements in experimental research designs. Objectives: This exploratory study examines the feasibility and social validity of SKOLKONTAKT, a social skills training program for educational settings derived from the scientifically well-ensured clinical training KONTAKT. The current study builds on our previous experience, seeking to systematically enlarge it in terms of further feasibility assurance, students’ satisfaction and controlled training efficacy. Methods: Participants are recruited from an on-going RCT of social skills group training. The study is a multi-responders study where participants are the students, the facilitating teachers and the school management. This triangulation will increase the validity through the convergence of information from different participants. Data collection are semi structured interviews. Social validity is measured by interviews with the students (both in control and active group), the facilitating teachers and the school management. At present the sample size is n = 17 (i. e. students n = 11, teachers n = 4 and school management n = 2). Larger sample sizes are preferable and this study will continue with data collection after the third RCT session. Data is handled with the NVivo 12 (QSR and Ltd.), and thematically analyzed. Results: The preliminary results based on the completed interviews (n = 17) show high levels of satisfaction. According to the responses, the school setting is beneficial for several reasons: the closeness, typically developed peers to interact with and develop friendship, the environment is less vulnerable though teachers and students have a reciprocal relationship. Teachers expressed better quality of life for adolescents as well as enlarged possibilities for academic achievement due to increased attendance at school. Students (n = 11) expressed enhanced social skills, where students in the training group expressed broader and more detail improvements. Furthermore, students expressed developed social skills valuable for future employment and overall more happiness and engagement. The school management saw overall improvements in students’ social skills. However, according to facilitating teachers (n = 4), the training is time demanding, especially at initial phase. Conclusions: These findings show advantages in implementing social skills group training in naturalistic settings for generalization and reflection of reality. Methods originally designed to support individuals on the autism in clinical settings are feasible and effective in school settings. Interventions targeting social skills can successfully be implemented in real-world settings like school and improves inclusion. As more student on the autism are attending inclusive environments, there is a need for interventions to increase social interactions and possibilities for enhanced participation. This study contributes to stakeholders and educators as well as to the society as a whole. Students’s well-being and safety in the school environment reduces school absenteeism and enhances academic achievement.
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| 2. |
- Afsharnejad, Bahareh, et al.
(författare)
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Cross-cultural adaptation to Australia of the KONTAKT© Social Skills Group Training Program for Youth with Autism Spectrum Disorder : A feasibility study
- 2020
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Ingår i: Journal of autism and developmental disorders. - : Springer. - 0162-3257 .- 1573-3432. ; 50, s. 4297-4316
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated the feasibility and cultural validity of KONTAKT©, a manualised social skills group training, in improving the social functioning of adolescents with autism spectrum disorder (ASD). KONTAKT© was delivered to 17 adolescents (mage = 14.09, SDage = 1.43; 70% male) with ASD over sixteen 90 min sessions. A pre-test post-test design evaluated changes in personally meaningful social goals, symptom severity, quality of life, interpersonal efficacy, social anxiety, loneliness, and facial emotion recognition at pre, post and 3 months follow-up. Focus groups were conducted post intervention. Findings indicate that KONTAKT© may support Australian adolescents with ASD in achieving their personally meaningful social goals. This study resulted in finalisation of KONTAKT© in preparation for evaluation of its efficacy in a randomised controlled trial (Australian New Zealand Clinical Registry (ANZCTR): ACTRN12617001117303, ClinicalTrials.gov: NCT03294668).
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| 3. |
- Afsharnejad, Bahareh, et al.
(författare)
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KONTAKT© for Australian adolescents on the autism spectrum : Protocol of a randomized control trial
- 2019
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Ingår i: Trials. - : BioMed Central. - 1745-6215. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Individuals diagnosed with autism spectrum disorder (ASD) experience impairing challenges in social communication and interaction across multiple contexts. While social skills group training (SSGT) has shown moderate effects on various sociability outcomes in ASD, there is a need for (1) replication of effects in additional clinical and cultural contexts, (2) designs that employ active control groups, (3) calculation of health economic benefits, (4) identification of the optimal training duration, and (5) measurement of individual goals and quality of life outcomes.METHOD/DESIGN:With the aim of investigating the efficacy and cost-effectiveness of a SSGT, KONTAKT©, a two-armed randomized control trial with adolescents aged 12-17 years (N = 90) with ASD and an intelligence quotient (IQ) of over 70 will be undertaken. Following stratification for centre and gender, participants will be randomly assigned to either KONTAKT© or to an active control group, a group-based cooking programme. Participants will attend both programmes in groups of 6-8 adolescents, over 16 one-and-a-half-hour sessions. The primary outcome examined is adolescent self-rated achievement of personally meaningful social goals as assessed via the Goal Attainment Scaling during an interview with a blinded clinician. Secondary outcomes include adolescent self-reported interpersonal efficacy, quality of life, social anxiety, loneliness, face emotion recognition performance and associated gaze behaviour, and parent proxy reports of autistic traits, quality of life, social functioning, and emotion recognition and expression. Cost-effectiveness will be investigated in relation to direct and indirect societal and healthcare costs.DISCUSSION:The primary outcomes of this study will be evidenced in the anticipated achievement of adolescents' personally meaningful social goals following participation in KONTAKT© as compared to the active control group. This design will enable rigorous evaluation of the efficacy of KONTAKT©, exercising control over the possibly confounding effect of exposure to a social context of peers with a diagnosis of ASD.TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12617001117303. Registered on 31 July 2017. anzctr.org.au ClinicalTrials.gov, NCT03294668. Registered on 22 September 2017. https://clinicaltrials.gov.
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| 4. |
- Afsharnejad, Bahareh, et al.
(författare)
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KONTAKT (R) social skills group training for Australian adolescents with autism spectrum disorder : a randomized controlled trial
- 2022
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Ingår i: European Child and Adolescent Psychiatry. - : Springer. - 1018-8827 .- 1435-165X. ; 31, s. 1695-1713
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Tidskriftsartikel (refereegranskat)abstract
- While there is a large body of evidence drawn from randomised controlled trials supporting the efficacy of SSGT in autistic adolescents, the control arms of these studies are almost exclusively treated either as usual or waitlist. Addressing this limitation, 90 verbal autistic adolescents (70% male) aged 12-17 years (M = 13.77, SD = 1.6) with IQ > 70 participated in this pragmatic two-armed randomised controlled trial design study evaluating the efficacy of sixteen 90-min sessions of SSGT KONTAKT (R) (n = 46) in comparison to a manualised interactive group cooking programme (n = 44) of equal dosage controlling for the potentially confounding effects of exposure to a social group context. The primary outcome was the adolescents' progress towards achieving their personally meaningful social goals at follow-up. Secondary outcomes were changes in autistic traits, quality of life, facial emotion recognition skills, social anxiety, and loneliness. Assessments were conducted at baseline, post intervention and 12-week follow-up. The interaction between time point and group allocation was investigated through a random-effects regression model (linear mixed model) to examine changes in the dependent outcomes. While intention-to-treat analysis (N = 90) demonstrated that both SSGT (ES = 1.36, p < .001) and active control (ES = 1.10, p < .001) groups made progress towards their personally meaningful social goals at follow-up, KONTAKT (R) participants demonstrated greater progress in social goal attainment than their peers in the active control group (ES = 0.35, p = .04). Findings suggest that KONTAKT (R) is efficacious in supporting autistic adolescents to achieve their personally meaningful social goals compared to other prosocial group activities.
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| 5. |
- Andréasson, Sven, et al.
(författare)
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Behandling av alkohol- och narkotikaproblem : En evidensbaserad kunskapssammanställning
- 2001
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Utvärderingens syfteMissbruk och beroende av alkohol är ett av de största folkhälsoproblemen. Narkotikamissbruk är mindre vanligt men har stora medicinska konsekvenser för de berörda. De sociala och juridiska aspekterna är betydande. En kritisk genomgång av litteraturen vad avser behandling av abstinens, protraherad abstinens, behandling i syfte att förhindra återfall, psykologiska och sociala behandlingar för att minska återfallsrisken, behandlingsprogram och institutionsvårdens roll, samt behandling av missbruk under graviditet. Dessutom en granskning av mini-intervention i primärvård och annan vård vars syfte är att minska konsumtionen hos högkonsumenter av alkohol. Nyligen gjorda meta-analyser inom området värderas och särskild vikt fästs vid interventioner som finns eller lätt kan introduceras i den svenska vårdorganisationen. Behandlingsprogram för patienter med samtidig annan psykisk störning värderas.Så kallat lågdosberoende av bensodiazepiner och andra lugnande medel eller sömnmedel behandlas inte. Inte heller belyses effekten av behandlingar vars primära mål är kroppsliga komplikationer av missbruket, och inte heller granskas metoder att minska tillgänglighet.TillvägagångssättStrukturerad översikt, kostnadsanalyser.Insamling av primärdataSystematisk sökning i relevanta databaser, litteraturlistor i påträffade studier samt i aktuella monografier. Ingen bakre tidsbegränsning och sökning i databaser till och med februari 1999.Utgångspunkt för urval av dataHuvudsakligen randomiserade, kontrollerade, dubbelblinda studier, samt metaanalyser som baseras på sådana studier. Vad gäller långtidsförlopp och ekonomiska analyser även kohortstudier och andra naturalistiska studier.Genomgång av publikationenSamtliga studier värderas med hjälp av en i gruppen utarbetad, och med övriga psykiatriprojekt gemensam, kvalitetsmall. Alla centrala studier läses av minst två i gruppen.Färdiga manuskript värderas av styrelse, expertgrupp samt externa granskare.
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| 6. |
- Dumitriu, Dani, et al.
(författare)
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Deciduous tooth biomarkers reveal atypical fetal inflammatory regulation in autism spectrum disorder.
- 2023
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Ingår i: iScience. - : Cell Press. - 2589-0042. ; 26:3
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Tidskriftsartikel (refereegranskat)abstract
- Atypical regulation of inflammation has been proposed in the etiology of autism spectrum disorder (ASD); however, measuring the temporal profile of fetal inflammation associated with future ASD diagnosis has not been possible. Here, we present a method to generate approximately daily profiles of prenatal and early childhood inflammation as measured by developmentally archived C-reactive protein (CRP) in incremental layers of deciduous tooth dentin. In our discovery population, a group of Swedish twins, we found heightened inflammation in the third trimester in children with future ASD diagnosis relative to controls (n = 66; 14 ASD cases; critical window: -90 to -50 days before birth). In our replication study, in the US, we observed a similar increase in CRP in ASD cases during the third trimester (n = 47; 23 ASD cases; -128 to -21 days before birth). Our results indicate that the third trimester is a critical period of atypical fetal inflammatory regulation in ASD.
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| 7. |
- Fridell, Anna, et al.
(författare)
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Effects of the Early Phase of COVID-19 on the Autistic Community in Sweden : A Qualitative Multi-Informant Study Linking to ICF
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:3
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Tidskriftsartikel (refereegranskat)abstract
- While the COVID-19 pandemic is ongoing, early outcome studies indicate severe and pervasive global effects of the pandemic and associated measures to prevent the spread of the virus. General population studies, as well as insight into the outcomes for particular groups, will be necessary in order to mitigate potentially long-term effects as well as to prepare for future epidemics or pandemics. The pandemic conditions have been marked by rapid and abrupt changes and unpredictability which are circumstances that leave the autistic population particularly vulnerable to adverse outcomes following the distinctive features of the diagnosis. Studies are only beginning to delineate the outcomes of the global autism community and the present study adds to these findings by providing a local, multi-perspective, qualitative analysis of the lived experiences of the Swedish autism community. In this study, autistic youth and adults, caregivers of autistic individuals, as well as representatives of Swedish interest organizations were interviewed. Thematic analysis was performed on the population as a whole and patterns of results were formalized according to the International Classification of Function, Disability and Health (ICF-CY). Participants report wide-ranging adverse outcomes of the pandemic relating to mental health and access to support, participation in daily activities and socialization, education, and work as well as parental resources. However, participants also report positive outcomes relating to a reduction in specific social and everyday demands, and normalization of lived experiences. Additionally, interviews outlined some strategies used to cope during pandemic conditions. Implications of these findings are discussed.
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| 8. |
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| 9. |
- Fridell, Mats, et al.
(författare)
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Prediction of psychiatric comorbidity on premature death in a cohort of patients with substance use disorders : A 42-year follow-up
- 2019
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 19:1, s. 150-150
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Tidskriftsartikel (refereegranskat)abstract
- Background: We need to better understand how the use of different substances and psychiatric comorbidity influence premature death generally and cause-specific death by overdose, intoxication and somatic disorders in people with substance use disorders. Method: A cohort of 1405 patients consecutively admitted to a Swedish detoxification unit for substance use disorders in 1970-1995 was followed-up for 42 years. Substances were identified by toxicological analyses. Mortality figures were obtained from a national registry. Causes of death were diagnosed by forensic autopsy in 594 patients deceased by 2012. Predictions were calculated by competing risks analysis. Results: Forty-two per cent of the cohort died during follow-up; more men than women (46.3% vs 30.4%). The standardised mortality ratio (SMR) was calculated as the ratio of observed deaths in males and females in specific age groups in the cohort versus expected deaths in corresponding groups in the general population. SMR was 5.68 for men (CI 95%; 5.04-6.11) and 4.98 (CI 95%; 4.08-5.88) for women. The crude mortality rate (number of deaths divided by number of person observation years) was 2.28% for men and 1.87% for women. Opiates predicted increased risk of premature death while amphetamine and cannabis predicted lower risk. Comorbid psychiatric disorders were identified in 378 cases and personality disorders in 763 cases. Primary psychoses or mood/depression and anxiety disorders predicted a higher risk of premature mortality. Death by overdose was predicted by male gender, younger age at admission to substance treatment, opiate use, and comorbid depression and anxiety syndromes. Cannabis and amphetamine use predicted a lower risk of overdose. Death by intoxication was predicted by male gender, use of sedatives/hypnotics or alcohol/mixed substances, primary psychoses and depression/anxiety syndromes. Premature death by somatic disorder was predicted by male gender and alcohol/mixed abuse. Conclusion: Psychiatric comorbid disorders were important risk factors for premature drug-related death. Early identification of these factors may be life-saving in the treatment of patients with substance use disorders.
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| 10. |
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| 11. |
- Hedman, Christina, 1964-, et al.
(författare)
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The IGF-system is not affected by a twofold change in protein intake in patients with type 1 diabetes
- 2005
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Ingår i: Growth Hormone & IGF Research. - : Elsevier BV. - 1096-6374 .- 1532-2238. ; 15:4, s. 304-310
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Tidskriftsartikel (refereegranskat)abstract
- Objective In type 1 diabetes the circulating IGF-system is altered with low IGF-I and changes in levels of IGF-binding proteins (IGFBPs) which may be of importance for the development of diabetes complications. Our aim was to study if IGF-I, as supported by experimental data in animals, can be affected by dietary protein intake.Design and methods Twelve patients with type 1 diabetes, age 37.5 ± 10.0 years (mean ± SD), diabetes duration 20.1 ± 9.3 years and HbA1c 6.3 ± 0.6% were allocated to isocaloric diets with either low normal protein content (LNP), (10 E%; 0.9 g protein/kg body weight) or high normal protein content (HNP) (20 E%; 1.8 g protein/kg body weight) in an open randomised cross-over study. Each diet was taken for 10 days with a wash-out period of 11 days in between. Circulating levels of total and free IGF-I and -II, IGFBP-1, -2 and -3 and GH-binding protein (GHBP) as well as ghrelin were measured with validated in-house immunoassays.Results At day 10, urinary urea excretion was 320 ± 75 mmol/24 h during LNP diet compared with 654 ± 159 mmol/24 h during HNP diet (p < 0.001). There were no changes in body weight or glycaemic control between the diets. Fasting levels of total IGF-I were 121 ± 33 μg/L after LNP and 117 ± 28 μg/L after HNP diet (ns) and the corresponding concentrations of IGFBP-1 were 142(141) and 132(157) μg/L [median (IQR)] (ns). There were no differences in plasma concentrations of total IGF-II, free IGF-I and -II, IGFBP-3, GHBP and ghrelin, whereas a small difference was found for IGFBP-2 (302 ± 97 vs. 263 ± 66 μg/L; LNP vs. HNP; p < 0.04).Conclusions A twofold change of the dietary protein intake does not influence the altered circulating IGF-system in type 1 diabetes. In order to affect the IGF-system other interventions must be used.
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| 12. |
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| 13. |
- Jones Piltz, Veronica, et al.
(författare)
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Symptom similarities and differences in social interaction between autistic children and adolescents with and without ADHD
- 2024
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Ingår i: Current Psychology. - : Springer Science and Business Media LLC. - 1046-1310 .- 1936-4733. ; 43, s. 3503-3513
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Tidskriftsartikel (refereegranskat)abstract
- Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) are two often co-occurring neurodevelopmental conditions. Nevertheless, there is limited research about symptom differences between ASD and ASD + ADHD groups. This study examined differences in social interaction and communication between children and adolescents with ASD and with ASD + ADHD. A total of 112 participants were identified from two clinical trials. Fifty-six children and adolescents with ASD aged 8–17 years were matched for age, gender and general intelligence quotient with fifty-six children and adolescents with ASD + ADHD. Group differences in scores on the Autism Diagnostic Observation Schedule were analysed. Our results showed that participants with ASD and with ASD + ADHD had similar profiles of social communication interaction challenges and restricted behaviour. However, items assessing gestures: Conventional, Instrumental or Informational Gestures and Empathic or Emotional gestures showed significant differences between the groups suggesting that the ASD + ADHD group used descriptive gestures to communicate to a greater extent than the ASD group. These findings suggest that children and adolescents in both groups have similar difficulties in social communication and interaction with observed differences in the use of gestures. Possible reasons and implications for the differences in the use of gestures are discussed.
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| 14. |
- Jonsson, Ulf, 1974-, et al.
(författare)
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Proof of concept : the TRANSITION program for young adults with autism spectrum disorder and/or attention deficit hyperactivity disorder.
- 2021
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Taylor & Francis. - 1103-8128 .- 1651-2014. ; 28:2, s. 78-90
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Tidskriftsartikel (refereegranskat)abstract
- Background: The support needs of people with neurodevelopmental disorders are not sufficiently met during the initial years of adulthood.Aim: To evaluate feasibility and preliminary effects of a novel programme designed to empower young adults with autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD) to make progress within significant life domains (i.e. work, education, finance, housing/household management, health, leisure/participation in society, and relationships/social network).Material and Method: TRANSITION is a 24-week programme that combines group-based workshops with personalised support based on goal attainment scaling. The study enrolled 26 young adults (50% females; age 17-24 years) in the normative intellectual range, diagnosed with ASD (n = 8), ADHD (n = 4), or both (n = 14). The intervention was delivered by the regular staff of publicly funded psychiatric services in Stockholm, Sweden.Results: The programme was possible to implement with minor deviations from the manual. Participants and staff generally viewed the intervention positively, but also provided feedback to guide further improvement. There was a high degree of attendance throughout, with 21 participants (81%) completing the programme. All completers exceeded their predefined goal expectations within at least one domain.Conclusions: The TRANSITION-programme is a promising concept that deserves further evaluation.
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| 15. |
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| 16. |
- Lunde Hermansson, Anna, et al.
(författare)
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Strong economic incentives of ship scrubbers promoting pollution
- 2024
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Ingår i: Nature Sustainability. - Göteborg : IVL Svenska Miljöinstitutet. - 2398-9629.
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Tidskriftsartikel (refereegranskat)abstract
- In response to stricter regulations on ship air emissions, many shipowners have installed exhaust gas cleaning systems, known as scrubbers, allowing for use of cheap residual heavy fuel oil. Scrubbers produce large volumes of acidic and polluted water that is discharged to the sea. Due to environmental concerns, the use of scrubbers is being discussed within the International Maritime Organization. Real-world simulations of global scrubber-vessel activity, applying actual fuel costs and expenses related to scrubber operations, show that 51% of the global scrubber-fitted fleet reached economic break even by the end of 2022, with a surplus of €4.7 billion in 2019 euros. Within five years after installation, more than 95% of the ships with the most common scrubber systems reach break even. However, the marine ecotoxicity damage cost, from scrubber water discharge in the Baltic Sea Area 2014–2022, amounts to >€680 million in 2019 euros, showing that private economic interests come at the expense of marine environmental damage.
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| 17. |
- Lunde Hermansson, Anna, 1987, et al.
(författare)
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Strong economic incentives of ship scrubbers promoting pollution
- 2024
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Ingår i: Nature Sustainability. - Göteborg : IVL Svenska Miljöinstitutet. - 2398-9629. ; 7:6, s. 812-822
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Tidskriftsartikel (refereegranskat)abstract
- In response to stricter regulations on ship air emissions, many shipowners have installed exhaust gas cleaning systems, known as scrubbers, allowing for use of cheap residual heavy fuel oil. Scrubbers produce large volumes of acidic and polluted water that is discharged to the sea. Due to environmental concerns, the use of scrubbers is being discussed within the International Maritime Organization. Real-world simulations of global scrubber-vessel activity, applying actual fuel costs and expenses related to scrubber operations, show that 51% of the global scrubber-fitted fleet reached economic break even by the end of 2022, with a surplus of €4.7 billion in 2019 euros. Within five years after installation, more than 95% of the ships with the most common scrubber systems reach break even. However, the marine ecotoxicity damage cost, from scrubber water discharge in the Baltic Sea Area 2014–2022, amounts to >€680 million in 2019 euros, showing that private economic interests come at the expense of marine environmental damage.
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| 18. |
- Mellin, Anna, et al.
(författare)
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Including maritime transport in the EU Emission Trading System – addressing design and impacts
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this project is to assess the overall design and consequences of including maritime transports in the EU emission trading system. The included aspects are geographical scope, allocation of allowances, time frame of implementation, as well as impacts on greenhouse gas emissions, economic impacts for the maritime sector as well as on early movers and modal split.
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| 19. |
- Mellin, Anna, et al.
(författare)
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Including maritime transport in the EU Emission Trading System – addressing design and impacts
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the project is to assess the overall design and consequences of including maritime transports in the EU ETS. An inclusion of shipping in the EU ETS would likely be built upon the data and scope of the current monitoring, reporting and verification system, which is covering the legs of a ship’s route before and after a port call to one of EEA’s states. The CO2 emissions captured by MRV was 141 Mtonnes in 2018, estimated to grow to approximately 178 Mtonnes by 2026 if no abatement measures are taken. Alternatively, only including emissions from intra-EEA shipping would limit the emission scope, estimated to reach approximately 75 Mtonnes in 2026. The costs for the shipping sector will be determined mainly by 1) the price of allowances and 2) if allowances are given for free or if they are auctioned. Based on our assumptions of 5 to 100 % of allowance auctioned, and a price of 25-70 EUR/tonne CO2 gives an estimated additional cost to the included shipping of 0.2 – 12.5 billion EUR. To set these cost increases into a context, it generates a price increase of between 0.6% and 33% per tonne marine gas oil.
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| 20. |
- Nyhlén, Anna, et al.
(författare)
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Causes of premature mortality in Swedish drug abusers : a prospective longitudinal study 1970-2006
- 2011
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Ingår i: Journal of Forensic and Legal Medicine. - : Elsevier BV. - 1752-928X .- 1878-7487. ; 18:2, s. 66-72
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Forskningsöversikt (refereegranskat)abstract
- AimsTo evaluate premature mortality and causes of death from young adulthood to middle age in a cohort of drug users followed during almost four decadesDesignFollow-up study of a consecutive cohort of patients with drug abuse/dependence.MethodsA cohort of 561 drug abusers, admitted to a detoxification and short-term rehabilitation unit 1970–1978 was followed to December 31st, 2006. Standardized interviews and hospital records with toxicological analyses were used for demographic data, substance use and psychiatric diagnoses at admission. For Follow-up analyses, autopsy protocols including toxicology tests and death certificates were obtained for assessment of causes of death which were coded according to ICD-10. Age-group standardized mortality ratios were calculated independently for both sexes.Results204 persons (36.4%) were deceased by 2006. SMR was 5.94 for the cohort. Compared to an age- and gender-matched population, the risk of premature death was about eighteen times higher between the ages of 20–44 and about five times higher from 45 up to the age of 69. Of 120 (59%) drug-related deaths, 43 were opiate overdoses, and 3 were overdose from amphetamine. A total of 53 (26%) persons died violent deaths: 39 suicides, of which 25 were drug-related, 3 homicides and 12 accidents. The Swedish national causes of death register underestimated drug-related death by 37% and suicide by 85% compared to the results from this study.ConclusionsThe cohort of drug abusers had an increased risk of premature often drug-related and violent death well into middle age, and to a great extent the drug addicts died from the same drug they had abused when they were first admitted for treatment. The underestimation of drug-related death and suicide in some national death cause registers could be reduced if the doctor routinely records ICD codes when issuing death certificates and autopsy protocols.
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| 21. |
- Nyhlén, Anna, et al.
(författare)
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Substance abuse and psychiatric co-morbidity as predictors of premature mortality in Swedish drug abusers a prospective longitudinal study 1970 - 2006
- 2011
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 11
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Forskningsöversikt (refereegranskat)abstract
- BackgroundFew longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades.MethodsFollow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis.ResultsOf 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death.ConclusionsThe cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.
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| 22. |
- Nyhlén, Anna, et al.
(författare)
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Substance abuse and psychiatric co-morbidity as predictors of premature mortality in Swedish drug abusers a prospective longitudinal study 1970-2006
- 2011
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Ingår i: BMC Psychiatry. - 1471-244X. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades. Methods: Follow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis. Results: Of 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death. Conclusions: The cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.
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| 23. |
- Skoglundh, Magnus, 1965, et al.
(författare)
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SO2 promoted oxidation of ethyl acetate, ethanol and propane
- 2001
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Ingår i: Applied Catalysis B: Environmental. - 0926-3373 .- 1873-3883. ; 30:3-4, s. 315-328
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Tidskriftsartikel (refereegranskat)abstract
- The effect of SO2 addition on the oxidation of ethyl acetate, ethanol, propane and propene, over Pt/gamma -Al2O3 and Pt/SiO2 has been investigated. The reactants (300-800 vol, ppm) were mixed with air and led through the catalyst bed. The conversions below and above light-off were recorded both in the absence and in the presence of 1-100 vol. ppm SO2. For the alumina-supported catalyst, the conversion of ethyl acetate, ethanol and propane was promoted by the addition of SO2, while the conversion of propene was inhibited. The effect of SO2 was reversible, i.e. the conversion of the reactants returned towards the initial values when SO2 was turned off. However, this recovery was quite slow. The oxidation of propane was inhibited by water, both in absence and presence of SO2. For the silica-supported catalyst no significant effect of SO2 could be observed on the conversion of ethyl acetate, ethanol or propane, whereas the conversion of propene was inhibited by the presence of SO2. In situ FTIR measurements revealed the presence of surface sulphates on the Pt/gamma -Al2O3 catalyst with and after SO2 addition. It is proposed that these sulphate groups enhance the oxidation of propane, ethyl acetate and ethanol by creating additional reaction pathways to Pt on the surface of the Pt/gamma -Al2O3 catalyst.
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| 24. |
- Skoglundh, Magnus, 1965, et al.
(författare)
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SO2 promoted oxidation of hydrocarbons
- 2001
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Ingår i: 5th European Congress on Catalysis, Limerick, Ireland, September 2-7, 2001.
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Konferensbidrag (refereegranskat)
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| 25. |
- Ytreberg, Erik, 1980, et al.
(författare)
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EMERGE deliverable 6.1. Baltic and North Sea report
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Shipping is responsible for a range of different pressures affecting air quality, climate, and the marine environment. However, most social and economic analysis of shipping have focused on air pollution assessment and how shipping may impact climate change and human health. This risks policies to be biased towards air pollution and climate change, while trading off impacts on the marine environment. One example is the IMO’s global sulphur cap, which requires shipowners to use a compliant fuel with a sulphur content of 0.5% (0.1% in SECA regions) or use alternative compliance options (scrubbers) that are effective in reducing sulphur oxide (SOX) emissions to the atmosphere. The scrubber process results in large volumes of acidic discharge water. Although regulations primarily target SOX removal, other pollutants such as polycyclic aromatic hydrocarbons (PAHs) and metals are transferred from the exhausts to the wash water and subsequently discharged to the marine environment. The aim of this deliverable has therefore been to develop a holistic framework to evaluate the impacts of shipping emissions, particularly those related to scrubbers, on the marine environment, human health, climate, and economy. The structure of this deliverable follows the well-established DAPSIR (Driver-Activity-Pressure-State-Impact-Response) framework, under which information, findings and conclusions from previous work packages are synthesized and integrated, including experiments of direct emissions from shipping to the marine environment (WP2) and the atmosphere (WP3), assessment of marine environmental impacts (WP2, WP4 and WP6), as well as human health and climate change impacts (WP5 and WP6). Finally, this deliverable provides recommendations and guidance for stakeholders and policymakers. The assessment is performed using a baseline scenario (year 2018) and three future scenarios (for year 2050) based on different projected future developments of shipping transport volumes and considering the development of ships regarding fuel efficiency and ship size. In this deliverable, we focused primarily on two of the different future scenarios, scenario 3 (high scrubber pressure) and scenario 8 (high use of liquefied natural gas (LNG) and methanol). The marine environmental risk assessment, performed in the Öresund region for the baseline scenario (2018), showed unacceptable risks when ships in the area were using open loop scrubbers. In the assessment, modelled predicted environmental concentrations (PECs) of open loop scrubber discharge water exceeded the tolerable marine threshold value (predicted no-effect concentration, PNEC) in almost the entire Öresund region. The PEC value was derived based on ship activity and discharges of scrubber water in 2018, while the PNEC value was derived based on the ecotoxicological assays performed within the EMERGE project. Notably, the modelling of open loop scrubber discharge water was performed using the ship traffic activity in 2018 when less than 200 ships in the Baltic Sea used scrubbers, collectively releasing 192 million tonnes of discharge water. By 2022 there were approximately 800 ships equipped with scrubbers in the Baltic Sea. In the high scrubber future scenario (S3) in 2050 this led to an assumption of the considerably higher scrubber water discharge (1740 million tonnes), representing almost one order of magnitude higher compared to our baseline scenario in 2018. In addition, our impact assessment, following Marine Environment Protection Committee (MEPC) guidelines, shows that a ban on discharge water from scrubbers should be considered in the entire Baltic and North Sea region, since all sea basins in the region fail to reach good environmental status (GES) as defined by the EU Marine Strategy Framework Directive (Directive 2008/56/EC). However, the costs of such a measure for the shipping sector (banning discharges from scrubbers, i.e., in practice a ban on scrubbers) have been questioned within the International Maritime Organisation (IMO). Therefore, EMERGE also focused on analysing to what extent the global scrubber fleet has reached break-even on their scrubber installations and the potential monetary gain of using Heavy Fuel Oil (HFO) as compared to the more expensive Marine Gas Oil (MGO) or Very Low Sulphur Fuel Oil (VLSFO). Our results showed that 51% of the global scrubber fleet had reached break-even by the end of 2022, resulting in a summarised balance of 4.7 billion €2019. In addition, the marine ecotoxicity damage cost, by not restricting scrubbers in the Baltic Sea Area, accumulated to >680 million €2019 from 2015 to end of 2022. For air quality, both future scenarios showed a decrease in shipping contribution to PM2.5 exposure by a factor of 2 to 3 compared to our baseline scenario in 2018. Scenario 8 is somewhat more efficient in decreasing the shipping originated PM2.5 than scenario 3. Using the Greenhouse gas and Air pollution Interactions and Synergies (GAINS) model for human health impact assessment in scenario 3 revealed the loss of life expectancy in most areas around the Baltic Sea, when considering all sources, to be limited to two to four months. However, the differences in life shortening between Scenarios 3 and 8 are two to three orders of magnitude lower when compared to human health impacts resulting from all sources, indicating that scrubbers alone have a minor impact on human health in the Baltic region from air quality perspective. For Öresund case the shipping-related health impacts from PM2.5 represented approximately 10% of the total burden of air pollution, in 2050 scenario simulations this burden decreased to 7-9%. Important improvement of air quality in the scenario simulations come also from reduction of NO2 which is a criteria pollutant regulated by the Air Quality Directive, where the decrease is 3 to 5-fold. In relative terms the shipping contribution to NO2 concentration levels, however, maintains similar, approximately 25%, as the land emissions are also expected to decrease. The GAINS health impact assessment for the Baltic Sea was compared to the Solent region using a statistical technique. The latter study showed that a relatively small fraction of all premature deaths in Southampton, Portsmouth, Poole, Christchurch & Bournemouth are attributable to air pollution from shipping, corroborating the conclusion that the deployment scrubbers alone has a minor impact on human life shortening through atmospheric transport.
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| 26. |
- Zandersen, Marianne, et al.
(författare)
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Shared socio-economic pathways extended for the Baltic Sea : exploring long-term environmental problems
- 2019
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Ingår i: Regional Environmental Change. - : Springer Science and Business Media LLC. - 1436-3798 .- 1436-378X. ; 19:4, s. 1073-1086
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Tidskriftsartikel (refereegranskat)abstract
- Long-term scenario analyses can be powerful tools to explore plausible futures of human development under changing environmental, social, and economic conditions and to evaluate implications of different approaches to reduce pollution and resource overuse. Vulnerable ecosystems like the Baltic Sea in North-Eastern Europe tend to be under pressure from multiple, interacting anthropogenic drivers both related to the local scale (e.g. land -use change) and the global scale (e.g. climate change).There is currently a lack of scenarios supporting policy-making that systematically explore how global and regional developments could concurrently impact the Baltic Sea region. Here, we present five narratives for future development in the Baltic Sea region, consistent with the global Shared Socioeconomic Pathways (SSPs) developed for climate research. We focus on agriculture, wastewater treatment, fisheries, shipping, and atmospheric deposition, which all represent major pressures on the Baltic Sea. While we find strong links between the global pathways and regional pressures, we also conclude that each pathway may very well be the host of different sectoral developments, which in turn may have different impacts on the ecosystem state. The extended SSP narratives for the Baltic Sea region are intended as a description of sectoral developments at regional scale that enable detailed scenario analysis and discussions across different sectors and disciplines, but within a common context. In addition, the extended SSPs can readily be combined with climate pathways for integrated scenario analysis of regional environmental problems.
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| 27. |
- Zetterberg, Lars, et al.
(författare)
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Shipping in the EU ETS - Policy brief
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This policy brief identifies and discusses key design features for including shipping in the EU ETS and assesses modal split impacts and economic implications. The ambition has not been to provide recommendations but rather to provide an overview and brief assessment of the options that has been part of the discussion pending the final legislative proposal, including: Covered ship categories. If shipping is included in the EU ETS the system will most likely cover the same ship categories as the shipping MRV (monitoring, reporting and verification) regulation, i.e., Ships >5000 gross tonnage. This would mean that 55% of all ships calling into EEA (European Economic Area) ports (together responsible for more than 90% of the CO2 emission from shipping) would be covered by the scheme. Geographical coverage. We have identified three main options: 1) EU internal routes; 2) all incoming and outgoing routes from EU/EEA ports; and 3) semi-full coverage meaning EU internal routes plus 50% of the routes to international ports. Only targeting internal-EU shipping would significantly reduce the overall shipping emissions covered but could be an easier political sell. The shipping industry has raised concerns that a ‘global’ scope may lead to perverse incentives, e.g. ships from international ports calling at a port just outside the EU before sailing to an EU port. However, recent estimates (Transport & Environment, 2020b) suggest that the added cost associated with port stops for the purpose of evading CO2 prizing rarely makes economic sense. Included Greenhouse gases. The system will initially most likely only cover carbon dioxide (CO2) emissions from shipping. Regulated entity. The ship owner is an obvious choice since they have the power to reduce emissions, by technical choices such as vessel form, power trains etc. However, for some categories of shipping it is common that the operators lease the ships. In these cases, operators may be a better choice as the regulated entity since they have power to reduce emissions by efficient routing, efficient loading and logistics. Choosing the fuel supplier will come with a high risk that fueling will occur outside the EU. Transport buyers could be the regulated entity since they are responsible for transporting the cargo and can choose other transport modes (substitution). However, it would be more administratively burdensome. Allocation of allowances. Auctioning is the main method for allocating allowances in the EU ETS. Auctioning is consistent with the polluter pays principle, transparent and creates high incentives for reducing emissions. If shipping is included in the EU ETS with semi-full geographical coverage, allowance auctioning and an allowance price of 50 EUR per ton, we estimate the compliance cost to be approximately 100 EUR per ton fuel used. This can be compared to the price of fuel which is currently at 480 EUR/ton and has varied between 200 and 500 the last 12 months. If we assume that fuel costs account for one third of total transport costs, the compliance cost for shipping in the EU ETS will be less than 7% of the total transport related costs. If instead 85% of allowances are allocated for free by benchmarking under a semi-full geographical scope, assuming an allowance price of 50 EUR per ton, we estimate the compliance cost to be 15 EUR per ton fuel used (on average for the whole sector) or approximately 1% the total transport related costs. Transport & Environment (2020b) has also investigated compliance costs, applying auctioning under a semi-full scope ETS design. They conclude that CO2 costs would add only a very small 4 amount to the overall transport costs. For transporting a standard container (TEU) from Spain to Singapore, the CO2 costs would represent less than 1% of the overall transport costs. Modal shift. Senders of goods consider transport costs to be one of the most important factors when choosing transport modes. This suggests that inclusion of shipping in the EU ETS could lead to modal shifts when there are other transport modes available. In the EU, RoRo and RoPax mostly operates on routes where there is a land-based transport option and largely utilizing road based load units, such as trucks and trailers, which makes this the most exposed segment to a potential modal shift. The extent of any modal shift will largely depend on the characteristics and competition for each route, although the currently estimated cost of EU ETS is in itself not likely to cause any major modal shift. The container feeder segment is also subject to a direct modal competition with road and rail, although to a lesser extent due to more relaxed transport time requirements and the dimensions of containers which are adapted to sea transport and are less efficiently transported by road. However, port rail shuttles could potentially compete with feeder traffic from continental Europe. We expect that bulk shipping will not be particularly impacted by the introduction of EU ETS, since typical bulk freight are often heavy weight and lower value (per ton) and cannot be efficiently transported by road. Rail has a better chance at competing in this segment, although the modal shift is also expected to be low, one reason being that the market already absorbs large fluctuations in bulk transport costs. Although EU ETS is not likely to be a major cost item for shipping, it obviously adds to total costs and might in the long run incur changes in trade patterns and localization of industry and terminals.
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| 28. |
- Öhlin, Leif, et al.
(författare)
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Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years.
- 2015
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 15:1, s. 56-68
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundA seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed. MethodsA consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions. Results148 patients started treatment. After seven years, 94/148 patients (64%) were retained in the program, employed and abstinent from drugs and alcohol. Women had more continuous abstinence, retention and employment than men (76% versus 60%). After one year patients with a high-risk consumption of alcohol were no longer heavy consumers of alcohol and remained so throughout the study (p < .001). All women regained custody of their children. At admission, more women than men had been admitted for psychiatric disorders (70%/44%) and to compulsory care for substance abuse (30%/18%). Initial gender differences of psychiatric co-morbidity decreased and were no longer significant after one year. More men than women had been imprisoned (62% versus 27%) or in non-institutional care (80% versus 49%). Criminal convictions were reduced from 1751 convictions at admission to 742 (58%) after seven years. Eight patients in the entire cohort died over the 7 years (0.7% per year). One patient died in the completers group while still in the program (0.1% per year). ConclusionsAfter seven years, two thirds of the patients in the program were abstinent and employed. Convictions ceased in the completers group. One patient died in the completers group. Women had superior long-term outcome compared to men: more continuous abstinence, employment and fewer convictions. Women also lived with their children to a higher extent than men. The positive outcome highlights the importance of maintaining high structure in combining pharmacological treatment with a focus on employment and psychological treatment and low tolerance for non-prescribed drug use.
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