| 1. |
- Fugelstad, Anna, et al.
(författare)
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Opioid-related deaths and previous care for drug use and pain relief in Sweden
- 2019
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Ingår i: Drug And Alcohol Dependence. - : ELSEVIER IRELAND LTD. - 0376-8716 .- 1879-0046. ; 201, s. 253-259
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Tidskriftsartikel (refereegranskat)abstract
- Aim: In 2006-2014, the rate of drug-related deaths, typically opioid poisonings, more than doubled in Sweden. Opioid prescriptions for pain control or opioid agonist therapy also increased. In this retrospective study, we compared death rates between individuals whose first recorded contact with prescribed opioids was for pain control and individuals that had received substance use disorder (SUD) treatment before their first recorded opioid prescription.Methods: We included 2834 forensically examined individuals (ages 15-64 years) that died of poisoning in Sweden in 2006-2014. For each death we acquired data on previous opioid prescriptions and SUD treatments. We compared three study groups: pain control (n = 788); a SUD treatment group (n = 1629); and a group with no prescription for pain control or SUD treatment (n = 417).Results: Overall fatal poisonings increased from 2.77 to 7.79 (per 100,000 individuals) from 2006 to 2014 (relative 181% increase). Fatal poisoning increased from 2006 to 2014 by 269% in the pain control group (0.64 to 2.36 per 100,000) and by 238% in the SUD treatment group (1.35 to 4.57 per 100,000). Heroin-related deaths remained constant; consequently, the increase was likely attributable to prescription opioids.Conclusion: A rapid increase in deaths attributable mainly to prescription opioids for pain control, was reported previously in the United States. Our study indicated that increased access to prescription opioids might contribute to higher death rates also in Sweden among patients seeking pain control and individuals with an established SUD; however, deaths related to prescription opioids mainly occurred among those with SUDs.
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| 2. |
- Björkenstam, Charlotte, et al.
(författare)
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Suicide or undetermined intent? : A register-based study of signs of misclassification
- 2014
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Ingår i: Population Health Metrics. - : Springer Science and Business Media LLC. - 1478-7954. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several studies have concluded that some deaths classified as undetermined intent are in fact suicides, and it is common in suicide research in Europe to include these deaths. Our aim was to investigate if information on background variables would be helpful in assessing if deaths classified as undetermined intent should be included in the analyses of suicides. Methods: We performed a register study of 31,883 deaths classified as suicides and 9,196 deaths classified as undetermined intent in Sweden from 1987 to 2011. We compared suicide deaths with deaths classified as undetermined intent with regard to different background variables such as sex, age, country of birth, marital status, prior inpatient care for self-inflicted harm, alcohol and drug abuse, psychiatric inpatient care, and use of psychotropics. We also performed a multivariate analysis with logistic regression. Results: Our results showed differences in most studied background factors. Higher education was more common in suicides; hospitalization for self-inflicted harm was more common among female suicides as was prior psychiatric inpatient care. Deaths in foreign-born men were classified as undetermined intent in a higher degree and hospitalization for substance abuse was more common in undetermined intents of both sexes. Roughly 50% of both suicide and deaths classified as undetermined intent had a filled prescription of psychotropics during their last six months. Our multivariate analysis showed male deaths to more likely be classified as suicide than female: OR: 1.13 (1.07-1.18). The probability of a death being classified as suicide was also increased for individuals aged 15-24, being born in Sweden, individuals who were married, and for deaths after 1987-1992. Conclusion: By analyzing Sweden's unique high-validity population-based register data, we found several differences in background variables between deaths classified as suicide and deaths classified as undetermined intent. However, we were not able to clearly distinguish these two death manners. For future research we suggest, separate analyses of the two different manners of death.
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| 6. |
- Fugelstad, Anna, et al.
(författare)
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Drug-related deaths : Statistics based on death certificates miss one-third of cases
- 2020
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Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 48:1, s. 29-37
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Statistics on drug-related deaths (DRD) provide crucial information on the drug situation. The European Monitoring Centre for Drug and Drug Addiction (EMCDDA) has published a specification for extracting DRD from national mortality registers to be used in international comparisons. However, surprisingly little is known of the accuracy of DRD statistics derived from national mortality registers. This study assesses the accuracy of Swedish data derived from national mortality registers by comparing it with other sources of data.METHODS: We compared five Swedish datasets. Three were derived from national mortality registers, two according to a Swedish specification and one according to the EMCDDA specification. A fourth dataset was based on toxicological analyses. We used a fifth dataset, an inventory of DRD in Stockholm, to assess the completeness and coverage of the Swedish datasets.RESULTS: All datasets were extracted from high-quality registers, but still did not capture all DRD, and both the numbers and demographic characteristics varied considerably. However, the time trends were consistent between the selections. In international comparisons, data completeness and investigation procedures may impact even more on stated numbers.CONCLUSIONS: Basing international comparisons on numbers or rates of DRDs gives misleading results, but comparing trends is still meaningful.
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| 7. |
- Fugelstad, Anna
(författare)
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Drug-related deaths in Stockholm during the period 1985-1994 : causes and manners of death in relation to type of drug abuse, HIV-infection and methadone treatment
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the period from 1984 to 1994 great changes occurred in the situation for drug addicts In Stockholm. The HIV-infection among intravenous drug addicts was detected in 1984 and a general HIV-screening started in 1985. In order to prevent the spread of the HIV-infection among drug addicts the medical and social drug treatment services were enlarged. A new methadone maintenance programme was started in Stockholm in 1987. There were approximately 4,500 IDUs in Stockholm 1992 and about 50% of them were opiate users. The rest mainly used amphetamine. The purpose of the thesis was to evaluate all drug-related deaths that occurred in the Stockholm area during a ten-year period, 1985-1994, in relation to main drug of abuse, HIV-infection and methadone treatment. The material comprises 830 drug-related deaths and 21 suicides among HIV-infected persons, examined at the Department of Forensic Medicine in Stockholm 1985-1994, 74 HIV-infected addicts who had died in hospital during the same period and 547 HIV-infected persons who were registered in the County of Stockholm between 1984 and 1994. Two cohorts were followed up: 101 compulsory treated drug addicts, 1986-93, and 1640 hospitalised drug users, 1985-92. Both the number of deaths among drug addicts in general and among HIV-infected drug addicts increased during the period. There were different causes and manners of death in relation to main drug of abuse. The majority of the heroin-related deaths were in connection with intravenous injection and there were few deaths from external violence. Amphetamine-related deaths were often due to accidents, homicides, suicides and somatic disease caused by long-standing drug abuse. Many of the cannabis-related deaths were due to traffic accidents, homicides and impulsive and violent suicides. There were few suicides among HIV-infected persons. Among the infected drug addicts there was no relation between suicide and the duration of infection. No addicts with an AIDS-diagnosis died from suicide. The majority of the HIV-infected heroin users died from injection after a short infection time and most amphetamine users died from somatic complications after a relatively long time of infection. The results from the two cohort studies show a lower mortality among those in the methadone programme from violent causes and poisoning among both HIV-seronegative and infected heroin users including those with a very long-standing and intensive drug abuse who had undergone coercive treatment. Most deaths in the methadone programme were due to HIV-related disease. A forensically based register of drug-related deaths in Stockholm 1985-94 has been established and it is concluded that this register gives a more comprehensive picture of drug-related deaths than the official cause-of-death register.
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| 9. |
- Fugelstad, Anna, et al.
(författare)
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Methadone-related deaths among youth and young adults in Sweden 2006-15
- 2021
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Ingår i: Addiction. - : John Wiley & Sons. - 0965-2140 .- 1360-0443. ; 116:2, s. 319-327
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Tidskriftsartikel (refereegranskat)abstract
- Aims To identify methadone-related deaths and determine the prevalence among youth and young adults in Sweden 2006-15. Design, Setting and Participants National retrospective registry study comparing data from all forensic autopsy examinations and toxicology cases involving methadone during 2006-15 in individuals aged 15-29 years with police records, previous pharmaceutical prescriptions and health-care episodes. Measurements Multinomial logistic regression. To assess the factors contributing to the deaths, we compared individuals with and without previous substance use treatment and opioid use-related diagnoses with regard to previous opioid agonist treatment (OAT), psychiatric care and previous pain medication. To assess the circumstances of deaths, we analyzed the presence of other drugs and other factors at time of death. Findings We identified 269 methadone-related deaths, and the rate increased during the study period. Seventy-two (27%) cases had not previously received substance use treatment, 112 (42%) had received treatment but had no opioid use-related diagnosis and 85 (32%) had received treatment and had an opioid use-related diagnosis. In total, only 10 individuals had been prescribed methadone during the year before death. Prescriptions of benzodiazepines (60%), antidepressants (62%) and opioids for pain (22%) the year before death were common. Most deaths occurred during sleep with a time lag from ingestion of methadone. Conclusion Prescription opioid- and methadone-related deaths increased in the group aged 15-29 years in Sweden between 2006 and 2015. Exposure to non-prescribed methadone and prescribed benzodiazepines, antidepressants and opioids for pain appears to be common in drug-related deaths in youth and young adults in Sweden.
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| 11. |
- Fugelstad, Anna, et al.
(författare)
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Oxycodone-related deaths in Sweden 2006-2018
- 2022
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Ingår i: Drug And Alcohol Dependence. - : Elsevier BV. - 0376-8716 .- 1879-0046. ; 234
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To identify and characterize oxycodone related deaths in Sweden from 2006 to 2018 and to compare them to other opioid-related deaths.Methods: To assess the factors contributing to the deaths, we used multinomial logistic regression to compare oxycodone-related deaths extracted from all forensic autopsy examinations and toxicology cases in the age groups 15-34 (reference group), 35-54 and 55-74 with regard to sex, presence of benzodiazepines and alcohol at the time of death, prescription of oxycodone, benzodiazepines and antidepressants, previous substance use related (SUD) treatment, and manner of death. The oxycodone related deaths were compared with deaths with presence of other opioids.Result: We identified 575 oxycodone-related deaths, and the rate increased during the study period from 0.10 to 1.12 per 100,000 in parallel with an increase of oxycodone prescriptions from 3.17 to 30.33 per 1000. Oxycodone-related deaths amounted to 10.0% of all opioid-related deaths. The deaths occurred mainly in older patients previously being prescribed oxycodone. Benzodiazepines were present at the time of death in 403 (70%) and alcohol in 259 (45%). Prescriptions of any opioid for pain (61%), oxycodone (50%), benzodiazepines (67%) and antidepressants (55%) were common. Only 15% had received treatment for SUD during the last year.Conclusion: Oxycodone-related deaths increased in Sweden between 2006 and 2018 in parallel to an increase in oxycodone prescriptions. The increase occurred mainly in older patients being prescribed oxycodone for pain. There might be specific interventions needed to avoid oxycodone-related deaths compared to other opioidrelated deaths associated with illicit opioid use.
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| 12. |
- Grenville-Briggs, Laura J., et al.
(författare)
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Cellulose synthesis in Phytophthora infestans is required for normal appressorium formation and successful infection of potato
- 2008
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Ingår i: The Plant Cell. - : Oxford University Press (OUP). - 1040-4651 .- 1532-298X. ; 20:3, s. 720-738
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Tidskriftsartikel (refereegranskat)abstract
- Cellulose, the important structural compound of cell walls, provides strength and rigidity to cells of numerous organisms. Here, we functionally characterize four cellulose synthase genes (CesA) in the oomycete plant pathogen Phytophthora infestans, the causal agent of potato (Solanum tuberosum) late blight. Three members of this new protein family contain Pleckstrin homology domains and form a distinct phylogenetic group most closely related to the cellulose synthases of cyanobacteria. Expression of all four genes is coordinately upregulated during pre- and early infection stages of potato. Inhibition of cellulose synthesis by 2,6-dichlorobenzonitrile leads to a dramatic reduction in the number of normal germ tubes with appressoria, severe disruption of the cell wall in the preinfection structures, and a complete loss of pathogenicity. Silencing of the entire gene family in P. infestans with RNA interference leads to a similar disruption of the cell wall surrounding appressoria and an inability to form typical functional appressoria. In addition, the cellulose content of the cell walls of the silenced lines is >50% lower than in the walls of the nonsilenced lines. Our data demonstrate that the isolated genes are involved in cellulose biosynthesis and that cellulose synthesis is essential for infection by P. infestans.
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| 13. |
- Haas, Brian J., et al.
(författare)
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Genome sequence and analysis of the Irish potato famine pathogen Phytophthora infestans
- 2009
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 461:7262, s. 393-398
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Tidskriftsartikel (refereegranskat)abstract
- Phytophthora infestans is the most destructive pathogen of potato and a model organism for the oomycetes, a distinct lineage of fungus-like eukaryotes that are related to organisms such as brown algae and diatoms. As the agent of the Irish potato famine in the mid-nineteenth century, P. infestans has had a tremendous effect on human history, resulting in famine and population displacement(1). To this day, it affects world agriculture by causing the most destructive disease of potato, the fourth largest food crop and a critical alternative to the major cereal crops for feeding the world's population(1). Current annual worldwide potato crop losses due to late blight are conservatively estimated at $6.7 billion(2). Management of this devastating pathogen is challenged by its remarkable speed of adaptation to control strategies such as genetically resistant cultivars(3,4). Here we report the sequence of the P. infestans genome, which at similar to 240 megabases (Mb) is by far the largest and most complex genome sequenced so far in the chromalveolates. Its expansion results from a proliferation of repetitive DNA accounting for similar to 74% of the genome. Comparison with two other Phytophthora genomes showed rapid turnover and extensive expansion of specific families of secreted disease effector proteins, including many genes that are induced during infection or are predicted to have activities that alter host physiology. These fast-evolving effector genes are localized to highly dynamic and expanded regions of the P. infestans genome. This probably plays a crucial part in the rapid adaptability of the pathogen to host plants and underpins its evolutionary potential.
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| 14. |
- Lundholm, Lena, et al.
(författare)
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Acute influence of alcohol, THC or central stimulants on violent suicide : a Swedish Population study
- 2014
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Ingår i: Journal of Forensic Sciences. - : Wiley. - 0022-1198 .- 1556-4029. ; 59:2, s. 436-440
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Tidskriftsartikel (refereegranskat)abstract
- Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC) or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the non-violent method self-poisoning and alcohol/illicit drugs negative suicide decedents. Multivariate analysis was conducted and the results revealed that acute influence of THC was related to using the violent suicide method; jumping from a height (RR 1.62; 95%CI 1.01-2.41). Alcohol intoxication was not related to any violent method, while the central stimulants positive suicide decedent had a higher, albeit not significant, risk for several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.
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| 15. |
- Romelsjö, Anders, et al.
(författare)
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Were the changes to Sweden's maintenance treatment policy 2000-06 related to changes in opiate-related mortality and morbidity?
- 2010
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 105:9, s. 1625-1632
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Tidskriftsartikel (refereegranskat)abstract
- Aims To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006. Design We collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden. Setting Sweden. Participants Patients in maintenance treatment. Measurements Survey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations. Findings The surveys showed a marked change to a less restrictive policy, with increased use of 'take-away doses' and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more than threefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20-30% reduction in opiate-related mortality and inpatient care between 2000-2002 and 2004-2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998-2006, statistically significant declines occurred only in Stockholm County. Conclusions The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.
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