| 11. |
- 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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| 12. |
- Nyhlén, Sara, 1980-, et al.
(författare)
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Human Security, Risk and Sustainability in the Swedish Policy for the Arctic
- 2018
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Ingår i: Human and Societal Security in the Cirumpolar Arctic. - : Brill Academic Publishers. - 9789004363045 ; , s. 76-99
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Bokkapitel (refereegranskat)abstract
- Although four million people live and work in the Arctic, it has become a ‘new’ place to discover and secure for the nation-states and companies that want to explore how to exploit newly available resources and territory as the ice melts. We have witnessed an increase in policies regarding the Arctic from many European and other countries throughout the last decade or more. Sweden became the last of the so-called Arctic states to launch a policy for the Arctic in 2011, and this chapter analyses this policy from a critical perspective. A seemingly ‘neutral’ language may characterize policies, but deriving from a feminist intersectional risk analysis, we argue that policy analysis is a key task for understanding contemporary power structures. By identifying enabling discourses, mobilizing metaphors and underlying assumptions, this analysis shows how Sweden’s policy produces normative constructions of environmental risks anchored in time- and context-dependent beliefs. The strategy adapts to and uses the dominant discourses about the Arctic; it puts risks such as climate change, energy shortage, and human and societal security in the centre while simultaneously positioning Sweden as having the best solutions for managing these risks in a sustainable way. The notion of security drifts towards risk management through arguments about developing and applying sustainable practices, and the strategy uses a language that echoes the language used in stories about conquests and colonial exploration of the Arctic written centuries ago.
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| 13. |
- 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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