| 1. |
- Bäckstrom, Björn, et al.
(författare)
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Injury-Related Healthcare Use and Risk of Filicide Victimization : A Population-Based Case-Control Study
- 2019
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Ingår i: Journal of Forensic Sciences. - : Wiley-Blackwell. - 0022-1198 .- 1556-4029. ; 64:1, s. 166-170
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Tidskriftsartikel (refereegranskat)abstract
- Research on child‐related risk factors for filicide is scant. We investigated whether prior healthcare use for injury (including poisoning) influences filicide risk. Victims (0–14 years; n = 71) were identified in a national autopsy database for the years 1994–2012 and compared to matched, general population controls (n = 355). Healthcare use data were retrieved from a national patient registry. Risks were estimated using odds ratios (ORs) and 95% confidence intervals (CIs). For females, prior inpatient care for injury conferred a statistically significant sevenfold risk (OR = 6.67 [95% CI: 1.49–29.79]), and any prior injury‐related healthcare use conferred a statistically significant fourfold risk (OR = 3.57 [95% CI: 1.13–11.25]), of filicide victimization. No statistically significant risks were found for males. Healthcare personnel should be aware that children treated for injuries, especially females, may be at an elevated risk of filicide victimization. Nevertheless, the filicide base rate remains low, and parents may be stigmatized by unfounded alerts; thus, prudent reflection should precede reports to the authorities.
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| 2. |
- Forsman, Jonas, et al.
(författare)
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Selective serotonin re-uptake inhibitors and the risk of violent suicide: a nationwide postmortem study
- 2019
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Ingår i: European Journal of Clinical Pharmacology. - : SPRINGER HEIDELBERG. - 0031-6970 .- 1432-1041. ; 75:3, s. 393-400
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Tidskriftsartikel (refereegranskat)abstract
- PurposeWe endeavored to investigate whether previous findings of an association between antemortem exposure to selective serotonin re-uptake inhibitors (SSRI) and method of suicide could be replicated.MethodsUsing the Swedish National Board of Forensic Medicines toxicology database and the Swedish National Board of Health and Welfares national registries of causes of death and prescriptions, 10,002 incidents of suicide were retrieved. Risks of violent suicide conferred by SSRIs, expressed as odds ratios (ORs) with 95% confidence intervals (CIs), were estimated using logistic regression. In accordance with previous work, suicide by violent meanscaseswere defined as death attributable to causes designated by ICD-10 codes X70-X83 and Y20-Y33; and suicide by non-violent meanscontrolsby codes X60-X69 and Y10-Y19.ResultsOur results imply that SSRI exposure confers a risk of violent suicide for shorter treatment durations; and that antemortem exposure to other substances (including illegal drugs) confounds estimates of risk. After adjustment for age, sex, and other substances, SSRIs treatment not exceeding 28days conferred an almost fourfold risk of violent suicide (OR 3.6 [95% CI 1.9-6.8]), a finding partly in line with a recent Swedish study that employed a case-crossover design.ConclusionsAlthough risks associated with shorter treatment duration may reflect latencies to onset of therapeutic effect, it is unclear how latencies would influence the choice of suicide method, unless conditions for which SSRIs are prescribed are themselves associated with violent suicide. Finally, in the total dataset, SSRIs were not associated with an increased risk of violent suicide; however, by adjusting for other substances, we avoided the spurious conclusion that the effect of medications in this regard is protective.
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| 3. |
- Hedlund, Jonatan, et al.
(författare)
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Intra- and extra-familial child homicide in Sweden 1992-2012 : A population-based study
- 2016
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Ingår i: Journal of Forensic and Legal Medicine. - : Elsevier BV. - 1752-928X .- 1878-7487. ; 39, s. 91-99
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Tidskriftsartikel (refereegranskat)abstract
- Previous studies have shown decreasing child homicide rates in many countries - in Sweden mainly due to a drop in filicideesuicides. This study examines the rate of child homicides during 21 years, with the hypothesis that a decline might be attributable to a decrease in the number of depressive filicide offenders (as defined by a proxy measure). In addition, numerous characteristics of child homicide are presented. All homicide incidents involving 0e14-year-old victims in Sweden during 1992-2012 (n = 90) were identified in an autopsy database. Data from multiple registries, forensic psychiatric evaluations, police reports, verdicts and other sources were collected. Utilizing Poisson regression, we found a 4% annual decrease in child homicides, in accordance with prior studies, but no marked decrease regarding the depressive-offender proxy. Diagnoses from forensic psychiatric evaluations (n = 50) included substance misuse (8%), affective disorders (10%), autism-spectrum disorders (18%), psychotic disorders (28%) and personality disorders (30%). Prior violent offences were more common among offenders in filicides than filicideesuicides (17.8% vs. 6.9%); and about 20% of offenders in each group had previously received psychiatric inpatient care. Aggressive methods of filicide predominated among fathers. Highly lethal methods of filicide (firearms, fire) were more commonly followed by same-method suicide than less lethal methods. Interestingly, a third of the extra-familial offenders had an autism-spectrum disorder. Based on several findings, e.g., the low rate of substance misuse, the study concludes that nontraditional risk factors for violence must be highlighted by healthcare providers. Also, the occurrence of autism-spectrum disorders in the present study is a novel finding that warrants further investigation.
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| 4. |
- Imrell, Kerstin, et al.
(författare)
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Multiple sclerosis with and without CSF bands : Clinically indistinguishable but immunogenetically distinct
- 2006
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Ingår i: Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 0028-3878 .- 1526-632X. ; 67:6, s. 1062-1064
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Tidskriftsartikel (refereegranskat)abstract
- We sought to determine whether Swedish patients with multiple sclerosis (MS) with and without oligoclonal bands (OCBs) in the CSF constitute distinct subpopulations, clinically and immunogenetically. Our findings indicate that OCB-negative MS shares the same clinical features as OCB-positive MS regarding female predominance, age at onset, proportion of primary progressive cases, rate of MRI positivity, and disease severity. Our HLA-DRB1 genotyping results suggest, however, that OCB-positive and OCB-negative MS are immunogenetically distinct. Copyright © 2006 by AAN Enterprises, Inc.
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| 5. |
- Johansson, Viktoria, et al.
(författare)
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Multiple sclerosis and psychiatric disorders : comorbidity and sibling risk in a nationwide Swedish cohort
- 2014
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Ingår i: Multiple Sclerosis Journal. - Stockholm : Sage Publications. - 1352-4585 .- 1477-0970. ; 20:14, s. 1881-1891
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Psychiatric disorders are known to be prevalent in multiple sclerosis (MS).OBJECTIVE: The objective of this paper is to study comorbidity between MS and bipolar disorder, schizophrenia and depression in a nationwide cohort and to determine whether shared genetic liability underlies the putative association.METHODS: We identified ICD-diagnosed patients with MS (n = 16,467), bipolar disorder (n = 30,761), schizophrenia (n = 22,781) and depression (n = 172,479) in the Swedish National Patient Register and identified their siblings in the Multi-Generation Register. The risk of MS was compared in psychiatric patients and in matched unexposed individuals. Shared familial risk between MS and psychiatric disorders was estimated by sibling comparison.RESULTS: The risk of MS was increased in patients with bipolar disorder (hazard ratio (HR) 1.8, 95% confidence interval (CI) 1.6-2.2, p < 0.0001) and depression (HR 1.9, 95% CI 1.7-2.0, p < 0.0001). MS risk in schizophrenia was decreased (HR 0.6, 95% CI 0.4-0.9, p = 0.005). The association between having a sibling with a psychiatric disorder and developing MS was not significant.CONCLUSION: We found a strong positive association between MS and bipolar disorder and depression that could not be explained by genetic liability. The unexpected negative association between MS and schizophrenia might be spurious or indicate possible protective mechanisms that warrant further exploration.
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| 6. |
- Lundberg, Mathias, et al.
(författare)
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Methodological Aspects of ELISA Analysis of Thioredoxin 1 in Human Plasma and Cerebrospinal Fluid
- 2014
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:7, s. e103554-
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Tidskriftsartikel (refereegranskat)abstract
- Thioredoxin-1 (Trx1) is a protein antioxidant involved in major cellular processes. Increased plasma levels of Trx1 have been associated with human diseases suggesting that Trx1 is a marker for oxidative stress with putative clinical use. However, the reported mean levels of Trx1 in the control cohorts vary a hundred-fold between studies (0.8-87 ng/ml), possibly due to methodological differences between the capture ELISA used in the different studies. The aim of this study was to investigate methodological aspects related to the ELISA measurement of Trx1. ELISAs utilizing different capture and detection combinations of antibodies to Trx1 and as well as recombinant human (rh) Trx1 standards from two sources were characterized. The different ELISAs were subsequently used to measure Trx1 in human plasma and cerebrospinal fluid samples (CSF) from healthy donors and from patients with various neurological diagnoses. The Trx1 standards differed in their content of monomeric and oligomeric Trx1, which affected the ELISAs composed of different antibody combinations. Thus, the levels of Trx1 determined in human plasma and CSF samples varied depending on the antibody used in the ELISAs and on the rhTrx1 standard. Furthermore, the relevance of preventing interference by heterophilic antibodies (HA) in human plasma and CSF was investigated. The addition of a HA blocking buffer to human samples drastically reduced the ELISA signals in many samples showing that HA are likely to cause false positive results unless they are blocked. In conclusion, the study shows that the design of a Trx1 ELISA in regards to antibodies and standards used has an impact on the measured Trx1 levels. Importantly, analyses of human plasma and CSF without preventing HA interference may obscure the obtained data. Overall, the results of this study are crucial for the improvement of future studies on the association of Trx1 levels with various diseases.
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| 7. |
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| 8. |
- Masterman, Thomas
(författare)
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Heritable modulators of the multiple sclerosis phenotype
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Studies of families in which more than one case of multiple sclerosis (MS) occurs have demonstrated that shared genetic and/or environmental factors appear to modify clinical features of the disease, including rate of progression and disease course. We undertook in the present project to determine to what extent selected genetic factors constitute heritable determinants of the MS phenotype. We first reviewed the medical records of over 1200 MS patients, cataloguing clinico-demographic data, including disease course, age at onset, results of paraclinical examinations, and degree of disability. In Paper I, we found that carriers of the HLA class II specificity DR15-long known to confer susceptibility to MS-developed MS at an earlier age than non-carriers; that a second HLA class II specificity, DR17, is also positively associated with the risk of MS; that no HLA-DRB1 allele influences course or outcome in MS; and that differences in DR15 positivity rates, after stratification for diagnostic category and examinations results, seem to reflect a gradient of phenocopy contamination, with rates increasing in proportion to the degree of clinical or paraclinical, verification of the MS diagnosis. In Paper II, we show that the "head start" provided by carriage of DR15 is observed, independently, in patients with both bout-onset (BO; i.e., relapsing- remitting or secondary progressive) MS and primary progressive (PP) MS. In Paper III, we examined the possibility-first suggested in a report from Germany-that a rare variant of the CD45-encoding PTPRC gene is associated with nearly full penetrance of MS in a small subset of patients; we found, however, no difference in the occurrence of the variant between Swedish MS patients and controls. In Paper IV, we studied the impact of the Alzheimer-associated APOE gene on disability in MS by comparing genotype frequencies in our cohort's most extreme disability-stratified septiles. We found no significant differences between the benign-MS and severe-MS septiles; however, the risk conferred by the epsilon4 allele rose progressively upon comparison of carriage rates in more narrowly defined antipodal quantiles. In Paper V, we undertook to determine to what extent promoter-exon 1 haplotypes of CTLA4-a gene associated with susceptibility to several autoimmune diseases-influence age at onset, disease severity and disease course in MS. We found that CTLA4 haplotypes had no effect on age at onset or severity, but that deviations in haplotype frequencies could be observed in patients subgrouped by disease course. After subsequent analysis of a second, independent dataset, we confirmed that BOMS patients exhibited the same genotype and phenotype frequencies as controls, but that homozygosity for haplotype 2-a genotype associated with lower expression of CTLA4-conferred a more than two-fold risk of PPMS. In Paper VI, we characterized a consanguineous family of Middle Eastern origin exhibiting multiple cases of MS and performed a genome-wide screen, using microsatellite markers, on five affected and four unaffected family members now residing in Sweden. We found a haplotype spanning 43 centimorgans on the short arm of chromosome 9 for which four of five affected family members were homozygous and all unaffected family members heterozygous; however, the nonparametric logarithm-of-odds score for the region was no higher than a nonsignificant 2.3. Ironically, post-migration disease onset and a tendency towards date-of-onset (rather than age-at-onset) clustering seem to suggest the primacy of environmental factors over heritable ones in the etiology of MS in the kinship.
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