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| 2. |
- 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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| 3. |
- 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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- 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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