| 61. |
- Cherpitel, Cheryl J, et al.
(författare)
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Multi-level analysis of alcohol-related injury and drinking pattern: emergency department data from 19 countries
- 2012
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Ingår i: Addiction. - : Wiley-Blackwell. - 0965-2140 .- 1360-0443. ; 107:7, s. 1263-1272
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Tidskriftsartikel (refereegranskat)abstract
- Aim While drinking in the event is an important factor in injury occurrence, the pattern of usual drinking may also be important in risk of injury. Explored here is the relationship of an alcohol-related injury with an individual usual drinking pattern. Design Alcohol-related injury is examined using hierarchical linear models, taking into account individual usual volume of consumption over the past 12 months, as well as aggregate-level detrimental drinking pattern (DDP) and alcohol policy measures. Setting Data analyzed are from emergency departments (EDs) in 19 countries, comprising three collaborative studies on alcohol and injury, all of which used a similar methodology. Participants The sample comprised 14 132 injured drinkers across 46 emergency room (ER) studies. Measurements Alcohol-related injury was measured, separately, by any self-reported drinking prior to injury, a blood alcohol concentration (BAC) = 0.08 and self-reported causal attribution of injury to drinking. Findings While individual usual volume strongly predicted an alcohol-related injury for all three measures, usual drinking pattern also predicted an alcohol-related injury (controlling for volume), with episodic heavy and frequent heavy drinking both more predictive of alcohol-related injury than other drinking patterns. When individual usual volume and drinking pattern were controlled, DDP was no longer a significant predictor of alcohol-related injury. Alcohol policy measures were predictive of both BAC and causal attribution (the stronger the policy the lower the rates of alcohol-related injury). Conclusions Volume of alcohol typically consumed and occurrence of heavy drinking episodes are associated independently with incidence of alcohol-related injury. The stronger the anti-alcohol policies in a country, the lower the rates of alcohol-related injury.
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| 62. |
- Danielsson, Anna-Karin, et al.
(författare)
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Alcohol use, heavy episodic drinking and subsequent problems among adolescents in 23 European countries : does the prevention paradox apply?
- 2012
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 107:1, s. 71-80
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Tidskriftsartikel (refereegranskat)abstract
- Aims According to the prevention paradox, a majority of alcohol-related problems in a population can be attributed to low to moderate drinkers simply because they are more numerous than heavy drinkers, who have a higher individual risk of adverse outcomes. We examined the prevention paradox in annual alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems among adolescents in 23 European countries.Design and setting Survey data from the 2007 European School Survey Project on Alcohol and Drugs (ESPAD) among 16-year-old students were analysed.Participants A total of 38 370 alcohol-consuming adolescents (19 936 boys and 18 434 girls) from 23 European countries were included.Measurements The upper 10% and the bottom 90% of drinkers by annual alcohol intake, with or without HED, and frequency of HED, were compared for the distribution of 10 different alcohol-related problems.Findings Although the mean levels of consumption and alcohol-related problems varied largely between genders and countries, in almost all countries the heavy episodic drinkers in the bottom 90% of consumers by volume accounted for most alcohol-related problems, irrespective of severity of problem. However, adolescents with three or more occasions of HED a month accounted for a majority of problems.Conclusions The prevention paradox, based on measures of annual consumption and heavy episodic drinking, seems valid for adolescent European boys and girls. However, a minority with frequent heavy episodic drinking accounted for a large proportion of all problems, illustrating limitations of the concept. As heavy episodic drinking is common among adolescents, our results support general prevention initiatives combined with targeted interventions.
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| 63. |
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| 64. |
- Enefalk, Hanna, 1976-
(författare)
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Swedish alcohol consumption on the threshold of modernity : Legislation, attitudes, and national economy c. 1775-1855
- 2013
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 108:2, s. 265-274
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Tidskriftsartikel (refereegranskat)abstract
- Aims We aimed to map the context of the large increase in vodka consumption in Sweden during the transition from early modern to modern times (c. 17751855). What were the attitudes to alcohol among the groups that dominated society, and how did these attitudes relate to contemporary legislation and socio-economic change? Methods Qualitative analysis of diaries and memoirs. Information was also collected from legislation, writings of the temperance movement and previous research. Findings During the period studied, attitudes to alcohol among the socio-economic elite were positive if the drinker was a person of standing, whereas drinking among the working population was scorned and, from the 1830s onwards, a cause for concern. Legislation was characterized by frequent and radical changes. Consumption levels are difficult to estimate: in the 1820s, agricultural overproduction, liberal legislation and improved distilling methods probably resulted in a major consumption increase. In 184653, permissive licensing laws and the industrialization of distilling similarly led to very high consumption levels. Conclusions In Sweden in the late 18th and early 19th centuries the social elite appears to have used alcohol as a tool in their negotiations with the working population but later, as the spread of wage labour and cheap vodka coincided with Sweden's largest ever population growth, the view that popular drinking must be checked gained support in leading circles.
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| 65. |
- Evans, Brittany E, 1982-, et al.
(författare)
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The relation between hypothalamic-pituitary-adrenal (HPA) axis activity and age of onset of alcohol use
- 2012
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Ingår i: Addiction. - : Blackwell Publishing. - 0965-2140 .- 1360-0443. ; 107:2, s. 312-322
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Hypothalamic-pituitary-adrenal (HPA) axis activity may prove a viable biomarker for identifying those susceptible to alcohol use disorders. The purpose of this study was to examine the relation of the age at which adolescents begin drinking with diurnal and stress cortisol.DESIGN: Adolescents' diurnal cortisol levels on a normal day and cortisol levels during a stress procedure were examined in relation to the age of onset of alcohol use.SETTING AND PARTICIPANTS: All adolescents (aged 14-20 years) were part of a general population study in the Netherlands (n = 2286).MEASUREMENTS: Ten assessments of salivary cortisol taken on a normal day (diurnal cortisol), as well as during a social stress procedure (stress cortisol) were used as indicators of HPA axis activity.FINDINGS: The age at which the first alcoholic drink was consumed varied as a function of cortisol levels at the onset of as well as during the stress procedure. Those who began drinking at an earlier age showed lower cortisol levels at the onset of the stressful tasks (r(2) = 0.14, P < 0.001) and during the stressful tasks (r(2) = 0.10, P < 0.05), although not after the tasks (cortisol recovery). Effects were strongest for anticipatory pre-task cortisol levels. Differences in diurnal cortisol levels did not explain variance in the age at which adolescents had begun drinking.CONCLUSIONS: Lessened activity of the hypothalamic-pituitary-adrenal axis at the onset of and during a stress procedure is present in adolescents who begin drinking at an early age.
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| 66. |
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| 67. |
- Fugelstad, A., et al.
(författare)
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Methadone maintenance treatment : the balance between life-saving treatment and fatal poisonings
- 2007
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 102:3, s. 406-412
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To determine the total mortality related to the Stockholm methadone programme during the period 1988-2000, both the mortality related to the treatment and fatal methadone intoxications in the Stockholm area during the same period. Methods: The study comprised all individuals (n = 848) who had been in contact with the methadone programme in Stockholm during the study period, including those patients who had been discharged from treatment and those opiate users who had applied for but not received methadone treatment. All deaths that had been the subject of medico-legal examination at the Department of Forensic Medicine in Stockholm where methadone was found in blood or urine were also analysed during the same period. Results: The mortality was lower among those opiate users who remained in maintenance treatment and 91% of the deceased individuals had died due to natural causes, in most cases related to HIV or hepatitis C, acquired before admission to the programme. Those who had been discharged from methadone treatment had a 20 times higher risk of dying from unnatural causes compared to the patients who remained in treatment. The majority died due to heroin injections ('overdoses'). Eighty-nine cases of fatal methadone intoxication were found, but in only two of these cases was there evidence of leakage from maintenance treatment. Conclusion: The 'high threshold programme' is safe as long as the patients remain in treatment and there are very few deaths due to leakage from the programme. However, there is a high mortality among those discharged from the programme and only a minority of the heroin users in Stockholm had applied for treatment.
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| 68. |
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| 69. |
- Fugelstad, A, et al.
(författare)
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Use of morphine and 6-monoacetylmorphine in blood for the evaluation of possible risk factors for sudden death in 192 heroin users
- 2003
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Ingår i: Addiction. - : Wiley. - 0965-2140 .- 1360-0443. ; 98:4, s. 463-470
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To detect risk factors for sudden death from heroin injection. Design: Evaluation of data from forensic investigations of all fatal cases of suspected heroin death in a metropolitan area. Only cases with detectable morphine and 6-monoacetylmorphine (6-MAM) in blood were included in order to select heroin intoxication cases. Setting: Stockholm, Sweden. Measurements: Autopsy investigation and toxicological analysis of blood and urine: and police reports. Findings: In two-thirds of the 192 cases, death occurred in public places, and mostly without any time delay. Blood concentrations of morphine ranged from 50 to 1200 ng/g, and of 6-MAM from 1 to 80 ng/g. Codeine was detected in 96% of the subjects. In the majority of cases the forensic investigation indicated polydrug use, the most common additional findings being alcohol and benzodiazepines. However, in one-quarter of the cases other drug combinations were found. Previous abstinence from heroin and use of alcohol were identified as risk factors. For 6-MAM there was also a correlation with the presence of THC and benzodiazepines. Despite a high frequency of heart abnormalities (e.g. myocarditis and focal myocardial fibrosis), these conditions did not correlate with morphine or 6-MAM blood concentrations. Conclusions: We confirm that alcohol intake and loss of tolerance are risk factors for death from heroin use, whereas no connection to heart pathology was observed. Further, prospective, studies should focus on other possible risk factors.
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| 70. |
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