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Ahlm, Kristin
Publications (10 of 16) Show all publications
Ahlm, K., Lindqvist, P., Saveman, B.-i. & Björnstig, U. (2015). Suicidal drowning deaths in northern Sweden 1992-2009: the role of mental disorder and intoxication. Journal of Forensic and Legal Medicine, 34, 168-172
Open this publication in new window or tab >>Suicidal drowning deaths in northern Sweden 1992-2009: the role of mental disorder and intoxication
2015 (English)In: Journal of Forensic and Legal Medicine, ISSN 1752-928X, E-ISSN 1878-7487, Vol. 34, p. 168-172Article in journal (Refereed) Published
Abstract [en]

Suicides by drowning have received limited attention by researchers. A recent finding that almost onethird of all drowning deaths in Sweden were classified as suicide instigated this study. We identified 129 cases of suicide by drowning in Northern Sweden and analyzed the circumstances and the psychiatric history prior to the suicide. Information was obtained from autopsy, police and medical records, as well as from the National Inpatient Register. One-third of the suicide victims had previously attempted suicide and half of the victims had been hospitalized due to mental health problems. One-third of these had left the hospital less than one week before the suicide. Alcohol and psychoactive drugs were present in 16% and 62% of the cases, respectively. A history of mental disorder and previous suicide attempt (s), especially by drowning, is an ominous combination necessitating efficient clinical identification, treatment and follow-up if a complete suicide is to be prevented.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Suicide, Drowning, Mental disorder, Intoxication
National Category
Forensic Science
Research subject
Forensic Medicine
Identifiers
urn:nbn:se:umu:diva-105720 (URN)10.1016/j.jflm.2015.06.002 (DOI)000357743300030 ()26165679 (PubMedID)
Funder
The Kempe Foundations
Note

The study was supported by grants from the Kempe Foundation and the Section of Forensic Medicine, Umeå University. We are also indebted to the National Board of Forensic Medicine and the National Board of Health and Welfare for providing data for the study.

Available from: 2015-06-29 Created: 2015-06-29 Last updated: 2018-06-07Bibliographically approved
Ahlm, K. (2014). Traffic and drowning incidents with emphasis on the presence of alcohol and drugs. (Doctoral dissertation). Umeå: Umeå universitet
Open this publication in new window or tab >>Traffic and drowning incidents with emphasis on the presence of alcohol and drugs
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Worldwide, fatal traffic injuries and drowning deaths are important problems. The aim of this thesis was to investigate the cirumstances of fatal and non-fatal traffic injuries and drowning deaths in Sweden including analysis of the presence of alcohol and drugs, which are considered to be major risk factors for these events. Data where obtained from the database of National Board of Forensic Medicine.

In the first study, we investigated 420 passenger deaths from 372 crashes during 1993-1996. There were 594 drivers involved. In total, 21% of the drivers at fault were alcohol positive compared to 2% of drivers not at fault (p<0.001) (Paper I). During 2004-2007, crashes involving 56 fatally and 144 non-fatally injured drivers were investigated in a prospective study from Northern Sweden (Paper II). The drivers were alcohol positive in 38% and 21%, respectively. Psychoactive drugs were found in 7% and 13%, respectively. Benzodiazepines, opiates and antidepressants were the most frequent drugs found in drivers. Illict drugs were found 9% and 4% respectively, with tetrahydrocannabinol being the most frequent of these drugs (Paper II).

We investigated 5,125 drowning deaths in Sweden during 1992-2009 (Paper III). The incidence decreased on average by about 2% each year (p<0.001). Unintentional drowning was most common (50%). Alcohol was found in 44% of unintentional, 24% of intentional, and 45% of undetermined drowning deaths. Psychoactive substances were detected in 40% and benzodiazepines were the most common substance. Illicit drugs were detected in 10%. Of all drowning deaths, a significantly higher proportion females commited suicide compared with males (55% vs. 21%, p<0.001). Suicidal drowning deaths (n=129) in Northern Sweden were studied further in detail (Paper IV). of these, 53% had been hospitalized due to a psychiatric diagnosis within five years prior to the suicide. Affective and psychotic disorders were the most common psychiatric diagnoses. Almost one third had performed a previous suicide attempt. One fourth had committed suicide after less than one week of discharge from hospital. Alochol was found in 16% and psychoactive drugs in 62% of these cases, respectively. 

In conclusion, alcohol and psychoactive drugs are commonly detected among injured drivers and drowning victims, and probably play a role in these events. Most of the individuals that tested positive for alcohol and high blood concentrations, indicating alochol dependence or abuse. This association warrants futher attention when planning future prevention. 

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2014. p. 62
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1662
Keywords
Traffic incidents, drivers, passenger, drowning, alochol, pharmaceuptical, illicit drugs, suicidal drowning, mental disorder
National Category
Forensic Science
Research subject
Forensic Medicine
Identifiers
urn:nbn:se:umu:diva-91526 (URN)978-91-7601-095-2 (ISBN)
Public defence
2014-09-19, Hörsal D, Unod T9, Norrlands Universitetssjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-08-29 Created: 2014-08-11 Last updated: 2018-06-07Bibliographically approved
Eriksson, A., Stenlund, H., Ahlm, K., Boman, K., Bygren, L. O., Johansson, L. A., . . . Weinehall, L. (2013). Accuracy of death certificates of cardiovascular disease in a community intervention in Sweden.. Scandinavian Journal of Public Health, 41(8), 883-889
Open this publication in new window or tab >>Accuracy of death certificates of cardiovascular disease in a community intervention in Sweden.
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2013 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 8, p. 883-889Article in journal (Refereed) Published
Abstract [en]

Aim: The aim was to investigate the possibility to evaluate the mortality pattern in a community intervention programme against cardiovascular disease by official death certificates.

Methods: For all deceased in the intervention area (Norsjö), the accuracy of the official death certificates were compared with matched controls in the rest of Västerbotten. The official causes of death were compared with new certificates, based on the last clinical record, issued by three of the authors, and coded by one of the authors, all four accordingly blinded.

Results: The degree of agreement between the official underlying causes of death in "cardiovascular disease" (CVD) and the re-evaluated certificates was not found to differ between Norsjö and the rest of Västerbotten. The agreement was 87% and 88% at chapter level, respectively, but only 55% and 55% at 4-digit level, respectively. The reclassification resulted in a 1% decrease of "cardiovascular deaths" in both Norsjö and the rest of Västerbotten.

Conclusions: The disagreements in the reclassification of cause of death were equal but large in both directions. The official death certificates should be used with caution to evaluate CVD in small community intervention programmes, and restricted to the chapter level and total populations.

Keywords
Accuracy, agreement, cardiovascular disease, cause of death, death certificate, re-classification
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-83346 (URN)10.1177/1403494813499653 (DOI)000330514500017 ()23982462 (PubMedID)
Available from: 2013-11-21 Created: 2013-11-21 Last updated: 2018-06-08Bibliographically approved
Ahlm, K., Saveman, B.-I. & Björnstig, U. (2013). Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs: a retrospective study, 1992-2009. BMC Public Health, 13, 216
Open this publication in new window or tab >>Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs: a retrospective study, 1992-2009
2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, p. 216-Article in journal (Refereed) Published
Abstract [en]

Background: Drowning deaths constitute a significant proportion of unnatural deaths globally. In Sweden and other high-income countries, drowning deaths have decreased. This study investigates the epidemiology and current trends of unintentional, intentional, and undetermined drowning deaths with emphasis on the presence of alcohol and other drugs.

Methods: During an 18-years period, 5,125 drowning deaths were autopsied in Sweden. Data on cases including toxicological analysis on alcohol, pharmaceutical drugs, and illicit drugs were obtained from the National Board of Forensic Medicine.

Results: During the study period, the annual incidence of drowning deaths in Sweden was 3.1/100,000 inhabitants and decreased on average by about 2% each year (p<0.001). The highest incidence was found among males and in middle/older age groups. The incidence increased 3% for each year of age. Children/adolescents (<= 18 years) constituted 5% of all drowning deaths. Of all drowned females in the study, 55% (847/1,547) committed suicide, which was a significantly higher proportion compared with males (21%, 763/3,578) (p<0.001). In total, 38% (1,656/4,377) of tested drowned persons had alcohol in their blood and the mean concentration was 1.8 g/l. In the unintentional drowning group, intentional drowning group, and the undetermined group, the proportion of alcohol positive was 44%, 24%, and 45%, respectively. One or several psychoactive drugs were present in the blood in 40% (1,688/4,181) of all tested persons and in 69% (965/1,394) of tested persons who died from suicidal drowning. The most common drug was benzodiazepines (21%, 891/4,181). Illicit drugs were detected in 10% (82/854) of tested persons.

Conclusion: Presence of alcohol and drugs were frequent and may have contributed to the drowning deaths. The incidence of drowning deaths significantly decreased during the study period. Males and the middle/older age groups had a higher incidence compared to females and children. Suicidal drowning was common especially among women. Alcohol and drugs are significant contributors in drowning deaths in Sweden and should be considered as part of a comprehensive prevention program.

Place, publisher, year, edition, pages
BioMed Central, 2013
Keywords
Alcohol, Drowning, Illicit drugs, Pharmaceutical drugs, Suicide
National Category
Substance Abuse Forensic Science
Identifiers
urn:nbn:se:umu:diva-70348 (URN)10.1186/1471-2458-13-216 (DOI)000317115800002 ()23497055 (PubMedID)
Available from: 2013-06-27 Created: 2013-05-14 Last updated: 2018-06-08Bibliographically approved
Connolly-Andersson, A.-M., Ahlm, K., Ahlm, C. & Klingström, J. (2013). Puumala virus infections associated with cardiovascular causes of death. Emerging Infectious Diseases, 19(1), 126-128
Open this publication in new window or tab >>Puumala virus infections associated with cardiovascular causes of death
2013 (English)In: Emerging Infectious Diseases, ISSN 1080-6040, E-ISSN 1080-6059, Vol. 19, no 1, p. 126-128Article in journal (Refereed) Published
Abstract [en]

We studied the causes of death of patients in Sweden with diagnoses of hemorrhagic fever with renal syndrome (HFRS) during 1997–2009. Cardiovascular disorders were a common cause of death during acute-phase HFRS and were the cause of death for >50% of those who died during the first year after HFRS.

National Category
Infectious Medicine
Research subject
Infectious Diseases
Identifiers
urn:nbn:se:umu:diva-62773 (URN)10.3201/eid1901.111587 (DOI)000328172800019 ()23260342 (PubMedID)
Funder
Swedish Heart Lung FoundationSwedish Research Council
Available from: 2012-12-18 Created: 2012-12-18 Last updated: 2018-06-08Bibliographically approved
Palmcrantz, J., Hardcastle, T. C., Naidoo, S. R., Muckart, D. J., Ahlm, K. & Eriksson, A. (2012). Pelvic fractures at a new level 1 trauma centre: who dies from pelvic trauma?: The Inkosi Albert Luthuli Central Hospital Experience. Orthopaedic surgery, 4(4), 216-221
Open this publication in new window or tab >>Pelvic fractures at a new level 1 trauma centre: who dies from pelvic trauma?: The Inkosi Albert Luthuli Central Hospital Experience
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2012 (English)In: Orthopaedic surgery, ISSN 1757-7861, Vol. 4, no 4, p. 216-221Article in journal (Refereed) Published
Abstract [en]

Objective: To identify the incidence of pelvic trauma, causes of death and factors predicting death with pelvic fractures.

Methods: All pelvic fractures were retrospectively identified from a registry spanning from March 2007 to August 2009. Data was captured on a proforma. Data for survivors, non-survivors and a subgroup with pelvic injury as the underlying cause of death were compared.

Results: Pelvic fracture incidence was 16% of major trauma cases. Patient with pelvic fractures had 31% mortality and 9% pelvic fracture-induced mortality. Motor vehicle collisions were the commonest external cause of pelvic fractures (59%); however, the highest mortality was from falls >6 m. The Injury Severity Score (ISS) was 29 in survivors, 36 in non-survivors, and 54 in the pelvic death subgroup. Type C fracture was a predictor of mortality (P = 0.135). 53% of the cases required transfusion in the first 24 hours. The pelvic death subgroup received a mean of 10.7 units of blood, versus 4 units for survivors and 3.7 units for non-survivors (P = 0.259).

Conclusion: The overall incidence of pelvic fracture and associated mortality were higher than previously reported. Fracture severity and falls from heights are associated with additional injuries (higher ISS) and mortality. More severe fractures cause deaths directly attributable to the pelvic injury. The requirement for major blood transfusions for pelvic fracture hemorrhage was related to mortality. Female patients appeared to fare worse than males.

Place, publisher, year, edition, pages
Tianjin Hospital and Wiley Publishing Asia Pty Ltd, 2012
Keywords
Fracture, Mortality, Pelvis, Transfusion requirement
National Category
Forensic Science
Research subject
Forensic Medicine
Identifiers
urn:nbn:se:umu:diva-62772 (URN)10.1111/os.12002 (DOI)
Available from: 2012-12-18 Created: 2012-12-18 Last updated: 2018-06-08Bibliographically approved
Ahlm, K. & Eriksson, A. (2011). Blood loss in exsanguination deaths. Indian Journal of Forensic Medicine & Toxicology, 5(2), 5-8
Open this publication in new window or tab >>Blood loss in exsanguination deaths
2011 (English)In: Indian Journal of Forensic Medicine & Toxicology, ISSN 0973-9122, Vol. 5, no 2, p. 5-8Article in journal (Refereed) Published
Abstract [en]

Deaths by exsanguination among various underlying causes of death were analyzed in order to expand the knowledge on the relation of extravasated blood volume to other documented parameters.

A consecutive series of 193 cases of ruptured thoracic aortic aneurysm (n=13), gunshot wounds (n=63), stab wounds (n=28), rib fractures (n=5), and blunt injury to thoracic aorta (n=84) were investigated.

The amount of internal bleeding into pleural cavities only varied greatly (200-3,400 ml) with a mean value of 1,174 ml, slightly higher among males. Age, body weight, cause and manner of death, external bleeding, alcohol inebriation, multiplicity of injuries, and degree of coronary heart disease did not significantly affect the amount of internal (pleural) bleeding. Also, post-mortem delay to autopsy did not correlated to the amount of extravasated blood, indicating that post-mortem bleeding is of no importance in these days.

 

National Category
Forensic Science
Identifiers
urn:nbn:se:umu:diva-50630 (URN)
Available from: 2011-12-16 Created: 2011-12-16 Last updated: 2018-06-08Bibliographically approved
Ahlm, K., Hassler, S., Sjölander, P. & Eriksson, A. (2010). Unnatural deaths in reindeer-herding Sami families in Sweden, 1961-2001. International Journal of Circumpolar Health, 69(2), 129-137
Open this publication in new window or tab >>Unnatural deaths in reindeer-herding Sami families in Sweden, 1961-2001
2010 (English)In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 69, no 2, p. 129-137Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Unnatural deaths among Indigenous populations, including the Swedish Sami, occur more often than among the general population. To find prevention strategies, we explored the circumstances of the unnatural deaths of members of reindeer-herding Sami families.

STUDY DESIGN: The number of deaths from among a cohort of 7,482 members of reindeer-herding Sami families were retrieved from the National Board of Health and Welfare for the years 1961- 2001.

METHODS: An evaluation of the information from autopsy records at the National Board of Forensic Medicine, police reports, and available medical records identified 158 unnatural deaths. These were then analysed in detail.

RESULTS: Transport-related deaths and suicides were the most common unnatural deaths among Swedish reindeer-herding Sami family members. Suicides contributed to 23% of all deaths, road traffic accidents to 16%, and snowmobile fatalities to 11%. The accidents generally reflected an "outdoor lifestyle" and the working conditions were characterized by the use of off-road vehicles such as snowmobiles. Half of the number of victims tested positive for alcohol and alcohol abuse was documented in 15% of all victims.

CONCLUSIONS: The results indicate that alcohol is an important factor in preventing unnatural deaths among reindeer-herding Sami, together with increased safety of both on-road and off-road transportation.

Keywords
alcohol, Indigenous populations, reindeer-herding, Sami; suicide, unnatural deaths
National Category
Forensic Science
Identifiers
urn:nbn:se:umu:diva-40914 (URN)000278825100003 ()20356469 (PubMedID)
Available from: 2011-03-14 Created: 2011-03-14 Last updated: 2018-06-08Bibliographically approved
Ahlm, K., Björnstig, U. & Öström, M. (2009). Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden. Accident Analysis and Prevention, 41(1), 129-136
Open this publication in new window or tab >>Alcohol and drugs in fatally and non-fatally injured motor vehicle drivers in northern Sweden
2009 (English)In: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 41, no 1, p. 129-136Article in journal (Refereed) Published
Abstract [en]

Alcohol and drugs are important risk factors for traffic injuries, a major health problem worldwide. This prospective study investigated the epidemiology and the presence of alcohol and drugs in fatally and hospitalized non-fatally injured drivers of motor vehicles in northern Sweden. During a 2-year study period, blood from fatally and hospitalized non-fatally injured drivers was tested for alcohol and drugs. The study subjects were recruited from well-defined geographical areas with known demographics. Autopsy reports, medical journals, police reports, and toxicological analyses were evaluated. Of the fatally injured, 38% tested positive for alcohol and of the non-fatally 21% tested positive; 7% and 13%, respectively, tested positive for pharmaceuticals with a warning for impaired driving; 9% and 4%, respectively, tested positive for illicit drugs. The most frequently detected pharmaceuticals were benzodiazepines, opiates, and antidepressants. Tetrahydrocannabinol was the most frequently detected illicit substance. No fatally injured women had illegal blood alcohol concentration. The relative proportion of positively tested drivers has increased and was higher than in a similar study 14 years earlier. This finding indicates that alcohol and drugs merit more attention in future traffic safety work.

Place, publisher, year, edition, pages
Elsevier, 2009
Keywords
Driver; Alcohol; Drugs; Road traffic; Injury
National Category
Forensic Science
Identifiers
urn:nbn:se:umu:diva-22359 (URN)10.1016/j.aap.2008.10.002 (DOI)19114147 (PubMedID)
Available from: 2009-05-06 Created: 2009-05-06 Last updated: 2018-06-08Bibliographically approved
Ahlm, K. & Eriksson, A. (2006). Driver's alcohol and passenger's death in motor vehicle crashes. Traffic Injury Prevention, 7(3), 219-223
Open this publication in new window or tab >>Driver's alcohol and passenger's death in motor vehicle crashes
2006 (English)In: Traffic Injury Prevention, ISSN 1538-9588, E-ISSN 1538-957X, Vol. 7, no 3, p. 219-223Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Previous studies on alcohol involvement associated with fatal injury in traffic crashes have focused on the drivers, but the passenger's view is not well known. This study (1) analyzes the relationship between passenger's death and alcohol inebriation of the driver and (2) estimates the role of alcohol as the cause of a crash by examining who was at fault, sober, or inebriated.

METHOD: The study includes all motor vehicle passengers (n = 420) who died in crashes in Sweden 1993 through 1996 and were medicolegally autopsied. Autopsy reports from the Departments of Forensic Medicine, including toxicological analyses, and police reports were studied. Presence of alcohol among drivers was based on blood and breath tests.

RESULTS: One-fifth of the fatally injured passengers and one-fifth of the tested drivers were under the influence of alcohol. The youngest drivers had the highest prevalence of drunken driving. Drivers at fault were alcohol positive in 21% of these crashes and drivers were not at fault in 2% of these crashes. In 53% of the crashes where both the passenger and driver were alcohol positive, the passenger had a lower alcohol concentration than the driver. Children (<16 years) comprised 15% of the killed passengers. Notably, the children were riding with a driver who was under influence of alcohol in 13% of these crashes. Alcohol involvement was not tested in half of the surviving drivers.

CONCLUSIONS: The data show that 20% of both passengers and drivers were under the influence of alcohol. Increased testing of surviving drivers regarding alcohol and other drugs is recommended.

Place, publisher, year, edition, pages
Taylor & Francis, 2006
Keywords
Accidents; Traffic/*mortality, Adolescent, Adult, Age Distribution, Aged, Aged; 80 and over, Alcohol Drinking/*mortality, Alcoholic Intoxication/*mortality, Breath Tests, Central Nervous System Depressants/*analysis, Child, Child; Preschool, Ethanol/*analysis, Female, Humans, Infant, Infant; Newborn, Male, Middle Aged, Sweden/epidemiology
National Category
Forensic Science
Identifiers
urn:nbn:se:umu:diva-12801 (URN)10.1080/15389580600727846 (DOI)16990235 (PubMedID)
Available from: 2008-01-08 Created: 2008-01-08 Last updated: 2018-06-09Bibliographically approved
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