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  • 1.
    Ahlm, Kristin
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs: a retrospective study, 1992-20092013In: BMC Public Health, E-ISSN 1471-2458, Vol. 13, p. 216-Article in journal (Refereed)
    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.

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  • 2.
    Beer, Torfinn
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Eriksson, Anders
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Forensic Medicine.
    Wingren, Carl Johan
    Unit for Forensic Medicine, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.
    Increased lung weight in fatal intoxications is not unique to opioid drugs2023In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 68, no 2, p. 518-523Article in journal (Refereed)
    Abstract [en]

    Fatal intoxications with opioids are known to be associated with an increased lung weight, as well as with brain and pulmonary edema and urinary retention. However, there is evidence to suggest that fatal intoxications with non-opioid substances are also associated with increased lung weight; however, the latter aspect has not been comprehensively analyzed. To determine to what extent opioid and non-opioid substances are associated with increased lung and brain weight, we studied these organs in cases where the cause of death was attributed to intoxication with a single agent. Using data from cases autopsied at the National Board of Forensic Medicine (NBFM) in Sweden from 2009 through 2019 where the cause of death was attributed to a single substance, we created models of combined lung weight and brain weight. The models used age and sex as predictors as well as nested varying effects for the specific intoxicant and category of intoxicant. Suicidal hanging with negative toxicology cases served as controls. The population majority was male among both intoxications (68%) and controls (83%). The most common single substance group was opioids. All tested substances were associated with heavier lungs than controls, with the largest effect in the opioid group. Our findings show that several substances are associated with increased lung weight and that among intoxication deaths there is no difference in expected brain weight between substances. Hence, heavy lungs, without a reasonable explanation, should prompt a broad toxicological screening.

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  • 3.
    Blom-Nilsson, Marcus
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Har problemen blivit värre? – en analys av hur problem med och hjälpbehov för psykisk hälsa, alkohol-och narkotikaanvändning förändrats över tid för socialtjänstens klienter2023In: Socialvetenskaplig tidskrift, ISSN 1104-1420, E-ISSN 2003-5624, Vol. 30, no 1, p. 477-498Article in journal (Refereed)
    Abstract [en]

    Changing patterns of addiction and increased psychiatric comorbidity pose new challenges for social services. As part of systematizing the work of assessing and investigating the need for help for people with alcohol or drug problems, use of the Addiction Severity Index is recommended. This descriptive quantitative study examines and compares how social workers and clients esti-mate the extent of a client’s problems in three areas: mental health, alcohol and drugs. Based on interviewer and client estimates, the study also examines whether the problems are estimated dif-ferently over time, from 2003 to 2017. The study includes ASI material for 15,005 people whose need for help for alcohol or drug problems has been investigated and assessed by the social services in 65 Swedish municipalities. The study shows that both clients and social workers estimate an increased problem level for the ASI domains of mental health and drugs. For alcohol, the trend is the opposite or is unchanged. Overall, interviewer as well as client estimates indicate an increased need for help and support for problems related to mental health and drug use, while the need for help and support for problems related to alcohol is unchanged or decreases over time among social service clients.

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  • 4. Bramness, Jorgen G.
    et al.
    Henriksen, Beate
    Persson, Olle
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Mann, Karl
    A Bibliometric Analysis of European versus USA Research in the Field of Addiction. Research on Alcohol, Narcotics, Prescription Drug Abuse, Tobacco and Steroids 2001-20112014In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 20, no 1, p. 16-22Article in journal (Refereed)
    Abstract [en]

    Background: To compare the publication and citation rate within the areas of drug abuse and dependence research in Europe with that in the USA. Methods: This is a bibliometric study using the Thomson Reuters Web of Knowledge as data source, 40 key words were used as search terms, but certain scientific publications not concerning the issue were excluded. Scientific publications from Denmark, England, Finland, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the USA were studied. The number of publications in each country and in each year in addition to the citation indices for these publications was retrieved. Results: Approximately two thirds of the publications came from the USA. Both in absolute and relative figures, Europe lagged behind. The trend over the last decade was a greater gap between the amount of research performed in Europe versus the USA. There were thematic differences. Smaller European countries had a greater relative publication rate. The citations were relatively evenly distributed. Conclusions: It has been claimed that 85% of the world's research within the field of drug abuse and dependence is carried out in the USA. This study challenges this figure, but European research within this field is lagging behind. Copyright (C) 2013 S. Karger AG, Basel

  • 5. Bramness, Jørgen G.
    et al.
    Henriksen, Beate
    Person, Olle
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Mann, Karl
    Bibliographic searches for a bibliometric analysis on drug addiction reply2015In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 21, no 1, p. 32-32Article in journal (Refereed)
  • 6.
    Di Castelnuovo, Augusto
    et al.
    Mediterranea Cardiocentro, Napoli, Italy.
    Costanzo, Simona
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Bonaccio, Marialaura
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    McElduff, Patrick
    University of Newcastle & Hunter Medical Research Institute, Australia.
    Linneberg, Allan
    Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
    Salomaa, Veikko
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Männistö, Satu
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Moitry, Marie
    Department of Public Health, University Hospital of Strasbourg and Department of Epidemiology and Public Health, University of Strasbourg, France.
    Ferrières, Jean
    Department of Cardiology and INSERM UMR 1295, Toulouse University Hospital, Toulouse, France.
    Dallongeville, Jean
    University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France.
    Thorand, Barbara
    Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany.
    Brenner, Hermann
    Division of Clinical Epidemiology and Aging Research and Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany.
    Ferrario, Marco
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Veronesi, Giovanni
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Pettenuzzo, Emanuela
    Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Tamosiunas, Abdonas
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Njølstad, Inger
    Department of community Medicine, University of Tromsø - the Arctic University of Norway, Norway.
    Drygas, Wojciech
    Department of Epidemiology CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland.
    Nikitin, Yuri
    The Institute of Internal and Preventive Medicine, Novosibirsk, Russian Federation.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Kee, Frank
    Centre for Public Health, Queens University of Belfast, Belfast, United Kingdom.
    Grassi, Guido
    Clinica Medica, Università Milano-Bicocca, Milano, Italy.
    Westermann, Dirk
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Schrage, Benedikt
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Dabboura, Salim
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Zeller, Tanja
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Kuulasmaa, Kari
    Finnish Institute for Health and Welfare, Helsinki, Finland.
    Blankenberg, Stefan
    Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for cardiovascular research, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany.
    Donati, Maria Benedetta
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    de Gaetano, Giovanni
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy.
    Iacoviello, Licia
    Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy; Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria, Varese, Italy.
    Alcohol intake and total mortality in 142 960 individuals from the MORGAM Project: a population-based study2022In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 117, no 2, p. 312-325Article in journal (Refereed)
    Abstract [en]

    Aim: To test the association of alcohol consumption with total and cause-specific mortality risk. Design: Prospective observational multi-centre population-based study.

    Setting: Sixteen cohorts (15 from Europe) in the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) Project.

    Participants: A total of 142 960 individuals (mean age 50 ± 13 years, 53.9% men).

    Measurements: Average alcohol intake by food frequency questionnaire, total and cause-specific mortality.

    Findings: In comparison with life-time abstainers, consumption of alcohol less than 10 g/day was associated with an average 11% [95% confidence interval (CI) = 7–14%] reduction in the risk of total mortality, while intake > 20 g/day was associated with a 13% (95% CI = 7–20%) increase in the risk of total mortality. Comparable findings were observed for cardiovascular (CV) deaths. With regard to cancer, drinking up to 10 g/day was not associated with either mortality risk reduction or increase, while alcohol intake > 20 g/day was associated with a 22% (95% CI = 10–35%) increased risk of mortality. The association of alcohol with fatal outcomes was similar in men and women, differed somewhat between countries and was more apparent in individuals preferring wine, suggesting that benefits may not be due to ethanol but other ingredients. Mediation analysis showed that high-density lipoprotein cholesterol explained 2.9 and 18.7% of the association between low alcohol intake and total as well as CV mortality, respectively.

    Conclusions: In comparison with life-time abstainers, consuming less than one drink per day (nadir at 5 g/day) was associated with a reduced risk of total, cardiovascular and other causes mortality, except cancer. Intake of more than two drinks per day was associated with an increased risk of total, cardiovascular and especially cancer mortality.

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  • 7.
    Gebregziabher, Hiben
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Franck, Jennifer
    Umeå University, Faculty of Medicine, Department of Nursing.
    När sjuksköterskan är missbrukaren: Sjuksköterskors upplevelse av alkohol- och substansmissbruk, samt rehabilitering. -En litteraturstudie2023Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Substance use disorder is a disease that afflicts millions of individuals worldwide today, of which nurses are vulnerable as a group because of the easy access to narcotics amongst other reasons. Despite this, there is a great lack of knowledge about the subject. This affects the nursing care negatively, and patients, colleagues and the substance abusing nurse themselves can be put at risk. Aim: To describe the nurses’ experience of personal substance abuse and rehabilitation. Methods: This literature study is based on eight qualitative studies acquired through database-searches in CINAHL and PubMed, the analysis was conducted using Friberg`s five step model. Results: Four main categories were found through the analysis: “Causes for substance abuse”, “consequences of substance abuse”, “Confronting the substance abuse” and “rehabilitation”. The main categories were divided into 8 subcategories. Conclusion: Substance abuse leads to social and economic consequences for the nurse and can negatively affect the quality of the patient's care. There are effective interventions but the experiences of these vary and are dependent on multiple variables. There is a lack of research on the subject, and more is needed. 

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  • 8. Gedeon, Charlotte
    et al.
    Sandell, Mikael
    Birkemose, Inge
    Kakko, Johan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Runarsdottir, Valgerdur
    Simojoki, Kaarlo
    Clausen, Thomas
    Nyberg, Fred
    Littlewood, Richard
    Alho, Hannu
    Standards for opioid use disorder care: An assessment of Nordic approaches2019In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 36, no 3, p. 286-298Article in journal (Refereed)
    Abstract [en]

    Aims: Outcomes in opioid use disorder (OUD) in Nordic countries have improved with integrated treatment and harm-reduction programmes. Approaches and the standard of care are different across the region. Evidence of treatment needs and current approaches are defined from evidence to inform development of a common standard.

    Method: Evidence of population sizes and treatment approach collected. Common standards for care (harm reduction, pharmacotherapy, psychology/social therapy) defined for each country.

    Results: Evidence defines number in treatment; potential population needing treatment not defined for all countries. Populations sizes, treatment access (ratio in treatment programme compared to total country population) defined: Sweden 4,000 in OUD care (access ratio 40); Finland 3,000 (55); Norway 8,000 (154); Denmark 7,500 (132). Approach to treatment similar: integrated treatment programmes standard. Care provided by specialists in outpatient clinics/primary care; secondary care/inpatient services are available. Harm reduction is limited in Sweden but available and more accessible elsewhere. Treatment entry criteria: access relatively unlimited in Norway and Denmark, more limited in Finland and Sweden. Standards of care defined: easy access to high-quality services, individual planning, care not limited by time, management of relapse, education for patients, continuous engagement, holistic approach including management of comorbidities, needle equipment programmes without limit, treatment in prisons as community.

    Conclusion: There are opportunities to improve OUD care in the Nordics. Policy makers and clinicians can advance OUD care and share common success factors. Collaborative work across the Nordic countries is valuable. Further research in clinical practice development can yield important results for the benefit of patients with OUD.

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  • 9.
    Gentile, Ambra
    et al.
    Sport and Exercise Research Unit, Department of Psychology, Educational Sciences, and Human Movement, University of Palermo, Palermo, Italy.
    Bianco, Antonino
    Sport and Exercise Research Unit, Department of Psychology, Educational Sciences, and Human Movement, University of Palermo, Palermo, Italy.
    Nordström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. School of Sports Science, The Arctic University of Norway, Tromsø, Norway.
    Nordström, Peter
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Use of alcohol, drugs, inhalants, and smoking tobacco and the long-term risk of depression in men: A nationwide Swedish cohort study from 1969–20172021In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 221, article id 108553Article in journal (Refereed)
    Abstract [en]

    Background: The use of alcohol, drugs, inhalants, and smoking tobacco may lead to mood disorders such as depression. However, knowledge on the independent contributions of the use of these substances to the risk of depression is lacking.

    Methods: The study cohort consisted of 24,564 men included in the Swedish national military conscription register who were conscripted in 1969–1970 and followed until 2017. Cox proportional hazard ratios were used to estimate the risk of depression according to alcohol, drug, inhalant, and cigarette consumption, and adjusted for body mass index, verbal comprehension test scores, handgrip strength, and the other main exposures investigated.

    Results: During an average follow-up period of 44 years, 4500 men were diagnosed with or treated for depression at a mean age of 54 years. A dose-dependent association was found in men who smoked cigarettes, with the highest risk for smoking >20 cigarettes per day, at time of conscription (aHR 1.86, 95 % CI 1.61–2.16, p < 0.001). Independent associations with an increased risk of depression were found for the use of drugs at least once (aHR 1.21, 95 % CI 1.10–1.32, p < 0.001) and >50 times (aHR 1.48, 95 % CI 1.23–1.77, p < 0.001) and the use of inhalants (aHR 1.16, 95 % CI 1.05–1.29). Excessive alcohol intake was not associated with the risk of depression.

    Conclusion: The results suggest that people who reported to have used cigarettes, alcohol, or drugs at 18 years of age have a moderately increased risk of depression later in life.

  • 10.
    Grahn, Robert
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Chassler, Deborah
    School of Social Work, Boston University, Boston, Massachusetts, USA.
    Lundgren, Lena
    School of Social Work, Boston University, Boston, Massachusetts, USA.
    Repeated addiction treatment use in Sweden: a national register database study2014In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 49, no 13, p. 1764-1773Article in journal (Refereed)
    Abstract [en]

    Sweden has a free, universal addiction treatment system yet few studies examining utilization of treatment in this country. This study identified predisposing, enabling and need factors associated with history of number of voluntary addiction treatment episodes for a national sample of 12,009 individuals assessed for an alcohol and/or drug use disorder in Sweden. On average, people reported 4.3 prior treatment episodes. Linear regression methods identified that of predisposing factors older age and being male were associated with more voluntary addiction treatment episodes compared to younger and female clients; a higher Addiction Severity Index (ASI) employment score (an enabling factor) was associated with more voluntary addiction treatment episodes; and need factors including a history of inpatient mental health treatment, a higher ASI psychiatric score, a higher ASI alcohol score, higher levels of illict drug use, more compulsory addiction treatment episodes, a lower ASI legal score and history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts. There were no differences in number of treatment episodes by education or immigrant status. Implications: (1) Need is a key factor associated with more treatment use. (2) Further studies are needed to identify gender differences in access/use of treatment. (3) Given multiple treatment histories Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.

  • 11.
    Hedman, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden..
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stridsman, Caroline
    Division of Nursing, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden..
    Bosson, Jenny A.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Pulmonary Medicine.
    Lundbäck, Magnus
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Ekerljung, Linda
    Krefting Research Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden..
    Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms2018In: JAMA Network Open, E-ISSN 2574-3805, Vol. 1, no 3, article id e180789Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE There is an ongoing debate about whether electronic cigarettes (e-cigarettes) are the solution to the tobacco epidemic or a new public health threat. Large representative studies are needed to study e-cigarette use in the general population, but hardly any have been published. OBJECTIVES To estimate the prevalence of e-cigarette use and to investigate the association of e-cigarette use with smoking habits, demographic factors, and respiratory symptoms. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional, population-based study of random samples of the population, performed within the Obstructive Lung Disease in Northern Sweden (OLIN) study and West Sweden Asthma Study (WSAS). The same validated questionnaire including identical questions was used in OLIN and WSAS. In 2016, OLIN and WSAS conducted postal questionnaire surveys in random samples of adults aged 20 to 75 years. In OLIN, 6519 participated (response rate, 56.4%); in WSAS, 23 753 participated (response rate, 50.1%). MAIN OUTCOMES AND MEASURES Electronic cigarette use, smoking habits, and respiratory symptoms. RESULTS Of 30 272 participants (16 325 women [53.9%]). 3897 (12.9%) were aged 20 to 29 years; 4242 (14.0%). 30 to 39 years; 5082 (16.8%). 40 to 49 years; 6052 (20.0%), 50 to 59 years; 6628 (21.9%), 60 to 69 years; and 4371(14.4%), 70 to 75 years. The number of current smokers was 3694 (12.3%), and 7305 (24.4%) were former smokers. The number of e-cigarette users was 529 (2.0%). and e-cigarette use was more common among men (275 of 12 347 [2.2%; 95% CI, 2.0%-2.5%]) than women (254 of 14 022 [1.8%; 95% CI, 1.6%-2.0%]). Among current smokers. 350 of 3566 (9.8%; 95% CI, 8.8%10.8%) used e-cigarettes compared with 79 of 6875 (1.1%; 95% CI, 0.9%-1.3%) in former smokers and 96 of 15 832 (0.6%; 95% CI, 0.5%-0.7%) in nonsmokers (P < .001). Among e-cigarette users who answered the survey question about cigarette-smoking habits (n = 525). 350 (66.7%; 95% CI, 62.7%-70.7%) were current smokers, 79 (15.0%; 95% CI, 11.9%-18.1%) were former smokers, and 96 (18.3%; 95% CI, 15.0%-21.6%) were nonsmokers (P < .001 for trend). In a regression analysis, e-cigarette use was associated with male sex (odds ratio [OR], 1.35; 95% CI. 1.12-1.62); age groups 20 to 29 years (OR. 2.77; 95% CI, 1.90-4.05), 30 to 39 years (OR, 2.27; 95% CI, 1.53-3.36), 40 to 49 years (OR, 1.65; 95% CI, 1.11-2.44). and 50 to 59 years (OR, 1.47; 95% CI, 1.01-2.12); educational level at primary school (OR, 1.99; 95% CI, 1.51-2.64) and upper secondary school (OR, 1.57; 95% CI, 1.25-1.96); former smoking (OR. 2.37; 95% CI, 1.73-3.24); and current smoking (OR. 18.10; 95% CI, 14.19-23.09). All respiratory symptoms were most common among dual users and former smokers and nonsmokers who used e-cigarettes. CONCLUSIONS AND RELEVANCE Use of e-cigarettes was most common among smokers, and dual users had the highest prevalence of respiratory symptoms. On a population level, this study indicates that the present use of e-cigarettes does not adequately serve as a smoking cessation tool.

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  • 12.
    Hedman, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland.
    Katsaounou, Paraskevi A.
    Filippidis, Filippos T.
    Ravara, Sofia B.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Janson, Christer
    Gratziou, Christina
    Rohde, Gernot
    Kyriakos, Christina N.
    Mons, Ute
    Fernandez, Esteve
    Trofor, Antigona C.
    Demjen, Tibor
    Przewozniak, Krzysztof
    Tountas, Yannis
    Fong, Geoffrey T.
    Vardavas, Constantine I.
    Glahn, Andrea
    Nguyen, Dominick
    Nikitara, Katerina
    Radu-Loghin, Cornel
    Starchenko, Polina
    Tsatsakis, Aristidis
    Girvalaki, Charis
    Igoumenaki, Chryssi
    Papadakis, Sophia
    Papathanasaki, Aikaterini
    Tzatzarakis, Manolis
    Vardavas, Alexander I.
    Becuwe, Nicolas
    Deaconu, Lavinia
    Goudet, Sophie
    Hanley, Christopher
    Riviere, Oscar
    Kiss, Judit
    Kovacs, Piroska A.
    Castellano, Yolanda
    Fu, Marcela
    Nogueira, Sarah O.
    Tigova, Olena
    McNeill, Ann
    East, Katherine
    Hitchman, Sara C.
    Kahnert, Sarah
    Behrakis, Panagiotis
    Katsaounou, Paraskevi
    Peleki, Theodosia
    Petroulia, Ioanna
    Tzavara, Chara
    Eremia, Marius
    Lotrean, Lucia
    Mihaltan, Florin
    Asano, Tamaki
    Cichon, Claudia
    Far, Amy
    Genton, Celine
    Jessner, Melanie
    Lindberg, Ann
    Maguire, Beth
    Ravara, Sofia
    Vaccaro, Valerie
    Ward, Brian
    Willemsen, Marc
    de Vries, Hein
    Hummel, Karin
    Nagelhout, Gera E.
    Zatonski, Witold A.
    Herbec, Aleksandra
    Janik-Koncewicz, Kinga
    Zatonski, Mateusz
    Agar, Thomas K.
    Driezen, Pete
    Gravely, Shannon
    Quah, Anne C. K.
    Thompson, Mary E.
    Receiving support to quit smoking and quit attempts among smokers with and without smoking related diseases: Findings from the EUREST-PLUS ITC Europe Surveys2018In: Tobacco Induced Diseases, E-ISSN 1617-9625, Vol. 16, article id A14Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION Having a chronic disease either caused or worsened by tobacco smoking does not always translate into quitting smoking. Although smoking cessation is one of the most cost-effective medical interventions, it remains poorly implemented in healthcare settings. The aim was to examine whether smokers with chronic and respiratory diseases were more likely to receive support to quit smoking by a healthcare provider or make a quit attempt than smokers without these diseases.

    METHODS This population-based study included a sample of 6011 adult smokers in six European countries. The participants were interviewed face-to-face and asked questions on sociodemographic characteristics, current diagnoses for chronic diseases, healthcare visits in the last 12 months and, if so, whether they had received any support to quit smoking. Questions on smoking behavior included nicotine dependence, motivation to quit smoking and quit attempts in the last 12 months. The results are presented as weighted percentages with 95% confidence intervals (CI) and as adjusted odds ratios with 95% CI based on logistic regression analyses.

    RESULTS Smokers with chronic respiratory disease, those aged 55 years and older, as well as those with one or more chronic diseases were more likely to receive smoking cessation advice from a healthcare professional. Making a quit attempt in the last year was related to younger age, high educational level, higher motivation to quit, lower nicotine dependence and having received advice to quit from a healthcare professional but not with having chronic diseases. There were significant differences between countries with smokers in Romania consistently reporting more support to quit as well as quit attempts.

    CONCLUSIONS Although smokers with respiratory disease did indeed receive smoking cessation support more often than smokers without disease, many smokers did not receive any advice or support to quit during a healthcare visit.

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  • 13.
    Hedman, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lyytinen, Gustaf
    Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
    Backman, Helena
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lundbäck, Magnus
    Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
    Stridsman, Caroline
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lindberg, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Kankaanranta, Hannu
    Krefting Research Center, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Rönnebjerg, Lina
    Krefting Research Center, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rönmark, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Ekerljung, Linda
    Krefting Research Center, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Electronic cigarette use in relation to changes in smoking status and respiratory symptoms2024In: Tobacco Induced Diseases, E-ISSN 1617-9625, Vol. 22, article id 21Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: How e-cigarette use relates to changes in smoking status and respiratory symptoms in the population remains controversial. The aim was to study the association between e-cigarette use and, changes in smoking status and changes in respiratory symptoms.

    METHODS: A prospective, population-based study of random samples of the population (age 16–69 years) was performed within The Obstructive Lung Disease in Northern Sweden (OLIN) study and West Sweden Asthma Study (WSAS). A validated postal questionnaire containing identical questions was used in OLIN and WSAS at baseline in 2006–2008 and at follow-up in 2016. In total, 17325 participated on both occasions. Questions about respiratory symptoms and tobacco smoking were included in both surveys, while e-cigarette use was added in 2016.

    RESULTS: In 2016, 1.6% used e-cigarettes, and it was significantly more common in persistent tobacco smokers (10.6%), than in those who quit smoking (2.1%), started smoking (7.8%), or had relapsed into tobacco smoking at follow-up (6.4%) (p<0.001). Among current smokers at baseline, tobacco smoking cessation was less common in e-cigarette users than e-cigarette non-users (14.2% vs 47.6%, p<0.001) and there was no association with a reduction in the number of tobacco cigarettes smoked per day. Those who were persistent smokers reported increasing respiratory symptoms. In contrast, the symptoms decreased among those who quit tobacco smoking, but there was no significant difference in respiratory symptoms between quitters with and without e-cigarette use.

    CONCLUSIONS: E-cigarette use was associated with persistent tobacco smoking and reporting respiratory symptoms. We found no association between e-cigarette use and tobacco smoking cessation, reduction of number of tobacco cigarettes smoked per day or reduction of respiratory symptoms.

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  • 14.
    Jemberie, Wossenseged Birhane
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Alcohol and aging: a multimethod study on heterogeneity and multidimensionality2023Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and Objectives: With an ageing population, the number of older persons with substance use problems, particularly problematic alcohol use, is increasing. Despite grow­ing recognition of the negative consequences of problematic alcohol use on older persons, there is a dearth of knowledge about the alcohol use profiles and the dimensionality of alcohol problems in older people. Moreover, little is known about older persons’ experi­ences and perspectives on alcohol use in relation to their ageing and their personal goals regarding treatment and recovery. This thesis aimed to (i) describe the characteristics of older persons who accessed municipal substance use treatment and care services (addic­tion services) and to investigate their future hospitalization; (ii) examine the heterogeneity and multidimensionality of problematic alcohol use among older persons; and (iii) to shed light on the experiences and perspectives of older persons regarding ageing, alcohol prob­lems and recovery.

    Methods: For studies I-III, municipal Addiction Severity Index (ASI) assessment data (between 2003 and 2017) from adults aged 50 years and older were used to select the study samples. Generalized linear regression models investigated hospitalization related out­comes among 3624 older persons in Study-I. In Study-II, a latent class analysis was applied on ASI data from 1747 individuals with alcohol problems. Study-III linked the ASI data from Study-II to hospital discharge and mortality data forming time-to-repeated-event dataset; Andersen-Gill regression model with a robust variance estimator was used for the analysis. Study-IV applied qualitative content analysis on interview data from ten older persons re­cruited from a specialist outpatient clinic for alcohol treatment. 

    Results: Nearly three-fourth of older persons assessed for substance use severity at municipal addiction services were later hospitalized (Study-I). Individuals diagnosed with substance use disorders, psychiatric or dual diagnoses had more cumulative hospitalized days, higher rates of hospital readmissions, and shorter time to first admission following an initial ASI assessment at municipal addiction services (Study-I). Five distinct groups of older persons with comparable alcohol problem severity but with variation in onset age, psychiatric comorbidities, polysubstance use, social support and gender composition were identified (Study-II). The five groups varied in risks of repeated hospitalizations due to substance use and psychiatric disorders (Study-III). Older persons experienced their ageing and alcohol use having a dynamic interplay (Study-IV). They needed to constantly negotiate with their environment to maintain a positive ageing trajectory. They perceived moderate alcohol use fosters healthy ageing, but over time, experienced their alcohol use as unsustainable and a threat to their pursuit of healthy ageing. Stigma and ambivalence delayed treatment seeking (Study-IV). They accessed treatment programs which re­spected their preferences and autonomy, engaged them in goal setting and strengthened their agency. After reducing their alcohol use, positive changes in their biopsychosocial functioning encouraged them to continue their recovery journey even in the presence of setbacks (Study-IV).

    Conclusion: Most older persons who access municipal addiction services are hospitalized repeatedly. Many older persons with alcohol problems live with medical and psychiatric comorbidities suggesting multiple care needs from health and social care services. Incor­porating older persons’ desire for healthy ageing into alcohol treatment plan can facilitate treatment engagement and recovery. Many older persons aim to moderate their alcohol consumption. Clinicians can deliver person-centered care for older persons, by consider­ing their heterogeneity in treatment goals, biopsychosocial functioning, and available re­sources. A multidimensional identification of alcohol use profiles could improve treatment by establishing the variation in alcohol problems among older treatment seekers. Older persons stay engaged in alcohol treatment programs which value their experiences and expertise, incorporate their personal treatment and life goals, respect their autonomy and agency, and involve them as active participants. Sensitizing service providers on old age substance use problems could provide multiple points of contact for screening of older persons and earlier referral to treatment. A streamlined data sharing within and between health and social care services fosters timely and equitable care and facilitates an inte­grated and person-centered care across the continuum. 

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  • 15.
    Jemberie, Wossenseged Birhane
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). SWEAH.
    Multiple indicators focusing on different alcohol-related domains should be used to describe alcohol use profiles among older patients2020In: popnadArticle in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Grouping older adults with alcohol use disorder as those with early versus late onset problem drinking does not capture the multiple intervention needs these patients present to service providers. We should instead use a range of indicators focusing on different alcohol-related domains to describe alcohol use profiles among older patients. This is the key finding of a recent study from Umeå University and the University of Denver, published in the Journal of Addiction Medicine.

  • 16.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Studying the trajectories and mediators of old-age problematic alcohol use and the agency of older persons2023Data set
    Abstract [en]

    Unit of analysis: Individual

    Population: Older people aged between 61 and 73 years who have sought treatment for alcohol at a specialist outpatient clinic in a metropolitan city in Sweden.

    Time Method: Cross-section

    Sampling procedure: Non-probability: Purposive

    The study participants were purposefully recruited from a specialist outpatient alcohol treatment clinic located in a Swedish metropolitan city. To be eligible for the study, participants had to be 55 years or older, had to self-report a history of problematic alcohol use and treatment for alcohol use after the age of 50. Individuals who were unable or unwilling to provide informed consent or participate in the interview via Zoom, Skype, or telephone were excluded from the study.

    Time period(s) investigated: 2021-12 – 2022-04

    Number of individuals/objects: 10

    Data format / data structure: Text

  • 17.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. The Cross-National Behavioral Health Laboratory; Graduate School of Social Work, University of Denver, Denver, Colorado.
    A Multidimensional Latent Class Analysis of Harmful Alcohol Use Among Older Adults: Subtypes Within the Swedish Addiction Severity Index Registry2020In: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227, Vol. 14, no 4, p. e89-e99Article in journal (Refereed)
    Abstract [en]

    Objectives: The present study aimed to identify multidimensional typologies of harmful alcohol use based on the Swedish Addiction Severity Index (ASI) assessment data on individuals aged 50 years and above.

    Methods: Latent class analysis examined 11 indicators from ASI data on 1747 individuals (men = 1255, women = 492) who reported they were troubled by alcohol problem at least one day in the past 30 days before their assessment. The discriminative validity of the classes was assessed by comparing other measures of individual characteristics and problem severity of other ASI dimensions.

    Results: Five subtypes of harmful alcohol use were identified. Two classes with alcohol problems varying in psychosocial functioning, age composition and ages of onset of both regular and heavy drinking. Two with psychiatric comorbidity but varying in violence, criminality, gender composition and ages of onset of regular and heavy drinking. One with high prevalence of concurrent use of other substances, psychiatric, legal, and employment problems.

    Conclusions: The analysis identified, in a national sample, heterogeneous risk groups of older adults with harmful alcohol use. These findings suggest a need for healthcare providers to assess older adults not only for their substance use but also for associated problems and needs. Given these findings, the Addiction Severity Index is a valuable assessment tool for older adults with harmful alcohol use.

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  • 18.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. Graduate School of Social Work, University of Denver, Denver, Colorado.
    Alcohol subtypes in older adults: A multidimensional Latent Class Analysis of harmful alcohol use among oder adults: Subtypes within the Swedish addiction severity index registry2019Conference paper (Other academic)
  • 19.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School for Competitive Science On Aging and Health (SWEAH), Faculty of Medicine, Lund University, Lund, Sweden.
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Hammarberg, Anders
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    "Ageing with an alcohol problem is not what I envision": reclaiming agency in shaping personal ageing trajectory and recovery from alcohol problems2023In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 23, article id 866Article in journal (Refereed)
    Abstract [en]

    Background: Eliciting and understanding older persons’ descriptions of their resources for healthy ageing and the interaction of these resources with alcohol use and alcohol problems can facilitate health promotion. It can also inform clinicians when identifying areas of recovery capital that present risks and strength for older people seeking alcohol treatment. The objective of this study was to illuminate the experiences and perspectives of older persons on ageing, alcohol use, treatment, and recovery from alcohol problems, as well as their understanding of healthy ageing.

    Methods: Eight men and two women, aged 61 to 73 years, with moderate drinking as a treatment goal and treated at an outpatient alcohol clinic in Sweden, participated in semi-structured audio-recorded virtual interviews. A qualitative content analysis examined the transcribed interviews.

    Results: Three themes were identified: “Tipping the balance”, “Staying behind a veil” and “Lifting the vail”. First, participants understood healthy ageing as a personal and multidimensional process that involved actively expanding, maintaining or adjusting to the resources needed to lead an active and meaningful life while preserving autonomy, dignity and independence for as long as possible. Second, most participants viewed moderate alcohol use as a contributor to healthy ageing. They sought treatment when their drinking became unsustainable and an immediate threat to their healthy ageing resources. Stigma, ambivalence and a lack of treatment options, however, contributed to delayed treatment. Third, the participants responded to treatment approaches that elicited their concern, incorporated their expertise and treatment and life goals, appreciated their autonomy and agency, and considered them partners in goal setting and decision making. Reduced drinking helped participants regain their agency and improved their healthy ageing capital which in turn catalyzed continuing recovery.

    Conclusions: Older persons in non-abstinent recovery perceive healthy ageing and alcohol recovery as personal and interacting multidimensional processes involving their agency to improve biopsychosocial functioning. Treatment approaches that recognize older persons’ desire for healthy ageing, incorporate their treatment goals and respect their autonomy are likely to be acceptable and effective.

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  • 20.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH), Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
    Stewart Williams, Jennifer
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Callaghan, NSW, Australia.
    Eriksson, Malin
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Grönlund, Ann-Sofie
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Ng, Nawi
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Blom Nilsson, Marcus
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Padyab, Mojgan
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Priest, Kelsey Caroline
    MD/PhD Program, School of Medicine, Oregon Health & Science University, Portland, OR, United States.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Snellman, Fredrik
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    McCarty, Dennis
    Oregon Health & Science University- Portland State University, School of Public Health, Portland, OR, United States.
    Lundgren, Lena M.
    Umeå University, Faculty of Social Sciences, Department of Social Work. Cross-National Behavioral Health Laboratory, Graduate School of Social Work, University of Denver, Denver, CO, United States.
    Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions2020In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 11, article id 714Article in journal (Refereed)
    Abstract [en]

    COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and well-being. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.

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  • 21.
    Johansson, Cecilia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Lind, Marcus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Eriksson, Marie
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health.
    Andersson, Jonas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Johansson, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Alcohol consumption and risk of incident atrial fibrillation: a population-based cohort study2020In: European journal of internal medicine, ISSN 0953-6205, E-ISSN 1879-0828, Vol. 76, p. 50-57Article in journal (Refereed)
    Abstract [en]

    AIMS: Atrial fibrillation (AF) is a common tachyarrhythmia. High alcohol consumption is associated with increased AF risk. It remains unclear whether lower levels of alcohol consumption are also associated with AF risk, and whether the association differs between men and women. In this study, we investigated the association between low to moderate levels of alcohol consumption and AF risk in men and women.

    METHODS: We performed a population-based cohort study of 109,230 health examination participants in northern Sweden. Data regarding alcohol intake were obtained using a questionnaire administered at the health examination. Incident AF cases were identified from the Swedish National Patient Registry.

    RESULTS: AF was diagnosed in 5,230 individuals during a total follow-up of 1,484,547 person-years. Among men, AF risk increased over quartiles of weekly alcohol consumption (P for trend 0.001). Men with alcohol consumption in the highest quartile (≥4.83 standard drinks [each drink containing 12 gs of ethanol] per week; SDW) had a HR of 1.21 (95% CI 1.09-1.34) for AF compared to men in the lowest quartile (<0.90 SDW). In men, problem drinking was also associated with an increased AF risk (HR: 1.24; 95% CI: 1.10-1.39). Among women, AF risk was not significantly associated with alcohol consumption (P for trend 0.09 for decreasing risk of AF over quartiles of weekly alcohol consumption) or problem drinking (HR: 1.00; 95% CI 0.70-1.42).

    CONCLUSION: Self-reported alcohol consumption and problem drinking were associated with an increased risk of AF among men, but not in women.

  • 22.
    Kakko, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Alho, Hannu
    Baldacchino, Alexander
    Molina, Rocio
    Nava, Felice Alfonso
    Shaya, Gabriel
    Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice2019In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 10, article id 592Article, review/survey (Refereed)
    Abstract [en]

    Opioid use disorder (OUD) is a major public health issue that has reached epidemic levels in some parts of the world. It is a chronic and complex neurobiological disease associated with frequent relapse to drug taking. Craving, defined as an overwhelmingly strong desire or need to use a drug, is a central component of OUD and other substance use disorders. In this review, we describe the neurobiological and neuroendocrine pathways that underpin craving in OUD and also focus on the importance of assessing and treating craving in clinical practice. Craving is strongly associated with patients returning to opioid misuse and is therefore an important treatment target to reduce the risk of relapse and improve patients' quality of life. Opioid agonist therapies (OAT), such as buprenorphine and methadone, can significantly reduce craving and relapse risk, and it is essential that patients are treated optimally with these therapies. There is also evidence to support the benefits of non-pharmacological approaches, such as cognitive behavioral therapy and mindfulness-based interventions, as supplementary treatments to opioid agonist therapies. However, despite the positive impact of these treatments on craving, many OUD patients continue to suffer with negative affect and dysphoria. There is a clear need for further studies to progress our understanding of the neurobiological basis of craving and addiction and to identify novel therapeutic strategies as well as to optimize the use of existing treatments to improve outcomes for the growing numbers of patients affected by OUD.

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  • 23.
    Kakko, Johan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Gedeon, Charlotte
    Sandell, Mikael
    Grelz, Henrik
    Birkemose, Inge
    Clausen, Thomas
    Runarsdottir, Valgerour
    Simojoki, Kaarlo
    Littlewood, Richard
    Alho, Hannu
    Nyberg, Fred
    Principles for managing OUD related to chronic pain in the Nordic countries based on a structured assessment of current practice2018In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 13, article id 22Article, review/survey (Refereed)
    Abstract [en]

    Background: Long-term use of opioid analgesics (OA) for chronic pain may result in opioid use disorder (OUD). This is associated with adverse outcomes for individuals, families and society. Treatment needs of people with OUD related to chronic pain are different compared to dependence related to use, and also injection, of illicit opioids. In Nordic countries, day-to-day practical advice to assist clinical decision-making is insufficient.

    Aim: To develop principles based on expert clinical insights for treatment of OUD related to the long-term use of OA in the context of chronic pain.

    Methods: Current status including an assessment of barriers to effective treatment in Finland, Denmark, Iceland, Norway, Sweden was defined using a patient pathway model. Evidence to describe best practice was identified from published literature, clinical guidelines and expert recommendations from practice experience.

    Results: Availability of national treatment guidelines for OUD related to chronic pain is limited across the Nordics. Important barriers to effective care identified: patients unlikely to present for help, healthcare system set up limits success, diagnosis tools not used, referral pathways unclear and treatment choices not elucidated. Principles include the development of a specific treatment pathway, awareness/education programs for teams in primary care, guidance on use of diagnostic tools and a flexible treatment plan to encourage best practice in referral, treatment assessment, choice and ongoing management via an integrated care pathway. Healthcare systems and registries in Nordic countries offer an opportunity to further research and identify population risks and solutions.

    Conclusions: There is an opportunity to improve outcomes for patients with OUD related to chronic pain by developing and introducing care pathways tailored to specific needs of the population.

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  • 24.
    Lakso, Hans-Åke
    et al.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Wuolikainen, Anna
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Sundkvist, Anneli
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Marklund, Stefan L.
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Long-term stability of the alcohol consumption biomarker phosphatidylethanol in erythrocytes at-80 degrees C2019In: Clinical Mass Spectrometry, ISSN 2213-8005, E-ISSN 2376-9998, Vol. 11, p. 37-41Article in journal (Refereed)
    Abstract [en]

    Phosphatidylethanol (PEth) is a recently introduced biomarker with high specificity, high sensitivity, and response correlating with alcohol consumption. It has the potential to be a valuable biomarker in population studies on the health effects of alcohol, however its stability in long-term stored blood is not known. We used LCMS/MS to assess the stability of PEth-16:0/18:1 in blood samples (packed erythrocytes) that were stored between 1 and 19 years at -80 degrees C in a biobank from a large population survey. The participants answered a lifestyle questionnaire that included questions on alcohol consumption. For analysis, we selected blood samples from seven homogenous ethanol consumption cohorts collected at intervals from 1997 to 2015. Despite the narrow stated alcohol consumption range, 10-15 g/day, there were large differences in PEth values between individuals in the cohorts, from below the limit of detection of 0.005 mu mol/L to 1.40 mu mol/L. The median was 0.08 mu mol/L. Neither generalized linear modeling, nor principal component analysis revealed a statistically significant association between time of storage and PEth levels. The PEth results indicate that the participants had, on average, under-reported their alcohol consumption several-fold. The findings suggest that PEth in blood has a sufficient long-term stability for use as an alcohol biomarker in prospective case-control studies. Analysis of blood stored in biobanks could significantly improve the validity of assessments exploring the health effects of alcohol.

  • 25. Larsson, Gerhard
    et al.
    Wiklund, Hans
    Jacobson, Dina
    Jacobson, Leif
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Socialdepartementet.
    Grönwall, Lars
    Bättre insatser vid missbruk och beroende: individen, kunskapen och ansvaret : slutbetänkande2011Book (Refereed)
  • 26. Larsson, Gerhard
    et al.
    Wiklund, HansSandlund, MikaelUmeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Missbruket, kunskapen och vården: missbruksutredningens forskningsbilaga : delbetänkande2011Collection (editor) (Refereed)
  • 27.
    Lindner, Stephan R.
    et al.
    Center for Health Systems Effectiveness (CHSE), Oregon Health & Science University, Portland, USA.
    Scarpa, Simone
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    McCarty, Dennis
    OHSU-PSU School of Public Health, Portland, USA.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. Cross-National Behavioral Health Laboratory, University of Denver, Denver, USA.
    Addiction severity and re-employment in Sweden among adults with risky alcohol and drug use2023In: Journal of Substance Use and Addiction Treatment, ISSN 2949-8767Article in journal (Refereed)
    Abstract [en]

    Background: The Addiction Severity Index (ASI) assesses respondents' biopsychosocial problems in seven addiction-related domains (mental health, family and social relations, employment, alcohol use, drug use, physical health, and legal problems). This study examined the association between the seven ASI composite scores and re-employment in a sample of Swedish adults screened for risky alcohol and drug use who were without employment at assessment.

    Methods: We conducted a retrospective cohort analysis of employment outcomes among 6502 unemployed adults living in Sweden who completed an ASI assessment for risky alcohol and drug use. The study linked ASI scores to annual tax register data. The primary outcome was employment, defined as having earnings above an administrative threshold. We used Cox proportional hazard models to estimate the association between time to re-employment and ASI composite scores, controlling for demographic characteristics.

    Results: Approximately three in ten individuals in the sample regained employment within five years. ASI composite scores suggested widespread biopsychosocial problems. Re-employment was associated with lower ASI composite scores for mental health (estimate: 0.775, 95 % confidence interval: 0.629–0.956), employment (estimate: 0.669, confidence interval: 0.532–0.841), drug use (estimate: 0.628, confidence interval: 0.428–0.924), and health (estimate: 0.798, confidence interval: 0.699–0.912).

    Conclusions: This study suggests that several ASI domains may provide information on the complex factors (i.e., mental health, health, drug use) associated with long-term unemployment for people with risky substance use.

  • 28.
    Lundgren, Lena
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Brännström, Jan
    Armelius, Bengt-Åke
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Chassler, Deborah
    Morén, Stefan
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Trocchio, Sarah
    Association between immigrant status and history of compulsory treatment in a national sample of individuals assessed for drug use disorders through the swedish public welfare system2012In: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 47, no 1, p. 67-77Article in journal (Refereed)
    Abstract [en]

    In-person interview data from 13,903 individuals assessed for a drug use disorder in the Swedish welfare system from 2002-2008, were analyzed using logistic regression methods. Second generation immigrants with non-Scandinavian parents were 41% more likely to report a history of compulsory treatment compared to those born in Sweden to Swedish parents after controlling for age, gender, education, mental health treatment homeless status history, and criminal justice history. Implications include the need to study acculturation, stigma, and discrimination-related factors as well as to promote culturally competent outreach to immigrant populations.

  • 29.
    Lundgren, Lena
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work. University of Denver Graduate School of Social Work, USA.
    Jemberie, Wossenseged Birhane
    Umeå University, Faculty of Social Sciences, Department of Social Work. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). The Swedish National Graduate School for Competitive Science on Ageing and Health (SWEAH), Faculty of Medicine, Lund University, Sweden.
    McCarty, Dennis
    OHSU-PSU School of Public Health, Oregon Health & Science University, USA.
    Introduction to a Special Issue: Care and treatment for substance use disorders: Studies from around the world2022In: Journal of Substance Abuse Treatment, ISSN 0740-5472, E-ISSN 1873-6483, Vol. 134, article id 108620Article in journal (Other academic)
  • 30.
    Lundgren, Lena
    et al.
    Boston University School of Social Work Center for Addictions Research and Services.
    Wilkey, Catriona
    Boston University School of Social Work Center for Addictions Research and Services.
    Chassler, Deborah
    Boston University School of Social Work Center for Addictions Research and Services.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Armelius, Bengt-Åke
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Armelius, Kerstin
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Brännström, Jan
    Integrating addiction and mental health treatment within a national addiction treatment system: Using multiple statistical methods to analyze client and interviewer assessment of co-occurring mental health problems2014In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, no 1, p. 59-79Article in journal (Refereed)
    Abstract [en]

    AIMS - For a Swedish national sample of 12,833 individuals assessed for a substance use disorder (SUD) (2002-2008) in the Swedish welfare system, client self-report and clinical staff Addiction Severity Index (ASI) assessment data were used to assess mental health problem severity and needs. METHODS - Analysis of client self-report data using regression methods identified demographic characteristics associated with reporting significant mental health problems. Clinical staff assessment data from the ASI Interviewer Severity Rating (ISR) score were used to develop a K-means cluster analysis with three client cluster profiles: Narcotics (n=4795); Alcohol (n=4380); and Alcohol and Psychiatric Problems (n=3658). Chi-square and one-way ANOVA analyses identified self-reported mental health problems for these clusters. RESULTS - 44% of clients had a history of using outpatient mental health treatment, 45% reported current mental health symptoms, and 19% reported significant mental health problems. Women were 1.6 times more likely to report significant mental health problems than men. Staff assessed that 74.8% of clients had current mental health problems and that 13.9% had significant mental health problems. Client and staff results were congruent in identifying that clients in the Alcohol profile were less likely (5%) to report having significant mental health problems compared to the other two profiles (30% each). CONCLUSIONS - About 19% of clients with SUDs reported significant mental health problems, need integrated addiction and mental health treatment, and these clients are clustered in two population groups. An additional 25% of the addiction treatment population report current mental health symptoms and have at some point used mental health treatment. This national level assessment of the extent and severity of co-occurring disorders can inform decisions made regarding policy shifts towards an integrated system and the needs of clients with co-occurring disorders.

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  • 31.
    Luoto, Kaisa E.
    et al.
    Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland; Department of Psychiatry, Seinäjoki Central Hospital, The Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland.
    Lassila, Antero
    Department of Psychiatry, Seinäjoki Central Hospital, The Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland.
    Leinonen, Esa
    Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland.
    Kampman, Olli
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland; Department of Clinical Medicine (Psychiatry), Faculty of Medicine, University of Turku, Turku, Finland; Department of Psychiatry, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland.
    Predictors of short-term response and the role of heavy alcohol use in treatment of depression2023In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 880Article in journal (Refereed)
    Abstract [en]

    Background: Depression and alcohol use disorders frequently co-occur. However, research on psychosocial interventions for treating this dual pathology is limited. The Ostrobothnian Depression Study (ODS) aimed to increase the systematic use of evidence-based methods, particularly among patients with comorbid depression and substance use in a naturalistic setting. This is a secondary analysis of the ODS study. The aim of the present study was to explore the predictors of a response to treatment during the first six months of the ODS intervention with a specific focus on the role of comorbid heavy alcohol use.

    Methods: The study sample (n = 242) comprised psychiatric specialist care patients with depression (Beck Depression Inventory score ≥ 17) at baseline. Patients with a baseline Alcohol Use Disorders Identification Test (AUDIT) score > 10 (n = 99) were assigned to the AUD (Alcohol Use Disorder) group in this study. The ODS intervention comprised behavioral activation (BA) for all and additional motivational interviewing (MI) for those in AUD group. The predictors of response to treatment (minimum of 50% reduction in depressive symptoms) during the first six months were analyzed with logistic regression models.

    Results: In the total sample at six months (n = 150), predictors of response to treatment were more severe depression (OR 1.10, CI 1.02–1.18), larger amounts of alcohol consumed (OR = 1.16, CI 1.03–1.31) and antipsychotic medication "not in use" (OR = 0.17, CI 0.07–0.44). In the non-AUD group (n = 100), more severe depression (OR 1.12, CI 1.01–1.25) and antipsychotics "not in use" (OR 0.20, CI 0.06–0.67) also predicted a positive response. Among AUD group patients (n = 50), larger amounts of alcohol consumed (OR 1.54, CI 1.04–2.27) and antipsychotic medication "not in use" (OR 0.12, CI 0.02–0.60) predicted a response to the treatment intervention.

    Conclusions: The severity of symptoms and comorbid disorders were found to predict better treatment response, suggesting that the intervention was more effective in patients with severe symptoms. Patients with depression should be treated effectively regardless of having concomitant AUD. The results of this study suggest that BA combined with MI should be one of the treatment options for this dual pathology.

    Trial registration: ClinicalTrials.gov Identifier NCT02520271 (11/08/2015).

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  • 32.
    Mazumder, Atiqul Haq
    et al.
    Department of Psychiatry, University of Oulu, Oulu, Finland.
    Barnett, Jennifer
    Cambridge Cognition, University of Cambridge, Cambridge, United Kingdom.
    Lindberg, Nina
    Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Torniainen-Holm, Minna
    Mental Health Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Lähteenvuo, Markku
    Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
    Lahdensuo, Kaisla
    Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
    Kerkelä, Martta
    Department of Psychiatry, University of Oulu, Oulu, Finland.
    Hietala, Jarmo
    Department of Psychiatry, University of Turku, Turku, Finland; Department of Psychiatry, Turku University Hospital, Turku, Finland.
    Isometsä, Erkki Tapio
    Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
    Kampman, Olli
    Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Psychiatry, Pirkanmaa Hospital District, Tampere, Finland.
    Kieseppä, Tuula
    Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
    Jukuri, Tuomas
    Department of Psychiatry, University of Oulu, Oulu, Finland; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
    Häkkinen, Katja
    Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
    Cederlöf, Erik
    Mental Health Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Haaki, Willehard
    Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland; Department of Psychiatry, University of Turku, Turku, Finland.
    Kajanne, Risto
    Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
    Wegelius, Asko
    Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Mental Health Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland.
    Männynsalo, Teemu
    Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland; Social Services and Health Care Sector, Helsinki, Finland.
    Niemi-Pynttäri, Jussi
    Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland; Social Services and Health Care Sector, Helsinki, Finland.
    Suokas, Kimmo
    Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
    Lönnqvist, Jouko
    Mental Health Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Department of Psychiatry, University of Helsinki, Helsinki, Finland.
    Niemelä, Solja
    Department of Psychiatry, University of Turku, Turku, Finland; Department of Psychiatry, Turku University Hospital, Turku, Finland.
    Tiihonen, Jari
    Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden.
    Paunio, Tiina
    Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Mental Health Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; Department of Psychiatry, University of Helsinki, Helsinki, Finland.
    Palotie, Aarno
    Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland; Stanley Center for Psychiatric Research, The Broad Institute of MIT (Massachusetts Institute of Technology) and Harvard, MA, Cambridge, United States; Analytical and Translational Genetics Unit, Massachusetts General Hospital, MA, Boston, United States.
    Suvisaari, Jaana
    Mental Health Unit, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
    Veijola, Juha
    Department of Psychiatry, University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland.
    Reaction time and visual memory in connection with alcohol use in schizophrenia and schizoaffective disorder2021In: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 11, no 6, article id 688Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to explore the association between cognition and hazardous drinking and alcohol use disorder in schizophrenia and schizoaffective disorder. Cognition is more or less compromised in schizophrenia, and schizoaffective disorder and alcohol use might aggravate this phenomenon. The study population included 3362 individuals from Finland with diagnoses of schizophrenia or schizoaffective disorder. Hazardous drinking was screened with the AUDIT-C (Alcohol Use Disorders Identification Test for Consumption) screening tool. Alcohol use disorder (AUD) diagnoses were obtained from national registrar data. Participants performed two computerized tasks from the Cambridge Automated Neuropsychological Test Battery (CANTAB) on a tablet computer: The Five-Choice Serial Reaction Time Task (5-CSRTT) or the reaction time (RT) test and the Paired Associative Learning (PAL) test. The association between alcohol use and the RT and PAL tests was analyzed with log-linear regression and logistic regression, respectively. After adjustment for age, education, housing status, and the age at which the respondents had their first psychotic episodes, hazardous drinking was associated with a lower median RT in females and less variable RT in males, while AUD was associated with a poorer PAL test performance in terms of the total errors adjusted scores (TEASs) in females. Our findings of positive associations between alcohol and cognition in schizophrenia and schizoaffective disorder are unique.

  • 33.
    Nicoll, Rachel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Henein, Michael Y
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Alcohol and the heart2011In: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 35, no 10, p. 1737-1738Article in journal (Refereed)
    Abstract [en]

    Alcohol consumption and disease or mortality display a J-shaped curve, with moderate amounts of alcohol being more protective than abstention, binge drinking, or heavy drinking. Red wine appears to be particularly protective for cardiovascular disease and associated conditions such as type 2 diabetes. There are, however, controversies concerning the effect of red wine on hypertension, in which there may be significant gender and ethnic differences. Overall, it seems that both ethanol and the polyphenols in red wine may contribute to the protective effect.

  • 34.
    Ort, Christoph
    et al.
    Swiss Fed Inst Aquat Sci andTechnol Eawag, Dubendorf, Switzerland.
    van Nuijs, Alexander L. N.
    Univ Antwerp, Toxicol Ctr, B-2610 Antwerp, Belgium.
    Berset, Jean-Daniel
    Water & Soil Protect Lab, Bern, Switzerland.
    Bijlsma, Lubertus
    Univ Jaume 1, Res Inst Pesticides & Water, Castellon De La Plana, Spain.
    Castiglioni, Sara
    IRCCS Ist Ric Farmacol Mario Negri, Dept Environm Hlth Sci, Milan, Italy.
    Covaci, Adrian
    Univ Antwerp, Toxicol Ctr, B-2610 Antwerp, Belgium.
    de Voogt, Pim
    KWR Watercycle Res Inst, Nieuwegein, Netherlands. Univ Amsterdam, Inst Biodivers & Ecosyst Dynam, Amsterdam, Netherlands.
    Emke, Erik
    KWR Watercycle Res Inst, Nieuwegein, Netherlands.
    Fatta-Kassinos, Despo
    Univ Cyprus, NIREAS Int Res Ctr, Nicosia, Cyprus.
    Griffiths, Paul
    European Monitoring Ctr Drugs & Drug Addict, Lisbon, Portugal.
    Hernandez, Felix
    Univ Jaume 1, Res Inst Pesticides & Water, Castellon De La Plana, Spain.
    Gonzalez-Marino, Iria
    Univ Santiago de Compostela, IIAA Inst Food Anal & Res, Santiago De Compostela, Spain.
    Grabic, Roman
    Univ South Bohemia Ceske Budejovice, South Bohemian Res Ctr Aquaculture & Biodivers Hy, Fac Fisheries & Protect Waters, Vodnany, Czech Republic.
    Kasprzyk-Hordern, Barbara
    Univ Bath, Dept Chem, Bath BA2 7AY, Avon, England.
    Mastroianni, Nicola
    IDAEA CSIC, Dept Environm Chem, Water & Soil Qual Res Grp, Barcelona, Spain.
    Meierjohann, Axel
    Abo Akad Univ, Organ Chem Lab, Turku, Finland.
    Nefau, Thomas
    Univ Paris Sud, Lab Sante Publ Environm, Chatenay Malabry, France.
    Östman, Marcus
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Pico, Yolanda
    Univ Valencia, Food & Environm Safety Res Grp, Valencia, Spain.
    Racamonde, Ines
    Univ Santiago de Compostela, IIAA Inst Food Anal & Res, Santiago De Compostela, Spain.
    Reid, Malcolm
    Norwegian Inst Water Res NIVA, Oslo, Norway.
    Slobodnik, Jaroslav
    Inst Environm, Kos, Slovakia.
    Terzic, Senka
    Rudjer Boskov Inst Bijenicka, Div Marine & Environm Res, Zagreb, Croatia.
    Thomaidis, Nikolaos
    Univ Athens, Dept Chem, Analyt Chem Lab, GR-10680 Athens, Greece.
    Thomas, Kevin V.
    Norwegian Inst Water Res NIVA, Oslo, Norway.
    Spatial differences and temporal changes in illicit drug use in Europe quantified by wastewater analysis2014In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 109, no 8, p. 1338-1352Article in journal (Refereed)
    Abstract [en]

    Aims To perform wastewater analyses to assess spatial differences and temporal changes of illicit drug use in a large European population. Design Analyses of raw wastewater over a 1-week period in 2012 and 2013. Setting and Participants Catchment areas of wastewater treatment plants (WWTPs) across Europe, as follows: 2012: 25 WWTPs in 11 countries (23 cities, total population 11.50 million); 2013: 47 WWTPs in 21 countries (42 cities, total population 24.74 million). Measurements Excretion products of five illicit drugs (cocaine, amphetamine, ecstasy, methamphetamine, cannabis) were quantified in wastewater samples using methods based on liquid chromatography coupled to mass spectrometry. Findings Spatial differences were assessed and confirmed to vary greatly across European metropolitan areas. In general, results were in agreement with traditional surveillance data, where available. While temporal changes were substantial in individual cities and years (P ranging from insignificant to <10(-3)), overall means were relatively stable. The overall mean of methamphetamine was an exception (apparent decline in 2012), as it was influenced mainly by four cities. Conclusions Wastewater analysis performed across Europe provides complementary evidence on illicit drug consumption and generally concurs with traditional surveillance data. Wastewater analysis can measure total illicit drug use more quickly and regularly than is the current norm for national surveys, and creates estimates where such data does not exist.

  • 35.
    Persson, Anna
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; The Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
    Lindmark, Sofia
    The Stockholm Centre for Dependency Disorders, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Petersson, Kerstin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Gabriel, Erin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Thorsell, Malin
    Division of Obstetrics and Gynecology, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Lindström, Karolina
    Pediatric Public Health Department in Stockholm County, Sweden.
    Göransson, Mona
    MG Psykoterapi AB, Stockholm, Sweden.
    Cardell, Gunilla
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Magnusson, Åsa
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; The Stockholm Centre for Dependency Disorders, Stockholm, Sweden.
    Alcohol and illicit and non-medical prescription drug use before and during pregnancy in Stockholm, Sweden: A cross-sectional study2021In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 29, article id 100622Article in journal (Refereed)
    Abstract [en]

    Objectives: To provide current estimates of alcohol and drug use among pregnant women attending antenatal care lectures in preparation for childbirth in Stockholm, Sweden.

    Study design: A cross-sectional study. Data was collected anonymously among women attending lectures in preparation for childbirth.

    Main outcome measures: The prevalence of alcohol and illicit and non-medical prescription drug use among pregnant women attending antenatal care lectures in preparation for childbirth.

    Results: Nine hundred and thirty-six pregnant women attending lectures in preparation for childbirth participated. Among those answering all questions about alcohol use during pregnancy, 4.2 percent reported use (95% confidence interval (CI), 3.0–5.7%) and among those answering all questions about illicit or non-medical prescription drug use during pregnancy, 0.5 percent reported such use (95% CI, 0.1–1.3%). The prevalences of binge drinking during pregnancy and alcohol and drug use before pregnancy are presented. Comparisons of anonymously and non-anonymously collected data are included.

    Conclusions: Approximately one in 25 women reported using alcohol and approximately one in 200 reported using illicit or non-medical prescription drugs while pregnant. Alcohol use during pregnancy may have decreased in Stockholm, Sweden.

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  • 36.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Further education for staff in drug abuse treatment: a realistic approach2012In: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 29, no 3, p. 267-268Article in journal (Refereed)
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  • 37.
    Scarpa, Simone
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Grahn, Robert
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Lundgren, Lena
    Umeå University, Faculty of Social Sciences, Department of Social Work. University of Denver, Denver, CO, United States.
    Compulsory care of individuals with severe substance use disorders and alcohol- and drug-related mortality: a Swedish registry study2023In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 14, article id 1106509Article in journal (Refereed)
    Abstract [en]

    Aim: This study used 17 year of Swedish registry data (2003–2019) for 25,125 adults assessed for their severity of substance use to identify the baseline factors predicting the risk of being court-ordered into compulsory care and examine the association between admission to compulsory care and mortality risks due to alcohol- or drug-related causes.

    Methods and materials: Addiction Severity Index (ASI) assessment data were linked to register data on demographic characteristics, compulsory care, and alcohol- and drug-related mortality. Cox regression models were used to identify baseline factors predictive of post-assessment admission to compulsory care in the 5 years post-substance use assessment. Discrete-time random-effect logistic regression models were used to examine the association between compulsory care duration and alcohol or drug-related mortality risks. Propensity score matching was used for validation.

    Results: The first models identified that younger age, female gender, and ASI composite scores for drug use, mental health and employment were significantly associated with the risk of placement in compulsory care for drugs other than alcohol. Female gender and ASI composite scores for alcohol, drug use and employment were significantly associated with compulsory care treatment for alcohol use. The second models showed that older individuals and men were more likely to die due to alcohol-related causes, while younger individuals and men were more likely to die due to drug-related causes. Length of stay in compulsory care institutions significantly increased the likelihood of dying due to substance use-related causes. Propensity scores analyses confirmed the results.

    Conclusion: In Sweden, a significant concern is the higher likelihood of women and young individuals to be court-ordered to compulsory care. Although compulsory care is often advocated as a life-saving intervention, our findings do not provide strong support for this claim. On the contrary, our findings show that admission to compulsory care is associated with a higher risk of substance use-related mortality. Factors such as compulsory care often not including any medical or psychological therapy, together with relapse and overdose after discharge, may be possible contributing factors to these findings.

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  • 38.
    Walde, Jonatan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Region Västerbotten, Umeå, Sweden.
    Andersson, Lisa
    Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden.
    Johnson, Björn
    Faculty of Health and Society, Department of Social Work, Malmö University, Malmö, Sweden; Lund University, School of Social Work, Lund, Sweden.
    Håkansson, Anders
    Department of Clinical Sciences Lund, Lund University, Psychiatry, Lund, Sweden; Malmö Addiction Center, Region Skåne, Malmö, Sweden.
    Drug prescriptions preceding opioid-related deaths: a register study in forensic autopsy patients2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 5, article id e0285583Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/AIM: Opioid overdose deaths have increased in Sweden and other developed countries in recent decades, despite increased treatment efforts and harm-reduction interventions. Further knowledge in this field is needed if this trend is to be reversed. Previous research suggests that mental health and patterns of prescription of opioids and other prescription drugs are associated with increased opioid-related mortality. The present study therefore aimed to investigate what drugs were prescribed during the last six months of life to individuals with a history of illicit substance use who died with opioids present in their blood, the relationship between drugs prescribed and drugs found in blood at time of death, and if prescription of specific drugs was temporally associated with death.

    METHODS: This was a retrospective, register-based observational study that utilized data from the National Board of Forensic Medicine, the Prescribed Drug Registry, regional health care services, and municipal social services. We used conditional logistic regression to find temporal associations between the prescription and dispensing of drugs and time of death.

    RESULTS: Prescription and dispensing of alprazolam and diazepam were temporally associated with death. The most frequently dispensed drugs were zopiclone, pregabalin, methylphenidate, diazepam and oxycodone. Methadone, alprazolam, and buprenorphine were the drugs most often found in the blood. Opioids and tranquilizers in combination were found in a vast majority of deaths, and prescription data suggested that the use of these drugs was illicit in a majority of cases.

    CONCLUSION: Prescription of certain drugs, especially alprazolam and diazepam, should be made with great caution to patients with a history of illicit substance use or concurrent use of opioids.

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  • 39.
    Welfordsson, Paul
    et al.
    Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
    Danielsson, Anna-Karin
    Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
    Björck, Caroline
    Department of Women’s and Children’s Health, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Region Gävleborg, Gävle, Sweden.
    Grzymala-Lubanski, Bartosz
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Centre for Research and Development, Region Gävleborg, Gävle, Sweden.
    Lidin, Matthias
    Department of Medicine, Unit of Cardiology, Karolinska Institutet, Solna, Stockholm, Sweden; Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden.
    Löfman, Ida Haugen
    Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Unit of Cardiology, Karolinska Institutet, Huddinge, Stockholm, Sweden.
    Finn, Sara Wallhed
    Department of Global Public Health, Karolinska Institutet, Solna, Sweden; Unit of Clinical Alcohol Research, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Centre for Dependency Disorders, Stockholm, Sweden.
    Mixed messages? Exposure to reports about alcohol’s suggested cardiovascular effects and hazardous alcohol use: a cross-sectional study of patients in cardiology care2024In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, no 1, article id 1302Article in journal (Refereed)
    Abstract [en]

    Background: Hazardous alcohol use is a leading risk factor for disability and death, yet observational studies have also reported reduced cardiovascular disease mortality among regular, low-level drinkers. Such findings are refuted by more recent research, yet have received significant media coverage. We aimed to explore: (1) how patients with cardiovascular diseases access health information about moderate drinking and cardiovascular health; (2) the perceived messages these sources convey, and (3) associations with own level of alcohol use.

    Methods: We conducted a cross-sectional survey of patients in cardiology services at three hospitals in Sweden. The study outcome was hazardous alcohol use, assessed using the AUDIT-C questionnaire and defined as ≥ 3 in women and ≥ 4 in men. The exposure was accessing information sources suggesting that moderate alcohol consumption can be good for the heart, as opposed to accessing information that alcohol is bad for the heart. Health information sources were described using descriptive statistics. Gender, age and education were adjusted for in multiple logistic regression analyses.

    Results: A total of 330 (66.3%) of 498 patients (mean age 70.5 years, 65% males) who had heard that drinking moderately can affect the heart described being exposed to reports that moderate alcohol use can be good for the heart, and 108 (21.7%) met criteria for hazardous alcohol use. Health information sources included newspapers (32.9%), television (29.2%), healthcare staff (13.4%), friends/family (11.8%), social media (8.9%) and websites (3.7%). Participants indicated that most reports (77.9%) conveyed mixed messages about the cardiovascular effects of moderate drinking. Exposure to reports of healthy heart effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use (OR = 1.67, 95%CI = 1.02–2.74).

    Conclusions: This study suggests that many patients in cardiology care access health information about alcohol from media sources, which convey mixed messages about the cardiovascular effects of alcohol. Exposure to reports that moderate drinking has protective cardiovascular effects, or mixed messages about the cardiovascular effects of alcohol, was associated with increased odds of hazardous alcohol use. Findings highlight a need for clear and consistent messages about the health effects of alcohol.

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  • 40. Wood, Angela M.
    et al.
    Kaptoge, Stephen
    Butterworth, Adam S.
    Willeit, Peter
    Warnakula, Samantha
    Bolton, Thomas
    Paige, Ellie
    Paul, Dirk S.
    Sweeting, Michael
    Burgess, Stephen
    Bell, Steven
    Astle, William
    Stevens, David
    Koulman, Albert
    Selmer, Randi M.
    Verschuren, W. M. Monique
    Sato, Shinichi
    Njolstad, Inger
    Woodward, Mark
    Salomaa, Veikko
    Nordestgaard, Borge G.
    Yeap, Bu B.
    Fletcher, Astrid
    Melander, Olle
    Kuller, Lewis H.
    Balkau, Beverley
    Marmot, Michael
    Koenig, Wolfgang
    Casiglia, Edoardo
    Cooper, Cyrus
    Arndt, Volker
    Franco, Oscar H.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gallacher, John
    de la Camara, Agustin Gomez
    Volzke, Henry
    Dahm, Christina C.
    Dale, Caroline E.
    Bergmann, Manuela M.
    Crespo, Carlos J.
    van der Schouw, Yvonne T.
    Kaaks, Rudolf
    Simons, Leon A.
    Lagiou, Pagona
    Schoufour, Josje D.
    Boer, Jolanda M. A.
    Key, Timothy J.
    Rodriguez, Beatriz
    Moreno-Iribas, Conchi
    Davidson, Karina W.
    Taylor, James O.
    Sacerdote, Carlotta
    Wallace, Robert B.
    Quiros, J. Ramon
    Tumino, Rosario
    Blazer, Dan G., II
    Linneberg, Allan
    Daimon, Makoto
    Panico, Salvatore
    Howard, Barbara
    Skeie, Guri
    Strandberg, Timo
    Weiderpass, Elisabete
    Nietert, Paul J.
    Psaty, Bruce M.
    Kromhout, Daan
    Salamanca-Fernandez, Elena
    Kiechl, Stefan
    Krumholz, Harlan M.
    Grioni, Sara
    Palli, Domenico
    Huerta, Jose M.
    Price, Jackie
    Sundstrom, Johan
    Arriola, Larraitz
    Arima, Hisatomi
    Travis, Ruth C.
    Panagiotakos, Demosthenes B.
    Karakatsani, Anna
    Trichopoulou, Antonia
    Kuhn, Tilman
    Grobbee, Diederick E.
    Barrett-Connor, Elizabeth
    van Schoor, Natasja
    Boeing, Heiner
    Overvad, Kim
    Kauhanen, Jussi
    Wareham, Nick
    Langenberg, Claudia
    Forouhi, Nita
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Despres, Jean-Pierre
    Cushman, Mary
    Cooper, Jackie A.
    Rodriguez, Carlos J.
    Sakurai, Masaru
    Shaw, Jonathan E.
    Knuiman, Matthew
    Voortman, Trudy
    Meisinger, Christa
    Tjonneland, Anne
    Brenner, Hermann
    Palmieri, Luigi
    Dallongeville, Jean
    Brunner, Eric J.
    Assmann, Gerd
    Trevisan, Maurizio
    Gillum, Richard F.
    Ford, Ian
    Sattar, Naveed
    Lazo, Mariana
    Thompson, Simon G.
    Ferrari, Pietro
    Leon, David A.
    Smith, George Davey
    Peto, Richard
    Jackson, Rod
    Banks, Emily
    Di Angelantonio, Emanuele
    Danesh, John
    Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies2018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 391, no 10129, p. 1513-1523Article in journal (Refereed)
    Abstract [en]

    Background: Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease.

    Methods: We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12.5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5.6 years [5th-95th percentile 1.04-13.5]) from 71 011 participants from 37 studies.

    Findings: In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5.4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1.14, 95% CI, 1.10-1.17), coronary disease excluding myocardial infarction (1.06, 1.00-1.11), heart failure (1.09, 1.03-1.15), fatal hypertensive disease (1.24, 1.15-1.33); and fatal aortic aneurysm (1.15, 1.03-1.28). By contrast, increased alcohol consumption was loglinearly associated with a lower risk of myocardial infarction (HR 0.94, 0.91-0.97). In comparison to those who reported drinking >0-<= 100 g per week, those who reported drinking >100-<= 200 g per week, >200-<= 350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively.

    Interpretation: In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines.

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