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  • 1.
    Ahlm, Kristin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
    Saveman, Britt-Inger
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Björnstig, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Drowning deaths in Sweden with emphasis on the presence of alcohol and drugs: a retrospective study, 1992-20092013Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, s. 216-Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 2. Bramness, Jorgen G.
    et al.
    Henriksen, Beate
    Persson, Olle
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    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 2001-20112014Inngår i: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 20, nr 1, s. 16-22Artikkel i tidsskrift (Fagfellevurdert)
    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

  • 3. Bramness, Jørgen G.
    et al.
    Henriksen, Beate
    Person, Olle
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Mann, Karl
    Bibliographic searches for a bibliometric analysis on drug addiction reply2015Inngår i: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 21, nr 1, s. 32-32Artikkel i tidsskrift (Fagfellevurdert)
  • 4. Gedeon, Charlotte
    et al.
    Sandell, Mikael
    Birkemose, Inge
    Kakko, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Runarsdottir, Valgerdur
    Simojoki, Kaarlo
    Clausen, Thomas
    Nyberg, Fred
    Littlewood, Richard
    Alho, Hannu
    Standards for opioid use disorder care: An assessment of Nordic approaches2019Inngår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 36, nr 3, s. 286-298Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 5.
    Grahn, Robert
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 study2014Inngår i: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 49, nr 13, s. 1764-1773Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 6.
    Hedman, Linnea
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Backman, Helena
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Stridsman, Caroline
    Bosson, Jenny A.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Lundbäck, Magnus
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönmark, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Ekerljung, Linda
    Association of Electronic Cigarette Use With Smoking Habits, Demographic Factors, and Respiratory Symptoms2018Inngår i: JAMA NETWORK OPEN, ISSN 2574-3805, Vol. 1, nr 3, artikkel-id e180789Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 7.
    Hedman, Linnea
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa. The Tobacco Control Committee of the European Respiratory Society, Lausanne, Switzerland.
    Katsaounou, Paraskevi A.
    Filippidis, Filippos T.
    Ravara, Sofia B.
    Lindberg, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    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 Surveys2018Inngår i: Tobacco Induced Diseases, ISSN 1617-9625, E-ISSN 1617-9625, Vol. 16, artikkel-id A14Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 8.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Padyab, Mojgan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Snellman, Fredrik
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lundgren, Lena
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. 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 Registry2020Inngår i: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9.
    Jemberie, Wossenseged Birhane
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Padyab, Mojgan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Snellman, Fredrik
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Lundgren, Lena
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. 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 registry2019Konferansepaper (Annet vitenskapelig)
  • 10.
    Kakko, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Alho, Hannu
    Baldacchino, Alexander
    Molina, Rocio
    Nava, Felice Alfonso
    Shaya, Gabriel
    Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice2019Inngår i: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 10, artikkel-id 592Artikkel, forskningsoversikt (Fagfellevurdert)
    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.

  • 11.
    Kakko, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    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 practice2018Inngår i: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 13, artikkel-id 22Artikkel, forskningsoversikt (Fagfellevurdert)
    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.

  • 12.
    Lakso, Hans-Åke
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Wuolikainen, Anna
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    Sundkvist, Anneli
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi. Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Johansson, Ingegerd
    Umeå universitet, Medicinska fakulteten, Institutionen för odontologi.
    Marklund, Stefan L.
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Klinisk kemi.
    Long-term stability of the alcohol consumption biomarker phosphatidylethanol in erythrocytes at-80 degrees C2019Inngår i: Clinical Mass Spectrometry, ISSN 2376-9998, Vol. 11, s. 37-41Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 13. Larsson, Gerhard
    et al.
    Wiklund, HansSandlund, MikaelUmeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Missbruket, kunskapen och vården: missbruksutredningens forskningsbilaga : delbetänkande2011Collection/Antologi (Fagfellevurdert)
  • 14.
    Lundgren, Lena
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Brännström, Jan
    Armelius, Bengt-Åke
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Chassler, Deborah
    Morén, Stefan
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    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 system2012Inngår i: Substance Use & Misuse, ISSN 1082-6084, E-ISSN 1532-2491, Vol. 47, nr 1, s. 67-77Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 15.
    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 universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Armelius, Bengt-Åke
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Armelius, Kerstin
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    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 problems2014Inngår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 31, nr 1, s. 59-79Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 16.
    Nicoll, Rachel
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Henein, Michael Y
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Alcohol and the heart2011Inngår i: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 35, nr 10, s. 1737-1738Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 17.
    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 universitet, Teknisk-naturvetenskapliga fakulteten, Kemiska institutionen.
    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 analysis2014Inngår i: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 109, nr 8, s. 1338-1352Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 18.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Bättre insatser vid missbruk och beroende: Individen, kunskapen och ansvaret (SOU 2011:35)2011Bok (Fagfellevurdert)
  • 19.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Further education for staff in drug abuse treatment: a realistic approach2012Inngår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 29, nr 3, s. 267-268Artikkel i tidsskrift (Fagfellevurdert)
  • 20. 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 universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    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 universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Näringsforskning.
    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 studies2018Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 391, nr 10129, s. 1513-1523Artikkel i tidsskrift (Fagfellevurdert)
    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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