Marlene Stenbacka

Association between use of sedatives or hypnotics, alcohol consumption, or other risk factors and a single injurious fall or multiple injurious falls: a longitudinal general population study

In this study, we investigated the association between risk factors, including use of sedatives or hypnotics or alcohol consumption, and injurious falls leading to hospitalization or death among 4023 subjects (1828 men and 2195 women) aged 20-89 years in Stockholm County, Sweden. Questionnaire data obtained from the 1984-1985 Stockholm Health of the Population Study (SHPS) were linked to official data registers on hospitalization and mortality. Of the 4023 subjects, 330 (121 men and 209 women) had been treated for or died of injurious falls during the 12-year follow-up period. High age was significantly associated with injurious falls among both men and women. Multivariate analyses showed that women who had used sedatives or hypnotics during the 2 weeks before an injurious fall were at increased risk [relative risk of 1.83 (95% confidence interval, 1.10-3.06)] for two or more injurious falls, but not for a single fall accident. High alcohol consumption and earlier self-reported injurious falls were significantly associated with injurious falls for women younger than 60 years of age and with earlier self-reported falls and living alone for men in the same age category. Among older women (>60 years of age), high alcohol consumption and use of sedatives or hypnotics were significantly associated with injurious falls, whereas living alone and earlier self-reported accidents were significant predictors for men in the same age category. These results support a cautious prescribing policy for sedatives and hypnotics, as well as an awareness of high alcohol consumption and its association with injurious falls.

Mortality and cause of death among 1705 illicit drug users: A 37 year follow up

INTRODUCTION AND AIMSnTo examine the overall mortality and causes of deaths of a large cohort of users of illicit drugs in Stockholm over 37 years.nnnDESIGN AND METHODSnPeople with substance abuse were identified through records collected by different institutions in Stockholm in 1967. Subjects were followed in registers recording mortality and cause of death and in-patient care stays until 2003.nnnRESULTSnMore than half (n = 860) of the 1705 identified substance abusers died at an average age of 47 years, 25-30 years younger than the general population. The standardised rate ratio (SRR) for mortality was 3.3 among men and 3.5 among women. Incidence of mortality per 1000 person-years was also increased, but somewhat lower for women. The difference between these two measures is mainly explained by a lower mortality among women in general. In-patient care stays with both alcohol and drug-related diagnoses were associated with higher risk of dying among women than men: SRR = 14.5 and SRR = 4.0, respectively. Accidents and suicide were the most common cause of death among the youngest subjects (15-24 years) and cardiovascular diseases and tumours among the oldest (> or =55 years).nnnDISCUSSION AND CONCLUSIONSnAccidents and suicide, especially at a young age, are two common causes of death that might be prevented by increased awareness in medical personnel, along with better treatment and supportive measures.

Initiation into drug abuse The pathway from being offered drugs to trying cannabis and progression to intravenous drug abuse

The aim of the study was to analyse the initiation process into illicit drug use focusing on three endpoints which can be seen as stages in the drug career: being offered drugs, using cannabis and using intravenous drugs. Questionnaire data were available on 23482 men, aged 18–20 years, conscripted for military service in 1969–70. The association between family background, social conditions, other licit drug use, emotional control and the three endpoints were analysed. Although many conscripts tried cannabis, a smaller number continued with intravenous drug abuse. These were in general characterised by poor emotional control and a history of social maladjustment, and early onset of use. Our findings give further evidence for social maladjustment as a causative factor for illicit drug use and for the role of cannabis as a stepping stone to heavy drug abuse.

Were the changes to Sweden's maintenance treatment policy 2000-06 related to changes in opiate-related mortality and morbidity?

AIMSnTo analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006.nnnDESIGNnWe collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden.nnnSETTINGnSweden.nnnPARTICIPANTSnPatients in maintenance treatment.nnnMEASUREMENTSnSurvey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations.nnnFINDINGSnThe surveys showed a marked change to a less restrictive policy, with increased use of take-away doses and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more than threefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20-30% reduction in opiate-related mortality and inpatient care between 2000-2002 and 2004-2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998-2006, statistically significant declines occurred only in Stockholm County.nnnCONCLUSIONSnThe liberalization of Swedens drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.

Problematic alcohol and cannabis use in adolescence—risk of serious adult substance abuse?

The aim of this longitudinal study was to investigate the problematic use of alcohol, cannabis or both in adolescence, identifying various risk factors for adult alcohol and drug abuse. The study included 7,577 18-year-old men conscripted in 1969-70. At enrollment, they completed two questionnaires about alcohol and drug use, social background, behavioural factors and health conditions. Data on adult alcohol and substance abuse were obtained from official registers up to 1996. A combination of problematic alcohol use and cannabis use in adolescence (>10 times) was associated more strongly with both adult alcohol abuse (RR=6.56, 95% CI 4.24-9.83) and drug abuse (RR=19.37, 95% CI 11.16-32.30) than adolescent use of cannabis or alcohol alone. When stratifying for different risk factors, the combination of both problematic alcohol use and cannabis use had higher relative risks of both outcomes than alcohol or cannabis use alone. In multivariate analyses, tobacco smoking was associated most strongly (RR=2.26, 1.58-3.24) with adult alcohol abuse, and a combination of problematic alcohol use and cannabis use (<10 times) in adolescence was associated most strongly with adult drug abuse (RR=5.60, 95% CI 2.92-10.75). Adolescent use of both cannabis and alcohol seems to be a more serious problem than adolescent use of either alcohol or cannabis alone with regard to escalation to adult alcohol and drug abuse. This is important knowledge for prevention of adult abuse. Special effort should be made to reach those who mix risky alcohol use and cannabis use in late adolescence.

The Impact of Methadone on Consumption of Inpatient Care and Mortality, with Special Reference to HIV Status

This study investigates the impact of methadone treatment on inpatient care admissions and mortality among 331 methadone-maintained patients compared with 1,483 similar untreated opiate misusers. The methadone patients manifested a lower mortality during treatment than the comparison group and those patients who had left their treatment. The annual incidence rate decreased from 1.4 inpatient care admissions per year for those who had stayed 0-1 year, less than 1 for those who stayed more than 2 years, and 0.3 for those who had stayed longer (>4 years) in methadone treatment. A similar decrease occurred in both sexes. The incidence rate decreased more among the HIV-negative than the HIV-positive patients. The low incidence of inpatient care during treatment may be due to treatment but may also be partly due to selection factors.

An 18-Year Follow-Up of Patients Admitted to Methadone Treatment for the First Time

ABSTRACT An 18-year addiction career, 1985-2003, for 157 heroin dependent subjects (73% men; 49% human immunodeficiency virus seropositive) admitted for the first time to Stockholms Methadone Maintenance Treatment program during 1989 to 1991 was analyzed with data from seven official registers and patient records. Regression analyses and incidence rates for various outcomes were calculated for subjects in first methadone maintenance treatment at the end of the observation period, discharged from first methadone maintenance treatment, in second methadone maintenance treatment, and discharged from second methadone maintenance treatment. Being human immunodeficiency virus positive (HR = 3.8), lodging (HR = 1.9) and prison sentence (HR = 1.7) predicted mortality for the 45% deceased. Approximately 70% of living subjects participated in methadone maintenance treatment at some period each year. Subjects in first or second methadone maintenance treatment had less criminality and had spent more time in methadone maintenance treatment (70% to 100%) than those discharged from first or from second methadone maintenance treatment (50%). Efforts and interventions should be intensified to increase time in treatment also for those with high problem severity.

Early risk factors for criminal offending in schizophrenia: a 35-year longitudinal cohort study

BackgroundRecent evidence suggests that factors predicting offending among individuals with no mental disorder may also predict offending among individuals with schizophrenia.AimsThe aims of the study were (1) to explore the prevalence of risk factors for criminal offending reported at age 18 among males later diagnosed with schizophrenia, (2) to explore the associations between risk factors reported at age 18 and lifetime criminal offending, (3) to predict lifetime serious violent offending based on risk factors reported at age 18, and (4) to compare the findings with those in males with no later diagnosis of schizophrenia.MethodsThe study was a prospective, longitudinal study of a birth cohort followed up through registers after 35xa0years. The cohort consisted of 49 398 males conscripted into the Swedish Army in 1969–1970, of whom 377 were later diagnosed with schizophrenia.ResultsAmong the subjects later diagnosed with schizophrenia, strong associations were found between four of the items reported at age 18 and lifetime criminal offending: (1) low marks for conduct in school, (2) contact with the police or child care authorities, (3) crowded living conditions, and (4) arrest for public drinking. Three of these four risk factors were found to double the risk of offending among males with no later diagnosis of schizophrenia.ConclusionsCriminality in individuals with schizophrenia may at least partly be understood as a phenomenon similar to criminality in individuals in the general population.

Adolescent use of illicit drugs and adult offending : a Swedish longitudinal study

The main aim of this study was to examine the role of illicit drug use before the age of 18 years in developing a criminal career. The study included 7577 18-year-old men conscripted for military service in Stockholm County in 1969/1970. At enrolment they answered questions regarding alcohol and illicit drug use, social background, behavioural factors and health. Data on adult and adolescent criminality were obtained from official registers from the age of 15 to the age of 43. Subjects with self-reported drug use were registered significantly more often (p <or= 0.0001) for future drug offences and other non-drug offences than were subjects with no drug use at all. Irrespective of the number of adolescent offences, if subjects also reported illicit drug use in adolescence, their adult criminal activity was considerably higher than if they had not used any drugs during adolescence. This was also true when examining other risk factors. Generally, adolescent illicit drug use was a risk factor over and above common risk factors for adult criminality. Early prevention of illicit substance use and criminality in adolescence is important in hindering a future criminal career.

Mortality and causes of death among violent offenders and victims-a Swedish population based longitudinal study

BackgroundMost previous studies on mortality in violent offenders or victims are based on prison or hospital samples, while this study analyzed overall and cause specific mortality among violent offenders, victims, and individuals who were both offenders and victims in a general sample of 48,834 18-20 year-old men conscripted for military service in 1969/70 in Sweden.MethodsEach person completed two non-anonymous questionnaires concerning family, psychological, and behavioral factors. The cohort was followed for 35 years through official registers regarding violent offenses, victimization, and mortality. The impact of violence, victimization, early risk factors and hospitalization for psychiatric diagnosis or alcohol and drug misuse during follow up on mortality was investigated using Cox proportional hazard regression analyses.ResultsRepeat violent offenses were associated with an eleven fold higher hazard of dying from a substance-related cause and nearly fourfold higher hazard of dying from suicide. These figures remained significantly elevated also in multivariate analyses, with a 3.03 and 2.39 hazard ratio (HR), respectively. Participants with experience of violence and inpatient care for substance abuse or psychiatric disorder had about a two to threefold higher risk of dying compared to participants with no substance use or psychiatric disorder.ConclusionsViolent offending and being victimized are associated with excess mortality and a risk of dying from an alcohol or drug-related cause or suicide. Consequently, prevention of violent behavior might have an effect on overall mortality and suicide rates. Prevention of alcohol and drug use is also warranted.