Svetlana Skurtveit

Coffee intake and mortality from liver cirrhosis.

PURPOSE The aim of the study was to evaluate the association between coffee consumption and mortality from liver cirrhosis. METHODS We conducted a mortality follow-up of 51,306 adults who underwent screening for cardiovascular disease from 1977 to 1983. During the subsequent 17 years, the total number of deaths from all causes in the studied cohort was 4207. Fifty-three had the diagnosis of cirrhosis mentioned on the death certificate; of these, 36 had alcoholic cirrhosis. RESULTS The relative risk of liver cirrhosis mentioned on the death certificate associated with an increase of two cups of coffee, adjusted for sex, age, alcohol use and other major cardiovascular risk factors was 0.6 (95% confidence interval, 0.5-0.8). For alcoholic cirrhosis the results were identical. When studying cirrhosis as the underlying cause of death, the inverse relationship becomes somewhat stronger. CONCLUSIONS The present study confirms the existence of an inverse association between coffee consumption and liver cirrhosis.

Clinical impairment of benzodiazepines--relation between benzodiazepine concentrations and impairment in apprehended drivers.

BACKGROUND Acute intake of benzodiazepines is followed by concentration-dependent deterioration of performance in controlled experimental studies. Whether this is true in a population of benzodiazepine users is uncertain. We studied the relationship in a population of suspected drugged drivers. METHODS In Norway physicians examine and take blood samples from nearly all suspected drivers. Our material comprised 818 samples containing only one benzodiazepine and our reference group consisted of 10,759 cases containing only alcohol. RESULTS 159 drivers (19%) were considered as not impaired and 659 (81%) as impaired. None of the background factors, e.g. gender, age or time of day when apprehended, related significantly to either the physicians conclusion or to blood levels of benzodiazepines. Impaired subjects had significantly higher blood levels of diazepam (n=411) (P<0.001), oxazepam (n=73) (P<0.05) and flunitrazepam (n=211) (P<0.05) than those not impaired. The risk of being assessed as impaired did rise with increasing benzodiazepine blood level, with odds ratios (ORs) for being assessed as impaired of 1.61, 3.65 and 4.11 for the three supratherapeutic drug levels. The corresponding OR found for different elevated blood-alcohol concentrations were 1.49, 2.94 and 10.49. CONCLUSION The blood concentration of benzodiazepines was the only characteristic which was related to impairment. This indicated a drug-concentration related effect of benzodiazepines on performance and paves the way for a discussion on legal limits for benzodiazepines in relation to driving.

Neonatal outcomes following in utero exposure to methadone or buprenorphine: A National Cohort Study of opioid-agonist treatment of Pregnant Women in Norway from 1996 to 2009

BACKGROUND In Norway, most opioid-dependent women are in opioid maintenance treatment (OMT) with either methadone or buprenorphine throughout pregnancy. The inclusion criteria for both medications are the same and both medications are provided by the same health professionals in any part of the country. International studies comparing methadone and buprenorphine in pregnancy have shown differing neonatal outcomes for the two medications. METHOD This study compared the neonatal outcomes following prenatal exposure to either methadone or buprenorphine in a national clinical cohort of 139 women/neonates from 1996 to 2009. RESULTS After adjusting for relevant covariates, buprenorphine-exposed newborns had larger head circumferences and tended to be heavier and longer than methadone-exposed newborns. The incidence of neonatal abstinence syndrome (NAS) and length of treatment of NAS did not differ between methadone- and buprenorphine-exposed newborns. There was little use of illegal drugs and benzodiazepines during the pregnancies. However, the use of any drugs or benzodiazepines during pregnancy was associated with longer lasting NAS-treatment of the neonates. CONCLUSIONS The clinical relevance of these findings is that both methadone and buprenorphine are acceptable medications for the use in pregnancy, in line with previous studies. If starting OMT in pregnancy, buprenorphine should be considered as the drug of choice, due to more favorable neonatal growth parameters. Early confirmation of the pregnancy and systematic follow-up throughout the pregnancy are of importance to encourage the women in OMT to abstain from the use of tobacco, alcohol, illegal drugs or misuse of prescribed drugs.

Breastfeeding reduces the need for withdrawal treatment in opioid-exposed infants

To examine the rate and duration of breastfeeding in a cohort of women in opioid maintenance treatment (OMT) in Norway, as well as the effect of breastfeeding on the incidence and duration of neonatal abstinence syndrome (NAS).

Engagement with opioid maintenance treatment and reductions in crime: a longitudinal national cohort study

AIMS This study investigates changes in criminal involvement among patients in opioid maintenance treatment (OMT) over a 7-year period prior to, during and after treatment, particularly in relation to differences in treatment engagement. DESIGN, SETTING AND PARTICIPANTS Treatment data on all patients who started OMT in Norway between 1997 and 2003 (n = 3221) were cross-linked with national criminal records. The period of observation was divided into four phases; pre-treatment, in-treatment, between treatments and post-treatment. FINDINGS During OMT, rates of criminal convictions for the cohort were reduced to fewer than half of waiting-list levels [incidence rate (IR) 0.63 versus 1.57]. Patients in continuous treatment had the fewest convictions (IR 0.47) during treatment. The highest rates were found among patients out of treatment after several treatment episodes (IR 1.52). All groups had significantly fewer criminal convictions during treatment compared to before treatment. Staying in OMT for 2 years or more was associated with significantly reduced rates of convictions during treatment. Younger age and pre-treatment criminal convictions were associated with significantly (P < 0.001) more convictions during treatment. Those who left treatment, permanently or temporarily, relapsed into high levels of convictions outside treatment. CONCLUSIONS Criminal activity appears to be reduced in Norway during opiate maintenance treatment. Younger age and prior history of criminal activity are important risk factors for continued criminal activity during treatment.

Undertreatment and overtreatment with statins: the Oslo Health Study 2000-2001.

Objective.  We examined the prevalence and factors associated with use of cholesterol‐lowering statins in the population.

Rearrest rates among Norwegian drugged drivers compared with drunken drivers

The rearrest rates among Norwegian drugged (n=1102) and a group of drunken drivers (n=850) (BAC: 0.16-0.19%) apprehended during 1992, were 57% (n=629) and 28% (n=238), respectively, when followed prospectively for 7 years. The most important risk factors for recidivism among drugged drivers were previous arrests for drugged or drunken driving (rearrest rate among previous arrests: 73%, no previous arrest: 42%), multi-drug detection at selection (multi-drug: 62%, single drug: 41%), sex (male: 61%, female: 35%) and age (below 36 years: 60%, 36 years and older: 44%). Most of the recidivist drugged drivers were rearrested during the year of selection (21%), followed by 13, 7 and 6%, retrospectively, during the following years. When followed both retrospectively and prospectively for a period extending from 1984 to 1998, 71% (n=779) and 40% (n=344) of the selected drugged and drunken drivers, respectively, were arrested two or more times.

Pharmacokinetic differences of morphine and morphine-glucuronides are reflected in locomotor activity

The main metabolites of morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), have been considered to participate in some of the effects of morphine. There is limited knowledge of the pharmacokinetics and dynamics of morphine and the main metabolites in mice, but mice are widely used to study both the analgesic effects and the psychomotor effects of morphine. The present study aimed to explore pharmacokinetic differences between morphine and morphine-glucuronides in mice after different routes of administration, and to investigate how possible differences were reflected in locomotor activity, a measure of psychostimulant properties. Mice were given morphine, M3G or M6G by different routes of administration. Serum concentrations versus time curves, pharmacokinetic parameters and locomotor activity were determined. Intraperitoneal administration of morphine reduced the bioavailability compared to intravenous and subcutaneous administration, but not so for morphine-glucuronides. The two morphine-glucuronides had similar pharmacokinetics, but morphine demonstrated higher volume of distribution and clearance than morphine-glucuronides. The present results demonstrated no locomotor effect of M3G, but a serum concentration effect relationship for morphine and M6G. When serum concentrations and effect changes were followed over time, there was some right hand shifts with respect to locomotor activity, especially during the declining phase of the concentration curve and particularly for M6G.

Testing for benzodiazepine inebriation—relationship between benzodiazepine concentration and simple clinical tests for impairment in a sample of drugged drivers

ObjectiveTo study how the various 25 subtests and observations of the Norwegian clinical test for impairment related to the blood benzodiazepine concentrations of apprehended drivers suspected of driving under the influence of benzodiazepines. The impact of single-dose intake in non-daily users of benzodiazepines on the clinical picture of inebriation was also studied.MethodsIncluded in the study were 818 drivers suspected of driving under the influence of non-alcoholic drugs with blood samples containing only one benzodiazepine. We determined which of the 25 subtests and observations of the clinical test for impairment related significantly to the blood benzodiazepine concentrations.ResultsSignificantly related to blood benzodiazepine concentrations were 13 subtests and observations. Of these, 9 withstood adjustment for a variety of background variables. Singledose intake in non-daily users only influenced 3 subtests and observations after adjustment for blood benzodiazepine concentration and background variables. Rombergs test, 1 observation concerning alertness (oriented for time and place), 4 tests on motor and coordination (walk and turn on line, finger-to-nose and finger-to-finger tests), 2 observations on speech (articulation and content) and 1 observation regarding appearance (general conduct) were related to blood benzodiazepine concentrations.ConclusionMany of these simple clinical tests are included in the standardized field sobriety test and are of value in revealing benzodiazepine impairment. The present study offered some possible additions. Combinations of these robust tests can also be used to reveal benzodiazepine inebriation in other contexts.

High validity of mother-reported use of antiasthmatics among children: a comparison with a population-based prescription database

OBJECTIVES To examine the validity of (1) maternal questionnaire report of childrens use of antiasthmatics using a prescription database as the reference standard and (2) dispensed antiasthmatics as a measure of asthma using maternal report of childrens asthma as the reference standard. STUDY DESIGN AND SETTING A total of 3,394 children in the Norwegian Mother and Child Cohort Study aged 7 years were linked to the Norwegian Prescription Database. Maternal report of both childrens use of antiasthmatics during the preceding year and the presence of asthma was compared with data on dispensed antiasthmatics. RESULTS A total of 2,056 mothers responded and reported use of antiasthmatics during the previous year in 125 of 147 children who had been dispensed antiasthmatics (sensitivity 85.0%). Of the 1,909 children with no dispensed antiasthmatics, 1,848 had no maternal report of antiasthmatic use (specificity 96.8%). Mothers reported current asthma in 133 (6.5% of 2,056) children, including in 122 (5.9%) reported as verified by a doctor. Of these 122, 98 had been dispensed antiasthmatics during the preceding year (sensitivity 80.3%). Only 1.2% of the children without reported asthma were dispensed antiasthmatics. CONCLUSION Mother-reported use of antiasthmatics during the previous year among 7-year-old children is highly valid. Dispensed antiasthmatics would be a useful proxy for the presence of current asthma when disease data are not available.