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A 20-year prospective study of mortality and causes of death among hospitalized opioid addicts in Oslo.

https://arctichealth.org/en/permalink/ahliterature87156
Source
BMC Psychiatry. 2008;8:8
Publication Type
Article
Date
2008
Author
Bjornaas Mari A
Bekken Anette S
Ojlert Aasa
Haldorsen Tor
Jacobsen Dag
Rostrup Morten
Ekeberg Oivind
Author Affiliation
Department of Acute Medicine, Ullevaal University Hospital, N-0407 Oslo, Norway. mabjornaas@gmail.com
Source
BMC Psychiatry. 2008;8:8
Date
2008
Language
English
Publication Type
Article
Keywords
Accidents - mortality
Adolescent
Adult
Cause of Death - trends
Cohort Studies
Female
Follow-Up Studies
Hospital Mortality - trends
Humans
Male
Mathematical Computing
Narcotics - poisoning
Neoplasms - mortality
Opioid-Related Disorders - mortality - rehabilitation
Overdose - mortality - prevention & control
Patient Admission - statistics & numerical data
Risk
Street Drugs - poisoning
Suicide - statistics & numerical data
Sweden
Violence - statistics & numerical data
Abstract
BACKGROUND: To study mortality rate and causes of death among all hospitalized opioid addicts treated for self-poisoning or admitted for voluntary detoxification in Oslo between 1980 and 1981, and to compare their mortality to that of the general population. METHODS: A prospective cohort study was conducted on 185 opioid addicts from all medical departments in Oslo who were treated for either self-poisoning (n = 93, 1980), voluntary detoxification (n = 75, 1980/1981) or both (n = 17). Their median age was 24 years; with a range from 16 to 41, and 53% were males. All deaths that had occurred by the end of 2000 were identified from the Central Population Register. Causes of death were obtained from Statistics Norway. Standardized mortality ratios (SMRs) were computed for mortality, in general, and in particular, for different causes of death. RESULTS: During a period of 20 years, 70 opioid addicts died (37.8%), with a standardized mortality ratio (SMR) equal to 23.6 (95% CI, 18.7-29.9). The SMR remained high during the whole period, ranging from 32.4 in the first five-year period, to 13.4 in the last five-year period. There were no significant differences in SMR between self-poisonings and those admitted for voluntarily detoxification. The registered causes of death were accidents (11.4%), suicide (7.1%), cancer (4.3%), cardiovascular disease (2.9%), other violent deaths (2.9%), other diseases (71.4%). Among the 50 deaths classified as other diseases, the category "drug dependence" was listed in the vast majority of cases (37 deaths, 52.9% of the total). SMRs increased significantly for all causes of death, with the other diseases group having the highest SMR; 65.8 (95% CI, 49.9-86.9). The SMR was 5.4 (95% CI, 1.3-21.5) for cardiovascular diseases, and 4.3 (95% CI, 1.4-13.5) for cancer. The SMR was 13.2 (95% CI, 6.6-26.4) for accidents, 10.7 (95% CI, 4.5-25.8) for suicides, and 28.6 (95% CI, 7.1-114.4) for other violent deaths. CONCLUSION: The risk of death among opioid addicts was significantly higher for all causes of death compared with the general population, implying a poor prognosis over a 20-year period for this young patient group.
PubMed ID
18271956 View in PubMed
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Acute child poisonings in Oslo: a 2-year prospective study.

https://arctichealth.org/en/permalink/ahliterature84591
Source
Acta Paediatr. 2007 Sep;96(9):1355-9
Publication Type
Article
Date
Sep-2007
Author
Rajka Thomas
Heyerdahl Fridtjof
Hovda Knut Erik
Stiksrud Birgitte
Jacobsen Dag
Author Affiliation
Department of Paediatric Intensive Care, Ullevaal University Hospital, Oslo, Norway.
Source
Acta Paediatr. 2007 Sep;96(9):1355-9
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Acute Disease
Adolescent
Age Distribution
Catchment Area (Health)
Child
Child, Preschool
Female
Hospitalization - statistics & numerical data
Humans
Incidence
Male
Norway - epidemiology
Poisoning - epidemiology - rehabilitation
Prevalence
Prospective Studies
Sex Distribution
Abstract
AIM: To study the current epidemiology, clinical course and outcome of poisonings among children in Oslo and compare findings to a similar study from 1980. METHODS: Observational study with prospective inclusion of all children ( or = 8 years ingested mainly ethanol (46%) or pharmaceuticals (36%). Five percent of all children were comatose, and complications were seen in 13%. All children survived without sequelae. Half of the admissions needed treatment; most commonly used treatments were activated charcoal (33%), gastric lavage (9%) and emetics (9%). CONCLUSION: The incidence of child poisonings in Oslo has significantly reduced since 1980. Only half of the poisonings needed treatment, most of the poisonings were mild and the clinical outcome was good.
PubMed ID
17718791 View in PubMed
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Acute poisonings treated in hospitals in Oslo: a one-year prospective study (II): clinical outcome.

https://arctichealth.org/en/permalink/ahliterature93789
Source
Clin Toxicol (Phila). 2008 Jan;46(1):42-9
Publication Type
Article
Date
Jan-2008
Author
Heyerdahl Fridtjof
Bjornas Mari A
Hovda Knut Erik
Skog Karina
Opdahl Anders
Wium Cecilie
Ekeberg Oivind
Jacobsen Dag
Author Affiliation
Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway. fridtjof.heyerdahl@medisin.uio.no
Source
Clin Toxicol (Phila). 2008 Jan;46(1):42-9
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antidotes - therapeutic use
Coma - chemically induced
Cross-Sectional Studies
Ethanol - poisoning
Female
Flumazenil - therapeutic use
Hospital Mortality - trends
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Naloxone - therapeutic use
Norway
Poisoning - epidemiology - therapy
Prospective Studies
Severity of Illness Index
Street Drugs - poisoning
Treatment Outcome
Abstract
OBJECTIVES. The changing pattern of acute poisoning may affect complications and outcome in these patients. An update study on acute poisonings was therefore performed and compared to similar data from 1980. DESIGN. A prospective cross-sectional multi-center study of all adult patients (> or = 16 years) hospitalized in Oslo with a main diagnosis of acute poisoning, irrespective of intention, over a one-year period. RESULTS. Of 947 admissions, 222 (23%) were comatose. Complications were observed in 173 (18%), slightly reduced from 1980 (22%). Ten (1.1%) died and six (0.6%) got permanent sequelae, of which seven and five were drug- or alcohol-related, respectively. Seventy-five percent received treatment besides observation; 39% received antidotes, increased from 21% in 1980, most frequently flumazenil (23%) and naloxone (14%). CONCLUSIONS. In-hospital mortality in poisoned patients remained low, few patients entailed complications, and most patients survived without permanent sequelae. Drug- and alcohol-abuse related poisonings were most severe.
PubMed ID
18167036 View in PubMed
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Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest.

https://arctichealth.org/en/permalink/ahliterature78993
Source
Resuscitation. 2007 Apr;73(1):29-39
Publication Type
Article
Date
Apr-2007
Author
Sunde Kjetil
Pytte Morten
Jacobsen Dag
Mangschau Arild
Jensen Lars Petter
Smedsrud Christian
Draegni Tomas
Steen Petter Andreas
Author Affiliation
Department of Anaesthesiology, Ulleval University Hospital, Oslo, Norway. kjetil.sunde@medisin.uio.no
Source
Resuscitation. 2007 Apr;73(1):29-39
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Blood Glucose - analysis
Cardiopulmonary Resuscitation
Case-Control Studies
Clinical Protocols
Emergency medical services
Female
Heart Arrest - mortality - therapy
Hospitalization
Humans
Hypothermia, Induced
Intensive Care Units
Intervention Studies
Logistic Models
Male
Middle Aged
Myocardial Infarction - epidemiology - therapy
Norway - epidemiology
Prospective Studies
Respiration, Artificial
Seizures - prevention & control
Survival Analysis
Thrombolytic Therapy
Abstract
BACKGROUND: Mortality among patients admitted to hospital after out-of-hospital cardiac arrest (OHCA) is high. Based on recent scientific evidence with a main goal of improving survival, we introduced and implemented a standardised post resuscitation protocol focusing on vital organ function including therapeutic hypothermia, percutaneous coronary intervention (PCI), control of haemodynamics, blood glucose, ventilation and seizures. METHODS: All patients with OHCA of cardiac aetiology admitted to the ICU from September 2003 to May 2005 (intervention period) were included in a prospective, observational study and compared to controls from February 1996 to February 1998. RESULTS: In the control period 15/58 (26%) survived to hospital discharge with a favourable neurological outcome versus 34 of 61 (56%) in the intervention period (OR 3.61, CI 1.66-7.84, p=0.001). All survivors with a favourable neurological outcome in both groups were still alive 1 year after discharge. Two patients from the control period were revascularised with thrombolytics versus 30 (49%) receiving PCI treatment in the intervention period (47 patients (77%) underwent cardiac angiography). Therapeutic hypothermia was not used in the control period, but 40 of 52 (77%) comatose patients received this treatment in the intervention period. CONCLUSIONS: Discharge rate from hospital, neurological outcome and 1-year survival improved after standardisation of post resuscitation care. Based on a multivariate logistic analysis, hospital treatment in the intervention period was the most important independent predictor of survival.
PubMed ID
17258378 View in PubMed
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Mortality and causes of death after hospital-treated self-poisoning in Oslo: a 20-year follow-up.

https://arctichealth.org/en/permalink/ahliterature92828
Source
Clin Toxicol (Phila). 2009 Feb;47(2):116-23
Publication Type
Article
Date
Feb-2009
Author
Bjornaas Mari Asphjell
Jacobsen Dag
Haldorsen Tor
Ekeberg Oivind
Author Affiliation
University of Oslo, Department of Behavioural Sciences in Medicine, Norway. mabjornaas@gmail.com
Source
Clin Toxicol (Phila). 2009 Feb;47(2):116-23
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Alcoholism - mortality
Cause of Death
Female
Follow-Up Studies
Humans
Male
Middle Aged
Norway - epidemiology
Overdose - mortality - therapy
Patient Discharge - statistics & numerical data
Prognosis
Proportional Hazards Models
Prospective Studies
Risk assessment
Risk factors
Substance-Related Disorders - mortality
Suicide - statistics & numerical data
Time Factors
Young Adult
Abstract
INTRODUCTION: Self-poisoning is a risk factor for premature death and for suicide, but for how long? The aims were to examine the mortality rate, causes of death, and risk factors for mortality and suicide during 20 years. METHOD: Prospective cohort study including all patients discharged after self-poisoning from all medical departments in Oslo in 1980 (n = 946, 51 % females, median age 31 years). Standardized mortality ratios (SMRs) and Cox regression analysis were used. RESULTS: During follow-up, 355 (37.5%) of the patients died, SMR 4.6 (95% CI, 4.2-5.1). After 15 years, the SMR was still 3.3 (95% C.I., 2.5-4.2). Sixty-seven (7.1%) committed suicide, SMR 26.7 (95% CI, 21.0-33.9). The risk of death from all causes was significantly higher. Unspecific risk factors for death were found. A suicidal motive was the only risk factor for suicide. CONCLUSION: The mortality rate implies a poor prognosis in this patient group.
PubMed ID
18608284 View in PubMed
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Pre-hospital treatment of acute poisonings in Oslo.

https://arctichealth.org/en/permalink/ahliterature91140
Source
BMC Emerg Med. 2008;8:15
Publication Type
Article
Date
2008
Author
Heyerdahl Fridtjof
Hovda Knut E
Bjornaas Mari A
Nore Anne K
Figueiredo Jose C P
Ekeberg Oivind
Jacobsen Dag
Author Affiliation
Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway. fridtjof.heyerdahl@medisin.uio.no
Source
BMC Emerg Med. 2008;8:15
Date
2008
Language
English
Publication Type
Article
Keywords
Acute Disease
Emergency Medical Services - organization & administration
Female
Humans
Incidence
Logistic Models
Male
Norway - epidemiology
Poisoning - mortality - therapy
Prospective Studies
Registries
Statistics, nonparametric
Treatment Outcome
Abstract
BACKGROUND: Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. METHODS: A one-year multi-centre study with prospective inclusion of all acutely poisoned patients > or = 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. RESULTS: A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40%) were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84%) were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%), were frequently comatose (35%), had respiratory depression (37%), and many received naloxone (49%). The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%), fewer were comatose (10%), and they rarely had respiratory depression (4%). Among the hospitalized, pharmaceutical poisonings were most common (58%), 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. CONCLUSION: More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often caused by drug and alcohol abuse than in those who were hospitalized, and more than two-thirds were males. Almost half of those discharged from ambulances received an antidote. The pre-hospital treatment of these poisonings appears safe regarding short-term mortality.
PubMed ID
19025643 View in PubMed
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Repetition of acute poisoning in Oslo: 1-year prospective study.

https://arctichealth.org/en/permalink/ahliterature90588
Source
Br J Psychiatry. 2009 Jan;194(1):73-9
Publication Type
Article
Date
Jan-2009
Author
Heyerdahl Fridtjof
Bjornaas Mari Asphjell
Dahl Rune
Hovda Knut Erik
Nore Anne Kathrine
Ekeberg Oivind
Jacobsen Dag
Author Affiliation
Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway. fridtjof.heyerdahl@medisin.uio.no
Source
Br J Psychiatry. 2009 Jan;194(1):73-9
Date
Jan-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Epidemiologic Methods
Female
Humans
Male
Middle Aged
Norway - epidemiology
Overdose - epidemiology
Recurrence
Self-Injurious Behavior - epidemiology - psychology
Suicide, Attempted - psychology
Young Adult
Abstract
BACKGROUND: The repetition of acute poisoning occurs frequently. The intention may change between episodes and many poisonings are treated outside the hospital setting. Few studies have taken this into account. AIMS: To quantify the repetition frequency regardless of the level of health care or the intention behind the poisoning, and to identify possible risk factors for repetition. METHOD: A prospective multicentre study of all acute poisonings in Oslo treated in hospital, at an out-patient clinic or by the ambulance service. Repetition was estimated using Kaplan-Meier calculations, and predictive factors were identified using Cox regression analysis. RESULTS: The estimated 1-year repetition rate was 30% (95% CI 24-35). Independent predictors of repetition were middle age (30-49 years), poisoning with opiates or sedatives, unemployment or living on social welfare, a previous suicide attempt, and a history of psychiatric treatment. Intention was not a significant predictor. CONCLUSIONS: Repetition of acute poisoning is high, irrespective of the level of healthcare and the intention behind the poisoning.
Notes
Erratum In: Br J Psychiatry. 2009 Feb;194(2):191
PubMed ID
19118331 View in PubMed
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7 records – page 1 of 1.