The main objective of the present study was to examine the relationship between regular benzodiazepine (BZD) use and drinking patterns in 55-year-old female residents of Malmö, Sweden. All women born in 1935 (a total of 1223 subjects) were invited to a health screening at the Preventive Medicine Section, Malmö General Hospital; 69% agreed to participate. The screening included an extensive health questionnaire, and the responses to 33 items assessing social background, including immigrant status, use of BZD and analgesics, alcohol consumption (the revised Malmö-MAST), smoking and morbidity were analysed. A psychiatric symptoms scale including five of these items was constructed, yielding a Cronbach's alpha of 0.57. Present use of BZD hypnotics and/or tranquillizers was acknowledged by 6% of the women. BZD use at any time in the past or present was endorsed by 23%. Endorsement of > or = 3 revised Malmö-MAST items, indicating problem drinking, occurred in 3% of the participants; 16% were teetotallers and about 25% were regular weekend drinkers. BZD use was significantly more likely to occur in women with the following characteristics: early retirement, pain symptoms, longstanding use of analgesics, multiple psychiatric symptoms. Drinking patterns in relation to BZD use indicated that regular weekend drinkers were significantly less likely to be current and/or previous BZD users than problem drinkers and teetotallers. Logistic regression analyses indicated that use of BZDs was mainly predicted by endorsement of multiple psychiatric symptoms.
Three hundred eighty-three alcoholics, who had at least once been ordered supervision or compulsory treatment at an institution for alcoholics by the Temperance Board, were compared with 383 other alcoholics matched for age and sex. All the alcoholics were first admitted to the Department of Psychiatry, University Hospital, Lund, during the years 1949 to 1969 and followed up until January 1, 1981. They were systematically rated concerning symptoms and etiological factors at first admission. According to a stepwise logistic regression analysis, the following initial symptoms were positively associated with later compulsory treatment: slight cerebral dysfunction/personality change, antisociality/criminality, and impaired social and work performance. Social pressure/responsibility/conflict, slight depression, and continuous drinking were positively associated with the controls. There were 168 deaths in the compulsory treatment group and 124 in the control group (p less than 0.01). The excess deaths in the compulsory treatment group were mainly caused by accidents, poisoning, and violence (21 cases) and sudden cardiac death (10 cases), while there were no differences concerning alcohol-related neoplasms and liver cirrhosis. The compulsory treatment group had a worse long-term social adjustment. The findings indicate that compulsory treatment was related to behavioral patterns showing a stability over time, supporting the validity of subclassification of alcoholics using social data.
Mortality in previously incarcerated individuals is known to be elevated, with high proportions of drug-related deaths. However, there is less documentation of whether specific substance use patterns and other clinical characteristics predict increased mortality in the group.
This is a follow-up study of mortality and causes of death in ex-prisoners with substance use problems prior to incarceration (N=4081), who were followed during an average of 3.6 years from release from prison until death or until data were censored. Baseline predictors of mortality, derived from interviews with Addiction Severity Index (ASI) in prison, were studied in a Cox regression analysis.
During follow-up, 166 subjects (4.1%) died. Standardized mortality ratios were 7.0 (3.6-12.2) for females and 7.7 (5.6-9.0) for males. In 84% of cases, deaths were unnatural or due to substance-related disease. Most common causes of death were accidental poisoning (27%), transport accidents (13%), poisoning/injury with undetermined intent (12%), and suicide (10%). Death was positively predicted by heroin use, overdose, and age, and negatively predicted by a history of depression.
A vast majority of deaths after release from prison in individuals with substance use are due to violent or substance-related causes. Significant predictors identified were mainly related to patterns of drug use, and need to be addressed upon incarceration as risk factors of death. The findings have implications for referral and treatment upon release from prison.
In a consecutive series of 257 alcoholics from an out-patient department 53 were judged as assaultive and 38 as suicidally inclined at the clinical examination 20 years ago. At the follow-up the assaultive alcoholics had a 3.3 times increased mortality rate, the suicidally inclined 1.9 times and the others 1.7 times compared with the general population. The assaultive alcoholics had an increased rate of suicides, intoxications and other alcohol-related deaths compared with other alcoholics. Repeated assaultive behaviour was uncommon. It is concluded that a skilled psychiatric evaluation of assaultive behaviour in alcoholism has an important predictive value.
Polysubstance use is common in substance users, and may complicate their clinical course. This study, in a criminal justice setting in Sweden, examines the association between the number of concurrently used substance types and psychiatric symptoms during 30 days before incarceration, while controlling for background variables such as family history (drug and alcohol problems, psychiatric problems, criminality), demographic data and history of emotional, physical or sexual abuse.
The data material comprised 5659 criminal justice clients reporting a substance use problem, examined with the Addiction Severity Index. Variables were compared in a multinomial regression analysis, comparing clients reporting one (n=1877), two (n=1408), three (n=956), four (n=443) and five or more (n=167) substance types.
The 30-day prevalence of most psychiatric symptoms included in the study (depression, anxiety, cognitive problems, hallucinations, difficulty controlling violent behaviour, suicidal ideation, suicide attempts) was higher in individuals with a higher number of concurrent substance types used. In multinomial regression analysis, while controlling for background variables, these associations remained for concurrent suicidal ideation, cognitive problems, hallucinations and violent behaviour, with the latter two being associated with the higher numbers of substance types. Binge alcohol drinking, tranquilizers, opioids and the number of substance types reported were associated with several of the psychiatric symptoms.
In the present criminal justice setting in Sweden, the use of multiple substance types and concurrent psychiatric symptoms appear to be associated, and a sub-group reporting particularly high numbers of concurrent substance types are particularly likely to report potentially severe psychiatric problems.
Anthropogenic metal contamination can cause increased stress in exposed organisms, but it can be difficult to disentangle the anthropogenic influence from natural variation in environmental conditions. In the proximity of a closed lead (Pb)/zinc (Zn) mine in northern Sweden, the health effects of Pb exposure, essential element (calcium [Ca] and Zn) uptake, and prey availability and composition were estimated on pied flycatcher (Ficedula hypoleuca) nestlings, using hemoglobin (Hb) level as a proxy for health. Pb concentration in nestling blood range between 0.00034 and 2.21?µg/g (ww) and nestlings close to the mine had higher Pb concentrations and lower Hb, but contrary to our hypothesis, Hb was not directly related to Pb accumulation. Proportions of flying terrestrial and aquatic insects in available prey and availability of flying terrestrial insects were positively associated with nestling Hb, whereas the proportion of terrestrial ground living prey, the most common prey type, showed a negative association. This suggests that positive influence of certain prey, which does not have to be the most common in the surroundings, can counteract the negative effects from Pb contamination on bird health. Nestlings inhabiting sites adjacent to lakes had an advantage in terms of prey composition and availability of preferred prey, which resulted in higher Hb. As such, our results show that during moderate exposure to metals, variation in natural conditions, such as prey availability, can have great impact on organism health compared to Pb exposure.
The lead concentration in capillary blood was investigated in 49 preschool children (0.7-7.4 years of age) visiting a day-care center in a Swedish community with high lead contamination from mining and milling in soil and dust in populated areas [up to 1400 and 14,000 micrograms.g-1 (6.76 and 67.63 mumol.g-1) of dry weight, respectively]. The blood lead levels were examined twice (in April and in September) in 33 of the children. The lead levels were low on both sampling occasions [arithmetic mean 31 (SD 13, median 30, range 13-79) micrograms.l-1, ie, arithmetic mean 0.15, (SD 0.06, median 0.14, range 0.06-0.38) mumol.l-1]. Whereas children up to four years of age showed significantly increased levels from April to September, a significant decrease was seen in older children. The level of lead in soil at home, gender, smoking habits at home, and estimated level of hand-to-mouth activity did not appear as strong determinants of lead in blood. The results indicate that lead from mine waste in soil and dust fallout does not constitute a significant health hazard for preschool children in Falun.
Co-exposure to environmental contaminants present in fish could mitigate the beneficial effects of fish consumption and possibly explain the lack of association observed for mortality in some geographical regions.
To assess the independent associations of dietary exposure to polychlorinated biphenyls (PCBs) and long-chain omega-3 fish fatty acids intake with cardiovascular and cancer mortality.
We used the prospective population-based Swedish Mammography Cohort and the Cohort of Swedish Men comprising 32 952 women and 36 545 men, free from cancer, cardiovascular disease and diabetes at baseline in 1998. Validated estimates of dietary PCBs and long-chain omega-3 fish fatty acids [i.e. eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] intake were obtained via a food frequency questionnaire at baseline. Information on death was ascertained through register linkage.
During a mean follow-up of 15.5 years, we ascertained 16 776 deaths. We observed for cardiovascular mortality, comparing extreme quintiles in multivariable models mutually adjusted for PCBs and EPA-DHA, dose-dependent associations for dietary PCB exposure, hazard ratio (HR) 1.31 (CI 95%: 1.08 to 1.57; P-trend 0.005) and for dietary EPA-DHA intake, HR 0.79 (CI 95%: 0.66 to 0.95; P-trend 0.041). For cancer mortality, no clear associations were discerned.
The beneficial effect of fish consumption on the cardiovascular system seems compromised by co-exposure to PCBs - one likely explanation for the inconsistent associations observed between fish consumption and mortality.