Substance abuse and psychiatric co-morbidity as predictors of premature mortality in Swedish drug abusers a prospective longitudinal study 1970 - 2006

<p>Abstract</p> <p>Background</p> <p>Few longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades.</p> <p>Methods</p> <p>Follow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis.</p> <p>Results</p> <p>Of 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death.</p> <p>Conclusions</p> <p>The cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.</p

Shared socio-economic pathways extended for the Baltic Sea: exploring long-term environmental problems

Long-term scenario analyses can be powerful tools to explore plausible futures of human development under changing environmental, social, and economic conditions and to evaluate implications of different approaches to reduce pollution and resource overuse. Vulnerable ecosystems like the Baltic Sea in North-Eastern Europe tend to be under pressure from multiple, interacting anthropogenic drivers both related to the local scale (e.g. land use change) and the global scale (e.g. climate change). There is currently a lack of scenarios supporting policy-making that systematically explore how global and regional developments could concurrently impact the Baltic Sea region. Here, we present five narratives for future development in the Baltic Sea region, consistent with the global Shared Socioeconomic Pathways (SSPs) developed for climate research. We focus on agriculture, wastewater treatment, fisheries, shipping, and atmospheric deposition, which all represent major pressures on the Baltic Sea. While we find strong links between the global pathways and regional pressures, we also conclude that each pathway may very well be the host of different sectoral developments, which in turn may have different impacts on the ecosystem state. The extended SSP narratives for the Baltic Sea region are intended as a description of sectoral developments at regional scale that enable detailed scenario analysis and discussions across different sectors and disciplines, but within a common context. In addition, the extended SSPs can readily be combined with climate pathways for integrated scenario analysis of regional environmental problems.Peer reviewe

Different subcellular localisations of TRIM22 suggest species-specific function

The B30.2/SPRY domain is present in many proteins, including various members of the tripartite motif (TRIM) protein family such as TRIM5α, which mediates innate intracellular resistance to retroviruses in several primate species. This resistance is dependent on the integrity of the B30.2 domain that evolves rapidly in primates and exhibits species-specific anti-viral activity. TRIM22 is another positively selected TRIM gene. Particularly, the B30.2 domain shows rapid evolution in the primate lineage and recently published data indicate an anti-viral function of TRIM22. We show here that human and rhesus TRIM22 localise to different subcellular compartments and that this difference can be assigned to the positively selected B30.2 domain. Moreover, we could demonstrate that amino acid changes in two variable loops (VL1 and VL3) are responsible for the different subcellular localisations

KONTAKT© for Australian adolescents on the autism spectrum: protocol of a randomized control trial

BACKGROUND:Individuals diagnosed with autism spectrum disorder (ASD) experience impairing challenges in social communication and interaction across multiple contexts. While social skills group training (SSGT) has shown moderate effects on various sociability outcomes in ASD, there is a need for (1) replication of effects in additional clinical and cultural contexts, (2) designs that employ active control groups, (3) calculation of health economic benefits, (4) identification of the optimal training duration, and (5) measurement of individual goals and quality of life outcomes.METHOD/DESIGN:With the aim of investigating the efficacy and cost-effectiveness of a SSGT, KONTAKT©, a two-armed randomized control trial with adolescents aged 12-17 years (N = 90) with ASD and an intelligence quotient (IQ) of over 70 will be undertaken. Following stratification for centre and gender, participants will be randomly assigned to either KONTAKT© or to an active control group, a group-based cooking programme. Participants will attend both programmes in groups of 6-8 adolescents, over 16 one-and-a-half-hour sessions. The primary outcome examined is adolescent self-rated achievement of personally meaningful social goals as assessed via the Goal Attainment Scaling during an interview with a blinded clinician. Secondary outcomes include adolescent self-reported interpersonal efficacy, quality of life, social anxiety, loneliness, face emotion recognition performance and associated gaze behaviour, and parent proxy reports of autistic traits, quality of life, social functioning, and emotion recognition and expression. Cost-effectiveness will be investigated in relation to direct and indirect societal and healthcare costs.DISCUSSION:The primary outcomes of this study will be evidenced in the anticipated achievement of adolescents' personally meaningful social goals following participation in KONTAKT© as compared to the active control group. This design will enable rigorous evaluation of the efficacy of KONTAKT©, exercising control over the possibly confounding effect of exposure to a social context of peers with a diagnosis of ASD.TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12617001117303. Registered on 31 July 2017. anzctr.org.au ClinicalTrials.gov, NCT03294668. Registered on 22 September 2017. https://clinicaltrials.gov.</p

The influence of seating load on internal and marginal fit of a fixed dental prosthesis

Syfte: Syftet med studien var att undersöka hur olika axiala tryck och skjuvkrafter påverkade marginal och intern passform i en sexledsbro i titan i överkäkens frontregion. Material och metod: En litteratursökning gjordes för att insamla bakgrundsmaterial. Stödtänderna 13 12 11 21 22 23 preparerades på en plastmodell för en sexledsbro och en anatomiskt utformad bro i titan framställdes med hjälp CAD/CAM. En mastermodell av stödtänderna tillverkades i epoxyresin. Genom att använda replikateknik utvärderades brons passform vid olika cementeringstryck; 20, 35, 50, 70 N och 50 N med skjuvkrafter. Varje replika snittades med hjälp av en ”jig” och cementspalten analyserades i ett mikroskop. All data granskades statistiskt. Resultat: Resultatet visade att ett tryck med 20 N generellt gav en ej acceptabel passform och ett tryck med 35 N hade en stor spridning. Vid tryck med 50 N kunde mindre cementspalter ses. De blev inte mindre vid test med 70 N. När skjuvkrafter adderades försämrades resultaten jämfört med försöken med 50 N och 70 N. Konklusion: Ett tryck vid cementering som överstiger 50 N förbättrar ej passformen markant. Närvaro av skjuvkrafter påverkar passformen negativt. Ett lägre tryck på 20 N ger dock en mindre fördelaktig passform jämfört med skjuvkrafter förutsatt att ett tillräckligt högt tryck används. Alla slutsatser var statistiskt signifikanta.Purpose: The purpose of this study is to investigate how different axial seating loads and shear loads influences the marginal and internal fit of a titanium six unit FDP in the upper jaw frontal region. Materials and Methods: A literature search was made to acquire background material. Preparations of abutment teeth for a six unit FDP 13 12 11 21 22 23 were made on plastic teeth, and an anatomically designed titanium FDP was constructed using CAD/CAM. A master cast of the abutment teeth was fabricated in epoxy resin. Using the impression replica technique the fit of the FDP was evaluated by different seating loads during cementation; 20, 35, 50, 70 N and 50 N under the presence of shear loads. The replicas were sectioned using a jig and the cement gap was analysed using a microscope. All the data were statistically analysed. Results: The results showed that a seating load of 20 N generally gave an unacceptable fit and that the seating load of 35 N had great range. At seating loads of 50 N less cement gaps could be seen, i.e. more favourable fit. These results did not improve when testing with 70 N. With a presence of shear loads the results were poorer than when testing with 50 and 70 N. Conclusions: A seating load exceeding 50 N during cementation does not markedly give a more favourable fit. The presence of shear loads affects the fit negatively. A lower seating load of 20 N gives a less favourable fit compared to shear loads provided that a seating load high enough is used. All of these conclusions were statistically significant

Buprenorphine maintenance program with contracted work/education and low tolerance for non-prescribed drug use: a cohort study of outcome for women and men after seven years.

Background A seven-year follow-up of heroin dependent patients treated in a buprenorphine-maintenance program combining contracted work/education and low tolerance for non-prescribed drug use. Gender-specific differences in outcome were analysed. Methods A consecutively admitted cohort of 135 men and 35 women, with eight years of heroin abuse/dependence on average was admitted to enhanced buprenorphine maintenance treatment. Standardized interviews, diagnostic assessments of psychiatric disorders and psychosocial conditions were conducted at admission and at follow-ups. Outcome associated with gender was reported for abstinence, retention, psychiatric symptoms, employment and criminal convictions. Results 148 patients started treatment. After seven years, 94/148 patients (64%) were retained in the program, employed and abstinent from drugs and alcohol. Women had more continuous abstinence, retention and employment than men (76% versus 60%). After one year patients with a high-risk consumption of alcohol were no longer heavy consumers of alcohol and remained so throughout the study (p < .001). All women regained custody of their children. At admission, more women than men had been admitted for psychiatric disorders (70%/44%) and to compulsory care for substance abuse (30%/18%). Initial gender differences of psychiatric co-morbidity decreased and were no longer significant after one year. More men than women had been imprisoned (62% versus 27%) or in non-institutional care (80% versus 49%). Criminal convictions were reduced from 1751 convictions at admission to 742 (58%) after seven years. Eight patients in the entire cohort died over the 7 years (0.7% per year). One patient died in the completers group while still in the program (0.1% per year). Conclusions After seven years, two thirds of the patients in the program were abstinent and employed. Convictions ceased in the completers group. One patient died in the completers group. Women had superior long-term outcome compared to men: more continuous abstinence, employment and fewer convictions. Women also lived with their children to a higher extent than men. The positive outcome highlights the importance of maintaining high structure in combining pharmacological treatment with a focus on employment and psychological treatment and low tolerance for non-prescribed drug use

iKONTAKT - a multimodal, online social skills group training for autistic youths

This research project aim to adapt a manualised social skills group training for autistic children and adoelscents implementented in-person within clinical healthcare services (KONTAKT) to multimodal, online format - iKONTAKT. Development is characterised by stakeholder consultation to increase the social validity of the product. First, outcomes of focus groups with clinicians, parents of autistic youth, and autistic adolescents will be implemented in iKONTAKT manual development. Second, a complete format of iKONTAKT will be implemented with two dyads of autistic youts and their caregiver (proof-of-concept) aiming to finalise the program. Finally, feasibility of iKONTAKT will be investigated in a pilottrial (N=40). Additionally, the project aim to investigate the psychometric propoerties of a newly developed questionnaire, Stockholm Social Skills Support Sensitivity Scale [6S]. The questionnaire has recently been developed at our research center, aiming to more closely investigate effects of KONTAKT (and its iterations) on psychological concepts such as empowerment and self-efficacy in social situations