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

An evaluation of an optimal sampling strategy for meropenem in febrile neutropenics

Optimal sampling design with nonparametric population modeling offers the opportunity to determine pharma-cokinetic parameters for patients in whom blood sampling is restricted. This approach was compared to a standard individualized modeling method for meropenem pharmacokinetics in febrile neutropenic patients. The population modeling program, nonparametric approach of expectation maximization (NPEM), with a full data set was compared to a sparse data set selected by D-optimal sampling design. The authors demonstrated that the D-optimal sampling strategy, when applied to this clinical population, provided good pharmacokinetic parameter estimates along with their variability. Four individualized and optimally selected sampling time points provided the same parameter estimates as more intensive sampling regimens using traditional and population modeling techniques. The different modeling methods were considerably consistent, except for the estimation of CLd with sparse sampling. The findings suggest that D-optimal sparse sampling is a reasonable approach to population pharmacokinetic/pharmacodynamic studies during drug development when limited sampling is necessary

Girls’ Perspectives on Gendered Violence in Rural Sweden : Photovoice as a Method for Increased Knowledge and Social Change

Research has shown for decades that gendered violence against girls and women is a major public health problem with devastating long-term health consequences for individuals and communities alike. Knowledge of gendered violence against girls and young women thus needs to be increased not only in urban, but also in rural areas, and from girls’ own perspectives. Research methods should also be developed that will facilitate the possibility of reaching policy makers, i.e. to reach those with the power to bring about social change. This study had two main goals. The first was to use photovoice as a methodology to gain increased knowledge about gendered violence against girls and young women in rural Sweden, while the second was to discuss the potential of reaching social change through photovoice as well as offer some critique. We worked with 35 adolescent girls enrolled in an upper secondary school in rural Sweden. Six workshops, which focused on (un)safety, different forms of violence, and the consequences of violence, were analyzed with an action-oriented approach and content analysis. The photovoice material also resulted in an exhibition that was used to reach policy makers. The findings show that the girls’ ability to control their own lives was limited and that a number of different situations in their everyday lives were related to a reduced sense of space and reduced sense of agency. The findings also highlight that the girls were constantly sexually harassed online, which created a feeling of being unable to escape. We argue that photovoice is suitable in mediating girls’ perspectives and in engaging and informing key policy makers, although the method alone cannot assure social change.