Adolescent alcohol use: Implications for prevention

Background Alcohol use, especially heavy episodic drinking, at an early age has been associated with various problems (e.g. risky sexual behaviours, health problems, depression, and heavy alcohol consumption at a later age). Thus, a better understanding of the risk and protective factors that influence adolescent alcohol use is crucial to developing effective prevention strategies. The aim of this thesis is to examine the importance of risk and protective factors in the development of heavy episodic drinking and subsequent problems for adolescent boys and girls. In addition, the prevention paradox (most alcohol-related problems occur in the 90 % of the population with lowest alcohol consumption) was examined among adolescents in Sweden and Europe. Methods Data from three different questionnaire studies were analysed: (1) a longitudinal cohort study with 1222 adolescents from Stockholm, aged 13 to 19 years, (2) a cross-sectional study with 3000 adolescents aged 15 years and 17 years from random samples of school classes throughout the whole of Sweden, and (3) a cross-sectional study (the European School Survey Project on Alcohol and Other Drugs, ESPAD) performed in 35 countries among students who turned 16 during the year of the data collection. Twenty-three countries with 38 370 alcohol-consuming adolescents were included. Results Smoking and peer alcohol use were strongly associated with heavy drinking among both boys and girls, both cross-sectionally and longitudinally. Some gender differences were found; parental provision of alcohol in the 7th grade increased the odds for heavy alcohol use in girls two years later, and truancy was associated with later heavy alcohol use in boys. For boys, heavy episodic drinking at age 13 was one of the most distinct predictors of later heavy episodic drinking. For girls, secure bonds to parents lowered the risk for heavy episodic drinking, even if the girls had friends who drank alcohol, money to spend, or parents who offered them alcohol. For boys whose parents offered them alcohol, parental monitoring had a protective effect. Also, we found that adolescents on a consistent high alcohol use trajectory during early adolescence had higher levels of heavy episodic drinking and alcohol-related problems at age 19. Furthermore, the prevention paradox was valid for adolescent boys and girls in Sweden and in most European countries; despite differences in annual alcohol consumption, levels of heavy episodic drinking, and reported problems, the heavy episodic drinkers in the bottom 90% consumer group accounted for a majority of all reported problems. Conclusions Effective population strategies may have large potential to reduce risk drinking and the overall problem level. A comprehensive prevention strategy should nevertheless also include efforts to reach adolescent high consumers. Furthermore, our results lend support to prevention initiatives to strengthen the parent–child relationship, to focus on adolescents‟ ability to resist peer pressure, and to limit parental provision of alcohol

Chemical and transcriptional responses of Norway spruce genotypes with different susceptibility to Heterobasidion spp. infection

Background: Norway spruce [Picea abies (L.) Karst.] is one of the most important conifer species in Europe. The wood is economically important and infections by wood-rotting fungi cause substantial losses to the industry. The first line of defence in a Norway spruce tree is the bark. It is a very efficient barrier against infection based on its mechanical and chemical properties. Once an injury or an infection is recognized by the tree, induced defences are activated. In this study we examined transcriptional response, using 454-sequencing, and chemical profiles in bark of Norway spruce trees with different susceptibility to Heterobasidion annosum s.l. infection. The aim was to find associations between the transcriptome and chemical profiles to the level of susceptibility to Heterobasidion spp. in Norway spruce genotypes. Results: Both terpene and phenol compositions were analysed and at 28 days post inoculation (dpi) high levels of 3-carene was produced in response to H. annosum. However, significant patterns relating to inoculation or to genotypes with higher or lower susceptibility could only be found in the phenol fraction. The levels of the flavonoid catechin, which is polymerized into proanthocyanidins (PA), showed a temporal variation; it accumulated between 5 and 15 dpi in response to H. annosum infection in the less susceptible genotypes. The transcriptome data suggested that the accumulation of free catechin was preceded by an induction of genes in the flavonoid and PA biosynthesis pathway such as leucoanthocyanidin reductase. Quantitative PCR analyses verified the induction of genes in the phenylpropanoid and flavonoid pathway. The qPCR data also highlighted genotype-dependent differences in the transcriptional regulation of these pathways. Conclusions: The varying dynamics in transcriptional and chemical patterns displayed by the less susceptible genotypes suggest that there is a genotypic variation in successful spruce defence strategies against Heterobasidion. However, both high levels of piceasides and flavonoids in the less susceptible genotypes suggested the importance of the phenolic compounds in the defence. Clearly an extended comparison of the transcriptional responses in the interaction with Heterobasidion between several independent genotypes exhibiting reduced susceptibility is needed to catalogue mechanisms of successful host defence strategies

Hazardous alcohol use:A cross-sectional study of cardiology patients in Sweden

Background Alcohol use is understudied in cardiology settings. We investigated the prevalence of hazardous alcohol use and probable dependence among cardiology patients. Methods Cross-sectional study in three regions of Sweden. Alcohol use was assessed using the AUDIT-10 questionnaire. We defined hazardous alcohol use as: AUDIT-10 ≥ 6 for women or ≥ 8 for men (primary definition) and probable dependence as AUDIT-10 ≥ 13 for women or ≥ 15 for men. We examined associations using logistic regression. Results We included 1107 participants (median age = 73 years; range = 18-102; 66% men). The prevalence of hazardous alcohol use was 7.8% (95%CI = 6.2-9.3, primary definition) and 0.9% (95%CI = 0.3-1.5) had probable alcohol dependence. We found increased odds of hazardous alcohol use in: age groups 18-39 years (OR = 4.90, 95%CI = 1.41-17.08) and 40-64 years (OR = 4.02, 95%CI = 1.69-9.67) compared to ≥80 years; a city compared to a small town (OR = 2.44, 95%CI = 1.02-5.84); participants with unhealthy diets (OR = 2.37, 95%CI = 1.36-4.13), and overweight participants (OR = 2.25, 95%CI = 1.23-4.12). Conclusions Hazardous alcohol use affected about one in 12 cardiology patients. However, less than 1 in 100 had probable alcohol dependence. Findings suggest that many cardiology patients with hazardous alcohol use are appropriate for brief interventions, and may not require more intensive alcohol dependence treatments.</p

Task sharing and teamwork:clinician preferences for alcohol screening and brief interventions in cardiology

Objective: To investigate clinicians’ preferences for alcohol screening and brief interventions in clinical cardiology settings. Results: A total of 664 cardiology clinicians responded to a cross-sectional survey (30.9% response rate), including 55.1% nurses, 21.4% assistant nurses, 18.8% doctors, and 4.7% other clinical staff. Among these participants, 87.5% indicated that patients should be screened for alcohol use on cardiology wards, 79.8% in outpatient clinics, 49.1% in emergency departments, and 45.9% on coronary care units. Doctors and nurses were the preferred professions to be responsible for screening across all clinical contexts, while fewer respondents indicated that assistant nurses or physiotherapists should be responsible for screening (p &lt;.001). Most participants (85.2%) indicated that patients should be screened in more than one clinical context and 84.6% indicated that more than one profession should be responsible for alcohol screening. Clinicians’ preferred modality for assessing alcohol use was verbal screening (92% of participants), followed by questionnaires (53.5%), digital tools (28.5%), and alcohol biomarkers (22.1%, p &lt;.001). Just over half of participants (58%) indicated that they would like to attend training on brief interventions. Findings suggest that task sharing, teamwork, and training may be effective strategies for implementation of alcohol screening and brief interventions in clinical cardiology.</p

Digital teknik och socialt arbete : Att motivera socialt utsatta ungdomar med stöd av motivationsappar och hälsoarmband

Digital teknik och socialt arbete är en pilotstudie som syftat till att undersöka effekter av att använda aktivitetsarmband med tillhörande motivationsapp för att stärka ungdomars motivation till fysisk aktivitet och goda sömnvanor. Projektet har präglats av ett explorativt angreppsätt i det att vi undersökt hur introduktion av ny digital teknik mottas av olika målgrupper inom socialtjänsten. Forskning har visat sig att det finns en tydlig koppling mellan ökad fysisk aktivitet och minskad psykisk ohälsa. Sömnen är ytterligare faktor som spelar en betydande roll för barn och ungas hälsa. Vi har denna kunskap om fysiska aktivitet och sömn i samhället idag samtidigt som barn och ungas psykiska och fysiska hälsosituation utgör ett uppmärksammat folkhälsoproblem. Att barn rör på sig för lite syns hos alla grupper av barn och unga oavhängigt faktorer som familjeförhållanden, arbetsmarknadsstatus och föräldrars samhällsekonomiska status. Enligt Socialstyrelsen (2013) är det av extra vikt att barn och unga uppnår bästa möjliga hälsa eftersom det visat sig att nedsatt hälsotillstånd i unga år kan få betydelse för resten av individens liv. Insatser för att preventivt främja våra barns och ungas hälsa är därför en önskvärd och god samhällsinvestering både för den enskilda individen och för allas vår gemensamma hållbara framtid. Denna rapport beskriver resultatet av ett forsknings-och utvecklingsprojekt där vi undersökt hur appar och aktivitetsarmband skulle kunna användas för att motivera barn och unga till ökad fysisk aktivitet samt bättre sömnvanor.  Våra undersökningar av tidigare forskning inom problemområdet har visat på att det finns en tydlig koppling mellan ökad fysisk aktivitet och minskad psykisk ohälsa, såsom t.ex. att fysisk aktivitet kan minska depression och ångest. Fysisk aktivitet har samma effekt som psykologisk behandling och medicinering, men ger betydligt färre biverkningar än medicinering. Det finns också framgångsrika försök med viktminskningsgrupper som arbetat med stöd av digitala lösningar. Tekniken i sig kan bidra med att sätta mål, motivera, och följa upp resultat. Sociala funktioner för att kunna följa andras framsteg har visat sig öka motivation gällande att vara mer fysiskt aktiv. Angreppsätt där man låter användare mäta och följa sitt eget beteende ger den största positiva effekten för att åstadkomma hälsofrämjande beteendeförändringar.  Om fysisk aktivitet är bra för hälsa är sömn om möjligt ännu viktigare. Forskning inom sömn visar att det en tydlig koppling mellan sömn och vardagligt välbefinnande. Det har konstaterats att olika typer av sömn har olika funktioner. REM-sömnen har t.ex. påvisat koppling till bättre mönsterigenkänning medan djupsömnen har en påverkan på minnet. Forskning visar också att sömnlöshet påverkar immunförsvaret negativt vilket i sin tur kan bidra till sömnstörningar och övervikt hos ungdomar. Vad gäller teknik så visar forskning att professionell kompetens inom hälsa och medicin inte alltid används vid framtagning av teknik, vilket utgör ett återkommande problem. Det är inte enbart är tekniken som måste fungera för att insatsen ska kunna lyckas, attityden till e-hälsa bland befolkningen generellt sett kan också ha en avgörande betydelse. Om den generella bilden av tekniken bland befolkningen är negativ så är det svårt att införa och lyckas med teknikstöd. Teknikutvecklingen är snabb, och vi står inför en dramatisk ökning av olika informations- och telekommunikationsteknologier vars syfte är att förbättra och utveckla egenvård och omsorg. Frågor om integritet hamnar ofta i skymundan. Flertalet av de identifierade relevanta publikationerna fokuserade mer på tekniken än det hälsobefrämjande stödet. Vår bibliografiska undersökning visar att det finns förhållandevis lite av samband mellan begrepp som är relaterade till hälsoappar och egenvård kontra motivationsarbete och socialt arbete. De starkaste sambanden av intresse för oss hittade vi i ett gränsland mellan medicin och datavetenskap. Sammanfattningsvis kan vi säga att flertalet av de här identifierade akademiska publikationerna diskuterar de tekniska lösningarna i sig, eller presenterar användarvalidering av olika lösningar; snarare än socialt arbete, eget motivations- och förändringsarbete av dåliga vanor och livsmönster - som är vårt intresseområde i denna studie. För att bättre förstå och bidra till utmaningarna så har ett samarbete initierats mellan Helsingborgs stads Forsknings- och utvecklingsenhet för social hållbarhet (FoU Helsingborg), Preventivt arbete tillsammans (PART) från Helsingborgs stad och forskare från både Lunds Internet institut (LUii), Lunds Universitet samt Digital design, Sektionen för hälsa och samhälle på Kristianstad Högskola (HKR). Ett internt utvecklingsprojekt har genomförts av PART med stöd av FoU i Helsingborgs stad. I samband med utvecklingsprojektet har ett gränsöverskridande samarbete initierats där aktionsforskning ramat in utvecklingsprojektets empiriska studie och möjliggjort en gemensam yta för ett bredare kunskapsskapande. Vårt fokus har varit ett kunskapsbildande vad gäller aktivitetsarmband och motivationsappar för barn och unga som löper risk för ohälsa. Denna rapport presenterar en akademisk kunskapsöversikt, samt resultatet från ett utvecklingsprojekt där vi tillsammans undersökt effekterna av att använda aktivitetsarmband och tillhörande social app. Vi har beforskat vilken påverkan dessa kan ha på ungdomars egen motivation till fysisk aktivitet och goda sömnvanor. Syftet med pilotprojektet har varit att kartlägga forskningen på området, undersöka de upplevda effekter av att använda aktivitetsarmband med tillhörande motivationsapp för att stärka deltagares motivation till fysisk aktivitet och förbättrade sömnvanor, samt undersöka hur vi kan förstå de faktorer som verkar vara mest betydande för att uppnå effekter. Det senare har vi gjort genom att fokusera på fyra övergripande områden: Användandet av motivationsapp - Hur länge och med vilken frekvens använder deltagarna armband och motivationsapp? Värdeskapande för ungdomar - Till vilka positiva resultat bidrar armband och motivationsapp? Negativa bieffekter - Kan armband och motivationsapp orsaka negativa bieffekter hos deltagarna? Om så, till vilka områden hänför sig dessa bieffekter? Värdeskapande för personal – Vilken nytta ser personalen av armband och motivationsapp i sitt arbete? Ur ett forskningsperspektiv så är studien att betrakta som mindre, varvid dess värde skall beaktas utifrån detta. Mer forskning behövs i området motivationsappar och socialt arbete. Studieresultatet visar på faktorer som har betydelse för frågeställningarna, som också kan identifieras i tidigare forskning. Positiva upplevelser har varit att ungdomarna fått en märkbart ökad medvetenhet om sina egna levnadsmönster vad gäller motion och sömn. Tydligast märktes den nya medvetenhet som växte fram runt egna sömnvanor, även att dessa inte alltid gick att åtgärda på egen hand. Det var också uppenbart att den nya medvetenheten ledde ökad motivation och fysisk aktivitet. Identifierade negativa bieffekter var att stress kunde uppstå när ungdomarna var förhindrade att själva öka sitt stegantal samtidigt som de såg andra ungdomars resultat öka. Det rapporterades problem med att sköta den dagliga laddningen av aktivitetsarmbandet, samt att aktivera sömnmätningen när de skulle lägga sig. Ett stort värde för personalen var att de fick ett instrument som berikade kommunikationen utifrån “objektiv” data genererad av ungdomarnas egna mätningar av motion och sömn. Ett verktyg som utgjorde god hjälp för samtal, som i sig kunde bidra till bättre struktur i ungdomars liv

Genetic- and Lifestyle-dependent Dental Caries Defined by the Acidic Proline-rich Protein Genes PRH1 and PRH2.

Dental caries is a chronic infectious disease that affects billions of people with large individual differences in activity. We investigated whether PRH1 and PRH2 polymorphisms in saliva acidic proline-rich protein (PRP) receptors for indigenous bacteria match and predict individual differences in the development of caries. PRH1 and PRH2 variation and adhesion of indigenous and cariogenic (Streptococcus mutans) model bacteria were measured in 452 12-year-old Swedish children along with traditional risk factors and related to caries at baseline and after 5-years. The children grouped into low-to-moderate and high susceptibility phenotypes for caries based on allelic PRH1, PRH2 variation. The low-to-moderate susceptibility children (P1 and P4a-) experienced caries from eating sugar or bad oral hygiene or infection by S. mutans. The high susceptibility P4a (Db, PIF, PRP12) children had more caries despite receiving extra prevention and irrespective of eating sugar or bad oral hygiene or S. mutans-infection. They instead developed 3.9-fold more caries than P1 children from plaque accumulation in general when treated with orthodontic multibrackets; and had basic PRP polymorphisms and low DMBT1-mediated S. mutans adhesion as additional susceptibility traits. The present findings thus suggest genetic autoimmune-like (P4a) and traditional life style (P1) caries, providing a rationale for individualized oral care

Alcohol-attributed disease burden and formal alcohol policies in the Nordic countries (1990–2019): an analysis using the Global Burden of Disease Study 2019

It is still unclear how changes in alcohol control policies may have contributed to changes in overall levels of alcohol-attributed harm between and within the Nordic countries. We modified and applied the Bridging the Gap (BtG)-scale to measure the restrictiveness of a set of alcohol control policies for each Nordic country and each year between 1990 and 2019. Alcohol-attributed harm was measured as total and sex-specific alcohol-attributed disease burden by age-standardized years of life losts (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) per 100 000 population from the Global Burden of Disease Study (GBD). Longitudinal cross-country comparisons with random effects regression analysis were employed to explore associations, within and across countries, differentiated by sex and the time to first effect. Overall, alcohol-attributed YLLs, YLDs, and DALYs decreased over the study period in all countries, except in Iceland. The burden was lower in those countries with restrictive national policies, apart from Finland, and higher in Denmark which had the least restrictive policies. Changes in restrictiveness were negatively associated with DALYs for causes with a longer time to effect, although this effect was stronger for males and varied between countries. The low alcohol attributed disease burden in Sweden, Norway, and Iceland, compared to Denmark, points towards the success of upholding lower levels of harm with strict alcohol policies. However, sex, location and cause-specific associations indicate that the role of formal alcohol policies is highly context dependent and that other factors might influence harm as well.publishedVersio

Alcohol-attributed disease burden and formal alcohol policies in the Nordic countries (1990–2019): an analysis using the Global Burden of Disease Study 2019

It is still unclear how changes in alcohol control policies may have contributed to changes in overall levels of alcohol-attributed harm between and within the Nordic countries. We modified and applied the Bridging the Gap (BtG)-scale to measure the restrictiveness of a set of alcohol control policies for each Nordic country and each year between 1990 and 2019. Alcohol-attributed harm was measured as total and sex-specific alcohol-attributed disease burden by age-standardized years of life losts (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) per 100 000 population from the Global Burden of Disease Study (GBD). Longitudinal cross-country comparisons with random effects regression analysis were employed to explore associations, within and across countries, differentiated by sex and the time to first effect. Overall, alcohol-attributed YLLs, YLDs, and DALYs decreased over the study period in all countries, except in Iceland. The burden was lower in those countries with restrictive national policies, apart from Finland, and higher in Denmark which had the least restrictive policies. Changes in restrictiveness were negatively associated with DALYs for causes with a longer time to effect, although this effect was stronger for males and varied between countries. The low alcohol attributed disease burden in Sweden, Norway, and Iceland, compared to Denmark, points towards the success of upholding lower levels of harm with strict alcohol policies. However, sex, location and cause-specific associations indicate that the role of formal alcohol policies is highly context dependent and that other factors might influence harm as well.publishedVersio

Disease Burden Attributed to Drug use in the Nordic Countries: a Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2019

The Nordic countries share similarities in many social and welfare domains, but drug policies have varied over time and between countries. We wanted to compare differences in mortality and disease burden attributed to drug use over time. Using results from the Global Burden of Disease (GBD) study, we extracted age-standardized estimates of deaths, DALYs, YLLs and YLDs per 100 000 population for Denmark, Finland, Iceland, Norway, and Sweden during the years 1990 to 2019. Among males, DALY rates in 2019 were highest in Finland and lowest in Iceland. Among females, DALY rates in 2019 were highest in Iceland and lowest in Sweden. Sweden have had the highest increase in burden since 1990, from 252 DALYs to 694 among males, and from 111 to 193 among females. Norway had a peak with highest level of all countries in 2001–2004 and thereafter a strong decline. Denmark have had the most constant burden over time, 566–600 DALYs among males from 1990 to 2010 and 210–240 DALYs among females. Strict drug policies in Nordic countries have not prevented an increase in some countries, so policies need to be reviewed.publishedVersio