Recurring alcohol-related care between 1998 and 2007 among people treated for an alcohol-related disorder in 1997: A register study in Stockholm County

<p>Abstract</p> <p>Background</p> <p>Inpatient care for alcohol intoxication is increasing in Sweden, especially among young women. Since it is well known that alcohol disorder is a chronic relapsing illness, this study examines the extent to which people return for more care.</p> <p>Method</p> <p>All inpatients with alcohol-related diagnoses in Stockholm County during 1997 were followed prospectively to 2007 through registers. The proportion reappearing for the same diagnosis, other alcohol-related inpatient, or outpatient care each year after baseline, as well as the number of years the inpatients reappeared were calculated (n = 2735). Three diagnoses were examined separately; alcohol dependence, harmful use of alcohol, and alcohol intoxication.</p> <p>Results</p> <p>Three out of five inpatients with an alcohol diagnoses reappeared for more alcohol-related inpatient care during the following decade. The proportion returning was largest the year after baseline and then decreased curvilinearly over time. The inclusion of outpatient care increased proportions, but did not change patterns. Of those with an alcohol dependence diagnosis at baseline 42 percent returned for more alcohol-related inpatient care the first, 28 percent the fifth, and 25 percent the tenth year. Corresponding proportions for harmful use and intoxication were smaller. One in five among those with an alcohol dependence returned for more than five of the ten years. Ordered logistic regressions confirmed that besides diagnosis, age and gender were independently related to the number of years returning to care.</p> <p>Conclusions</p> <p>While middle-aged males with alcohol dependence were in a revolving door, young female inpatients with intoxication diagnosis returned to a comparably lower degree.</p

Recurrent governance challenges in the implementation and alignment of flood risk management strategies: a review

In Europe increasing flood risks challenge societies to diversify their Flood Risk Management Strategies (FRMSs). Such a diversification implies that actors not only focus on flood defence, but also and simultaneously on flood risk prevention, mitigation, preparation and recovery. There is much literature on the implementation of specific strategies and measures as well as on flood risk governance more generally. What is lacking, though, is a clear overview of the complex set of governance challenges which may result from a diversification and alignment of FRM strategies. This paper aims to address this knowledge gap. It elaborates on potential processes and mechanisms for coordinating the activities and capacities of actors that are involved on different levels and in different sectors of flood risk governance, both concerning the implementation of individual strategies and the coordination of the overall set of strategies. It identifies eight overall coordination mechanisms that have proven to be useful in this respect

The Association Between Self-Reported Mental Health Status and Alcohol and Drug Abstinence 5 Years Post-Assessment for an Addiction Disorder in U.S. and Swedish Samples

This study compared whether self-reported mental health status was associated with likelihood of being abstinent from alcohol and drugs five years after baseline assessment for an addiction disorder in two representative samples; one from Sweden (n = 469) and one from the US (n = 667). Self-reported mental health status was measured through the ASI score of mental health symptoms and history of inpatient and/or outpatient treatment. Through logistic regression modeling the study controlled for demographic characteristics including age, gender, employment status and social network connection with individuals who do not use alcohol/drugs. For both the US and Swedish samples employment status and having a social network that does not use alcohol and drugs were associated with being likely to be abstinent from alcohol and drugs five years after initial assessment. For the US sample only, individuals who reported symptoms of anxiety were 50% more likely not to be abstinent from alcohol and drugs at follow-up. For the Swedish sample, current mental health status was not significantly associated with abstinence. However, reporting a lifetime history of inpatient psychiatric treatment at the baseline assessment was significantly associated with not being abstinent at 5 years post assessment; those with a lifetime history of inpatient mental health treatment were 47% less likely to report abstinence. While specific variables differ across Sweden and the US, psychiatric comorbid status, employment and social network are each associated with drug and alcohol abstinence cross-nationally