uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Thiblin, Ingemar
Publications (10 of 48) Show all publications
Tamsen, F., Sturup, J. & Thiblin, I. (2019). Homicide injury severity in association with the victim-offender relationship. Forensic Science International, 300, 151-156
Open this publication in new window or tab >>Homicide injury severity in association with the victim-offender relationship
2019 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 300, p. 151-156Article in journal (Refereed) Published
Abstract [en]

There are previous studies that have found associations between specific injury patterns and different victim-offender relationships (VORs) in homicides. We have used quantitative injury severity scores to further investigate this issue. The amount and severity of injuries were assessed in 178 Swedish homicide victims, retrospectively included from the years 2007-2009. We analyzed whether different injury measures could be used to predict the VOR. In addition to a deeper understanding of violent behavior, such associations may be of help to homicide investigators for offender profiling. The victims' injuries were assessed with eleven different methods. The cases with known VORs were divided into four categories: partner, relative, acquaintance, and stranger. The injury seventies were then compared between these categories. No relevant differences were found. Thus, the current study does not support the claim that the VOR can be predicted from the injury severity in a general homicide population. These findings are in contrast to the results of some previous studies but confirm those of others.

Keywords
Homicide, Injury score, Injury quantification, Offender profiling
National Category
Forensic Science
Identifiers
urn:nbn:se:uu:diva-383634 (URN)10.1016/j.forsciint.2019.05.012 (DOI)000470903500030 ()
Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-07-05Bibliographically approved
Fugelstad, A., Thiblin, I., Johansson, L. A., Ågren, G. & Sidorchuk, A. (2019). Opioid-related deaths and previous care for drug use and pain relief in Sweden. Drug And Alcohol Dependence, 201, 253-259
Open this publication in new window or tab >>Opioid-related deaths and previous care for drug use and pain relief in Sweden
Show others...
2019 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 201, p. 253-259Article in journal (Refereed) Published
Abstract [en]

Aim: In 2006-2014, the rate of drug-related deaths, typically opioid poisonings, more than doubled in Sweden. Opioid prescriptions for pain control or opioid agonist therapy also increased. In this retrospective study, we compared death rates between individuals whose first recorded contact with prescribed opioids was for pain control and individuals that had received substance use disorder (SUD) treatment before their first recorded opioid prescription.

Methods: We included 2834 forensically examined individuals (ages 15-64 years) that died of poisoning in Sweden in 2006-2014. For each death we acquired data on previous opioid prescriptions and SUD treatments. We compared three study groups: pain control (n = 788); a SUD treatment group (n = 1629); and a group with no prescription for pain control or SUD treatment (n = 417).

Results: Overall fatal poisonings increased from 2.77 to 7.79 (per 100,000 individuals) from 2006 to 2014 (relative 181% increase). Fatal poisoning increased from 2006 to 2014 by 269% in the pain control group (0.64 to 2.36 per 100,000) and by 238% in the SUD treatment group (1.35 to 4.57 per 100,000). Heroin-related deaths remained constant; consequently, the increase was likely attributable to prescription opioids.

Conclusion: A rapid increase in deaths attributable mainly to prescription opioids for pain control, was reported previously in the United States. Our study indicated that increased access to prescription opioids might contribute to higher death rates also in Sweden among patients seeking pain control and individuals with an established SUD; however, deaths related to prescription opioids mainly occurred among those with SUDs.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
Keywords
Prescription opioids, Fatal poisoning, Mortality, Epidemiology, Opioid dependence
National Category
Substance Abuse
Identifiers
urn:nbn:se:uu:diva-391284 (URN)10.1016/j.drugalcdep.2019.04.022 (DOI)000476963200035 ()31260826 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00117
Available from: 2019-08-22 Created: 2019-08-22 Last updated: 2019-08-22Bibliographically approved
Gravensteen, I. K., Ekeberg, Ö., Thiblin, I., Helweg-Larsen, K., Hem, E., Rogde, S. & Töllefsen, I. M. (2019). Psychoactive substances in natural and unnatural deaths in Norway and Sweden: a study on victims of suicide and accidents compared with natural deaths in psychiatric patients. BMC Psychiatry, 19, Article ID 33.
Open this publication in new window or tab >>Psychoactive substances in natural and unnatural deaths in Norway and Sweden: a study on victims of suicide and accidents compared with natural deaths in psychiatric patients
Show others...
2019 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 19, article id 33Article in journal (Refereed) Published
Abstract [en]

Background: The extent of post-mortem detection of specific psychoactive drugs may differ between countries, and may greatly influence the national death register's classification of manner and cause of death. The main objective of the present study was to analyse the magnitude and pattern of post-mortem detection of various psychoactive substances by the manner of death (suicide, accidental, undetermined and natural death with a psychiatric diagnosis) in Norway and Sweden.

Methods: The Cause of Death Registers in Norway and Sweden provided data on 600 deaths in 2008 from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of death and 200 as natural deaths in individuals with a diagnosis of mental disorder as the underlying cause of death. We examined death certificates and forensic reports including toxicological analyses.

Results: The detection of psychoactive substances was commonly reported in suicides (66 and 74% in Norway and Sweden respectively), accidents (85 and 66%), undetermined manner of deaths (80% in the Swedish dataset) and in natural deaths with a psychiatric diagnosis (50 and 53%). Ethanol was the most commonly reported substance in the three manners of death, except from opioids being more common in accidental deaths in the Norwegian dataset. In cases of suicide by poisoning, benzodiazepines and z-drugs were the most common substances in both countries. Heroin or morphine was the most commonly reported substance in cases of accidental death by poisoning in the Norwegian dataset, while other opioids dominated the Swedish dataset. Anti-depressants were found in 22% of the suicide cases in the Norwegian dataset and in 29% of suicide cases in the Swedish dataset.

Conclusions: Psychoactive substances were detected in 66 and 74% of suicides and in 85 and 66% of accidental deaths in the Norwegian and Swedish datasets, respectively. Apart from a higher detection rate of heroin in deaths by accident in Norway than in Sweden, the pattern of detected psychoactive substances was similar in the two countries. Assessment of a suicidal motive may be hampered by the common use of psychoactive substances in suicide victims.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Accidental deaths, Natural deaths, Psychoactive substances, Suicide
National Category
Psychiatry Forensic Science
Identifiers
urn:nbn:se:uu:diva-376882 (URN)10.1186/s12888-019-2015-9 (DOI)000456167700002 ()30658618 (PubMedID)
Available from: 2019-02-13 Created: 2019-02-13 Last updated: 2019-02-13Bibliographically approved
Högberg, U., Andersson, J., Squier, W., Hogberg, G., Fellman, V., Thiblin, I. & Wester, K. (2018). Epidemiology of subdural haemorrhage during infancy: A population-based register study. PLoS ONE, 13(10), Article ID e0206340.
Open this publication in new window or tab >>Epidemiology of subdural haemorrhage during infancy: A population-based register study
Show others...
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 10, article id e0206340Article in journal (Refereed) Published
Abstract [en]

Objectives To analyse subdural haemorrhage (SDH) during infancy in Sweden by incidence, SDH category, diagnostic distribution, age, co-morbidity, mortality, and maternal and perinatal risk factors; and its association with accidents and diagnosis of abuse. Methods A Swedish population-based register study comprising infants born between 1997 and 2014, 0-1 years of age, diagnosed with SDH-diagnoses according to the (International Classification of Diseases, 10th version (ICD10), retrieved from the National Patient Register and linked to the Medical Birth Register and the Death Cause Register. Outcome measures were: 1) Incidence and distribution, 2) co-morbidity, 3) fall accidents by SDH category, 4) risk factors for all SDHs in the two age groups, 0-6 and 7-365 days, and for ICD10 SDH subgroups: S06.5 (traumatic SDH), I62.0 (acute nontraumatic), SDH and abuse diagnosis. Results Incidence of SDH was 16.5 per 100 000 infants (n = 306). Median age was 2.5 months. For infants older than one week, the median age was 3.5 months. Case fatality was 6.5%. Male sex was overrepresented for all SDH subgroups. Accidental falls were reported in 1/3 of the cases. One-fourth occurred within 0-6 days, having a perinatal risk profile. For infants aged 7-365 days, acute nontraumatic SDH was associated with multiple birth, preterm birth, and small-for-gestational age. Fourteen percent also had an abuse diagnosis, having increased odds of being born preterm, and being small-for-gestational age. Conclusions The incidence was in the range previously reported. SDH among newborns was associated with difficult birth and neonatal morbidity. Acute nontraumatic SDH and SDH with abuse diagnosis had similar perinatal risk profiles. The increased odds for acute nontraumatic SDH in twins, preterm births, neonatal convulsions or small-for-gestational age indicate a perinatal vulnerability for SDH beyond 1st week of life. The association between prematurity/small-for-gestational age and abuse diagnosis is intriguing and not easily understood.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-370020 (URN)10.1371/journal.pone.0206340 (DOI)000448823700102 ()30379890 (PubMedID)
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2018-12-19Bibliographically approved
Högberg, U., Lampa, E., Högberg, G., Aspelin, P., Serenius, F. & Thiblin, I. (2018). Infant abuse diagnosis associated with abusive head trauma criteria: incidence increase due to overdiagnosis?. European Journal of Public Health, 28(4), 641-646
Open this publication in new window or tab >>Infant abuse diagnosis associated with abusive head trauma criteria: incidence increase due to overdiagnosis?
Show others...
2018 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 4, p. 641-646Article in journal (Refereed) Published
Abstract [en]

Background: The hypothesis of this study is that the diagnosis of infant abuse is associated with criteria for shaken baby syndrome (SBS)/abusive head trauma (AHT), and that that changes in incidence of abuse diagnosis in infants may be due to increased awareness of SBS/AHT criteria.

Methods: This was a population-based register study. Setting: Register study using the Swedish Patient Register, Medical Birth Register, and Cause of Death Register. The diagnosis of infant abuse was based on the International Classification of Diseases, 9th and 10th revision. Participants: All children born in Sweden during 1987-2014 with a follow-up until 1 year of age (N = 2 868 933). SBS/AHT criteria: subdural haemorrhage, cerebral contusion, skull fracture, convulsions, retinal haemorrhage, fractures rib and long bones. Outcomes: Incidence, rate ratios, aetiologic fractions and Probit regression analysis.

Results: Diagnosis of infant abuse was strongly associated with SBS/AHT criteria, but not risk exposure as region, foreign-born mother, being born preterm, multiple birth and small for gestational age. The incidence of infant abuse has increased tenfold in Sweden since the 1990s and has doubled since 2008, from 12.0 per 100 000 infants during 1997-2007 to 26.5/100 000 during 2008-2014, with pronounced regional disparities.

Conclusions: Diagnosis of infant abuse is related to SBS/AHT criteria. The increase in incidence coincides with increased medical preparedness to make a diagnosis of SBS/AHT. Hidden statistics and a real increase in abuse are less plausible. Whether the increase is due to overdiagnosis cannot be answered with certainty, but the possibility raises ethical and medico-legal concerns.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2018
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-364991 (URN)10.1093/eurpub/cky062 (DOI)000440944400011 ()29672696 (PubMedID)
Available from: 2018-11-07 Created: 2018-11-07 Last updated: 2018-11-07Bibliographically approved
Andersson, J. & Thiblin, I. (2018). It is important not to assume an aetiology for the triad before the outcomes of diagnostic investigations [Letter to the editor]. Acta Paediatrica, 107(8), 1308-1309
Open this publication in new window or tab >>It is important not to assume an aetiology for the triad before the outcomes of diagnostic investigations
2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 8, p. 1308-1309Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-366664 (URN)10.1111/apa.14276 (DOI)000438490100005 ()29450911 (PubMedID)
Available from: 2018-11-28 Created: 2018-11-28 Last updated: 2018-11-28Bibliographically approved
Högberg, U., Andersson, J., Högberg, G. & Thiblin, I. (2018). Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A population register study. PLoS ONE, 13(12), Article ID e0208033.
Open this publication in new window or tab >>Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A population register study
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0208033Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to assess the incidence of fractures in infancy, overall and by type of fracture, its association with accidents, metabolic bone disease risk factors, and abuse diagnosis.

Methods: The design was a population-based register study in Sweden. Participants: Children born 1997-2014,0-1 years of age diagnosed with fracture-diagnosis according to International Classification of Diseases (ICD10) were retrieved from the National Patient Register and linked to the Swedish Medical Birth Register and the Death Cause Register. Main outcome measures were fractures of the skull, long bone, clavicle and ribs, categorized by age (younger or older than 6 months), and accident or not.

Findings: The incidence of fractures during infancy was 251 per 100 000 infants (n = 4663). Major fracture localisations were long bone (44.9%), skull (31.7%), and clavicle (18.6%), while rib fractures were few (1.4%). Fall accidents were reported among 71-4%. One-third occurred during the first 6 months. Metabolic bone disease risk factors, such as maternal obesity, pre-term birth, vitamin D deficiency, rickets, and calcium metabolic disturbances, had increased odds of fractures of long bones and ribs in early infancy (0-6 months): birth 32-36 weeks and long bone fracture [AOR 2.13 (95%CI 1.67-2.93)] and rib fracture [AOR 4.24 (95%Cl 1.40-12.8)]. Diagnosis of vitamin D deficiency/rickets/disorders of calcium metabolism had increased odds of long bone fracture [AOR 49.5 (95%CI 18.3-134)] and rib fracture [AOR 617 (95%CI 162-2506)]. Fractures without a reported accident had higher odds of metabolic risk factors than those with reported accidents. Abuse diagnosis was registered in 105 infants, with overrepresentation of preterm births, multiple births and small-for-gestational age.

Interpretation: Metabolic bone disease risk factors are strongly associated with fractures of long bone and ribs in early infancy. Fracture cases with abuse diagnosis had a metabolic bone risk factor profile.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2018
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-372889 (URN)10.1371/journal.pone.0208033 (DOI)000453779300022 ()30566429 (PubMedID)
Available from: 2019-01-09 Created: 2019-01-09 Last updated: 2019-01-09Bibliographically approved
Andersson, J. & Thiblin, I. (2018). National study shows that abusive head trauma mortality in Sweden was at least 10 times lower than in other Western countries.. Acta Paediatrica, 107(3), 477-483
Open this publication in new window or tab >>National study shows that abusive head trauma mortality in Sweden was at least 10 times lower than in other Western countries.
2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 3, p. 477-483Article in journal (Refereed) Published
Abstract [en]

AIM: The validity of the diagnostic criteria for abusive head trauma (AHT) and its attributes have been widely debated. This national study investigated the possibility of false positive and false negative cases of fatal AHT in Sweden.

METHOD: This was a retrospective evaluation of the records of 733 deceased infants up to the age of 365 days who were examined during 1994-2013 at the six forensic medicine departments. All the records were scrutinised for possible cases of AHT.

RESULTS: We included 12 cases, out of which eight had been diagnosed as AHT. Of these 12 infants, eight had a concomitant disease or perinatal illness, five were born prematurely, and three were twins. Figures from other Western countries would suggest 6-7 deaths per 100,000 per year in Sweden but in reality, there was a maximum possible incidence of 0.6 per 100,000 infants per year.

CONCLUSION: The risk of unreported fatal AHT in Sweden was low and there may have been cases misdiagnosed as AHT. The at least 10 times lower incidence than has been reported from other Western countries, raises the question if previously reported higher incidences of fatal AHT have been exaggerated.

Keywords
Abusive head trauma, Sweden, infant death, shaken baby syndrome, subdural hematoma
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333284 (URN)10.1111/apa.14138 (DOI)000424884000021 ()29105967 (PubMedID)
Available from: 2017-11-09 Created: 2017-11-09 Last updated: 2018-03-22Bibliographically approved
Gedeborg, R., Svennblad, B., Byberg, L., Michaëlsson, K. & Thiblin, I. (2017). Prediction of mortality risk in victims of violent crimes. Forensic Science International, 281, 92-97
Open this publication in new window or tab >>Prediction of mortality risk in victims of violent crimes
Show others...
2017 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 281, p. 92-97Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: To predict mortality risk in victims of violent crimes based on individual injury diagnoses and other information available in health care registries.

METHODS: Data from the Swedish hospital discharge registry and the cause of death registry were combined to identify 15,000 hospitalisations or prehospital deaths related to violent crimes. The ability of patient characteristics, injury type and severity, and cause of injury to predict death was modelled using conventional, Lasso, or Bayesian logistic regression in a development dataset and evaluated in a validation dataset.

RESULTS: Of 14,470 injury events severe enough to cause death or hospitalization 3.7% (556) died before hospital admission and 0.5% (71) during the hospital stay. The majority (76%) of hospital survivors had minor injury severity and most (67%) were discharged from hospital within 1day. A multivariable model with age, sex, the ICD-10 based injury severity score (ICISS), cause of injury, and major injury region provided predictions with very good discrimination (C-index=0.99) and calibration. Adding information on major injury interactions further improved model performance. Modeling individual injury diagnoses did not improve predictions over the combined ICISS score.

CONCLUSIONS: Mortality risk after violent crimes can be accurately estimated using administrative data. The use of Bayesian regression models provides meaningful risk assessment with more straightforward interpretation of uncertainty of the prediction, potentially also on the individual level. This can aid estimation of incidence trends over time and comparisons of outcome of violent crimes for injury surveillance and in forensic medicine.

Keywords
Bayesian inference, Forensic medicine, Mortality, Violent crime
National Category
Forensic Science
Identifiers
urn:nbn:se:uu:diva-334432 (URN)10.1016/j.forsciint.2017.10.015 (DOI)000417055800017 ()29125989 (PubMedID)
Available from: 2017-11-23 Created: 2017-11-23 Last updated: 2018-11-30
Tamsen, F., Sturup, J. & Thiblin, I. (2017). Quantifying Homicide Injuries:: A Swedish Time Trend Study Using the Homicide Injury Scale. Scandinavian Journal of Forensic Science, 23(2)
Open this publication in new window or tab >>Quantifying Homicide Injuries:: A Swedish Time Trend Study Using the Homicide Injury Scale
2017 (English)In: Scandinavian Journal of Forensic Science, ISSN 2353-0707, Vol. 23, no 2Article in journal (Refereed) Published
Abstract [en]

Studies report that the homicide rate has decreased considerably in most Western countries since the 1990s. However, few studies have examined the level of injury in homicides. The injury severity in homicide victims was studied in the Stockholm area using both the Homicide Injury Scale (HIS) and the number of lethal injuries per victim. Cases were included from four periods; 1976-78, 1986- 88, 1996-98, and 2006-08. The number of homicides with overkill according to the HIS was significantly higher in 1996-98 compared to 1976-78. Compared with 1976-78, the number of lethal injuries per victim was significantly higher both in 1986-88 and 1996-98. There are various possible reasons for the changes, including a brutalization of lethal violence or a more effective trauma care. More in-depth analysis of individual cases together with research on victims of attempted homicides is needed to explain these shifts in injury severity.

National Category
Forensic Science
Identifiers
urn:nbn:se:uu:diva-383632 (URN)10.1515/sjfs-2017-0005 (DOI)
Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2019-09-03Bibliographically approved
Organisations

Search in DiVA

Show all publications