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  • 1.
    Andersson, Jacob
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    It is important not to assume an aetiology for the triad before the outcomes of diagnostic investigations2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 8, p. 1308-1309Article in journal (Other academic)
  • 2.
    Andersson, Jacob
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    National study shows that abusive head trauma mortality in Sweden was at least 10 times lower than in other Western countries.2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 3, p. 477-483Article in journal (Refereed)
    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.

  • 3.
    Bagge, A. S. Lindqvist
    et al.
    Univ Gothenburg, Gothenburg, Sweden.
    Rosen, T.
    Univ Gothenburg, Gothenburg, Sweden.
    Fahlke, C.
    Univ Gothenburg, Gothenburg, Sweden.
    Ehrnborg, C.
    Univ Gothenburg, Gothenburg, Sweden.
    Eriksson, B. O.
    Univ Gothenburg, Gothenburg, Sweden.
    Moberg, T.
    Univ Gothenburg, Gothenburg, Sweden.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Somatic effects of AAS abuse: A 30-years follow-up study of male former power sports athletes2017In: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 20, no 9, p. 814-818Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aim of the present study was to investigate the association between somatic health and former abuse of AAS in former elite male athletes 30 years after the end of their active sports career.

    Design

    Retrospective follow-up study.

    Methods

    N = 996 former elite male athletes were sent a questionnaire concerning sociodemographic variables, previous and past sport activity and lifetime prevalence of seeking professional help for health problems. N = 683 (68.6%) answered the questionnaire. The lifetime prevalence of AAS-abuse was 21% (n = 143), while 79% (n = 540) did not admit having ever used AAS.

    Results

    Former AAS-abuse was associated with tendon ruptures (p = 0.01), depression (p = 0.001), anxiety (p = 0.01) and lower prevalence of prostate hypertrophy (p = 0.01) and decreased libido (p = 0.01). Former advanced AAS-abusers had higher anxiety (p = 0.004) compared to the former less advanced AAS-abusers. Moreover, former advanced AAS-abusers, compared to AAS-naïves, reported more psychiatric problems (p = 0.002), depression (p = 0.003) and anxiety (p = 0.00).

    Conclusions

    A former AAS-abuse seems to be associated with some somatic and mental health problem, although a former less advanced AAS-abuse is related to lower incidence of prostate hypertrophy. The results raise the question whether some of these associations might be dose- and frequency dependent. These findings should however be seen as hypothesis generating and further studies are needed.

  • 4. Björkenstam, Charlotte
    et al.
    Johansson, Lars Age
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Nordström, Peter
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Fugelstad, Anna
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Ljung, Rickard
    Suicide or undetermined intent?: A register-based study of signs of misclassification2014In: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 12, article id 11Article in journal (Refereed)
    Abstract [en]

    Background: Several studies have concluded that some deaths classified as undetermined intent are in fact suicides, and it is common in suicide research in Europe to include these deaths. Our aim was to investigate if information on background variables would be helpful in assessing if deaths classified as undetermined intent should be included in the analyses of suicides. Methods: We performed a register study of 31,883 deaths classified as suicides and 9,196 deaths classified as undetermined intent in Sweden from 1987 to 2011. We compared suicide deaths with deaths classified as undetermined intent with regard to different background variables such as sex, age, country of birth, marital status, prior inpatient care for self-inflicted harm, alcohol and drug abuse, psychiatric inpatient care, and use of psychotropics. We also performed a multivariate analysis with logistic regression. Results: Our results showed differences in most studied background factors. Higher education was more common in suicides; hospitalization for self-inflicted harm was more common among female suicides as was prior psychiatric inpatient care. Deaths in foreign-born men were classified as undetermined intent in a higher degree and hospitalization for substance abuse was more common in undetermined intents of both sexes. Roughly 50% of both suicide and deaths classified as undetermined intent had a filled prescription of psychotropics during their last six months. Our multivariate analysis showed male deaths to more likely be classified as suicide than female: OR: 1.13 (1.07-1.18). The probability of a death being classified as suicide was also increased for individuals aged 15-24, being born in Sweden, individuals who were married, and for deaths after 1987-1992. Conclusion: By analyzing Sweden's unique high-validity population-based register data, we found several differences in background variables between deaths classified as suicide and deaths classified as undetermined intent. However, we were not able to clearly distinguish these two death manners. For future research we suggest, separate analyses of the two different manners of death.

  • 5. Fugelstad, A.
    et al.
    Stenbacka, M.
    Leifman, A.
    Nylander, M.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Methadone maintenance treatment: the balance between life-saving treatment and fatal poisonings2007In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 102, no 3, p. 406-412Article in journal (Refereed)
    Abstract [en]

    Aim: To determine the total mortality related to the Stockholm methadone programme during the period 1988-2000, both the mortality related to the treatment and fatal methadone intoxications in the Stockholm area during the same period. Methods: The study comprised all individuals (n = 848) who had been in contact with the methadone programme in Stockholm during the study period, including those patients who had been discharged from treatment and those opiate users who had applied for but not received methadone treatment. All deaths that had been the subject of medico-legal examination at the Department of Forensic Medicine in Stockholm where methadone was found in blood or urine were also analysed during the same period. Results: The mortality was lower among those opiate users who remained in maintenance treatment and 91% of the deceased individuals had died due to natural causes, in most cases related to HIV or hepatitis C, acquired before admission to the programme. Those who had been discharged from methadone treatment had a 20 times higher risk of dying from unnatural causes compared to the patients who remained in treatment. The majority died due to heroin injections ('overdoses'). Eighty-nine cases of fatal methadone intoxication were found, but in only two of these cases was there evidence of leakage from maintenance treatment. Conclusion: The 'high threshold programme' is safe as long as the patients remain in treatment and there are very few deaths due to leakage from the programme. However, there is a high mortality among those discharged from the programme and only a minority of the heroin users in Stockholm had applied for treatment.

  • 6. Fugelstad, Anna
    et al.
    Johansson, Lars Age
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Allt fler dör av metadon: "Läckage" från dagens mer liberala behandlingsprogram kan vara en orsak2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 18, p. 1225-1228Article in journal (Refereed)
  • 7. Fugelstad, Anna
    et al.
    Johansson, Lars Age
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Faktisk ökning av antalet narkotikadödsfall mörkas2016In: Dagens Nyheter, Vol. April, no 12Article in journal (Other (popular science, discussion, etc.))
  • 8.
    Fugelstad, Anna
    et al.
    Inst. för klinisk nerurovetenskap, karolinska Institutet..
    Johansson, Lars Age
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Ny metod att redovisa narkotikarelaterade dödsfall2010In: Svenska läkaresällskapets handlingar, ISSN 0349-1722Article in journal (Other academic)
  • 9. Fugelstad, Anna
    et al.
    Lars, Age Johansson
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Allt fler dör av metadon. »Läckage« från dagens mer liberala behandlingsprogram kan vara en orsak: [More and more methadone deaths. "Leakage" from ongoing more liberal treatment programs might be a cause].2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 18, p. 1225-1228Article in journal (Refereed)
  • 10.
    Fugelstad, Anna
    et al.
    Stockholms beroendecentrum.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Johansson, Lars Age
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Drogrelaterade dödsfall i Stockholms län: trender – droger - jämförelser med övriga riket2009In: Svenska läkaresällskapets handlingar 2009, 2009Conference paper (Other academic)
  • 11.
    Gedeborg, Rolf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Chen, Li-Hui
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Thiblin, Ingemar
    Centers for Disease Control and Prevention, Hyattsville, Maryland; Department of Surgical Sciences—Forensic Medicine.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Warner, Margaret
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Prehospital injury deaths-Strengthening the case for prevention: Nationwide cohort study2012In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 72, no 3, p. 765-772Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To determine the frequency and characteristics of prehospital deaths compared with hospital deaths in different subpopulations with severe injuries.

    METHODS: Population-based cohort study using person-based linkage of the Swedish nationwide hospital discharge register with death certificate data. In all, 28,715 injury deaths were identified among 419,137 cases of severe injury during 1998 to 2004. Prehospital deaths were defined as autopsied out-of-hospital deaths with injury as the underlying cause. Their impact on mortality prediction was assessed using the International Classification of Disease Injury Severity Score with the C statistic as a measure of discrimination.

    RESULTS: The majority of all injury deaths occurred either at the scene or before hospitalization. Among persons younger than 65 years, for each hospital death there were nine prehospital deaths. A high proportion of deaths from drowning, suffocation, and firearm injuries were prehospital (85, 82, and 67% of all cases, respectively). More than 90% of hospital deaths resulted from unintentional injuries, while only 43% of prehospital deaths were unintentional. The largest increase in a cause-specific case fatality risk estimate was seen for poisoning, where inclusion of prehospital deaths increased the risk estimate from 1.6% to 22.8%. Injury mortality prediction based on International Classification of Disease Injury Severity Score improved when prehospital deaths were added to hospital data (C statistic increased from 0.86 to 0.93).

    CONCLUSIONS: Prehospital deaths constitute the majority of trauma deaths and differ in major characteristics from hospital deaths. The high proportion of prehospital deaths among young and middle aged people highlights the potential impact of preventive efforts.

  • 12.
    Gedeborg, Rolf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Svennblad, Bodil
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Prediction of mortality risk in victims of violent crimes2017In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 281, p. 92-97Article in journal (Refereed)
    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.

  • 13.
    Gedeborg, Rolf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Lindbäck, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Population density and mortality among individuals in motor vehicle crashes2010In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 16, no 5, p. 302-308Article in journal (Refereed)
    Abstract [en]

    Objective

    To assess whether higher mortality rates among individuals in motor vehicle crashes in areas with low population density depend on injury type and severity or are related to the performance of emergency medical services (EMS).

    Methods

    Prehospital and hospital deaths were studied in a population-based cohort of 41 243 motor vehicle crashes that occurred in Sweden between 1998 and 2004. The final multivariable analysis was restricted to 6884 individuals in motor vehicle crashes, to minimise the effects of confounding factors.

    Results

    Crude mortality rates following motor vehicle crashes were inversely related to regional population density. In regions with low population density, the unadjusted rate ratio for prehospital death was 2.2 (95% CI 1.9 to 2.5) and for hospital death 1.5 (95% CI 1.1 to 1.9), compared with a high-density population. However, after controlling for regional differences in age, gender and the type/severity of injuries among 6884 individuals in motor vehicle crashes, low population density was no longer associated with increased mortality. At 25 years of age, predicted prehospital mortality was 9% lower (95% CI 5% to 12%) in regions with low population density compared with high population density. This difference decreased with increasing age, but was still 3% lower (95% CI 0.5% to 5%) at 65 years of age.

    Conclusions

    The inverse relationship between population density and mortality among individuals in motor vehicle crashes is related to pre-crash factors that influence the type and severity of injuries and not to differences in EMS.

  • 14.
    Högberg, Ulf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Lampa, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Högberg, Göran
    Karolinska Inst, Dept Womens & Childrens Hlth, Child & Adolescent Psychiat Unit, Stockholm, Sweden..
    Aspelin, Peter
    Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden..
    Serenius, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Perinatal, Neonatal and Pediatric Cardiology Research.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Infant abuse diagnosis associated with abusive head trauma criteria: incidence increase due to overdiagnosis?2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 4, p. 641-646Article in journal (Refereed)
    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.

  • 15.
    Klötz, Fia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Petersson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Hoffman, Orsolya
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    The significance of anabolic androgenic steroids in a Swedish prison population2010In: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 51, no 3, p. 312-318Article in journal (Refereed)
    Abstract [en]

    Use of anabolic androgenic steroids (AAS) has been associated with adverse psychiatric effect, violent behavior, and criminality. The aim of this study was to further investigate the motives for and consequences of AAS use, with focus on violent and antisocial behavior. Fifty-nine prisoners were interviewed on their use of AAS, and their history was mapped with Addiction Severity Index interviews. Of these prisoners, 56% admitted previous use of AAS, of whom 24% declared to have committed violent crimes in connection with use of AAS. However, the only significant difference between users and nonusers with regard to criminal history when measured with the Addiction Severity Index was that the AAS users more often stated that they had been prosecuted for crimes labeled as “other crimes,” which did not include violent crimes. The reported side effects of AAS corresponded well to those previously reported. These results indicate that use of AAS is common among Swedish prisoners and that the motives and consequences of such use are similar to what has been observed in other AAS-using populations. Furthermore, this study supports earlier notions that misuse of AAS might cause violent behavior, but only in certain individuals and mainly in combination with other substances.

  • 16.
    Lundholm, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Haggård, Ulrika
    Möller, Jette
    Hallqvist, Johan
    Department of Public Health Sciences, Division of Public Health Epidemiology, Karolinska Institutet, Stockholm, Sweden.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study2013In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 129, no 1-2, p. 110-115Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The association between substance abuse, particularly alcohol abuse, and violence has been well established. However, since substance abuse co-occurs with several other risk factors for violence, the causal link between substance abuse and violence and the extent to which the acute influence of alcohol, illicit drugs, benzodiazepines, and anabolic androgenic steroids have a triggering effect on violent behavior are more uncertain.

    METHODS:

    Case-crossover design was used based on data from structured face to face interviews with remand prisoners (n=194; 172 men, 22 women) suspected of violent crimes. Main outcome measure: odds ratio (OR 95% CI) for a violent crime, 24h after exposure to different substances, compared to periods of no exposure was calculated using conditional logistic regression and a Mantel-Haenszel estimator with confidence intervals for sparse data.

    RESULTS:

    Intake of alcohol (OR 6.41 CI 4.24-9.67) and large doses of benzodiazepines (OR 36.32 CI 7.14-183.65) triggered interpersonal violence. Stratified analyses of possible effect modifiers were sex, conduct/behavioral problems, trauma experiences; psychiatric vulnerability did not reveal any substantial differences.

    CONCLUSION:

    Influences of alcohol and unusually high doses of benzodiazepines are proximal risk factors for violent crime. Improved knowledge of short-term (and dose-related) risk factors may contribute to treatment planning and risk assessment of violence.

  • 17.
    Lundholm, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Käll, Kerstin
    Wallin, Sussi
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Use of anabolic androgenic steroids in substance abusers arrested for crime2010In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 111, no 3, p. 222-226Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Use of anabolic androgenic steroids (AASs) has been associated with both violent crime and the use of illicit drugs. The scientific literature on polysubstance abuse as a confounder for AAS-related violence is sparse and ambiguous. With the intent of further investigating this issue, we have gathered data concerning drug abuse and AAS experience among substance abusers who have been arrested for a variety of crimes. METHODS: Data were collected from structured interviews with substance abusers (n=3597) apprehended at two remand prisons in Sweden from 2002 through 2008. Analyses concerned type of criminal act, primary drug used during the past year, and experience of AAS use. RESULTS: Those stating AAS experience (n=924, 20 women and 904 men) were more often apprehended for violent crimes (OR=1.65). This association remained significant after controlling for age and sex (OR=1.28). AAS users and non-users claimed similar primary substances of use during the past year, with the exception of benzodiazepine use, which was more common in the AAS group (OR=2.30), although this did not affect the frequency of violent crime. Among AAS-experienced participants, there was no difference in violent crime incidence between current users and former users. CONCLUSIONS: Study results suggest that AASs do not function as a proximal trigger for violence but still involve an increased risk for violence in users of illicit drugs. These findings also suggest that AAS use is highly overrepresented in women who commit crimes.

  • 18.
    Lundholm, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Runeson, Bo
    Department of Clinical Neuroscience, Karolinska Institutet.
    Leifman, Anders
    Stockholm Dependency Center.
    Fugelstad, Anna
    Department of Clinical Neuroscience.
    Acute influence of alcohol, THC or central stimulants on violent suicide: a Swedish Population study2014In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 59, no 2, p. 436-440Article in journal (Refereed)
    Abstract [en]

    Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC) or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the non-violent method self-poisoning and alcohol/illicit drugs negative suicide decedents. Multivariate analysis was conducted and the results revealed that acute influence of THC was related to using the violent suicide method; jumping from a height (RR 1.62; 95%CI 1.01-2.41). Alcohol intoxication was not related to any violent method, while the central stimulants positive suicide decedent had a higher, albeit not significant, risk for several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.

     

  • 19.
    Mobini Far, Hamid Reza
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Ågren, Greta
    Lindqvist, Ann-Sophie
    Marmendal, Maarit
    Fahlke, Claudia
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Administration of the anabolic androgenic steroid nandrolone decanoate to female rats causes alterations in the morphology of their uterus and a reduction in reproductive capacity2007In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 131, no 2, p. 189-197Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the present investigation was to characterize the effects of supraphysiological doses of the anabolic androgenic steroid nandrolone decanoate (ND) on the fertility of female rats, as well as on the morphology of their uterus. STUDY DESIGN: Female Wistar rats (n=15) received a subcutaneous injection of ND (15 mg/kg) once daily during a 2-week period, while the control animals (n=10) were administered vehicle alone (arachidis oleum) in the same manner. Estrus behavior was evaluated 4 weeks after termination of this treatment and in cases where signs of receptivity were present, the female rat was given the opportunity to copulate with a male. After breeding, the female animals were sacrificed and their uteri examined histomorphologically. RESULTS: All ND-treated animals exhibited abnormal vaginal smears, whereas all of the control smears were normal. Most (73%) of the treated females demonstrated normal estrus behavior (i.e., willingness) on the day of mating, but none got pregnant; whereas all of the control rats became pregnant. The female rats receiving the ND showed an enhanced rate of weight gain and the myometrium thickness of their uteri was significantly increased, while the endometrium was significantly thinner. Furthermore, ND caused a significant proportion of the treated animals to display tortuous and irregularly branching endometrial glands, as well as a lack of the physiologically normal infiltration of eosinophilic leukocytes into the endometrium (endometrial eosinophilic homing), a finding that has not been reported previously. CONCLUSION: The present findings indicate that high doses of ND cause morphological and physiological alterations in the uterus of female rats that are associated with a suppression of their reproductive capacity.

  • 20.
    Mobini Far, Hamid Reza
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Ågren, Greta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Cardiac hypertrophy in deceased users of anabolic androgenic steroids: an investigation of autopsy findings2012In: Cardiovascular pathology, ISSN 1054-8807, E-ISSN 1879-1336, Vol. 21, no 4, p. 312-316Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The use of anabolic androgenic steroids (AASs) has been associated with hypertrophy of the left cardiac ventricle (LVH) as diagnosed by echocardiography. Case reports suggest that AAS-related LVH may lead to sudden death. We performed an investigation of the gross cardiac pathological findings in deceased male AAS users in order to further elucidate the proposed role of AAS in cardiac hypertrophy.

    METHODS:

    Eighty-seven deceased males who tested positive for AAS at autopsy and 173 age-adjusted control deceased males without suspected AAS use were studied for cardiac hypertrophy. The AAS-positive subjects had been examined at any of the six departments of forensic medicine in Sweden during the period from 1989 to 2009. Data were assessed employing multivariate analyses controlling for body weight, height, age, bleeding after trauma, and the impact of weight training.

    RESULTS:

    The analysis of the logarithm of heart mass by multivariate statistics implied that strong correlations existed between body mass and heart mass (P<.00001), height and heart mass (P<.02), age and heart mass (P<.00001), and trauma (bleeding) and heart mass (P=.00001). After controlling for these factors, a significantly higher heart mass (P=.0001) was found among the AAS-positive males.

    CONCLUSION:

    Our findings suggest that use of AAS may lead to cardiac hypertrophy with a direct cardiotropic effect.

  • 21.
    Petersson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Begtsson, Johanna
    Voltaire-Carlsson, Anette
    Thiblin, Ingemar
    Use of anabolic androgenic steroids at an outpatient substance abuse clinic in Stockholm, SwedenManuscript (Other academic)
  • 22.
    Petersson, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Bengtsson, Johanna
    Voltaire-Carlsson, Anette
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Substance abusers' motives for using anabolic androgenic steroids2010In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 111, no 1-2, p. 170-172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of anabolic androgenic steroids (AAS) has been associated with the use of illegal drugs. Earlier observations suggested that users of illegal drugs may use AAS for reasons other than increasing muscle strength or size. The aim of the present study was to investigate the motives for AAS use among outpatients at a substance abuse center in Stockholm, Sweden. METHODS: All male patients under the age of 50 were asked whether they had used AAS during a 2-month period. An AAS survey was administered to those who reported AAS experiences in the admittance interview. RESULTS: Twenty of the 175 respondents (11%) reported using AAS. The most frequently reported motives were related to anabolic effects (i.e., for a good-looking body, to become stronger, or to perform better in sports). However, some users reported other motives; for example, to conceal concomitant drug use, to alleviate insecurity or low self-esteem, to become brave, or in preparation of committing a crime. Furthermore, many respondents reported side effects that were associated with AAS; most notably, irritability and depression/suicidal ideation. CONCLUSION: Some users of illicit drugs also use AAS for reasons other than the anabolic properties of these compounds. Therefore, considering that AAS may cause or contribute to diverse morbidity, it is important to ask users of illicit drugs about AAS use, even when obvious external signs of AAS use are lacking.

  • 23.
    Petersson, Anna
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Garle, Mats
    Granath, Fredrik
    Thiblin, Ingemar
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Morbidity and mortality in patients testing positively for the presence of anabolic androgenic steroids in connection with receiving medical care. A controlled retrospective cohort study.2006In: Drug Alcohol Depend, ISSN 0376-8716, Vol. 81, no 3, p. 215-20Article in journal (Refereed)
  • 24.
    Petersson, Anna
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Garle, Mats
    Holmgren, Per
    Druid, Henrik
    Krantz, Peter
    Thiblin, Ingemar
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Toxicological findings and manner of death in autopsied users of anabolic androgenic steroids.2006In: Drug Alcohol Depend, ISSN 0376-8716, Vol. 81, no 3, p. 241-9Article in journal (Refereed)
  • 25. Petersson, Anna
    et al.
    Klötz, Fia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Voltaire-Carlsson, Anette
    Bengtsson, Johanna
    Granath, Fredrik
    Thiblin, Ingemar
    Use of anabolic androgenic steroids at an outpatient substance abuse clinic in Stockholm, SwedenManuscript (Other academic)
  • 26. Romelsjö, Anders
    et al.
    Engdahl, Barbro
    Stenbacka, Marlene
    Fugelstad, Anna
    Davstad, Ingrid
    Leifman, Anders
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Were the changes to Sweden's maintenance treatment policy 2000-06 related to changes in opiate-related mortality and morbidity?2010In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 105, no 9, p. 1625-1632Article in journal (Refereed)
    Abstract [en]

    Aims To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006. Design We collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden. Setting Sweden. Participants Patients in maintenance treatment. Measurements Survey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations. Findings The surveys showed a marked change to a less restrictive policy, with increased use of 'take-away doses' and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more than threefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20-30% reduction in opiate-related mortality and inpatient care between 2000-2002 and 2004-2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998-2006, statistically significant declines occurred only in Stockholm County. Conclusions The liberalization of Sweden's drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.

  • 27.
    Semenas, Egidijus
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Nozari, Ala
    Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, 02114 Boston, Massachusetts, USA.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Modulation of nitric oxide expression with methylene blue does not improve outcome after hypovolemic cardiac arrest2011In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, no 10, p. 1344-1349Article in journal (Refereed)
    Abstract [en]

    Aim of the study: We recently reported that female sex protects against cerebral and cardiac injury after hypovolemiccardiac arrest (CA), independent of sex hormone effects. As female sex was also associated with a smaller increase in inducible and neuronal nitric oxide synthase (NOS), we hypothesised that nitric oxide inhibition with methylene blue (MB) improves the outcome, primarily in male animals. Methods: Twenty sexually immature piglets (10 males and 10 females) were bled to mean arterial blood pressure of 35 mmHg, and were subjected to 2 min of untreated CA followed by 8 min of open chest cardiopulmonary resuscitation (CPR). Volume resuscitation was started during CPR with intravenous administration of 3 ml kg(-1) hypertonic saline-dextran. Methyleneblue was then administered as bolus of 2.5 mg kg(-1) over 20 min, followed by 1.5 mg kg(-1) infusion over 40 min. Historical data from 21 animals were used as control (no MB). Hemodynamic parameters, myocardial injury (troponin I), and short-term survival (3-h) were evaluated. Histopathological evaluation of heart specimens was performed. Results: There were no differences between male and female animals in survival or resuscitation rate. After CA female pigletshad significantly greater systolic and mean arterial pressures, and had lower troponin I plasma concentrations compared to malepiglets, with or without MB. No difference was observed in histopathological analysis of heart specimens between sexes. Conclusions: After resuscitation from hypovolemic CA, female sex protects against cardiac injury, independent of sex hormones. Modulation of NO expression with MB does not improve survival or myocardial histological injury in either sex. 

  • 28.
    Tamsen, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Logan, Fia Klötz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Homicide Injury Quantification: Correlations and Reliability of Injury Severity Scores Applied to Homicide Victims2015In: Homicide Studies, ISSN 1088-7679, E-ISSN 1552-6720, Vol. 19, no 1, p. 88-100Article in journal (Refereed)
    Abstract [en]

    No generally accepted method exists for quantifying the degree of injury in homicide victims. This study explores six different injury severity scores with the goal to recommend a valid method that is reliable and easy to use. To investigate this issue, 103 homicides are examined regarding the correlations between these scores. This study concludes that the Homicide Injury Scale is valid, easy to use, and has a satisfactory inter-rater reliability.

  • 29.
    Tamsen, Fredrik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Deaths during apprehensions of agitated persons: A review of proposed pathophysiological theories.2013In: Scandinavian Journal of Forensic Science, ISSN 1503-9552, Vol. 1, no 1, p. 1-6Article in journal (Refereed)
    Abstract [en]

    The pathophysiology of sudden death during apprehension remains largely unclear. The most frequently discussed mechanisms are excited delirium, positional asphyxia, metabolic acidosis, acute and chronic drug abuse, and autonomic instability. As in most areas of forensic medicine, much of the knowledge comes from case reports, which are of little use in understanding causality. Experimental studies of some aspects have been performed, and they show somewhat divergent results and interpretations. The aim of this review is to summarize the different proposed theories, and to point out important issues for further research.

  • 30.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Diagnostik av barnmisshandel måste vara evidensbaserad2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, article id C9SMArticle in journal (Other academic)
  • 31.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Narkotikarelaterad död2011In: Beroendemedicin / [ed] Johan Franck & Ingrid Nylander, Lund: Studentlitteratur, 2011, 1. uppl., p. 323-327Chapter in book (Refereed)
  • 32.
    Thiblin, Ingemar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Fugelstad, Anna
    Felaktiga slutsatser om narkotikadödsfall2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, article id EC63Article in journal (Other academic)
  • 33.
    Thiblin, Ingemar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Garmo, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Garle, Mats
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Endocrine Surgery.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Gedeborg, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Anabolic steroids and cardiovascular risk: A national population-based cohort study2015In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 152, p. 87-92Article in journal (Refereed)
    Abstract [en]

    Background: Non-therapeutic use of anabolic androgenic steroids (AAS) has been associated with various adverse effects; one of the most serious being direct cardiovascular effects with unknown long-term consequences. Therefore, large studies of the association between AAS and cardiovascular outcomes are warranted. We investigated cardiovascular morbidity and mortality in individuals who tested positive for AAS. Methods and results: Between 2002 and 2009, a total of 2013 men were enrolled in a cohort on the date of their first AAS test. Mortality and morbidity after cohort entry was retrieved from national registries. Of the 2013 individuals, 409(20%) tested positive for MS. These men had twice the cardiovascular morbidity and mortality rate as those with negative tests (adjusted hazard ratio (aHR) 2.0; 95% confidence interval (CI) 1.2-3.3). Compared to the Swedish population, all tested men had an increased risk of premature death from all causes (standardized mortality ratio for MS-positive: 19.3, 95% CI 12.4-30.0; for AAS-negative: 8.3,95% CI 6.1-11.0). Conclusion: Non-therapeutic exposure to MS appears to be an independent risk factor for cardiovascular morbidity and premature death.

  • 34.
    Thiblin, Ingemar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Michard, Jean-Francois
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Rättsmedicin i teori och praktik: En guide för läkare och jurister2014 (ed. 1)Book (Refereed)
    Abstract [sv]

    Rättsmedicin är en medicinsk vetenskap, men samtidigt väsentligt skild från den terapeutiskt inriktade kliniska medicinen. Syftet med rättsmedicin är sakkunnigverksamhet på vetenskaplig grund till gagn för rättsväsendet och rättssäkerheten. Rättsmedicin i teori och praktik belyser dessa skillnader i förhållningssätt och förmedlar principiella frågor och kunskaper på ett lättillgängligt sätt. Boken ger även praktisk handledning i att skriva rättsintyg och att göra skadetolkningar och bedömningar.

    I första delen av boken beskrivs läkarens roll i förhållande till rättsväsendet samtidigt som de vetenskapliga begreppen och tankemodellerna reds ut och kopplas till den kliniska verkligheten. Vanliga fallgropar och missräkningar förmedlas också. Den andra delen av boken är en handbok i hur man skriver rättsintyg och utlåtanden samt hur man bedömer och tolkar skador. Boken är rikligt försedd med fallbeskrivningar som på ett pedagogiskt sätt applicerar teorierna i praktiken.

    Målgruppen är främst blivande och praktiserande läkare och jurister. Även naturvetenskapligt orienterade experter som avger utlåtanden till rätten, till exempel kriminaltekniker, och de som i sin profession kommer i kontakt med rättsmedicinska bedömningar, till exempel socialtjänsten, har nytta av boken, liksom politiska beslutsfattare och personer med intresse för rättssäkerhetsfrågor.

  • 35.
    Thiblin, Ingemar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Mobini-Far, Hamid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Frisk, M.
    Sudden unexpected death in a female fitness athlete, with a possible connection to the use of anabolic androgenic steroids (AAS) and ephedrine2009In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 184, no 1-3, p. e7-11Article in journal (Refereed)
    Abstract [en]

    The use of anabolic androgenic steroids (AAS) has been associated with different adverse effects, some of which potentially lethal. Most users of AAS are male, but the prevalence of such use appears to be increasing in females. Here we present a sudden unexpected death in a female fitness athlete with a possible connection to use of doping agents.

  • 36.
    Thiblin, Ingemar
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences.
    Petersson, Anna
    Pharmacoepidemiology of anabolic androgenic steroids: a review.2005In: Fundam Clin Pharmacol, ISSN 0767-3981, Vol. 19, no 1, p. 27-44Article in journal (Refereed)
  • 37.
    Thiblin, Ingemar
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Wennström, Bo
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Law, Center for Police Research. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Law, Department of Law.
    Allen, Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Genomics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medicinsk genetik och genomik.
    Låt även försvararsidan få tillgång till rättsmedicinsk expertis: [Let the defence have access to forensic expertise, too]2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 1-2, p. 39-39Article in journal (Refereed)
  • 38. Tøllefsen, Ingvild Maria
    et al.
    Helweg-Larsen, Karin
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Hem, Erlend
    Kastrup, Marianne C
    Nyberg, Ullakarin
    Rogde, Sidsel
    Zahl, Per-Henrik
    Østevold, Gunvor
    Ekeberg, Øivind
    Are suicide deaths under-reported? Nationwide re-evaluations of 1800 deaths in Scandinavia.2015In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 11, article id e009120Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Valid mortality statistics are important for healthcare planning and research. Suicides and accidents often present a challenge in the classification of the manner of death. The aim of this study was to analyse the reliability of the national suicide statistics by comparing the classification of suicide in the Scandinavian cause of death registers with a reclassification by 8 persons with different medical expertise (psychiatry, forensic pathology and public health) from each of the 3 Scandinavian countries.

    METHODS: The cause of death registers in Norway, Sweden and Denmark retrieved available information on a sample of 600 deaths in 2008 from each country. 200 were classified in the registers as suicides, 200 as accidents or undetermined and 200 as natural deaths. The reclassification comprised an assessment of the manner and cause of death as well as the level of certainty.

    RESULTS: In total, 81%, 88% and 90% of deaths registered as suicide in the official mortality statistics were confirmed by experts using the Swedish, Norwegian and Danish data sets, respectively. About 3% of deaths classified as accidents or natural deaths in the cause of death registers were reclassified as suicides. However, after a second reclassification based on additional information, 9% of the natural deaths and accidents were reclassified as suicides in the Norwegian data set, and 21% of the undetermined deaths were reclassified as suicides in the Swedish data set. In total, the levels of certainty of the experts were 87% of suicides in the Norwegian data set, 77% in the Swedish data set and 92% in Danish data set; the uncertainty was highest in poisoning suicides.

    CONCLUSIONS: A high percentage of reported suicides were confirmed as being suicides. Few accidents and natural deaths were reclassified as suicides. Hence, reclassification did not increase the overall official suicide statistics of the 3 Scandinavian countries.

  • 39.
    Tøllefsen, Ingvild Maria
    et al.
    Oslo Univ Hosp Ullevaal, Dept Acute Med, Box 4950, N-0424 Oslo, Norway.;Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1072, N-0316 Oslo, Norway.;Oslo Univ Hosp Ullevaal, Dept Acute Med, Div Med, Box 4950, N-0424 Oslo, Norway..
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Helweg-Larsen, Karin
    Univ Copenhagen, Dept Social Med & Publ Hlth Res, Norregade 10, DK-1165 Copenhagen K, Denmark..
    Hem, Erlend
    Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1072, N-0316 Oslo, Norway.;Oslo Univ Hosp Ullevaal, Div Mental Hlth & Addict, Box 4950, N-0424 Oslo, Norway..
    Kastrup, Marianne
    Amalievej 23, DK-1875 Frederiksberg, Denmark..
    Nyberg, Ullakarin
    Karolinska Inst, Stockholm Ctr Psychiat Res & Educ, Dept Clin Neurosci, Stockholm, Sweden.;Norra Stocholms Psychiat, St Gorans Sjukhus, S-11281 Stockholm, Sweden..
    Rogde, Sidsel
    Norwegian Inst Publ Hlth, Box 4404, N-0403 Oslo, Norway.;Univ Oslo, Inst Clin Med, Box 1072, N-0316 Oslo, Norway..
    Zahl, Per-Henrik
    Norwegian Inst Publ Hlth, Box 4404, N-0403 Oslo, Norway..
    Ostevold, Gunvor
    Norwegian Inst Publ Hlth, Box 4404, N-0403 Oslo, Norway..
    Ekeberg, Oivind
    Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1072, N-0316 Oslo, Norway.;Oslo Univ Hosp Ullevaal, Div Mental Hlth & Addict, Box 4950, N-0424 Oslo, Norway..
    Accidents and undetermined deaths: re-evaluation of nationwide samples from the Scandinavian countries2016In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, article id 449Article in journal (Refereed)
    Abstract [en]

    Background: National mortality statistics should be comparable between countries that use the World Health Organization's International Classification of Diseases. Distinguishing between manners of death, especially suicides and accidents, is a challenge. Knowledge about accidents is important in prevention of both accidents and suicides. The aim of the present study was to assess the reliability of classifying deaths as accidents and undetermined manner of deaths in the three Scandinavian countries and to compare cross-national differences. Methods: The cause of death registers in Norway, Sweden and Denmark provided data from 2008 for samples of 600 deaths from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of deaths and 200 as natural deaths. The information given to the eight experts was identical to the information used by the Cause of Death Register. This included death certificates, and if available external post-mortem examinations, forensic autopsy reports and police reports. Results: In total, 69 % (Sweden and Norway) and 78 % (Denmark) of deaths registered in the official mortality statistics as accidents were confirmed by the experts. In the majority of the cases where disagreement was seen, the experts reclassified accidents to undetermined manner of death, in 26, 25 and 19 % of cases, respectively. Few cases were reclassified as suicides or natural deaths. Among the extracted accidents, the experts agreed least with the official mortality statistics concerning drowning and poisoning accidents. They also reported most uncertainty in these categories of accidents. In a second re-evaluation, where more information was made available, the Norwegian psychiatrist and forensic pathologist increased their agreement with the official mortality statistics from 76 to 87 %, and from 85 to 88 %, respectively, regarding the Norwegian and Swedish datasets. Among the extracted undetermined deaths in the Swedish dataset, the two experts reclassified 22 and 51 %, respectively, to accidents. Conclusion: There was moderate agreement in reclassification of accidents between the official mortality statistics and the experts. In the majority of cases where there was disagreement, accidents were reclassified as undetermined manner of death, and only a small proportion as suicides.

  • 40.
    Ågren, Greta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Lund, Irene
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Lundeberg, Thomas
    Tail skin temperatures reflect coping styles in rats2009In: Physiology and Behavior, ISSN 0031-9384, E-ISSN 1873-507X, Vol. 96, no 2, p. 374-82Article in journal (Refereed)
    Abstract [en]

    This study was carried out to elucidate the predictive value of tail skin temperatures (TSTs) assessed in naïve rats as a non-invasive pre-experimental method of classification of coping style. Male Lewis rats were classified according to tail skin temperatures (TST), and relative size within cage-groups. TSTs were monitored over two-hour periods following exposure to physical and emotional stressors. Bodyweight-shifts associated to the experiments were analysed. Six organs of neuroendocrine relevance to allostasis were weighed. Challenge-specific TST-profiles were size-related and consistent with proactive or reactive coping. Pro-active (A) rats showed a more pronounced TST-response to unknown conspecifics, but reactive (B) rats to environmental novelties. B-rats showed challenge-specific weight-losses while A-rats gained more after experiments. Second size males showed rapidly decreased TSTs (vasoconstriction) after nociceptive stimulation. Males that showed the highest basal TSTs and weight-loss in emotionality tests had lost a first rank position during a pre-experimental period, suggesting long-lasting effects of social defeat. Pre-experimental growth correlated positively to adiposisity post-experimentally, but negatively to testes relative weight in B-rats. Scaling effects explained heart-size in B-rats and pituitary-size in A-rats. The overall patterns that emerged, in factor analyses including organ sizes, were consistent with pro-active coping in A-rats and reactive in B-rats. Our results, controlling for rank-effects, suggest that non-invasively assessed TSTs may predict individual stress-coping phenotypes pre-experimentally in rats housed in groups.

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