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  • 51.
    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.

  • 52.
    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.
    Wernroth, Lisa
    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. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , UCR-Uppsala Clinical Research center.
    The impact of clinically undiagnosed injuries on survival estimates2009In: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 37, no 2, p. 449-55Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:: Missed injury diagnoses may cause potentially preventable deaths. To estimate the effect of clinically undiagnosed injuries on injury-specific survival estimates and the accuracy of an injury severity score. To also estimate the potentially preventable mortality attributable to these injuries. DESIGN, SETTING, AND PATIENTS:: In a nation-wide, population-based study, data were collected from all hospital admissions for injuries in Sweden between 1998 and 2004. We studied 8627 deaths in hospital among 598,137 incident hospital admissions. MEASUREMENTS AND MAIN RESULTS:: New specific-injury categories were added in 7.4% (95% confidence interval [CI] 6.8-8.0) of all deaths with an autopsy rate of 24.2%. It was estimated that this proportion would have increased to 25.1% (95% CI 23.0-27.2), if all deaths had been autopsied. The most pronounced effect of clinically undiagnosed injuries was found for internal organ injury in the abdomen or pelvis, where they reduced the estimated survival from 0.83 to 0.69 (95% CI for the difference: 0.09-0.20). Autopsy diagnoses also revealed substantial bias of survival estimates for vascular injuries in the thorax and crush injuries to the head. The performance of the International Classification of Diseases Injury Severity Score improved when autopsy diagnoses were added to hospital discharge diagnoses. The maximum proportion of injury deaths attributable to missed injuries was estimated to be 6.5%. CONCLUSIONS:: Maintaining a high autopsy rate and merging accurate hospital discharge data and autopsy data are effective ways to improve the accuracy of survival estimates and mortality prediction models, and to estimate mortality attributable to diagnostic failures.

  • 53.
    George, Mary
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Wiklund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Aastrup, M
    Pousette, J
    Thunholm, B
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Wernroth, L
    Zaren, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Holmberg, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Incidence and geographical distribution of sudden infant death syndrome in relation to content of nitrate in drinking water and groundwater levels.2001In: Eur J Clin Invest, Vol. 31, p. 1083-Article in journal (Refereed)
  • 54.
    Gravensteen, Ida Kathrine
    et al.
    Oslo Univ Hosp, Dept Forens Sci, Box 4950 Nydalen, N-0424 Oslo, Norway.
    Ekeberg, Öivind
    Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1111 Blindern, N-0317 Oslo, Norway;Oslo Univ Hosp Ullevaal, Div Mental Hlth & Addict, Box 4956 Nydalen, 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, Copenhagen, Denmark.
    Hem, Erlend
    Univ Oslo, Inst Basic Med Sci, Dept Behav Sci Med, Fac Med, Box 1111 Blindern, N-0317 Oslo, Norway;Oslo Univ Hosp Ullevaal, Div Mental Hlth & Addict, Box 4956 Nydalen, Oslo, Norway.
    Rogde, Sidsel
    Oslo Univ Hosp, Dept Forens Sci, Box 4950 Nydalen, N-0424 Oslo, Norway;Univ Oslo, Inst Clin Med, Box 1072 Blindern, N-0316 Oslo, Norway.
    Töllefsen, Ingvild Maria
    Oslo Univ Hosp Ullevaal, Div Med, Dept Acute Med, Box 4950 Nydalen, N-0424 Oslo, Norway.
    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 patients2019In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 19, article id 33Article in journal (Refereed)
    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.

  • 55.
    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.
    Andersson, Jacob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Högberg, Göran
    Karolinska Inst, Dept Womens & Childrens Hlth, Child & Adolescent Psychiat Unit, Stockholm, Sweden.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A population register study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 12, article id e0208033Article in journal (Refereed)
    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.

  • 56.
    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.
    Andersson, Jacob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Squier, Waney
    Univ Oxford, John Radcliffe Hosp, Dept Neuropathol, Oxford, England.
    Hogberg, Goren
    Karolinska Inst, Child & Adolescent Psychiat Unit, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Fellman, Vineta
    Lund Univ, Dept Clin Sci, Pediat, Lund, Sweden;Univ Helsinki, Childrens Hosp, Helsinki, Finland;Folkhalsan Res Ctr, Helsinki, Finland.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Wester, Knut
    Univ Bergen, Dept Clin Med, Bergen, Norway;Haukeland Hosp, Dept Neurosurg, Bergen, Norway.
    Epidemiology of subdural haemorrhage during infancy: A population-based register study2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 10, article id e0206340Article in journal (Refereed)
    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.

  • 57.
    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.

  • 58.
    Jabbar, Rowa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    A new predictor of risk for sudden cardiac death2006In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 111, no 2, p. 169-177Article in journal (Refereed)
    Abstract [en]

    Background. Long-chain fatty acids, particularly omega-3 fatty acids found primarily in fish oil, are beneficial in different physiological conditions in the human body. High intake of omega-3 fatty acids has been found to have a strong inverse relationship to sudden cardiac death. An index showing the relationship between different fatty acids in the blood could be an important risk indicator for sudden cardiac death. Methods. Whole-blood samples from the fingertip were collected and fatty acids were measured by a new simple method using direct transmethylation. Two groups were compared: subjects who had been taking fish oil daily during the last 6 years, and subjects who had not been taking fish oil. Results. Six different fatty acid indices were calculated. Five of them take both DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) into consideration, and the sixth includes only EPA and not DHA in the calculation. This latter index, the ratio between EPA and arachidonic acid, gave the best result, with the largest difference between the two groups. This index varied between 5 and 118 among the different individuals; 70% of the fish oil consumers having an index >= 50. Based on the present knowledge about the relationship between blood levels of omega-3 fatty acids and sudden cardiac death obtained from studies of 14,000 individuals, a subject with an index below 50 should be advised to increase his/her intake of omega-3 fatty acids. Conclusion. The EPA/arachidonic acid index may be an important new predictor of risk for sudden cardiac death, and reflects the individual requirement for consumption of omega-3 fatty acids.

  • 59. Jacobs, M M
    et al.
    Okvist, A
    Horvath, Monika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Keller, E
    Bannon, M J
    Morgello, S
    Hurd, Y L
    Dopamine receptor D1 and postsynaptic density gene variants associate with opiate abuse and striatal expression levels2013In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578, Vol. 18, no 11, p. 1205-1210Article in journal (Refereed)
    Abstract [en]

    Opioid drugs are highly addictive and their abuse has a strong genetic load. Dopamine-glutamate interactions are hypothesized to be important for regulating neural systems central for addiction vulnerability. Balanced dopamine-glutamate interaction is mediated through several functional associations, including a physical link between discs, large homolog 4 (Drosophila) (DLG4, PSD-95) and dopamine receptor 1 (DRD1) within the postsynaptic density to regulate DRD1 trafficking. To address whether genetic associations with heroin abuse exist in relation to dopamine and glutamate and their potential interactions, we evaluated single-nucleotide polymorphisms of key genes within these systems in three populations of opiate abusers and controls, totaling 489 individuals from Europe and the United States. Despite significant differences in racial makeup of the separate samples, polymorphisms of DRD1 and DLG4 were found to be associated with opiate abuse. In addition, a strong gene-gene interaction between homer 1 homolog (Drosophila) (HOMER1) and DRD1 was predicted to occur in Caucasian subjects. This interaction was further analyzed by evaluating DRD1 genotype in relation to HOMER1b/c protein expression in postmortem tissue from a subset of Caucasian subjects. DRD1 rs265973 genotype correlated with HOMER1b/c levels in the striatum, but not cortex or amygdala; the correlation was inversed in opiate abusers as compared with controls. Cumulatively, these results support the hypothesis that there may be significant, genetically influenced interactions between glutamatergic and dopaminergic pathways in opiate abusers.

  • 60.
    Johansson, Anna
    et al.
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden..
    Lindstedt, Daniel
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden..
    Roman, Markus
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden..
    Thelander, Gunilla
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden..
    Nielsen, Elisabet I.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Lennborn, Ulrica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Sandler, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. Natl Board Forens Med, Dept Forens Med, Uppsala, Sweden.
    Rubertsson, Sten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Ahlner, Johan
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Div Drug Res, Linkoping, Sweden..
    Kronstrand, Robert
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Div Drug Res, Linkoping, Sweden..
    Kugelberg, Fredrik C.
    Natl Board Forens Med, Dept Forens Genet & Forens Toxicol, Linkoping, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Div Drug Res, Linkoping, Sweden..
    A non-fatal intoxication and seven deaths involving the dissociative drug 3-MeO-PCP2017In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 275, p. 76-82Article in journal (Refereed)
    Abstract [en]

    Introduction: 3-methoxyphencyclidine (3-MeO-PCP) appeared on the illicit drug market in 2011 and is an analogue of phencyclidine, which exhibits anesthetic, analgesic and hallucinogenic properties. In this paper, we report data from a non-fatal intoxication and seven deaths involving 3-MeO-PCP in Sweden during the period March 2014 until June 2016. Case descriptions: The non-fatal intoxication case, a 19-year-old male with drug problems and a medical history of depression, was found awake but tachycardic, hypertensive, tachypnoeic and catatonic at home. After being hospitalized, his condition worsened as he developed a fever and lactic acidosis concomitant with psychomotor agitation and hallucinations. After 22 h of intensive care, the patient had made a complete recovery. During his hospitalization, a total of four blood samples were collected at different time points. The seven autopsy cases, six males and one female, were all in their twenties to thirties with psychiatric problems and/or an ongoing drug abuse. Methods: 3-MeO-PCP was identified with liquid chromatography (LC)/time-of-flight technology and quantified using LC-tandem mass spectrometry. Results: In the clinical case, the concentration of 3-MeO-PCP was 0.14 mu g/g at admission, 0.08 mu g/g 2.5 h after admission, 0.06 mu g/g 5 h after admission and 0.04 mu g/g 17 h after admission. The half-life of 3-MeO-PCP was estimated to 11 h. In the autopsy cases, femoral blood concentrations ranged from 0.05 mu g/g to 0.38 mu g/g. 3-MeO-PCP was the sole finding in the case with the highest concentration and the cause of death was established as intoxication with 3-MeO-PCP. In the remaining six autopsy cases, other medications and drugs of abuse were present as well. Conclusion: Despite being scheduled in January 2015, 3-MeO-PCP continues to be abused in Sweden. Exposure to 3-MeO-PCP may cause severe adverse events and even death, especially if the user does not receive life-supporting treatment.

  • 61.
    Jonasson, B
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Jonasson, U
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Among fatal poisonings dextropropxyphene predominates in younger people, antidepressants in the middle aged and sedatives in the elderly2000In: J Forensic Sci, Vol. 45, p. 7-Article in journal (Refereed)
  • 62. Jonasson, B
    et al.
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Citalopram in fatal poisoning cases.2002In: Forensic Sci Int, Vol. 126, p. 1-Article in journal (Refereed)
  • 63.
    Jonasson, U
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Jonasson, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Middle-aged men - A risk category regarding fatal poisoning due to dextropropoxyphene and alcohol in combination.2000In: Prev Med, Vol. 31, p. 103-Article in journal (Refereed)
  • 64.
    Jonasson, U
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Jonasson, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Thuen, E
    The prevalence of analgesics containing dextropropoxyphene or codeine in individuals suspected of driving under the influence of drugs2000In: Forensic Sci Int, Vol. 14, p. 163-Article in journal (Refereed)
  • 65.
    Klötz, Fia
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Anabolic Androgenic Steroids and Criminality2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Anabolic Androgenic Steroids (AAS) have been associated with adverse psychiatric effects, aggression and violent behaviour. The use of them has spread to a larger subpopulation, and the use has been connected to different risk behaviours, such as use of other illicit substances and carrying a gun. Case reports tell about a connection between AAS use and violent crimes, including homicide. The aim of this thesis is to investigate the proposed connection between AAS and crime, focusing on violent crimes, and to inquire into whether this proposed connection between AAS and criminality is affected by other risk factors for criminal behaviour.

    The first two studies of this thesis investigated the registered criminality of individuals testing positively for AAS, with individuals testing negatively serving as control groups. In the two last studies individuals at a clinic for substance abuse treatment (Paper III) and in a prison (Paper IV) were asked about their use of AAS, and their history was assessed using the Addiction Severity Index.

    The main finding of Paper I was the development of criminal patterns over time, with a clear increase of the proportion of violent crimes and weapons offences seen only among the pure AAS users. In Paper II an increased risk for weapons offences among AAS users was reported. In Paper III an increased risk of having been prosecuted for violent crimes and of having been physically abused was seen among the AAS users. In Paper IV, the main finding was the close resemblance of users and non users.

    In summary, this thesis have concluded that the violence previously reported as connected to use of AAS can, to a large extent, be accounted for by other risk factors. There seems, however, to be a connection between use of AAS and a heavy, more planned form of criminality.

    List of papers
    1. Violent crime and substance abuse: A medico-legal comparison between deceased users of anabolic androgenic steroids and abusers of illicit drugs
    Open this publication in new window or tab >>Violent crime and substance abuse: A medico-legal comparison between deceased users of anabolic androgenic steroids and abusers of illicit drugs
    2007 (English)In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 173, no 1, p. 57-63Article in journal (Refereed) Published
    Abstract [en]

    Several case reports and survey studies have indicated that abuse of anabolic androgenic steroids (AAS) often leads to increased aggressiveness and feelings of hostility that may occasionally trigger violent behaviour. Other observations indicate that many users of AAS also abuse alcohol and/or various illegal substances. Since substance abuse is a well-known risk factor for violent behaviour, it could be that violence committed by AAS users might, at least in many cases, actually be caused by abuse of other drugs. In order to examine this possibility further here, the criminal histories (in terms of incidences of convictions) of deceased users of AAS with (AASpos-subst.pos) and without (AASpos-subst.neg) signs of abuse of other illegal substances were compared to the corresponding histories of deceased users of illicit substances testing negatively for AAS (subst.pos-AASneg) at the time of autopsy. The risk of being convicted for a crime against property was significantly higher in the subst.pos-AASneg group than in either the AASpos-subst.neg or AASpos-subst.pos groups (RR=0.048 versus 0.408). At the same time, the risk of being convicted for a crime of violence was at least as high for the two AAS-positive groups as for the AAS-negative group. Furthermore, when compared with the first 3 years after the first criminal conviction, a pronounced increase in the proportion of incidence of violent crimes and a marked reduction in the proportion of incidence of crime against property was observed during the 3-year period immediately preceding death only among the AASpos-subst.neg subjects. In conclusion, the incidence of violent crime among users of AAS without signs of other drug abuse was comparable to the corresponding incidences for drug addicts without AAS use. This observation suggests that the violent criminality observed among AAS users is not confounded in any systematic fashion by abuse of other drugs. The findings also indicate that use of AAS in certain predisposed individuals might cause a high rate of violent crimes, especially if the use of AAS is combined with the use of other illegal substances.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96839 (URN)10.1016/j.forsciint.2007.01.026 (DOI)000250193300008 ()17337333 (PubMedID)
    Available from: 2008-03-14 Created: 2008-03-14 Last updated: 2017-12-14Bibliographically approved
    2. Criminality Among Individuals Testing Positive for the Presence of Anabolic Androgenic Steroids
    Open this publication in new window or tab >>Criminality Among Individuals Testing Positive for the Presence of Anabolic Androgenic Steroids
    2006 (English)In: Archives of General Psychiatry, ISSN 0003-990X, E-ISSN 1538-3636, Vol. 63, no 11, p. 1274-1279Article in journal (Refereed) Published
    Abstract [en]

    CONTEXT: Observations suggest that the use of anabolic androgenic steroids (AAS) may trigger uncontrolled, violent rage. Other observations indicate that certain groups of criminals may use AAS with the intention of being capable of committing crime more efficiently. OBJECTIVE: To examine the proposed association between the use of AAS and criminality. DESIGN: A controlled retrospective cohort study of registered criminal activity among individuals tested for AAS use during the period of January 1, 1995, to December 31, 2001. SETTING: All individuals in Sweden who were tested for AAS use during this period. These individuals were referred for testing from both inpatient and outpatient clinics as well as from centers for treatment of substance abuse. PARTICIPANTS: Individuals testing positive for AAS (n=241), with those testing negative for AAS during the same period (n=1199) serving as the control group. MAIN OUTCOME MEASURES: The ratios (expressed as relative risk [RR]) of the incidences of several categories of crime in the 2 study groups. RESULTS: The risk of having been convicted for a weapons offense or fraud was higher among individuals testing positive for AAS than among those testing negative (RR, 2.090 and 1.511, respectively; 95% confidence interval [CI], 1.589-2.749 and 1.208-1.891, respectively) whereas there were no significant differences with respect to violent crimes (RR, 1.116; 95% CI, 0.981-1.269) or crimes against property (RR, 0.942; 95% CI, 0.850-1.044). When patients referred from substance abuse centers were excluded, a lower risk for crimes against property was observed for the individuals who tested positive for AAS (RR, 0.761; 95% CI, 0.649-0.893) and the risk for fraud in the 2 groups was equalized (RR, 1.117; 95% CI, 0.764-1.635). The increased risk for a weapons offense among the individuals testing positive for AAS remained virtually unchanged. CONCLUSIONS: In addition to the impulsive violent behavior previously shown to be related to AAS use, such use might also be associated with an antisocial lifestyle involving various types of criminality. However, the existence and nature of this possible association remain unclear and call for further investigation.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96840 (URN)10.1001/archpsyc.63.11.1274 (DOI)000241802000014 ()17088508 (PubMedID)
    Available from: 2008-03-14 Created: 2008-03-14 Last updated: 2017-12-14Bibliographically approved
    3. Use of anabolic androgenic steroids at an outpatient substance abuse clinic in Stockholm, Sweden
    Open this publication in new window or tab >>Use of anabolic androgenic steroids at an outpatient substance abuse clinic in Stockholm, Sweden
    Show others...
    (English)Manuscript (Other academic)
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96841 (URN)
    Available from: 2008-03-14 Created: 2008-03-14 Last updated: 2013-08-15Bibliographically approved
    4. The significance of anabolic androgenic steroids in a Swedish prison population
    Open this publication in new window or tab >>The significance of anabolic androgenic steroids in a Swedish prison population
    2010 (English)In: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 51, no 3, p. 312-318Article in journal (Refereed) Published
    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.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-96842 (URN)10.1016/j.comppsych.2009.05.007 (DOI)000277112700013 ()
    Available from: 2008-03-14 Created: 2008-03-14 Last updated: 2017-12-14Bibliographically approved
  • 66.
    Klötz, Fia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Garle, Mats
    Granath, Fredrik
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Criminality Among Individuals Testing Positive for the Presence of Anabolic Androgenic Steroids2006In: Archives of General Psychiatry, ISSN 0003-990X, E-ISSN 1538-3636, Vol. 63, no 11, p. 1274-1279Article in journal (Refereed)
    Abstract [en]

    CONTEXT: Observations suggest that the use of anabolic androgenic steroids (AAS) may trigger uncontrolled, violent rage. Other observations indicate that certain groups of criminals may use AAS with the intention of being capable of committing crime more efficiently. OBJECTIVE: To examine the proposed association between the use of AAS and criminality. DESIGN: A controlled retrospective cohort study of registered criminal activity among individuals tested for AAS use during the period of January 1, 1995, to December 31, 2001. SETTING: All individuals in Sweden who were tested for AAS use during this period. These individuals were referred for testing from both inpatient and outpatient clinics as well as from centers for treatment of substance abuse. PARTICIPANTS: Individuals testing positive for AAS (n=241), with those testing negative for AAS during the same period (n=1199) serving as the control group. MAIN OUTCOME MEASURES: The ratios (expressed as relative risk [RR]) of the incidences of several categories of crime in the 2 study groups. RESULTS: The risk of having been convicted for a weapons offense or fraud was higher among individuals testing positive for AAS than among those testing negative (RR, 2.090 and 1.511, respectively; 95% confidence interval [CI], 1.589-2.749 and 1.208-1.891, respectively) whereas there were no significant differences with respect to violent crimes (RR, 1.116; 95% CI, 0.981-1.269) or crimes against property (RR, 0.942; 95% CI, 0.850-1.044). When patients referred from substance abuse centers were excluded, a lower risk for crimes against property was observed for the individuals who tested positive for AAS (RR, 0.761; 95% CI, 0.649-0.893) and the risk for fraud in the 2 groups was equalized (RR, 1.117; 95% CI, 0.764-1.635). The increased risk for a weapons offense among the individuals testing positive for AAS remained virtually unchanged. CONCLUSIONS: In addition to the impulsive violent behavior previously shown to be related to AAS use, such use might also be associated with an antisocial lifestyle involving various types of criminality. However, the existence and nature of this possible association remain unclear and call for further investigation.

  • 67.
    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.

  • 68.
    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.
    Isacson, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Violent crime and substance abuse: A medico-legal comparison between deceased users of anabolic androgenic steroids and abusers of illicit drugs2007In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 173, no 1, p. 57-63Article in journal (Refereed)
    Abstract [en]

    Several case reports and survey studies have indicated that abuse of anabolic androgenic steroids (AAS) often leads to increased aggressiveness and feelings of hostility that may occasionally trigger violent behaviour. Other observations indicate that many users of AAS also abuse alcohol and/or various illegal substances. Since substance abuse is a well-known risk factor for violent behaviour, it could be that violence committed by AAS users might, at least in many cases, actually be caused by abuse of other drugs. In order to examine this possibility further here, the criminal histories (in terms of incidences of convictions) of deceased users of AAS with (AASpos-subst.pos) and without (AASpos-subst.neg) signs of abuse of other illegal substances were compared to the corresponding histories of deceased users of illicit substances testing negatively for AAS (subst.pos-AASneg) at the time of autopsy. The risk of being convicted for a crime against property was significantly higher in the subst.pos-AASneg group than in either the AASpos-subst.neg or AASpos-subst.pos groups (RR=0.048 versus 0.408). At the same time, the risk of being convicted for a crime of violence was at least as high for the two AAS-positive groups as for the AAS-negative group. Furthermore, when compared with the first 3 years after the first criminal conviction, a pronounced increase in the proportion of incidence of violent crimes and a marked reduction in the proportion of incidence of crime against property was observed during the 3-year period immediately preceding death only among the AASpos-subst.neg subjects. In conclusion, the incidence of violent crime among users of AAS without signs of other drug abuse was comparable to the corresponding incidences for drug addicts without AAS use. This observation suggests that the violent criminality observed among AAS users is not confounded in any systematic fashion by abuse of other drugs. The findings also indicate that use of AAS in certain predisposed individuals might cause a high rate of violent crimes, especially if the use of AAS is combined with the use of other illegal substances.

  • 69. Konstenius, Maija
    et al.
    Larsson, Henrik
    Lundholm, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Philips, Bjorn
    van de Glind, Geurt
    Jayaram-Lindstrom, Nitya
    Franck, Johan
    An Epidemiological Study of ADHD, Substance Use, and Comorbid Problems in Incarcerated Women in Sweden2015In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 19, no 1, p. 44-52Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to examine the prevalence of ADHD and psychiatric comorbidity, including substance use in incarcerated women. Method: This was a cross-sectional study, consisting of two parts: (a) screening using the ADHD Self-Rating Scale (ASRS) and (b) diagnostic assessment using a structured interview. Results: A sample of 96 incarcerated women was screened and 56 underwent the diagnostic assessment. Twenty-nine percent of the women met the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnostic criteria for adult ADHD in the diagnostic assessment. Forty-four of the women had misuse of alcohol, and 83% had misuse of narcotics the year prior to the incarceration. The ASRS showed sensitivity of 1.0 and specificity of 0.66. Conclusion: The prevalence rate of ADHD in incarcerated women was high and comparable to that in male offenders. Illicit stimulant use and antisocial personality disorder were significantly more common in women with ADHD. ASRS is useful as a screener in this population.

  • 70.
    Kovacs, Gabor G.
    et al.
    Med Univ Vienna, Inst Neurol, A-1097 Vienna, Austria.;Semmelweis Univ, Neuropathol & Prion Dis Reference Ctr, H-1085 Budapest, Hungary..
    Horvath, Monika Cs.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Majtenyi, Katalin
    Semmelweis Univ, Neuropathol & Prion Dis Reference Ctr, H-1085 Budapest, Hungary..
    Lutz, Mirjam I.
    Med Univ Vienna, Inst Neurol, A-1097 Vienna, Austria..
    Hurd, Yasmin L.
    Icahn Sch Med Mt Sinai, Dept Neurosci, New York, NY 10029 USA.;Icahn Sch Med Mt Sinai, Dept Psychiat, New York, NY 10029 USA..
    Keller, Eva
    Semmelweis Univ, Dept Forens & Insurance Med, H-1085 Budapest, Hungary..
    Heroin abuse exaggerates age-related deposition of hyperphosphorylated tau and p62-positive inclusions2015In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 36, no 11, p. 3100-3107Article in journal (Refereed)
    Abstract [en]

    The observation of increased hyperphosphorylated tau levels correlating with microglial activation in opiate abusers has been interpreted as predisposition to accelerated Alzheimer diseaseerelated changes. The present study focused on evaluating additional neurodegeneration-related proteins, including a-synuclein and TDP-43, and p62-positive deposits. We performed a systematic mapping of protein deposits in the brains of 27 individuals with documented heroin addiction (age: 19-40 years) and compared with 11 controls (age: 15-40 years). We confirm previous findings that heroin addiction associates with tau hyperphosphorylation in predilection brain areas for aging and Alzheimer disease. Furthermore, we show that this occurs also in areas implicated in the molecular disturbances and in vivo neuronal networks related to heroin abuse. There was, however, no presence of amyloid-beta deposits. We extend previous findings by showing the lack of TDP-43 or alpha-synuclein pathology and emphasize the independent effect of the duration of drug use on the appearance of age-related p62-positive neuritic profiles. These observations provide unique insights about neuropathological alterations in the brains of young heroin addicts and have implications about brain aging and the influences of environmental and toxic factors.

  • 71.
    Li, D
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Chen, H
    Romeo, F
    Sawamura, T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Mehta, JL
    Statins modulate oxidized low-density lipoprotein-mediated adhesionmolecule expression in human coronary artery endothelial cells: role ofLOX-1.2002In: J Pharmacol Exp Ther, Vol. 302, p. 601-Article in journal (Refereed)
  • 72.
    Li, D
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Mehta, JL
    Effects of alpha-tocopherol on ox-LDL-mediated degradation of IkappaB and apoptosis in cultured human coronary artery endothelial cells2000In: J Cardiovasc Pharmacol, Vol. 36, p. 297-Article in journal (Refereed)
  • 73. Li, D
    et al.
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Romeo, F
    Mehta, JL
    Different isoforms of tocopherols enhance nitric oxide synthasephosphorylation and inhibit human platelet aggregation and lipidperoxidation: implications in therapy with vitamin E.2001In: J Cardiovasc Pharmacol Ther, Vol. 6, p. 155-Article in journal (Refereed)
  • 74. Li, D
    et al.
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Romeo, F
    Mehta, JL
    Oxidized LDL upregulates angiotensin II type 1 receptor expression incultured human coronary artery endothelial cells: the potential role oftranscription factor NF-kappaB.2000In: Circulation, Vol. 102, p. 1970-Article in journal (Refereed)
  • 75.
    Li, Xiaogai
    et al.
    Royal Inst Technol KTH, Sch Technol & Hlth, Div Neuron Engn, S-14152 Huddinge, Sweden.
    Sandler, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. National Board of Forensic Medicine, Uppsala, Sweden.
    Kleiven, Svein
    Royal Inst Technol KTH, Sch Technol & Hlth, Div Neuron Engn, S-14152 Huddinge, Sweden.
    Infant skull fractures: Accident or abuse? Evidences from biomechanical analysis using finite element head models2019In: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 294, p. 173-182Article in journal (Refereed)
    Abstract [en]

    Abusive Head Trauma (AHT) is considered by some authors to be a leading cause of traumatic death in children less than two years of age and skull fractures are commonly seen in cases of suspected AHT. Today, diagnosing whether the observed fractures are caused by abuse or accidental fall is still a challenge within both the medical and the legal communities and the central question is a biomechanical question: can the described history explain the observed fractures? Finite element (FE) analysis has been shown a valuable tool for biomechanical analysis accounting for detailed head geometry, advanced material modelling, and case-specific factors (e.g. head impact location, impact surface properties). Here, we reconstructed two well-documented suspected abuse cases (a 3- and a 4-month-old) using subject-specific FE head models. The models incorporate the anatomical details and age-dependent anisotropic material properties of infant cranial bones that reflect the grainy fibres radiating from ossification centres. The impact locations are determined by combining multimodality images. The results show that the skull fracture patterns in both cases of suspected abuse could be explained by the described accidental fall history, demonstrating the inherent potential of FE analysis for providing biomechanical evidence to aid forensic investigations. Increased knowledge of injury mechanisms in children may have enormous medico-legal implications world-wide.

  • 76. Li, Xiaogai
    et al.
    Sandler, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine. National Board of Forensic Medicine, Uppsala, Sweden.
    Kleiven, Svein
    The importance of nonlinear tissue modelling in finite element simulations of infant head impacts2017In: Biomechanics and Modeling in Mechanobiology, ISSN 1617-7959, E-ISSN 1617-7940, Vol. 16, no 3, p. 823-840Article in journal (Refereed)
    Abstract [en]

    Despite recent efforts on the development of finite element (FE) head models of infants, a model capable of capturing head responses under various impact scenarios has not been reported. This is hypothesized partially attributed to the use of simplified linear elastic models for soft tissues of suture, scalp and dura. Orthotropic elastic constants are yet to be determined to incorporate the direction-specific material properties of infant cranial bone due to grain fibres radiating from the ossification centres. We report here on our efforts in advancing the above-mentioned aspects in material modelling in infant head and further incorporate them into subject-specific FE head models of a newborn, 5- and 9-month-old infant. Each model is subjected to five impact tests (forehead, occiput, vertex, right and left parietal impacts) and two compression tests. The predicted global head impact responses of the acceleration-time impact curves and the force-deflection compression curves for different age groups agree well with the experimental data reported in the literature. In particular, the newly developed Ogden hyperelastic model for suture, together with the nonlinear modelling of scalp and dura mater, enables the models to achieve more realistic impact performance compared with linear elastic models. The proposed approach for obtaining age-dependent skull bone orthotropic material constants counts both an increase in stiffness and decrease in anisotropy in the skull bone-two essential biological growth parameters during early infancy. The profound deformation of infant head causes a large stretch at the interfaces between the skull bones and the suture, suggesting that infant skull fractures are likely to initiate from the interfaces; the impact angle has a profound influence on global head impact responses and the skull injury metrics for certain impact locations, especially true for a parietal impact.

  • 77. Lindström, Eva
    et al.
    Eriksson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Levander, Sten
    Suicides during 7 years among a catchment area cohort of patients with psychoses2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 1, p. 8-13Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate a series of consecutive suicides at a psychosis clinic by using a psychological autopsy technique. Method: The clinic serves an adult population of 225,000 individuals, of whom 0.5% have regular contact with the clinic. During a 7 1/2-year period, 23 men and nine women committed suicide, which corresponds to an odds ratio of 14. Results: Most patients were schizophrenic, and 24 were outpatients. Suicide methods were violent in all but two cases. Nineteen had a history of at least one suicide attempt, and 24 were known to have had suicidal ideation. More than half had no social contacts over the last year except with psychiatric staff. The median time between the last contact with the psychiatric services and the suicide was 4 days. No warning signs were noted. At the time of death, 3 of the 24 who were prescribed antipsychotics, and none of the 10 who were prescribed antidepressants had plasma levels of the corresponding drug. Conclusion: Findings of special interest are the lack of forewarnings and the poor drug compliance. Patients appear to have played "business as usual" with the care-givers, and did it well. Is it a sign of health and despair, or illness?

  • 78. Liu, M
    et al.
    Wallin, R
    Wallmon, A
    Saldeen, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Mixed tocopherols have a stronger inhibitory effect on lipid peroxidationthan alpha-tocopherol alone.2002In: J Cardiovasc Pharmacol, Vol. 39, p. 714-Article in journal (Refereed)
  • 79.
    Lundholm, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Substance Use and Violence: Influence of Alcohol, Illicit Drugs and Anabolic Androgenic Steroids on Violent Crime and Self-directed Violence2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Interpersonal violence and suicide are major health concerns, leading to premature death, extensive human suffering and staggering monetary costs. Although violent behaviour has multiple causes, it is well known that acute substance intake and abuse increase the risks of both interpersonal and self-directed violence. This association is quite well established for alcohol, while a more ambiguous literature exists for other common drugs of abuse. For example, anabolic androgenic steroids (AAS), synthetic analogues to the “male” sex hormone testosterone are suggested to elicit violent and aggressive behaviour. Two studies (I and III) in the present thesis addressed the association between AAS use and being suspected or convicted of a violent crime among remand prisoners and in a general population sample, respectively. Further, using the case-crossover design to control for confounders stable within individuals, I also investigated the triggering (short-term risk) effect of alcohol and drugs such as benzodiazepines and AAS, on violent crime (Study II). Finally, a fourth study (IV) based on a large national forensic sample of suicide completers (n=18,894) examined the risk of using a violent, more lethal, suicide method, when under acute influence of alcohol, central stimulants or cannabis.

    The results of this thesis suggested that AAS use in itself is not a proximal risk factor for violent crime; the observed risk is probably due to the co-occurrence of abuse of other substances. Alcohol is a strong triggering risk factor for violent crime, constant across males and females as well as individuals with or without behavioral and psychiatric vulnerability. Intake of high doses of benzodiazepines is associated with an increased risk for violent crime. Cannabis use is associated with an increased risk of using the lethal suicide method of jumping from a height. I conclude that mapping substance abuse patterns may inform violence risk assessment and treatment planning.

    List of papers
    1. Use of anabolic androgenic steroids in substance abusers arrested for crime
    Open this publication in new window or tab >>Use of anabolic androgenic steroids in substance abusers arrested for crime
    2010 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 111, no 3, p. 222-226Article in journal (Refereed) Published
    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.

    Keywords
    Anabolic androgenic steroids; Violent crime; Substance abuse
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-130376 (URN)10.1016/j.drugalcdep.2010.04.020 (DOI)000283969900006 ()20627426 (PubMedID)
    Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2017-12-12Bibliographically approved
    2. The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study
    Open this publication in new window or tab >>The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study
    Show others...
    2013 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 129, no 1-2, p. 110-115Article in journal (Refereed) Published
    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.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-188722 (URN)10.1016/j.drugalcdep.2012.09.019 (DOI)000316827600015 ()23102731 (PubMedID)
    Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2017-12-06Bibliographically approved
    3. Anabolic androgenic steroids and violent offending: Confounding by polysubstance abuse among 10,365 general population men
    Open this publication in new window or tab >>Anabolic androgenic steroids and violent offending: Confounding by polysubstance abuse among 10,365 general population men
    2015 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 1, p. 100-108Article in journal (Refereed) Published
    Abstract [en]

    Background and AimsAnabolic androgenic steroid (AAS) use is associated with aggressive and violent behaviour, but it remains uncertain if this relationship is causal in humans. We examined the link between AAS use and violent crime while controlling for polysubstance abuse and additional suggested risk factors for violence. DesignCross-sectional study of a population-based sample. SettingIn 2005, all Swedish-born male twins aged 20-47 years were invited to participate in the Swedish Twin Adults: Genes and Environment (STAGE) survey of the Swedish Twin Register (response rate=60%). ParticipantsA total of 10365 male survey participants with information on AAS use. MeasurementData on self-reported use of AAS, alcohol and other substances, attention deficit hyperactivity disorder (ADHD) and personality disorder symptoms were linked to nation-wide, longitudinal register information on criminal convictions, IQ, psychological functioning and childhood socio-economic status (SES) covariates. FindingsAny life-time use of AAS was associated strongly with conviction for a violent crime [2.7 versus 0.6% in convicted and non-convicted men, respectively; odds ratio (OR)=5.0, 95% confidence interval (CI)=2.7-9.3]. However, this link was substantially reduced and no longer significant when controlling for other substance abuse (OR=1.6, 95% CI=0.8-3.3). Controlling for IQ, psychological functioning, ADHD, personality disorder symptoms and childhood SES did not reduce the risk further. ConclusionIn the general population, co-occurring polysubstance abuse, but not IQ, other neuropsychological risks or socio-economic status, explains most of the relatively strong association between any anabolic androgenic steroid use and conviction for a violent crime.

    Keywords
    Anabolic androgenic steroids; general population; polysubstance abuse; psychiatry; survey; violent crime
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-193290 (URN)10.1111/add.12715 (DOI)000346699700017 ()25170826 (PubMedID)
    Available from: 2013-01-30 Created: 2013-01-30 Last updated: 2017-12-06
    4. Acute influence of alcohol, THC or central stimulants on violent suicide: a Swedish Population study
    Open this publication in new window or tab >>Acute influence of alcohol, THC or central stimulants on violent suicide: a Swedish Population study
    Show others...
    2014 (English)In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 59, no 2, p. 436-440Article in journal (Refereed) Published
    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.

     

    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-193294 (URN)10.1111/1556-4029.12353 (DOI)000332307900020 ()
    Available from: 2013-01-30 Created: 2013-01-30 Last updated: 2017-12-06Bibliographically approved
  • 80.
    Lundholm, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Frisell, Thomas
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
    Långström, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
    Anabolic androgenic steroids and violent offending: Confounding by polysubstance abuse among 10,365 general population men2015In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 1, p. 100-108Article in journal (Refereed)
    Abstract [en]

    Background and AimsAnabolic androgenic steroid (AAS) use is associated with aggressive and violent behaviour, but it remains uncertain if this relationship is causal in humans. We examined the link between AAS use and violent crime while controlling for polysubstance abuse and additional suggested risk factors for violence. DesignCross-sectional study of a population-based sample. SettingIn 2005, all Swedish-born male twins aged 20-47 years were invited to participate in the Swedish Twin Adults: Genes and Environment (STAGE) survey of the Swedish Twin Register (response rate=60%). ParticipantsA total of 10365 male survey participants with information on AAS use. MeasurementData on self-reported use of AAS, alcohol and other substances, attention deficit hyperactivity disorder (ADHD) and personality disorder symptoms were linked to nation-wide, longitudinal register information on criminal convictions, IQ, psychological functioning and childhood socio-economic status (SES) covariates. FindingsAny life-time use of AAS was associated strongly with conviction for a violent crime [2.7 versus 0.6% in convicted and non-convicted men, respectively; odds ratio (OR)=5.0, 95% confidence interval (CI)=2.7-9.3]. However, this link was substantially reduced and no longer significant when controlling for other substance abuse (OR=1.6, 95% CI=0.8-3.3). Controlling for IQ, psychological functioning, ADHD, personality disorder symptoms and childhood SES did not reduce the risk further. ConclusionIn the general population, co-occurring polysubstance abuse, but not IQ, other neuropsychological risks or socio-economic status, explains most of the relatively strong association between any anabolic androgenic steroid use and conviction for a violent crime.

  • 81.
    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.

  • 82.
    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.

  • 83.
    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.

     

  • 84. Mazei-Robison, Michelle S.
    et al.
    Koo, Ja Wook
    Friedman, Allyson K.
    Lansink, Carien S.
    Robison, Alfred J.
    Vinish, Monika
    Krishnan, Vaishnav
    Kim, Seyun
    Siuta, Michael A.
    Galli, Aurelio
    Niswender, Kevin D.
    Appasani, Raghu
    Horvath, Monika C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Neve, Rachel L.
    Worley, Paul F.
    Snyder, Solomon H.
    Hurd, Yasmin L.
    Cheer, Joseph F.
    Han, Ming-Hu
    Russo, Scott J.
    Nestler, Eric J.
    Role for mTOR Signaling and Neuronal Activity in Morphine-Induced Adaptations in Ventral Tegmental Area Dopamine Neurons2011In: Neuron, ISSN 0896-6273, E-ISSN 1097-4199, Vol. 72, no 6, p. 977-990Article in journal (Refereed)
    Abstract [en]

    While the abuse of opiate drugs continues to rise, the neuroadaptations that occur with long-term drug exposure remain poorly understood. We describe here a series of chronic morphine-induced adaptations in ventral tegmental area (VTA) dopamine neurons, which are mediated via downregulation of AKT-mTORC2 (mammalian target of rapamycin complex-2). Chronic opiates decrease the size of VTA dopamine neurons in rodents, an effect seen in humans as well, and concomitantly increase the excitability of the cells but decrease dopamine output to target regions. Chronic morphine decreases mTORC2 activity, and overexpression of Rictor, a component of mTORC2, prevents morphine-induced changes in cell morphology and activity. Further, local knockout of Rictor in VTA decreases DA soma size and reduces rewarding responses to morphine, consistent with the hypothesis that these adaptations represent a mechanism of reward tolerance. Together, these findings demonstrate a novel role for AKT-mTORC2 signaling in mediating neuroadaptations to opiate drugs of abuse.

  • 85.
    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.

  • 86.