The purpose of this thesis is to study cultural aspects of alcohol and drug use in Sweden, and also to some extent in other countries. In the context of changing patterns of drinking and drug use in Sweden and in the rest of the world, such studies are increasingly important. The thesis comprises four self-contained but interrelated studies. Each study, in different ways, addresses the question of cultural variation (within and between cultures) and the cultural position of intoxicating substances. Acknowledging that young people’s use of intoxicating substances as well as women’s and men’s use of such substances are important social policy issues, each of the four studies also relates to the position of either young people or the position of gender with regard to intoxicating substance use. Study 1 investigates what it means to drink, take drugs and become intoxicated as understood from the official-organizational perspective of the FMN’s (Parents Against Drugs’) 2003 campaign directed towards teenagers´ parents. As a contrast to the hegemonic perspective presented by the organization in Study 1, Study 2 explicitly tries to find and describe different lines of reasoning with regard to alcohol use and intoxication among young people. Study 3 investigates the link – so commonly referred to in the Western world – between drinking, drug use and intoxication, on the one hand, and sexuality and gender, on the other. Study 3 further tries to grasp why women who drink are considered bad both because they violate the norms of feminine appearance and because they are perceived as sexually promiscuous and “available”. Study 4 focuses on cultural variation in the intoxication – sexuality link. It uses cross-country comparisons and multiple regression analysis of data from 11 countries within and outside the West to examine the link between positive expectancies about the effects of drinking on sexual feelings, on the one hand, and drinking, on the other.

A significant number of teenagers are killed each year by unintentional or intentional injuries. A teenager is in a vulnerable phase of her/his life, going from being a child to adult. This transition often includes testing the limits of their capabilities, which can include, e.g., high speed driving, testing alcohol and other drugs, including drinking and driving. The development from child to adult includes different psychological stress factors, such as, e.g., school problems, broken love affairs and bullying. The demands – perceived or real – also increases over time and vulnerable individuals can turn to self-harm and in the most extreme case suicide. The aim of this thesis was to investigate teenager fatalities in the northern half of Sweden and to suggest preventive measures. A survey of teenager fatalities during a twenty-year period revealed that the incidence of unintentional (n=248) deaths decreased, while intentional (n=102) deaths were unaffected over time. Most unintentional deaths were transportation related (n=204) while most of the intentional deaths were suicides (n=88). Twenty-eight percent of the decedents were test-positive for alcohol at autopsy. In a series of three studies, teenager suicides were investigated in depth, firstly through an interview study with the investigating police officer in charge of the investigation of a teenager suicide. Most of the suicides occurred in rural and depopulated areas despite the fact that most teenagers live in the larger cities along the coastline. A majority of the suicides appeared to be planned. Females, contrary to males, often had a psychiatric history. One of the conclusions was that police officers provide essential information concerning the circumstances around a teenager suicide. Parents who had lost a child through suicide, and in some cases siblings, were interviewed 15-25 months after the suicide. It was striking how the life of the surviving family members were still affected by the devastating trauma of the suicide; most parents testified that they were still struggling with the question “why?” and that they were thinking of their lost child every day. Post suicide support was often badly timed and insufficient, especially for the younger siblings. The family doctor has an important role as a co-ordinator of a long-term individually formulated support scheme for the bereaved. Evidence of suicide contagion and suicide cluster formation, i.e., one teenager suicide led to another suicide, was found in these studies, and two suicide clusters were identified, with links between the victims in each cluster. Both clusters occurred within a geographical and timely proximity. Everyone involved in the well-being of the young should be aware of the risk of contagion and suicide cluster formation. The fifth study concerned 12,812 teenagers who visited the Emergency Room at Umeå University Hospital due to an injury during 1993 through 2006. Sixty-one of these were found dead through 2007, 49 by unnatural (of which 38 were included) and 12 by natural causes. The standard mortality rate for unnatural death was calculated to 1.44 (1.02-1.98), confirming an increased risk of premature death. In many of these deaths, alcohol and drugs may have contributed. By increasing the awareness among health professionals that injury can predict a premature death - primarily among those who develop substance abuse - some premature deaths may be prevented by early intervention. This thesis confirms that most teenagers die from unnatural causes, mostly in transportation-related events and by suicide. By studying these deaths, preventive measures that could save lives have been suggested.

There is today much evidence for a positive relationship between alcohol and violence. There are however still many questions about the nature of the relationship. Somewhat simplified, the research on the link between alcohol and violence can be divided into four different lines of research, research focusing on: the effect of alcohol as a psychoactive substance, the drinking context, the personality of the drinker, and societal attitudes, expectations and values. The dissertation focuses on the last area, the importance of the cultural context. One influential theory within this field is the time-out theory formulated by MacAndrew and Edgerton in the late 1960s. Since drunken comportment varied between cultures and between different contexts within the same culture and changed over time, they suggested that the effects of alcohol on people’s behaviour was socially constructed. They suggest that many societies had a created a time-out situation for drunken behaviour that explained people’s behaviour while drunk. The general aim for this dissertation is to study young Swedes’ attitudes, experiences and expectations around drunken behaviour, with a special focus on expectancies around alcohol as a cause and excuse for violence. Three different data sets have been used. The first study is based on 4 focus-group interviews with Swedish football fans during the European football championship in Holland in 2000. The second material is eight focus-group interviews involving 47 students aged 18-20 living in Stockholm. The last material is a nationally representative survey of young adults, 16-25 years old. One part of the survey consisted of 4 vignettes which we used to elicit cultural norms around drunken behaviour. The findings suggest that young Swedes believe that alcohol can be used as a means to accomplish a pleasurable state of mind, and that alcohol could be used as a means to transgression – since alcohol reduce inhibitions it could be used to put them in a less controlled mode. The rationale for those changes was often described in terms of the psychoactive effect of alcohol. However, it was also shown that the context was important. When the situation demanded alcohol the most, their expectations together with the situation almost turned water into beer. It was also shown that there was a norm which said that one should not use alcohol as an excuse, but on the other hand, the participants said that they used alcohol as an excuse and that they thought that it was accepted. Alcohol could work as an excuse since alcohol made the aggressor look less deviant and the acts less severe. The vignette studies indicated that an aggressor who was drunk when he committed a violent act was seen as less blameworthy than a sober or less drunk aggressor. However, this applied only under certain circumstances: alcohol seemed to be a better excuse if the victim is drunk as well and the act is relatively severe. Taken together, the studies suggest that the Swedish drinking culture provides people with a drunken excuse, which helps young people to expand the room for possible action.

In eukaryotic cells, most proteins in the cytosol and nucleus are degraded via the ubiquitin-proteasome pathway. Ubiquitin is best known for its role in targeting proteins for degradation by the proteasome. Ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) is found specifically in central and peripheral neurons, and is responsible for the removal of small peptide fragments from the ubiquitin chain and for co-translational processing of ubiquitin gene products to generate free monomeric ubiquitin. In response to extreme conditions, cells exhibit an up-regulation of heat shock protein (HSP) expression, which contributes to repair and protective mechanisms. Within the HSP family, HSP70 is the major inducible member that protects against cell death. Based on the pharmacologic property of organophosphates as an inhibitor of cholinesterase, it is generally contended that manifestations of organophosphate poisoning, including secretion and muscle fasciculation, stupor, cardiopulmonary collapse, respiratory failure, coma or death, result from accumulation of, and over-stimulation by acetylcholine at peripheral of central synapses. One approach in furthering our understanding on organophosphate poisoning is delineation of its potential protective mechanisms. In this regard, the information on the cellular and molecular mechanisms that underlie organophosphate poisoning has received attention. Our laboratory demonstrated previously that a crucial brain site via which mevinphos (Mev), an organophosphate insecticide of the P=O type, acts is the rostral ventrolateral medulla (RVLM), the medullary origin of premotor sympathetic neurons that are responsible for the maintenance of vasomotor tone. The phasic changes in cardiovascular events over the course of acute Mev intoxication also parallel fluctuations of the ¡§life-and-death¡¨ signals that emanate form the RVLM. Based on a rat model of organophosphate poisoning that provides continuous information on cellular and molecular mechanisms in the RVLM, the present study was undertaken to evaluate whether changes in protein level of UCH-L1 or HSP70 are associated with death arising from Mev intoxication. We also evaluated the efficacy of both of them in the neuroprotection against fatality during Mev intoxication. The first part of this study investigated whether UCH-L1 plays a neuroprotective role at the RVLM, where Mev acts to elicit cardiovascular toxicity. In Sprague-Dawley rats maintained under propofol anesthesia, Mev (960 µg/kg, i.v.) induced a parallel and progressive augmentation in UCH-L1 or ubiquitin expression at the ventrolateral medulla during the course of Mev intoxication. The increase in UCH-L1 level was significantly blunted on pretreatment with microinjection bilaterally into the RVLM of a transcription inhibitor, actinomycin D (5 nmol) or a translation inhibitor, cycloheximide (20 nmol). Compared to artificial cerebrospinal fluid (aCSF) or sense uch-L1 oligonucleotide (100 pmol) pretreatment, microinjection of an antisense uch-L1 oligonucleotide (100 pmol) bilaterally into the RVLM significantly increased mortality, reduced the duration of the phase I (¡§pro- life¡¨ phase), blunted the increase in ubiquitin expression in ventrolateral medulla, and augmented the induced hypotension in rats that received Mev. The second part of this study investigated whether HSP70 plays a neuroprotective role at the RVLM. Intravenous administration of Mev (960

Compared with the population at-large, the Emergency Department (ED) population sees a high percentage of people with alcohol use and abuse problems. Therefore, the ED is well suited for the implementation of alcohol screening and interventions. It is important to be able to identify at risk drinkers who come to the ED for treatment for injury or other medical problems so that interventions may occur. Project ED Health conducted intensive interviews with harmful and hazardous drinkers presenting to the ED for treatment of injury or medical problem. The data was entered into a database and analyzed to find differences between injured and non-injured at risk drinkers. We found that 2/3 of at risk drinkers presented without injury. Compared to participants without injuries, injured individuals were significantly younger and more likely to be male. Injured and non-injured individuals had similar drinking patterns and health behaviors. Individuals at risk for alcohol-associated problems are similar in terms of drinking patterns and consequences and health status. Any screening tactic that is less than comprehensive, (i.e. that targets only injured individuals), will miss a significant number of at risk drinkers.

Reproduction de : Thèse d'exercice : Médecine : Nancy 1 : 2007. / Titre provenant de l'écran-titre.

No description available.

Interpersonal violence is a matter of growing concern. Where the safety of the common man is concerned, the dangerousness of mental patients, the ongoing de-institutionalization within psychiatry, and the role of alcohol is disputed. In order to analyze the significance of abuse and mental disorder in violent behaviour, this subject was approached from two different perspectives; from a specific violent offence - homicide - examining the mental status of the offenders, and from individuals with a specific mental disorder - schizophrenia -and assessing the rate of criminal offence amongst them. Homicides in northern Sweden and in Stockholm, legally characterized as murder, manslaughter or assault and causing another’s death, and homicides followed by the offenders’ suicide, were studied. Medicolegal autopsy records, police reports, pretrial psychiatric reports and court records were collected and scrutinized. The criminal records of 644 persons, discharged from hospitals in Stockholm with a diagnosis of schizophrenia, were studied. The relative risk of criminal offence was analyzed by indirect standardization using the general population as a standard. Violent offenders were further examined from psychiatric records. In the homicide material, 16 females and 160 males killed 94 men, 78 women, and 15 children. Forty percent of all surviving offenders were abusers without a major mental disorder, 39% were mentally disordered, 11% committed suicide, and 10% were considered "normal". The abusers and their victims were older, often socially and mentally deteriorated, and well known to each other. The victim was the prime aggressor in half of the cases. Killings by mentally disordered persons and by those who committed suicide were characterized by intimacy between offender and victim; one third were also abusers. Multiple homicides and child murder were mainly seen among homicide-suicice cases. The "normal" offenders were more often of foreign origin and two thirds of the victims initiated the violence by physical attacks. Relatively more of the homicides in northern Sweden concerned intimate parties, use of firearms, and cases of homicide-suicide, as compared to homicides in Stockholm where drug abuse was more prevalent. Sixteen offenders (9%) in the homicide sample had schizophrenia (all males), while 38 subjects (6%) in the cohort of schizophrenics had committed a violent offence. No homicide was recorded and most of the offences were of minor severity. The rate of violent offence was four times higher in the study group as compared to the general population. Most homicides involved closely related persons with separation and dependence as the dominating psychological theme, especially in homicide- suicide cases. Intoxication was regularly seen among the abusers but not among the non-abusers. The acute effect of alcohol intoxication may be of lesser importance in violence as compared to the long-term effects of abuse. Schizophrenics do not impress as a particularly dangerous group. Prevention by psychiatry is difficult; most offenders did not have any contact with psychiatry prior to the act. / <p>S. 1-70: sammanfattning, s. 71-176: 5 uppsatser</p> / digitalisering@umu

Objectives – To ascertain the annual number of users who were discharged home after visits to the emergency department, grouped by age, gender and number of visits during the calendar year, and to assess whether an increasing number of visits to the department predicted a higher mortality. Methods – This is a retrospective cohort study, at the emergency department of Landspitali University Hospital, Reykjavik capital city area, Iceland. During the years of 1995 to 2001 19259 users visited the emergency department, and were discharged home and they were follow-up for cause specific mortality through a national registry. Standardised mortality ratio, with expected number based on national mortality rates was calculated and hazard ratios according to number of visits per calendar year using time dependent multivariate regression analysis were computed. Results – The annual increase of visits to the emergency department among the patients discharged home was seven to 14 per cent per age group during the period 1995 to 2001, with a highest increase among older men. The most common discharge diagnosis was the category Symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified. When emergency department users were compared with the general population, the standardised mortality ratio was 1.81 for men and 1.93 for women. Among those attending the emergency department two times, and three or more times in a calendar year, the mortality rate was higher than among those coming only once in a year. The causes of death which led to the highest mortality among frequent users of the emergency department were neoplasm, ischemic heart diseases, and the category external causes, particularly drug intoxication, suicides and probable suicides. Conclusions – The mortality of users of the emergency department who had been discharged home turned out to be higher than that of the general population. Frequent users of the emergency department had a higher mortality than those visiting the department no more than once in a year. Since the emergency department serves general medicine and surgery patients, not injuries, the high mortality due to drug intoxication, suicide and probable suicide is notable. Further studies are needed into the diagnosis at discharge of those frequently using emergency departments, in an attempt to understand and possibly prevent this mortality / <p>ISBN 91-7997-128-8</p>

Lic.-avh. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 3 uppsatser.