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The use of anabolic androgenic steroids (AAS) has been associated with use of illegal or unprescribed prescription drugs, as well as different adverse psychiatric effects, such as ma-nia, psychosis and hostility. Further, there is an association between use of AAS and other different risk behaviours, including carrying guns and reckless driving. Taken together, these data suggest that there is a group of AAS users that are not elite athletes, but rather young men at risk for psychiatric illness and criminality, and who use AAS primarily for their aes-thetic effects and possibly for their psychoactive effects. The aim of this thesis is to investi-gate further the connection between use of AAS and use of other drugs, and to investigate whether the proposed side effects of AAS cause an increase in morbidity and mortality. The first study (Paper I) investigates morbidity and mortality in persons testing positive for AAS compared to persons testing negative for AAS at a doping laboratory. Paper II of this thesis studies the presence of psychoactive drugs in diseased men who tested positive for AAS upon autopsy and whether there is any difference between deceased users of AAS and deceased users of heroin or amphetamine (control group). The third article (Paper III) dis-cusses a surprising finding in paper I of increased seizures NOS in users of AAS. Paper IV and V are interview studies from an out-patient substance abuse clinic. The main findings in Paper I was that the majority of deceased users of AAS were also positive for other drugs and/or alcohol on autopsy, and that users of AAS more often than the control group had died from intentional death (suicide or homicide). The main finding of Paper II was that users of AAS were severely at risk for premature death compared to both the control group and the general population. Paper III concluded that the high prevalence of Convulsion NOS in users of AAS most likely was the result of concomitant substance abuse and withdrawal from such use. Paper IV concluded that twelve percent of the patients at the substance abuse clinic had used AAS for at least one cycle. Users of AAS had a higher risk of having been convicted of a violent offence, and users of AAS more often reported having been physically abused. In Paper V, long-terme users of AAS were found to have an increased risk for developing depression in connection with cessation of AAS use. AAS was also re-ported to be used in preparation for crime. In summary, this thesis concludes that there is a solid association between use of AAS and use of other psychotropic drugs in certain subpopulations, and that users of AAS are at risk for premature death due to unnatural causes that may be secondary to use of AAS.

Brottslingen och samhället - mot en diskursens ordning?

<p>Uppsatsens syfte är att undersöka vilken funktion och betydelse kroppen har i första säsongen av CSI: Crime Scenen Investigation (CBS, 2000-). Detta eftersom det kan ge en ökad förståelse för de föreställningar som omgärdar kroppen i vår kultur idag. Författaren gör närläsningar av analysobjektet som relateras till relevant litteratur, såväl som tidigare praktiker och representationer av kroppslighet.</p><p>I den första delen undersöker författaren vilken roll kroppen spelar i utredningsarbetets sökande efter en säker sanning. Författaren konstaterar att utredarna använder sig av en kroppslig utredningsteknik och att kroppen dessutom ses som en privilegierad form av bevis, vars tillgänglighet ökar med hjälp av obduktionsförfarandet och olika teknologiska hjälpmedel. Vidare ifrågasätter författaren hur långsökta slutsatser om individen dras från kroppen. Till sist föreslår författaren att tron på säker kunskap känns betryggande i en tid då kroppen ses som föränderlig och där begrepp som verklighet och sanning blivit flytande.</p><p>I den andra delen undersöker författaren hotfull kroppslighet och hur dessa hot eventuellt neutraliseras. Författaren drar här fyra huvudsakliga slutsatser:</p><p>1. Den uppstyckade kroppen är skrämmande eftersom den uppfattas som gränsöverskridande och utredarnas ihopsamlande av kroppsdelar är ett sätt att återskapa de ursprungliga gränserna.</p><p>2. Döden är ytterligare en gränsöverskridande praktik som dessutom innebär kroppens totala förintelse, utredningsarbetet är en kamp mot döden som strävar efter att återupprätta livet.</p><p>3. Utredarnas förhållande till den döda kroppen är synnerligen komplext eftersom de bör förbli objektiva, men samtidigt inte får riskera att objektifiera den döda kroppen.</p><p>4. Själva filmmediet kan ses som ett hot mot kroppen genom sitt fragmenterande bildspråk, men också som ett försvar mot döden genom förmågan att skildra rörelse.</p>

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.

Uppsatsens syfte är att undersöka vilken funktion och betydelse kroppen har i första säsongen av CSI: Crime Scenen Investigation (CBS, 2000-). Detta eftersom det kan ge en ökad förståelse för de föreställningar som omgärdar kroppen i vår kultur idag. Författaren gör närläsningar av analysobjektet som relateras till relevant litteratur, såväl som tidigare praktiker och representationer av kroppslighet. I den första delen undersöker författaren vilken roll kroppen spelar i utredningsarbetets sökande efter en säker sanning. Författaren konstaterar att utredarna använder sig av en kroppslig utredningsteknik och att kroppen dessutom ses som en privilegierad form av bevis, vars tillgänglighet ökar med hjälp av obduktionsförfarandet och olika teknologiska hjälpmedel. Vidare ifrågasätter författaren hur långsökta slutsatser om individen dras från kroppen. Till sist föreslår författaren att tron på säker kunskap känns betryggande i en tid då kroppen ses som föränderlig och där begrepp som verklighet och sanning blivit flytande. I den andra delen undersöker författaren hotfull kroppslighet och hur dessa hot eventuellt neutraliseras. Författaren drar här fyra huvudsakliga slutsatser: 1. Den uppstyckade kroppen är skrämmande eftersom den uppfattas som gränsöverskridande och utredarnas ihopsamlande av kroppsdelar är ett sätt att återskapa de ursprungliga gränserna. 2. Döden är ytterligare en gränsöverskridande praktik som dessutom innebär kroppens totala förintelse, utredningsarbetet är en kamp mot döden som strävar efter att återupprätta livet. 3. Utredarnas förhållande till den döda kroppen är synnerligen komplext eftersom de bör förbli objektiva, men samtidigt inte får riskera att objektifiera den döda kroppen. 4. Själva filmmediet kan ses som ett hot mot kroppen genom sitt fragmenterande bildspråk, men också som ett försvar mot döden genom förmågan att skildra rörelse.

The genetic code in our cells is built up by deoxyribonucleic acid (DNA) with a sequence that is individual and unique to each person. A cell’s origin can be decided by comparing an established DNA profile with a known profile. The most publicly known application is in the forensic field and its use for identification and for establishing a connection between perpetrators and victims or crime scenes. DNA profiling is also commonly used for kinship investigations. The information embedded in the DNA is also used for diagnostic purposes in conventional medicine. Generating DNA profiles is a well-established procedure, which is used daily and for many purposes. An amount of approximately 150-1500 cells is required to be able to establish a full DNA profile using current methods. There are several situations where the amount of material is limited. To enable analysis where the testing material is limited it is of great value to develop a method that can perform these analyses on minute amounts of cells. If there were a method for generating DNA profiles from single cells then mixed samples from crime scenes would be separable. In tumour biology it is also of interest to obtain information from single cells. The aim with the thesis was to establish the smallest amount of cells needed for a full DNA profile. The thesis started with analyses on extracted DNA. During several experiments dilution series were made to investigate the possibilities to establish profiles from minute amounts of extracted DNA. The main methods used during this thesis were polymerase chain reaction (PCR) and capillary gel electrophoresis (CGE). These methods are well-established tools both in biomedical science and at The Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine. Different factors were optimized and the acquired knowledge resulted in application of DNA on FTA® Micro Cards. The cards are used in the daily routines and are easy to use. Several experiments were then performed on peripheral lymphocytes based on the knowledge acquired during the process. Applying a low amount of lymphocytes on FTA cards proved to be very successful and the method generates DNA profiles at a single cell level. The method is applicable for approximately 5-10 cells.

Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns. Aim: The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods: A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV). Results: In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions: This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.