Lotta Borg Skoglund

The aim of the present study was to examine parental experiences of homeschooling during the COVID-19 pandemic in families with or without a child with a mental health condition across Europe. The study included 6720 parents recruited through schools, patient organizations and social media platforms (2002 parents with a child with a mental health condition and 4718 without) from seven European countries: the UK (n = 508), Sweden (n = 1436), Spain (n = 1491), Belgium (n = 508),
the… Visa mer

The aim of the present study was to examine parental experiences of homeschooling during the COVID-19 pandemic in families with or without a child with a mental health condition across Europe. The study included 6720 parents recruited through schools, patient organizations and social media platforms (2002 parents with a child with a mental health condition and 4718 without) from seven European countries: the UK (n = 508), Sweden (n = 1436), Spain (n = 1491), Belgium (n = 508),
the Netherlands (n = 324), Germany (n = 1662) and Italy (n = 794). Many parents reported negative effects of homeschooling for themselves and their child, and many found homeschooling to be of poor quality, with insufficient support from schools. In most countries, contact with teachers was limited, leaving parents with primary responsibility for managing homeschooling. Parents also reported increased levels of stress, worry, social isolation, and domestic conflict. A small number of parents
reported increased parental alcohol/drug use. Some differences were found between countries and some negative experiences were more common in families with a child with a mental health condition. However, differences between countries and between families with and without a mental health condition were generally small, indicating that many parents across countries reported negative experiences. Some parents also reported positive experiences of homeschooling. The adverse
effects of homeschooling will likely have a long-term impact and contribute to increased inequalities. Given that school closures may be less effective than other interventions, policymakers need to carefully consider the negative consequences of homeschooling during additional waves of the COVID-19 pandemic and future pandemics. Visa mindre

Antidepressant treatment when facing a pregnancy is an important issue for many women and their physicians. We hypothesized that women with a greater burden of pre-pregnancy psychiatric illness would be more likely to re-initiate antidepressants following discontinuation of treatment during pregnancy. A register-based cohort study was carried out including 38,595 women who gave birth between the 1st of January 2007 and the 31st of December 2014, who had filled a prescription for an… Visa mer

Antidepressant treatment when facing a pregnancy is an important issue for many women and their physicians. We hypothesized that women with a greater burden of pre-pregnancy psychiatric illness would be more likely to re-initiate antidepressants following discontinuation of treatment during pregnancy. A register-based cohort study was carried out including 38,595 women who gave birth between the 1st of January 2007 and the 31st of December 2014, who had filled a prescription for an antidepressant medication in the year prior to conception. Logistic regressions were used to explore associations between maternal characteristics and antidepressant treatment discontinuation or re-initiation during pregnancy. Most women discontinued antidepressant treatment during pregnancy (n = 29,095, 75.4%), of whom nearly 12% (n = 3434, 11.8%) re-initiated treatment during pregnancy. In adjusted analyses, parous women (aOR 1.22, 95% CI 1.12-1.33), with high educational level (aOR 1.21, 95% CI 1.08-1.36); born within the EU (excluding Nordic countries, aOR 1.41, 95% CI 1.03-1.92) or a Nordic country (aOR 1.42, 95% CI 1.22-1.65); who more often reported prior hospitalizations due to psychiatric disorders (aOR 1.50, 95% CI 1.10-2.03, for three or more episodes); and had longer duration of pre-pregnancy antidepressant use (aOR 6.10, 95% CI 5.48-6.77, for >2 years antidepressant use), were more likely to re-initiate antidepressants than were women who remained off treatment. Women with a greater burden of pre-pregnancy psychiatric illness were more likely to re-initiate antidepressants. Thus, pre-pregnancy psychiatric history may be particularly important for weighing the risks and benefits of discontinuing antidepressants during pregnancy. Visa mindre

In this nationwide, register-based study, we estimated the risk of mental health problems in 2822 individuals diagnosed with cancer in adolescence (13-19 years). Mental health problems were assessed by psychiatric diagnoses and/or prescribed psychotropic drugs. Cox proportional hazards models estimated hazard ratio (HR) for a psychiatric diagnosis and prescription of psychotropic drug compared to a matched comparison group (n = 28 220). Estimates were adjusted for calendar period and parent… Visa mer

In this nationwide, register-based study, we estimated the risk of mental health problems in 2822 individuals diagnosed with cancer in adolescence (13-19 years). Mental health problems were assessed by psychiatric diagnoses and/or prescribed psychotropic drugs. Cox proportional hazards models estimated hazard ratio (HR) for a psychiatric diagnosis and prescription of psychotropic drug compared to a matched comparison group (n = 28 220). Estimates were adjusted for calendar period and parent characteristics (eg, history of psychiatric diagnosis, education, country of birth). We found an increased risk of a psychiatric diagnosis during the first 5 years after the cancer diagnosis (females: HR 1.23, 95% CI, 1.06-1.44; males: HR 1.32, 95% CI, 1.11-1.56), and at >5 years after diagnosis (females: HR 1.31, 95% CI, 1.09-1.58, males: HR 1.45, 95% CI, 1.18-1.77). The risk of being prescribed antidepressant (females: HR 1.54, 95% CI, 1.30-1.84, males: HR 2.06, 95% CI, 1.66-2.55), antipsychotic (females: HR 2.28, 95% CI, 1.56-3.34, males: HR 3.07, 95% CI, 2.13-4.42), anxiolytic (females: HR 1.95, 95% CI, 1.64-2.31, males: HR 4.02, 95% CI, 3.34-4.84) and sedative drugs (females: HR 2.24, 95% CI, 1.84-2.72, males: HR 3.91, 95% CI, 3.23-4.73) were higher than for comparisons during the first 5 years after diagnosis. Median age at first psychiatric diagnosis and first prescribed psychotropic drug were 18 years. In conclusion, cancer during adolescence is associated with increased risk of mental health problems that may develop in close proximity to treatment. The findings emphasize the need for comprehensive care during treatment and follow-up. Visa mindre

Objective: Attention deficit hyperactivity disorder (ADHD) affects 3-7% of women of childbearing age. Whether ADHD is associated with an increased risk of preterm birth is unclear.

Design: National register-based cohort study.

Setting: Sweden.

Population: Nulliparous women giving birth to singleton infants 2007-2014 (n = 377 381).

Methods: Women were considered to have ADHD if they had been dispensed at least one prescription for ADHD medication, i.e. a central… Visa mer

Objective: Attention deficit hyperactivity disorder (ADHD) affects 3-7% of women of childbearing age. Whether ADHD is associated with an increased risk of preterm birth is unclear.

Design: National register-based cohort study.

Setting: Sweden.

Population: Nulliparous women giving birth to singleton infants 2007-2014 (n = 377 381).

Methods: Women were considered to have ADHD if they had been dispensed at least one prescription for ADHD medication, i.e. a central nervous system stimulant or non-stimulant drugs for ADHD, prior to, during or after pregnancy (2005-2014). Women with ADHD were compared with women without ADHD in regard to prevalence, severity and mode of onset of preterm birth. Logistic regression models were used, estimating adjusted odds ratios (aOR) with 95% confidence intervals (CI). Adjustments were made for maternal age and country of birth (model 1), and in addition for body mass index (BMI), education, alcohol or substance use disorders, and pre-gestational medical and psychiatric co-morbidity (model 2).

Main outcome measures: Preterm birth (<37 weeks).

Results: During the study period, 6327 (1.7%) women gave birth and had ADHD according to our definition. These women had a higher rate of preterm birth compared with women without ADHD (7.3 versus 5.8%, aOR model 2: 1.17; 95% CI 1.05-1.30). ADHD was particularly associated with very (<32 weeks) preterm births, and associations were seen with both spontaneous and medically indicated onsets.

Conclusions: Women with ADHD (i.e. who had been dispensed ADHD medication at any time in 2005-2014) had an increased risk of preterm birth. Visa mindre

High alcohol consumption and use of illicit drugs among young people is of great concern
and there is a need to identify arenas where this group can be reached by preventive measures. The
aim of the present study was to study prevalence of risky alcohol consumption, illicit drug use, and
risky sexual behaviour (RSB) among young people visiting youth health clinics in Stockholm county.
Another aim was to explore the association between risky alcohol consumption, illicit drug use… Visa mer

High alcohol consumption and use of illicit drugs among young people is of great concern
and there is a need to identify arenas where this group can be reached by preventive measures. The
aim of the present study was to study prevalence of risky alcohol consumption, illicit drug use, and
risky sexual behaviour (RSB) among young people visiting youth health clinics in Stockholm county.
Another aim was to explore the association between risky alcohol consumption, illicit drug use and
RSB.

Methods: During autumn 2016, an anonymous questionnaire comprising questions about
alcohol, illicit drugs and risky sexual behaviour was given to visitors at 11 youth health clinics in Stockholm county. Results: A total of 328 youths (M ¼ 18.8 years, 89% girls) answered the
questionnaire.

Results show that 61.7% had risky alcohol consumption and 41.8% had tried illicit
drugs. Risky sexual behaviour was more prevalent among respondents with risky alcohol consumption, and it was more common among non-students than students.

Conclusions: Findings indicate that a large proportion of visitors at youth health clinics in Stockholm county has a risky alcohol consumption and experiences of other drugs, and also that risky alcohol consumption is associated with three of five RSB outcomes. Non-students seemed to be a particularly exposed risk group with regard to both risky alcohol consumption and RSB. Overall, the results indicate
that youth health clinics are an important arena for alcohol prevention. Visa mindre

Purpose: Hirschsprung disease (HSCR) is a multifactorial disease. Maternal intake of selective serotonin reuptake inhibitors (SSRI) during early pregnancy has previously been associated with increased risk for HSCR. The aim of this study was to assess the risk for HSCR in newborns after maternal intake of SSRI in a population-based Swedish cohort.

Methods: This was a Swedish nationwide, population-based, case-control cohort study containing all children born in Sweden between 1/12006 and… Visa mer

Purpose: Hirschsprung disease (HSCR) is a multifactorial disease. Maternal intake of selective serotonin reuptake inhibitors (SSRI) during early pregnancy has previously been associated with increased risk for HSCR. The aim of this study was to assess the risk for HSCR in newborns after maternal intake of SSRI in a population-based Swedish cohort.

Methods: This was a Swedish nationwide, population-based, case-control cohort study containing all children born in Sweden between 1/12006 and 31/122012. The cases were identified in the Swedish National Patient Register and the controls (five age- and sex-matched controls per case) were randomly selected among children without HSCR in the cohort. Data on maternal SSRI use during pregnancy were collected from the Swedish Prescribed Drug Register.

Results: Out of 775,024 born children during the study period, 150 cases of HSCR (112 males) and 750 controls (560 males) were included. Five (3.3%) mothers of newborns with HSCR had used SSRI during pregnancy compared to 16 (2.1%) mothers of the controls (p = 0.372). The mean age was similar in mothers who had used SSRI compared to those who had not (30.9 (SD +/- 5.1) versus 30.6 (SD +/- 5.0), p = 0.81).

Conclusions: There was no increased risk of HSCR owing to maternal intake of SSRI in this cohort. Visa mindre

Background: Attention-deficit/hyperactivity disorder (ADHD) is often associated with other neurodevelopmental disorders (NDs) and with risky behaviors and adverse health outcomes, including injuries. Treatment with ADHD medication has been associated with reduced risk of injuries. However, it is unknown whether the association is present in individuals with co-occurring NDs. The aim of the present study was to estimate the association between ADHD medication use and unintentional injuries in… Visa mer

Background: Attention-deficit/hyperactivity disorder (ADHD) is often associated with other neurodevelopmental disorders (NDs) and with risky behaviors and adverse health outcomes, including injuries. Treatment with ADHD medication has been associated with reduced risk of injuries. However, it is unknown whether the association is present in individuals with co-occurring NDs. The aim of the present study was to estimate the association between ADHD medication use and unintentional injuries in Sweden in children and adolescents with ADHD, including those with co-occurring NDs.

Methods: Using a linkage of several national registers via the unique personal identification number, we identified individuals with a diagnosis of ADHD and of other NDs, including autism spectrum disorder, intellectual disability, communication disorders, learning disorders and motor disorders. The primary outcome was unintentional injuries. Secondary outcome was traumatic brain injury (TBI). We compared the rate of injuries during periods on-treatment with the rate of injuries during periods off-treatment within the same individual using stratified Cox regression to calculate hazard ratio (HR) with 95% confidence intervals (CIs).

Results: The rate of any unintentional injuries (HR = 0.85; 95% CI = 0.78-0.92) and TBIs (HR = 0.27; 95% CIs = 0.20-0.38) during medicated periods was lower than during non-medicated periods. Similar results were found among individuals with co-occurring NDs (N = 2,986), for unintentional injuries (HR = 0.88; 95% CI = 0.77-1.01) and for TBIs (HR = 0.27; 95% CI = 0.16-0.44).

Conclusions: Beneficial effects of ADHD medication may extend beyond reduction of ADHD core symptoms to prevention of unintentional injuries in children and adolescents, including individuals with co-occurring NDs.

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Aim: Hirschsprung disease is usually treated during infancy. The long-term impact on mental health has not been well studied. The aim of this study was to assess the risk for depressive disorders in individuals with Hirschsprung disease.

Methods: This was a nationwide, population-based cohort study. The study exposure was Hirschsprung disease and the study outcome was depression. The exposed cohort included all individuals with Hirschsprung disease, registered in the Swedish National… Visa mer

Aim: Hirschsprung disease is usually treated during infancy. The long-term impact on mental health has not been well studied. The aim of this study was to assess the risk for depressive disorders in individuals with Hirschsprung disease.

Methods: This was a nationwide, population-based cohort study. The study exposure was Hirschsprung disease and the study outcome was depression. The exposed cohort included all individuals with Hirschsprung disease, registered in the Swedish National Patient Register between 1964 and 2013 and the unexposed cohort included ten age- and sex-matched controls per patient. The diagnosis of depression was confirmed by diagnosis in the Swedish National Patient Register.

Results: The cohort included 739 (76.5% males) individuals with Hirschsprung disease and 7390 (76.5% males) controls. Among the patients with Hirschsprung disease, 35 (4.7%) of the patients had had a depressive disorder and 187 (2.5%) of controls, hazard ratio 1.98, 95% confidence interval 1.38-2.84. The mean age at diagnosis of first depression was 21.9 years (SD ± 7) in Hirschsprung disease patients and 23.4 years (SD ± 7), p = 0.236 in the unexposed group. There were no significant gender differences.

Conclusion: We found an increased risk of having depressive disorders among individuals with Hirschsprung disease compared to controls. Visa mindre

Question
Is attention-deficit/hyperactivity disorder (ADHD) associated with increased risk of teenage birth?

Findings
This nationwide cohort study of 384 103 women and girls in Sweden who gave birth for the first time between 2007 and 2014, including 6410 women and girls with ADHD, found that teenage deliveries occurred at a significantly higher rate among women and girls with ADHD than among those without ADHD (15.2% vs 2.8%).

Meaning
This study suggests that women and… Visa mer

Question
Is attention-deficit/hyperactivity disorder (ADHD) associated with increased risk of teenage birth?

Findings
This nationwide cohort study of 384 103 women and girls in Sweden who gave birth for the first time between 2007 and 2014, including 6410 women and girls with ADHD, found that teenage deliveries occurred at a significantly higher rate among women and girls with ADHD than among those without ADHD (15.2% vs 2.8%).

Meaning
This study suggests that women and girls with ADHD may have an increased risk of giving birth as teenagers compared with their unaffected peers. Visa mindre

ADHD hos äldre är ett förbisett fenomen. ADHD är en neuropsykiatrisk diagnos kännetecknad av
varaktiga svårigheter med uppmärksamhet och/eller impulsivitet och hyperaktivitet. För att ställa diagnosen krävs att symtomen bidrar till funktionsnedsättning och lidande inom flera områden av livet.
I dag upptäcks och diagnostiseras allt fler över 18 års ålder på grund av ihållande och funktionsnedsättande symtom av ADHD. För många är det första gången de får en hållbar förklaringsmodell till en… Visa mer

ADHD hos äldre är ett förbisett fenomen. ADHD är en neuropsykiatrisk diagnos kännetecknad av
varaktiga svårigheter med uppmärksamhet och/eller impulsivitet och hyperaktivitet. För att ställa diagnosen krävs att symtomen bidrar till funktionsnedsättning och lidande inom flera områden av livet.
I dag upptäcks och diagnostiseras allt fler över 18 års ålder på grund av ihållande och funktionsnedsättande symtom av ADHD. För många är det första gången de får en hållbar förklaringsmodell till en livslång upplevelse av att fungera annorlunda, känslor av utanförskap och bristande självkänsla, eller en (del)-förklaring till psykiatrisk samsjuklighet.

Skoglund L 2019 . Läkartidningen. 2019;116:FFPW Läkartidningen 06/2019 Lakartidningen.se 2019-02-01 Visa mindre

Molecular Psychiatry 2019
Family and twin studies of Borderline Personality Disorder (BPD) have found familial aggregation and genetic propensity for BPD, but estimates vary widely. Large-scale family studies of clinically
diagnosed BPD are lacking. Therefore, we performed total-population study estimating the familial
aggregation and heritability of clinically diagnosed BPD. We followed 1,851,755 individuals born
1973-1993 in linked Swedish national registries. BPD-diagnosis was… Visa mer

Molecular Psychiatry 2019
Family and twin studies of Borderline Personality Disorder (BPD) have found familial aggregation and genetic propensity for BPD, but estimates vary widely. Large-scale family studies of clinically
diagnosed BPD are lacking. Therefore, we performed total-population study estimating the familial
aggregation and heritability of clinically diagnosed BPD. We followed 1,851,755 individuals born
1973-1993 in linked Swedish national registries. BPD-diagnosis was ascertained between 1997 and 2013, 11,665 received a BPD-diagnosis. We identified relatives and estimated sex and birth year adjusted hazard ratios, i.e., the rate of BPD-diagnoses in relatives to individuals with BPD-diagnosis compared to individuals with unaffected relatives, and used structural equation modeling to estimate heritability. The familial association decreased along with genetic relatedness. The hazard ratio was 11.5 (95% confidence interval (CI) = 1.6–83.8) for monozygotic twins; 7.4 (95% CI = 1.0– 55.3) for dizygotic twins; 4.7 (95% CI = 3.9–5.6) for full siblings; 2.1 (95% CI = 1.5–3.0) for maternal half-siblings; 1.3 (95% CI = 0.9–2.1) for paternal half-siblings; 1.7 (95% CI = 1.4–2.0) for cousins whose parents were full siblings; 1.1 (95% CI = 0.7–1.8) for cousins whose parents were maternal halfsiblings; and 1.9 (95% CI = 1.2–2.9) for cousins whose parents were paternal half-siblings. Heritability was estimated at 46% (95% CI = 39–53), remaining variance was explained by individually unique environmental factors. Our findings pave the way for further research into specific genetic variants, unique environmental factors implicated, and their interplay in risk for BPD. Visa mindre

Denna rapport syftar till att undersöka utfallet av PRIMAs uppdrag och arbete med ett psykiatriskt beroendeteam i den integrerade behandlingen av de patienter som har såväl en psykos- som en beroendediagnos. Jämförelser med andra vårdgivare, verksamma inom SLL och med andra konstruktioner av team för vård och behandling av målgruppen, har genomförts. Ytterligare ett användningsområde för rapporten är den övergripande belysningen av vård av personer med samtidigt missbruk och psykisk sjukdom… Visa mer

Denna rapport syftar till att undersöka utfallet av PRIMAs uppdrag och arbete med ett psykiatriskt beroendeteam i den integrerade behandlingen av de patienter som har såväl en psykos- som en beroendediagnos. Jämförelser med andra vårdgivare, verksamma inom SLL och med andra konstruktioner av team för vård och behandling av målgruppen, har genomförts. Ytterligare ett användningsområde för rapporten är den övergripande belysningen av vård av personer med samtidigt missbruk och psykisk sjukdom utöver psykos.
Medförfattare: Erica.Brostedt@sll.se och Lena.Brandt@ki.se
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Purpose: Hirschsprung disease (HSCR) has previously been associated with increased need of special education services despite normal intelligence. The aim of this study was to assess the risk of attention deficit hyperactivity disorders (ADHD) in individuals with HSCR in a population-based cohort.

Methods: This was a nationwide, population-based cohort study. The study exposure was HSCR and the study outcome was ADHD. The cohort included all individuals with HSCR registered in the… Visa mer

Purpose: Hirschsprung disease (HSCR) has previously been associated with increased need of special education services despite normal intelligence. The aim of this study was to assess the risk of attention deficit hyperactivity disorders (ADHD) in individuals with HSCR in a population-based cohort.

Methods: This was a nationwide, population-based cohort study. The study exposure was HSCR and the study outcome was ADHD. The cohort included all individuals with HSCR registered in the Swedish National Patient Register between 1964 and 2013 and ten age- and sex-matched controls per patient, randomly selected from the Population Register.

Results: The cohort comprised 739 individuals with HSCR and 7390 controls. Twenty-six of the 739 individuals with HSCR and 202 of the 7390 controls were diagnosed with ADHD, Odds ratio (OR) 1.30, Confidence interval (CI) 95% 0.84-1.93, indicating no difference in risk for ADHD. The mean age at diagnosis of ADHD was not different between the groups; 18.1 years (SD 8.4) vs 16.7 years (SD 7.8), p = 0.39. Down syndrome did not affect the risk for ADHD, OR 2.26 (CI 95% 0.68-5.53). Female gender decreased the risk for ADHD, OR 0.58 (CI 95% 0.40-0.83).

Conclusions: There is no increased risk of ADHD in patients with Hirschsprung disease. Visa mindre

Molecular Psychiatry 2018/10/17 doi 10.1038/s41380-018-0248-5

Large-scale family studies on the co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are lacking. Thus, we aimed to estimate the co-occurrence and familial co-aggregation of clinically ascertained ADHD and BPD diagnoses using the entire Swedish population. In a register-based cohort design we included individuals born in Sweden 1979–2001, and identified their diagnoses… Visa mer

Molecular Psychiatry 2018/10/17 doi 10.1038/s41380-018-0248-5

Large-scale family studies on the co-occurrence of attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are lacking. Thus, we aimed to estimate the co-occurrence and familial co-aggregation of clinically ascertained ADHD and BPD diagnoses using the entire Swedish population. In a register-based cohort design we included individuals born in Sweden 1979–2001, and identified their diagnoses during 1997–2013; in total, 2,113,902
individuals were included in the analyses. We obtained clinical diagnoses of ADHD and BPD from inpatient and outpatient care. Individuals with an ADHD diagnosis had an adjusted (for birth year, sex, and birth order) odds ratio (aOR) of 19.4 (95% confidence interval [95% CI] = 18.6–20.4) of also having a BPD diagnosis, compared to individuals not diagnosed with ADHD. Having a sibling with ADHD also increased the risk for BPD (monozygotic twins, aOR = 11.2, 95%
CI = 3.0–42.2; full siblings, aOR = 2.8, 95% CI = 2.6–3.1; maternal half-siblings, aOR = 1.4, 95% CI = 1.2–1.7; paternal half-siblings, aOR = 1.5, 95% CI = 1.3–1.7). Cousins also had an increased risk. The strength of the association between ADHD and BPD was similar in females and males, and full siblings showed similar increased risks regardless of sex. Among both males and females, ADHD and BPD co-occur within individuals and co-aggregate in relatives; the pattern suggests
shared genetic factors and no robust evidence for etiologic sex differences was found. Clinicians should be aware of increased risks for BPD in individuals with ADHD and their relatives, and vice versa. Visa mindre

Ment Health Fam Med (2018) 13: 763-771.
Risky sexual behaviour is common among adolescents and young adults and often occurs under the influence of alcohol and sometimes other drugs. Swedish youth health clinics are an important arena for prevention of unplanned pregnancies and sexually transmitted diseases, as well as mental health problems. Alcohol and drug consumption have been shown to be higher among youths visiting youth health clinics than their peers. Since alcohol and drug… Visa mer

Ment Health Fam Med (2018) 13: 763-771.
Risky sexual behaviour is common among adolescents and young adults and often occurs under the influence of alcohol and sometimes other drugs. Swedish youth health clinics are an important arena for prevention of unplanned pregnancies and sexually transmitted diseases, as well as mental health problems. Alcohol and drug consumption have been shown to be higher among youths visiting youth health clinics than their peers. Since alcohol and drug consumption affect both sexual behaviour and mental health, the youth health clinics are wellsuited for alcohol and drug prevention. The aim of this study was to investigate the organizational readiness for development and implementation of alcohol and drug prevention policy and interventions at youth health clinics in Stockholm county. Methods: Face-to-face interviews were conducted with midwives and social counsellors (n=22) at 11 youth health clinics in Stockholm county, using a semi-structured interview guide.
Results: Motivation and general capacity were identified as two main categories in the interview material, along with five subcategories. The midwives and social counsellors were highly aware of the association between alcohol and drug use and risky sexual behaviour, and the subject was often brought up in conversations with youths. They also expressed dedication to their
work. At several clinics, there was a supportive organizational climate with staff motivated to work with alcohol and drug prevention, although sometimes burdened by various requests from
external stakeholders. However, the interviewees occasionally felt that they did not have sufficient knowledge to give proper guidance and support to youths with risky alcohol consumption or
youths using other drugs and expressed interest in developing their knowledge and activities regarding alcohol and drug prevention. At the same time, they argued that shortage of time and resources could be an obstacle for this.
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DOI: 10.1186/s13011-017-0103-8

Background: Alcohol-related problems at professional sporting events are of increasing concern and alarming reports are often reported in international media. Although alcohol consumption increases the risk for interpersonal violence, it is viewed as a focal element of large football events. Sweden has a long tradition of high public support for strict alcohol-control policies. However, little is known about public opinions on alcohol intoxication and the… Visa mer

DOI: 10.1186/s13011-017-0103-8

Background: Alcohol-related problems at professional sporting events are of increasing concern and alarming reports are often reported in international media. Although alcohol consumption increases the risk for interpersonal violence, it is viewed as a focal element of large football events. Sweden has a long tradition of high public support for strict alcohol-control policies. However, little is known about public opinions on alcohol intoxication and the support for interventions to decrease intoxication at football events. The current study explored the public opinion
towards alcohol use, intoxication and alcohol policies at professional football matches in Sweden.
Methods: A cross-sectional design was utilized and a random general population sample of 3503 adult Swedish residents was asked to participate in a web survey during 2016 (response rate 68%).
Results: In total, 26% of the respondents supported alcohol sales at football events. Over 90% reported that obviously intoxicated spectators should be denied entrance or evicted from arenas. The support for regulations limiting alcohol availability varied with background factors such as gender, alcohol use and frequency of football event attendance.
Conclusions: There is a strong public consensus for strategies and policies to reduce alcohol sales and intoxication levels at football matches. This public support has implications for our preventive efforts and will facilitate the implementation of strategies and policy changes. Visa mindre

Om tonårstiden är stökig och svår – hur kan man prata med sitt barn? Den här boken vänder sig till föräldrar och anhöriga som oroar sig över kommunikationen med de växande barnen. Du får lära dig sätt att samtala som väcker motivation utan att skapa motstånd hos den du talar med. Metoderna heter MI (motiverande samtal) och CRAFT (Community Reinforement Approach and Family training). Du lär dig bland annat att hejda reflexen att tillrättavisa och rätta – och kan därmed skapa ett bättre… Visa mer

Om tonårstiden är stökig och svår – hur kan man prata med sitt barn? Den här boken vänder sig till föräldrar och anhöriga som oroar sig över kommunikationen med de växande barnen. Du får lära dig sätt att samtala som väcker motivation utan att skapa motstånd hos den du talar med. Metoderna heter MI (motiverande samtal) och CRAFT (Community Reinforement Approach and Family training). Du lär dig bland annat att hejda reflexen att tillrättavisa och rätta – och kan därmed skapa ett bättre samtalsklimat och på sikt åstadkomma förändringar i positiva riktningar både för dig, ditt barn och resten av familjen. Visa mindre

Ibland kan tonårstiden vara stökig och svår. I den här artikeln får du ett smakprov på sätt att samtala som väcker motivation utan att skapa motstånd hos den du talar med. Metoderna heter MI (motiverande samtal) och CRAFT (Community Reinforement Approach and Family training). Syftet är att skapa ett bättre samtalsklimat och på sikt åstadkomma förändringar i positiva riktningar både för dig, ditt barn och resten av familjen.

Adherence to treatment is one of the most consistent factors associated with a favorable addiction treatment outcome. Little is known about the predictors for treatment adherence in individuals affected with comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD). This study aimed to explore whether treatment-associated factors, such as the prescribing physician’s (sub) specialty and methylphenidate (MPH) dose, or patient-related factors, such as sex, age, SUD… Visa mer

Adherence to treatment is one of the most consistent factors associated with a favorable addiction treatment outcome. Little is known about the predictors for treatment adherence in individuals affected with comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD). This study aimed to explore whether treatment-associated factors, such as the prescribing physician’s (sub) specialty and methylphenidate (MPH) dose, or patient-related factors, such as sex, age, SUD subtype and psychiatric comorbidity, were associated with adherence to MPH treatment. Swedish national registers were used to identify adult individuals with prescriptions of MPH and medications specifically used in the treatment of SUD or a diagnosis of SUD and/or coexisting psychiatric diagnoses. Primary outcome measure was days in active MPH treatment in stratified dose groups (≤ 36mg, ≥37mg - ≤54mg, ≥55mg - ≤72mg, ≥73mg - ≤90mg, ≥91mg - ≤108mg and ≥109mg). Lower MPH doses (i.e. ≤36 mg day 100) predicted treatment discontinuation between day 101 and 830 (HR≤36 mg 1.67; HR37-54mg 1.37; HR55-72mg 1.36; HR73-90mg 1.19; HR≥108mg 1.09). The results showed a trend (linear trend, p<0.0001) towards decreased risk of treatment discontinuation between days 101 and 830 along with increase of MPH doses. In conclusion this study show that higher MPH doses predicted long-term treatment adherence in individuals with ADHD and SUD. Visa mindre

Det finns en stor underdiagnostik och underanvändning av läkemedel vid alkoholproblem. Som en hjälp till läkare som kommer i kontakt med personer med symtom relaterade till alkohol finns nu en ny lathund. Lathunden har tagits fram av två av Stockholms läns läkemedelskommittés expertråd: expertrådet för psykiatriska sjukdomar samt allmänmedicin. Den bygger på Socialstyrelsens uppdaterade nationella riktlinjer för vård och stöd vid missbruk och beroende som kom under 2015.

Det har länge varit känt att personer med ADHD har ökad risk för SUD och att personer som lider av båda tillstånden ofta har allvarligare problem, högre psykiatrisk samsjuklighet och sämre behandlingsresultat än personer utan ADHD. Trots att såväl familje- som tvillingstudier har visat att både ADHD och missbruk i hög utsträckning är ärftligt är de bakomliggande mekanismerna till stor del okända.
Samtidigt som många epidemiologiska studier har visat att farmakologisk behandling av ADHD kan… Visa mer

Det har länge varit känt att personer med ADHD har ökad risk för SUD och att personer som lider av båda tillstånden ofta har allvarligare problem, högre psykiatrisk samsjuklighet och sämre behandlingsresultat än personer utan ADHD. Trots att såväl familje- som tvillingstudier har visat att både ADHD och missbruk i hög utsträckning är ärftligt är de bakomliggande mekanismerna till stor del okända.
Samtidigt som många epidemiologiska studier har visat att farmakologisk behandling av ADHD kan skydda mot framtida missbruksproblem finns fortfarande, främst baserat på resultat från djur- och hjärnavbildningsstudier, en kvardröjande oro för skadliga effekter av centralstimulerande medicinering. Det finns en rädsla för att vi genom medicinering med centralstimulerande substanser kan utsätta känsliga individer för återfall eller framtida SUD som kan leda till att vissa personer undanhålls farmakologisk behandling. Det är därför viktigt att öka förståelsen för sambandet mellan dessa två sjukdomar, inte bara för personer med ADHD och deras familjer, utan även för kliniker som utreder och behandlar personer med samtidig ADHD och SUD. Visa mindre

Exhaled breath has recently been proposed as a matrix for drug testing. This study aims to further explore, develop and validate exhaled breath as a safe and effective non-invasive method for drug testing in a clinical setting. Self-reported drug use was recorded and drug testing was performed by mass spectrometry and immunochemical methods using breath, plasma and urine samples from 45 individuals voluntarily seeking treatment for recreational drug use. Cannabis was the most prevalent drug… Visa mer

Exhaled breath has recently been proposed as a matrix for drug testing. This study aims to further explore, develop and validate exhaled breath as a safe and effective non-invasive method for drug testing in a clinical setting. Self-reported drug use was recorded and drug testing was performed by mass spectrometry and immunochemical methods using breath, plasma and urine samples from 45 individuals voluntarily seeking treatment for recreational drug use. Cannabis was the most prevalent drug detected by any method. Urine sampling detected most cases. The exhaled breath technique was less sensitive (73%) than plasma analysis for detection of cannabis uses but captures a more recent drug intake than both plasma and urine. Exhaled breath was the preferred specimen to donate according to interview data of the participants. Testing illicit drugs with the exhaled breath sampling technique is a sufficient, non-invasive and safe alternative and complement to plasma and/or urine sampling. Visa mindre

Previous research indicates that Attention-deficit hyperactivity disorder (ADHD) is highly associated with Substance Use Disorders (SUD). These studies however, have failed to clarify the nature of the overlap. The main aim was to explore if the overlap between ADHD and SUD could be explained by shared genetic and environmental factors or by harmful effects of ADHD medication. Matched cohort design across different levels of family relatedness recorded from 1973 to 2009. By linking longitudinal… Visa mer

Previous research indicates that Attention-deficit hyperactivity disorder (ADHD) is highly associated with Substance Use Disorders (SUD). These studies however, have failed to clarify the nature of the overlap. The main aim was to explore if the overlap between ADHD and SUD could be explained by shared genetic and environmental factors or by harmful effects of ADHD medication. Matched cohort design across different levels of family relatedness recorded from 1973 to 2009. By linking longitudinal Swedish national registers, 62,015 ADHD probands and their first and second degree relatives were identified and matched 1:10 with non-ADHD controls and their corresponding relatives. Any record of SUD defined by discharge diagnoses of the International Classification of Diseases and/or a purchase of any drug used in the treatment of SUD.
First degree relatives of ADHD probands were at elevated risk for SUD (ORSUD1st 2.2 and 1.8) compared to relatives of controls. The corresponding relative risk in second degree relatives was substantially lower (ORSUD2nd 1.4 and 1.4). The familial aggregation patterns remain similar for first degree and second degree relatives after excluding individuals with coexisting disorders such as schizophrenia, bipolar disorder, depression and conduct disorder.
Our findings suggest that the co-occurrence of ADHD and SUD are due to genetic factors shared between the two disorders, rather than to a general propensity for psychiatric disorders or harmful effects of ADHD medication.
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Maternal Smoking During Pregnancy (SDP) has consistently been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in offspring, but recent studies indicate that this association might be due to unmeasured familial confounding.A total of 813 030 individuals born in Sweden between 1992 and 2000 were included in this nationwide population based cohort study. Data on maternal SDP and ADHD diagnosis were obtained from national registers and patients were followed up… Visa mer

Maternal Smoking During Pregnancy (SDP) has consistently been associated with increased risk of attention deficit hyperactivity disorder (ADHD) in offspring, but recent studies indicate that this association might be due to unmeasured familial confounding.A total of 813 030 individuals born in Sweden between 1992 and 2000 were included in this nationwide population based cohort study. Data on maternal SDP and ADHD diagnosis were obtained from national registers and patients were followed up from the age of 3 to the end of 2009. Hazard Ratios (HRs) were estimated using stratified Cox regression models. Cousin and sibling data were used to control for unmeasured familial confounding. At the population level maternal SDP predicted ADHD in offspring (HRModerateSDP=1.89; HRHighSDP=2.50). This estimate gradually attenuated towards the null when adjusting for measured confounders (HRModerateSDP=1.62; HRHighSDP=2.04), unmeasured confounders shared within the extended family (i.e., cousin comparison) (HRModerateSDP= 1.45; HRHighSDP=1.69), and unmeasured confounders within the nuclear family (i.e., sibling comparison) (HRModerateSDP=0.88; HRHighSDP=0.84).
Our results suggest that the association between maternal SDP and offspring ADHD are due to unmeasured familial confounding.
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Vi missar flickorna med adhd när vi letar efter symtom som är vanligare hos pojkar. Flickor och unga kvinnor får inte heller lika effektiv behandling eftersom de flesta läkemedelsstudier på preparat och doser är gjorda på pojkar och män.

Vi vet idag, tack vare forskning och lång klinisk erfarenhet, att adhd tar sig olika uttryck hos olika individer. Vi vet också att biologiska skillnader mellan könen spelar roll, och vi vet mycket om vad som ligger bakom problemen vid adhd. Men vi vet… Visa mer

Vi missar flickorna med adhd när vi letar efter symtom som är vanligare hos pojkar. Flickor och unga kvinnor får inte heller lika effektiv behandling eftersom de flesta läkemedelsstudier på preparat och doser är gjorda på pojkar och män.

Vi vet idag, tack vare forskning och lång klinisk erfarenhet, att adhd tar sig olika uttryck hos olika individer. Vi vet också att biologiska skillnader mellan könen spelar roll, och vi vet mycket om vad som ligger bakom problemen vid adhd. Men vi vet ännu inte så mycket om vad som är unikt hos flickor och kvinnor. Vi missar flickor med adhd när vi letar efter symtom som är vanligare hos pojkar.

Adhd - från duktig flicka till utbränd kvinna tar avstamp i det faktum att flickor och kvinnor diagnostiseras i mindre utsträckning än pojkar och män vid adhd - och vilka konsekvenser det får. Boken beskriver fakta och kunskapsläge vad gäller adhd bland flickor och kvinnor, och visar genom patientberättelser hur livet kan se ut och vilket stöd det går att få. Visa mindre

Introduction: Adolescence and young adulthood is a period in life when individuals may be especially vulnerable to harmful substance use. Several critical developmental processes are occurring in the brain, and substance use poses both short-term and long-term risks with regard to mental health and social development. From a public health perspective, it is important to prevent or delay substance use to reduce individual risk and societal costs. Given the scarcity of effective interventions… Visa mer

Introduction: Adolescence and young adulthood is a period in life when individuals may be especially vulnerable to harmful substance use. Several critical developmental processes are occurring in the brain, and substance use poses both short-term and long-term risks with regard to mental health and social development. From a public health perspective, it is important to prevent or delay substance use to reduce individual risk and societal costs. Given the scarcity of effective interventions targeting substance use among adolescents and young adults, cost-effective and easily disseminated interventions are warranted. The current study will test the effectiveness of a fully automated digital brief intervention aimed at reducing alcohol and other substance use in adolescents and young adults aged 15 to 25 years.

Methods and analysis: A two-arm, double-blind, randomised controlled trial design is applied to assess the effectiveness of the intervention. Baseline assessment, as well as 3-month and 6-month follow-up, will be carried out. The aim is to include 800 participants with risky substance use based on the screening tool CRAFFT (Car,Relax, Alone, Forget, Friends, Trouble). Recruitment, informed consent, randomisation, intervention and follow-up will be implemented online. The primary outcome is reduction in alcohol use, measured by Alcohol Use Disorders Identification Test total score. Secondary outcomes concern binge drinking, frequency of alcohol consumption, amount of alcohol consumed a typical day when alcohol is consumed, average daily drinks per typical week, other substance use, mental health, sexual risk behaviours and perceived peer pressure. Moreover, the study involves analyses of potential moderators including perfectionism, openness to parents, help-seeking and background variables. Visa mindre

Acta Paediatr. 2019 Mar 29. doi: 10.1111/apa.14801. [Epub ahead of print]
Hirschsprung disease is usually treated during infancy. The long-term impact on mental health has not been well studied. The aim of this study was to assess the risk for depressive disorders in individuals with Hirschsprung disease.
Methods
This was a nationwide, population-based cohort study. The study exposure was Hirschsprung disease and the study outcome was depression. The exposed cohort included all… Visa mer

Acta Paediatr. 2019 Mar 29. doi: 10.1111/apa.14801. [Epub ahead of print]
Hirschsprung disease is usually treated during infancy. The long-term impact on mental health has not been well studied. The aim of this study was to assess the risk for depressive disorders in individuals with Hirschsprung disease.
Methods
This was a nationwide, population-based cohort study. The study exposure was Hirschsprung disease and the study outcome was depression. The exposed cohort included all individuals with Hirschsprung disease, registered in the Swedish National Patient Register between 1964-2013 and the unexposed cohort included ten age- and sex-matched controls per patient. The diagnosis of depression was confirmed by diagnosis in the Swedish National Patient Register.
Results
The cohort included 739 (76.5% males) individuals with Hirschsprung disease and 7390 (76.5% males) controls. The patients with Hirschsprung disease, 35 (4.7%) of the patients had had a depressive disorder and 187 (2.5%) of controls, hazard ratio 1.98, 95% confidence interval 1.38-2.84. The mean age at diagnosis of first depression was 21.9 years (SD±7) in Hirschsprung disease patients and 23.4 years (SD±7), p=0.236 in the unexposed group. There were no significant gender differences.
Conclusion
We found an increased risk of having depressive disorders among individuals with Hirschsprung disease compared to controls. Visa mindre