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Although the association between substance use and violence has been well established, knowledge on predictors for violent victimization of individuals treated for alcohol use disorder (AUD) or drug use disorder (DUD) is lacking. Using Goldstein’s tripartite conceptual framework, this study examines the relationship between substance use and violent victimization. Data were derived from national registers on persons aged between 15 and 75 years, living in Denmark, and admitted for AUD or DUD treatment during 2006-2016 ( n = 82,767). Rates of new incidence of violent victimization were estimated per 10,000 person years for the patient cohort, and for an age- and gender-matched control group of 492,397 people with no history of treatment for drug and alcohol problems. The incidence of victimization for the AUD/DUD sample was 145.6 per 10,000 person years and 5.4 per 10,000 person years for the comparison cohort. Results of multivariate Cox regression on specific types of substance use supported Goldstein’s psychopharmacological and economic compulsive models of victimization, but not the systemic model. Gender-stratified results showed that the use of cannabis and methadone was associated with victimization in women treated for AUD and DUD. Patients with a non-Western background were more likely to experience victimization than Danish patients. The study highlights the strong association between substance use disorder and victimization, and the important role that service providers play in addressing the high levels of victimization experienced by patients with AUD or DUD.

Background Alcohol and other drug use disorders contribute substantially to the global burden of illness. The majority of people with substance use disorders do not receive any treatment for their problems, and developing treatments that are attractive and effective to patients should be a priority. However, whether treatment is best delivered in a group format or an individual format has only been studied to a very limited degree. The COMDAT (Combined Drug and Alcohol Treatment) trial evaluates the feasibility, acceptability, and cost effectiveness of MOVE group (MOVE-G) treatment versus MOVE individual (MOVE-I) treatment in four community-based outpatient treatment centres in Denmark. Methods A two-arm non-inferiority trial comparing MOVE-I (Pedersen et al., Drug Alcohol Depend 218:108363, 2020) with MOVE-G a combined group treatment for both alcohol use disorder and drug use disorder. The primary objective is to examine whether MOVE-G is non-inferior to MOVE-I in relation to abstinence from drug and/or alcohol, number of sessions received, and completion of treatment as planned. All participants will receive treatment based on cognitive behavioral therapy and motivational interviewing, vouchers for attendance and text reminders, as well as medication as needed (MOVE). Participants (n = 300) will be recruited over a one-year period at four public treatment centers in four Danish municipalities. A short screening will determine eligibility and randomization status. Hereafter, participants will be randomized to the two treatment arms. A thorough baseline assessment will be conducted approximately 1 week after randomization. Follow-up assessments will be conducted at 9 months post-randomization. In addition, patients’ use of drugs and alcohol, and patients’ wellbeing will be measured in all sessions. The main outcome measures are drug and alcohol intake at 9 months follow-up, number of sessions attended, and dropout from treatment. Discussion The present study will examine the potential and efficacy of combined groups (patients with alcohol and drug disorders in the same group) versus individually based treatment both based on the treatment method MOVE (Pedersen et al., Drug Alcohol Depend 218:108363, 2020). Trial registration ISRCTN88025085, registration date 30/06/2020.

Cannabis use peaks during adolescence and emerging adulthood, and cannabis use disorder (CUD) is associated with a wide range of adverse outcomes. This is particularly pertinent in youth, because the developing brain may be more vulnerable to adverse effects of frequent cannabis use. Combining evidence-based psychosocial interventions with safe and effective pharmacotherapy is a potential avenue to improve youth outcomes, but we lack approved CUD pharmacotherapies. Here, we review new potential avenues for helping youth with CUD, with a particular focus on cannabinoid-based treatments. Evidence from placebo-controlled RCTs suggests synthetic delta-9-tetrahydrocannabinol (THC) decreases withdrawal symptoms, but not cannabis use, in adults with daily cannabis use/CUD, while findings regarding formulations containing THC combined with cannabidiol (CBD) are mixed. Preliminary evidence from two placebo-controlled RCTs in adults with CUD suggests that both Fatty Acid Amide Hydrolase inhibitors and CBD can reduce cannabis use. However, larger trials are needed to strengthen the evidence. Findings from adults point to cannabinoid-based treatments as a potential strategy that should be examined in youth with CUD.

Cocaine-related emergency department admissions are increasing, and cocaine seizures are at an all-time high in Europe. Our aim was to investigate the trends in purity and adulterants over time in cocaine available to cocaine users at street level in Denmark. We used a representative sample of cocaine seized at street level and analyzed by the national departments of forensic medicine between 2006 and 2019 (n = 1460). Latent profile analysis was used to classify the samples based on cocaine, levamisole, and phenacetin content. Low purity cocaine comprised most of the cocaine seizures in early years, but its share began to decline in 2013, and from 2016 to 2019, the high purity profile was dominant. While the total number of samples containing adulterants decreased, levamisole remained a common and dangerous adulterant. The findings underline the need to inform the public, medical doctors, and service providers for people with drug use disorders about the higher potency of street cocaine.

Background The use of cannabis as medicine (CaM) both prescribed and non-prescribed has increased markedly in the last decade, mirrored in a global shift in cannabis policy towards a more permissive stance. There is some evidence that cannabis functions as a substitute for prescription drugs, particularly opioids; however, more knowledge is needed on the motives of substitution users, their patterns of use, and perceived effects of substitution use. Aims To explore who substitutes prescription drugs with cannabis, the type of prescription drugs substituted and the type of cannabis used, and the impact that substitution with cannabis has on prescription drug use as well as the motives for substitution in terms of experienced effects and side effects. Methods A self-selected convenience sample was recruited through social media, public media, and patient organizations to take part in an anonymous online survey. Inclusion criteria were 18 years or older and use of cannabis (prescribed or non-prescribed) with a medical purpose. Results The final sample included 2.841 respondents of which the majority (91%) used non-prescribed cannabis, and more than half (54.6%) had used CaM with the purpose of replacing a prescribed drug. Compared to non-substitution users, substitution users were more likely to be women and to use CaM in the treatment of chronic pain and other somatic conditions. Pain medication (67.2%), antidepressants (24.5%), and arthritis medication (20.7%) were the most common types of drugs replaced with CaM. Among substitution users, 38.1% reported termination of prescription drug use, and 45.9% a substantial decrease in prescription drug use. The most frequent type of cannabis used as a substitute was CBD-oil (65.2%), followed by ‘hash, pot or skunk’ (36.6%). More than half (65.8%) found CaM much more effective compared to prescription drugs, and 85.5% that the side effects associated with prescription drug use were much worse compared to use of CaM. Conclusion CaM is frequently used as a substitute for prescription drugs, particularly opioids. More research is needed on the long-term consequences of use of CaM, including the impact from low and high THC cannabis products on specific somatic and mental health conditions.

OBJECTIVE: This multicenter, parallel randomized, open study examined the effect of using vouchers and session reminders as an added element to outpatient treatment for drug use disorders in youth. It was hypothesized that being randomly assigned to a contingency management condition would lead to a reduction of psychiatric symptoms, and that this reduction would be mediated through abstinence and treatment completion.METHODS: A total of 460 participants aged 15 to 25 years from nine outpatient sites were randomized to one of four treatment conditions (standard treatment alone [STD], i.e., 12 sessions using motivational interviewing and cognitive behavioral therapy, STD plus vouchers for attendance [VOU], STD plus text reminders [REM], or STD plus vouchers and text reminders [REM + VOU]). Participants' symptoms of psychological distress were assessed using the YouthMap 12 instrument at intake, and at 3, 6, and 9 months post-treatment initiation. Interviewers were blinded to interventions.RESULTS: 114 participants were randomized to STD, 112 to REM, 113 to VOU, and 121 to VOU + REM. 69 clients were never interviewed for follow-up, leaving 391 for analysis (n = 90, n = 94, n = 99, n = 108). The mean age was 20.5 years (SD = 2.6), 23% were female, and 34% reported having a psychiatric diagnosis. Random effects regression showed that participants randomized to one of the two voucher-based conditions experienced significantly steeper declines in symptoms compared with STD (p CONCLUSIONS: Adding contingency management to interventions for drug use disorders can reduce symptoms of psychological and emotional distress among populations of treatment-seeking youth, in part due to indirect effects through abstinence at follow-up. The data is collected from a clinical trial registered as ISRCTN27473213, at https://www.isrctn.com/.

Background Substance use disorders show a high comorbidity with externalizing behavior difficulties, creating treatment challenges, including difficulties with compliance, a high risk of conflict, and a high rate of offending post-treatment. Compared with people with other substance use disorders those with opioid use disorders have the highest risk of criminal activity, but studies on the evidence base for psychosocial treatment in opioid agonist treatment (OAT) are scarce. The Impulsive Lifestyle Counselling (ILC) program may be associated with better retention and outcomes among difficult-to-treat patients with this comorbidity. Methods The study is a multicenter, randomized, controlled, superiority clinical trial. Participants will be a total of 137 hard-to-treat individuals enrolled in opioid agonist treatment (OAT). Participants will be randomized to either a standard treatment (14 sessions of individual manual-based cognitive behavioral therapy and motivational interviewing (MOVE-I)) or six sessions of ILC followed by nine sessions of MOVE-I. All participants will receive personalized text reminders prior to each session and vouchers for attendance, as well as medication as needed. The primary outcome is retention in treatment. Secondary measures include severity of drug use and days of criminal offending for profit three and nine months post-randomization. A secondary aim is, through a case-control study, to investigate whether participants in the trial differ from patients receiving treatment as usual in municipalities where ILC and MOVE-I have not been implemented in OAT. This will be done by comparing number of offences leading to conviction 12 months post-randomization recorded in the national criminal justice register and number of emergency room contacts 12 months post-randomization recorded in the national hospital register. Discussion This is the first randomized, controlled clinical trial in OAT to test the effectiveness of ILC against a standardized comparison with structural elements to increase the likelihood of exposure to the elements of treatment. Results obtained from this study may have important clinical, social, and economic implications for publicly funded treatment of opioid use disorder. Trial registration ISRCTN, ISRCTN19554367, registered on 04/09/2020.

Introduction An increasing number of adolescents and emerging adults are entering treatment for drug use disorders in high-income countries. This fact points not only to a need to evaluate treatment outcomes related to drug use reduction, but also to evaluate other indicators of treatment success. The aim of this study was to examine treatment effects on predicting readmission to drug use treatment and being convicted for a criminal offence among youth. A second aim was to examine whether a psychiatric history had an impact on these outcomes. Methods Participants were 460 youth aged 15–25 who took part in the YouthDAT, a randomized pragmatic clinical trial for outpatient drug use treatment. The trial compared four treatment conditions consisting of 12 sessions of a manualized treatment based on cognitive behavioral therapy and motivational interviewing. Condition one was the standard (only the manual); condition two consisted of standard treatment and contingency management (CM) (Vouchers); condition three included standard treatment, text reminders, and low-intensity aftercare (Reminders+LIA); and condition four combined the standard treatment, CM, text reminders, and low-intensity aftercare (Combined+LIA). The study linked participants to register data on psychiatric history, drug use treatment history, and criminal convictions. Results Treatment conditions Reminders+LIA (aB = 0.42, p = .026) and Combined+LIA (aB = 0.69, p = .000) predicted longer time to readmission compared to standard treatment. The Vouchers condition predicted a lower risk for criminal convictions (aIRR = 0.26, p = .001). Half of the participants had a psychiatric history. The treatments with additional strategies were useful in delaying readmission and reducing convictions for these youth. The results remained significant in the adjusted models accounting for relevant participant characteristics. Conclusions Additional treatment strategies in outpatient drug use treatment, such as CM, text reminders, and low-intensity aftercare, predicted delayed readmission to treatment and fewer legal problems. Mental health problems were common among youth. However, the treatments with additional strategies were effective with youth with a psychiatric history. Overall, while the additional strategies may be resource demanding for clinical settings, they support treatment success and may also help to decrease other public costs. Trial registration ISRCTN registry ISRCTN27473213.

Background: In Denmark the boundaries between cannabis as an illicit drug and licit medicine have shifted rapidly in recent years, affecting also policy. However, the vast majority of Danes, who use cannabis as medicine (CaM) continue to rely on the unregulated market for supply. This study explores patterns of use and motives for use of CaM in Denmark. Methods: An anonymous online survey was made available to a convenience sample of users of CaM from July 14, 2018 to November 1, 2018. Participants were recruited through patient organisations, social and public media, and the illegal open cannabis market. Results: Of the final sample ( n = 3,021), a majority were women (62.6%) and the mean age was 49 years. Most had no prescription for CaM (90.9%), a majority had no or limited previous experience with recreational cannabis use (63.9%), and had used CaM for two years or less (65.0%). The most common form of intake was oil (56.8%) followed by smoke (24.0%). CBD oil (65.0%) was used more than hash, pot or skunk (36.2%). Most frequent conditions treated were chronic pain (32.0%), sleep disturbances (27.5%), stress (23.7%), osteoarthritis (22.7%), anxiety (19.6%), and depression (19.6%). Overall, users experienced CaM to be effective in managing somatic and mental health conditions and reported relatively few side-effects. CBD oil only users were more likely to be women, older, have limited recreational experience and have initiated use recently. Conclusions: A new user group has emerged in Denmark that, for the most part, use illegally sourced CaM to treat a broad range of somatic and mental health conditions, often with experienced effect and relatively low level of side-effects. The prevalent use of low-potency CBD oil indicates an interest in effects beyond the high normally associated with cannabis use. More clinical research into the effects and side-effects of CaM is needed to draw the boundaries of the medical utility of cannabis.

Background Over the last few decades, evidence-based treatments for emerging adults with drug use disorder (DUD) have been developed, but dropout and inconsistent session attendance persist. This study assessed the efficacy of voucher reinforcement and/or text reminders for treatment attendance and completion in emerging adults with DUD in Denmark. Methods The study compared four levels of treatment intensity, with participants randomly assigned to standard outpatient counseling only (STD), outpatient counseling plus vouchers for attendance (VOU), outpatient counseling plus text reminders (REM), or outpatient counseling plus vouchers and text reminders (REM + VOU). A total of 460 individuals aged 15–25 years seeking treatment for DUD were randomly assigned to the four treatment conditions across nine sites. Results STD counseling had the lowest completion rate (25%), followed by REM (39%), VOU (46%), and REM + VOU (49%). Additionally, post hoc comparisons indicated that clients randomized to the REM + VOU condition differed in terms of zero no-shows from clients who were randomized to the VOU condition (χ2(1) = 6.90, p = 0.009) and the REM condition (χ2(1) = 5.87, p = 0.015). Conclusions Vouchers and text reminders contribute to reduced dropout and increased treatment attendance in emerging adults with DUD. The combination of vouchers and reminders in particular has the potential to reduce the number of no-shows.

This article conceptualizes the experience of self-tracking as flow, a central technique, utilized by digital media companies to hook their users. We argue the notion of flow is valuable for understanding both the temporal lock-ins of self-tracking practices in sequences and repetition, and the way self-tracking technologies thrive on data sequences for retaining users and creating viable businesses. To substantiate this, we present a qualitative empirical study of how users experience flow when tracking various aspects of their personal lives. Users find self-tracking technology and the metrics they generate to have much more limited relevance and thus guide their attention elsewhere. If they are hooked, they are so in ways different from those projected by the technology. Users find meaning in their self-tracking in moments of registration, allocution, consultation and conversation, but also problematize their attachment to specific temporal tracking regimes.

Background: The current level of alcohol consumption has placed Nigeria and Uganda in the group of high consumption countries, however little is known about how people with problematic alcohol use and related problems utilize treatment services. Aims: This study examined the relationship between alcohol consumption and mental health status in Nigeria and Uganda, and the relationship between heavy episodic drinking and treatment-seeking and treatment-receiving behavior. Data and methods: Analyses were based on cross-sectional survey data from Nigeria (N= 2018) and Uganda (N=1478) aged > 18 years from the 2003 Gender, Alcohol, and Culture: An International Study (GENACIS). Results: In both countries, the level of alcohol consumption was comparatively high, however, associations between drinking status and mental health problems were found only in Nigeria. Heavy episodic drinkers were more likely to report having sought help in both countries, only in Nigeria was it also related to ever receiving help. Conclusion: National strategies in both countries must continue allocation of resources to treatment services, supporting treatment availability and early identification of alcohol and related mental health problems. Implementation of national alcohol policies should be followed up with assessment and adjustments.

Geolocation as an increasingly common technique in dating apps is often portrayed as a way of configuring uncertainty that facilitates playful interaction with unknown strangers while avoiding subjecting the user to unwanted risks. Geolocation features are used in these apps on the one hand as matching techniques that created links between the user and potential partners through geographical location, and on the other as warranting techniques that can help a user to determine whether to trust a given profile. Tracing a trajectory from Georg Simmel’s figure of the stranger as intrinsic to modern urban culture, through Stanley Milgram’s familiar stranger as an inspiration for the infrastructure of social networking sites, to a consideration of the double perspective of overview and embedment inherent in geolocation’s ability to map, we identify the stalker as an emblematic figure that appears not as a threatening Other, but rather as our own doubling.

BACKGROUND: Opioid agonist treatment (OAT) for opioid use disorders may be delivered at treatment clinics or dispensed from pharmacies, however the type of delivery may be associated with different risks and benefits. The aim of the study was to investigate whether dispensing of methadone or buprenorphine at pharmacies during treatment for opioid use disorders was associated with adverse outcomes.METHODS: Retrospective cohort study using a national, linked, population-level data set from Denmark. Patients included were between 18 and 75 years, living in Denmark, and admitted for treatment for opioid use disorders during 2000-2016 (n = 9299). Cox proportional hazards regression was estimated for convictions, non-fatal overdoses, and death, after the first dispensing of either methadone or buprenorphine from a pharmacy after starting treatment.FINDINGS: Of all patients, 68 % had methadone and 31 % had buprenorphine dispensed at a pharmacy. Compared with the time prior to pharmacy dispension, the risk of criminal convictions increased after having methadone dispensed from a pharmacy (adjusted hazard ratio (aHR) = 1.22, 95 % confidence interval (CI) = 1.16-1.28), non-fatal overdoses (aHR = 1.55, CI 1.41-1.71), and all-cause mortality (aHR = 1.54, CI = 1.43-1.76). After having buprenorphine dispensed at a pharmacy, risk of criminal convictions increased (aHR = 1.08, CI = 1.01-1.16) and non-fatal overdoses (aHR = 1.31, CI = 1.18-1.45), but not all-cause mortality (aHR = 1.07, CI = 0.94-1.23).CONCLUSIONS: For almost all outcomes investigated across medication type, the risk of adverse events increased following a switch from clinic dispension to pharmacy dispension of medications in OAT. Medically responsible and safe provision of OAT may often require more clinical follow-up than what is typically provided when medication is dispensed at pharmacies.

Background Overdose education and naloxone distribution programs decrease opioid overdose deaths. However, no studies of such programs have been carried out in Denmark. The aim of this study was to evaluate the feasibility and the effect of a broader “training-the-trainers” model in low-threshold settings after participation in the “Danish Save Lives” [SL] program. Methods Between May 2013 and November 2015, 552 participants from four municipalities took part in the SL program. The program is built on the train-the-trainers model where a central trainer trains others (trainers), who in turn train others (helpers). Participants were 30 police officers (5%), 188 people who use opioids (34%), 23 significant others (4%), and 217 social workers (39%). Ninety-four participants could not be classified (17%). At follow-up, participants were interviewed to determine the number and outcomes of opioid overdoses. Logistic regression was used to assess predictors of treating an overdose. Results In all, 37 (7%) participants had intervened in 45 opioid overdose events (two trainers and 35 helpers). Detailed descriptions of the overdose event were available from 32 follow-up interviews (70%). In 16 cases, the person who intervened was already present at the site when the overdose occurred, and in 17 cases, the overdose victim recovered without complications. All overdose victims survived except one. People who used opioids were more likely to have treated an overdose than other participants (adjusted odds ratio [AOR] = 8.50, p = 0.001), and the likelihood of treating and overdose declined over time AOR = 0.37 (0.13, 0.93), p = 0.034). Conclusions Prevention programs that target people who use opioids are more likely to be effective than programs that target professionals, especially in high-risk settings that can be hard for paramedics to reach. A future goal is to explore how prevention programs can be adapted to new user groups. Trial registration The Danish Data Protection Agency, 2015-57-0002, Aarhus University, 2016-051-000001, 184, retrospectively registered

From global search engines to local smart cities, from public health monitoring to personal self-tracking technologies, digital technologies continuously capture, process, and archive social, material, and affective information in the form of big data. Although the use of big data emerged from the human desire to acquire more knowledge and master more information and to eliminate human error in large-scale information management, it has become clear in recent years that big data technologies, and the archives of data they accrue, bring with them new and important uncertainties in the form of new biases, systemic errors, and, as a result, new ethical challenges that require urgent attention and analysis. This collaboratively written article outlines the conceptual framework of the Uncertain Archives research collective to show how cultural theories of the archive can be meaningfully applied to the empirical field of big data. More specifically, the article argues that this approach grounded in cultural theory can help research going forward to attune to and address the uncertainties present in the storage and analysis of large amounts of information. By focusing on the notions of the unknown, error, and vulnerability, we reveal a set of different, albeit intertwined, configurations of archival uncertainty that emerge along with the phenomenon of big data use. We regard these configurations as central to understanding the conditions of the digitally networked data archives that are a crucial component of today’s cultures of surveillance and governmentality.

Background Drug overdoses remain a significant public health burden throughout the world. This study assessed the incidence and predictors of non-fatal and fatal drug overdoses among patients with an opioid use, treated for drug use disorders (DUD) at public treatment centers in Denmark. Methods A consecutive cohort of patients (n = 11,199) were tracked from date of first registered enrollment between the year 2000 and 2010 to first registered drug overdose, death or December 31st 2010, whichever occurred first. Competing-risks regression models were fitted to estimate the sub hazard ratios (SHRs) of non-fatal and fatal drug overdoses and confounding risk factors. Results A total of 3186 (28%) patients experienced a non-fatal drug overdose during follow-up, and 572 (6%) died from an overdose. Use of benzodiazepines (SHR: 1.15 95% CI 1.03, 1.28) was significantly associated with non-fatal overdose. Intravenous drug use and previous hospitalization for a non-fatal overdose increased the risk of later non-fatal (SHR: 1.57 95% CI 1.42, 1.73) and fatal overdoses (SHR: 1.43 95% CI 1.12, 1.82). Conclusions Patients who use opioids remain at risk of overdoses for a long time after discharge from drug treatment. Besides relevant monitoring and psychosocial support in opioid maintenance treatment, there is a need for informing and educating opioid users in risk factors and preventive measures in settings where they are often difficult to access for traditional treatment services.

To review evidence on the effects of training programs in dual diagnosis treatment for mental health professionals. Three databases were searched. Included studies were evaluated by an adapted version of Kirkpatrick’s Training Evaluation Model, which evaluates participant perception of training, the effect on professional competencies, transfer of training, and the effect on the patients. Overall findings from the eleven included studies suggested that participants valued the training, increased some professional competencies, and that some transfer of training occurred. The effect at the patient level showed mixed results. Training mental health professionals in dual diagnosis treatment may have a positive effect on professional competencies and clinical practice. Any conclusion regarding the overall training effect is premature due to limitations in study designs. Future studies on the effects of dual diagnosis training programs for mental health professionals should involve control groups, validated measures, follow-ups, and patient outcomes.

The nexus between love and digitization has become a significant matter of concern in contemporary society. On the one hand, the romantic subject has never had more help at hand to seek out love th...

Objectives To present the prevalence and incidence of cardiovascular disease (CVD) in a national cohort of patients seeking treatment for drug use disorders (DUD). Methods Longitudinal record-linkage study of consecutive DUD treatment admissions between 2000-2006 from Denmark. Results Of 17,642 patients seeking treatment for DUD, 828 individuals (4.53%) had a history of CVD at treatment entry. Among the remaining patients, 16,820 were traced and 1,535 new incident cases of CVD were observed during a mean follow-up time of 7.5 years. The incidence of CVD was associated with intravenous drug use (subhazard ratio [SHR]=1.41, p

Thumbnail images are discreet, yet central navigational tools in increasingly complex visual information environments. Indeed, without thumbnail images there would be no image search: they are an inherent part of the information architecture of most digital information platforms. Yet, how might we understand the role of the thumbnail as an attention technology in the digital economy? And what kind of aesthetic does it produce? This paper examines the legal negotiations of the thumbnail image and the ensuing decision to conceptualize the thumbnail as a functional image against the cultural history of visual attention technologies and the aesthetics of their connective function. Such an endeavour, we propose, allows us to understand and appreciate the significant digital economy and particular aesthetic of the thumbnail image despite its apparent subtlety.

Catherine D’Ignazio is a scholar, artist/designer and software developer who focuses on data literacy, feminist technology and civic art. She has run breastpump hackathons, created award-winning water quality sculptures that talk and tweet, and led walking data visualizations to envision the future of sea level rise. Her research at the intersection of gender, technology and the humanities has been published in the Journal of Peer Production, the Journal of Community Informatics, and the proceedings of Human Factors in Computing Systems (ACM SIGCHI). D’Ignazio is an Assistant Professor of Civic Media and Data Visualization at Emerson College, a faculty director of the Engagement Lab and a research affiliate at the MIT Center for Civic Media.

BACKGROUND: Patients with schizophrenia and comorbid drug use disorders (DUD) have a severe course of illness. Despite strong evidence that drug use can exacerbate psychotic symptoms, we have limited knowledge of how specific drugs may increase risk of schizophrenia readmission in this group. This study aimed to assess drug-related predictors of readmission for schizophrenia among a national cohort of patients with a history of schizophrenia admitted to DUD treatment.METHODS: A record-linkage study was used to assess drug-related factors associated with readmission to mental health treatment for schizophrenia, using a consecutive cohort of 634 patients admitted to DUD treatment between 2000 and 2006 in Danish treatment services and tracked until February 2013 or death, controlling for baseline psychiatric treatment variables.RESULTS: The majority of patients were males (79.8%) and the mean age was 34.7years. Of all patients, 78.7% were readmitted for schizophrenia during follow-up, and 6.8% died without having been readmitted. We found a robust association between use of amphetamine at baseline and elevated risk of readmission, a less robust association between use of cannabis and elevated risk of readmission, and no association with cocaine, opioids, alcohol, benzodiazepines, and MDMA. Furthermore, one or more psychiatric inpatients visit in the year prior to DUD admission was robustly associated with elevated risk of schizophrenia readmission.CONCLUSIONS: Use of amphetamine and cannabis are risk markers for schizophrenia readmission among patients with a history of schizophrenia and DUD. Psychiatric history is a predictor of schizophrenia readmission in this patient group.

Background The Addiction Severity Index (ASI) is a widely used assessment instrument for substance abuse treatment that includes scales reflecting current status in seven potential problem areas, including psychiatric severity. The aim of this study was to assess the ability of the psychiatric composite score to predict suicide and psychiatric care after residential treatment for drug use disorders after adjusting for history of psychiatric care. Methods All patients treated for drug use disorders in residential treatment centers in Denmark during the years 2000–2010 with complete ASI data were followed through national registers of psychiatric care and causes of death (N = 5825). Competing risks regression analyses were used to assess the incremental predictive validity of the psychiatric composite score, controlling for previous psychiatric care, length of intake, and other ASI composite scores, up to 12 years after discharge. Results A total of 1769 patients received psychiatric care after being discharged from residential treatment (30.3%), and 27 (0.5%) committed suicide. After adjusting for all covariates, psychiatric composite score was associated with a higher risk of receiving psychiatric care after residential treatment (subhazard ratio [SHR] = 3.44, p Conclusions The ASI psychiatric composite score has significant predictive validity and promises to be useful in identifying patients with drug use disorders who could benefit from additional mental health treatment.

This article describes contributions from the Centre for Alcohol and Drug Research (CRF), Faculty of Business and Social Sciences, Aarhus University, within treatment for alcohol and drug problems. This article focuses on three key research areas: evaluation research and development of monitoring systems/registers, development of screening and treatment methods, and treatment system research. Some of the important findings from the studies conducted within these three areas will be presented and the impact that these findings have had on Danish treatment policy will be described.

IntroductionPatients with antisocial personality disorder incur high costs on society, and are at high risk of dropping out of treatment and are often excluded from treatment, yet very little research has been conducted on how to best help these patients.ObjectivesTo test a six-session psychoeducation program, Impulsive Lifestyle Counselling, in outpatients with substance use disorders and antisocial personality disorder.AimsTo test the efficacy of the intervention versus treatment as usual in community outpatient treatment for substance use disorders.MethodsPragmatic randomized trial in 13 outpatient community substance abuse treatment uptake areas. Patients were interviewed by blinded interviewers 3, 9 and 15 months post-randomization and tracked through a national substance abuse treatment register. Mixed effects regression were used to assess substance use and self-reported aggression and Cox regression was used to assess risk of dropout.ResultsA total of 175 patients was randomized. At 3-month follow-up, patients randomized to intervention reported more days abstinent and less drug use severity than patients randomized to treatment as usual. In addition, patients randomized to intervention were at lower risk of dropout after intervention. In addition, patients randomized to intervention were more likely to report having received help for antisocial personality disorder at follow-up interviews.ConclusionsA brief psychoeducational intervention may improve outcomes for outpatients with antisocial personality disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Purpose – This paper aims to view the concept of persuasive technology as a framework for discussing cultural politics on the internet. Taking digital collections as a point of departure, the cases of Europeana and Google Books are to be discussed as promoting different assemblies of information, practice and identity politics. Through this discussion the study aims to show how the internet becomes territorialized through persuasive mechanisms.Design/methodology/approach – The study applies different concepts on the cases, derived from different fields of social theory, such as “soft power”, “assembly” and “folksonomy” in order to question the traditional view of persuasive technology as a concept instrumental to, for example, marketing agendas. Targeting the relation between policy and everyday practice, the paper aims to open a discussion of persuasive technology deeply embedded in digital cultural politics.Findings – The study points through a conceptual investigation to a new scene for critically deba...

The Internet and the World Wide Web (WWW) have become dominant fields for European Union (EU) politics. What used to be at the outer fringes of the EU policies has now taken centre stage. The transnational and dialogical structure of the Internet has hardwired it for international cultural politics, yet the very same structure also works to erode the very territorial foundation of traditional cultural politics. Given the delicate and complex terrain cultural politics traverse in international politics, and the trailblazing progression of the Internet, it seems on-line cultural politics is not just the application of existing cultural politics to cyberspace but a new field to be explored, analyzed and taught. The present article maps a constituent European cultural boundary on the WWW as the EU has circumscribed it and places this cultural node within a wider array of Europeanization and globalization processes.

This study describes cellular and microradiographic findings in thin undemineralized enamel-dentine sections from 36 enamel caries lesions from freshly extracted third molars. Lesions activity was determined by clinical examination and the estimated age of the lesion at extraction time. The cellular reactions to the enamel/dentine lesion complex were measured using computerized histomorphometry under the following conditions: (a) the cytoplasm:nucleus ratio of the odontoblast cell; (b) the odontoblast cell:dentinal tubule ratio, and (c) the adjacent predentine area (μm2). The first cellular reactions were observed beneath superficial enamel lesions before visible alterations in dentine mineralization. The cytoplasm:nucleus ratio of the odontoblast cells was markedly reduced, and only active lesions showed evidence of cellular proliferation into the cell-free zone. In more advanced active lesions the affected odontoblast cells had a significantly lower cytoplasm:nucleus ratio compared with the controls. Similar changes were not seen in arrested or slow-progressing lesions. Before onset of tertiary dentine formation there was a positive correlation between odontoblast cell size and predentine formation. Primary odontoblast cells were involved in early tertiary or reactionary dentine formation without odontoblast cell replacement. Reactionary dentine was only seen in active lesions, suggesting that reactions in the dentine/pulp complex are closely associated with the external environment.

Concern about the survival of microorganisms in deep carious lesions may often lead to unnecessary exposure of the pulp during final excavation. There are reasons, therefore, to initiate systematic studies on the alternative procedure known as stepwise excavation. Clinical evaluation of stepwise excavation was performed on 31 deep carious lesions considered to result in pulp perforation by traditional excavation. This study examines the clinical and microbiological alterations during the final excavation performed during long intervals (6-12 months) after the initial treatment that included peripheral dentine excavation and removal of the central cariogenic biomass and the superficial necrotic dentine. The dentine colour and consistency were assessed by means of standardized scales before application of a Ca(OH)2 compound and a temporary sealing for 6-12 months. Reassessments were performed before the after final excavation. Microbiological dentine samples were obtained in 19 randomly selected lesions by a sterile bur, transferred to and diluted in reduced transport fluid, and plated on tryptic soy agar. After anaerobic incubation at 37 degrees C for 7 days, total colony-forming units per millilitre were counted from (1) peripheral excavated and hard dentine (control), (2) central demineralized dentine before and final excavation, and (3) central dentine after the final excavation. Six samples of central demineralized dentine were without any cultivable flora increasing to 9 samples after the final excavation. The clinical dentine changes occurring during stepwise excavation were characterized by enhanced hardness of the dentine which was associated with a marked reduction in bacterial growth after the final excavation. Despite the presence of bacteria in the excavated dentine none of the carious lesions resulted in pulp perforation, suggesting that the initial removal of the cariogenic biomass appears to be essential for control of caries progression. Stepwise excavation is not only an appropriate treatment of deep carious lesions but is also considered a suitable model for microbiological studies to determine the bacteria persisting in clinically excavated lesions.

Blood pressure self-measurement requires the patient to follow a range of recommendations in order to be considered valid for diagnostic use. We investigated how a lightweight and context-aware system designed for sensing and correcting incorrect usage of home blood pressure self-measurement devices was perceived by a group of four patients. We found that using a context-aware system for improving adherence is feasible for overcoming the challenges related to moving from the supervised clinical setting to the unsupervised home setting. We also found that patients are willing to accept more advanced monitoring systems and increased surveillance, as long as it is only used during self-measurement periods and is proportional to the severity of the disease.

In the past 20 years, a great many studies have identified secondary caries to be the most common reason for the replacement of restorations. This review raises the question whether clinicians use 'secondary caries' as a catch-all into which they put a variety of reasons for replacement, or whether they do have professionally based reasons for focusing on caries adjacent to restorations. There is no consensus among researchers concerning the nature of secondary caries, but it is possible to identify two major-and conflicting-trends : One adheres to a critical approach concerning the frequency of replacements and recommends a much more conservative evaluation of existing fillings. In contrast, the other trend focuses on the clinical undetectable microleakage as the major risk factor for the initiation and uncontrolled dentinal spread of secondary caries. Since the latter trend offers a reasonable explanation for the clinicians' concern about invisible 'secondary caries', and hence reinforces the tendency to replacement, it is relevant to reconsider the conventional concept that microleakage leads to the initiation of secondary caries. Available data indicate that visible gaps and marginal discrepancies are poorly related to secondary caries, and that secondary caries is a localized phenomenon caused by localized conditions for the evolution of cariogenic plaque. Consequently, secondary caries is not a universal attack along the entire interface between tooth and restoration, but rather a new lesion or a re-beginning of caries on the surface due to local conditions for plaque formation with cariogenic potential. It is concluded that reinforcement of a new and more appropriate professional behavior should be based on diffusion of existing knowledge of dental caries as a disease rather than on simplified criteria for the placement and replacement of dental restorations.

– This study examines the restorative caries treatment pattern in Danish 20-year-old military conscripts in 1986 and 1991. The study groups comprised 85 and 164 males born in 1966 and 1971, respectively. The examination was performed as a part of the routine for each conscript according to directions from Dental Service, Danish Defense Forces and included surface recording of fillings on all teeth except third molars. Two bitewing radiographs were taken of all conscripts in the 1986-group and of those who gave permission (59) in the 1991-group. The mean number of filled surfaces was 10.2 and 8.8 in 1986 and in 1991, respectively. 80% of the occlusal surfaces on permanent first molars were filled in the 1986-group and filled or sealed in the 1991-group in contrast to 45% of permanent second molars. Data from maxillary molars indicated a tendency to placement of fillings related to tooth specific morphology whereas extended fillings involving the entire occlusal surface dominated on mandibular molars. The X-ray examination disclosed that the majority of approximal molar surfaces were classified as sound in both study groups. Less than 1% of the approximal molar surfaces were recorded as having lesions penetrating deep into the dentin. In 1981 and in 1986 the participants in the study groups were 15 yr old. In these years the mean number of filled surfaces in Danish children amounted to 11.0 and 6.9 respectively, which indicates that very few lesions in need of operative treatment developed from age 15 to age 20 in both study groups.

This study examines cellular differences between undemineralized and demineralized tooth sections. The material comprised unerupted and partly erupted third molars. After fixation for 24 h, 10- to 15-microns ground sections were prepared from half of the tooth, using a cutting-grinding system. The sections were compared with demineralized routine sections from the other half of the tooth. Undemineralized sections showed a better capacity for preserving the tissue integration. Especially between the odontoblast layer and the predentin a low frequency of disjunctions or tears were noted. At this level of examination fixation quality and vacuole frequency (intra-cellular spaces) did not show any differences between the two methods.

Aims Research on substance abuse treatment suggests patient satisfaction is linked to use of services and abstinence. However, patient perspectives on treatment are rarely examined. This study used mixed methods to examine correlations between patients’ treatment satisfaction, retention and abstinence from drugs and provide a transpersonal account of patient perspectives on treatment. Data and Methods Eight Danish outpatient substance abuse treatment centres participated in the study. Data was collected from 186 patients. Quantitative measures were used at baseline screenings and at 6 months follow-up interviews, including the Client Satisfaction Questionnaire-8 (CSQ-8). Qualitative measures were used for patient descriptions of treatment at follow-up. Results Patient satisfaction with treatment was linked to retention, abstinence and program differences. The qualitative data described patient's views on high or low treatment satisfaction. Conclusion The CSQ-8 is a valuable tool for monitoring patient engagement and treatment effect in substance abuse treatment services. The inclusion of patient perspectives underlined the importance of a more contextual understanding of program components.

Treatment of patients with concurrent mental illness and substance abuse represents a challenge to the traditional treatment systems. This article gives: 1) an introduction of the concept and frequency of dual diagnosis (DD), 2) a presentation and discussion of the latest guidelines on DD treatment, 3) status on the current situation in the DD field in Denmark, and 4) potentials for future research. The article is based on systematic examination of evidence-based research and popularized latest guidelines on DD treatment. Methodologically, both treatment and research is challenged by the diversity in DD combinations. Although integrated treatment with the inclusion of cognitive-behavioural therapy, motivational interviewing and family intervention in DD treatment show promising results, it remains to establish which treatment programme is the most qualified in improving mental health and reducing substance use. A future priority is the development of DD treatment that targets specific co-morbid combinations and treatment needs.

Eleven children, each having one or two pairs of premolars to be extracted for orthodontic purposes, participated in the study. The model involved placement of a special orthodontic band that allowed the accumulation of plaque in a defined area between the band and the buccal enamel. Examination of enamel changes was carried out in experimental teeth that had been exposed to local plaque accumulation for one, two, four, eight, or 14 days. The specimens were examined under the light (LM) and the scanning electron microscope (SEM). All teeth had signs of very mild dental fluorosis. No indications of demineralization were noted after one day. SEM examination showed signs of crystal dissolution in some of the two-day specimens. Six of eight four-day specimens exhibited surface dissolution. All eight- and 14-day specimens showed signs of surface demineralization in the LM as well as in the SEM. These observations documented that undisturbed bacterial deposits are capable of initiating enamel demineralization within short time periods, even in children living in a water-fluoridated area.

Recent clinical and laboratory evidence has suggested that systemic fluoride plays a more minor role in caries inhibition than was previously believed. This paper reviews clinical data on water fluoridation, the topical administration of fluorides, and fluoride supplements in the light of more recent understanding of the disease dental caries. Due to reduced functional usage, erupting teeth tend to accumulate plaque which has cariogenic potential. For this reason, the period from tooth emergence to the establishment of interproximal contact and full occlusion is the most critical for caries initiation. Analyses of clinical data indicate that maximum protection against caries is obtained when teeth erupt into an environment with low concentrations of ionic fluoride. The similarity in caries reductions obtained in water fluoridation studies and long-term studies with topically administered fluoride regimens, including fluoride-containing dentifrices, indicates that the pre-eruptive effect of fluoride is of borderline significance relative to the more significant post-eruptive effect. Water fluoridation and topical fluoride programs are thus important measures for the control of caries at the community level. For the individual, topical application of fluoride is seen as an integral part of caries treatment aimed at arresting progressive caries. Fluoride application is thus considered a supportive therapy, in conjunction with cariogenic plaque control. Daily use of fluoridated dentifrices from tooth eruption is more efficacious than daily use of fluoride supplements from birth.

The aim of this study was to develop a new in vivo caries model for the occlusal surface and to describe the enamel features observed before and after dental plaque control (DPC). Four volunteers (12-15 years old) participated in the experiment, each of which was due to have 2 homologous first premolars extracted for orthodontic reasons. Test surfaces did not present visible signs of demineralization, opacities or fillings. A wire mesh was used to promote dental plaque accumulation on the occlusal surface. After 4 weeks, the wire mesh was removed and DPC was performed. In Groups 1 and 2, DPC was performed by the subjects daily and, in Groups 3 and 4, DPC was performed by the subjects daily and by the professional weekly. One tooth/pair of Groups 1 and 3 was extracted after 2 weeks. One tooth/pair of Groups 2 and 4 was extracted after 4 weeks. All test surfaces showed demineralization after the wire mesh was removed. The observed re-establishment of the enamel brightness was directly related to the increase of the DPC duration. In polarized light microscopy, interindividual differences varying from pseudoisotropic areas to enamel lesions were noted in specimens submitted to 2 weeks of DPC. Specimens submitted to 4 weeks of DPC showed less tissue porosity. It was concluded that the new in vivo caries model was effective since all occlusal surfaces presented clinical and microscopic signs of mineral loss in different stages after 4 weeks of cariogenic challenge. After DPC on the test surfaces, there was a reduction of mineral loss suggesting control of demineralization on these surfaces. O objetivo deste estudo foi desenvolver um modelo de cárie in vivo para superfície oclusal e descrever as características do esmalte observadas antes e após o controle mecânico de placa dental (CMPD). Quatro voluntários (12-15 anos) participaram do experimento, contribuindo com um par de pré-molares homólogos, com indicação de extração por motivos ortodônticos, sem sinais visíveis de desmineralização, opacidades nem restaurações. Uma tela metálica colocada sobre a superfície oclusal propiciou acúmulo microbiano. Após 4 semanas, removeu-se a tela e a superfície foi submetida ao CMPD. Nos Grupos 1 e 2, o CMPD foi realizado pelo indivíduo diariamente e nos Grupos 3 e 4 diariamente pelo indivíduo e semanalmente pelo profissional. Os dentes dos Grupos 1 e 3 foram extraídos após 2 semanas, e os dos Grupos 2 e 4, após 4 semanas de CMPD. Após a remoção da tela, foram visíveis diferentes graus de desmineralização em todas as superfícies-teste, e a recuperação do brilho foi diretamente proporcional ao tempo de CMPD. Microscopicamente, foram notadas diferenças interindividuais como áreas pseudo-isotrópicas até lesões em esmalte, após 2 semanas de reexposição ao CMPD. Uma menor porosidade tecidual foi encontrada nos espécimes submetidos a 4 semanas de CMPD. Concluiu-se que o modelo de cárie in vivo desenvolvido foi efetivo, visto que todas as superfícies oclusais apresentaram sinais clínicos e microscópicos de perda mineral em diferentes graus, após 4 semanas de desafio cariogênico. Após a reexposição das superfícies-teste ao CMPD, notou-se uma redução das perdas minerais que foi sugestiva do controle da desmineralização nessas superfícies.

This study reports results from a practice-based study in which deep carious lesions were treated by general dental practitioners using stepwise excavation. The material comprised 94 teeth with deep carious lesions which the clinicians considered would result in pulp perforation if treated by a single and terminal excavation. At the first visit excavation of the peripheral dentine was completed. The outermost part of the central and necrotic dentine was gently removed with a sharp excavator. Standardized assessments of the dentine colour and consistency were made before application of a calcium hydroxide-containing base material and temporary filling. The final excavation was completed after a treatment interval ranging from 2 to 19 months, with a median of 6 months. Reassessments of the dentine colour and consistency were made before complete removal of demineralized dentine. The central dentine was significantly browner and less softened after the sealing period. After removal of the dark-brownish dentine during the final excavation, the colour and consistency of the exposed central dentine was found to resemble that of the completely excavated peripheral dentine. Only five cases resulted in pulp perforation during the final excavation. The high success rate of teeth surviving the final treatment without pulp exposure after 1 year of observation shows that it was possible for dentists in general practice to administer and manage the treatment of deep carious lesions, a process which may prolong tooth survival compared with conventional endodontic techniques.

This paper examines the characteristics of the process of innovation as applied to provision of dental health to children. The data are from a demonstration project conducted in a Danish public child dental health clinic to evaluate the appropriateness and effectiveness of an individualized and alternative, mainly non-operative, caries treatment strategy that was implemented in 1987. The aim of the strategy was to avoid operative intervention and sealants, and was based on three principles: caries is a localized disease; intensive training in home-based treatment; and individualized risk assessments and controls in conjunction with professional plaque removal. The major influence on the innovation process appeared to be personal education of the personnel, active participation in research, and feedback from clinical observations, In 1992 an additional feedback measure was introduced addressing the question: how much time does the individual child spend on treatment during one year? Mean total treatment time varied from 12 min for 1- to 4-yr-olds to 44–58 min for 7- to 17-yr-olds. About 60% of the total treatment time was used on non-operative caries treatment (diagnosis, risk assessment, plaque removal, toothbrushing training) and about 25% on operative caries treatment for 3- to 17-yr-olds. The 1–2-yr-olds required only non-operative treatment. The new treatment strategy reduced operative procedures by 60%. The paper introduces an easily applicable measure of treatment outcome in terms of teeth that have not been restored or sealed ax a result of regular professional treatment or care. The main conclusion drawn is that the dominant moving forces in the innovation process were professional responsibility and self-adjustment by a constant learning process involving clinical feedback measures in conjunction with modern understanding of caries as a localized disease caused by local evolution of microbial cariogenic biofilms.

The present study examines the correlation between caries lesions in enamel and the corresponding dentin reactions in proximal tooth surfaces with lesions ranging from enamel lesions to cavitations without dentin exposure. Using quantitative imbibition technique, the highest degree of tissue porosity, irrespective of lesion activity, was always noted along a Central-Traverse (CT), which followed the direction of the rods from the deepest point of penetration to the surface. The conical shape of approximal enamel lesions can thus be seen as the result of systematic variations in porosity along the rods determined by the specific interproximal environment. The initial dentin reaction, related to the enamel lesion approaching the enamel-dentin junction (EDJ), was seen as a local dentin translucency where the CT crossed the EDJ. Results from histomorphometric analyses revealed that, when the enamel lesions reached the EDJ, brownish discoloration in the dentin never exceeded the histologic contact area between the enamel lesion and the EDJ. In relation to the less advanced parts of the individual enamel lesion, the dentin responded with formation of translucent dentin. These reactions did not occur beyond an area determined by lines in the direction of the rods from the peripheral part of the enamel lesion towards the EDJ. The results did not support the view that dentin caries spreads along the enamel-dentin junction. The peripheral dentin translucency is therefore generated by stimuli transmitted along the rods of the less advanced parts of the enamel lesions.

This study examines the influence of sagittal occlusion on occlusal plaque formation in permanent first molars (PFM) in 72 7–10-yr-olds before loss of primary second molars. Of a total of 288 PFM, 140 (49%) were sealed and 23 (8%) filled. Occlusal plaque was recorded at two levels of examination: 1) visible plaque on the entire surface and 2) detailed macromorphologic mapping. Enamel caries was recorded after professional tooth cleaning. After 48 h without tooth brushing, plaque examinations were repeated. Stone models were used for 1) identification of interocclusal contact areas and 2) classification of sagittal molar occlusion. The detailed mapping of plaque on unfilled surfaces showed a clear pattern of preferential locations related to the macromorphology of the occlusal surfaces. Active caries was restricted to those anatomic structures where plaque accumulated. 48-h median plaque values on mandibular molars in normal and with one cusp distal occlusion were significantly lower (P < 0.01) compared to surfaces in 1/4, 1/2 and 3/4 distal molar occlusion. Maxillary molars with normal and with 1 cusp distal occlusion had lower median plaque values than other sagittal occlusion categories. In general, however, plaque scores were higher in maxillary teeth because more than 2/3 of these teeth were without occlusal contact in the distal part. Mandibular occlusal surfaces in normal and with one cusp distal occlusion had significantly fewer active lesions than teeth with 1/4, 1/2 and 3/4 cusp distal occlusion. The significant influence of variations in sagittal molar relation on occlusal plaque formation and caries initiation occurring in fully erupted PFM before loss of primary second molars thus supports the view that physical forces operating during mastication are an important factor for colonization and growth of bacteria with cariogenic potential.

The aim of the present study was to examine clinical and histological events taking place in vivo during the initial period of arrestment of active enamel carious le sions. For this purpose we developed lesions in vivo during a period of 4 weeks. To ensure plaque accumulation, orthodontic bands with a standardized buccal space were placed on 4 premolars in each of 4 patients undergoing orthodontic treatment. After 4 weeks with local cariogenic challenge, all teeth were debanded and one tooth in each patient extracted as control. All teeth had ‘white spot lesions’ corresponding to the plaque retention area. No professional tooth cleaning was performed. The remaining teeth were extracted 1 2, or 3 weeks after debanding. No fluoride was added during the entire test period and the patients were told to maintain usual oral hygiene. A gradual regression of the lesions in terms of reduction in lesion area and degree of opacity was noted during the following 3 weeks. The polarized light examinations disclosed a prompt reaction to the removal of the bands as no further lesion progress was noted. In addition we observed a decrease in tissue porosity especially in the deepest parts of the lesions while the outer surface appeared more porous than in the base-line lesions.

The present study examines early enamel surface alterations taking place when active carious lesions enter an arrested stage. Orthodontic bands with a standardized space for plaque accumulation were used to produce incipient carious lesions on the buccal surface of all four first premolars of four young adolescents. The premolars were to be extracted for orthodontic reasons. After 4 weeks of local cariogenic challenge, all teeth were debanded. In each patient one tooth was extracted at the time of debanding. The remaining premolars were extracted 1, 2, and 3 weeks after re-exposure to the oral environment. No fluoride was added during the entire test period, and the patients were told to maintain usual oral hygiene. Scanning electron microscope examination of the experimental surface areas disclosed a gradual wearing away of the outermost crystals during the 3 weeks of observation. This was associated with a leveling off of surface irregularities and the development of a multitude of scratches. The observed attrition of the porous surface in the lesion area indicates that functional wear and toothbrushing were responsible for the arrestment by disturbance and removal of bacterial deposits.

Assessment of dental fluorosis and localized enamel opacities was performed amongst children resident in areas having 6 F- in the drinking water. Evalu