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Adolescent substance use is a growing problem that causes a myriad of negative outcomes. Using substances during adolescence can lead to decreased executive functioning and is correlated with the top three causes of deaths for adolescents. Treatment options vary and the impact on outcomes are mixed, with engagement being of the most important indicators. Gaming is a popular activity among adolescents, and yet smartphone applications are relatively unexplored within substance use disorder treatment programs. This paper explores the feasibility and acceptability of implementing a mobile application as a supplement to existing adolescent substance use disorder treatment in a behavioral health agency in eastern Missouri. Feedback was received from staff and clients to assess feasibility and acceptability of implementation with barriers discussed. Results indicate there is promise with incorporation of smartphone-based applications into existing interventions and act as recommendations for other providers.

ObjectiveTo examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults.MethodsNationwide survey in February-March 2021 of adults representative across sex, age and location. Vaccine uptake and a range of putative drivers of uptake, including vaccine confidence, socioeconomic status, and sources of trust, were examined using logistic and Bayesian regressions for vaccines generally and for SARS-CoV-2 vaccines.ResultsOverall 1,166 surveys were collected from participants aged 18-90 years (mean 52, SD of 19). Seventy-eight percent reported being likely to receive a vaccine against COVID-19. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 1.04 95%CI [1.03-1.044]), being male (OR: 1.37, 95% CI [1.08 – 1.72]), residing in the least disadvantaged area quintile (OR: 2.27 95%CI [1.53 – 3.37]) and a self-perceived high risk of getting COVID-19 (OR: 1.52 95% CI [1.08 – 2.14]). However, 72% of participants did not believe that they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level, and rurality. Knowing that the vaccine is safe and effective, and that getting vaccinated will protect others, trusting the company that made it and getting vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight percent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing etc.) post-vaccine.ConclusionsSeventy-eight percent of Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified in this study (e.g. knowing that the vaccine is safe and effective, getting a doctor’s recommendation to get vaccinated) can be used to inform public health messaging to enhance vaccination rates.Strengths and limitations of this studyThis research captured a large, representative sample of the adult Australian population across age, sex, location, and socioeconomic status.We have self-reported Australian uptake intentions and attitudes on general vaccines and COVID-19 vaccine, and intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing etc.) post SARS-CoV-2 vaccine.We examine a range of drivers and factors that may influence intent to get the SARS-CoV-2 vaccine uptake, including vaccine confidence, demographics and socioeconomic status.The survey is based on established behavioural theories, and is the Australian arm of the international iCARE survey which to date has collected global comparative information from over 90,000 respondents in 140 countries.Our survey was only available in English, which may have led to an underrepresentation of ethnic groups, and participation was voluntary, so our sample may be prone to selection bias from those with more interest or engagement in COVID-19.

Despite reduction of xerostomia with intensity-modulated compared to conformal X-ray radiotherapy, radiation-induced dental complications continue to occur. Proton therapy is promising in head and neck cancers to further reduce radiation-induced side-effects, but the optimal dental management has not been defined.Dental management before proton therapy was assessed compared to intensity-modulated radiotherapy based on a bicentric experience, a literature review and illustrative cases.Preserved teeth frequently contain metallic dental restorations (amalgams, crowns, implants). Metals blur CT images, introducing errors in tumour and organ contour during radiotherapy planning. Due to their physical interactions with matter, protons are more sensitive than photons to tissue composition. The composition of restorative materials is rarely documented during radiotherapy planning, introducing dose errors. Manual artefact recontouring, metal artefact-reduction CT algorithms, dual or multi-energy CT and appropriate dose calculation algorithms insufficiently compensate for contour and dose errors during proton therapy. Physical uncertainties may be associated with lower tumour control probability and more side-effects after proton therapy. Metal-induced errors should be quantified and removal of metal restorations discussed on a case by case basis between dental care specialists, radiation oncologists and physicists. Metallic amalgams can be replaced with water-equivalent materials and crowns temporarily removed depending on rehabilitation potential, dental condition and cost. Implants might contraindicate proton therapy if they are in the proton beam path.Metallic restorations may more severely affect proton than photon radiotherapy quality. Personalized dental care prior to proton therapy requires multidisciplinary assessment of metal-induced errors before choice of conservation/removal of dental metals and optimal radiotherapy.

Researchers have developed many different computerized interventions designed to teach students about the dangers of substance use. Following in this tradition, we produced a series of video games called Bacon Brains. However, unlike many other programs, ours focused on the “Science of Addiction,” providing lessons on how alcohol and other drugs affect the brain. The purpose of this study was to evaluate the effectiveness of our games in teaching students our science-based curriculum. We enrolled over 200 students and randomly assigned them to play our games or a different series of NIDA-produced games. Of the students in the Bacon Brains conditions, half were instructed to play collaboratively and the other half was told to play competitively. Results indicate significantly greater knowledge gains among students in Bacon Brains compared to the existing games (5.01 mean knowledge score difference; [F(1,242)=9.588, p=.002]). Girls demonstrated knowledge gains in both collaborative and competitive conditions, but boys demonstrated similar gains only in the competitive condition. Based on our outcomes, we conclude that video games can serve as an effective method of science instruction. We further discuss the importance of considering gender differences in light of differential response to collaborative vs. competitive learning environments.

The goal of this study was to identify theFive subjects with xerostomia wore custom made retainers carrying 5 demineralized enamel chips for periods of 1 week each. In 1 study arm, subjects used the test agent plus oral hygiene self-care; in the other they used oral hygiene self-care only, with a 1 week washout in between arms. The treatment sequence was randomized. Before and after each study arm Plaque Index (PI), Gingival Index (GI) and Sulcus Bleeding Index (mSBI) were recorded. Clinical plaque staining was quantified using digital image analysis. Saliva production, pH and buffering capacity were recorded. Subjects completed a self-evaluation questionnaire for oral comfort. Enamel samples underwent standardized Knoop microhardness testing to quantify mineralization status.Plaque presence and clinical Plaque Indices decreased significantly with test agent use (p0.05). Five-minute saliva production almost doubled 10 and 40 minutes after oral test disc insertion (significant, p0.05). Salivary pH buffering improved in 4/5 subjects with disc use. All demineralized tooth samples re-hardened intraorally (p0.05). The discs favorably impacted eating problems and dental sensitivity. Subjects were positive about disc flavor and mouth feel.Using establishedXerostomia management is challenging. A novel dry mouth disc was effective in alleviating dry mouth symptoms.

Acute traumatic coagulopathy (ATC) has been reported in the setting of isolated traumatic brain injury (iTBI) and associated with high mortality and poor outcomes. The aim of this systematic review was to examine the incidence and outcome of patients with ATC in the setting of iTBI.We conducted a search of the MEDLINE database and Cochrane library, focused on subject headings and keywords involving coagulopathy and TBI. Design and results of each study were described. Studies were assessed for heterogeneity and the pooled incidence of ATC in the setting of iTBI determined. Reported outcomes were described.There were 22 studies selected for analysis. A statistically significant heterogeneity among the studies was observed (p0.01). Using the random effects model the pooled proportion of patients with ATC in the setting of iTBI was 35.2% (95% CI: 29.0-41.4). Mortality of patients with ATC and iTBI ranged between 17% and 86%. Higher blood transfusion rates, longer hospital stays, longer ICU stays, decreased ventilator free days, higher rates of single and multiple organ failure and higher incidence of delayed injury and disability at discharge were reported among patients with ATC.ATC is commonly associated with iTBI and almost uniformly associated with worse outcomes. Any disorder of coagulation above the normal range appears to be associated with worse outcomes and therefore a clinically important target for management. Earlier identification of patients with ATC and iTBI, for recruitment into prospective trials, presents avenues for further research.

Smart phone usage has greatly increased in recent years. Not only has the computing power of these mobile devices dramatically improved but so has the variety of functions they can accomplish—an amazing array of tasks that once would have been considered remarkable. Historically, mental health professionals have been quick to embrace smart phone technology and there are now literally hundreds of applications for practitioners and clients alike. This article discusses the advantages and disadvantages of using smart phone technology in clinical practice and considers the implications for the future of clinical practice.

This study investigated the knowledge gains and attitude shifts attributable to a unique online science education game, Uncommon Scents. The game was developed to teach middle school students about the biological consequences of exposure to toxic chemicals in an environmental science context, as well as the risks associated with abusing these chemicals as inhalants. Middle school students (n = 444) grades six through eight participated in the study consisting of a pre-test, three game-play sessions, and a delayed post-test. After playing the game, students demonstrated significant gains in science content knowledge, with game usability ratings emerging as the strongest predictor of post-test content knowledge scores. The intervention also resulted in a shift to more negative attitudes toward inhalants, with the most negative shift occurring among eighth grade students and post-test knowledge gains as the strongest predictor of attitude change across all grade levels. These findings suggest that the environmental science approach used in Uncommon Scents is an efficacious strategy for delivering both basic science content and influencing perceived harm relating to the inhalation of toxic chemicals from common household products.

Using a grant from the National Institute on Drug Abuse, The Missouri Institute of Mental Health produced a series of media tools designed to teach fourth-, fifth-, and sixth-grade children from African–American churches about the science of drug addiction. Beginning with a core curriculum, we created two separate interventions. In the SpaceScouts version of the program, the content is embedded within a narrative storyline delivered via an interactive DVD. In the LockerTalk version of the program, content is delivered in a more didactic form via an interactive CD-ROM. Youths from a dozen churches were randomly assigned to one of these two conditions or to a wait-list control. We conducted pretest, posttest, and four- and eight-month follow-up evaluations. We ran an additional sample of youths through our programs during a summer camp. Analyses of our programs revealed that students who received our interventions demonstrated some modest gains in knowledge. Specifically, students who viewed SpaceScouts dem...

“The Doubles,” funded by the National Institute on Drug Abuse, is a seven-episode series of media tools designed to teach third-and fourth-grade students about the science of drug addiction. The program's curriculum was delivered through a set of DVDs, interactive CD-ROMs, workbooks, or an Internet Site. Results indicate that although the interventions were successful in teaching students about the biological bases of substance abuse, they had little effect on student attitudes. Implications for future studies are discussed.

Space Scouts, funded by the National Institute on Drug Abuse (NIDA) and produced by the Missouri Institute of Mental Health (MIMH), is a three-episode series of media tools designed to teach fourth-, fifth-, and sixth-grade children from African American churches about the science of drug addiction. This article examines the effectiveness of the principles of practice for community-based participatory research used to create Space Scouts. Academic researchers at MIMH collaborated with an inter-faith agency-Committed Caring Faith Communities (CCFC)-and solicited feedback from members of the target audience, their pastors, and other church staff, substance abuse researchers, and curriculum development specialists in order to ensure that the final program would meet the needs of all involved parties.

This study was designed to examine the influence a potential date’s physical attractiveness and sexual history has on an individual’s intentions to engage in safer sex. Over 1,200 participants completed an Internet survey. The questionnaire presented a randomized biography and photograph and asked participants to rate their interest in dating and having a sexual relationship with the target. Participants were randomly assigned to one of six conditions based on the target’s physical attractiveness (low vs. high) and sexual experience (low, medium, or high). Results indicated that men reported greater intentions to have sex than women did, and all participants reported greater likelihood of having sex when the potential partner was highly attractive. Participants rated men and more experienced targets as more risky sexual partners, and the level of a target’s sexual experience was directly related to participants’ willingness to discuss sexual risks. Results indicate a continuing need to include discussion of cognitive factors in all HIV prevention efforts.

There is some disagreement as to whether the Internet has a positive or negative impact on social connection and well-being for older adults. Using an online survey, we assessed self-reported social support, health, and Internet use patterns among users over fifty years of age. In a comparison of highly social Internet users versus low-social users, we found that high-social users spent more time on-line and reported more physical and mental health problems. However, the groups did not differ in amount of or satisfaction with social support they received. Implications of these results are discussed.

Alcohol and drug use education and prevention continue to be core educational issues. In seeking to inform students at all levels about drug use, the present exploratory study highlights the potential educational use of interactive computer programs for this purpose. Seventy-three college students from two substance abuse classes interacted for at least 20 minutes with a CD-ROM program that was developed to explicitly teach and demonstrate concepts of addiction and recovery. Results indicated that most participants reported increased interest in course material and felt they had learned more about various drugs and their consequences after using the interactive program. Specifically, 81 % of the participants indicated that the program increased their knowledge of drug use and addiction. Components of the interactive exercises were also evaluated separately. One implication of the study is that multimedia programs can be effective tools that complement current substance abuse education methods.

This report discusses the process of developing and deploying an Internet-based study that sought to replicate the results of a traditionally administered questionnaire. We present data on the characteristics of respondents, hit and completion rates, and the effectiveness of a dozen different methods of advertising the survey. Overall, we were very successful in soliciting a gay and lesbian sample of Internet-users and collected one of the largest samples for a Web-based survey to date. Publicity methods that addressed the target audience's specific interests were far more effective than broader advertising methods.

As North Americans live longer, have more chronic conditions and take more medications, adverse oral events are likely to increase and aggravate the symptoms of Sjögren syndrome (SS).A total of 151 adults who self-reported having SS and who had a mean (standard deviation [SD]) age of 65.8 (11.5) years completed a survey that included questions about basic demographic information, current medical conditions, medications used (prescription and over the counter [OTC]) and the use of oral products to manage SS symptoms. Owing to the self-reporting process in our survey, the term "SS" in our study population represented a mixture of people with SS and people with dry mouth symptoms.The mean (SD) number of daily medications recorded as prescription, OTC and oral care products were 4.9 (3.5), 4.5 (2.8) and 4.6 (1.4), respectively. Participants with four or more comorbid medical conditions (n = 74; 49.0 percent) had significant differences (P.05) in oral symptoms compared with those who had fewer than four (n = 75; 49.7 percent). Participants who were taking fewer than four prescription and OTC medications daily (n = 61; 40.4 percent) has significant differences (P.05) in voice hoarseness compared with those taking four or more prescription and OTC medications daily (n = 54; 35.8 percent).The survey results indicated that medication use and comorbid medical conditions demonstrated significant differences and may have had a substantial impact on the oral symptoms in adults who self-reported having SS.

The Policy Information Exchange (PIE) on-line system (http://www.mimh.edu/mimhweb/pie/pie.asp) allows access to a database of full-text mental health policy reports via an easy to use Internet interface. Originally developed by the Mental Health Policy Resource Center as a subscription-based service, the Missouri Institute of Mental Health acquired and redesigned the system. This article describes the process used to revise the original system, a brief evaluation, and a discussion of the difficulties associated with maintaining such a complex Internet site.

ATOD-TV (Alcohol, Tobacco, and Other Drugs-TV), an interactive multimedia program funded by the National Institute on Drug Abuse, was designed to teach the general public about the importance of substance abuse research and treatment. This article examines the process used to develop the program and argues that its success is due more to careful planning and formative evaluation than the use of sophisticated tools and techniques.

Use of a prophylactic feeding tube before concurrent chemotherapy and radiotherapy (CRT) for patients with head and neck cancer is often debated.A retrospective, exploratory study of 109 veterans with stage III/IV head and neck cancer who completed standard CRT was conducted. Relationships among 3 feeding tube status groups: prophylactic feeding tube (PFT), reactive feeding tube (RFT), and no feeding tube (no-FT) were compared for clinical outcomes.Patients with a PFT had significantly less weight loss during CRT, fewer nutrition-related emergency department visits or hospitalizations, and higher proportions of chemotherapy cycles completed compared to those with an RFT or no-FT. At 12 months post-CRT, there was no relationship between the use of a PFT and 100% feeding tube dependency.Use of a PFT in this veteran population with stage III/IV head and neck cancer produced better outcomes when compared to both an RFT or no feeding tube without higher rates of long-term dysphagia.

The Mental Health Studios is an interactive multimedia program designed to educate the public about the biological basis of mental and addictive disorders. Using sound, text, graphics, charts, and video, the software provides detailed scientific information about the brain and depression, bipolar disorder, schizophrenia, anxiety disorders, and substance abuse. An evaluation study of a permanent display at the St. Louis Science Center revealed that most visitors spent less than 5 min with the computer program but nevertheless demonstrated significant changes in attitude toward people with mental and addictive disorders. Senior high-school students who interacted with the program for 20 min experienced even greater attitude changes, and their knowledge about mental and addictive disorders also increased significantly.

Background: Women are disproportionately likely to assist aging family members; approximately 53 million in the United States are involved with the health care of aging parents, in-laws, or other relatives. The busy schedules of ?sandwich generation? women who care for older relatives require accessible and flexible health education, including Web-based approaches. Objective: This paper describes the development and implementation of a Web-based health education intervention, The Sandwich Generation Diner, as a tool for intergenerational caregivers of older adults with physical and cognitive impairments. Methods: We used Bartholomew?s Intervention Mapping (IM) process to develop our theory-based health education program. Bandura?s (1997) self-efficacy theory provided the overarching theoretical model. Results: The Sandwich Generation Diner website features four modules that address specific health care concerns. Our research involves randomly assigning caregiver participants to one of two experimental conditions that are identical in the type of information provided, but vary significantly in the presentation. In addition to structured Web-based assessments, specific website usage data are recorded. Conclusions: The Sandwich Generation Diner was developed to address some of the informational and self-efficacy needs of intergenerational female caregivers. The next step is to demonstrate that this intervention is: (1) attractive and effective with families assisting older adults, and (2) feasible to embed within routine home health services for older adults. [JMIR Res Protoc 2016;5(2):e91]

Oral health care professionals can play an important role in preventing oral cancer by performing oral mucosal examinations to detect pre-cancerous changes and by educating patients about oral cancer prevention strategies, including dietary approaches.Current evidence supports a diet high in fruits, vegetables and plant-based foods for prevention of oral cancer. Dietary supplements-including vitamins and minerals-have not been shown to be effective as substitutes for a diet high in fruits and vegetables.In addition to discussing tobacco and alcohol use with patients (and, if relevant, betel nut and gutka consumption), as well as the risk of sexual transmission of human papillo-mavirus, clinicians should provide dietary advice for the prevention of oral cancer as part of routine patient education practices.

This topical review presents an overview of orofacial manifestations associated with the more common connective tissue diseases affecting multiple organs. The orofacial manifestations associated with these autoimmune disorders include oral mucosa alterations, salivary gland pathosis, sensory neuropathies, headaches, and temporomandibular disorders. Since many of these orofacial manifestations may be painful, the practitioner managing pain patients should be familiar with them. An understanding of the orofacial manifestations associated with these systemic diseases will enable the pain practitioner to establish an appropriate diagnosis within the context of the underlying systemic disease. This will allow the practitioner the opportunity to contribute and collaborate as a member of a multidisciplinary health-care team in the management of these systemic autoimmune diseases.

This position paper addresses the prevention of bisphosphonate-associated osteonecrosis (BON) and the management of care of patients with cancer and/or osteoporosis who are receiving bisphosphonates and who have BON or are at risk of developing it.The authors reviewed the literature available on this newly described oral complication. Information of interest included bisphosphonates, the medications associated with this oral complication; the patient population at risk of developing BON and the diseases being treated with this class of medications; the clinical presentation of the oral lesions; guidelines for managing the care of patients who develop BON; the prevention of this complication based on current knowledge; and recommendations for routine dental treatment of patients receiving bisphosphonates.There is strong evidence that bisphosphonate therapy is the common link in patients with BON. The pathobiological mechanism leading to BON may have to do with the inhibition of bone remodeling and decreased intraosseous blood flow caused by bisphosphonates. People at risk include patients with multiple myeloma and patients with cancer metastatic to bone who are receiving intravenous bisphosphonates, as well as patients taking bisphosphonates for osteoporosis. The risk of developing complications appears to increase with time of use of the medication. There are no guidelines based on evidence, and the clinical management of the oral complication is based on expert opinion.Prevention of BON is the best approach to management of this complication. Existing protocols to manage the care of patients who will receive radiation therapy or chemotherapy may be used until specific guidelines for BON are developed.

Dental professionals should be aware that methamphetamine (MA) use is on the rise in North America. MA is a potent central nervous system stimulant with limited therapeutic effects. The allure of this drug is its availability in many different forms that are relatively easy to make and distribute and inexpensive to purchase and that produce prolonged euphoria for the user. This euphoria results from alteration of the normal physiologic processing of several centrally acting neurotransmitters, which also causes neurotoxicity and neurodegeneration with long-term use. Long-term use of MA has been associated with severe oral health effects, the most notable being a distinctive pattern of caries called methamphetamine-induced caries. Dental professionals need to recognize and understand patients who may be using MA and the risk factors associated with its deleterious oral effects. This knowledge will allow appropriate and effective preventive and treatment strategies for users of this drug.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used in the treatment of pain, including pain of dental origin, for many years. Even though they are effective in relieving symptoms, they are not without adverse events, most notably upper gastrointestinal toxicity. To prevent this side effect, the pharmaceutical industry developed NSAIDs that selectively inhibit the cyclooxygenase 2 (COX-2) isoenzyme, which is inducible and expressed at sites of inflammation, while sparing the COX-1 isoenzyme, which is associated with gastric protection. On September 30, 2004, the company that produced rofecoxib (Vioxx), a COX-2 inhibitor, voluntarily withdrew this product from the market based on the discovery of its association with increased risk of adverse cardiovascular events reported in an ongoing large clinical trial. This unexpected event caused the medical community to review existing literature regarding this and related medications and also led to the emergence of novel research to improve understanding of the potential mechanisms for this serious side effect. However, instead of clarifying the situation, reports created confusion and controversy regarding the safety of all types of NSAIDs. The major concern is an increase in adverse cardiovascular events with the use of individual drugs as well as the potential for a class effect. In this article, we review recent events and findings and discuss the implications for dentistry.

The Doubles, funded by the National Institute on Drug Abuse, is a seven-episode series of media tools designed to teach third and fourth grade students about the science of drug addiction. The program’s curriculum is delivered via a set of videos, interactive CD-ROMs, workbooks, or an Internet site. This article examines the process used to develop The Doubles and argues that its success stems from the careful balancing of the needs of the funding agency, state and national curricular guidelines, and the target audience.