Applying Social Practice Theory to Explore Australian Preschool Children's Oral Health

INTRODUCTION

Despite substantial research and provision of dental care, significant morbidity remains for children's oral health. Guided by social practice theory (SPT), this research moves away from the often-ineffective focus on changing individual behavior to rethinking the centrality of the social world in promoting or undermining oral health outcomes. We define social practice as a routinized relational activity linking and integrating certain elements (competence, materials, and meanings) into the performance of a practice that is reproduced across time and space.

OBJECTIVE

To investigate oral health in preschool children in Perth, Western Australia, using social practice theory.

METHODS

With no definitive methodology for investigating SPT, we chose focused ethnography as a problem-focused, context-specific approach using mainly interviews to investigate participants' experience caring for their children's oral health. The focus of analysis was the practice of oral health care, not individual behavior, where themes identified from participants' transcripts were organized into categories of elements and performance.

RESULTS

Eleven parents, all of whom were married or partnered, were interviewed in 2021. Findings identified social practices relevant to oral health within parenting and family relations linked to routine daily activities, including shopping, consumption of food and beverages, and toothbrushing. Oral health literacy was reflected in integrating competence, materials, and meanings into performing oral health care, notably preferences for children to drink water over sugary beverages and information often being sourced from social media and mothers' groups rather than health providers.

CONCLUSION

Focusing on social practices as the unit of analysis offers a more layered understanding of elements in young children's oral health care that can indicate where the problem may lie. Findings provide an opportunity to consider future research and policy directions in children's oral health.

KNOWLEDGE TRANSFER STATEMENT

Examining social practices related to young children's oral health care identifies parents/carers' knowledge about, for example, toothbrushing, the resources required, and why toothbrushing is important. Analyzing these separate elements can reveal both enablers and barriers to oral health care. This provides researchers, clinicians and policymakers an opportunity to focus on not changing individual behavior but understanding how social context impacts parents/carers' capacity to make optimum decisions around young children's oral health.

Rethinking Oral Health in Aging: Ecosocial Theory and Intersectionality

Poor oral health affects the health and well-being of older adults in many ways. Despite years of international research investigating poor oral health among older adults, it has remained a largely unresolved problem. The aim of this article is to explore the combination of 2 key frameworks, ecosocial theory and intersectionality, to guide our exploration and understanding of oral health and aging and help inform research, education, policy, and services. Proposed by Krieger, ecosocial theory is concerned with the symbiotic relationship among embodied biological processes and social, historical, and political contexts. Building on the work of Crenshaw, intersectionality explores how social identities such as race, gender, socioeconomic status, and age interconnect in ways that can enhance privilege or compound discrimination and social disadvantage. Intersectionality offers a layered understanding of how power relations reflected in systems of privilege or oppression influence an individual's multiple intersecting social identities. Understanding this complexity and the symbiotic relationships offers an opportunity to reconsider how inequities in oral health for older adults can be addressed in research, education, and practice and increase the focus on equity, prevention, interdisciplinary care, and use of innovative technology.

Reciprocity in the intercultural conference space to improve Aboriginal oral health: A qualitative study

OBJECTIVES

Despite high rates of oral disease in Indigenous communities globally, progress is slow in implementing policies and practices so the depth of inequity is addressed and oral health outcomes improve. Indigenous communities are often poorly consulted in the process. This paper responds to this inequity by seeking to create a respectful intercultural space at international dental conferences where Aboriginal health practitioners and dental public health researchers can discuss ways forward for oral health in Indigenous communities.

METHODS

Participatory action research informed by Indigenist methodologies guided this research. Two roundtable discussions between Australian Aboriginal and non-Aboriginal participants were recorded, transcribed and analysed for themes related to problems and potential solutions to dental disease in Indigenous communities. Follow-up discussions on participants' reflections engaging in this intercultural space were recorded and analysed.

RESULTS

Two Aboriginal health practitioners and five non-Aboriginal international dental public health researchers identified the importance of inclusion where intercultural engagement and collaboration with Indigenous Peoples were integral to conducting research in this context and improving oral health outcomes.

CONCLUSIONS

Creating a safe, respectful space between Aboriginal health practitioners and non-Aboriginal dental public health researchers at an international conference fostered dialogue to better understand barriers and enablers to good oral health outcomes. Intercultural engagement and discussion is a step towards mutual understanding of oral health perspectives and experiences that can foster equity and enable more collaborative responses to improve oral health outcomes.

Oral health education and prevention strategies among remote Aboriginal communities: a qualitative study

BACKGROUND

The delivery of effective oral health promotion strategies is essential to improving oral health outcomes among remote Aboriginal communities. This study aimed to explore the perceptions and attitudes of Aboriginal Australians living in remote Kimberley communities towards oral health education and disease prevention.

METHODS

Semi-structured interviews and yarning circles were carried out following purposive sampling of Aboriginal adults living in the East Kimberley region of Western Australia.

RESULTS

A total of 80 community members participated in the yarning process. School-based oral health promotion and community-driven restrictions on the sale of sugary food and drink were seen as positive strategies in improving oral health. Lifestyle changes brought about by modernity, internet availability and fixed community stores were perceived to create new challenges and shift the priorities for those living in remote communities.

CONCLUSIONS

Community-based yarning may better inform future oral health strategies in the Kimberley. A neoliberal approach of shifting responsibility onto the individual ignores the complex social inequities faced by Aboriginal people living in remote communities where macro-level determinants such as remoteness, food security and education significantly influence decisions around diet and oral health.

Dental professionals' perspectives working with Aboriginal children in Western Australia: a qualitative study

BACKGROUND

The disproportionate burden of oral disease in Aboriginal children and the issues in accessing mainstream dental services are well documented. Yet little is known about dental professionals' perspectives in providing oral care for Aboriginal children. This paper presents findings from a study exploring such perspectives.

METHODS

Semi-structured interviews were carried out in Western Australia following purposive sampling of non-Aboriginal dentists, dental clinic assistants (dental nurses) and oral health therapists/dental hygienists. Interviews were recorded, transcribed and analysed guided by grounded theory for key themes related to the topic.

RESULTS

Findings included a service delivery model sometimes unresponsive to Aboriginal families' needs; dental professionals' limited education and training to work with confidence and cultural sensitivity with Aboriginal patients and socioeconomic influences on Aboriginal children's poor oral health considered outside dental professionals' remit of care.

DISCUSSION

Findings suggest oral health policies and practices and dental professionals' education and training need reviewing for how well such policies support dental professionals in an Aboriginal context. This includes engaging with Aboriginal stakeholders, working effectively with Aboriginal families, and developing shared understandings about what is needed to increase access to care and improve oral health outcomes for Aboriginal children.

Oral health interventions in Australian Aboriginal communities: a review of the literature

Aboriginal Australians experience significant disparities in oral health with even poorer outcomes reported in rural and remote areas. The high rates of preventable dental disease in Aboriginal communities are a serious concern from a social standpoint and in terms of service provision and health care expenditure. In this review, primary research literature was comprehensively reviewed. Papers were selected if they reported designing or implementing an intervention or oral health programme specific to the needs of Aboriginal communities. Twenty-one publications fulfilled the inclusion criteria with 19 different interventions being described. Interventions were categorized using a classification adapted from the work of Whitehead (2002). The review identified interventions that aimed to reduce early childhood caries, increase services to remote communities, develop the role of Aboriginal health workers, improve oral health literacy, establish water fluoridation and provide periodontal therapy. Implementing successful oral health interventions in Aboriginal communities is a challenge that is compounded by the complex interplay between psychosocial and cultural determinants. Even interventions that follow a rigorous and consultative design have a high failure rate in Aboriginal communities if upstream determinants of health are not adequately understood and addressed.

Barriers and enablers for oral health care for people affected by mental health disorders

BACKGROUND

People with mental health disorders are reported to have poorer access to dental services and poorer oral health outcomes. The aim of this paper is to analyze current published work regarding barriers and enablers for oral health outcomes and access to dental care for adults with mental health disorders which will be addressed from individual, organizational and systemic perspectives METHODS: A narrative review based on a search of the relevant published work regarding oral health for people with mental health disorders was undertaken using Medline, Web of Science, ERIC and Psychlit. Any relevant systematic reviews were highlighted in this process along with primary studies.

RESULTS

The published work repeatedly verified poorer oral health and inadequate access to dental services in people with mental health disorders. The published work identified barriers at individual, organizational and systemic levels. Much of the published work focused on barriers with less focus on enablers and interventions.

CONCLUSIONS

Considerable investigation of barriers had not elucidated options to improve care or outcomes.

Oral Health in Young Australian Aboriginal Children

Despite dedicated government funding, Aboriginal Australians, including children, experience more dental disease than other Australians, despite it being seen as mostly preventable. The ongoing legacy of colonization and discrimination against Aboriginal Australians persists, even in health services. Current neoliberal discourse often holds individuals responsible for the state of their health, rather than the structural factors beyond individual control. While presenting a balanced view of Aboriginal health is important and attests to Indigenous peoples’ resilience when faced with persistent adversity, calling to account those structural factors affecting the ability of Aboriginal people to make favorable oral health choices is also important. A decolonizing approach informed by Indigenous methodologies and whiteness studies guides this article to explore the perceptions and experiences of Aboriginal parents ( N = 52) of young children, mainly mothers, in Perth, Western Australia, as they relate to the oral health. Two researchers, 1 Aboriginal and 1 non-Aboriginal, conducted 9 focus group discussions with 51 Aboriginal participants, as well as 1 interview with the remaining individual, and independently analyzed responses to identify themes underpinning barriers and enablers to oral health. These were compared, discussed, and revised under key themes and interpreted for meanings attributed to participants’ perspectives. Findings indicated that oral health is important yet often compromised by structural factors, including policy and organizational practices that adversely preclude participants from making optimal oral health choices: limited education about prevention, prohibitive cost of services, intensive marketing of sugary products, and discrimination from health providers resulting in reluctance to attend services. Current government intentions center on Aboriginal–non-Aboriginal partnerships, access to flexible services, and health care that is free of racism and proactively seeks and welcomes Aboriginal people. The challenge is whether these good intentions are matched by policies and practices that translate into sustained improvements to oral health for Aboriginal Australians.

Knowledge Transfer Statement: Slow progress in reducing persistent oral health disparities between Aboriginal and non-Aboriginal Australians calls for a new approach to this seemingly intractable problem. Findings from our qualitative research identified that structural factors—such as cost of services, little or no education on preventing oral disease, and discrimination by health providers—compromised Aboriginal people’s optimum oral health choices and access to services. The results from this study can be used to recommend changes to policies and practices that promote rather than undermine Aboriginal health and well-being and involve Aboriginal people in decisions about their health care.

The mouth as a site of structural inequalities; the experience of Aboriginal Australians

OBJECTIVE

To address the mouth as a site of structural inequalities looking through the lens of Aboriginal Australian experience.

RESEARCH DESIGN

This is a critical review of published literature relevant to our objective. Criteria for selection included articles on: the social context of oral and general health inequalities for Aboriginal Australians; Aboriginal perceptions and meanings of the mouth and experiences of oral health care and the role of the current political-economic climate in promoting or compromising oral health for Aboriginal Australians.

RESULTS

Evidence suggests oral health is important for Aboriginal Australians yet constrained by challenges beyond their control as individuals, including accessing dental services. Competing demands on limited budgets often led to oral health dropping off the radar unless there was an emergency.

CONCLUSIONS

Structural (social, political and economic) factors often inhibited Aboriginal people making optimum health choices to prevent oral disease and access services for treatment. Factors included cost of services, limited education about oral health, intense advertising of sugary drinks and discrimination from service providers. Yet the literature indicates individuals, rather than structural factors, are held responsible and blamed for the poor state of their oral health. The current neoliberal climate focuses on individual responsibility for health and wellbeing often ignoring the social context. To avoid the mouth becoming an ongoing site for structural inequality, critically reviewing oral health policies and practices for whether they promote or compromise Aboriginal Australians' oral health is a step towards accountability-related oral health outcomes.

Improving forensic mental health care to Indigenous Australians: theorizing the intercultural space

This paper uses the 'intercultural space' as an educational strategy to prepare nurses to work respectfully with Indigenous patients in a forensic mental health context; offers an educational approach that introduces nurses to Indigenous knowledge, beliefs and values, examines power relations in colonized countries between the dominant white cultural group and the Indigenous population and encourages nurses to critically reflect on their health care practice; and explores the intercultural space as a shared space between cultures fostering open and robust inquiry where neither culture dominates and new positions, representations and understandings can emerge. Given the disproportionately high number of Indigenous people imprisoned in colonized countries, this paper responds to research from Western Australia on the need to prepare forensic mental health nurses to deliver care to Indigenous patients with mental health disorders. The paper highlights the nexus between theory, research and education that can inform the design and implementation of programmes to help nurses navigate the complex, layered and contested 'intercultural space' and deliver culturally safe care to Indigenous patients. Nurses are encouraged to critically reflect on how beliefs and values underpinning their cultural positioning impact on health care to Indigenous patients. The paper draws on intercultural theory to offer a pedagogical framework that acknowledges the negative impacts of colonization on Indigenous health and well-being, repositions and revalues Indigenous cultures and knowledges and fosters open and robust inquiry. This approach is seen as a step towards working more effectively in the intercultural space where ultimately binary oppositions that privilege one culture over another and inhibit robust inquiry are avoided, paving the way for new, more inclusive positions, representations and understandings to emerge. While the intercultural space can be a place of struggle, tension and ambiguity, it also offers deep potential for change.

Time to bring down the twin towers in poor Aboriginal hospital care: addressing institutional racism and misunderstandings in communication

Improvements in Aboriginal health have been slow. Research demonstrates ongoing discrimination towards Aboriginal Australians based on race, including in health services, leads to poor health outcomes. Using an eclectic methodology based on observations and discussions with health practitioners experienced in working with Aboriginal patients, this paper identifies how cross-cultural misunderstandings undermine the quality of care to Aboriginal patients in hospital and offers suggestions for improving practice. It also explores the concept of institutional racism and challenges doctors to reflect on their role in perpetuating power imbalances. We argue that physicians and healthcare providers need to do more than just deliver evidence-based interventions, by critically reflecting on their own attitudes to and practices with Aboriginal Australians and work collectively to effect systemic change which creates a more inclusive and safe environment for all people accessing healthcare.

Principal Component Structure and Sport-Specific Differences in the Running One-Leg Vertical Jump

The aim of this study is to identify the kinetic principal components involved in one-leg running vertical jumps, as well as the potential differences between specialists from different sports. The sample was composed of 25 regional skilled athletes who play different jumping sports (volleyball players, handball players, basketball players, high jumpers and novices), who performed a running one-leg jump. A principal component analysis was performed on the data obtained from the 200 tested jumps in order to identify the principal components summarizing the six variables extracted from the force-time curve. Two principal components including six variables accounted for 78 % of the variance in jump height. Running one-leg vertical jump performance was predicted by a temporal component (that brings together impulse time, eccentric time and vertical displacement of the center of mass) and a force component (who brings together relative peak of force and power, and rate of force development). A comparison made among athletes revealed a temporal-prevailing profile for volleyball players, and a force-dominant profile for Fosbury high jumpers. Novices showed an ineffective utilization of the force component, while handball and basketball players showed heterogeneous and neutral component profiles. Participants will use a jumping strategy in which variables related to either the magnitude or timing of force production will be closely coupled; athletes from different sporting backgrounds will use a jumping strategy that reflects the inherent demands of their chosen sport.

Movement reversals in ball catching

This study aimed to determine whether the interception of a moving object is achieved by implementing a predictive or a prospective strategy. We examined the kinematics of catching movement in a situation in which the catching hand was constrained to move along a single dimension. In line with predictions based on a prospective strategy, the results obtained indicated that, for the same interception point and the same initial hand position, modification of the spatiotemporal characteristics of the ball's trajectory (via modification of the angle of approach of the ball) gave rise to systematic changes in the kinematics of catching movement. Moreover, the production of movement reversals when the hand was already positioned at the interception point, while in line with the predictions of the prospective strategy formalized by Bootsma et al. (1997), allowed for rejection of a predictive strategy.

Increase in energy cost of running at the end of a triathlon

The purpose of the present study was to verify the increase in energy cost of running at the end of a triathlon. A group 11 trained male subjects performed a triathlon (15-km swimming, 40-km cycling, 10-km running). At least 1 week later the subjects ran 10-km as a control at the same pace as the triathlon. Oxygen uptake (VO2), ventilation (VE) and heart rate (HR) were measured during both 10-km runs with a portable telemetry system. Blood samples were taken prior to the start of the triathlon and control run, after swimming, cycling, triathlon run and control run. Compared to the control values the results demonstrated that triathlon running elicited a significantly higher (P < 0.005) mean VO2 [51.2 (SEM 0.4) vs 47.8 (SEM 0.4) ml.min-1.kg-1] VE [86 (SEM 4.2) vs 74 (SEM 5.3) l.min-1], and HR [162 (SEM 2) vs 156 (SEM 1.9) beats.min-1)]. The triathlon run induced a greater loss in body mass than the control run [2 (SEM 0.2) vs 0.6 (SEM 0.2) kg], and a greater decrease in plasma volume [14.4% (SEM 1.5) vs 6.7% (SEM 0.9)]. The lactate concentrations observed at the end of both 10-km runs did not differ [2.9 (SEM 0.2) vs 2.5 (SEM 0.2) m.mol.l-1]. Plasma free fatty acids concentrations were higher (P < 0.01) after the triathlon than after the control run [1.53 (SEM 0.2) to 0.51 (SEM 0.07) mmol.l-1]. Plasma creatine kinase concentrations rose under both conditions from 58 (SEM 12) to 112 (SEM 14) UI.l-1 after the triathlon, and from 61 (SEM 7) to 80 (SEM 6) UI.l-1 after the control run. This outdoor study of running economy at the end of an Olympic distance triathlon demonstrated a decrease in running efficiency.

Value of somatosensory evoked potentials in saphenous entrapment neuropathy

Neuralgia of the saphenous nerve (SN) is a rare clinical syndrome simulating a vascular disorder of the lower extremities. In four cases, the presenting complaint was persistent pain on the medial aspect of the knee. Examination revealed tenderness over the site of exit of the SN form the femoral canal. Femoral nerve motor conduction, quadriceps H-reflex and EMG of the leg muscles were normal. The sensory nerve action potential of the SN in the leg was not obtained in some patients, even in the unaffected leg. SEP were therefore preferred for diagnosis and performed at the infrapatellar and descending branches of the right and left SN and recordings from the Cz'-Fz electrode. Latency and amplitude differences were evaluated and compared with a control group of healthy subjects. An alteration in the SEP from one branch was observed on the painful side. Posterior tibial responses were normal. In one case, pain resolved immediately after neurolysis, confirming SN entrapment above the femoral canal, before its division. Pain resolved in two other cases and persisted in the last after medical treatment. SEP studies are valuable in the diagnosis of an isolated lesion of the SN.

Avulsion fractures of the tibial tuberosity in the adolescent athlete. Risk factors, mechanism of injury, and treatment

Based on a review of the literature and our study of six cases, we investigated avulsion fractures of the tibial tuberosity in the athletic adolescent. A study of the mechanism of this acute injury helps to explain the different types of avulsion fractures of the tibial tuberosity. An understanding of predisposing factors and the biomechanical conditions leading to this injury may help identify those young athletes at the highest risk and may help the surgeon determine the most effective treatment for such a fracture. No complications were experienced by the patients in our study. Displaced fractures underwent open reduction and fixation with screws. This method shortens the period during which athletic activities are restricted.

[The treatment of lumbosciatica by intra-discal injection of proteolytic enzymes (nucleolysis). 80 cases (author's transl)]

Proteolytic enzymes originated from carica papaya, injected extra durally in the lumbar intervertebral disc of 80 patients suffering from intractable root pain due to herniated discs, led to 85% of satisfactory results as far as root pain is concerned. Strong motivation and appropriate deals with residual lumbar pain which was absent or kept under control in 85% of all cases. Surgery can be successfully carried out after nucleolysis, when an adherent root and/or an extruded fragment is responsible of the failure.