Strengthening Social Interactions and Constructing New Oral Health and Health Knowledge:The Co-design, Implementation and Evaluation of A Pedagogical Workshop Program with and for Homeless Young People

Young homeless people make up nearly one-third of those experiencing homelessness. The need to provide an educative approach, to strengthen social interacting, and construct new knowledge to increase social inclusivity, is required. The aim of this qualitative exploration was to use critical consciousness as an educative tool, to co-design, implement, and evaluate a series of oral health and health pedagogical workshops to strengthen social engagement and to construct new health knowledge, with, and for, homeless young people and their service providers. An action research design permitted the simultaneous development, implementation, and evaluation of the pedagogical workshop program. A Non-Governmental Organization (NGO), providing supported accommodation for young homeless people, acted as the partner organization. Thirteen young people and five staff members from this NGO participated and co-designed eight workshops. Qualitative data collection included unstructured post-intervention interviews together with verbatim quotes from the group discussions during the workshops and from the post-workshop questionnaires. The qualitative analysis was informed by content analysis to permit the emergence of key themes from the data. The two themes were: 1. ‘trust building and collective engaging’ and 2. ‘constructing knowledge and developing skills’. Theme 1 highlighted engagement with the service provider, illustrating the transformation of the young people’s relationships, strengthening of their social interacting, and enabling their critical reflexive thinking on sensitive issues present in the homelessness trajectory. Theme 2 illustrated the young people’s ability to share, lend, and encode their new health information and convert it into an understandable and useable form. This new comprehension permitted their behavior change and social interaction. These findings provide an approach to increase young people’s knowledge, health literacy, and strengthen their social interacting to support community action

Rheumatic heart disease and endomyocardial fibrosis: Distinguishing the etiology of mitral regurgitation in low-resourced areas

Rheumatic heart disease (RHD) and endomyocardial fibrosis (EMF) are 2 neglected cardiovascular diseases that disproportionately affect young populations, living in poverty. RHD characteristically occurs in low- and middle-income countries, as well as in some disadvantaged populations within high-income countries, such as the Aboriginal peoples of Australia. In contrast, EMF is primarily a tropical cardiomyopathy, with both high-prevalence countries and high-prevalence regions within affected countries.The etiology, pathogenesis, echocardiographic findings, interventions and prognosis are quite distinct. While RHD is unarguably the most preventable of all cardiac diseases, resulting from untreated or undertreated group A streptococcal infections, EMF’s etiology remains unclear. It has been related to infections, dietary factors and toxic agents, and currently there are no specific drugs to treat EMF.The distinction of mitral lesions due to RHD from leftsided EMF, can be difficult in endemic areas for both diseases, especially in the context of lack of resources for diagnosis. However, the correct distinction is highly important since medical management, surgical and interventional options and prognosis are considerably different. Here we describe the features that allow this distinction in African settings where both diseases occur, paying particular emphasis to echocardiography

Implementing the Smile4life intervention for people experiencing homelessness : a path analytical evaluation

This evaluation was part of the Smile4life programme funded by the Scottish Government (grant number: 121.80.4497).Background: People experiencing homelessness have high levels of dental decay, oral cancer and poor oral health-related quality of life. The Scottish Government sought to address these issues by developing a national oral health improvement programme for people experiencing homelessness, named Smile4life. The aim was to investigate implementation behaviours and the role of work-related beliefs upon the delivery of the Smile4life programme across NHS Board areas in Scotland. Methods: Non-probability convenience sampling, supplemented by snowball sampling, was used to recruit practitioners working across the homelessness sector. The overall evaluation of the implementation of the Smile4life programme was theoretically informed by the Behaviour Change Wheel. The questionnaire was informed by the Theoretical Domains Framework and was divided into three sections, demography and Smile4life Awareness; Smile4life Activities; and Smile4life work-related beliefs. A psychometric assessment was used to develop Smile4life Awareness, Smile4life Activities, Ability to Deliver and Positive Beliefs and Outcomes subscales. The data were subjected to K-R20, exploratory factor analysis, Cronbach’s alpha, t-tests, ANOVA, Pearson’s correlation analysis and a multivariate path analysis. Results: One hundred participants completed the questionnaire. The majority were female (79%) and worked in NHS Boards across Scotland (55%). Implementation behaviour, constructed from the Delivering Smile4life scale and the summated Smile4life activities variable, was predicted using a linear model a latent variable. The independent variables were two raw variables Positive Beliefs and Outcomes, and Ability to deliver Smile4life. Results showed relatively good model fit (chi-square (1.96; p > 0.15), SRMR (< 0.08) and R2 (0.62) values). Positive and highly significant loadings were found describing the Implementation Behaviour latent variable (0.87 and 0.56). The two independent variables were associated (p < 0.05) with Implementation Behaviour. Conclusions: Work-related factors, such as positive beliefs and outcomes and ability to deliver are required for implementation behaviours associated with the delivery of the Smile4life programme. Future work should include training centred on the specific needs of those involved in the homelessness sector and the development of accessible training resources, thereby promoting implementation behaviours to assist the progression and sustainability of the Smile4life programme.Publisher PDFPeer reviewe

Promoting inclusion oral-health:social interventions to reduce oral health inequities

The aim of this collection of papers is to provide the reader with a cogent understanding of the role of evidence in the development of social or community-based interventions to promote inclusion oral-health and reduce oral health, health, and psychosocial inequities. In addition, this material will include various methods used for their implementation and evaluation. At the outset, the reader will be offered a working definition of inclusion oral-health, which will be modelled on the work of Luchenski et al. [1]. The interventions described are theoretically underpinned by a pluralistic definition of evidence-based practice [2] and the radical discourse of health promotion as postulated by Laverack and Labonte [3] and others [4,5]. This Special Issue will consist of eight papers, including an introduction. The first three papers will examine the various sources of evidence used to transform top-down into bottom-up community-based interventions for people experiencing homelessness; people in custody and for families residing in areas of high social deprivation. The final four papers will report on the implementation and evaluation of social or community-based interventions. This collection of research papers will highlight the importance of focusing on prevention and the adoption of a common risk factor agenda to tackle oral health, health and psychosocial inequities felt by those most excluded in our societies

Exploring the engagement behaviours of Smile4life practitioners:lessons from an evaluation of the national oral health improvement programme for people experiencing homelessness in Scotland

Introduction: Smile4life is Scotland's national oral health improvement programme for people experiencing homelessness, aimed at reducing oral health inequalities experienced by this population. This study forms part of an evaluation of how the Smile4life intervention was being implemented within Scottish NHS Boards. The aim was to investigate the influence of the Smile4life intervention upon the engagement behaviours of Smile4life practitioners.Methods: Focus groups were conducted with Smile4life practitioners, to provide an insight into how the Smile4life intervention affected their skills, attitudes and experiences while interacting with people experiencing homelessness and their services providers. A purposive sample of oral health practitioners, including dental health support workers, oral health promoters/educators, and oral health improvement coordinators working in three NHS Boards were invited to take part. One focus group was conducted in each of the three NHS Boards. The focus groups were audio-recorded and transcribed. The COM-B model of behaviour was used as a framework for analysis.Results: Eleven Smile4life practitioners took part in the focus groups. All had first-hand experience of working with the Smile4life intervention. The average focus group length was 67 min. Working on the Smile4life intervention provided the Smile4life practitioners with: (i) the capability (physical and psychological), (ii) the opportunity (to establish methods of communication and relationships with service providers and service users) and (iii) the motivation to engage with Third Sector homelessness services and service users, by reflecting upon their positive and negative experiences delivering the intervention. Enablers and barriers to this engagement were identified according to each of the COM-B categories. Enablers included: practitioners' sense of responsibility, reflecting on positive past experiences and success stories with service users. Barriers included: lack of resources, negative past experiences and poor relationships between Smile4life practitioners and Third Sector staff.Conclusion: The Smile4life programme promoted capability, provided opportunities and increased motivation in those practitioners who cross disciplinary boundaries to implement the Smile4life intervention, which can be conceptualised as “boundary spanning”. Practitioners who were found to be boundary spanners often had a positive mindset and proactive attitude towards the creation of strategies to overcome the challenges of implementation by bridging the gaps between the NHS and the Third Sector, and between oral health and homelessness, operating across differing fields to achieve their aims

Common and specific impairments in attention functioning in girls with chromosome 22q11.2 deletion, fragile X or Turner syndromes.

BACKGROUND: Chromosome 22q11.2 deletion syndrome (22q11.2DS), fragile X syndrome (FXS), and Turner syndrome (TS) are complex and variable developmental syndromes caused by different genetic abnormalities; yet, they share similar cognitive impairments in the domains of numbers, space, and time. The atypical development of foundational neural networks that underpin the attentional system is thought to result in further impairments in higher-order cognitive functions. The current study investigates whether children with similar higher-order cognitive impairments but different genetic disorders also show similar impairments in alerting, orienting, and executive control of attention. METHODS: Girls with 22q11.2DS, FXS, or TS and typically developing (TD) girls, aged 7 to 15 years, completed an attention network test, a flanker task with alerting and orienting cues. Exploration of reaction times and accuracy allowed us to test for potential commonalities in attentional functioning in alerting, orienting, and executive control. Linear regression models were used to test whether the predictors of group and chronological age were able to predict differences in attention indices. RESULTS: Girls with 22q11.2DS, FXS, or TS demonstrated unimpaired function of the alerting system and impaired function of the executive control system. Diagnosis-specific impairments were found such that girls with FXS made more errors and had a reduced orienting index, while girls with 22q11.2DS showed specific age-related deficits in the executive control system. CONCLUSIONS: These results suggest that the control but not the implementation of attention is selectively impaired in girls with 22q11.2DS, TS or FXS. Additionally, the age effect on executive control in girls with 22q11.2DS implies a possible altered developmental trajectory

Rheumatic heart disease in Uganda: the association between MHC class II HLA DR alleles and disease: a case control study

Background Rheumatic heart disease (RHD), the only long term consequence of acute rheumatic fever, remains a leading cause of morbidity and mortality among young adults in Uganda. An inherited susceptibility to acute rheumatic fever centers around the major histocompatibility class II human leucocyte antigens. However, there is paucity of data from sub-Saharan Africa. This study compares the frequency of HLA class II DR alleles between RHD cases and normal controls in Uganda. Methods One hundred ninety-nine participants including 96 established RHD cases aged 5–60 years and 103 age and sex matched normal controls were recruited for participation. DNA was manually extracted from buffy coat samples and HLA analysis was performed. HLA-DR allelic frequency comparison between cases and controls were estimated using conditional logistic regression with 95% confidence intervals. P -values were corrected for multiple hypothesis testing. Results 199 participants (103 female, 51.8%) completed the study. The mean (SD) age in years for cases and controls were 29.6 (10.2) and 29(18), respectively. After conditional logistic regression and multiple hypothesis testing, HLA-DR1was associated with a decreased risk of RHD (OR = 0.42, CI 0.21-085, P = 0.01, Corrected P value (PC) = 0.09,) while HLA-DR11 was associated with increased risk of RHD (OR = 3.31, CI 1.57-6.97, P = \u3c0.001, Pc \u3c 0.001). No other significant associations were found. Conclusion In this first study of HLA genetic susceptibility to RHD in Uganda, HLA- DR1 was more common in normal controls while HLA- DR11 was more common among RHD cases suggesting a disease susceptibility association. In future studies, high resolution HLA analysis and genome wide studies should be carried out to confirm this pattern

Resting and reactive frontal brain electrical activity (EEG) among a non-clinical sample of socially anxious adults: Does concurrent depressive mood matter?

A number of studies have noted that the pattern of resting frontal brain electrical activity (EEG) is related to individual differences in affective style in healthy infants, children, and adults and some clinical populations when symptoms are reduced or in remission. We measured self-reported trait shyness and sociability, concurrent depressive mood, and frontal brain electrical activity (EEG) at rest and in anticipation of a speech task in a non-clinical sample of healthy young adults selected for high and low social anxiety. Although the patterns of resting and reactive frontal EEG asymmetry did not distinguish among individual differences in social anxiety, the pattern of resting frontal EEG asymmetry was related to trait shyness after controlling for concurrent depressive mood. Individuals who reported a higher degree of shyness were likely to exhibit greater relative right frontal EEG activity at rest. However, trait shyness was not related to frontal EEG asymmetry measured during the speech-preparation task, even after controlling for concurrent depressive mood. These findings replicate and extend prior work on resting frontal EEG asymmetry and individual differences in affective style in adults. Findings also highlight the importance of considering concurrent emotional states of participants when examining psychophysiological correlates of personality