Community water fluoridation : is it still worthwhile

Community Water Fluoridation (CWF) is the adjustment of fluoride concentration in community drinking water to a level that confers optimal protection from dental caries (Truman et al 2002). It is supported by many authorities as the single most effective public health measure for reducing dental caries (DHS 2007). It has consistently been shown to be effective in reducing the prevalence and severity of dental caries in populations following its introduction (NHMRC 1999). The most dramatic reductions (50-60%) were demonstrated in the earlier studies although more recent research has still shown reductions of between 30 and 50% (Truman et al 2002). Despite the strong scientific evidence for its beneficial effects and safety the issue of the appropriateness of CWF is often the focus of public debate. Proponents argue that it reduces dental caries. is safe and cost effective. and that it provides significant benefits to all social classes (Slade et al 1995: Slade et a 1996: Spencer et al 1996). Opponents question its efficacy and safety and argue that its addition to community water supplies is unethical mass medication (Colquhoun 1990: Diesendorf 1986: Diesendorf et al 1997).More recently, however, there have been important questions raised regarding the continuing benefit of CWF over and above that produced by the widespread use of other sources of fluoride (toothpaste. mouth rinses. varnish and other professionally applied fluorides). Generally, dental caries has declined steeply in the last thirty years and many have observed that dental caries has also reduced in parts of Australia and other countries where there has never been CWF or where it has ceased. It has been suggested that because of the current low population levels of dental caries and the increase in alternate sources of fluoride, CWF no longer offers the benefits it may have in the past. Given this notion, together with the concerns of a minority subgroup of the population regarding the safety of CWF, it is valuable to examine current evidence to answer the question: Is there still a role for CWF in Australia?This paper will firstly examine the history of water fluoridation and its mechanisms of action. Secondly. trends in dental decay experience over the last three decades with particular emphasis on social and geographical inequities in Australia will be described. We also review the current state of scientific evidence for the benefits of CWF including the contribution it makes to the reduction of oral health inequalities. In light of this we will provide a response to the question posed above.<br /

Are the potential benefits of a community-based participatory approach to public health research worth the potential cost?

Much of public health research is conducted in a community setting or is designed to target particular population groups. Community-based participatory research (CBPR) is gaining recognition as good practice in studies of this type(Flicker et al 2007). Its merit is based on the inclusion of the community as active participants at all stages of the research process (Goodman 2006). The focus on justice and equity in this approach is seen to contribute to a range of additional potential research benefits including increased relevance and sustainability of interventions arising from the research ( Blumenthal 2004; Wallestein 2006) However, it is widely acknowledged that adoption of a consciously CBPR approach requires additional expertise. time and resources from researchers and from communities (Tanjasiri et al 2002; Massaro &amp; Claiborne 2001; Israel et al 1998). Adoption of CBPR is also limited by existing infrastructures which are supportive of more&middot; traditional models of research. Changes to professional development programs, funding guidelines and criteria. grant review processes and ethics requirements are needed to support increased application of this approach (Israel et al 2001). As all research resources are limited, the potential additional benefits offered by CBPR over and above a more traditional research approach need to be weighed against the potential additional costs involved. Changes to research infrastructure are unlikely to occur until the costs andbenefits of a consciously CBPR approach as compared to a more traditional research approach can be demonstrated. This is an exploratory paper that summarises the arguments put forward to date in relation to CBPR. A research case study and an evaluation framework are then used for a conceptual analysis of differences in the potential costs and benefits of the two approaches. Firstly, the paper describes the differences between traditional and consciously CBPR approaches. The reported benefits of CBPR are then outlined, followed by a discussion of the potential costs. Finally, the potential costs are compared to the potential benefits of using a CBPR approach, using a case study of existing research.<br /

Interpreting in Sexual and Reproductive Health Consults With Burma Born Refugees Post Settlement: Insights From an Australian Qualitative Study

Interpreters work with health care professionals to overcome language challenges during sexual and reproductive (SRH) health discussions with people from refugee backgrounds. Disclosures of traumatic refugee journeys and sexual assault combined with refugees’ unfamiliarity with Western health concepts and service provision can increase the interpreting challenges. Published literature provides general guidance on working with interpreters in primary care but few studies focus on interpretation in refugee SRH consults. To address this, we explored the challenges faced by providers of refugee services (PRS) during interpreter mediated SRH consultations with Burma born refugees post settlement in Australia. We used qualitative methodology and interviewed 29 PRS involved with migrants from Burma including general practitioners, nurses, interpreters, bilingual social workers, and administrative staff. The interviews were audio-recorded, transcribed, and subjected to thematic analysis following independent coding by the members of the research team. Key themes were formulated after a consensus discussion. The theme of “interpretation related issues” was identified with six sub-themes including 1) privacy and confidentiality 2) influence of interpreter’s identity 3) gender matching of the interpreter 4) family member vs. professional interpreters 5) telephone vs. face-to-face interpreting 6) setting up the consultation room. When faced with these interpretation related challenges in providing SRH services to people from refugee backgrounds, health care providers combine best practice advice, experience-based knowledge and “mundane creativity” to adapt to the needs of the specific patients. The complexity of interpreted SRH consultations in refugee settings needs to be appreciated in making good judgments when choosing the best way to optimize communication. This paper identifies the critical elements which could be incorporated when making such a judgement. Future research should include the experiences of refugee patients to provide a more comprehensive perspective

An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds: a protocol paper for Teeth Tales

Introduction: Inequalities are evident in early childhood caries rates with the socially disadvantaged experiencing greater burden of disease. This study builds on formative qualitative research, conducted in the Moreland/Hume local government areas of Melbourne, Victoria 2006–2009, in response to community concerns for oral health of children from refugee and migrant backgrounds. Development of the community-based intervention described here extends the partnership approach to cogeneration of contemporary evidence with continued and meaningful involvement of investigators, community, cultural and government partners. This trial aims to establish a model for child oral health promotion for culturally diverse communities in Australia.&lt;p&gt;&lt;/p&gt; Methods and analysis: This is an exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds. Families from an Iraqi, Lebanese or Pakistani background with children aged 1–4 years, residing in metropolitan Melbourne, were invited to participate in the trial by peer educators from their respective communities using snowball and purposive sampling techniques. Target sample size was 600. Moreland, a culturally diverse, inner-urban metropolitan area of Melbourne, was chosen as the intervention site. The intervention comprised peer educator led community oral health education sessions and reorienting of dental health and family services through cultural Competency Organisational Review (CORe).&lt;p&gt;&lt;/p&gt; Ethics and dissemination: Ethics approval for this trial was granted by the University of Melbourne Human Research Ethics Committee and the Department of Education and Early Childhood Development Research Committee. Study progress and output will be disseminated via periodic newsletters, peer-reviewed research papers, reports, community seminars and at National and International conferences.&lt;p&gt;&lt;/p&gt

Having a say in research directions : The role of community researchers in participatory research with communities of refugee and migrant background

Research teams in high-income countries often fail to acknowledge the capacity and contributions of Community Researchers. This qualitative exploratory study used decolonising methodology and the Foundation House ‘Refugee Recovery Framework’ to understand Community Researchers’ perceptions and experiences of their role, and how research teams can integrate the knowledge they bring into research. Purposive sampling was used to facilitate the recruitment of eight Community Researchers from five different community groups working in Melbourne, Victoria. Semi-structured interviews lasting forty to sixty minutes occurred between December 2020 and January 2021. Data were analysed using reflexive thematic analysis. Findings reported in this paper include eight themes: ‘nothing about us without us’; ‘open the door’; a safe space to share; every step of the way; this does not translate; finding the right way to ask; a trauma-informed approach; and support within the workplace. The knowledge obtained demonstrates that Community Researchers facilitate meaningful participation in research for women, families, and communities of refugee or migrant background. Community Researchers’ presence, knowledge, and skills are vital in establishing culturally safe research practices and developing accessible language to facilitate conversations about sensitive research topics across multiple languages. Community Researchers can make important contributions at all stages of research, including data collection and interpretation

Addressing child oral health inequalities in refugee and migrant communities

© 2010 Dr. Elisha RiggsGood health is vital for successful settlement for people from refugee and migrant backgrounds newly arrived in developed countries. Such good health enables them to deal effectively with the challenges of settling in a new country and to participate fully in economic, social, cultural and community life. Although in the developed world there have been dramatic improvements in child oral health over the past thirty years, there is a widening gap of oral health inequalities experienced by some communities. In developed countries, it is suggested that disadvantaged children, including those of refugee and migrant backgrounds, experience up to 70 per cent more dental caries than the rest of the population. Moreover, there is strong evidence that severe dental decay that is experienced early in a child’s life is an extremely debilitating disease with lifelong consequences. Despite clear evidence of consistent health inequities for refugee and migrant communities, there is little knowledge to assist in the understanding of the social and cultural determinants of child oral health in these communities. Community-based participatory research is an ideal approach for engaging and empowering communities to improve their health, in a sensitive and appropriate manner. However, strategies and methods informing participative research with refugee and migrant communities are limited. Past research has often excluded these communities due to perceived methodological difficulties. This research proposes to address these gaps in the evidence by exploring the social and cultural influences of child oral health in refugee and migrant communities. This will inform the development of culturally competent intervention strategies to address these significant inequalities. This research will demonstrate a commitment to working in partnership with the communities at all stages of the research process. Accordingly, this PhD has the following objectives: - To systematically review the evidence-base of the oral health status, practices and environments for children from migrant and refugee backgrounds in Australia, and internationally - To work within a culturally competent framework to explore the social, cultural and environmental determinants of oral health of children and families in refugee and migrant communities - To identify the strategies for a feasible, acceptable and culturally appropriate oral health promotion intervention for children and families of refugee and migrant communities A systematic review of all national and international child oral health research undertaken with refugees and migrants was conducted. A total of 48 studies were included. In all studies that had a comparison group, child oral health for refugees and migrants was worse than that of the host or comparison population. The review identified that there are few community-based intervention research studies addressing child oral health inequalities and that the research is of limited cultural competence. In response, Teeth Tales was developed. This is a community-based participatory research study working in partnership with a community health services and cultural organisations. The study involved working with Iraqi, Lebanese and Pakistani communities in Melbourne. Eleven focus groups and seven interviews were conducted with people from these cultural backgrounds. Five interviews were also conducted with a range of health care professionals. Four broad categories of results were identified: ‘Child Oral Health’, ‘Service Use’, ‘Migration and Settlement’, and ‘Community Solutions’. This thesis has been successful in generating new knowledge about sociocultural differences in child oral health using culturally competent strategies. This in turn has informed the development of culturally competent intervention strategies. These strategies include a peer education program, and a reorientation of universal primary health and social health systems to become culturally competent. A further outcome of this thesis is the successful funding for the implementation and evaluation of the community-based intervention, from the Australian Research Council, 2010-2013. Furthermore, this study has demonstrated that oral health research with refugee and migrant communities can be conducted in a culturally competent manner. The consideration and application of a social model of health and social theory further informs the study. Critically, in terms of both ethics and rigour within an overall cultural competence framework, the contributions of this study are all firmly based on strong collaborative partnerships with cultural and community organisations throughout the research process. This adds further weight to the validity of the findings and to the contributions of the study

Rethinking the ethical and methodological dimensions of research with refugee children

This paper discusses the ethical and methodological dimensions of educational research with refugee children. The authors illustrate that research ethics need contextual, temporal and social flexibility to resonate with the changing needs and extraordinary contexts of this population, and that the flexibility is often too complex for ethical preassessments to address. The authors propose relational ethics, engaging with children and working from the "minds and hearts" rather than fixed ethical guidelines as one way to consider the ethics of working with this vulnerable population. (DIPF/Orig.)Dieser Artikel thematisiert die ethischen und methodologischen Dimensionen der Bildungsforschung mit geflüchteten Kindern. Die Autoren illustrieren, dass Forschungsethik kontextbezogene, zeitliche und soziale Flexibilität bedarf, um den sich ändernden Bedürfnissen und außergewöhnlichen Lebenskontexten dieser Personengruppe nachzukommen, und dass die Flexibilität häufig zu komplex ist, um ethische Vorannahmen zu adressieren. Die Autoren plädieren für eine relationale Ethik, die sich mit Kindern beschäftigt, in der Interaktion mit dem, Verstand und dem Herz\u27 der Kinder statt mit feststehenden ethischen Richtlinien, als eine Herangehensweise im Umgang mit den ethischen Fragen in der Arbeit mit dieser schutzbedürftigen Gruppe. (DIPF/Orig.

Promoting Child Health Equity through Health Literacy

Every child has the right to a fulfilling and thriving life [...

Vitamin D deficiency awareness among African migrant women residing in high-rise public housing in Melbourne, Australia: a qualitative study

The aims of this study were: 1) to explore the individual perceptions, experience and understandings of vitamin D deficiency (VDD) amongst African migrant women residing in high-rise public housing, 2) to identify the most useful sources of information about VDD among this population, and 3) to document the barriers and enablers to addressing VDD. The Health Belief Model was used to guide the study. Convenience sampling was used with women living in particular high-rise public housing. Five focus group discussions were conducted (n=30). Thematic analysis was used to code and categorise the data to develop a deeper, conceptual understanding of the issue. We found that participants were aware of VDD and could identify the impacts that VDD had on their health. Barriers to addressing VDD included the women's: 1) living conditions in Australia, 2) risk of skin cancer, and 3) cultural roles in the family. The most positive strategy for preventing and addressing VDD was peer information sharing. This study has highlighted the significant need for health promotion strategies to combat VDD in this population. Future health promoting public health strategies for this population should encompass communitybased peer education programs. This study demonstrates the critical role of qualitative inquiry in gaining a deeper understanding of VDD in a particular migrant community. It is clear that this issue requires a coordinated solution that must involve the community themselves. Health care professionals must take into consideration the multiple barriers that exist to address VDD which is a significant public health issue