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Sofronas M, Carnevale FA, Macdonald ME, Bitzas V, Wright DK. "We are not the person we will be when these things happen:" Reflections on personhood from an ethnography of neuropalliative care. Nurs Inq 2024; 31:e12646. [PMID: 38838221 DOI: 10.1111/nin.12646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
Neuropalliative care developed to address the needs of patients living with life-limiting neurologic disease. One critical consideration is that disease-related changes to cognition, communication, and function challenge illness experiences and care practices. We conducted an ethnography to understand neuropalliative care as a phenomenon; how it was experienced, provided, conceptualized. Personhood served as our conceptual framework; with its long philosophical history and important place in nursing theory, we examined the extent to which it captured neuropalliative experiences and concerns. Personhood contextualized complex losses, aligning the impact of functional and relational changes. Cognition, communication, and functional alterations stretched conceptions of personhood, insinuating it can be relational, fluid, adaptive. Although normative conceptions of personhood guided research and decision-making, ethical considerations suggested personhood could be transformed, remade. We consider the implications of our findings through three themes. First, we examine how literature on illness experience fails to integrate the realities of people living with and dying from neurologic disease; we counter this by interrogating the concept of experience. Second, we turn to Ricoeur's work on recognition to illuminate relational conceptions of personhood to inform care practices. Finally, we reflect on how personhood can bridge the gap left by functional changes, enhance relational engagement, and promote dignity at the end of life.
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Affiliation(s)
- Marianne Sofronas
- School of Nursing, University of Ottawa, Ottawa, Canada
- Ingram School of Nursing, McGill University, Montreal, Canada
| | | | | | - Vasiliki Bitzas
- Ingram School of Nursing, McGill University, Montreal, Canada
- CIUSSS Centre Ouest de l'Ile de Montreal, Montreal, Canada
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Rashid M, Goldszmidt M. Critical ethnography: implications for medical education research and scholarship. MEDICAL EDUCATION 2024. [PMID: 38600755 DOI: 10.1111/medu.15401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
CONTEXT Medical education (ME) must rethink the dominant culture's fundamental assumptions and unintended consequences on less advantaged groups and society at large. Doing so, however, requires a robust understanding of what we are teaching, regardless of our intentions, and what is being learned across the multiple settings that our learners find themselves in, from classrooms to clinical spaces and beyond. APPROACH Gaining such understandings and fully exploring the extent to which we are rising to the challenges of today's society in authentic ways require robust methodologies. In this research approaches paper, we introduce unfamiliar readers to one such methodology-critical ethnography. By doing so, we hope to demonstrate its potential for helping ME both identify and gain novel insight into necessary solutions for many of today's educational challenges regarding healthcare disparities and inequities. CONCLUSION The readers of this paper will gain novel insights into how critical ethnographers see the world and ask questions, thereby changing the way they (the reader) see the world. At its heart, critical ethnography is about thinking differently and that is something that should be accessible to all. Doing so may also enhance our ability to both question dominant ways of thinking and, ultimately, to enact positive change in training and practices to enhance inclusivity and fairness for all regardless of their gender, race and status.
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Affiliation(s)
- Marghalara Rashid
- Department of Paediatrics, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Goldszmidt
- Centre for Education Research and Innovation (CERI); Division of General Internal Medicine, Department of Medicine, Western University, London, Ontario, Canada
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Balasooriyan A, van der Veen MH, Bonifácio CC, Dedding C. Understanding parental perspectives on young children's oral health (≤ 4 years) growing up in a disadvantaged neighbourhood of Amsterdam, the Netherlands: an exploratory study. BMC Public Health 2024; 24:627. [PMID: 38413935 PMCID: PMC10900557 DOI: 10.1186/s12889-024-18073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Families' understanding towards oral health problems among young children is poorly studied. More insight into parents' experiences, especially of those living in disadvantaged neighbourhoods, is needed to address persistent oral health inequalities. This qualitative study aims to explore parental perspectives on children's oral health (≤ 4 years) and the opportunities they see to improve children's oral health. METHODS Forty-seven mothers and five fathers with different migration backgrounds from a disadvantaged neighbourhood in Amsterdam, the Netherlands, participated in our study. Semi-structured interviews (n = 27), participant observations (n = 7) and one focus group discussion were conducted. A thematic data analysis was used. RESULTS Parents describe their daily life with young children as busy, hectic and unpredictable. Parents seem to be most concerned about parenting. Mothers, in particular, feel fully responsible for raising their children and managing daily complexities. While most parents value their children's oral health, they all experience challenges. Parents find it hard to limit daily candy intake and to handle unwilling children during tooth brushing. They feel limited support for these issues from their household, social network and professionals. CONCLUSION Parental struggles in children's oral health are complex and interrelated as they occur across family, societal, community and professional levels. Given the complex daily reality of families with young children, establishing and maintaining healthy oral health habits seems not at the top of parents' minds. They ask for advice in the upbringing of their children backed up by social support, increased attention to children's oral health within the community and professional assistance. Collaborating with parents as knowledgeable partners might be the first step in acting upon the endeavour to address oral health inequality among young children.
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Affiliation(s)
- Awani Balasooriyan
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands.
| | - Monique H van der Veen
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands
- Department of Paediatric Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands
| | - Clarissa Calil Bonifácio
- Department of Paediatric Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU Amsterdam, Amsterdam, The Netherlands
| | - Christine Dedding
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centre (UMC), Amsterdam, The Netherlands
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Hedges J, Poirier B, Soares G, Haag D, Sethi S, Santiago PR, Cachagee M, Jamieson L. Journeying towards decolonising Aboriginal and Torres Strait Islander oral health re-search. Community Dent Oral Epidemiol 2023; 51:1232-1240. [PMID: 37294001 DOI: 10.1111/cdoe.12881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Arguably, the deficit narrative of oral health inequities, perpetuated by colonial re-search agendas, media and sociopolitical discourse, contributes to oral disease burden and fatalism among Aboriginal and Torres Strait Islander Peoples. There remains a need to evolve the way oral health is understood, in a manner that reflects the lived experiences of Aboriginal and Torres Strait Islander Peoples. METHODS This paper proposes decolonising methodologies as a strategy to ensure oral health re-search creates more equitable oral health outcomes and realities for Aboriginal and Torres Strait Islander Communities. Anchored by a critical reflection of the failure of dominant oral health inequity re-search practices to address Indigenous oral health, both in Australia and internationally, we propose five explicit pathways for decolonising Aboriginal and Torres Strait Islander oral health re-search. RESULTS We argue the need for (1) positionality statements in all re-search endeavours, (2) studies that honour reciprocal relationships through the development of proposals that ask questions and follow models based on Traditional Knowledges, (3) the development of culturally secure and strengths-based data capturing tools, (4) frameworks that address the intersection of multiple axes of oppression in creating inequitable conditions and (5) decolonising knowledge translation techniques. CONCLUSION Importantly, we recognize that re-search will never be entirely 'decolonised' due to the colonial foundations upheld by academic institutions and society more broadly; however, as oral health re-searchers, we ascertain that there is an ethical compulsion to drive decolonising re-search pursuits that produce equitable oral health outcomes for Aboriginal and Torres Strait Islander Communities.
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Affiliation(s)
- Joanne Hedges
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Brianna Poirier
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Gustavo Soares
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Dandara Haag
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Sneha Sethi
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Pedro Ribeiro Santiago
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Madison Cachagee
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - Lisa Jamieson
- Indigenous Oral Health Unit, Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, Adelaide, Australia
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Leite JR, Bomfim RA. Sedentary behaviour and traumatic dental injuries in adolescents: A population-based study. Dent Traumatol 2023; 39:478-482. [PMID: 37010883 DOI: 10.1111/edt.12846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/22/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE Analyse factors associated with dental trauma in 12-year-old adolescents. METHODS An epidemiological survey was carried out in the five largest cities in the state of Mato Grosso do Sul, Brazil. Data on traumatic dental injuries (TDI) based on the World Health Organization (WHO), sociodemographic characteristics and individual clinical and behavioural characteristics in 615 adolescents were collected. Univariate and adjusted multilevel logistic regressions were performed to test the association of dental trauma with behavioural and sociodemographic factors. The study was approved by the Ethics Committee (CAAE number 85647518.4.0000.0021). RESULTS The prevalence of TDI at 12 years was 3.4% (95% CI 1.8; 6.4). In the adjusted models, clinical characteristics of adolescents such as overjet >3 mm (OR = 1.51 [95% CI 1.00; 2.41]) were associated with trauma. Sociodemographic characteristics such as female sex (OR = 0.13 [95% CI 0.07; 0.25]), income above the poverty level (OR = 0.34 [95% CI 0.15; 0.78]), who declared themselves white (OR = 0.23 [95% CI 0.11; 0.47]) and with sedentary behaviour (OR = 0.69 [95% CI 0.59; 0.80]) were associated with trauma, as protective factors. CONCLUSION Sociodemographic, behavioural and individual clinical characteristics were associated with TDI in adolescents. Oral health teams should focus on the most vulnerable groups, encouraging the use of mouthguards and access to treatment services.
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Affiliation(s)
- Jean Ribeiro Leite
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Rafael Aiello Bomfim
- School of Dentistry, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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Bastos JL, Fleming E, Haag DG, Schuch HS, Jamieson LM, Constante HM. The Relations between Systems of Oppression and Oral Care Access in the United States. J Dent Res 2023; 102:1080-1087. [PMID: 37464815 DOI: 10.1177/00220345231184181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
We applied a structural intersectionality approach to cross-sectionally examine the relationships between macro-level systems of oppression, their intersections, and access to oral care in the United States. Whether and the extent to which the provision of government-funded dental services attenuates the emerging patterns of associations was also assessed in the study. To accomplish these objectives, individual-level information from over 300,000 respondents of the 2010 US Behavioral Risk Factor Surveillance System was linked with state-level data for 2000 and 2010 on structural racism, structural sexism, and income inequality, as provided by Homan et al. Using multilevel models, we investigated the relationships between systems of oppression and restricted access to oral health services among respondents at the intersections of race, gender, and poverty. The degree to which extended provision of government-funded dental services weakens the observed associations was determined in models stratified by state-level coverage of oral care. Our analyses bring to the fore intersectional groups (e.g., non-Hispanic Black women and men below the poverty line) with the highest odds of not seeing a dentist in the previous year. We also show that residing in states where high levels of structural sexism and income inequality intersect was associated with 1.3 greater odds (95% confidence interval, 1.1-1.5) of not accessing dental services in the 12 mo preceding the survey. Stratified analyses demonstrated that a more extensive provision of government-funded dental services attenuates associations between structural oppressions and restricted access to oral health care. On the basis of these and other findings, we urge researchers and health care planners to increase access to dental services in more effective and inclusive ways. Most important, we show that counteracting structural drivers of inequities in dental services access entails providing dental care for all.
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Affiliation(s)
- J L Bastos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - E Fleming
- Department of Dental Public Health, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - D G Haag
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - H S Schuch
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - L M Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, SA, Australia
| | - H M Constante
- Department of Sociological Studies, The University of Sheffield, Sheffield, United Kingdom
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Fleming E, Bastos JL, Jamieson L, Celeste RK, Raskin SE, Gomaa N, McGrath C, Tiwari T. Conceptualizing inequities and oppression in oral health research. Community Dent Oral Epidemiol 2023; 51:28-35. [PMID: 36749670 DOI: 10.1111/cdoe.12822] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 02/08/2023]
Abstract
Major sociohistorical processes have profound effects on oral health, with impacts experienced through structural oppression manifested in policies and practices across the lifespan. Structural oppression drives oral health inequities and impacts population-level oral health. In this global perspective paper, we challenge old assumptions about oral health inequities, address misleading conceptualizations in their description and operation and reframe oral health through the lens of intersecting systems of oppression. Furthermore, we emphasize the need for oral health researchers to explore causal pathways through which oppression harms oral health and engage in social science concepts to understand the root causes of oral health inequities fully. Finally, we call on policymakers, dental scholars and decision makers to consider health equity in all policies and to take a systems-oriented approach to effectively address oral health inequities.
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Affiliation(s)
| | - João L Bastos
- Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - Roger K Celeste
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Sarah E Raskin
- iCubed Initiative Oral Health Core, Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Virginia, USA
| | - Noha Gomaa
- Oral Diagnostic Sciences, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Colman McGrath
- Applied Oral Sciences & Community Dental Care, University of Hong Kong, Hong Kong, Hong Kong
| | - Tamanna Tiwari
- School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
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Reginaldo I, Fernandes IAM, Nuernberg GN, Bastos JL. Race in public health dentistry: a critical review of the literature. Rev Saude Publica 2022; 56:57. [PMID: 35766786 PMCID: PMC9239422 DOI: 10.11606/s1518-8787.2022056004173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To carry out a critical review of the literature on the use of race, color, and ethnicity in the field of public health dentistry. METHODS A literature search was conducted in MEDLINE via PubMed for articles published between 2014 and 2019. Using a data extraction form, we collected information on (1) bibliographic characteristics of the selected papers; (2) race, color, and ethnicity of the study participants and their sociodemographic profiles; and (3) the extent to which the original publications followed the recommendations by Kaplan and Bennett (2003) on the use of race, color, or ethnicity in biomedical research. RESULTS Our initial search identified 2,032 articles, 53 of which were selected for full-text examination and assessment following pre-established eligibility criteria. Around 60% (n = 32) of the included studies did not justify the use of race, color, or ethnicity in their analyses, and 9% (n = 5) took these variables as indicators of the participants’ genetic makeup. On the other hand, 68% (n = 36) of the reviewed papers considered race, color, and ethnicity as risk markers – not risk factors – for adverse oral health outcomes, whereas 80% (n = 42) adjusted racial/ethnic inequities for a range of socioeconomic and demographic factors in statistical models. Only one study (2%) explicitly took race, color, or ethnicity as a contextually dependent dimension of the participants’ identities. CONCLUSION Our findings indicate that research on oral health inequities is often based on reductionist and stigmatizing conceptions of race, color, or ethnicity. Such harmful misconceptions should be replaced with anti-racist narratives in order to effectively address racial oral health inequities.
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Affiliation(s)
- Isabela Reginaldo
- Universidade Federal de Santa Catarina. Departamento de Saúde Pública. Florianópolis, SC, Brasil
| | | | | | - João Luiz Bastos
- Universidade Federal de Santa Catarina. Departamento de Saúde Pública. Florianópolis, SC, Brasil
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