Introduction: The management of early childhood caries (ECC) is challenging. Objectives: A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. Methods: Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. Results: A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. Conclusion: A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. Knowledge Transfer Statement: This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.
Scraton's (1992) ground breaking research highlighted how Physical Education (PE) contributed to the reproduction of gender power relations; more specifically, how three messages around motherhood, sexuality and physicality, reflected through PE's structures, activities and delivery, contributed to young women's sense of self. Twenty five years on, this paper explores how contemporary PE reproduces and challenges gender power relations in four English secondary schools. Data were generated from eighty hours of observations of PE lessons, and eight semistructured interviews with PE teachers. Guided by Hill Collins' (2000) four domains (structural, disciplinary, hegemonic, interpersonal) underpinning the matrix of domination the findings demonstrate that gender remains a visible organising feature in the structural arrangements of PE.Moreover, teachers' gendered beliefs and assumptions circulating within the hegemonic domain, and actions in the disciplinary domain, ensure that students embody their gender in appropriate ways.Furthermore, a consistency of practice was evident in teachers' pedagogy despite differences in the schools' cohorts. Similar blocks of teaching activities and a performance-based pedagogy failed to include difference. We suggest this is unsurprising and unlikely to change with the current National Curriculum promoting a performative, PE as sport discourse, and teacher training not conducive to developing teachers who can engage with difference and challenge inequalities. As such, PE continues to reinforce gender power relations and gender differences. By drawing upon the matrix, the need for change to occur at different levels and contexts is identified. To this end, teacher training must do better in developing the next generation of teachers who are willing and able to critique the status quo and work with girls to advocate for change. Relatedly, we draw attention to what can be achieved when power is shared through a democratic pedagogy that values girls' voices and recognises them as co-collaborators in curriculum design.
Objectives:The management of early childhood caries is challenging and the impacts of its treatment on child oral health-related quality of life (COHRQoL) and dental anxiety among Australian Aboriginal children is relatively unknown. The aim of the study was to compare the impact on COHRQoL and dental anxiety after approximately 12 months among Aboriginal children treated for early childhood caries (ECC) using the Atraumatic Restorative Treatment and the Hall Technique (ART/HT: test) or standard care (control).Methods: Consenting Aboriginal communities in the North-West of Western Australia were randomized into early (test) or delayed (control) intervention for the management of ECC. Children and parents/carers completed a questionnaire at baseline and at follow-up. The questionnaire sought information on COHRQoL using the proxyreported Early Childhood Oral Health Impact Scale (ECOHIS) and the self-reported Caries Impacts and Experiences Questionnaire for Children (CARIES-QC). The test group was provided with the ART/HT care at baseline while the control group was advised to seek care through the usual care options available within the community. At follow-up, both groups were offered care using the ART/HT approach. Changes in the mean scores from baseline to follow-up within groups were evaluated using appropriate paired (t-test, Wilcoxon paired test), and between groups with unpaired tests (ttest). Multivariate regression analysis after multiple imputations of missing data used generalized estimating equation (GEE) controlling for clustering within communities.Results: Twenty-five communities and 338 children (mean age = 3.6 years, sd 1.7) participated in the study (test = 177). One child was excluded from the analysis because of a missing questionnaire and clinical data at baseline and follow-up. At baseline, test group children were older (test = 3.8 years, 95% CI 3.6-4.1;control = 3.3 years, 95% CI 3.1-3.6) and had higher caries experience (test dmft = 4.4, 95% CI 3.8-5.0;control dmft = 3.1, 95% CI 2.5-3.7), but there was no significant difference in COHRQoL or
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