The pediatric nurse practitioner's role in reducing oral health disparities in homeless children.

Dental caries is the most common infectious disease of children. The majority of children in the United States who experience dental decay are from low-income, minority families. Many low- income, minority families are at risk for homelessness and, indeed, mothers with children are the fastest growing homeless group. Once homeless, families end up in shelters. Shelters are a unique source for the provision of health care; however, the provision of dental care to mothers and children in shelters is limited. At a shelter-based clinic, of a total number of children assessed in a 24-month period (n = 264), 22.7% (n = 60) had obvious gross dental cavities. The school-aged children (6-12 years) (n = 41) had the highest prevalence of dental cavities (34%). Consistent with the literature, dental caries was the most prevalent condition of homeless children and the most difficult for which to obtain treatment. Follow-up was difficult because of the transient nature of homeless families.

Comfort Theory and its application to pediatric nursing.

Although written protocols currently are directed more to pain relief than to the comfort of each child, there is increasing interest in pediatric literature about comforting strategies for children and their families. However, pediatric nurses/researchers currently utilize measures of discomfort that designate a neutral sense of comfort as in the absence of a specific discomfort. Assessing comfort as a positive, holistic outcome is important for measuring effectiveness of comforting strategies. Comfort Theory (Kolcaba, 2003), with its inherent emphasis on physical, psychospiritual, sociocultural, and environmental aspects of comfort, will contribute to a proactive and multifaceted approach to care. The framework of Comfort Theory for pediatric practice and research is easy to understand and implement. The application of the theory is strengthening and satisfying for pediatric patients/families and nurses, and benefits institutions where a culture of comfort is valued. Moreover, comfort is a transcultural and interdisciplinary concern.

Childhood obesity and dental caries in homeless children.

INTRODUCTION: Childhood obesity and dental caries are increasing epidemics, especially among children who are living below the poverty level. This study was conducted to determine the relationship between body mass index (BMI) and caries in homeless children. METHODS: A secondary data analysis with a correlational design was used. A convenience sample of 157 children was recruited from a homeless shelter. RESULTS: Pearson's and partial correlations were used to explore the relationships among age, BMI, and caries. Most of the children were girls and were African American. Slightly more than half of the children were overweight (19.7%) or obese (30.6%) and had caries (50.3%). Significant positive correlations between age and BMI (p = .03) as well as between age and caries (p = .003) were found. As BMI increased, so did caries (p = .08). DISCUSSION: Consistent with reports from the Centers for Disease Control and Prevention, homeless children had higher BMI and caries rates than the national averages. Although a definitive conclusion between obesity and dental caries cannot be drawn, these two health issues are important areas for all pediatric health care providers to address at every visit.

Performing oral health screenings on children.

This article describes ways to elicit the cooperation of a young patient while limiting fear and/or alarm, provides steps for performing a complete oral exam to evaluate the oral health of a child, and discusses reimbursement for the application of fluoride varnish.

A pilot study comparing two developmental screening tools for use with homeless children.

Homelessness and poverty can present serious health issues for children, including those associated with developmental delays. Early identification and intervention may decrease risk associated with delayed development. Parent-completed measures have been used to help screen for children's development, but little is known about how they may enhance early detection with homeless children. The primary aims of this pilot study were to describe growth and developmental characteristics of homeless children and to compare a parent-completed measure with professionally-conducted developmental screening results. A prospective, comparative study was conducted with 20 homeless mothers and their 21 children. Health professionals used the Denver Developmental Screening Test II, identifying nine children with possible language delay. Mothers completed the Ages and Stages Questionnaires and identified three areas of concern: fine motor (n = 9), communication/language (n = 4), and problem solving (n = 4). The percentage agreement between these two tools was strongest in gross motor (95%) and personal social development (95%) but weakest in language development (67%). While it is essential for all children, developmental screening is particularly crucial for homeless children because of increased risks related to poverty and homelessness. Nurses and nurse practitioners are in a unique position to assess applicability of such instruments and to provide critically needed interventions for these children.

Considerations for preparing collaborative international research: a Ugandan experience.

This article describes issues to consider when planning and conducting international research projects. Key considerations include building collaboration, developing a comprehensive and feasible research plan, funding and budgets, addressing human subjects concerns, and analyzing and disseminating project findings. These considerations and related methodological issues are discussed in the context of a replication pilot project conducted outside Kampala, Uganda. Ongoing dialog, flexibility, and collaboration, in addition to good science, are critical to developing successful international research projects.