Public Health Nurses as Oral Health Advocates: A Feasibility Study

描述（由申请人提供）：有充分的证据表明，母亲的口腔健康状况与其子女的口腔健康直接相关，特别是在围产期。这种关联是复杂的，母亲的口腔健康状况以及母亲的知识，态度和健康行为都影响儿童的口腔健康。幼儿龋齿（ECC）是一种传染性慢性疾病，最常由母亲传染给孩子，是母婴联系的一个主要例子。儿童感染变形链球菌（MS）越早，这种细菌主要与龋齿有关，儿童患龋齿的风险就越大。口腔健康状况较差的母亲，尤其是存在未经治疗的蛀牙的母亲，患多发性硬化症的可能性更高，更有可能感染孩子，并且更有可能在较早的时候感染孩子。专门为服务不足的儿童制定了家访方案;据估计，每年有100多万儿童在家中接受保健服务。家访模式为纳入旨在降低ECC患病率的口腔健康促进活动提供了理想的场所，因为1）这些计划已经针对牙病风险最高的儿童，2）健康促进是他们的主要目标之一，3）卫生专业人员提供预防服务，4）以家庭为基础的卫生保健提供者比以诊所为基础的提供者有更少的时间限制。建立在长期护理模式的原则，这项探索性研究的目的是评估公共卫生护士纳入口腔健康促进活动到一个正在进行的产前和纳塔尔家访计划的可行性。具体目标包括：1）确定口腔健康促进模式，重点是以患者为中心的咨询和ECC预防，可以有效地提供护士作为一个正在进行的围产期家访计划的一部分; 2）确定护士的能力，准确评估口腔健康状况，在家庭环境中，和3）确定患者接受口腔健康促进正在提供护士。本研究的长期目标是使用这些结果来设计和测试一种多方面的干预措施，以防止ECC，该干预措施将以患者为中心的咨询和氟化物清漆应用于家访环境。使用这种交付策略来解决高风险妇女和儿童的口腔健康需求，当在其他环境中复制时，可能会对消除口腔疾病和口腔健康差异产生深远的影响。

DESCRIPTION (provided by applicant): It has been well documented that a mother's oral health status is directly related to the oral health of her children, especially during the perinatal period. This association is complex, with maternal oral health status as well as maternal knowledge, attitudes and health behaviors all affecting the child's oral health. Early childhood caries (ECC), an infectious, chronic disease most commonly transmitted from mother to child, is a prime example of the maternal-child link. The earlier a child is infected with Mutans Streptococcus (MS), the bacteria primarily associated with dental caries, the greater the child's risk of developing dental caries. Mothers who have poorer oral health, especially the presence of untreated dental decay, are more likely to have higher rates of MS, more likely to infect their child and more likely to infect their child at an earlier age. Home visiting programs were specifically developed to reach underserved; at risk children and annually over 1 million children are estimated to receive health care in their homes. The home visiting model offers an ideal venue to incorporate oral health promotion activities aimed at reducing ECC prevalence since 1) these programs already target children at highest risk for dental disease, 2) health promotion is one of their primary aims, 3) health professionals provide preventive services and 4) home-based health care providers have less time constraints than clinic based providers. Building on the tenets of the chronic care model, this exploratory study is designed to assess the feasibility of public health nurses incorporating oral health promotion activities into an ongoing pre and post natal home visiting program. The specific aims include: 1) to determine if an oral health promotion model, with a focus on patient-centered counseling and ECC prevention, can be effectively delivered by nurses as part of an ongoing perinatal home visiting program; 2) to determine nurses' ability to accurately assess oral health status, in a home setting, and 3) to determine patient acceptance of oral health promotion being delivered by nurses. The long term goal of this study is to use these results to design and test a multifaceted intervention to prevent ECC that incorporates both patient centered counseling and fluoride varnish applications in a home visiting setting. Using this delivery strategy to address the oral health needs of high risk women and children, when replicated in other settings, could potentially have far reaching impact in eliminating oral disease and oral health disparities.