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Alex R Kemper

Publications and source records attributed to Alex R Kemper.

At least 19 recordsLinked to original sources
PubMed2005

Follow-up testing among children with elevated screening blood lead levels.

CONTEXT: Follow-up testing after an abnormal screening blood lead level is a key component of lead poisoning prevention. OBJECTIVES: To measure the proportion of children with elevated screening lead levels who have follow-up testing and to determine factors associated with such care. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, observational cohort study of 3682 Michigan Medicaid-enrolled children aged 6 years or younger who had a screening blood lead level of at least 10 microg/dL (0.48 micromol/L) between January 1, 2002, and June 30, 2003. MAIN OUTCOME MEASURE: Testing within 180 days of an elevated screening lead level. RESULTS: Follow-up testing was received by 53.9% (95% confidence interval [CI], 52.2%-55.5%) of the children. In multivariate analysis adjusting for age, screening blood lead level results, and local health department catchment area, the relative risk of follow-up testing was lower for Hispanic or nonwhite children than for white children (0.91; 95% CI, 0.87-0.94), for children living in urban compared with rural areas (0.92; 95% CI, 0.89-0.96), and for children living in high- compared with low-risk lead areas (0.94; 95% CI, 0.92-0.96). Among children who did not have follow-up testing, 58.6% (95% CI, 56.3%-61.0%) had at least 1 medical encounter in the 6-month period after the elevated screening blood lead level, including encounters for evaluation and management (39.3%; 95% CI, 36.9%-41.6%) or preventive care (13.2%; 95% CI, 11.6%-14.8%). CONCLUSIONS: The rate of follow-up testing after an abnormal screening blood lead level was low, and children with increased likelihood of lead poisoning were less likely to receive follow-up testing. At least half of the children had a missed opportunity for follow-up testing. The observed disparities of care may increase the burden of cognitive impairment among at-risk children.

Child↗
PubMed2005

Comparison of monocular autorefraction to comprehensive eye examinations in preschool-aged and younger children.

BACKGROUND: Monocular autorefraction is a newly available technology for vision screening that has been advocated to test young children. Such devices automatically determine the refractive state of each eye, but cannot directly detect amblyopia or strabismus. OBJECTIVE: To compare the results of a commercially available monocular autorefractor (SureSight; Welch Allyn Medical Products, Skaneateles Falls, NY) with findings from a comprehensive eye examination for significant refractive error, strabismus, and amblyopia. METHODS: Children 5 years and younger who were new patients attending a pediatric ophthalmology clinic were tested with the monocular autorefractor without dilation and underwent a comprehensive eye examination that included dilation. MAIN OUTCOME MEASURES: The proportion of children who could be tested and the sensitivity and specificity of the screening. RESULTS: Of the 170 children enrolled (age, <3 years, n = 80; age range, 3-5 years, n = 90), 36% had abnormal eye examination findings. Most (84%) children 3 years or older could be tested compared with 49% of the children younger than 3 years (P<.001). Among those who were testable, for children younger than 3 years the sensitivity was 80% (95% confidence interval [CI], 44%-97%) and the specificity was 41% (95% CI, 24%-61%). For children aged 3 to 5 years, the sensitivity was 88% (95% CI, 68%-97%) and the specificity was 58% (95% CI, 43%-71%). CONCLUSIONS: Our findings suggest that screening children aged 3 to 5 years with monocular autorefraction would identify most cases of visual impairment but would be associated with many false-positive results. For children younger than 3 years, testability was low and results were nonspecific.

Age Factors↗
PubMed2005

Blood lead testing among Medicaid-enrolled children in Michigan.

BACKGROUND: Federal regulations mandate that Medicaid-enrolled children be tested for lead poisoning at the age of 1 and 2 years or 3 through 5 years if not previously tested. OBJECTIVES: To measure the rate of blood lead testing among Medicaid-enrolled children in Michigan and the subsequent proportion of children with elevated lead levels and to determine factors associated with testing and elevated lead levels. METHODS: We performed a retrospective analysis of children aged 5 years or younger continuously enrolled in Michigan Medicaid during 2002. RESULTS: There were 216,578 children included in the analysis. The overall rate of blood lead testing was 19.6% (95% confidence interval [CI], 19.4-19.8) of which 8.3% (95% CI, 8.0-8.5) had a level of 10 microg/dL [0.48 micromol/L] or higher. Hispanic or nonwhite children or those living in high-risk areas for lead exposure were more likely to be tested and more likely to have an elevated blood lead level. However, 1.2% of tested children without these additional risk factors had a level of 10 microg/dL or higher. Enrollment in Medicaid managed care was associated with an increased likelihood of blood lead testing. After adjusting for other factors, those in managed care for 75% or more of their enrollment in 2002 had 1.98 (95% CI, 1.46-2.68) greater odds of being tested than those in fee-for-service for 75% or more of their enrollment. CONCLUSIONS: The rate of blood lead testing was low. Patterns suggest testing was targeted to those at highest risk, potentially leading some children with elevated blood lead levels to be missed.

Child, Preschool↗
PubMed2005

Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis.

Selective serotonin reuptake inhibitors (SSRIs) are frequently used to treat depression during pregnancy and the postpartum period. These drugs are capable of crossing the placenta and being transferred to the newborn during lactation. This report reviews the available information regarding the effects of SSRIs on the fetus and newborn; including long-term neurodevelopmental outcomes.

Child Development↗
PubMed2005

Willingness of private physicians to be involved in smallpox preparedness and response activities.

BACKGROUND: The public health system continues its efforts to prepare for bioterrorist events, such as a smallpox outbreak, but may need to call on other health professionals to ensure sufficient capacity to implement preparedness plans. OBJECTIVE: The goal was to understand the willingness of primary care physicians to participate in possible smallpox pre- or post-event activities. METHODS: A 23-question mail survey was sent to a national random sample of 727 internists and 720 family physicians. After three mailings, a one-page version of the survey was sent to nonrespondents. RESULTS: Response rates were 26% for questions common to both surveys and 22% for questions on the longer survey only. Respondents to the survey expressed moderate support for participating in certain smallpox pre- and post-event activities. Under a pre-event scenario, many providers would be willing to vaccinate first responders in their practice, and roughly one-third would be willing to vaccinate patients in their practice or to work in a public health clinic as a vaccinator. Most physicians, however, would be unwilling to be vaccinated themselves. Under post-event conditions, most providers would be willing to vaccinate their own patients, and many would vaccinate other community members in their practice. CONCLUSIONS: Despite the low response rate, information from this study on the smallpox preparedness activities in which physicians are most willing to participate can help to inform efforts by public health officials and private physicians to collaborate on bioterrorism preparedness efforts.

Adult↗
PubMed2005

Hospital decision-making regarding the smallpox pre-event vaccination program.

OBJECTIVES: To understand the factors underlying the decision by U.S. hospitals to participate or not in the U.S. Smallpox Pre-Event Vaccination Program (SPVP). METHODS: We conducted semistructured telephone interviews with a convenience sample of 123 hospital decision-makers in nine states between June and November 2003. RESULTS: Within our sample, 88 hospitals (72%) decided to participate in the SPVP and 35 (28%) decided against doing so. Nearly all hospital decision-makers considered the risk of a smallpox outbreak, risks associated with vaccination, hospital costs, and the reaction of hospital stakeholders. However, these factors often were weighed differently by hospitals that decided to participate compared to those that did not. Fewer than half of all hospitals reported that public health officials played an important role in their decision-making process, but those that did felt the influence of public health officials was positive. CONCLUSIONS: Strengthening the linkage between the public and private health sectors may help to address some of the barriers to broader participation by hospitals in the SPVP and foster the success of smallpox outbreak response preparedness efforts in the future.

Community-Institutional Relations↗
PubMed2005

Completeness and complexity of information available to parents from newborn-screening programs.

BACKGROUND: In 2000, the American Academy of Pediatrics (AAP) Task Force on Newborn Screening published a blueprint for the future of newborn screening that included recommendations for information provided to parents about screening. OBJECTIVES: To evaluate the completeness of educational material provided by newborn-screening programs and to measure the reading level and complexity of the material. METHODS: Telephone survey of newborn-screening programs (n = 51) followed by content analysis of educational material. RESULTS: All 51 programs responded (response rate: 100%); 47 of these programs made educational material available. None of the material included all elements recommended in the blueprint. Benefits of screening (98%) and how parents would be notified of results (87%) were included more often than the risks of screening (19%), possibility of a false-positive result (13%), importance of (34%) and how to respond to (28%) a positive result, and the storage and use of residual samples (11%). The median readability grade level was 10. Grade-level complexity of the material was not associated with completeness according to the AAP criteria. CONCLUSIONS: Parent educational materials for newborn-screening programs do not meet the standard recommended by the AAP, and there are important variations between programs in the information provided to parents. Continuing research is needed to measure progress toward the goals outlined within the blueprint and to assess how these changes impact the care provided through newborn-screening programs.

Comprehension↗
PubMed2004

Hearing and vision screening program for school-aged children.

BACKGROUND: Hearing and vision screening programs for school-aged children are common, yet little is known about their impact. OBJECTIVE: To evaluate Michigan's screening program, in which local health department (LHD) staff screen school-aged children using standardized protocols. METHODS: This project was completed in three phases: interviews with officials and screening technicians from ten LHDs, audit of LHD records regarding outcomes of screening during the 2000-2001 school year, and telephone interviews with randomly selected parents of children with an abnormal screen. RESULTS: Variations in LHD program implementation pertained to methods for tracking outcomes, screening of older children, parental notification of screening results, and availability of follow-up hearing clinics. According to LHD records, documentation of follow-up examination after an abnormal screen was low (hearing 27%, vision 25%). In contrast, most parents reported follow-up (74% hearing, 76% vision), and many reported that this resulted in treatment (50% hearing, 74% vision). In logistic regression modeling, the odds of follow-up after hearing or vision screening according to parents was not associated with income, health insurance status, or race/ethnicity. For hearing screening, the odds of follow-up decreased with school grade (p <0.001); however, the proportion who received treatment did not vary by grade. For vision screening, follow-up did not vary by grade, but the proportion who received treatment increased with grade (p =0.05). CONCLUSIONS: According to parent reports, most children had follow-up after an abnormal screen, and the majority of these children received treatment. Screening school-aged children for sensory impairment appears to be an important public health function.

Adolescent↗
PubMed2004

Prevalence and distribution of corrective lenses among school-age children.

BACKGROUND: No population-based data are available regarding the proportion of school-age children who have corrective lenses in the U.S. The objective of this study was to quantify the proportion of children who have corrective lenses (glasses or contact lenses) and to evaluate the association of corrective lenses with age, gender, race/ethnicity, health insurance status, and family income. METHODS: Children 6 to 18 years of age were identified in the 1998 Medical Expenditure Panel Survey. National estimates were made of the proportion with corrective lenses. Logistic regression modeling was used to assess factors that were associated with corrective lenses. RESULTS: Based on the 5,141 children in the 1988 Medical Expenditure Panel Survey, an estimated 25.4% of the 52.6 million children between 6 and 18 years had corrective lenses. Girls had greater odds than boys of having corrective lenses (odds ratio, 1.41; p < 0.001). Insured children, regardless of race/ethnicity, and uninsured nonblack/non-Hispanic children had similar odds of having corrective lenses. Compared with uninsured black or Hispanic children (odds ratio, 1), greater odds of corrective lens use was found among uninsured nonblack/non-Hispanic children (odds ratio, 2.29; p = 0.002) and black or Hispanic children with public (odds ratio, 1.67; p = 0.005) or private health insurance (odds ratio,1.77; p = 0.004). Among families with an income > or =200% of the federal poverty level, the odds of having corrective lenses increased with age (p < or = 0.04). In contrast, among those families <200% of the federal poverty level, the odds of having corrective lenses at 12 to 14 years was similar to 15- to 18-year olds (p = 0.93). CONCLUSIONS: The use of corrective lenses suggests that correctable visual impairment is the most common treatable chronic condition of childhood. Income, gender, and race/ethnicity, depending on insurance status, are associated with having corrective lenses. The underlying causes and the impacts of these differences must be understood to ensure optimal delivery of eye care.

Adolescent↗
PubMed2004

Valuing vision.

Explore the source record for details and available documents.

Amblyopia↗
PubMed2004

Patterns of vision care among Medicaid-enrolled children.

OBJECTIVE: To describe patterns of vision care among Medicaid-enrolled children. METHODS: We evaluated claims data over a 1-year period among children who were 18 years and younger, living in Michigan, and continuously enrolled in Medicaid but did not have a complex medical condition or were disabled. For this study, vision care comprised eye care services provided by optometrists or ophthalmologists and lens services, including dispensing and fitting of corrective lenses. RESULTS: Children in rural counties had increased odds of receiving eye care (odds ratio [OR]: 1.24) or lens services (OR: 1.22) compared with those in urban counties. In urban counties, non-Hispanic white children had greater odds than Hispanic or nonwhite children to have eye care (OR: 1.37) and lens services (OR: 1.37). An increasing supply of eye care professionals per population within a county was associated with decreased vision care in urban counties and slightly increased eye care and no changes in lens services in rural counties. Urban children who received mostly fee-for-service Medicaid had greater odds of receiving vision care than those with longer periods of managed care. Rural children who received mostly fee-for-service Medicaid had greater odds of eye care but similar odds of lens services. Regardless of urban/rural status, girls had increased odds of receiving eye care (OR: 1.24 for urban, 1.20 for rural) and lens services (OR: 1.36 for urban, 1.24 for rural). CONCLUSIONS: Patterns emerged that suggest underutilization or overutilization of vision care services. Such differences may have an impact on the development of children or waste limited health care resources.

Child↗
PubMed2003

Association between outpatient follow-up and pediatric emergency department asthma visits.

BACKGROUND: The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that patients receive a follow-up outpatient asthma visit after being discharged from an emergency department (ED) for asthma. OBJECTIVE: To measure the frequency of follow-up outpatient asthma visits and its association with repeat ED asthma visit. DESIGN: We conducted a retrospective cohort study of children with asthma using claims data from a university-based managed care organization from January 1998 to October 2000. We performed a multivariate survival analysis using Cox proportional hazards model to determine the effect of follow-up outpatient asthma visits on the likelihood of a repeat ED asthma visit, after controlling for severity of illness, patient age, gender, insurance, and the specialty of the primary care provider. RESULTS: A total of 561 children had 780 ED asthma visits. Of these, 103 (17%) had a repeat ED asthma visit within 1 year. Almost two-thirds of children (66%) did not receive outpatient follow-up for asthma within 30 days of an ED asthma visit. Outpatient asthma visits within 30 days of an ED asthma visit are associated with an increased likelihood (relative risk = 1.80; 95% confidence interval 1.19, 2.72) for repeat ED asthma visits within 1 year. CONCLUSIONS: Most patients do not have outpatient follow-up after an ED asthma visit. However, those patients that present for outpatient follow-up have an increased likelihood for repeat ED asthma visits. For the primary care provider, these outpatient follow-up visits signal an increased risk that a patient will return to the ED for asthma and are a key opportunity to prevent future ED asthma visits.

Adolescent↗
PubMed2003

Preschool vision screening in primary care after a legislative mandate for diagnostic eye examinations.

BACKGROUND: Kentucky legislation now requires that children entering public school receive a diagnostic eye examination. METHODS: Mail survey of randomly selected office-based primary care pediatricians (PDs, n = 221) and family physicians (FPs, n = 207) in Kentucky to assess the impact of the mandated eye examination. RESULTS: The response rate was 71% PDs and 51% FPs. Most offer preschool vision screening (PD 86%; FP 79%; P = 0.16), but many report they will be less likely to offer it in the future because of the mandated diagnostic eye examination (PD 61%; FP 50%; P = 0.09). Perceived barriers to the diagnostic eye examination include lack of parental knowledge about the requirement, belief by parents that they will need to pay, difficulty in getting an appointment, and lack of endorsement by primary care physicians. CONCLUSION: Most primary care physicians in Kentucky offer preschool vision screening, but many now are likely to reduce their screening effort. Until more data are available regarding the impact of the required eye examination, primary care providers should not change their screening practices.

Attitude of Health Personnel↗
PubMed2003

Under scrutiny: smallpox vaccine recommendations.

The eradication of smallpox is widely considered to be one of the great achievements of public health. However, international terrorism in the US and elsewhere has led to increasing concern about vulnerability to a smallpox bioterror attack. Timely vaccination is highly protective against smallpox but carries risks of morbidity and mortality. Significant debate has therefore emerged regarding the optimal strategy for defence. In principle, there are three options: either mass or limited vaccination prior to an attack; quarantine and vaccination of all suspected cases of smallpox following an attack with isolation and vaccination of potential case contacts; and mass vaccination after the identification of a case of smallpox. This paper reviews smallpox disease, smallpox vaccination and the development of current smallpox vaccination policy in the US. Mathematical models of the spread of smallpox and control strategies are reviewed to explore specific smallpox vaccine policy considerations. Limitations of these models are considered and recommendations are made for future research.

Humans↗
PubMed2002

Claims of equivalence in randomized controlled trials of the treatment of bacterial meningitis in children.

OBJECTIVE: To evaluate claims of therapeutic equivalence in studies of the treatment of bacterial meningitis in children. METHODS: We performed a systematic review of randomized controlled trials of antimicrobial therapy for bacterial meningitis in children indexed in MEDLINE and published after 1980 and that claimed equivalency. The sample size of each trial was compared with the minimum sample size needed to rigorously claim equivalence. The primary endpoint was case fatality. RESULTS: Twenty-five studies were identified that met the inclusion criteria. Two of these were specifically designed to test equivalence, and the remaining based claims of equivalence on failed tests of superiority. The majority of these trials (24 of 25) that claimed equivalence had sufficient sample size to exclude a 20% difference in mortality between the tested therapies. Only 3 of the 25 trials could exclude a 10% difference in mortality. CONCLUSION: Few of the trials in this study had sufficient sample size to claim equivalence within 10% of the expected mortality. Proving equivalency is challenging because large sample sizes are often needed to ensure adequate statistical power to rule out clinically important differences between the standard of care and new therapies.

Anti-Bacterial Agents↗