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Biomedical subjects

K J Kemper

Publications and source records attributed to K J Kemper.

At least 37 records · Page 2Linked to original sources
PubMed1997

A randomized controlled trial of group versus individual well child care for high-risk children: maternal-child interaction and developmental outcomes.

OBJECTIVE: To determine if group well child care (GWCC) for high-risk children affects maternal-child interaction and development as compared to these outcomes in children receiving traditional individual well child care (IWCC). STUDY DESIGN: Randomized controlled trial. PARTICIPANTS: Infants less than 4 months old at the initiation of the study who came from high-risk families. Families were classified as high risk, and eligible for study participation, if the mother had one or more of the following characteristics: poverty, single marital status, less than a high school education, age less than 20 years at delivery, previous substance abuse, or a history of abuse as a child. SETTING: Two urban, university pediatric clinics in Seattle, Washington. INTERVENTIONS: Study children were randomized to receive GWCC or IWCC prior to the first study visit at the age of 4 months. Study health supervision visits were scheduled at 4, 5, 6, 8, 10, 12, and 15 months of age. For children randomized to receive GWCC, study visits consisted of an age-matched group discussion of child rearing issues, either preceding or following a brief physical examination. After the 15-month visit, development of study patients was assessed by the use of Bayley Scales of Infant Development (Bayley). Maternal-child interaction and the home environment were evaluated by the use of the Nursing Child Assessment Teaching Scale (NCATS) and the Home Observation for Measurement of the Environment (HOME), respectively. RESULTS: At least one outcome measure was obtained on 114 children; 86 patients completed all three outcome measures. Bayley psychomotor mean scores were 103.6 +/- 11.5 for GWCC patients versus 100.0 +/- 12.4 for those receiving IWCC (P = .14); mean scores for the mental section were 99.3 +/- 14.8 and 100.4 +/- 14.3, respectively (P = .71). The prevalence of high-risk maternal-child interactions was 10% in both the GWCC and IWCC groups. A high-risk home environment was found in 16% of IWCC patients versus 4% of those randomized to GWCC (odds ratio comparing IWCC to GWCC 4.6, 95% confidence interval 0.78, 26.0, after controlling for confounding variables). Provider time was similar among groups (mean number of minutes/patient/study visit: 19.8 +/- 5.6 and 20.4 +/- 6.7 for GWCC and IWCC, respectively, P = .66). CONCLUSION: GWCC is a viable alternative to IWCC for high-risk children. Developmental outcomes and maternal-child interaction are at least as good for children who received GWCC as compared to traditional IWCC, without any increase in provider time required.

Adult↗
PubMed1996

Improving participation and interrater agreement in scoring Ambulatory Pediatric Association abstracts. How well have we succeeded?

OBJECTIVE: To determine whether increasing the number and types of raters affected interrater agreement in scoring abstracts submitted to the Ambulatory Pediatric Association. METHODS: In 1990, all abstracts were rated by each of the 11 members of the board of directors of the Ambulatory Pediatric Association. In 1995, abstracts were reviewed by four to five raters, including eight members of the board of directors, two chairpersons of special interest groups, and 10 regional chairpersons, for a total of 20 potential reviewers. Submissions were divided into the following three categories for review: emergency medicine, behavioral pediatrics, and general pediatrics. Weighted percentage agreement and weighted kappa scores were computed for 1990 and 1995 abstract scores. RESULTS: Between 1990 and 1995, the number of abstracts submitted to the Ambulatory Pediatric Association increased from 246 to 407, the number of reviewers increased from 11 to 20, the weighted percentage agreement between raters remained approximately 79%, and weighted kappa scores remained less than 0.25. Agreement was not significantly better for the emergency medicine and behavioral pediatrics abstracts than for general pediatrics, nor was it better for the raters who reviewed fewer abstracts than those who reviewed many. CONCLUSIONS: The number and expertise of those rating abstracts increased from 1990 to 1995. However, interrater agreement did not change and remained low. Further efforts are needed to improve the interrater agreement.

Abstracting and Indexing↗
PubMed1995

Maternal factors and child's health care use.

There is inadequate data about the association between specific psychosocial factors and pediatric health care use. We hypothesized that maternal substance abuse, depression, and low social support would be associated with increased medical visits, emergency room (ER) use, visits for injuries and delays in immunization. We conducted a prospective study of 202 U.S. families with preschool children in a clinic serving the inner city poor. Psychosocial factors were assessed from standardized screening questionnaires for substance abuse, depression and low social support. Research assistants blind to the study hypothesis reviewed medical records for health care over the year following completion of the questionnaire: number of clinic visits, use of emergency room, visits to the ER or clinic for injuries, and delays in immunizations of two months or more. Among the 202 mothers, the mean age was 24.4 years, 47% were African American, 32% Caucasian, and 14% Asian; 55% were high school graduates. The average household income was $7620 per year; the mean age of children was 12.2 months. Thirty-seven percent of mothers screened positively for substance abuse, 34% for depression, and 60% for low social support. Children had an average of 8.6 clinic visits per year; 41% had an ER visit, 21% had an injury resulting in an ER or clinic visit, and 43% of children under 2 years of age had a delay of 2 months or more in recommended immunizations. After controlling for maternal and child age in a regression equation, none of the psychosocial factors were significant predictors of health care use outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

A cost-effectiveness analysis of prevaccination testing for hepatitis B in adolescents and preadolescents.

OBJECTIVE: To study the clinical effectiveness and cost-effectiveness of prevaccination testing for hepatitis B virus in adolescents and preadolescents. DESIGN: Decision analysis model comparing (1) prevaccination testing for hepatitis B surface antibodies, (2) no testing, and (3) testing at the same time as the first vaccine dose. Sensitivity analyses of the first two strategies were performed varying the seroprevalence of hepatitis B surface antibodies, compliance with follow-up, and costs of testing. SETTING: Charges for testing and vaccination were obtained from Children's Hospital and Medical Center in Seattle, Wash. Vaccination compliance, hepatitis B surface antibodies seroprevalence, and vaccine response rates are from published literature. PATIENTS: A hypothetical cohort of 100,000 11-year-old children presenting for well-child care. MAIN OUTCOME MEASURES: Rate of complete vaccination, cost of testing and vaccination for each cohort, and cost per patient protected from hepatitis B virus. RESULTS: No testing was the most cost-effective strategy. Prevaccination testing elevated costs by $2.9 million for every 100,000 patients and lowered the rate of complete vaccination by 22% compared with vaccination without testing. For prevaccination testing to be cost-effective, the seroprevalence of hepatitis B surface antibodies needed to be greater than 40%. As the seroprevalence of hepatitis B surface antibodies decreased, the ratio of testing costs to vaccination costs had to decrease for prevaccination testing to remain cost-effective. Even with perfect compliance, prevaccination testing required high seroprevalence rates to be cost-effective. CONCLUSIONS: For most populations of preadolescents and adolescents, prevaccination testing for hepatitis B virus is not effective in terms of cost or rate of complete vaccination.

Adolescent↗
PubMed1994

Risk factors for dropping out of a parenting education program.

This study compared those who completed a clinic-based parenting program to dropouts in an attempt to identify risk factors for parents not completing the program. The program, aimed at mothers at risk for child maltreatment, was offered at three Seattle, Washington health centers providing comprehensive pediatric care to low-income families. We obtained baseline information from an intake questionnaire, the Nursing Child Assessment Teaching Scale (NCATS), and the Home Observation for Measurement of the Environment (HOME). Of the 172 enrollees, 124 (72%) completed the program. Univariate analyses showed that dropouts were more likely to be located at Clinic Site Three (42% vs. 10%, p < .001), teenaged (44% vs. 23%, p = .010), and African-American (56% vs. 32%, p = .010), and to have HOME scores less than 32 (57% vs. 33%, p = .023). There were no statistically significant differences between those who dropped out and those who didn't in marital status, education, referral rate to Child Protective Services prior to the start of parenting classes, or NCATS scores. Multivariate analyses showed that age less than 20 was significantly associated with dropping out when race and HOME scores were taken into account. There was significant interaction between age less than 20 and Clinic Site Three. These data suggest that program planners need to develop appropriate strategies to retain teenage mothers in parenting programs.

Adult↗
PubMed1994

Punishments: what predicts adult approval.

We surveyed 449 parents to assess: (a) the prevalence of different types of physical and emotional punishment during their childhoods: (b) the prevalence of current parental approval of these types of punishments, and (c) risk factors for current approval of physical and emotional punishments. Parents in waiting rooms of pediatric clinics were asked to complete an anonymous questionnaire about their childhood punishment experiences and their current approval of various types of punishment. Reported experiences and approval were as follows: 24% experienced and 6% approved of uncommon punishments (e.g., burned), 45% experienced and 17% approved of common punishments (e.g., shaken), and 94% experienced and 88% approved of very common punishments (e.g., spanked). Having experienced each type of punishment was a highly significant risk factor for currently approving of that type of punishment (p < .01 for each). Race, income, and education were not significant risk factors for approval of different types of punishment. Many parents have experienced harsh types of punishment during their childhoods. Efforts at identifying and educating parents who approve of harsh and/or abusive types of punishment should focus on those who have experienced harsh punishment rather than on particular racial or socioeconomic groups.

Adult↗
PubMed1994

Screening for maternal experiences of physical abuse during childhood.

Because a parental history of abuse during childhood is a documented risk factor for child abuse, pediatricians have been urged to assess parents' childhood discipline experiences. A brief set of questions was developed to detect a maternal history of childhood physical abuse that could be incorporated into a comprehensive psychosocial screening questionnaire. A criterion-based definition was used as the measure for physical abuse. In phase I, four screening questions were developed in a cross-sectional survey of 284 middle-class women attending a family medicine clinic, of whom 32% met the criteria definition for physical abuse. In phase II, the screening questions were tested in 428 mothers seen in Salt Lake City- and Seattle-area pediatric clinics. The four screening questions had a sensitivity of > 90%, a specificity of > 85%, a positive predictive value of > 75%, and a negative predictive value of > or = 90%--as compared with the criteria-based definition in both pediatric settings. These four screening questions compared favorably to a criteria-based definition of physical abuse during childhood and may be useful additions to psychosocial questionnaires.

Adult↗
PubMed1994

Family psychosocial screening: should we focus on high-risk settings?

The objective of this study was to address the question of whether or not psychosocial screening should be focused on "high-risk" populations. A cross-sectional survey of mothers of young children was conducted in various clinics: 758 in teaching clinics, 444 in private practices, and 202 at a military clinic. The self-administered questionnaire covered demographic factors, problems in mothers family of origin, maternal depression, and substance abuse. Mothers in the teaching clinics were younger and had less education and lower incomes than mothers in private practices, with intermediate levels in the military clinic. However, a substantial proportion of mothers seen in all sites reported psychosocial problems. Approximately 20% of mothers in all sites reported a family history of alcoholism. Positive screens for maternal depression ranged from about 15% to 35%. Binge drinking was reported by 10% to 20% at different sites. Psychosocial problems were common even among families seen in "low-risk" settings. Focusing screening only on high-risk clinics would miss many families with psychosocial problems.

Adolescent↗
PubMed1994

Is abuse during childhood a risk factor for developing substance abuse problems as an adult?

The purpose of this study was to evaluate the relationship between a history of childhood physical abuse and later substance abuse, controlling for family history of substance abuse. The study was a cross-sectional survey. Subjects were a convenience sample of mothers with children younger than 6 years being seen for routine care in five pediatric clinics. Mothers were given an anonymous, self-administered questionnaire on demographics, substance abuse, history of physical abuse, and family history of substance abuse. Of the 733 respondents, 24% reported having been physically abused, 24% reported a family history of substance abuse, and 36% had a positive screen for substance abuse. A positive screen for substance abuse was more common among those who reported having been abused than those who had not (47% vs 32%, p < .001). After controlling for family history of substance abuse, a history of being abused remained significantly associated with current substance abuse (odds ratio = 1.58, 95% confidence interval 1.1, 2.2). Suffering abuse during childhood is a significant risk factor for later substance abuse, even after controlling for a family history of substance abuse. Clinicians treating victims of abuse may wish to include substance abuse prevention measures.

Adolescent↗
PubMed1993

Screening mothers of young children for substance abuse.

Pediatricians have been urged to screen for parental substance abuse, but few screening instruments have been tested for mothers. We compared six screening questions for maternal alcohol and drug abuse with the Michigan Alcoholism Screening Test (MAST) and the Drug Abuse Screening Test (DAST). Questionnaires were completed by 507 mothers; most were Caucasian (78%) and married (75%). Eighteen percent were positive on the MAST, and 3% were positive on the DAST. The screening questions for drinking had a 90% sensitivity compared with the MAST; the questions about drug use had a sensitivity of 88% compared with the DAST. The MAST detected only 25% of mothers who reported physiologic tolerance to alcohol and 32% of those who reported binge drinking; the DAST failed to detect any mothers who reported using drugs in the previous 24 hours. The six screening questions about alcohol and drug use had good sensitivity, detected potential drinking problems and drug abuse missed by the MAST and DAST, and can be incorporated easily into a comprehensive psychosocial questionnaire.

Adult↗
PubMed1993

Parents in jail.

OBJECTIVE: To determine the number of children in the United States with parents incarcerated in jail and to describe the characteristics of these parents and their criminal histories. SETTING: Inmates of local jails accounting for 36.5% of the incarcerated population of the US in 1989. PARTICIPANTS: Personal interviews with 5675 inmates randomly selected from 393,553 inmates of 3312 local jails in 1989. RESULTS: 44,263 (36%) inmates had children younger than the age of 15. Fathers outnumbered mothers 10-fold; the majority were in their 20s or 30s, unmarried, and poorly educated. The vast majority of parents had a record of prior offenses, and substance abuse accounted for one third of the incarcerations. Substance abuse was reported by 84% of inmates and 95% had sought prior treatment for alcohol, drug, or other mental health problems. CONCLUSIONS: Nearly 1 of 50 children in the US has a parent in jail. Parental imprisonment is not rare, is often chronic, and is strongly associated with other psychosocial and health problems in the family. Screening for parental imprisonment potentially should be included as part of a comprehensive biopsychosocial assessment.

Adolescent↗
PubMed1993

Does excluding patients without telephones affect the results of telephone reminder studies?

Studies of the effectiveness of telephone reminders to improve the rate of appointments kept have shown conflicting results. Few have accounted for patients without telephones. We conducted a controlled clinical trial to study the effect of excluding patients without telephones in a study of telephone reminders in an urban pediatric clinic. Telephone reminders were attempted the evening before scheduled visits for 238 subjects; 259 controls received no reminders. The overall rate of kept appointments was the same (54%) for both the intervention group and the control group. In neither group was there a substantial difference in the "show" rate between patients with and without telephones (intervention group 52% versus 57%, control group 55% versus 54%). In the intervention group, the show rate was higher for those with telephones who were contacted (66%) than for those who were not (37%) (P < .001). Telephone reminders did not improve the overall rate of kept appointments but appeared to result in a significant improvement in the show rate of those who could be reached. Excluding patients who could not be reached by telephone may affect the usefulness of previous studies.

Appointments and Schedules↗
PubMed1992

The case against screening urinalyses for asymptomatic bacteriuria in children.

Screening children for asymptomatic bacteriuria to prevent pyelonephritis and renal scarring is widely recommended, but its cost-effectiveness has not been established. We reviewed published studies to determine the costs and benefits of screening toilet-trained, asymptomatic children for bacteriuria. Given the sensitivity and specificity of current screening methods (approximately 80% each) and the prevalence of bacteriuria in asymptomatic children (approximately 1% in girls and 0.03% in boys), screening 100,000 children would result in 19,897 (20%) false-positive tests; initial screening and two urine cultures to confirm the diagnosis of asymptomatic bacteriuria would miss 28% of 515 children with true bacteriuria, and cost nearly $2.9 million. There is no evidence that detection and treatment of children with asymptomatic bacteriuria prevents subsequent pyelonephritis or renal scarring. Screening for bacteriuria in asymptomatic children is costly, fails to prevent pyelonephritis or renal scarring, and should be discontinued as a part of routine well-child care.

Bacteriuria↗
PubMed1992

Screening for maternal depression in pediatric clinics.

OBJECTIVE: The purpose of this study was to assess the frequency of and risk factors for depressive disorders among mothers of young children and to compare the eight-item RAND screening instrument for depressive disorders with an easily scored three-item version of the test. DESIGN: A cross-sectional survey. SETTING: Five pediatric clinics in the Seattle-Tacoma, Washington area, two private practices, two university-affiliated teaching clinics, and the Madigan Army Medical Center pediatric clinic. PARTICIPANTS: Convenience sample of 667 English-speaking mothers who completed the depression items on an anonymous self-administered questionnaire on family health. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The results of women surveyed showed that 19% were positive for depression on the RAND instrument. Women whose survey results were positive were younger (28.2 vs 30.3 years of age), had less education (12.9 vs 14.4 years), and had lower monthly incomes ($1803 vs $2923) than those who results were not positive. Positive scores were more common among women surveyed in teaching clinics (20%) and military clinics (24%) than among women surveyed in private practices (12%), among single vs married mothers (32% vs 15%), among nonwhites vs whites (29% vs 16%), and among those with positive screening test results for drugs compared with those with negative screening test results (45% vs 17%) (P less than .01 for all comparisons). Compared with the eight-item instrument, the three-item version had a sensitivity of 100%, a specificity of 88%, and a positive predictive value of 66%. CONCLUSIONS: Depression is common among mothers of young children. The three-item version compares favorably with the eight-item RAND screening instrument for depressive disorders.

Adult↗