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Biomedical subjects

A J Alario

Publications and source records attributed to A J Alario.

At least 19 recordsLinked to original sources
PubMed2001

An analysis of the immunization status of preschool children enrolled in a statewide Medicaid managed care program.

OBJECTIVES: To measure immunization coverage rates for children enrolled in a statewide Medicaid managed care program and determine the impact of sociodemographic characteristics and the type of primary care provider site on immunization coverage. STUDY DESIGN: A random sample of 2000 was chosen from children between the ages of 19 and 35 months who had been continuously enrolled in the Medicaid managed care program for 1 year. Sociodemographic data and a list of primary care providers for the study children were obtained from administrative databases. Immunization histories were determined by medical record review. RESULTS: Vaccine-specific immunization rates for diphtheria-tetanus-pertussis, polio, Haemophilus influenzae type b, hepatitis B, and measles-mumps-rubella ranged from 87% to 94%, with an overall coverage rate of 75%. Overall immunization status varied by primary care provider site as follows: office-based, 72%; community health center, 75%; hospital-based clinic, 79%; and staff model health maintenance organization, 85% (chi(2) test, P =.008). CONCLUSIONS: Immunization rates compare favorably with national rates for this low-income group. Sociodemographic characteristics were not important predictors of underimmunization, but rates did vary by the type of primary care provider site.

Child Health Services↗
PubMed2001

A statewide assessment of lead screening histories of preschool children enrolled in a Medicaid managed care program.

OBJECTIVES: Despite the prominence of lead poisoning as a public health problem, recent Government Accounting Office reports indicate that only one fifth of children who are covered by Medicaid have been screened for lead poisoning. The purpose of this study was to examine the lead screening histories of children who were enrolled in a statewide, Medicaid managed care plan to determine the relative impact of the type of primary care provider site and family sociodemographic characteristics on the likelihood of being screened. The study also examined the prevalence of and risk factors for lead poisoning of children who had been screened. METHODS: A random sample of 2000 preschool-age children was chosen from those who were enrolled continuously in the statewide, expanded, Medicaid managed care program for a 1-year period and between the ages of 19 and 35 months at the end of that year. Sociodemographic characteristics and lists of primary care providers were obtained from administrative data sets. Medical record audits at primary care provider sites were performed to obtain the lead screening histories of the children, including test dates and results. RESULTS: Data on 1988 children were used for study analyses, and 80% of these children had at least 1 documented blood lead level. Children whose primary care provider was an office-based physician were less likely to be screened as compared with patients of health centers, hospital-based clinics, and staff model health maintenance organizations (68%, 86%, 89%, and 91% respectively). Variation in screening rates persisted in a multivariate analysis controlling for family sociodemographic characteristics and practice level variation. Of the 1587 children who had a documented blood lead test, 467 children (29%) had a blood lead level of >/=10 mg/dL on at least 1 test. CONCLUSIONS: Blood lead screening rates in Rhode Island's Medicaid managed care program are dramatically higher than national estimates for children who are enrolled in Medicaid. Potential explanations for this finding are 1) a high sensitization to the problem of lead poisoning in Rhode Island, 2) the primary care focus of the Medicaid program in Rhode Island facilitates the delivery of preventive services, and 3) the medical record audit approach used in this study was more comprehensive in identifying blood lead screens than techniques used in national studies. The high prevalence of elevated blood lead levels found in this study emphasizes the importance of screening among children who are enrolled in Medicaid.

Child, Preschool↗
PubMed2001

Blue balls.

Explore the source record for details and available documents.

Adolescent↗
PubMed2000

The impact of outreach efforts in reaching underimmunized children in a Medicaid managed care practice.

BACKGROUND: National immunization standards call for all primary care providers to implement immunization tracking systems that include contacting families when children are overdue for vaccines. The restructuring of Medicaid systems toward managed care models with a greater emphasis on having defined medical homes for children presents opportunities to expand the use of immunization recall systems among low-income children. OBJECTIVE: To assess the impact of telephone, mail, and a combined approach to reaching underimmunized children enrolled in a hospital-based Medicaid managed care practice. DESIGN AND METHODS: All underimmunized children younger than 6 years who had been continuously enrolled in the hospital-based Medicaid managed care practice for 3 months were randomly assigned to 1 of 4 groups: (1) control group with no intervention, (2) telephone reminder group, (3) mail reminder group, or (4) sequential mail/telephone reminder group. After a 10-week follow-up, medical records and the hospital's computerized appointment scheduling system were reviewed to determine the effect of the outreach effort on appointments made, visits attended, immunizations received, and immunization status. RESULTS: Outreach efforts had a positive impact on the proportion of children immunized and on the resulting immunization coverage rates. The percentage of children receiving immunizations during the 10-week follow-up was 4.2% (3/71) for the control group, 16.7% (10/60) for the telephone reminder group, 19.0% (12/63) for the mail reminder group, and 25.7% (18/70) for the sequential mail/telephone reminder group. The percentage of children up-to-date for all immunizations at the end of the 10-week follow-up was 2.8% (2/71) for the control group, 13.3% (8/60) for the telephone reminder group, 14.3% (9/63) for the mail reminder group, and 17.1% (12/70) for the sequential mail/telephone reminder group. Forty-eight children were seen during follow-up without receiving all indicated vaccines. CONCLUSIONS: Outreach efforts were modestly successful in reaching underimmunized children in a Medicaid managed care practice, although the lack of accurate information on telephone numbers and addresses limited the effectiveness. Missed opportunities for immunization also reduced the impact of outreach on immunization coverage. Arch Pediatr Adolesc Med. 2000;154:1243-1247.

Child↗
PubMed1999

Immunization status of children enrolled in a hospital-based medicaid managed care practice: the importance of the timing of vaccine administration.

OBJECTIVES: To evaluate the immunization status of children enrolled in a hospital-based Medicaid managed care practice and to assess the impact of the timing of vaccine administration on measured immunization rates. DESIGN AND METHODS: The medical records of all children between the ages of 19 and 35 months who were continuously enrolled in the Medicaid managed care practice for the last 6 months of 1996 were reviewed. Immunization status was determined for the following vaccines: diphtheria-tetanus-pertussis/diphtheria-tetanus-acellular pertussis (4 doses); Haemophilus influenzae type b (3 doses); poliovirus (3 doses); hepatitis B (3 doses); measles-mumps-rubella (1 dose); and overall for the basic series. Two assessment methods were used to determine the immunization status of the study children: (1) a count of all documented vaccines ("count"); and (2) only including vaccines that met minimal age and spacing intervals based on American Academy of Pediatrics and CDC recommendations ("interval assessment"). RESULTS: With the count method vaccine-specific immunization rates ranged from 88 to 95%, with overall coverage of 80% for the basic series. With the interval assessment method vaccine-specific immunization rates ranged from 74 to 92%, with overall coverage of 53% for the basic series. CONCLUSIONS: When all documented vaccines were included in the assessment, vaccine-specific immunization rates approached national goals, although overall coverage remained below 90% in this Medicaid managed care practice. The substantially lower immunization rates obtained by the interval assessment method demonstrate the importance of considering the issue of vaccine timing when interpreting immunization rates and the need for policies for revaccinating children who were immunized at less than recommended intervals. The results also have implications for provider education regarding the early administration of vaccines.

Child, Preschool↗
PubMed1999

Literacy promotion for Hispanic families in a primary care setting: a randomized, controlled trial.

BACKGROUND: Reading aloud is an important activity to prepare children to succeed in learning to read. Many Hispanic children have reading difficulties and therefore are at increased risk for school failure. METHODS: We conducted a prospective, randomized, controlled study to evaluate the effectiveness of a literacy promoting intervention delivered to low-income Hispanic families with infants. We consecutively enrolled 135 low-income Hispanic parents of healthy 5 to 11 month old infants. Families were randomly assigned to an intervention (n = 65) or control (n = 70) group. At enrollment and at two consecutive well-child visits, pediatricians gave intervention families: 1) an age-appropriate bilingual children's book, 2) a bilingual handout explaining the benefits of reading to children, and 3) literacy-promoting anticipatory guidance. Ten months after enrollment we reinterviewed 130 parents. RESULTS: Both groups were comparable at baseline. At follow-up, intervention parents were more likely to read books with their child at least 3 days/week (intervention = 66% vs control parents = 24%) and to report that reading books was one of their three most favorite things to do with their child (intervention = 43% vs controls = 13%). Intervention families also had a greater number of children's books and total books at home. Using a multiple logistic regression model, controlling for child and parental age, reading habits, and English proficiency, we found that the odds of parents reading to their child at least 3 days/week were 10 times greater in intervention families (OR 10.1, 95% CI 4.0-25.6) compared with control families. CONCLUSIONS: This simple, culturally appropriate intervention significantly increased literacy behaviors in low-income Hispanic families.

Adult↗
PubMed1997

Child temperament, parenting discipline style, and daytime behavior in childhood sleep disorders.

Fifty-two children without significant sleep disturbance seen at a primary care clinic for well-child care were compared on measures of temperament, parenting style, daytime behavior, and overall sleep disturbance to three diagnostic subgroups identified in a pediatric sleep clinic: children with obstructive sleep apnea (n = 33), parasomnias (night terrors, sleepwalking, etc.) (n = 16), and behavioral sleep disorders (limit-setting disorder, etc.) (n = 31). The mean age of the entire sample was 5.7 years. Temperamental emotionality in the behavioral sleep disorders group was associated with a higher level of sleep disturbance (p < .001); parenting laxness was associated with sleep disturbance in the general pediatric population (p < .01); and intense and negative temperament characteristics seemed to be associated with clinically significant behavioral sleep disturbances. Ineffective parenting styles and daytime disruptive behaviors were more likely to be associated with the milder sleep disturbances found in children in a primary care setting.

Analysis of Variance↗
PubMed1996

Encopresis treatment outcome: long-term follow-up of 45 cases.

Among children diagnosed and treated for encopresis (N = 88) at either of two incontinence clinics between 1986 and 1994, 45 could be assessed for long-term (>12 months) outcome. Measures consisted of retrospective analysis of clinical charts and parent report of child soiling status. At follow-up (mean duration 53 months, range 15 to 99 months), 26 children (58%) were in remission, 13 (29%) were improved, and six (13%) showed no improvement. Logistic regression showed that children who presented with no previous encopresis treatment(s) (odds ratio 5.88, 95% confidence interval 1.61 to 21.55, p < .01) and/or children who presented with fecal retention (odds ratio 17.8, 95% confidence interval 2.70 to 153.37, p < .01) were more likely to be in remission. The interval between treatment and follow-up was significantly longer (mean 62 months, range 26 to 94) for children in remission than for children still soiling (mean 45 months, range 15 to 75) (p < .01). At follow-up 1 year or more after treatment for encopresis, a significant number of children may continue to soil. Previous encopresis treatment(s) and/or nonretentive encopresis may be risk factors for persistent soiling. The chances of complete remission of encopresis tend to increase with the passage of time.

Behavior Therapy↗
PubMed1995

The relationship between oxygen saturation and the clinical assessment of acutely wheezing infants and children.

The objective of this study was to determine the relationship between oxygen saturation (Sao2) and traditional clinical assessment measures in infants and young children presenting as outpatients with acute wheezing. To accomplish this, Sao2 before and after medication was compared in a post hoc analysis with the clinical response to treatment (respiratory rate and a standardized index of respiratory distress) in children who participated in a randomized, placebo controlled medication trial. The study was done in a pediatric emergency department and outpatient clinic, and the participants were 74, full-term previously well infants and young children, aged 1 to 36 months (mean age 16.1 months), presenting with acute wheezing and participating in the randomized trial. The results showed that Sao2 was found to be inversely correlated with both respiratory rate (r = -0.29, P < or = 0.05) and an index of respiratory distress (r = -0.36, P < or = 0.01) prior to medication but not afterward. There was no significant difference in Sao2 when infants, who had a clinical response to treatment based on a priori criteria, were compared to nonresponders (mean difference per patient: responders = 0.86% vs nonresponders = 0.79%, P = 0.51). This was due to a large amount of individual variability in postmedication Sao2 in both groups. We conclude that, before therapy, there are only weak correlations between SaO2 and both respiratory rate and an index of respiratory distress in acutely wheezing infants and children. After therapy, young children can appear clinically improved but measured oxygen saturation may be variable and not correlated with traditional clinical assessment measures.

Acute Disease↗
PubMed1995

Is continuity of care preserved in children who utilize the pediatric emergency department?

OBJECTIVE: Inner city families often use multiple sites for nonemergent medical care, including the pediatric emergency department. This practice raises concerns about continuity of care. The present study examined one aspect of continuity of care: Do children who receive care in a pediatric emergency department return to their primary care site so that appropriate follow up may be obtained? METHODS: Over a 4-week period two groups of neighborhood health center children were studied: Those who sought care at the pediatric emergency department and those who were "walk-ins" at the health centers. All visits during the 4-week study period which resulted in a recommendation for the child to be seen within 6 weeks at the health centers were included in the analysis. RESULTS: During the study period there were 87 patient visits to the pediatric emergency department with a documented physician instruction to be seen at their health center within 6 weeks. In 66 (76%) of the cases, the patient was seen at one of the health centers during the 6 weeks following the pediatric emergency department visit. There were 146 "walk-in" visits to the health centers with a documented physician instruction to be seen again at the health centers during the 6 weeks following the walk-in visit. In 111 (76%) of the cases, the patient was seen during the 6-week period. CONCLUSION: Our study shows that revisit rates were comparable for the two groups. We conclude that the rate of compliance with follow-up recommendations is similar for those who utilized the pediatric emergency department versus those who used the primary care site.

Adolescent↗
PubMed1994

Communication behaviors of infants of teen mothers. An exploratory study.

PURPOSE: To study the relationship between mother-infant interaction and an infant's preverbal communication skills among a group of teenage mothers and their infants, 13 teenage mother-infant pairs were videotaped in a free-play setting. The infants were then videotaped in a structured setting, with an examiner, designed to elicit preverbal communication behaviors. Mothers were < 17 years old and from low SES backgrounds. Their infants were 9-12 months old, full-term, first born, and developmentally normal. METHODS: Mothers' interactions were assessed from the free-play setting using the Parent-Infant Interaction Scale. The infants' preverbal communication behaviors were measured using the Communication and Symbolic Behavior Scales. Both the frequency of communication behaviors and the range of purposes of these behaviors were assessed. RESULTS: A significant correlation was identified between a mother's interaction scores and the range of purposes for which her infant used communication behaviors (p < 0.01). No correlation was found between maternal interaction scores and the frequency of communication behavior. CONCLUSIONS: Infants whose mothers scored poorly on the Parent-Infant Interaction Scale used most of their communication behaviors to demand or protest. Infants from more optimally interacting dyads used communication behaviors for social interaction and commentary as well as to demand or protest. Maternal interaction and an infant's early communication skills appear to be related in this exploratory study.

Adolescent↗
PubMed1994

Appropriate use of a pediatric emergency department: is the pediatrician called before the visit?

The objective of this study was to examine the appropriateness of utilization of an urban pediatric emergency department (ED) by children who had a pediatrician and factors relating to whether the pediatrician was called before an ED visit. This was done prospectively and randomly in an urban teaching hospital pediatric ED. One hundred and sixty-six patients, 18 years old and younger, who presented for nontraumatic conditions and had a pediatrician, classified as private or nonprivate, were enrolled. A questionnaire was completed and appropriateness of visit was determined using previously published criteria. No difference in appropriateness of visit was found between private and nonprivate patients (58/98, 40/68, NS). Thirty-five of 54 (65%) parents who called their pediatrician were classified as an appropriate ED visit as opposed to 62 of 112 who did not call (55%, NS). Private patients called their physicians more often then nonprivate patients (P < 0.001). Lack of access to their primary care providers was the more common reason among nonprivate patients (P < 0.05) for not calling their pediatricians. We conclude that appropriateness of pediatric ED visits is independent of type of physician. Nonprivate patients tend to consult their physician less often before ED visits because of access problems.

Child, Preschool↗
PubMed1994

Access to care among children visiting the emergency room with acute exacerbations of asthma.

To determine differences in access to continuing and preventive care among pediatric patients utilizing the emergency room for treatment of acute exacerbation of asthma, families of 170 asthma patients aged 2 to 17 years were surveyed prospectively. An interview schedule instrument generated information about socioeconomic factors, source of medical care including maintenance and specialty care, medication use, and plans for management of asthma exacerbations. A primary physician or clinic could be identified by 162 patients (95%). Regular preventive therapy (cromolyn, theophylline, or steroids) was used by 45 patients (27%). Allergy evaluations had been previously performed for 59 patients (35%). "Come to Emergency Room" was part of the asthma management plan for 56 patients (33%) and was the only asthma management plan for 34 patients (20%). Logistic regression analysis found that black and Hispanic patients (odds ratio = 0.38) and patients with Medicaid (odds ratio = 0.43) were less likely to call their MD or clinic prior to reporting to the emergency room. Patients with Medicaid were more likely to have two or more prior emergency room visits compared with a group of patients with private insurance and self-paying patients (odds ratio = 4.17). While the majority of patients in this study could identify a source of primary care, patients on Medicaid were significantly less likely to access continuing and preventive care and more likely to utilize the emergency room.

Adolescent↗