Childhood Lead Poisoning in Wisconsin.

INTRODUCTION: In 2016, 4,353 Wisconsin children under 6 years of age were identified with elevated blood lead levels (≥ 5 µg/dL). There is no safe level of lead in the human body; extensive research shows that children with blood lead levels < 5 µg/dL may still be at risk for adverse health effects including developmental delays. DISCUSSION: Physicians should follow current guidelines and consider factors such as the child's age, socioeconomic status, and housing situation when determining need for testing. In addition to Wisconsin's screening recommendations, federal requirements exist for testing Medicaidenrolled children. Under state statute, all blood lead test results and specified demographic information must be reported to the Wisconsin Childhood Lead Poisoning Prevention Program. To eliminate elevated blood lead levels, primary prevention is key. Physicians play an important role by educating parents, prospective parents, and caregivers about lead poisoning risks and prevention measures. Physicians are also vital in secondary prevention-mitigating the adverse effects in children already exposed to lead. Secondary prevention requires first identifying children with elevated blood lead levels through appropriate testing. Use of the Wisconsin Blood Lead Registry can alert providers about children with elevated blood lead levels and reduce duplicate testing. Recent surveillance data show current screening is inadequate; in 2015, only 32% of Medicaid-enrolled children received appropriate testing. Physicians should provide clinical management for children with elevated blood levels and their families. CONCLUSIONS: Physicians are a vital partner in preventing, identifying, and mitigating the effects of elevated blood lead levels for Wisconsin's children.

Using Medicaid Data to Improve Childhood Lead Poisoning Prevention Program Outcomes and Blood Lead Surveillance.

CONTEXT: Wisconsin-specific data revealed that not all Medicaid providers were testing children appropriately for blood lead levels and not all blood lead tests were reported to the Department of Health Services, Childhood Lead Poisoning Prevention Program. The Medicaid program requires blood lead screening for all Medicaid-enrolled children at specific ages. Wisconsin state law requires reporting of all blood lead test results. Projects were implemented to encourage appropriate testing for Medicaid-enrolled children and improve blood lead surveillance. METHODS: Medicaid billing data were linked to blood lead data to identify Medicaid-enrolled children who had not received the required tests. Medicaid provider report cards were distributed annually from 2006 to 2011 to inform providers of their compliance with federal testing requirements and of the names of children within their practice who had not been tested. Blood lead tests billed to Medicaid but not in the blood lead database were identified and billing providers were contacted to obtain the test report. RESULTS: The number of children tested increased from 81 834 children per year in 2006 to 106 003 children per year in 2010. Testing of Medicaid-enrolled children increased by 31% from 2006 to 2010. The percentage of Medicaid-enrolled children receiving an age-appropriate test increased from 46% in 2004 to a high of 55% in 2010. There were 9035 blood lead tests identified in the Medicaid billing data that had not been reported from 2007 to 2015. There were 468 billing providers who had unreported tests. All sites with unreported tests were contacted, 84% of test results were obtained, and 14% of test records could not be retrieved. Outpatient clinics accounted for the majority of all unreported tests (72%) and irretrievable test records (74%). DISCUSSION: Childhood lead poisoning prevention programs can effectively utilize Medicaid data to increase testing and improve blood lead surveillance. Primary health care providers should ensure that Medicaid-enrolled children in their care receive the age-appropriate tests. Many Wisconsin health care providers lack awareness of blood lead test reporting requirements. Outpatient clinics account for the largest proportion of unreported tests and highest priority should be given working with these sites to improve reporting practices.

Using environmental public health tracking to identify community targets for public health actions in childhood lead poisoning in Wisconsin.

OBJECTIVE: In an effort to improve the ability of local public health departments to target resources to the highest need regions, the Wisconsin Environmental Public Health Tracking (WI EPHT) Program worked to enhance its public portal to benefit the Wisconsin Childhood Lead Poisoning Prevention Program (WCLPPP) and other programs. The WI EPHT Program conducted this enhancement in collaboration with WCLPPP. DESIGN/SETTING: The WI EPHT enhanced public portal is the next phase of Wisconsin's ongoing efforts in environmental public health tracking. As part of this process, this new mapping application includes mapping capacity that provides information on childhood lead testing and results at county and census tract levels in Wisconsin. METHODS: The WI EPHT Program will update its public portal to have the capability to map data at a subcounty level (ie, census tract or zip code) for some data topics when such data are available. RESULTS: This tool is available to local public health departments and other public health organizations throughout Wisconsin as a resource to identify communities most affected by the Centers for Disease Control and Prevention's new guidelines with regard to childhood lead poisoning. CONCLUSIONS: The collaboration between WI EPHT and WCLPPP on updating and enhancing the portal exemplifies the power of environmental health data to inform a more accurate understanding of public health problems.

Cognitive Set and Coping Strategy Affect Mothers' Sensitivity to Infant Cries: A Signal Detection Approach.

We used Signal Detection methodology to examine how cognitiveset affects mothers' response to an infant cry. We asked whether a cry from a "difficult" versus an "easy" infant would elicit a change in sensitivity or response bias in mother processing of these cries. Thirty-eight mothers of 4- to 6-month-old infants participated in a Signal Detection task in which they were asked whether they could detect differences between a standard cry and 1 to 4 cry variants. Cry variants differed from the standard cry in small, systematic changes in fundamental frequency. The task was conducted in 2 parts; each part constituted a condition wherein mother received a cognitive set manipulation that labeled the identical cry as coming from either a''difficult''or an "easy" infant. An increase in mothers' sensitivity was associated with the "difficult" infant cognitive set. We examined as well how a coping strategy(illusion of control) affected cry signal processing. Mothers who Exhibited high illusory control were least -sensitive in detecting differences between cries. Two information-prcessing, measures response time and heart rate, were also collected and showed that greater sensitivity was associated with more efficient processing of the cry signal.