Pediatrics
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Comparative Study
Reduction in racial and ethnic disparities after enrollment in the State Children's Health Insurance Program.
Racial/ethnic disparities are associated with lack of health insurance. Although the State Children's Health Insurance Program (SCHIP) provides health insurance to low-income children, many of whom are members of racial/ethnic minority groups, little is known about whether SCHIP affects racial/ethnic disparities among children who enroll. ⋯ Enrollment in SCHIP was associated with (1) improvement in access, continuity, and quality of care for all racial/ethnic groups and (2) reduction in preexisting racial/ethnic disparities in access, unmet need, and continuity of care. Racial/ethnic disparities in quality of care remained, despite improvements for all racial groups. Sociodemographic and health system factors did not add to the understanding of racial/ethnic disparities. SCHIP improves care for vulnerable children and reduces preexisting racial/ethnic disparities in health care.
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Comment Letter Comparative Study
Oral versus intravenous rehydration of moderately dehydrated children.
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Parenting practices have been linked with an array of adolescent health-compromising behaviors, but little is known about their possible long-lasting effects. In this study, we estimate the extent to which parental monitoring, parental involvement and reinforcement, and coercive parental discipline during primary school might exert a durable influence on the risk of transitioning into an early stage of youthful cannabis involvement, ie, the first chance to try cannabis. ⋯ Early-onset cannabis involvement can be hazardous. Certain parenting practices in the mid-primary school years may have a durable impact, perhaps helping to shield youths from having a chance to try cannabis throughout adolescence and into young adulthood.
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To endeavor to explain why some graduates of extracorporeal membrane oxygenation (ECMO) therapy develop sensorineural hearing loss (SNHL) whereas others do not, to study the variability seen in the degree of SNHL, to attempt to explain why some graduates with SNHL experience progressive worsening whereas others do not, and to describe the time course of the onset of SNHL on the basis of identified risk factors. ⋯ These findings illustrate the need for early, routine, audiologic evaluations throughout childhood for all ECMO graduates. Children at even greater risk for developing SNHL because of a history of congenital diaphragmatic hernia, prolonged ECMO therapy, and/or a lengthy course of aminoglycoside antibiotic therapy should be monitored even more closely throughout childhood, depending on the child's individual risk indicators, as suggested here. On the basis of these risk indicators, efforts can be made to minimize the risk of hearing loss while a child is being treated with ECMO. In addition, these risk indicators can assist with counseling families of ECMO graduates regarding the child's specific risk of developing SNHL and how it can be managed should it occur.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cardiovascular support for low birth weight infants and cerebral hemodynamics: a randomized, blinded, clinical trial.
Maintaining adequate organ blood flow is the target of vasopressor treatment, but the impact of these measures on cerebral perfusion has not yet been evaluated systematically in a randomized, blinded, clinical trial. ⋯ Among hypotensive LBW infants, cardiovascular support with low/moderate-dose DP or low-dose EP increased cerebral perfusion, as indicated by the increase in both CBV and HbD. Low-dose EP was as effective as low/moderate-dose DP in increasing MBP among LBW infants.