Pediatrics
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Traumatic brain injury (TBI) is a common, acquired disability that may be used as a model to understand the impact of early brain injury on brain structure and function. To date, few studies have followed very young children over time after insult. ⋯ This study has confirmed the high risk of persisting and global deficits associated with severe brain insult in early childhood. Contrary to previous speculation about "growing into deficits," children with severe brain insults have more protracted recovery periods but do not continue to lose ground compared with their peers. By 30 months after insult, recovery seems to stabilize and children begin to make appropriate developmental gains.
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Comparative Study
What factors are associated with state performance on provision of transition services to CSHCN?
To examine whether individual, condition-related, and system-related characteristics are associated with state performance (high, medium, low) on the provision of transition services to children with special health care needs (CSHCN). ⋯ Key factors found to be important in a state's performance on provision of transition services to CSHCN were race/ethnicity and having a medical home and adequate insurance coverage. Efforts to support the Maternal and Child Health Bureau's integration of system-level factors in quality-improvement activities, particularly establishing a medical home and attaining and maintaining adequate insurance, are likely to help states improve their performance on provision of transition services.
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We hypothesized that pressure reactivity index (PRx) values indicating preserved cerebrovascular pressure autoregulation would be associated with survival in children with traumatic brain injury (TBI). This hypothesis was tested in a prospective, blinded, observational, pilot study. ⋯ Intact cerebrovascular pressure reactivity quantified with the PRx is associated with survival after severe head trauma in children. The PRx is CPP dependent in children. The PRx may be useful for defining age-specific and possibly patient-specific optimal targets for CPP after TBI.
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In this study we examined geographic disparities in medical home access among US children with special health care needs (CSHCN) aged 0 to 17 years. ⋯ Although individual-level sociodemographic and state-level health policy variables are important predictors of access, substantial geographic disparities remain, with CSHCN in several western and northeastern states at high risk of not having a medical home.
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The goal was to elicit perspectives of selected health insurance plan medical or quality improvement directors regarding factors related to coverage and reimbursement and perceptions of financing as a barrier to child and adolescent immunization. ⋯ Although these data suggest that health insurance coverage for recommended vaccines is high, coverage is not universal across all products offered.