Amy Cassedy

The Impact of Insurance Instability on Children's Access, Utilization, and Satisfaction with Health Care

OBJECTIVES We describe instability of health insurance coverage for children aged 2 to 17 years and relate insurance instability to access, utilization and satisfaction. METHODS Three 2-year panels of the Medical Expenditure Panel Survey were used to measure insurance instability and its relationship to access, utilization, and problems with medical care. RESULTS Over a 2-year period, 53% of children were continuously insured with private coverage, 19% had continuous public insurance, 20% had a single gap in coverage, 2% had multiple gaps, and 6% were continuously uninsured. Compared with children continuously insured through private coverage, children with single or multiple gaps or who were continuously uninsured were significantly more likely to lack a usual source of care (adjusted odds ratios [AORs] = 2.3, 3.5, and 4.5, respectively), to have no well-child visits (AORs = 1.2, 2.2 and 2.4, respectively), and to have unmet medical or prescription drug needs (AORs = 4.5, 4.2 and 3.4, respectively). There were no significant differences between children continuously insured through private coverage and children with single or multiple gaps or continuously uninsured and having at least 1 problem with medical care (AORs = 0.8, 1.3, and 1.4, respectively). While there were no differences between children continuously insured through private coverage and children with multiple gaps or continuously uninsured, children with single gap in coverage were significantly more likely to report having at least one problem with medical care (AOR = 1.5). CONCLUSIONS Compared with those with continuous coverage, children with gaps in coverage--especially those with multiple gaps--are less likely to have a usual source of care and receive well-child care. The national debate should incorporate discussions of policies to promote not only expansions of coverage, but also initiatives to eliminate gaps in coverage.

The relationship of parental warm responsiveness and negativity to emerging behavior problems following traumatic brain injury in young children

Parenting behaviors play a critical role in the childs behavioral development, particularly for children with neurological deficits. This study examined the relationship of parental warm responsiveness and negativity to changes in behavior following traumatic brain injury (TBI) in young children relative to an age-matched cohort of children with orthopedic injuries (OI). It was hypothesized that responsive parenting would buffer the adverse effects of TBI on child behavior, whereas parental negativity would exacerbate these effects. Children, ages 3-7 years, hospitalized for TBI (n = 80) or OI (n = 113), were seen acutely and again 6 months later. Parent-child dyads were videotaped during free play. Parents completed behavior ratings (Child Behavior Checklist; T. M. Achenbach & L. A. Rescorla, 2001) at both visits, with baseline ratings reflecting preinjury behavior. Hypotheses were tested using multiple regression, with preinjury behavior ratings, race, income, child IQ, family functioning, and acute parental distress serving as covariates. Parental responsiveness and negativity had stronger associations with emerging externalizing behaviors and attention-deficit/hyperactivity disorder symptoms among children with severe TBI. Findings suggest that parenting quality may facilitate or impede behavioral recovery following early TBI. Interventions that increase positive parenting may partially ameliorate emerging behavior problems.

High costs of influenza: direct medical costs of influenza disease in young children.

This study determined direct medical costs for influenza-associated hospitalizations and emergency department (ED) visits. For 3 influenza seasons, children <5 years of age with laboratory-confirmed influenza were identified through population-based surveillance. The mean direct cost per hospitalized child was

Impact of Cardiac Devices on the Quality of Life in Pediatric Patients

5402, with annual cost burden estimated at

Age at injury and long-term behavior problems after traumatic brain injury in young children

44 to

Trajectories of Adherence to Airway Clearance Therapy for Patients with Cystic Fibrosis

163 million. Factors associated with high-cost hospitalizations included intensive care unit (ICU) admission and having an underlying high-risk condition. The mean medical cost per ED visit was

Exposure and Effect Assessment of Aerosolized Red Tide Toxins (Brevetoxins) and Asthma

512, with annual ED cost burden estimated at

Indirect, out-of-pocket and medical costs from influenza-related illness in young children

62 to

Intestinal Parasite Screening in Internationally Adopted Children: Importance of Multiple Stool Specimens

279 million. Implementation of the current vaccination policies will likely reduce the cost burden.

Parenting Style Is Related to Executive Dysfunction After Brain Injury in Children

Background— Cardiac rhythm devices are increasingly used in the pediatric population, although their impact on quality of life (QOL) is poorly understood. The purpose of this study was to compare (QOL) scores among pediatric device patients, healthy controls, and congenital heart disease (CHD) patients and determine the key drivers of QOL in pediatric device patients. Methods and Results— Multicenter, cross-sectional study at 8 pediatric centers of subjects aged 8 to 18 years with either a pacemaker or defibrillator was carried out. Patient–parent pairs completed the Pediatric Quality of Life Inventory and Pediatric Cardiac Quality of Life Inventory. QOL outcomes in device patients were compared with healthy controls and patients with various forms of CHD. Structural equation modeling was used to test for differences in Pediatric Cardiac Quality of Life Inventory scores among (1) device type, (2) presence of CHD, and (3) hypothesized key drivers of QOL. One hundred seventy-three patient–parent pairs (40 defibrillators/133 pacemakers) were included. Compared with healthy controls, patients with devices and their parents reported significantly lower Pediatric Quality of Life Inventory scoring. Similarly, compared with patients with mild forms of CHD, parents and patients with devices reported significantly lower Pediatric Cardiac Quality of Life Inventory scores and were similar to patients with more severe CHD. Key drivers of patient QOL were presence of implantable cardioverter-defibrillator and CHD. For patients, self-perception was a key driver of lower QOL, whereas for parents behavioral issues were associated with lower QOL. Conclusions— Patient QOL is significantly affected by the presence of cardiac rhythm devices. Whether these effects can be mitigated through the use of psychotherapy needs to be assessed.