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Biomedical subjects

L E Barker

Publications and source records attributed to L E Barker.

11 recordsLinked to original sources
PubMed2001

National, state and urban-area vaccination-coverage levels among children aged 19-35 months, United States, 1999.

BACKGROUND: Assessment of vaccination coverage is an important component of the U.S. vaccination program and is primarily measured by the National Immunization Survey (NIS). METHODS: The 1999 NIS is a nationally representative sample of children aged 19 to 35 months, verified by provider records, that is conducted to obtain estimates of vaccination coverage rates. Coverage estimates are calculated for the nation, states, and selected urban areas for recommended vaccines and selected vaccine series. RESULTS: Coverage estimates are presented by a variety of demographic and healthcare-related factors: overall, by poverty status, race/ethnicity, selected milestone ages, participation in WIC, level of urbanicity, provider participation in VFC, and by provider facility type. In 1999, national coverage estimates were high for most vaccines and among most demographic groups. State and urban-area level estimates varied.

Aid to Families with Dependent Children↗
PubMed2001

Changes in vaccination coverage estimates among children aged 19-35 months in the United States, 1996-1999.

BACKGROUND: Childhood vaccinations have a major impact on the reduction and elimination of many causes of morbidity and mortality among children. Monitoring of annual vaccination coverage levels over time is necessary to characterize undervaccination. Here, coverage estimates for 1996 (1997 for varicella) were compared with those of 1999. METHODS: Immunization coverage among children aged 19 to 35 months in 1996 (1997 for varicella) and 1999 for a variety of vaccines and vaccine series were compared using Wald chi-square tests and data from the National Immunization Survey. RESULTS: Record high immunization coverage among children aged 19 to 35 months in the United States has increased by a statistically significant amount between 1996 and 1999 for diphtheria, tetanus, and pertussis; measles, mumps, and rubella; Haemophilus influenzae type b; hepatitis B; and standard series made up of these individual vaccines. Coverage with the vaccine for varicella dramatically increased between 1997 and 1999. However, between 1996 and 1999, coverage with three or more doses of polio vaccine decreased by a small but statistically significant amount. CONCLUSION: Despite the drop for polio vaccine, coverage remains high. Continued monitoring is required to determine if the drop in polio coverage is a cause for concern.

Child, Preschool↗
PubMed2001

Health department clinics as pediatric immunization providers: a national survey.

OBJECTIVE: To describe a national sample of health department immunization clinics in terms of populations served, patient volume trends, services offered, and immunization practices. METHODS: Telephone survey conducted with health departments sampled from a national database, using probability proportional to population size. RESULTS: All (100%) 166 sampled and eligible clinics completed the survey. The majority of pediatric patients were uninsured (42%) or enrolled in Medicaid (34%). Most children (69%) and adolescents (70%) were referred to the health department, with only 12% using these clinics as a medical home. A number of clinics (72%) reported recent increases in adolescents served. Less than 25% of clinics offered comprehensive care, 47% conducted semiannual coverage assessments, and 76% and 38% operated recall systems for children and adolescents. Storage of records in an electronic database was common (83%). CONCLUSIONS: Although the majority of these clinics do not provide comprehensive care, they continue to serve vulnerable children, including adolescents, Medicaid enrollees, and the uninsured, and may represent the main contact with the healthcare system for such patients. Because assuring the immunization of these children is essential to their health and the health of our nation as a whole, this immunization safety net must be preserved. Experience implementing key recommendations such as coverage assessment and feedback as well as reminder or recall may enable health department staff to assist private provider colleagues. Further research is needed to investigate how patient populations, services offered, and immunization practices vary by different clinic characteristics.

Adolescent↗
PubMed1991

The total artificial heart.

In the early 1800s, an awareness of potential ventricular failure stimulated interest in artificial heart replacement. In 1937 the first total artificial heart (TAH) was implanted into the chest of a dog by Russian physicians. The primary driving force for mechanical cardiac assistance developed from the necessity for circulatory assistance in order to perform corrective cardiac surgery. In 1953 the first successful closure of an atrial septal defect using extracorporeal circulation was performed. During the following decade the concept of using mechanical devices to assist the failing heart was aggressively pursued. This culminated in the first implant of a TAH in a human in 1969 as a bridge to transplant. Clinical implant of the TAH as a permanent device was performed in 1982 by researchers at the University of Utah. This patient lived for 112 days. Three successive permanent implants were performed in Louisville, Kentucky, with one patient surviving for 620 days. All of these permanent TAH patients suffered from device-related complications including bleeding, infection, and thromboembolic events. It became apparent that the present configuration of the TAH with its external drive lines and large air console was not ideal for long-term support. In 1985 the first implant of the Symbion J-7-100 TAH (Jarvik-7) as a bridge to transplant was performed. This patient was supported by the device for 9 days and was successfully transplanted and discharged home. Since 1985 more than 170 patients have been bridged using the Symbion J-7 TAH with more than 70% of these patients being successfully transplanted. The incidence of thromboembolic events has dramatically reduced with better understanding of anticoagulation requirements. Infection continues to be the greatest potential complication with these patients. In spite of this, the pneumatic TAH has proved to be an adequate bridge to transplant device.

Equipment Design↗
PubMed1989

Initial experience with the HEMOPUMP.

Preclinical and clinical trial investigations are now underway for a variety of ventricular assist devices at centers around the country. The current progress of the HEMOPUMP is encouraging, and survival rates show the potential for a successful outcome. This article describes the HEMOPUMP system, and discusses patient description and clinical experience with the system.

Adult↗