PubMed Health⌕ Search

Biomedical subjects

Ronald D Barr

Publications and source records attributed to Ronald D Barr.

41 records · Page 3Linked to original sources
PubMed2002

Health status and health-related quality of life associated with hemophilia.

The hemophilias are a group of disorders associated with a chronic burden of morbidity and early mortality. Improvements in these adverse features have been achieved by the use of clotting factor concentrates within comprehensive centers of specialized care providing home infusion programs. Offsetting effects from transfusion-transmitted hepatitis and HIV infection are in recent decline. The net impact of these changes merits assessment. To test the a priori hypotheses that increasing severity of factor VIII deficiency would be associated with an increasing burden or morbidity and that hepatitis and HIV positivity would impair health status further, a cross-sectional study of a population-based cohort was undertaken in a regional hemophilia program in Ontario, Canada. A survey was made of mild, moderate, and severe hemophiliacs over 13 years of age who self-reported their health status using a standard 15-item questionnaire. The responses were converted to levels in the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) health status classification systems to form multi-element vectors from which single-attribute morbidity and overall health-related quality of life utility scores were determined. The burden of morbidity was greater in hemophiliacs than in the general population and correlated with the category of disease (mild < moderate < severe). Hepatitis and HIV positivity conferred additional burdens of morbidity, which were mainly in the attributes of mobility (HUI2), ambulation (HUI3), and pain (HUI2/3), all of these differences reaching levels of statistical significance. Despite demonstrable improvements in the safety, effectiveness, and utilization of clotting factor concentrates, hemophiliacs continue to experience an important burden of morbidity. Measurement of this burden, as reported here, provides a basis for future economic evaluation of the costs and consequences of health care interventions provided to this population.

Adolescent↗
PubMed2002

The importance of lowering the costs of stem cell transplantation in developing countries.

The effectiveness and efficiency of health care systems can be assessed by economic evaluation, comparing the costs and outcomes of alternative interventions. Direct costs include accommodation, nursing, physicians' fees, diagnostic tests and treatment. Indirect costs derive from the loss of a persons ability to use life in a productive way e.g. employment. In cost-effectiveness analyses, cost is the numerator and effectiveness (related to health outcomes) is the denominator. The unit of measurement of effectiveness is usually years of life saved. Cost utility analyses require a preference-based measurement of health-related quality of life (HRQL) to allow the calculation of utility scores for health states and so the adjustment of effectiveness for quality. Typically, this allows the calculation of quality-adjusted life years (QALYs). A review of published reports, to be presented in detail, yields the following summation. The greater cost of stem cell harvest from peripheral blood is more than offset by the reduced costs associated with a shorter hospital stay. Transplants early in first remission cost less than those undertaken at later points in disease evolution/treatment experience. Changing the primary locus of care from inpatient to outpatient may result in notable cost savings but can produce cost-shifting (from inpatient to outpatient). Nevertheless, in selected patient, the use of non-myeloablative transplants may offer a cost-effective option, especially in the developing country context.

Cost Control↗
PubMed2002

Osteopenia in survivors of Wilms tumor.

Diminished bone mass (osteopenia) is recognized increasingly as a consequence of therapy in survivors of cancer in childhood. It has been reported in two small series of survivors of Wilms tumor. The objectives of this study were to explore, in a larger sample of such subjects, the prevalence of osteopenia and a possible relationship between osteopenia of the lumbar spine and abdominal irradiation. All survivors of Wilms tumor (n=49) in a single institution were considered eligible for study. Thirty-one agreed to participate; the non-participants were not notably different in their demographic characteristics and diseases/treatment experience. Information was obtained about prior treatment, and usual diet, sun exposure and physical activity. Bone mineral content was measured by dual energy X-ray absorptiometry, and biochemical markers of bone turnover, calciotropic hormones and minerals were assessed in a single blood sample. By Z-scores of whole body bone mineral content, 8 subjects were osteopenic. This was unrelated to milk intake or sun exposure and was not more common in the lumbar spine of those who had been irradiated (15/31 subjects). Physical activity correlated positively with bone mineral density Z-scores (p<0.005). Normal bone formation was reflected in normal blood levels of osteocalcin. C-telopeptide levels, reflecting bone resorption, were high but approximately correlated inversely with maturity. Low serum magnesium and parathyroid hormone levels were detected in a minority of subjects. Osteopenia is present in a large minority (27%) of survivors of Wilms tumor, and an imbalance of bone turnover (with excessive resorption) may be common. Irradiation does not appear to play a causal role. It is possible that a subtle renal tubular defect exists in these individuals; a prospect worthy of further exploration.

Adolescent↗