Health outcomes

The problems often encountered in retrospective cohort studies include poor exposure data and incomplete follow-up of all individuals. The accuracy of health outcome data may also be low. 

Exposure Registries. No exposure registries for methyl parathion were located. This substance is not currently one of the compounds for which a subregistry has been established in the National Exposure Registry. The substance will be considered in the future when chemical selection is made for subregistries to be established. The information that is amassed in the National Exposure Registry facilitates the epidemiological research needed to assess adverse health outcomes that may be related to exposure to methyl parathion. 

In the recently released book on worldwide compliance issues (Adherence to Long-term Therapies, Evidence for Action),7 published by the World Health Organization, researchers indicate that the problem of noncompliance is worse in countries in the developing world than in countries in the industrialized world. Many parts of the United States have similar morbidity and mortality rates as countries in the Third World.8 Specific disease states may have significant additional noncompliance ramifications due to the development of drug-resistant strains of bacteria.9 Many times what is necessary is referral to specific clinicians for individualized treatment and monitoring to enhance compliance. The case histories provided in this text will allow you to follow what others have done in similar situations to optimally help patients succeed in improving compliance rates and subsequent positive health outcomes. 

The relationship of PbB level to systolic and diastolic blood pressure was determined in a study of 89 Boston policemen (race not specified) (Weiss et al. 1986, 1988). These policemen were under observation for health outcomes related to environmental work exposures (i.e., they had traffic exposure histories). After statistically adjusting for previous systolic blood pressure, body mass index, age, and cigarette smoking, high PbB level ( 30 pg/dL) was a significant (p=0.01) predictor of subsequent elevation in systolic blood pressure of 1.5-11 mm Hg in the working policemen with normal blood pressure. Low PbB level (20-29 pg/dL) was not a predictor of subsequent systolic blood pressure elevations. Diastolic pressure was unrelated to PbB levels. 

Children s Susceptibility. Many of the known health effects that have been associated with low level lead exposure have been detected in children who experienced lead exposures both in utero and postnatally. Considerable uncertainty remains about the relative contribution of in utero and postnatal exposures to the development of health outcomes that are expressed later in childhood. This information is important for distinguishing those health outcomes that might be mitigated during the post-natal period from those that must be mitigated by limiting in utero exposure. Considerable uncertainty also remains... 

The interaction between exposure intensity and duration of exposure in the development of neurobehavioral deficits is not understood, in part because of a lack of biomarkers of long-term lead exposure. The strongest evidence for health effects of low level lead exposures on neurodevelopmental deficits is based on relationships between measured health outcomes and PbB concentrations. Although these studies suggest that a significant amount of the variability in the health outcomes (e.g., neurobehavioral deficits) can be attributed to variability in PbB concentrations, a substantial amount of variability in the outcomes usually cannot be assigned to PbB, even after many known potential confounders have been considered (i.e., Needleman and Gatsonis 1990 Pocock et al. 1994 Schwartz 1994 Winneke 1996). 

Korrish S Harvard School of Public Health, Boston, MA Associations of in utero environmental exposures with newborn and infant health outcomes National Institute of Environmental Health Sciences... 

In Chapter 8, professor J.L. Pinto Prades of Pompeu Fabra University and X. Badla Llach of the Health Outcomes Research Unit at Santa Creu i Sant Pau Hospital take a look at the potential contribution of economic evaluation to the regulation and control of public spending on pharmaceuticals. The authors focus on observing how economic evaluation can be used in pharmaceutical policy. To this end, they distinguish and analyse the potential this instrument has in six distinct areas the approval of pharmaceuticals by health... 

In order to associate a number to represent the utility of these four outcomes we have to choose between several types of economic evaluations, basically between cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. The first of these is ruled out because it measures the health outcome in natural units. Given that the side effects of drags are of a varied nature, we need to be able to aggregate the different seriousness of these side effects in order to obtain a single utility, at least for the NSEA event. Furthermore, this utility must be comparable with that of, for example, the SER event. This is not possible with cost-effectivity. If we chose cost-utility, the utility associated with each event would be measured in QALYs gained or lost in each option. As QALYs are a universal measure of health benefit, cost-utility analysis could be appropriate for this type of decision. Lastly, cost-benefit analysis would also be appropriate, as it measures the utilities associated with each outcome in monetary terms, which reflect the willingness to pay for one of the outcomes in terms of safety and effectiveness. 

X. Bad i a Llach Consultant, Clinical Epidemiology and Public Health Department, Health Outcomes Research Unit, Sant Pau Hospital, Barcelona... 

What do patterns of observed health outcomes or even patterns of human migration suggest for sources of genetic diversity ... 

Lyseng-Williamson, K. and Plosker, G. 2002. Management of relapsing-remitting multiple sclerosis - defining the role of subcutaneous recombinant interferon-(3-la (Rebif). Disease Management and Health Outcomes 10(5), 307-325. 

But assume that those barriers are overcome and a pharmaceutical company markets an important drug based on pharmacogenomics. Assume, for example, that pharmacogenomics research allows the firm to know which 80% of the population will benefit from the drug, which 10% will receive absolutely no benefit, and which 10% will be seriously harmed by it. The short-term consequence would be to improve health outcomes of everyone, not just the 80% who would benefit but the other 20% who should not take the drug. The dynamic consequences are less clear. If such pharmacogenomic... 

In a cost-benefit analysis, both costs and consequences are valued in dollars and the ratio of cost to benefit (or more commonly benefit to cost) is computed. Cost-benefit analysis has been used for many years to assess the value of investing in a number of different opportunities, including investments (or expenditure) for health care services. Cost-effectiveness analysis attempts to overcome (or avoid) the difficulties in cost-benefit analysis of valuing health outcomes in dollars by using nonmonetary outcomes such as life-years saved or percentage change in biomarkers like serum cholesterol levels. Cost-minimization analysis is a special case of cost-effectiveness analysis in which the outcomes are considered to be identical or clinically equivalent. In this case, the analysis defaults to selecting the lowest-cost treatment alternative. Cost-utility analysis is another special case of cost-effectiveness analysis in which the value of the outcome is adjusted for differences in patients preferences (utilities) for the outcomes. Cost-utility analyses are most appropriate when quality of life is a very important consideration in the therapeutic decision. 

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