Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Expenditures”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources
PubMed2005

Predicting walking METs and energy expenditure from speed or accelerometry.

PURPOSE: a) Compare the predictive potential of speed and CSA(hip) (Computer Science Applications accelerometer positioned on the hip) for level terrain walking METs (1 MET = VO2 of 3.5 mL.kg(-1).min(-1)) and energy expenditure (kcal.min(-1)); b) cross-validate previously published CSA(hip)- and speed-based MET and energy expenditure prediction equations; c) measure self-paced walking speed, exercise intensity (METs) and energy expenditure in the middle aged population. METHODS: Seventy-two 35- to 45-yr-old volunteers walked around a level, paved quadrangle at what they perceived to be a moderate pace. Oxygen consumption was measured using the criterion Douglas bag technique. Speed, CSA(hip), heart rate, and Borg rating of perceived exertion were also monitored. RESULTS: Speed explained 10% more variance of walking METs than CSA(hip). Speed and mass explained 8% more variance of walking energy expenditure (kcal.min) than CSA(hip) and mass. The best previously published regression equations predict our walking METs and energy expenditures within 95% prediction limits of +/- 0.7 METs and +/- 1.0 kcal.min(-1), respectively. Women paced themselves at a significantly higher mean speed (5.5 km.h(-1)) and intensity (4.1 METs) than their male counterparts (5.2 km.h(-1) and 3.8 METs). Both genders expended approximately 0.75 kcal.kg(-1) for every kilometer of level terrain walked. CONCLUSION: Speed-based MET and energy expenditure predictions during level terrain walking were more accurate than those utilizing CSA(hip).

Acceleration↗
PubMed2006

Energy expenditure estimated by accelerometry and doubly labeled water: do they agree?

PURPOSE: The purpose of this study was to compare energy expenditure derived from regression equations determined from accelerometry with energy expenditure obtained from the doubly labeled water method (DLW). METHODS: Thirteen subjects participated in a 7-d protocol during which total daily energy expenditure (TDEE) was measured with DLW. Simultaneously, during the 7 d, subjects wore a Tritrac-R3D and an Actigraph (ACT). Pearson and concordance correlations and one-sample t-tests were used to determine the agreement of six Tritrac and eight ACT regression equations that convert body acceleration to energy expenditure with the DLW measurements. RESULTS: Tritrac TDEE determined from the different Tritrac regression equations under- and overestimated TDEE determined with DLW that ranged from -10 to +101%. For ACT, the percent difference between DLW and ACT-TDEE determined with the regression equation developed by Hendelman and Swartz were not statistically significantly different from zero. The mean of the difference was -2 and -4%, but the range of the difference was large for both equations, -29 to +24%. TDEE determined with the six other ACT equations were significantly different compared with DLW. CONCLUSION: Of the 14 different regression equations from the literature, only two developed for ACT compared favorably with DLW; however, the difference in TDEE between these two methods was variable and rather large. These results reemphasize the difficulty in converting body movement into energy expenditure on an individual basis from accelerometry. These results imply that researchers may want to avoid using accelerometers to predict energy expenditure in free-living conditions, instead using these instruments only to measure patterns of physical activity.

Acceleration↗
PubMed1991

[Industrial hygienic study on nursing activities. I. Investigation on heart rate and energy expenditure of ward nurses by nursing activity].

Using a Holter electrocardiograph (ECG), we recorded the heart rates of ward nurses by working hours and nursing activity. Energy expenditure was calculated from the heart rate data and nurse work lord was evaluated. The following results were obtained. 1) Average heart rates were 77 (beats/min) for day-shift nurse in surgical ward, 76 for evening-shift nurse in mixed, ward, and 74 for night-shift nurse in mixed ward. 2) The energy expenditures per day were calculated to be 3,474 kcal for day-shift nurse in surgical ward, 3,060 kcal for evening-shift nurse in mixed ward, and 3,238 kcal for night-shift nurse in mixed ward. 3) The energy expenditures during working hours were 2,110 kcal/510 min for day-shift nurse in surgical ward, 1,805 kcal/495 min for evening shift nurse, and 2,014 kcal/570 min for night-shift nurse in mixed ward. 4) The highest energy expenditures of nurse engaged in direct nursing care were 834 kcal (39.5%) for day-shift nurse in surgical ward, 632 kcal (34.9%) for evening-shift nurse in mixed ward, and 790 kcal (39.2%) for night-shift nurse in mixed ward. 5) The longest working hours were 174 min (34.1%) in assisting with medical examinations and treatment by day-shift nurse, 155 min (31.3%) in direct care by evening-shift nurse, and 222 min (39.0%) by night-shift nurse. The results indicate that the energy expenditure calculated from the average heart rate of ward nurses in higher than that of other types of workers. The reason for this difference is discussed in this report. Also, this study showed that the energy expenditure determined by this method does not necessarily increase in proportion to working hours.

Adult↗
PubMed1997

Otitis media-related antibiotic prescribing patterns, outcomes, and expenditures in a pediatric medicaid population.

BACKGROUND: Treatment of otitis media is the most frequent reason for administering antibiotics to children in the United States. However, only limited data are available on medical effectiveness of antibiotic prescribing patterns for otitis media and their associated expenditures or the factors that influence antibiotic prescribing. METHODS: The study population consisted of 131 169 children during 1991 and 157 065 children during 1992 who were </=13 years of age and enrolled in Colorado's fee-for-service Medicaid program. Among these children, 5127 (1991) and 7254 (1992) were enrolled in the cohort treated for a "new" episode of acute otitis media. An analysis using this cohort was performed to document the antibiotics used to treat a new episode of acute otitis media, factors influencing antibiotic selection, and the short-term outcomes of therapy. An analysis using the entire Medicaid population was performed to document the annual use of antibiotics for otitis, the associated antibiotic expenditures, and factors influencing antibiotic selection. RESULTS: In the cohort analysis, office-based physicians prescribed second- and third-generation cephalosporins more often than did physicians in other settings (17% vs 9.7% and 11.8%), whereas hospital clinics prescribed trimethoprim plus sulfamethoxazole more frequently than did office-based physicians (19.2% vs 7.1% and 10.9%). Family physicians prescribed second- and third-generation cephalosporins more often than did pediatricians (16.6% vs 12.3%) but trimethoprim plus sulfamethoxazole and erythromycin plus sulfisoxazole less often than did pediatricians (10.5% vs 17%). The average rate of prescribing a second course of antibiotics within 24 days after initial antibiotic treatment of a new acute otitis media episode was 11.6% when less expensive antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, or erythromycin plus sulfisoxazole) were prescribed, and 13.2% when more expensive antibiotics (cefaclor, amoxicillin plus clavulanate, or cefixime) were prescribed. The average adverse drug reaction rate was 5.9% when less expensive antibiotics were prescribed, compared with 6.1% when more expensive antibiotics were prescribed. In each of the two study years, amoxicillin accounted for almost half of the total antibiotic fills but only 9% to 10% of the expenditures. Low-cost antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, and erythromycin plus sulfisoxazole) were prescribed for 66% to 67% of the total fills and accounted for 21% of the total projected expenditures. More expensive antibiotics (cefaclor, cefixime, amoxicillin plus clavulanate) prescribed for 30% of the fills generated 76% to 77% of expenditures. Cefaclor, prescribed for 17% to 18% of the total fills, generated 43% to 45% of total antibiotic expenses. CONCLUSIONS: The findings of this study document a preference for amoxicillin as the initial antibiotic for a new episode of acute otitis media. Although there was a wide variation in the selection of antibiotics to treat otitis, the more expensive antibiotics were not associated with better outcomes. This wide variation has important financial implications because of differences in antibiotic costs. Changes in prescribing patterns among initially uncomplicated children that reduce the use of high-cost antibiotics could reduce expenditures substantially without compromising short-term outcomes.

Acute Disease↗
PubMed1998

Developmental changes in energy expenditure and physical activity in children: evidence for a decline in physical activity in girls before puberty.

OBJECTIVE: To examine individual changes in energy expenditure and physical activity during prepubertal growth in boys and girls. METHODS: Total energy expenditure (TEE), resting energy expenditure, physical activity-related energy expenditure, reported physical activity, and fat and fat-free mass were measured three times over 5 years in 11 boys (5.3 +/- 0.9 years at baseline) and 11 girls (5.5 +/- 0.9 years at baseline). RESULTS: Four-year increases in fat ( approximately 6 kg) and fat-free mass ( approximately 10 kg) and resting energy expenditure ( approximately 200 kcal/day) were similar in boys and girls. In boys, TEE increased at each measurement year, whereas in girls, there was an initial increase from age 5.5 (1365 +/- 330 kcal/day) to age 6.5 (1815 +/- 392 kcal/day); however, by age 9.5, TEE was reduced significantly (1608 +/- 284 kcal/day) with no change in energy intake. The gender difference in TEE changes over time was explained by a 50% reduction in physical activity (kcal/day and hours/week) in girls between the ages of 6.5 and 9.5. CONCLUSIONS: These data suggest a gender dimorphism in the developmental changes in energy expenditure before adolescence, with a conservation of energy use in girls achieved through a marked reduction in physical activity.

Basal Metabolism↗
PubMed2003

Health care utilization and expenditures associated with child care attendance: a nationally representative sample.

OBJECTIVE: Participation in center-based child care among preschool-aged children is associated with an increased incidence of communicable illness. Although estimates of health care utilization and costs associated with child care attendance exist in other countries with different health care systems, nationally representative data for the United States are lacking. The objective of this study was to determine the patterns of health care utilization and costs associated with attendance at different types of child care, among a nationally representative sample of preschool-aged children. METHODS: A nationally representative sample of children aged 0 to 5 years enrolled in the Medical Expenditure Panel Survey, 1997 Cohort were studied. Data were analyzed by cross-sectional analysis within a single calendar year. The Rand Health Insurance experiment 2-part multivariate regression model was used to accommodate skewed expenditure data. RESULTS: A total of 871 children were included in the study. A total of 484 (56%) attended no child care provided by anyone other than their primary caregiver; 134 (15%) attended center-based child care; 76 (9%) attended friend or neighbor care; and 170 (20%) attended in-home or relative care. In a weighted multivariate model, children in center-based child care were more likely than those not in child care to have attended at least 1 office-based visit (adjusted odds ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.0-7.9) and emergency department visit (aOR: 2.0; 95% CI: 1.1-3.6) and to have received a medication prescription (aOR: 2.8; 95% CI: 1.2-6.1). The adjusted 2-part model predicted total health care expenditures for those not attending child care to be 642 dollars (95% CI: 508-813), versus 985 dollars (95% CI: 714-1336) for a similar population in center-based child care. Expenditure data for office-based visits and medication prescriptions mirrored these trends. CONCLUSION: In the immediate term, children in center-based child care tend to use more health care services. This increased utilization translates into modest per-child differences in health care expenditures. We hypothesize that this pattern of utilization and expenditure is attributable primarily to a higher incidence of minor, self-limited, communicable illness among children in center-based child care.

Child Care↗
PubMedDate not supplied

Heart rate as a predictor of energy expenditure in people with spinal cord injury.

This study evaluated the accuracy of heart rate calibrated from a maximum exercise test for predicting energy expenditure during five activities of daily living (ADL) in participants with spinal cord injury (SCI). Thirteen individuals with SCI underwent maximum exercise testing, followed by portable heart rate and metabolic testing during five ADL. A regression equation was developed from heart rate and oxygen uptake responses during the maximum exercise test for each subject. Based on this individualized equation, heart rate measured during the ADL was used to estimate energy expenditure for each participant. Predicted energy expenditure from heart rate was compared with that measured by indirect calorimetry with the use of oxygen uptake. Heart rate derived from the individualized regression equations explained 55% of the variance in measured energy expenditure, compared with only 8.3% from heart rate alone. However, calibrated heart rate consistently overestimated the actual kilocalories used; on average, the estimated energy expenditure was roughly 25% higher than that measured by oxygen uptake. Heart rate can be used as a gross estimate of energy expenditure during higher-intensity ADL in people with SCI when individual calibration of heart rate from maximum exercise testing is used.

Activities of Daily Living↗
PubMed1997

State variations in Medicare expenditures.

OBJECTIVES: This study examined variations in Medicare expenditures across states. METHODS: 1992 data on average Medicare expenditures per enrollee, users of services per 1000 enrollees, service use per user, and payment per unit of service were compared across states for various services. Weighted least squares regression analysis was employed to examine total Medicare expenditures per enrollee by state. RESULTS: Variation in Medicare expenditures across states is driven more by average number of service users per 1000 enrollees and average service units per user than by average payment per service unit. Medicare expenditures per enrollee by state are primarily a function of Medicare HMO penetration rate (P = .000), urban area (P = .001), hospital bed supply (P = .005), elderly mortality rate (P = .012), Medicare physician assignment rate (P = .026), percentage of primary care practitioners (P = .042), and interactions between urban elderly and percentage of primary care physicians (P = .005) and Black elderly and nursing home bed supply (P = .012). CONCLUSIONS: Before sweeping Medicare cuts are undertaken or excessive reliance on managed care occurs, attention should be focused on the current disproportionate distribution of expenditures across states.

Aged↗
PubMed2005

Using policy simulation to predict drug plan expenditure when planning reimbursement changes.

BACKGROUND: Drug plan decision makers need accurate financial impact projections before the implementation of new drug policy initiatives. Tools for such projections need to have small margins of error and be based on methodology that is easy to communicate to stakeholders. Ad hoc methods typically used for financial impact projections by health plans are inadequate. OBJECTIVE: To present a flexible tool for projecting the financial impact of drug policy changes based on historical dispensing data and simulation, and explore its validity using a recent example of a complex drug policy change in British Columbia, Canada. METHODS: A policy simulator (SAS) program using a Web browser interface) was used to produce 3-year forecasts of expenditure (for the drug plan and for individual families) along with the number of patients who would pay more or less for their drugs (stratified by age and income level) for various proposed drug policies starting in 2003. Drug expenditure under each policy was simulated based on projections from prescription claim records of the British Columbia PharmaNet database of community pharmacy prescriptions from 1 January 2001 to 31 December 2001. The simulator selected a random 1% sample of British Columbia families (175,000 families) in the database. Once the new drug policy was selected and implemented, the accuracy of the predictions were tested by comparing the actual PharmaCare expenditure for the period 1 May 2003 to 31 March 2004 after implementation of the new drug policy with the final simulation made for this policy in February 2003, 2 months before the policy was implemented. RESULTS: The policy simulation tool produced hundreds of variations for decision makers in the months before the final policy rules were decided upon. When compared with actual drug expenditure after policy implementation, it was found that the tool had predicted spending with <1% error for the first 11 months after introduction of the policy. As well as producing accurate expenditure forecasts for the insurer, the tool was able to predict how family out-of-pocket expenditure would be affected. CONCLUSIONS: The simulator aided drug policy planning and communication. The tool provided rapid and accurate results that were communicated easily to decision makers. Such policy simulation can be applied to a wide range of health plans and policy changes.

Aged↗
PubMed1995

Estimation of daily minimum energy expenditure in free-moving rats and mice.

In this paper, we presented a new procedure to determine daily minimum energy expenditure (MEE) in free-moving rats and mice kept in a chamber. Energy expenditure was measured for 23 h period and averaged every 10 min. Data were sorted in ascending order. MEE was estimated from the regression line with the smallest slope and the biggest intercept among the regression lines calculated between the sorted energy expenditure and the data ranking. Among three duplicate measurements in individual animals, MEE gave the smallest coefficient of variation (2.2%) as compared with actual measured-values: either the single lowest value (4.0%) or the average of the 6 lowest values (2.5%). Judging from diurnal patterns of energy expenditure and locomotor activity and from video tape observation of the rat's performance, it was confirmed that MEE represented an energy expenditure at rest. MEE decreased with fasting from days 1 to 5. MEE per body weight also declined with age, but stayed around 71-72 kcal/day/kg3/4 at 18 and 34 weeks of age in male Wistar rats. MEE in mice increased at lower ambient temperatures between 16 and 32 degrees C, but stayed fairly constant at the same temperature in repeated experiments. Thus, MEE estimated by the present regression procedure was highly reproducible and valid to determine the fundamental value of daily energy expenditure under free-moving conditions.

Aging↗
PubMed2006

Energy expenditure in hospitalized patients: implications for nutritional support.

An understanding of energy expenditure in hospitalized patients is necessary to determine optimal energy supply in the care of individuals who require nutritional support. A review was conducted of 19 studies in which resting energy expenditure (REE) had been measured using indirect calorimetry and compared with estimated basal energy expenditure (BEE) from the Harris-Benedict equation. Studies of patients with burns, head injuries, and fever were excluded because REE is known to be increased in these conditions. The studies reported data on 1256 patients with the following diagnoses: postoperative (28%), trauma or sepsis (26%), cancer (18%), pulmonary disease (9%), cardiovascular disease (2%), miscellaneous (9%), and unspecified (6%). The average REE in the 19 studies was 113% of the BEE. The mean +/- SD REE/BEE ratio was higher in 11 studies in which the REE was measured during feeding than in 5 studies in which the measurement was made during fasting (117% +/- 3% vs 105% +/- 4%; P = .047). In those 11 studies, overfeeding may have contributed to higher REE values than otherwise would have been observed. Some evidence indicated that the REE/BEE ratio is higher in more severe illness, but results were inconsistent. Unfortunately, little information is available concerning total energy expenditure, which includes the contribution of physical activity. It appears that most patients can be fed adequately with energy equal to 100% to 120% of estimated BEE. Hypoenergetic feeding may be appropriate in some overweight and obese individuals. Additional research in hospitalized patients on total energy expenditure and on the relationship between severity of illness and energy expenditure is needed.

Basal Metabolism↗
PubMed2005

Potential savings from substituting generic drugs for brand-name drugs: medical expenditure panel survey, 1997-2000.

BACKGROUND: Generic substitution is one mechanism of curtailing prescription drug expenditures. Limited information is available about the potential savings associated with generic substitution. OBJECTIVE: To estimate the potential savings associated with broad substitution of generic drugs. DESIGN: Cross-sectional, nationally representative survey of noninstitutionalized adults. SETTING: United States. PARTICIPANTS: Adults included in the Medical Expenditure Panel Survey Household Component, 1997-2000. MEASUREMENTS: Use of a multisource drug (that is, a drug available in a brand-name and > or =1 generic formulation) or a generic drug and the potential cost savings associated with broad generic substitution for all multisource products. RESULTS: Fifty-six percent of all outpatient drugs were multisource products, accounting for 41% of total outpatient drug expenditures. Of these multisource drugs, 61% were dispensed as a generic. If a generic had been substituted for all corresponding brand-name outpatient drugs in 2000, the median annual savings in drug expenditures per person would have been 45.89 dollars (interquartile range, 10.35 dollars to 158.06) for adults younger than 65 years of age and 78.05 dollars (interquartile range, 19.94 dollars to 241.72 dollars) for adults at least 65 years of age. In these age groups, the national savings would have been 5.9 billion dollars (95% CI, 5.5 billion dollars to 6.2 billion dollars) and 2.9 billion dollars (CI, 2.6 billion dollars to 3.1 billion dollars), respectively, representing approximately 11% of drug expenditures. LIMITATIONS: Specific information about an individual's formulary was not available, so the authors could not estimate how much of the potential savings would benefit an individual or his or her health plan. CONCLUSION: Although broad substitution of generic drugs would affect only a modest percentage of drug expenditures, it could result in substantial absolute savings.

Adolescent↗
PubMed2000

Higher sedentary energy expenditure in patients with Huntington's disease.

Weight loss is common among patients with Huntington's disease (HD), although the mechanisms contributing to this phenomenon are not known. We measured 24-hour sedentary energy expenditure (24-hour EE) and sleeping metabolic rate (SMR) in a human respiratory chamber in 17 patients with mild to moderate HD and 17 control subjects matched for age, sex, and body mass index. Total energy expenditure was measured during 7 days in free-living conditions, using the doubly labeled water technique. Body weight, fat mass, and fat-free mass (measured by dual-energy x-ray absorptiometry) were similar in patients with HD and control subjects. Twenty-four-hour EE was 14% higher in HD patients than controls in absolute terms (2,038+/-98 vs 1,784+/-68 kcal/24 hours) and after adjustment for age, sex, fat mass, and fat-free mass (1,998+/-45 vs. 1,824+/-45 kcal/24 hours). In contrast, SMR and total energy expenditure were similar in patients and controls both in absolute terms (1,314+/-38 vs 1,316+/-42 and 2,402+/-102 vs. 2,373+/-98 kcal/24 hours, respectively) and after adjustment. Spontaneous physical activity measured by radar in the chamber and the ratio of 24-hour EE to SMR were significantly higher in HD patients than controls (11.4+/-1.4 vs 6.1+/-0.6% and 1.54+/-0.05 vs 1.36+/-0.03, respectively). In the group as a whole, 24-hour EE/SMR correlated with spontaneous physical activity. Among HD patients, both 24-hour EE/SMR and spontaneous physical activity correlated with the severity of chorea, but SMR and total energy expenditure did not. There were no differences in reported energy intake during 7 days in patients with HD compared with controls. The results of this study indicate that sedentary energy expenditure is higher in patients with HD than in controls in proportion to the severity of the movement disorder. Total free-living energy expenditure is not higher, however, because patients with HD appear to engage in less voluntary physical activity.

Adult↗
PubMed1996

Expenditures on family dental care by active duty soldiers.

Expenditures on family dental care by U.S. active duty soldiers were explored in this 1992 worldwide survey. Of 9,560 respondents (62% response rate), 7,187 claimed dependents and 5,569 provided reliable data. Mean annual expenditures and multinomial regression on a distribution of expenditures were calculated. Results show average family dental care expenditures were as follows: total sample, $135; childless couples, $59; couples with children, $154; and single parents, $120. Between 72 and 83% of families spent $0 on dental care. Excluding non-spenders, overall expenditures averaged as follows: total sample, $531; childless couples, $354; couples with children, $560; and single parents, $470. Regression results show that expenditures on family dental care by soldiers are influenced by different factors depending on family composition. Policy measures to encourage optimal dental care by families of active duty soldiers should focus on increasing insurance coverage and use.

Adult↗
PubMed2001

Energy expenditure and physical activity of obese and non-obese Thai children.

The objective of this study was to assess the energy expenditure and physical activity in obese (n=21) and non-obese (n=21) children (aged 9-12 years) in Bangkok. Anthropometric measurements were performed. Energy expenditure and physical activity were determined by indirect calorimetry (based on oxygen consumption) and the heart rate monitoring method. Physical activity index was calculated by the ratio of total energy expenditure (TEE) to sedentary energy expenditure (SEE). The results showed that obese children had significantly greater (p<0.05) body weight, body mass index, relative weight, body fat (%), fat mass except for height, and fat free mass than the non-obese group. The TEE, SEE, and activity energy expenditure (AEE) were higher (p<0.05) in the obese children when compared with the non-obese ones. The mean values of respiratory quotient (RQ) were 0.91+/-0.06 in obese and 0.89+/-0.08 in the non-obese group, respectively, indicating the contribution of carbohydrate substrate to energy production. Both obese and non-obese children were similar in the physical activity index level of 1.48+/-0.17 and 1.51+/-0.22, respectively, which was lower than that recommended by the World Health Organization (1.7). In conclusion, energy expenditure of obese children was higher than non-obese children because of greater body weight. Furthermore, the physical activity of both groups was lower than that recommended by WHO. To prevent obesity in children, programmimg of exercise and activities as well as nutritional education should be emphasized for school children and parents.

Anthropometry↗
PubMed2002

[Energy expenditure: method employed].

Energy expenditure (or energy needs) corresponds to the energy required for the body to work under all circumstances. This is the energy that should be taken (with food) to maintain energy balance, i.e. the constancy of body weight. Energy is expended at rest (referred to as basal or resting metabolic rate), when food is consumed (diet induced thermogenesis) and with physical activity. In obese people, energy expenditure is increased because of the proportion between body mass and energy expenditure. There is no definite proof that there is a metabolic defect in obese persons by which energy expenditure would be lower than expected for body mass. Hence obesity can only be the result of a positive energy balance. Energy expenditure can be measured by indirect calorimetry or estimated with equations. These equations use factors as weight, age, gender and sometime height. These equations are generally valid although there is a need for more validation studies. This paper also describes in which clinical circumstances the measurement or the estimate of energy expenditure are useful for the care of obese patients.

Basal Metabolism↗
PubMed2003

Sleeping energy expenditure in paediatric patients with obstructive sleep apnoea syndrome.

OBJECTIVE: To investigate sleeping energy expenditure in paediatric patients with obstructive sleep apnoea syndrome. DESIGN: Retrospective study. Setting. University teaching hospital, Hong Kong. PATIENTS AND METHODS: A retrospective analysis comparing sleeping energy expenditure in patients with confirmed obstructive sleep apnoea syndrome and control subjects matched for age, sex, and ideal weight for body height. Subjects were recruited from the Paediatric Chest Clinic and all had undergone overnight polysomnography and sleeping energy expenditure measurement by open-circuit indirect calorimetry using a metabolic cart and canopy system. The measurements were taken during slow-wave sleep. RESULTS: Twenty-four cases with obstructive sleep apnoea syndrome (apnoea hypopnoea index >5) and 23 control subjects were studied. Mean age and ideal weight for body height were 9.4 (standard deviation, 3.9) years and 152.5% (27.2%), respectively. Mean sleeping energy expenditure corrected for body weight for the cases and the control group were 44.83 (standard deviation, 10.49) Kcal/day and 40.71 (10.60) Kcal/day, respectively. Sleeping energy expenditure was not found to be associated with the severity of obstructive sleep apnoea syndrome (r=0.34, P=0.27). CONCLUSION: A trend towards greater sleeping energy expenditure was found in patients with obstructive sleep apnoea syndrome. Further studies on the metabolic aspects of this condition are required.

Calorimetry, Indirect↗
PubMed2004

[Simple method to detect factors influencing drug expenditures].

BACKGROUND: Analysis of drug expenditures as part of an assessment of various forms of management interventions is rarely reported. Several strategies have been used to decrease injudicious drug use: restricted availability of specific drugs under formulary instructions, educational programs for prescribing practices and streamlining to discontinue or limit therapy. Each intervention has limited effectiveness. OBJECTIVE: To detect factors influencing drug expenditures by a simple and accessible method. METHOD: Data analysis on drug utilization and expenditures was performed according to the "Pareto" technique and changes were calculated. Changes in expenditure due to inflation were also calculated; the cost value of each drug in 2000 was multiplied by its quantity used in years 2000 and 2001. Comparison of expenditures using this method of calculation enabled us to find the inflation rate of the drugs used in the hospital. RESULTS: Five important factors were found to have an impact on the pharmacy budget and calculations: drug inflation rate (-1%), new drugs introduced through the Pharmaceuticals & Therapeutic Committee (1.9%), extended usage of drugs due to new approved clinical indications (0.7%), opening of new services or widening of special old services (3.4%) and usage of commonly high volume prescribed drugs in various wards of the hospital (-8.9%). Quantities and costs for the 80 most expensive pharmaceuticals showed factors responsible for the drug expenditure when compared with the leading drug classes, as well as with leading drugs. Antimicrobials (27.5%), high volume IV infusions (11.0%), small volume infusions (8.5%), and anticoagulants (6.7%) were the most prominent drug classes that contributed to the high cost of the drug budget. Small volume infusions of Sodium Chloride 0.9% (7.8%), Piperacillin and tazobactam injections (5.6%). Ofloxacin & Ciprofloxacin drugs (4.7%), and Enoxaparin injections (4.6%) were the highest costing drugs. CONCLUSION: This simple method based on comparison of costs, utilization and judicious drug use, can provide accurate information that can be useful in planning and implementing a reasonable drug budget.

Costs and Cost Analysis↗