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PubMed1993

[Industrial hygienic study on nursing activities. II. Investigation on heart rate and energy expenditure of ward nurses on shift].

By using a Holter electrocardiograph (ECG), we calculated the heart rates of ward nurses on day shift which included different activities. Energy expenditure was calculated from the heart rate data and nurse work load was evaluated. The following results were obtained. 1) Average heart rates during working hours were 86 (beats/min) in children ward nurses, 77 in ophthalmology ward nurses, 85 in surgery ward nurses, 85 in mixed ward nurses, 85 in neurosurgery ward nurses, 81 in circulatory organs ward nurses and 83 in ICU ward nurses. 2) The energy expenditures were calculated to be 1,891 kcal in children ward nurse on day shift, 1,866 kcal in ophthalmology ward nurses, 1,969 kcal in surgery ward nurses, 1,899 kcal in mixed ward nurses, 1,976 kcal in neurosurgery ward nurses, 1,873 kcal in circulatory organs ward nurses and 1,744 kcal in ICU ward nurses. 3) The highest energy expenditures in direct nursing care were 918 kcal (48.3%) in mixed ward nurses; in assisting medical examination and treatment, 770 kcal (39.1%) in surgery ward nurses and in indirect nursing care, 679 kcal (35.9%) in children ward nurses. 4) The longest working hours in direct nursing care were 217 min (42.5%) in neurosurgery ward nurses; in assisting medical examination and treatment, 193 min (37.8%) in surgical ward nurses and in indirect nursing care, 207 min (40.5%) in children word nurses. The results indicated that the energy expenditure calculated from the average heart rate of ward nurses on day shift was very high in all wards. The attributable causes are discussed in this report.

Adult↗
PubMed1998

[Energy expenditure in adolescent students in night school].

OBJECTIVE: It is well-known that energy expenditure provides a feasible way to measure the individual's energy needs. The final aim of this paper was to discover the level of physical activity and to quantify the energy expenditure of adolescents who either participated, otherwise, in the labor market. METHODS: This paper focussed on the evaluation of the energy expenditure of 273 students of both sexes attending the evening period of six schools belonging to the State School Network of Santo André, State of S. Paulo, Brazil, through a self-applied questionnaire dealing with their physical, occupational and discretionary activities. RESULTS: Data revealed that the students who were employed worked from 40 to 50 hours a week, earning a monthly salary varying from 1 to 3 Brazilian minimum wages. Watching television was the discretionary activity most frequently referred to. The energy expenditure of these students was 3,000 and 2,100 calories for boys and girls, respectively. CONCLUSIONS: The results found indicated that the students who were on the labor market did not expend more energy than those who were not.

Adolescent↗
PubMed2001

[Analysis of household expenditures with food in the city of S. Paulo in the 1990's].

OBJECTIVE: To identify food consumption patterns in the city of S. Paulo, from 1990 to 1996, and compare these patterns with those derived from nutritionally balanced food baskets (FB). METHODS: Household budget surveys were verified and the percentage of food expenditures was assessed according to three food groups: semi-elaborated, industrialized and non-processed food (an emphasis was given to this group). Data on prices to consumer were used to evaluate the relative cost of the products and their influence on household budgets. FB were elaborated using linear programming. RESULTS: From 1990 to 1996, there was a relative increase in household expenditures with industrialized foods and a relative decrease with semi-elaborated foods. The percentage of expenditures with non-processed group revealed an important reduction (35%), but these changes cannot be fully explained by variations in products' prices. Results indicated that household consumption patterns differ from those recommended in the FB and the cost of almost all FB was lower than the actual household expenditures with food. CONCLUSIONS: An inadequate nutritional consumption in São Paulo's households is probable, which carry the risks associated with an insufficient ingestion of vegetables and fruits.

Brazil↗
PubMedDate not supplied

Energy expenditure after 2- to 3-hour elective surgical operations.

UNLABELLED: Energy expenditure was measured by indirect calorimetry in 17 adult patients (8 women and 9 men) before surgery, 4 hours immediately after surgery, and 24 hours late after surgery in patients undergoing elective surgery of small-to-medium scope. MATERIAL AND METHODS: The total duration of surgery ranged from 2 to 3 hours. Repeated measures were performed on the same patient, so that each patient was considered to be his/her own control. All patients received a 5% dextrose solution (2000 mL/day) throughout the postoperative period. RESULTS: Men showed a reduction in CO2 production during the immediately after surgery period (257+/-42 mL/min) compared to before surgery (306+/-48 mL/min) and late after surgery (301+/-45 mL/min); this reduction was not observed in women. Energy expenditure was also lower in men during immediately after surgery (6.6 kJ/min). None of the other measurements, including substrate oxidation, showed significant differences. CONCLUSION: Therefore, elective surgery itself cannot be considered an important trauma that would result in increased energy expenditure. According to this study, it is not necessary to prescribe an energy supply exceeding basal expenditure during the immediate after-surgery period. The present results suggest that the energy supply prescribed during the postoperative period after elective surgery of small-to-medium scope should not exceed 5-7 kJ/min, so the patient does not receive a carbohydrate overload from energy supplementation.

Adolescent↗
PubMed2004

Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients.

STUDY OBJECTIVE: To determine which of four commonly used equations to estimate energy expenditure is precise and unbiased compared with energy expenditure as measured by indirect calorimetry. DESIGN: Retrospective, observational study. SETTING: Adult medical intensive care unit in a research hospital of the National Institutes of Health Clinical Center. PATIENTS: Seventy-six adult, mechanically ventilated, critically ill patients. INTERVENTION: Indirect calorimetry reports generated by the National Institutes of Health Critical Care Medicine Department's Metabolic Cart Consult Service were reviewed. Bias and precision of resting energy expenditure (REE) estimated by equations were computed using mean prediction error (ME) and root mean squared prediction error (MSE). Equations were considered precise if the 95% confidence interval for MSE was within 15% of the measured energy expenditure (MEE) determined by indirect calorimetry. Equations were considered unbiased if the 95% confidence interval for ME included zero. Paired t tests were used to compare estimated REE values for each predictive equation with MEE values determined by indirect calorimetry. Data were stratified into regions of bias using classification and regression tree analysis, as well as visual inspection of estimated REE-versus-MEE curves for each equation. MEASUREMENTS AND MAIN RESULTS: The Harris-Benedict equation multiplied by an activity factor of 1.2 was unbiased and precise. The Ireton-Jones equation was precise but biased. The American College of Chest Physicians' consensus recommendation was biased and imprecise. The Harris-Benedict equation without an activity factor also demonstrated bias and imprecision. CONCLUSIONS: The Harris-Benedict equation multiplied by an activity factor of 1.2 is suitable for predicting REE and may be used in the absence of indirect calorimetry.

Adult↗
PubMed2002

Impact of generosity level of outpatient prescription drug coverage on prescription drug events and expenditure among older persons.

OBJECTIVES: This study examined the impact of drug coverage generosity on older persons' prescription events (fills) and expenditures. METHODS: A cross-sectional study was conducted of 6237 older persons from the 1995 Medicare Current Beneficiary Survey. Dependent variables were per capita prescription events and expenditures. Independent variables were insurance type and drug coverage generosity. Control variables included sociodemographic and health status factors. RESULTS: Regardless of insurance type, per capita prescription events increased as drug coverage generosity improved and then decreased at the most generous level. Per capita prescription expenditures increased as generosity improved; with generous prescription coverage, prescription expenditures were approximately 3 times those with Medicare only. CONCLUSIONS: Even when factors that affect drug use and insurance selection are controlled, prescription coverage generosity influences prescription use.

Aged↗
PubMed2006

Energy expenditure in maximal jumps on sand.

The purpose of this study was to comparatively investigate the energy expenditure of jumping on sand and on a firm surface. Eight male university volleyball players were recruited in this study and performed 3 sets of 10 repetitive jumps on sand (the S condition), and also on a force platform (the F condition). The subjects jumped every two seconds during a set, and the interval between sets was 20 seconds. The subjects performed each jump on sand with maximal exertion while in the F condition they jumped as high as they did on sand. The oxygen requirement for jumping was defined as the total oxygen uptake consecutively measured between the first set of jumps and the point that oxygen uptake recovers to the resting value, and the energy expenditure was calculated. The jump height in the S condition was equivalent to 64.0 +/- 4.4% of the height in the maximal jump on the firm surface. The oxygen requirement was 7.39 +/- 0.33 liters in S condition and 6.24 +/- 0.69 liters in the F condition, and the energy expenditure was 37.0 +/- 1.64 kcal and 31.2 +/- 3.46 kcal respectively. The differences in the two counter values were both statistically significant (p < 0.01). The energy expenditure of jumping in the S condition was equivalent to 119.4 +/- 10.1% of the one in the F condition, which ratio was less than in walking and close to in running.

Adult↗
PubMed1993

Drug expenditure and new drug introductions: the Swedish experience.

This article measures the impact of the switch to new and more expensive drugs on the aggregate drug expenditure (both prescription and nonprescription) in Sweden during the period 1974 to 1991, and also on the disaggregated expenditure for 3 medical areas: asthma, hypertension and peptic ulcer disease. During the period studied, nominal drug expenditure increased 6-fold. The retail price index of drugs and the number of prescribed drugs accounted for 51.6 and 5.8% of this increase, respectively. The remaining residual amount accounted for 42.6%. Since the price index of drugs increased more slowly than the overall net price index of goods and services, the relative price of drugs decreased dramatically by about 30%. This means that increases in prices of drugs cannot explain the increase in real inflation-adjusted drug expenditure. We also show that the residual increase can be partly explained by the introduction of new and more expensive drugs. It is therefore argued that economic evaluations which compare the extra costs induced by new drugs with the extra benefits should be undertaken to guide decisions about the prescription of new and more expensive drugs.

Asthma↗
PubMed1997

General practitioner fundholding and prescribing expenditure control. Evidence from a rural English health authority.

In April 1991, the fundholding and indicative prescribing schemes introduced budgets for expenditure on prescribed drugs into UK general practice. Although both schemes were designed to be equally effective at containing prescribing-cost inflation, several studies suggest that expenditure growth has been lower in fundholding practices, compared with nonfundholding practices. This study attempts to ascertain how fundholding practices control their expenditure by examining data from a rural English health authority for the financial year 1993 to 1994. The fundholding practices sampled were found to control their expenditure through: (i) reduced overprescribing; (ii) using fewer drugs that have limited clinical value; (iii) substituting similar, but less expensive, drugs; (iv) more generic prescribing; and (v) appropriate use of expensive preparations. However, whether the cost differential between fundholding and nonfundholding practices is sustained in future years will depend upon: (i) the ability of fundholding practices to generate further savings; (ii) the characteristics of the practices that enter the fundholding scheme in subsequent waves; (iii) the way in which the scheme is organised; and (iv) the level at which budgets are set.

Cost Control↗
PubMed2001

A Ser311Cys mutation in the human dopamine receptor D2 gene is associated with reduced energy expenditure.

Brain dopaminergic pathways play a major role in the control of movement. Absence of the murine dopamine D2 receptor gene (drd2) produces bradykinesia and hypothermia. A Ser311Cys mutation of the human DRD2 produces a marked functional impairment of the receptor and is associated with higher BMI in some populations. We hypothesized that the Ser311Cys mutation of DRD2 may inhibit energy expenditure. Here we report that total energy expenditure (doubly labeled water) measured in 89 nondiabetic Pima Indians was 244 kcal/ day lower in homozygotes for the Cys311-encoding allele when compared with those heterozygous and homozygous for the Ser311-encoding allele (P = 0.056). The 24-h resting energy expenditure (respiratory chamber) measured in 320 nondiabetic Pimas was also 87 kcal/day lower in homozygotes for the Cys311-encoding allele when compared with those heterozygous and homozygous for the Ser311-encoding allele (P = 0.026). These findings are the first evidence that a genetic mutation is associated with reduced energy expenditure in humans. Because the impact of this mutation on human obesity is small, we suggest that either the energy deficit induced is not large enough to significantly influence body weight in this population and/or that the Cys311-encoding allele is also associated with reduced energy intake.

Adult↗
PubMed2004

The effect of liraglutide, a long-acting glucagon-like peptide 1 derivative, on glycemic control, body composition, and 24-h energy expenditure in patients with type 2 diabetes.

OBJECTIVE: Glucagon-like peptide (GLP)-1 is a gut hormone that exerts incretin effects and suppresses food intake in humans, but its therapeutic use is limited due to its short half-life. This was a randomized, double-blind, parallel-group, placebo-controlled trial investigating the effect of the long-acting GLP-1 derivative liraglutide (NN2211) on glycemic control, body weight, body composition, and 24-h energy expenditure in obese subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: Thirty-three patients (mean +/- SD) aged 60.0 +/- 9.5 years, with HbA(1c) 7.5 +/- 1.2% and BMI 36.6 +/- 4.1 kg/m(2), were randomized to treatment with a single daily subcutaneous dose of 0.6 mg liraglutide (n = 21) or placebo (n = 12) for 8 weeks. In addition to weight and glycemic parameters, body composition was assessed by dual-energy X-ray absorptiometry (DEXA) scanning and 24-h energy expenditure in a respiratory chamber. RESULTS: After 8 weeks, liraglutide reduced fasting serum glucose (liraglutide, -1.90 mmol/l, and placebo, 0.27 mmol/l; P = 0.002) and HbA(1c) (liraglutide, -0.33%, and placebo, 0.47%; P = 0.028) compared with placebo. No change in body weight was detected (liraglutide, -0.7 kg, and placebo, -0.9 kg; P = 0.756). There was a nonsignificant trend toward a decrease in total fat mass (liraglutide, -0.98%, and placebo, -0.12%; P = 0.088) and toward an increase in lean body mass (liraglutide, 1.02%, and placebo, 0.23%; P = 0.118) in the liraglutide group compared with the placebo group. Twenty-four-hour energy expenditure was unaffected by the treatment (liraglutide, -12.6 kJ/h, and placebo, -13.7 kJ/h; P = 0.799). CONCLUSIONS: Eight weeks of 0.6-mg liraglutide treatment significantly improved glycemic control without increasing weight in subjects with type 2 diabetes compared with those on placebo. No influence on 24-h energy expenditure was detected.

Blood Glucose↗
PubMed1995

Circadian changes in energy expenditure in the preruminant calf: whole animal and tissue level.

A study was conducted using four preruminant calves to determine the contribution of portal-drained viscera, liver, and hindquarters to circadian changes in total energy expenditure, after removing variations due to behavioral patterns. Indirect calorimetry and in vivo arterio-venous techniques were used. Standing time was longer (P < .01) after the meals and shorter (P < .01) at night. These variations were associated with higher (P < .01) energy cost of standing immediately after the meals and lower (P < .01) ones at night. When these behavioral effects were removed, total energy expenditure of lying calves was shown to be stable between the morning and evening meal, to increase by 11.5% and remained elevated during the 6 h after the evening meal, and to reach the lowest values at night. Portal-drained viscera and liver contributed 32.8 to 53.7% and 29.1 to 32.2%, respectively, to the circadian variations calculated for calves that were always standing. Changes in splanchnic tissue energy expenditure resulted from combined modifications in blood flow and O2 extraction rate. The contribution of hindquarters could not be clearly established. Overall, portal-drained viscera, liver, and hindquarters contributed 17.2, 12.8, and 18.0%, respectively, to total energy expenditure of standing calves. Their respective in vivo metabolic activities averaged 1.08, 2.10, and .25 mumol of O2 consumed.min-1.g-1 of fresh tissue.

Animals↗
PubMed1996

Energy expenditure and fatiguability in paraplegic ambulation using reciprocating gait orthosis and electric stimulation.

To clarify the relationship between metabolic energy expenditure and fatiguability in paraplegic persons fitted with orthoses, we measured energy consumption in six thoracic paraplegic patients ambulating by means of reciprocating gait orthosis (RGO) used with and without functional electrical stimulation (FES). The data obtained from persons using both RGO and FES were adjusted to allow for the effects of fatiguability so as to obtain an approximate value for upper-body consumption. The data obtained from persons using RGO only were not adjusted, because no energy consumption occurred in the lower portion of the body. The data, expressed in kcal/kg-min and kcal/kg-m, were plotted against walking speed attained using RGO, and RGO with FES. The results were compared with those from persons fitted with long leg braces (LLB), hip guidance orthoses (HGO) and an FES walking aid (data obtained from available literature). We found that the lowest energy expenditure in kcal/kg-m across the full range of walking speeds occurred when both RGO and FES were used together, followed by RGO only, HGO, LLB, and FES only, respectively. The lowest energy expenditure in kcal/kg-min, for walking speeds, below 0-28 m/s, also occurred when both RGO and FES were used together, followed by RGO only, HGO, LLB, and FES only. The results suggest that, although the use of FES with RGO may increase oxygen uptake, it decreases energy expenditure in the upper extremities, thereby reducing patient fatigue. They also suggest that mechanical orthosis giving passive support to the hip, knee and ankle in combination with FES may provide the most efficient walking aid for paraplegic persons.

Adult↗
PubMed1987

Nutritional support and measured energy expenditure of the child and adolescent with head injury.

Energy expenditure, nitrogen excretion, and serum protein levels were studied from the time of hospital admission until 2 weeks after severe head injury in eight adolescents and four children with peak 24-hour Glasgow Coma Scale scores ranging from 3 to 8. The mean measured energy expenditure (MEE) was 1.3 times Harris and Benedict's predicted value for energy expenditure. Seventy percent of the patients achieved caloric balance (MEE X 1.2) by 4 to 14 days after injury, but balance was not consistently maintained. Five of the 12 patients had intermittent diarrhea, and two had increased gastric residuals. In five patients fluid restrictions were imposed due to either the syndrome of inappropriate secretion of antidiuretic hormone, pulmonary complications, or intracranial pressure complications. For the adolescents (aged 11 to 17 years) the mean calorie intake during the 1st week was 752 kcal/day and for the children (aged 2 to 5 years) it was 340 kcal/day. During the 2nd week the mean calorie intake for the adolescents was 1671 kcal/day and for the children was 691 kcal/day. Mean urinary nitrogen excretion was 307 mg/kg/day for the adolescents and 160 mg/kg/day for the children. The calculated mean nitrogen balance for the eight adolescents and the four younger children was -13.6 and -4.1, respectively. Mean albumin levels decreased from 2.9 gm/dl during the 1st week to 2.4 gm/dl during the 2nd week (normal 3.5 to 5.0 gm/dl). Mean total protein level during the 1st week was 5.4 gm/dl and increased to a mean of 6.0 gm/dl during the 2nd week (normal 6.0 to 7.8 gm/dl). Weight loss ranged from 2 to 26 lb during the 2-week period. From these studies it can be concluded that head injury in the child and adolescent induces a metabolic response that includes increased energy expenditure and decreased serum albumin levels similar to those observed for head-injured adults. Mean nitrogen excretion values are less than those in adults with a severe head injury.

Adolescent↗
PubMed2000

Physical activities and energy expenditures of institutionalized Japanese elderly women.

The daily energy expenditure and physical activity index of institutionalized Japanese elderly women were measured. One hundred and thirteen Japanese elderly women (aged 79.5 -/+ 7.0 y) who live in institutions for the elderly and receive meal services participated voluntarily. A dietary survey, energy metabolic study, and time study were carried out over three consecutive days, and the basal metabolic rate (BMR) and energy expenditure by physical activity were measured. The intensity of daily physical activity was based on the physical activity index (PAI: total/basal energy expenditure). The mean BMR was 881 +/- 145 kcal/d (20.9 +/- 3.8 kcal/kg BW). The PAI in individuals ranged from 1.01 to 1.57, the mean value was 1.26 +/- 0.14, and 64% of the subjects examined showed a lower value than 1.3 of PAI. From these values, the mean total energy expenditure was calculated as 1,112 +/- 231 kcal/d (26.2 +/- 5.2 kcal/kg BW).

Aged↗
PubMed2006

Increased expenditure on Australian health and medical research and changes in numbers of publications determined using PubMed.

OBJECTIVE: To determine temporal trends in PubMed publications for Australian authors compared with changes in funding for health and medical research (HMR). DESIGN: Retrospective observational study. SETTING: Internet-based bibliometric study that collated Australian HMR expenditure from the Australian Institute of Health and Welfare and Australian (and other) research publications from PubMed. MAIN OUTCOME MEASURES: Australian expenditure on HMR and numbers of PubMed-cited publications from 1980 to 2004, with subgroup analyses for universities, clinical trials, and genetic and biotechnology research, and comparison with similar results from the United Kingdom and New Zealand. RESULTS: From 1980-81 to 2003-04, Australian HMR expenditure increased from $66 million to $1503 million and total Australian PubMed publications increased from 844 to 13 836. From 1995-96 to 2003-04, Australian publications for university-derived research and for clinical trials increased at a fairly constant rate. Genetic and biotechnology publications increased about fivefold (49 to 277) between 1990-91 and 2003-04. Between 1990 and 2004, total publications increased from 1754 to 3288 for New Zealand and from 12 401 to 19 600 for the UK. CONCLUSIONS: There is an association between increased funding for HMR and increased publications, as determined using PubMed, in the past 10 years. Using PubMed may be a simple way to track output from HMR expenditure.

Australia↗
PubMedDate not supplied

Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program.

OBJECTIVE: To evaluate changes in antimicrobial use and expenditures and the rates of selected nosocomial infections due to resistant organisms associated with implementation of an antimicrobial-prescribing improvement program. DESIGN: Before-after trial comparing 1992 (pre-program), 1993 (a transition year), and 1994 (after full implementation of the program). SETTING AND PARTICIPANTS: Academic medical center, all patients and physicians. INTERVENTION: An antimicrobial-prescribing improvement program with prior approval requirement for use of restricted agents. MAIN OUTCOME MEASURES: Antimicrobial use and expenditures, rates of selected nosocomial infection marker events. RESULTS: Between 1992 and 1994, there were substantial decreases in antimicrobial use, from 158,107 to 137,364 defined daily doses, and in expenditures from $2,486,902 ($24.01 per patient day) to $1,701,522 ($18.49 per patient day). After adjusting for changes in purchase prices and census days, we estimated savings attributable to the program of $279,573 in 1993 and $389,814 in 1994. In addition, we found significant decreases between 1992 and 1994 in the rates of enterococcal bacteremia (.34 vs .16 events per 1,000 patient days; P = .016), selected gram-negative bacteremia (.26 vs .11; P = .015), methicillin-resistant Staphylococcus aureus colonization or infection (.66 vs .20; P < .0001), and Stenotrophomonas colonization or infection (.35 vs .17; P = .019). No significant change occurred in rates of nosocomial candidemia or Clostridium difficile toxin-positive diarrhea. Values for 1993 were intermediate between those of 1992 and 1994. CONCLUSION: Implementation of an antimicrobial-prescribing improvement program was associated with substantial savings in antimicrobial use and expenditures and significant decreases in rates of selected nosocomial infections due to resistant organisms.

Anti-Infective Agents↗
PubMed1984

Medicaid nursing home reimbursement policies, rates, and expenditures.

Nursing home expenditures, along with those of hospitals, have been a target of cost containment efforts because they constitute a growing share of overall public expenditures for health. Of the total $287 billion spent on personal health care in 1982, $27 billion (9.5 percent) was spent on nursing home care (Gibson, Waldo, and Levit, 1983). Nationally, nursing home expenditures increased at a rate of 17.4 percent between 1980 and 1981 and 12.9 percent between 1981 and 1982, more rapidly than overall health care expenditures (Gibson, Waldo, and Levit, 1983).

Medicaid↗