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PubMedDate not supplied

[Energy expenditures in patients with insulin-dependent diabetes mellitus in a hospital and ambulatory environment (computer analysis)].

Original computer programs for assessment of energetic value of nutrition and daily energy expenditures of man based on physical activity protocols have been developed. The programs were tried in 16 patients with insulin-dependent diabetes, and essential individual differences from tentative table estimations of energy expenditures were detected. Correlations between treatment efficacy and individual energy expenditures of patients were observed; a moderate deficit of nutrition calories was found more detrimental for metabolic control than their moderate excess. The regularities detected even in such a nonrepresentative sample permit us evaluate high the potentialities and significance of the suggested method for assessment of energy expenditures.

Adolescent↗
PubMed1994

Whole body energy expenditure protein breakdown and polyamine excretion during high dose treatment with interleukin-2 and interferon-alpha.

OBJECTIVE: To correlate changes in whole body resting energy expenditure and protein breakdown with the production of stress hormones, excretion of polyamines, and circulating concentrations of interleukin-1 (IL-1), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-alpha), in patients undergoing treatment with high doses of interleukin-2 (IL-2) and interferon-alpha (IFN-alpha). DESIGN: Prospective open study. SETTING: University Department of Surgery. SUBJECTS: 11 Patients with malignant melanoma (n = 8) or renal cell carcinoma (n = 3) all of whom had a Karnofsky score of 80 or more. INTERVENTIONS: Daily intravenous infusion of IL-2 (18 x 10(6) IU/m2/day) and subcutaneous injection of IFN-alpha (3 x 10(6) IU/m2/day) for days 1-5 and 8-12 in two courses with a three week interval. MAIN OUTCOME MEASURES: Energy expenditure measured by indirect calorimetry, body temperature, heart rate, urinary excretion of amino acids and nitrogen, and plasma cytokine concentrations. RESULTS: Three patients had a partial response. IL-1 was not detectable in plasma; and concentrations of IL-2 increased rapidly during the infusion before falling rapidly when it stopped, of IL-6 increased significantly (mean (SEM) 3.44 (1.6) to 11 (2) U/ml, p < 0.05), and of TNF-alpha increased by 295% (p < 0.05). Resting energy expenditure increased from 92 (4) to 113 (4) kJ/kg/day (p < 0.001) during the infusion and this was accompanied by a rise in temperature and an increase in the urinary excretion of cortisol (which also correlated with increased breakdown of whole body protein). CONCLUSION: The increased energy expenditure and protein breakdown were probably a result of stimulation of production of catecholamines and cortisol, as after injury, but the direct effects on temperature regulating neurons may be important.

Aged↗
PubMed1993

Impact of expenditures for veterinary services and medical supplies on dairy farm productivity and profitability.

The value of the marginal product (VMP) for veterinary services and medical supplies (VETMED), and the profit maximizing level of VETMED were estimated for dairy producers. Data from the Pennsylvania Farmers Association-Dairy Farm Business Analysis system during the years of 1986 to 1990 were used to evaluate the functional relationship between production and expenditures for VETMED. Other input variables examined were man-year equivalents of labor, asset values, value of feed fed, and culling rate. Data were screened to reflect economically viable dairy farms in Pennsylvania, and 173 such farms participated for each of the 5 years analyzed. The VMP was estimated for 1990. Profit maximizing levels for VETMED were estimated for 1990 holding other input variables at their mean values. Mean expenditures for VETMED were $2,606/farm, or $43/cow in 1990. The VMP for VETMED was estimated to be $3.22 or $4.98, depending on the method of calculation. In other words, the marginal dollar spent on VETMED generated $3.22 ($4.98) in additional revenue from milk production. The profit maximizing level of expenditures for VETMED was $138/cow, substantially more than the mean, indicating the potential for farms in this data set to improve profitability through additional expenditures on VETMED.

Animals↗
PubMed1993

Effect of circadian variation in energy expenditure, within-subject variation and weight reduction on thermic effect of food.

Thermic effect of food (TEF) studies give conflicting answers to research questions and in many cases data from one laboratory to another is not comparable because of the utilization of different experimental methods. Likewise, how weight reduction affects measurement of TEF is controversial. Two studies were conducted on how TEF affects energy expenditure. The first study examined how resting energy expenditure (REE) measurements can affect TEF studies and how much within-subject variation is found in TEF studies. The TEF of a standard meal was measured in six subjects for 6.5 h on three different occasions by indirect calorimetry. REE was measured on each subject for 1 h before the meal was given on each measurement occasion. On a separate day, the energy expenditure was measured on each subject during the same time period as the TEF measurement, but without any food given to determine if a circadian increase in REE over the time period of the measurement was observed. We found no circadian increase in energy expenditure during the 6.5 h of the REE study. While the within-subject variation in REE (four measurements) had an average coefficient of variation of 5.2% (range 2.4-8.5%), the coefficient of variation of the TEF measured (three measurements) was 26.4% (range 13.6-50.9). In the second study, REF and the TEF were measured before and after weight reduction in moderately overweight adult women. Nine women weighing between 62.1 and 84.7 kg lost an average of 7.3 kg while on a reduced calorie, low fat diet for between 12 and 14 weeks. After weight reduction, the average REE of these subjects decreased by 8.8% or 515 kJ (123 kcal)/24 h. The TEF of these nine women was measured for 6.5 h before and after weight reduction using 16 oz of Sustacal, 2008 kJ (480 kcal). Before weight reduction the thermic effect of Sustacal was 264 kJ (63 kcal) or 13% of calories consumed, and after weight reduction it was 251 kJ (60 kcal) or 12.5% of calories consumed. We did not find the TEF to be lower than expected in these subjects before weight reduction, since TEF is often reported to be around 10% of energy consumed, and it was not changed after weight reduction.

Adult↗
PubMed1995

Daily energy expenditure in free-living conditions in obese and non-obese children: comparison of doubly labelled water (2H2(18)O) method and heart-rate monitoring.

OBJECTIVE: To compare the heart-rate monitoring with the doubly labelled water (2H2(18)O) method to estimate total daily energy expenditure in obese and non-obese children. DESIGN: Cross sectional study of obese and normal weight children. SUBJECTS: 13 prepubertal children: six obese (4M, 2F, 9.1 +/- 1.5 years, 47.3 +/- 9.7 kg) and seven non-obese (3M, 4F, 9.3 +/- 0.6 years, 31.8 +/- 3.2 kg). MEASUREMENTS: Total daily energy expenditure was assessed by means of the doubly labelled water method (TEEDLW) and of heart-rate monitoring (TEEHR). RESULTS: TEEHR was significantly (P < 0.05) higher than TEEDLW in obese children (9.47 +/- 0.84 MJ/d vs 8.99 +/- 0.63 MJ/d) whereas it was not different in non-obese children (8.43 +/- 2.02 MJ/d vs 8.42 +/- 2.30 MJ/d, P = NS). The difference of TEE assessed by HR monitoring in the obese group averaged 6.2 +/- 4.7%. At the individual level, the degree of agreement (difference between TEEHR and TEEDLW +/- 2s.d.) was low both in obese (-0.36, 1.32 MJ/d) and in non-obese children (-1.30, 1.34 MJ/d). At the group level, the agreement between the two methods was good in nonobese children (95% c.i. for the bias:-0.59, 0.63 MJ/d) but not in obese children (0.04, 0.92 MJ/d). Duration of sleep and energy expenditure during resting and physical activity were not significantly different in the two groups. Patterns of heart-rate (or derived energy expenditure) during the day-time were similar in obese and non-obese children. CONCLUSION: The HR monitoring technique provides an estimation of TEE close to that assessed by the DLW method in non-obese prepubertal children. In comparison with DLW, the HR monitoring method yields a greater TEE value in obese children.

Anthropometry↗
PubMed1997

Accuracy of Calorie Counter method to assess daily energy expenditure and physical activities in athletes and nonathletes.

OBJECTIVE: The aim of this study was to examine the accuracy of the Calorie Counter personal activity computer (CC method) for athletic activity. DESIGN: An observational study for a week or on a day. SETTING: Healthy Japanese volunteers. PARTICIPANTS: Nonathletes (54 males and 53 females) and 38 male athletes, with ages between 13 and 73 years old. MEASURES: Daily energy expenditure and weekly physical activity were simultaneously assessed using the CC method and a daily record on physical activity (daily record method) for a week for the nonathletes and one day for the athletes. RESULTS: Mean daily energy expenditures were 9630 (standard deviation, SD, 1250) kJ.d-1 by the CC method, compared with 9530 (SD, 1120) kJ.d-1 by the daily record method for male nonathletes; 7822 (SD, 768) kJ.d-1 and 7790 (SD, 810) kJ.d-1, respectively, for female nonathletes; and 1120 (SD, 1520) kJ.d-1 and 11580 (SD, 1580) kJ.d-1, respectively, for athletes. The correlation coefficients between daily energy expenditures by these two methods ranged from 0.72 to 0.90. Mean daily physical activities were 1520 (SD, 637) kJ.d-1 by the CC method, compared with 1580 (SD, 691) kJ.d-1 by the daily record method for male nonathletes; 1033 (SD, 318) kJ.d-1 and 1080 (SD, 346) kJ.d-1, respectively, for female nonathletes; and 2770 (SD, 914) kJ.d-1 and 3250 (SD, 1090) kJ.d-1, respectively, for athletes. The correlation coefficients between daily physical activities by these two methods ranged from 0.56 to 0.96. CONCLUSIONS: Our results suggest that the CC method may be reliable enough for assessing the energy expenditure in athletes as well as in nonathletes during free-living activities.

Adolescent↗
PubMed1997

Metabolizable energy intake and sustained energy expenditure of Alaskan sled dogs during heavy exertion in the cold.

OBJECTIVE: To measure energy expenditures of Alaskan sled dogs at rest and during racing under frigid conditions, using the doubly labeled water (DLW) technique. ANIMALS: 18 fit Alaskan sled dogs. PROCEDURE: Energy expenditure was measured in 9 dogs during a 490-km sled dog race by use of the DLW technique, whereby dogs were administered water enriched with nonradioactive isotopes of hydrogen and oxygen. Energy intake was determined by dietary analysis. Changes in background abundance of the isotopes 2H and 18O were monitored in 5 dogs that did not receive isotope-enriched water. RESULTS: Dogs completed the 490-km race at an average speed of 7 km/h at ambient temperature of -35 to -10 C. Total energy expenditure, measured by the DLW technique, was 47,100 +/- 5,900 kJ/d (4,400 +/- 400 kJ.kg-0.75/d), and metabolizable energy intake was 44,600 kJ/d (4,100 kJ.kg-0.75/d) during the 70-hour race. CONCLUSIONS: The sustained metabolic rate for these sled dogs during racing was extraordinarily high for a large mammal. This study validated use of the DLW technique in dogs with exceptionally high energy expenditure associated with prolonged exercise in the cold.

Animals↗
PubMed1997

Oxygen consumption and energy expenditure of level versus downhill running.

OBJECTIVE: The purpose of this study was to assess and compare submaximal oxygen consumption (VO2) and energy expenditure (kJ) while running at 0, -1.8, -3.6, and -5.4% grades for three individually selected running speeds (9.4 + 0.79, 10.3 + 0.74, 11.3 + 0.73 km.h-1). EXPERIMENTAL DESIGN: Subjects completed the four grade conditions in random order via a modified Latin squares design at three self-selected submaximal running speeds for each condition. PARTICIPANTS: Thirteen (5 females and 8 males) recreational (< 35 km.wk-1) runners (age: 27.7 +/- 4.3 yrs) volunteered for the study. MEASURES: Two-way repeated measures ANOVA (Grade x Speed) was used to analyze steady-state VO2 and kJ expenditure. Stepwise linear multiple regression was used to develop an equation for predicting VO2 for running at recreational speeds on moderately negative grades. RESULTS: VO2 and kJ mean values were significantly different between all speed and % grade comparisons. Compared to level grade, the average reductions in VO2 and kJ expenditure ranged from approximately 9% at a grade of -1.8% to 22% at a grade of -5.4%. The relationship between VO2 and % grade for each running speed was linear. CONCLUSIONS: For a given speed, running at a modest negative grade can significantly decrease VO2 and kJ expenditure compared to level running. The following regression equation can be used to estimate VO2 (ml.kg-1.min-1) for running at recreational speeds on slight downhills: VO2 = 6.8192 + 0.1313 (speed in m.min-1) + 1.2367 (% grade).

Adult↗
PubMed1998

Estimation of energy expenditure in free-living red deer (Cervus elaphus) with the doubly-labelled water method.

Energy expenditure was estimated using the doubly-labelled water (DLW) method in summer in five free-living adult, non-pregnant, non-lactating, red deer (Cervus elaphus) hinds (weight 107.3 (SE 0.9) kg; age 6 (SE 1) years) on lowland pasture under typical farming conditions. Climatic conditions were monitored throughout the experiment. Errors due to 2H losses in CH4 and faeces were calculated from previous estimates of stoichiometries. CH4 production, fractionated water loss, urinary N and O2 consumption were estimated using an iterative approach. The water flux (rH2O) in these animals consuming only fresh grass was 12 (SE 0.5) kg/d, the CO2 production (rCO2) was 1271 (SE 40) litres/d and the mean energy expenditure was 25 (SE 0.8) MJ/d. There were no significant differences in the isotope distribution spaces and flux rates, rH2O, rCO2 or energy expenditure using the multi-point or two-point approaches to calculation. The DLW-derived energy expenditure of 25 MJ/d is approximately 20% higher than the recommended intake of 21 MJ/d for adult hinds kept outdoors (Adam, 1986) and, at 757 kJ/kg0.75 per d, one third higher than the value of 570 kJ/kg0.75 per d for stags penned indoors (Key et al. 1984).

Animals↗
PubMed1992

Public expenditures and health care in Africa.

Unfavorable economic conditions in most of Africa (in this paper Africa refers to Sub-Saharan Africa only) have meant public austerity and a deceleration in government health spending. Given the dominant role of government in providing health services in Africa there is a need to investigate the links between public spending and the provision of health care. Analyzing information from five Sub-Saharan African countries, namely Botswana, Burkina Faso, Cameroon, Ethiopia and Senegal, we investigate the impacts of shifting expenditure patterns and levels on the process of providing health services as well as on delivery of health care. The country analyses indicate that in addition to the level of public spending, the expenditure mix (i.e. salaries, drugs, supplies etc.), the composition of the health infrastructure (hospitals, clinics, health posts etc.), community efforts, and the availability of private health care all influence health care delivery. Consequently, per capita public expenditure (the most important indicator in a number of related studies) alone as a measure of the availability of health care and especially for cross-country comparisons is inadequate. Reductions in government resources for health care often result in less efficient mixing of resources and hence less health care delivery, in quality and quantity terms. With the recent trends in health care spending in Africa there should be greater effort to increase the efficient use of these increasingly scarce resources, yet the trend in resource mix has been in the opposite direction. Given the input to public health care of local communities, as well as the provision of private health care, it would seem that government spending on health care should be counter-cyclical, i.e. government health spending should accelerate during periods of economic down turns. Such counter-cyclical spending would tend to offset the difficulties facing local communities and the declining ability of individuals to pay for private health care. Recommending counter-cyclical health spending may seem wishful, but it points up the necessity of understanding what is likely to happen to health care in African countries in the face of economic difficulties, and particularly in the face of fiscal austerity.

Botswana↗
PubMed1993

Health expenditure and household budgets in rural Liberia.

Fieldwork conducted in Kpelle village in north-central Liberia revealed that health-care expenses constitute a major part of domestic spending. The actual transactions for major health-care expenditures are handled by men, typically using income that jointly belongs to the couple in addition to the husband's personal income. Women are likely to spend their personal incomes on minor health expenses for themselves and their children. Women's health expenditure, as well as their income handling arrangements, seem to differ according to the type of conjugal union they are in. Although Kpelle wives have input in most financial decisions, they tend to defer to men on issues which are associated with the Western world, namely Western health care, educational and tax expenditures.

Adolescent↗
PubMed2000

Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition.

This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality.

Data Collection↗
PubMed2000

Benchmarks for health expenditures, services and outcomes in Africa during the 1990s.

There is limited information on national health expenditures, services, and outcomes in African countries during the 1990s. We intend to make statistical information available for national level comparisons. National level data were collected from numerous international databases, and supplemented by national household surveys and World Bank expenditure reviews. The results were tabulated and analysed in an exploratory fashion to provide benchmarks for groupings of African countries and individual country comparison. There is wide variation in scale and outcome of health care spending between African countries, with poorer countries tending to do worse than wealthier ones. From 1990-96, the median annual per capita government expenditure on health was nearly US$ 6, but averaged US$ 3 in the lowest-income countries, compared to US$ 72 in middle-income countries. Similar trends were found for health services and outcomes. Results from individual countries (particularly Ethiopia, Ghana, Côte d'Ivoire and Gabon) are used to indicate how the data can be used to identify areas of improvement in health system performance. Serious gaps in data, particularly concerning private sector delivery and financing, health service utilization, equity and efficiency measures, hinder more effective health management. Nonetheless, the data are useful for providing benchmarks for performance and for crudely identifying problem areas in health systems for individual countries.

Africa↗
PubMed1988

[[A regional perspective in population study--based on national consumption expenditure surveys]].

The author examines "regional characteristics of population in [Japan] from the standpoint of consumption behavior and [assesses] the significance of 'regionality' in population study. Data [are from] the National Consumption Expenditure Surveys conducted...every five years...from 1959-1984." Topics covered include differences in household consumption and expenditures, particularly food expenditures, by prefecture and for rural and urban areas, and regional similarity indexes. (SUMMARY IN ENG)

Asia↗
PubMedDate not supplied

Household health expenditures in Morocco: implications for health care reform.

The purpose of this study was to investigate the level and distribution of household health care expenditures in Morocco, and to compare the level of health care funds provided by households with the levels provided by the government and international donors. In addition, the reliance of poor and non-poor households on both public and private providers was investigated. The study was based on data collected in the 1995 Demographic and Health Survey, which included a special supplement on health care expenditures. Descriptive statistics are presented on utilization of out-of-pocket expenditures for antenatal and obstetric care, chronic care, and non-chronic care associated with illness and injury, by urban/rural status and by socio-economic status. The results indicate that government health care providers are an important source of modern health care not only for poor households, but for better-off households as well. While individuals who use private health care providers incur substantially higher costs than those who use public providers, an unexpected finding of the study is the degree to which public clients pay for health care services, despite the fact that public care is nominally priced in Morocco. We conclude by discussing the implications of our results on the design and implementation of health care reform policies.

Child↗
PubMed2006

Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons.

Switzerland (7.2 million inhabitants) is a federal state composed of 26 cantons. The autonomy of cantons and a particular health insurance system create strong heterogeneity in terms of regulation and organisation of health care services. In this study we use a single-equation approach to model the per capita cantonal expenditures on health care services and postulate that per capita health expenditures depend on some economic, demographic and structural factors. The empirical analysis demonstrates that a larger share of old people tends to increase health costs and that physicians paid on a fee-for-service basis swell expenditures, thus highlighting a possible phenomenon of supply-induced demand.

Delivery of Health Care↗
PubMed2006

A re-examination of the impact of reference pricing on anti-hypertensive drug plan expenditures in British Columbia.

Reference pricing (RP) limits drug plan reimbursement of interchangeable medicines to a reference price, which is typically equal to the price of the lowest-cost interchangeable drug; any cost above that is borne by the patient. Much of the evidence of the effects of RP comes from 'before and after' studies of the RP scheme adopted by Pharmacare, the publicly funded drug plan for seniors and others in British Columbia, Canada. We critically assess the identifying assumption inherent in the before and after design - namely, that pre-RP trends accurately predict counterfactual outcomes - in the context of estimating the impact of RP on Pharmacare's expenditure on anti-hypertensive drugs for its senior beneficiaries. We use similar data from a public plan that has not introduced RP to estimate the effects on drug expenditures of patent expiration, secular changes in prescribing patterns and various other factors common to all Canadian public drug plans that could potentially confound the before and after estimates of the effect of RP on drug plan expenditures. We find that controlling for such factors reduces estimates of drug plan savings attributable to RP of the Calcium Channel Blockers by about half.

Antihypertensive Agents↗
PubMed2007

Government health expenditures and health outcomes.

This paper provides econometric evidence linking a country's per capita government health expenditures and per capita income to two health outcomes: under-five mortality and maternal mortality. Using instrumental variables techniques (GMM-H2SL), we estimate the elasticity of these outcomes with respect to government health expenditures and income while treating both variables as endogenous. Consequently, our elasticity estimates are larger in magnitude than those reported in literature, which may be biased up. The elasticity of under-five mortality with respect to government expenditures ranges from -0.25 to -0.42 with a mean value of -0.33. For maternal mortality the elasticity ranges from -0.42 to -0.52 with a mean value of -0.50. For developing countries, our results imply that while economic growth is certainly an important contributor to health outcomes, government spending on health is just as important a factor.

Child Mortality↗