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PubMed2004

Relationship between temperament, nonresting energy expenditure, body composition, and physical activity in girls.

OBJECTIVES: To assess the extent that predilection for movement, as measured by a temperament questionnaire (activity temperament), contributes to nonresting energy expenditure and body composition in girls. DESIGN, SETTING, AND PARTICIPANTS: Baseline data for 196 premenarcheal non-obese girls aged 8-12 y were obtained from a longitudinal study of growth and development. The association of activity temperament with nonresting energy expenditure in girls with low and high levels of physical activity was evaluated, as was the association of activity temperament with body composition. MEASURES: Maternal reports of child activity temperament were obtained by questionnaire. Nonresting energy expenditure was calculated as total energy expenditure (measured by doubly labeled water) minus resting energy expenditure (obtained by indirect calorimetry). Body composition was estimated by total body water. Questionnaires and activity diaries were used to assess physical activity and sedentary behavior. RESULTS: Higher activity temperament was associated with higher nonresting energy expenditure after multivariate control for weight, vigorous activity, walking and light activity, and television viewing, although activity temperament did not account for a large percentage of the variability in nonresting energy expenditure (partial squared correlation coefficient=0.03). In girls with physical activity levels below the median, high activity temperament was associated with a mean+/-s.d., nonresting energy expenditure of 310+/-138 kJ (74+/-33 kcal) above that of girls with a low activity temperament. Girls with a high activity temperament had less body fat than did girls with a low activity temperament (21.6 vs 24.5%, a difference of 2.9 percentage points; 95% confidence interval, 1.3-4.4 percentage points). CONCLUSION: Predilection for movement, as measured by a temperament questionnaire, contributes to nonresting energy expenditure and may be useful in capturing an aspect of energy expenditure in population studies. The cross-sectional observation that girls with a high activity temperament were leaner than girls with a low activity temperament suggests that a constitutional predilection for movement may play a role in the development of obesity.

Anthropometry↗
PubMed1996

Total energy expenditure and physical activity measured with the bicarbonate-urea method in patients with human immunodeficiency virus infection.

1. Our objectives were to measure total energy expenditure, the daily variation in total energy expenditure and the physical activity level in a group of HIV-positive subjects using the bicarbonate-urea method. The study also aimed to asses the practicalities of using the bicarbonate-urea technique in free-living conditions. 2. Total energy expenditure was measured with the bicarbonate-urea method over 2 consecutive days (1 day in one subject) in 10 male patients with HIV infection (median CD4 count = 30). Resting energy expenditure was measured by indirect calorimetry. Physical activity level (total energy expenditure/resting energy expenditure) was calculated from these measurements and from activity diaries. 3. Resting energy expenditure was found to be 7.46 +/- 0.87 MJ/day, 5% higher than predicted values. Total energy expenditure was 10.69 +/- 1.95 MJ/day with an intra-individual day-to-day variation of 6 +/- 6%. The measured physical activity level was 1.42 +/- 0.14, higher than the diary estimate of 1.34 +/- 0.16 (P = 0.029), and there were large intermethod differences in individual values. The subcutaneous infusion of bicarbonate was well tolerated and did not seem to restrict normal activities. 4. Total energy expenditure was not elevated in the group of HIV-positive subjects when compared with reference values for normal subjects. The physical activity level of the patients in this study was lower than that measured using other techniques in healthy young men, but was compatible with that expected for people leading a sedentary lifestyle. Reductions in physical activity in patients with HIV are likely to contribute to the wasting process and physical activity level may thus be a clinically useful measure. This study has also provided the first tracer estimate of the day-to-day variation in total energy expenditure. The bicarbonate-urea method represents an important new investigative tool for measuring total energy expenditure which has previously only been possible within the confines of a whole-body calorimeter or using the expensive doubly labelled water method.

Adult↗
PubMed1998

Evaluation of a commercial accelerometer (Tritrac-R3 D) to measure energy expenditure during ambulation.

This study evaluated the ability of a commercially available accelerometer (Tritrac-R3 D) to measure energy expenditure in 16 subjects at rest (pre- and post-exercise) and during three different intensities of steady-state exercise (40-70% of peak oxygen consumption [VO2peak]) while ambulating on a treadmill (no grade). Oxygen consumption and the respiratory exchange ratio from indirect calorimetry and the vector magnitude of triaxial accelerations were used to estimate energy expenditure using the manufacturers' equations. There was a significant relationship between indirect calorimetry-derived energy expenditure and the energy expenditure derived from the accelerometer (r=0.96). Using analysis of variance, there was no difference in the energy expenditure derived by the two methods at rest before exercise and during the three different intensities of ambulatory exercise. There was a significant difference between energy expenditure derived via indirect calorimetry and with the accelerometer during rest after exercise, probably due to the failure of the accelerometer to accurately estimate the energy expenditure associated with the progressive decline in post-exercise oxygen consumption. Thus, this commercially available accelerometer appears to provide statistically acceptable estimates of energy expenditure at rest and during zero-grade treadmill ambulation up to about 70% VO2peak. This may indicate its acceptable utility for large-scale population studies of physical activity involving this mode of movement. The failure of the accelerometer to accurately estimate energy expenditure during recovery from exercise may contribute to an underestimation of energy expenditure in some physically active individuals.

Adult↗
PubMed1995

Changes in energy expenditure resulting from altered body weight.

BACKGROUND: No current treatment for obesity reliably sustains weight loss, perhaps because compensatory metabolic processes resist the maintenance of the altered body weight. We examined the effects of experimental perturbations of body weight on energy expenditure to determine whether they lead to metabolic changes and whether obese subjects and those who have never been obese respond similarly. METHODS: We repeatedly measured 24-hour total energy expenditure, resting and nonresting energy expenditure, and the thermic effect of feeding in 18 obese subjects and 23 subjects who had never been obese. The subjects were studied at their usual body weight and after losing 10 to 20 percent of their body weight by underfeeding or gaining 10 percent by overfeeding. RESULTS: Maintenance of a body weight at a level 10 percent or more below the initial weight was associated with a mean (+/- SD) reduction in total energy expenditure of 6 +/- 3 kcal per kilogram of fat-free mass per day in the subjects who had never been obese (P < 0.001) and 8 +/- 5 kcal per kilogram per day in the obese subjects (P < 0.001). Resting energy expenditure and nonresting energy expenditure each decreased 3 to 4 kcal per kilogram of fat-free mass per day in both groups of subjects. Maintenance of body weight at a level 10 percent above the usual weight was associated with an increase in total energy expenditure of 9 +/- 7 kcal per kilogram of fat-free mass per day in the subjects who had never been obese (P < 0.001) and 8 +/- 4 kcal per kilogram per day in the obese subjects (P < 0.001). The thermic effect of feeding and nonresting energy expenditure increased by approximately 1 to 2 and 8 to 9 kcal per kilogram of fat-free mass per day, respectively, after weight gain. These changes in energy expenditure were not related to the degree of adiposity or the sex of the subjects. CONCLUSIONS: Maintenance of a reduced or elevated body weight is associated with compensatory changes in energy expenditure, which oppose the maintenance of a body weight that is different from the usual weight. These compensatory changes may account for the poor long-term efficacy of treatments for obesity.

Adult↗
PubMed1989

Comparison of three methods of estimating energy expenditure: caltrac, heart rate, and video analysis.

This study examined the accuracy of a new device (Caltrac) in estimating energy expenditure via acceleration measurements. Energy expenditure of 20 high school students during basketball class activity (average length = 37 min) was estimated using the Caltrac, heart rate recording, and video analysis. Heart rate recording and video analysis estimates of energy expenditure were determined from heart rate, caloric expenditure curves, and an activity rating scale, respectively. The following estimates of caloric expenditure (M +/- SD) were found: heart rate recording = 196 +/- 73 greater than Caltrac = 163 +/- 49 greater than film analysis = 123 +/- 30 kcal (p less than .05). Laboratory simulations of the basketball activity revealed that the Caltrac energy expenditure was not significantly different from the actual energy expenditure (p greater than .05). The heart rate recording and video analysis estimates of energy expenditure were significantly (p less than .05) higher and lower, respectively, than the actual energy expenditure. The Caltrac is a lightweight, low-cost device that provides a relatively accurate estimate of energy expenditure in free-ranging activities, such as basketball.

Adolescent↗
PubMed1994

Energy expenditure and withdrawal of sedation in severe head-injured patients.

OBJECTIVES: To determine the outcome of oxygen consumption (VO2) and energy expenditure after cessation of sedation in severe head-injured patients and to assess its usefulness as a predictor of neurologic severity. DESIGN: Prospective, descriptive study. SETTING: Neurosurgical intensive care unit (ICU) in a university hospital. PATIENTS: Fifteen severe head-injured patients with tracheostomies and who were mechanically ventilated and sedated at the time of the study. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: VO2 and energy expenditure were measured, using indirect calorimetry during and after discontinuation of sedation. After the measurement period, the patients were divided into two groups. Group 1 included patients who were completely weaned from sedation; group 2 included patients who had to be sedated again using predetermined criteria. In both groups, energy expenditure was close to basal energy expenditure during sedation, and increased to 150% of basal energy expenditure during the recovery period, with maximum hourly values 80% above basal energy expenditure. In group 1, VO2 and energy expenditure changed from 284 +/- 44 mL/min and 1833 +/- 261 kcal/day during sedation to 390 +/- 85 mL/min and 2512 +/- 486 kcal/day for the period without sedation. During this period, there was a significant correlation between VO2 and mean arterial pressure. For the recovery period, there was no difference in mean or maximum VO2 between the two groups of patients. At 24 and 48 hrs after cessation of sedation, VO2 and energy expenditure decrease to 30% above basal energy expenditure. These changes may be due to the recovery of muscular activity, weaning from mechanical ventilation, or an increase in the amount of circulating catecholamines. CONCLUSION: In severe head-injured patients, during the first 12 hrs after the discontinuation of sedation, the patients experienced a large increase in VO2, energy expenditure, and mean arterial pressure. Although these changes have no prognostic value in our study, they have potential deleterious effects in head-injured patients. Methods that blunt these changes which have proven efficacious in anesthesia may be effective for intensive care patients.

Acute Disease↗
PubMed1994

The effect of pharmacological dosages of glucocorticoids on free living total energy expenditure in man.

OBJECTIVES: Weight gain had previously been thought to be due to increased calorie intake alone though no information on its effect on total energy expenditure is available in humans. We therefore assessed whether weight gain associated with glucocorticoids is due to a reduction in energy expenditure. DESIGN: We performed an open study with 1 mg of betamethasone given orally twice a day for 21 days. SUBJECTS: Seven healthy female volunteers, age range 26-55 years, body mass index 19 to 40, mean 27 kg/m2. MEASUREMENTS: Total free living energy expenditure was measured by the doubly labelled water method (D2 18O), resting metabolic rate by ventilated hood indirect calorimetry and fat free mass from the dilution volume of oxygen-18 labelled water. Body composition and components of energy expenditure were assessed before and during the final 14 days of betamethasone administration. RESULTS: Weight increased by a mean of 1.2 kg (P < 0.05) because of a significant rise in fat mass (1.5 kg) with no change in fat free mass. Resting metabolic rate remained unaltered on betamethasone but total energy expenditure increased in all subjects with a significant mean rise of 26% from 11.7 to 14.7 MJ/24 h (P < 0.05). The energy component of physical activity with thermogenesis increased on average 52% (from 5.8 to 8.9 MJ/24 h; P < 0.05). The rise in energy expenditure was still apparent after correction for the increase in body weight. Fasting respiratory quotient (RQ) increased from 0.81 to 0.86 with no change in fasting blood glucose. Betamethasone did not result in an energy sparing effect on the two components of energy expenditure studied. CONCLUSIONS: Body weight increased on betamethasone entirely due to an increase in fat mass. This occurred despite a rise in total energy expenditure which involved specifically that component accounted for by physical activity plus thermogenesis. The most likely explanation is that betamethasone increased dietary energy intake significantly in excess of expenditure. We estimate that an average extra energy intake of 2.8 MJ/day would have had to be consumed for this rise in fat mass to occur even before taking into account the energy intake cost of the rise in expenditure.

Adult↗
PubMed2005

Impact of initial dialysis modality and modality switches on Medicare expenditures of end-stage renal disease patients.

BACKGROUND: The number of end-stage renal disease (ESRD) enrollees and Medicare expenditures have increased dramatically. Pathways and associated Medicare expenditures in ESRD treatment need to be examined to potentially improve the efficiency of care. METHODS: This study examines the impact of initial dialysis modality choice and subsequent modality switches on Medicare expenditure in a 3-year period. The Dialysis Morbidity and Mortality Study Wave 2 data by the United States Renal Data System (USRDS) is used along with the USRDS Core CD and USRDS claims data. RESULTS: A total of 3423 incident dialysis patients (approximately equal number of peritoneal dialysis and hemodialysis) were included in the analysis. Unadjusted average annual Medicare expenditure (in 2004 dollars) for peritoneal dialysis as first modality was 53,277 dollars(95% CI 50,626 dollars-55,927 dollars), and 72,189 dollars (95% CI 67,513 dollars-76,865 dollars) for hemodialysis. Compared to "hemodialysis, no switch" subgroup, "peritoneal dialysis, no switch" had a significantly lower annual expenditure (44,111 dollars vs. 72,185 dollars) (P < 0.001). "Peritoneal dialysis, with at least one switch" and "hemodialysis, with at least one switch" had a lower or similar annual expenditure of 66,639 dollars and 72,335 dollars, respectively. After adjusting for patient characteristics, annual Medicare expenditure was still significantly lower for patients with peritoneal dialysis as the initial modality (56,807 dollars vs. 68,253 dollars) (P < 0.001). Similarly, compared to "hemdialysis, no switch" subgroup, "peritoneal dialysis, no switch" and "peritoneal dialysis, with at least one switch" had a significantly lower total expenditure. Further analysis showed that time-to-first switch also independently impacted total expenditure. CONCLUSION: Initial modality choice (peritoneal dialysis or hemodialysis) and subsequent modality switches had significant implications for Medicare expenditure on ESRD treatments.

Adult↗
PubMed1999

Predicting expenditures for Medicare beneficiaries with diabetes. A prospective cohort study from 1994 to 1996.

OBJECTIVE: To describe health care expenditures and utilization patterns among older adults with diabetes and to examine factors associated with expenditures over a 3-year period. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort study of health care expenditures and utilization by diabetic patients from a random nationwide sample of aged Medicare beneficiaries from 1994 to 1996. All services covered by the Medicare program were examined. Multivariate regression was used to assess the contribution of patient characteristics in 1994 on Part B, inpatient, and total expenditures in 1995 and 1996. RESULTS: Per capita expenditures for beneficiaries with diabetes (n = 169,613) were 1.7 times greater than those for those beneficiaries without diabetes (n = 968,832) in 1994. This ratio remained fairly constant over the 2 years of follow-up. Expenditures for beneficiaries with diabetes were highly skewed. However, few of these individuals remained in the highest expenditure quintile over the 2 years of follow-up. Using multiple regression analysis to adjust for demographic and clinical characteristics, we were able to explain 7% of the variation in total expenditures in 1995 and 6% of the variation in 1996. Using the same model, we were able to explain 10.7% of the variation in Part B expenditures in 1995 and 8% in 1996. CONCLUSIONS: Beneficiaries with diabetes are consistently more expensive than beneficiaries without diabetes. Demographic and clinical factors at baseline are able to predict only a small portion of future expenditures among this population, and the most expensive patients in one year were often not the most expensive in subsequent years. More work is necessary to assure equitable risk adjustment in the calculation of capitation rates for health plans and practitioners who specialize in the care of individuals with diabetes.

Adult↗
PubMed2002

The energy expenditure of snowshoeing in packed vs. unpacked snow at low-level walking speeds.

Snowshoeing is currently ranked as one of the top 20 participatory sports in the United States, and the number of participants almost tripled, from 440,000 to 1.2 million in 1998. Despite this large increase in participation, no scientific evidence exists to quantify any physiologic response to the activity. Therefore, the purpose of this investigation was to assess the energy expenditure of snowshoeing at selected low-level speeds and evaluate its acceptability as a form of aerobic conditioning exercise. Ten habitually active subjects (7 men, 3 women, mean age = 24 +/- 3.9 years, mass = 76.6 +/- 14.5 kg, height = 173.7 +/- 9.6 cm) were recruited. Steady state heart rate data were determined from 2 treadmill tests at 4 and 6 mph. Steady state heart rates at 4 mph and 6 mph from treadmill speeds were then reproduced outdoors under 2 snow conditions, packed, and unpacked snow, while caloric expenditure and speed were determined. Expired gases were collected in Douglas bags for both snowshoe and treadmill trials and then analyzed and corrected indoors for the fractional concentrations of carbon dioxide and oxygen. Data analyses indicate that caloric expenditure during snowshoeing may be considerably higher than previously reported. Snowshoeing on packed snow at 2.95 mph elicited a similar heart rate and energy expenditure response as walking on a treadmill at 4 mph or snowshoeing in unpacked snow at 2.04 mph (Vo(2) = 18.18 +/- 0.8 ml x kg(-1) x min(-1)). Snowshoeing on packed snow at 3.97 mph elicited the same heart rate and energy expenditure response as walking on a treadmill at 6 mph or snowshoeing on unpacked snow at 2.87 mph (Vo(2) = 36.72 +/- 0.8 ml x kg(-1) x min(-1)). Furthermore, increasing walking speed on snow by just 1 mph at slow speeds (2 and 3 mph) resulted in approximately twice the energy expenditure. Our data indicate that current estimates of energy expenditure while snowshoeing underestimate by greater than 50%. Apparently the energy expenditure during snowshoeing is much higher than previously considered and varies considerably because of snow terrain. Furthermore, energy expenditure levels similar to walking can be achieved on snowshoes at much slower speeds. This study represents an original investigation into energy expenditure during snowshoeing.

Anaerobic Threshold↗
PubMed2004

The agreement between measured and predicted resting energy expenditure in patients with pancreatic cancer: a pilot study.

OBJECTIVE: To compare measured resting energy expenditure to resting energy expenditure predicted from eight published prediction equations in a sample of patients with pancreatic cancer. DESIGN: Cross-sectional study. SETTING: Ambulatory patients of a tertiary private hospital. PARTICIPANTS: Eight patients with pancreatic cancer (5 males, 3 females; age: 62.0+/- 5.2 years; BMI: 24.4+/- 3.2 kg/m2; weight loss: 12.1+/- 6.0%; mean+/- SD). METHODS: Resting energy expenditure was measured using indirect calorimetry and predicted from eight published prediction methods (Harris-Benedict with no injury factor, Harris-Benedict with 1.3 injury factor, Schofield, Owen, Mifflin, Cunningham, and Wang equations and the 20 kcal/kg ratio). Body composition was assessed by deuterium oxide dilution technique. Statistical analysis was performed by using the method of Bland and Altman, and the Student's t-test. RESULTS: The Harris-Benedict equations with an injury factor of 1.3 resulted in a significantly higher mean predicted resting energy expenditure compared to measured resting energy expenditure, while there was no significant difference between mean measured and predicted resting energy expenditure and the other 7 methods. At an individual level, the limits of agreement are wide for all equations. The best combination of low bias and narrowest limits of agreement was observed in the prediction of resting energy expenditure from the Wang equation (based on fat free mass) and the Harris-Benedict equation (based on weight and height). CONCLUSION: At a group level, there is agreement between mean measured and predicted resting energy expenditure with the exception of the Harris-Benedict equation with an injury factor of 1.3. The results of this pilot study suggest that, for an individual, the limits of agreement are wide, and clinically important differences in resting energy expenditure would be obtained. Clinicians need to be aware of the limitations of the use of resting energy expenditure prediction equations for individuals.

Aged↗
PubMed1991

[Evaluation of methods for measuring daily physical activity in terms of energy expenditure].

Various methods exist for measuring daily physical activity and daily energy expenditure and daily pedometer readings are most commonly used for the amount of physical activity. In this study, three methods for measuring energy expenditure-24-hr heart rate method (HR), time study method, and caloric expenditure accumulator (CC)-, and the feasibility of a pedometer for the assessment of energy expenditure were examined under laboratory conditions and during normal daily life. Daily physical activity was measured by four methods (HR, Time study, CC, Pedometer) in a field study of 14 young, healthy and sedentary women, and compared. Laboratory validation of the three methods with measurement of oxygen uptake was performed with 5 young men and 1 woman walking and running at different speeds and grades on a treadmill. In addition validation tests of whether pedometer readings reflect differences in energy expenditure due to speed and grade and whether pedometer counts steps exactly were also conducted. The 24-hr energy expenditure derived from CC was significantly lower than that derived from HR and Time study, due to lower estimation of energy expenditure from activities compared to other methods. In the laboratory study, the energy expenditure measured at 5% grade was low by CC and differences in energy expenditure for changes in grade could not be differentiated. Time study revealed a significant relationship between CC and HR in field study. These results suggest that CC tends to underestimate the 24-hr energy expenditure from activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Energy expenditure in acute trauma to the head with and without barbiturate therapy.

The increased energy expenditure associated with severe trauma to the head appears genuine but exhibits wide variation in its magnitude. Patients with severe acute trauma to the head without barbiturate treatment are hypermetabolic with an average energy expenditure 26 per cent over predicted. Barbiturate therapy abolishes this hypermetabolism and decreases energy expenditure to 14 per cent below predicted. In the individual patient, there appears to be a close relationship between the degree of suppression of energy expenditure and the serum barbiturate level. However, this relationship would appear to be different in each patient, and therefore, for this group, a significant correlation between energy expenditure and serum barbiturate level does not exist. The wide variability of energy expenditure in individual patients makes the estimation of energy expenditure by population predictive formulas imprecise. This may lead to incorrect estimates of caloric requirements and inappropriate provision of exogenous energy substrates. Although for those patients receiving energy expenditure and serum barbiturate levels in the individual may further aid in estimating the caloric expenditure for each individual, in order to provide appropriate amounts of calories to the patient with trauma to the head, energy expenditure should be measured in each instance.

Adolescent↗
PubMed1999

Medical care expenditures for diabetes, its chronic complications, and its comorbidities.

BACKGROUND: Medical expenditures for diabetes are estimated, including expenditures for chronic complications of diabetes, unrelated conditions for which diabetics are at higher risk, and various comorbidities that raise the cost of medical care. METHODS: A variety of national data sources are used to disaggregate the Health Care Financing Administration's national health expenditures in 1995 by sex, age, and diagnosis. Expenditures for chronic complications and other unrelated conditions for which diabetics have higher rates of utilization are determined by analysis of attributable risks. Additional expenditures generated by extra hospital inpatient days and higher charges for nursing home and home health care for comorbidities are estimated by regression analyses. Sensitivity analysis is used to calculate a range of estimated expenditures. RESULTS: Total expenditures attributed to diabetes are $47.9 billion in 1995, including $18.8 billion for first listed diabetes, $18.7 billion for chronic complications, $8.5 billion for unrelated conditions, and $1.9 billion for comorbidities. The range of total expenditures is $34.3 to $63.7 billion. CONCLUSIONS: Comprehensive accounting of expenditures more accurately assesses the economic burden of diabetes and potential savings from prevention, especially of chronic complications. This analysis is illustrative for other chronic illnesses.

Adult↗
PubMed2004

Health care utilization and expenditures in the United States: a study of osteoporosis-related fractures.

BACKGROUND: More than 1.5 million fractures occur due to osteoporosis each year. This study examines the annual health care utilization and associated expenditures of osteoporotic patients who sustain a new fragility fracture and of those without a new fracture. METHODS AND PROCEDURES: The study sample from commercial claims databases consisted of patients enrolled in US plans between January 1, 1997, and December 31, 2001. Patients with both an osteoporosis diagnosis and a related fracture were classified as "osteoporosis with concurrent fracture"; all other osteoporosis patients were classified as "osteoporosis without concurrent fracture." Annual utilization and expenditures for the concurrent-fracture cohort were compared with those without concurrent fracture, as well as with a group of patients without osteoporosis (controls) that was matched to the concurrent-fracture cohort based on age, gender, US region, health plan type, and length of enrollment. Exponential conditional mean models were used to compute regression-adjusted total expenditures across the groups. The differences in adjusted expenditures were used to generate the economic burden-of-illness estimates. RESULTS: Osteoporosis patients with concurrent fracture incurred more than twice the overall health care expenditures in the study period, compared with those without fracture (US $15,942 vs $6,476), and nearly three times those of the control group (US $15,942 vs $4,658). Approximately 25% of the overall health care expenditures (US $4,014 of $15,942) for the concurrent-fracture group were osteoporosis-related expenditures, leading to the conclusion that comorbid conditions in osteoporosis patients with concurrent fracture contribute significantly to overall health care costs. Some of these comorbidity-related costs were likely due to pain-related disorders, which occurred significantly more frequently in the concurrent-fracture cohort than in the other groups. CONCLUSION: Osteoporosis-related expenditures, particularly those related to fracture, were substantial. However, non-osteoporosis-related expenditures to treat comorbid conditions constituted 75% of the overall health care costs in the year after an osteoporosis-related fracture, which warrants further investigation.

Adolescent↗
PubMed2004

[Health care expenditure in Spain compared with developed Europe, 1985-2001. The Spanish primary health care, the European Cinderella].

OBJECTIVE: To describe the evolution of the funds distribution in our health care system since the start of the primary care reform to 2001, in comparison with the European countries members of the Organisation for Economic Co-operation and Development (OECD). DESIGN: A longitudinal descriptive and retrospective study. PARTICIPANTS: European countries members of the OECD. SETTING: Countries members of the OECD. METHODS: The data come from the OECD database Health Data 2003. The data refer to period 1985-2001, and to a group of variables of health care expenditure by sectors and of income (Gross Domestic Product [GDP] per capita). We compare Spanish data series with those of the group of 22 European members countries of the OECD. RESULTS: Europe increased public expenditure on out-patient care both as a percentage of public health care expenditure and as a percentage of GDP. Spain reduced public expenditure on out-patient care in both senses. Spanish public expenditure on in-patient care reduced a great part of its difference with Europe so that since 1995 it is found, as a percentage of GDP, in the European average and, as per capita, it is according with the Spanish income. In contrast, public expenditure on out-patient care as a percentage of GDP in Spain is very much lower than the European average and, as per capita, is very much lower than the Spanish income. The Spanish private expenditure on out-patient is found among the highest in Europe and, compared with Europe, exceeds very much Spanish income, in contrast with his homonymous public. The Spanish private expenditure on in-patient care is found among the lowest in Europe and, compared with Europe, is very much lower than Spanish income level. CONCLUSIONS: With respect to public resources assigned, the reform of primary care in Spain has not been useful to approach Spanish primary health care level to Europe, in contrast with the Spanish hospital level. The difference between Spain and Europe in public expenditure on out-patient care as a percentage of GDP is, even, bigger than the one there was when the reform of Spanish primary care started.

Delivery of Health Care↗
PubMed2003

Adolescent health care expenditures: a descriptive profile.

PURPOSE: To examine health care spending patterns for U.S. adolescents aged 10 to 18 years using nationally representative household survey data. METHODS: We analyzed data from the 1997 Medical Expenditure Panel Survey on total expenditures and out-of-pocket expenditures for health care based on a sample of 4882 adolescents. RESULTS: Compared with that for adults, health care expenditures for adolescents were low, averaging $799 US dollars per adolescent in 1997. Disabled and functionally impaired adolescents had disproportionately high expenditures ($1960 US dollars per capita). Blacks and adolescents living in poor families had disproportionately low expenditures ($358 and $609 US dollars per capita, respectively). Professional services provided by physicians and dentists accounted for more than one-half of all health care spending for adolescents. Only 2% of adolescents were hospitalized in 1997, but they accounted for about one-fifth of all health care expenditures. The share of health expenditures paid out of pocket varied by type of service, ranging from 3% for inpatient hospital care to 51% for dental care. When covered, insurance provided substantial financial protection for families of adolescents: those with public coverage paid 8%, those with private coverage paid 32%, and those without coverage paid 61% of their health care bills out of pocket. The share of health care bills paid out of pocket would be much lower if dental care was excluded. CONCLUSIONS: On the basis of our findings that health care expenditures for adolescents are low and that insurance coverage provides critically needed financial protection, we conclude that further expansions of public and private health insurance coverage for this population would provide significant benefits at modest additional cost. Additional efforts to improve coverage of services that are not now well-covered, such as dental care, would also be valuable.

Adolescent↗
PubMed1990

Expenditures and sources of funds for mental health organizations: United States and each state, 1986.

EXPENDITURES: Expenditures by the 8 types of mental health organizations covered in this report totaled $18.5 billion in 1986, for the United States and the Territories. Three States (California, New York, and Pennsylvania) accounted for one-third of this total. Nationally, the largest proportion of total expenditures were the expenses of State and county mental hospitals (34 percent, down from 38 percent in 1983) and those of multiservice mental health organizations (20 percent). In all but 19 States, State and county mental hospitals (hereafter called State mental hospitals) had the largest expenditures of any type of mental health organization; in 10 of the remaining 19 states, expenditures of multiservice mental health organizations were largest. Nationally, separate psychiatric services of non-Federal general hospitals, private psychiatric hospitals, and VA psychiatric organizations ranked next, with 16, 14, and 7 percent of total mental health expenditures, respectively. At the other extreme, residential treatment centers (RTCs) for emotionally disturbed children, freestanding psychiatric outpatient clinics, and freestanding psychiatric partial care organizations accounted for 5 percent, 3 percent, and less than 1 percent of national total expenditures, respectively. The $18.5 billion expenditure in 1986 was a 28 percent increase over the 1983 figure, but when adjusted for inflation, the estimated increase was only 5 percent overall and 3 percent on a per capita basis. Constant dollar expenditures (1983 = 100) of most types of mental health organizations increased between 1983 and 1986, but those of freestanding psychiatric outpatient clinics were virtually unchanged, and those of State mental hospitals and VA psychiatric organizations actually decreased. SOURCES OF FUNDS: In 1986, the funds received by mental health organizations totaled $19.0 billion. Of this total, $7.9 billion (41 percent) was provided directly by State governments, predominantly by the State mental health agencies. Direct Federal funds plus Medicare and Medicaid (including the State and local share of Medicaid) provided $4.8 billion, or one-fourth, of total funding. Fees from clients (including private insurance) provided $4 billion, or 21 percent, of total funding; direct local government funds provided 8 percent and all other sources 5 percent. State governments provided 78 percent of the funds received by State mental hospitals and were also the largest single source of funds, although not so dominant, for multiservice mental health organizations, freestanding psychiatric partial care organizations, and freestanding psychiatric outpatient clinics. VA medical centers were funded by the Federal Government, while two-thirds of funding for private psychiatric hospitals came from client fees...

Costs and Cost Analysis↗