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At least 19 recordsLinked to original sources
PubMed1990

Health-related expenditure patterns in selected migrant groups: data from the Australian Household Expenditure Survey, 1984.

Australians born in Italy, Greece and East and South East Asia all have substantially lower mortality levels than those born in Australia, the British Isles or Holland and Germany. Using data from the 1984 Household Expenditure Survey, the health-related consumption expenditure of these six groups was compared (excluding expenditure on medical care). The heterogeneity of household types was largely removed by confining attention to married couple households with dependent children. The two groups with mortality levels comparable to those of the Australian-born (British Isles and Holland/Germany) also shared a similar pattern of consumption expenditures. There was a tendency (not always fully consistent), for the low mortality groups to spend more on fruits, vegetables, cereal products and fish and substantially less on alcohol. Patterns that might be 'unexpected' in low mortality groups are the (presumptively) substantial expenditures on tobacco among males (especially in the Greek group) and the substantial expenditures on red meat in all three groups. Analysis of available data sets such as this can provide useful descriptions of the distribution of health-influencing behaviour in our population.

Adolescent↗
PubMed1988

Relation between energy expenditure and body composition in man: specific energy expenditure in vivo of fat and fat-free tissue.

The relationship between energy expenditure and body composition, in terms of fat and fat-free masses, has previously been described by a variety of predictive regression equations with parameters devoid of physiological content. We present here results obtained by calculating the specific energy expenditure, ie, the energy expenditure per unit of mass, of fat and fat-free tissue on the basis of measurements of the total energy expenditure (EE), the masses of fat (FM), and fat-free (FFM) tissue using the following simple model: EE = k1.FM + k2.FFM where k1 and k2 are the specific energy expenditures of fat and fat-free tissue, respectively. The results of observations on 104 women at rest yielded values for k1 and k2 of 0.31 and 1.35 watts/kg of fat and fat-free mass, respectively, with standard errors of estimate of 0.074 and 0.052 watts/kg, respectively. Analysis of several series of measurements, from other sources and on smaller samples of subjects, yielded similar values at rest but with larger standard errors of estimate. Data from subjects performing varying amounts of work in 24-h measurements showed, as expected, larger values for both tissues. The results explain to a very large extent the well-established relation between resting metabolic rate and body weight, ie, a linear relation with a non-zero intercept. The results also offer a clear-cut explanation for the well known difference in energy expenditure between men and women with the same body weight.

Adipose Tissue↗
PubMed1991

The energy expenditure and nutritional status of college students. I. The energy cost and the total energy expenditure per day.

The energy cost of major activities was determined in healthy students. Among the 606 medical students, 319 were males and 287 were females. Their ages ranged from 18 to 24 years. Douglas' method was used to measure energy cost of each of a total of 42 activities, as well as that of the basal metabolic rates (BMR), resting metabolic rates (RMR) and the total energy expenditure per day under normal situations. The average RMR of male and female subjects were 0.669 +/- 0.033 and 0.656 +/- 0.030 kcal/sq.m/min respectively. The total energy expenditure per day of male students were 2706 kcal, and 2373 kcal for female students. The energy cost of single activities can be used as the basal data in studies of energy metabolism.

Adolescent↗
PubMedDate not supplied

The energy expenditure index: a method to quantitate and compare walking energy expenditure for children and adolescents.

We used heart rate and walking speed to calculate an energy expenditure index (EEI), the ratio of heart rate per meter walked, for 102 normal subjects, age 6-18 years. Heart rate was measured at self-selected slow, comfortable, and fast walking speeds on the floor and on a motor-driven treadmill. At slow walking speeds (37 +/- 10 m/min) the EEI was elevated (0.71 +/- 0.32 beats/m), indicating poor economy. At comfortable speeds (70 +/- 11 m/min) the EEI values decreased to the maximum economy (0.47 +/- 0.13 beats/m). At fast speeds (101 +/- 13 m/min), the EEI increased (0.61 +/- 0.17 beats/m), indicating poor economy relative to comfortable speeds. A graph of the EEI versus walking speed provides a way to evaluate and compare energy expenditure in a clinical setting.

Adolescent↗
PubMed1988

Studies on the energy expenditure following surgical stress (II. The correlation between energy expenditure and hormonal changes).

The correlation between energy expenditure and hormonal changes following surgical stress was studied using rats. Blood concentrations of catecholamine, insulin, corticosterone, glucagon, T3, and T4 were compared between the rats (IIa and IIb) in the ebb phase and those (III and IV) in the flow phase, 6 hours after being inflicted with a burn. Noradrenaline was higher, though not significantly, and glucagon was significantly higher in the latter groups than in the former groups. When glucagon was administered to the rats in the ebb phase, RME increased significantly. From these results, it is suggested that glucagon plays an important role in the transition from ebb phase to flow phase.

Animals↗
PubMed1986

An energy 'sources' and 'fractions' approach to the mechanical energy expenditure problem--III. Mechanical energy expenditure reduction during one link motion.

Mechanical energy economy and transformation during one link motion are analyzed on the basis of the theory developed in the previous publications (parts I and II of this series, J. Biomechanics 19, 287-300). The 'compensation coefficient' characterizing mechanical energy economy is introduced. The attempts to estimate MEE using only energy curves and neglecting the powers of real sources of energy implicitly lead to replacement of real force and moment systems by the systems reduced to the centers of mass. But such an unintentional substitution of imaginary sources for real ones, specifically, the reduction of forces acting on the link to the equivalent system, changes estimates of mechanical energy expenditure (MEE). That is why the methods of calculating MEE economy based on the determination of so-called 'quasi-mechanical' work (the sum of the kinetic and potential energy increases per one cycle of motion) are not correct. There are two mechanisms to reduce the MEE using the antiphase fluctuations (corresponding to energy transformations) of the (a) rotational and translational fractions of the total energy (at the expense of the F-sources); (b) potential and kinetic energies (at the expense of the mg-source).

Biomechanical Phenomena↗
PubMedDate not supplied

Medical expenditures and insurance coverage for people with diabetes: estimates from the National Medical Care Expenditure Survey.

Access to health insurance and protection against expenditures for medical care are of special concern to diabetic patients in the United States. This study examines some information on the extent and breadth of public and private health insurance for individuals with diabetes, as well as some estimates of their use of health-care services and their mean expenses for this care. About 12% of all diabetic patients less than 65 yr old (approximately 311,000 individuals) were uninsured throughout 1977, a rate not much different from that for the rest of the United States population. Those with diabetes who are uninsured tend to be younger, Black or Hispanic, in excellent or good health, and live outside of metropolitan areas and in the South or West. As expected, diabetic patients use more medical care than others of their age and sex, and their medical expenses are also much higher, particularly in younger age groups. In 1977, average total medical-care expenses for people with diabetes were $1514 compared with $548 for the rest of the population. They and their families paid approximately 20% out of pocket (approximately $355). Their health insurance premiums were not much different from those without diabetes, averaging approximately $1000 in 1977 for those under age 65. The private insurance coverage for diabetic patients was similar to that for others, although slightly fewer had major medical coverage than the general population.

Adult↗
PubMed1986

An energy 'sources' and 'fractions' approach to the mechanical energy expenditure problem--V. The mechanical energy expenditure reduction during motion of the multi-link system.

Mechanical energy economy during motion of the multi-link system is analyzed on the basis of the theory developed in the previous publications (parts I-IV of this series, J. Biomechanics 19, 287-309). The compensation coefficients for the F- and M-sources and also the absolute compensation coefficient reflecting the mechanical energy economy due to four possible resources are introduced. These resources are the antiphase fluctuations of (I) each link's total energy fractions involving energy transformations between (1) rotational and translational fractions by F-sources, (2) kinetic and potential fractions by mg-source; (II) the links' total energies involving energy transfers between (3) links by F-sources, (4) links by M-sources. The conditions of mechanical energy economy, particularly due to M-sources, are analyzed.

Biomechanical Phenomena↗
PubMed1991

Energy expenditure and substrate metabolism measured by 24 h whole-body calorimetry in patients receiving cyclic and continuous total parenteral nutrition.

1. Twenty-four hour energy expenditure and its components, i.e. 'basal metabolic rate', activity energy expenditure and diet-induced thermogenesis were measured, using continuous whole-body indirect calorimetry, in patients receiving total parenteral nutrition while in remission from Crohn's disease (weight 51.9 +/- 9.9 kg, body mass index 19.2 +/- 2.0 kg/m2). 2. Total parenteral nutrition was infused continuously over 24 h in four subjects and cyclically, between 22.00 and 10.00 hours, in eight subjects. Twenty-four hour energy expenditure (6.83 +/- 1.10 MJ/24 h) was lower than total energy intake (10.09 +/- 1.63 MJ/24 h), resulting in a positive energy balance (3.26 +/- 1.42 MJ) in all subjects. Repeated measurements of resting energy expenditure in the continuously fed subjects (5.82 +/- 1.11 MJ/24 h) did not change significantly at different times of day (coefficient of variation 2.2-6.6%). In contrast, in cyclically fed subjects, resting energy expenditure was 24.2 +/- 9.0% higher towards the end of the 12 h feeding period than the 'basal metabolic rate', which was measured just before the start of the feeding period. 3. Diet-induced thermogenesis, calculated as the increment in resting energy expenditure above 'basal metabolic rate' over the 24 h period (adjusted for the reduction in energy expenditure during sleep), was found to be 0.60 +/- 0.29 MJ or 6.1 +/- 3.1% of the energy intake. 4. The energy cost of activity (activity energy expenditure) in the continuously fed patients, calculated as the difference between 24 h energy expenditure and the integrated 24 h measurements of resting energy expenditure, was 0.88 +/- 0.53 MJ, i.e. 12.9 +/- 5.9% of the 24 h energy expenditure. 5. The non-protein non-glycerol respiratory quotient exceeded 1.0 for varying periods of time (0.5-17 h) in 11 subjects, indicating net lipogenesis from carbohydrate. 6. The results demonstrate favourable rates of deposition, during intravenous feeding, of both energy and nitrogen over a 24 h period in patients recovering from an episode of Crohn's disease. The efficacy of these commonly used total parenteral nutrition regimens in these patients is related to three features that are absent in normal healthy individuals, namely a low basal metabolic rate, a low activity-related energy expenditure and prolonged periods of lipogenesis from carbohydrate.

Adult↗
PubMed1991

Resting energy expenditure in patients with pancreatitis.

OBJECTIVE: To assess the resting energy expenditure of hospitalized patients with pancreatitis. DESIGN: Prospective, case-referent study. SETTING: Nutrition support service in a university tertiary care hospital. PATIENTS: Patients referred to the Nutrition Support Service with the diagnosis of pancreatitis. Excluded from study entry included those with cancer, obesity (greater than 150% ideal body weight), those measured within 3 postoperative days, or patients requiring ventilator support with an FIO2 of greater than 0.5. Forty-eight patients with either acute pancreatitis (n = 13), chronic pancreatitis (n = 24), acute pancreatitis with sepsis (n = 7), or chronic pancreatitis with sepsis (n = 7) were studied. The two septic groups were combined into a single pancreatitis-with-sepsis group, since no significant differences among measured variables were observed between individual septic groups. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Resting energy expenditure was measured by indirect calorimetry and compared with the predicted energy expenditure, as determined by the Harris-Benedict equations. Resting energy expenditure (percent of predicted energy expenditure) was significantly (p less than .02) greater for patients with pancreatitis complicated by sepsis (120 +/- 11%) compared with the nonseptic chronic pancreatitis group (105 +/- 14%). Resting energy expenditure for the nonseptic acute pancreatitis patients (112 +/- 17%) was not significantly different from the other groups. The septic pancreatitis group had the largest percentage (82%) of hypermetabolic (resting energy expenditure greater than 110% of predicted energy expenditure) patients, whereas 61% and 33% of the acute and chronic pancreatitis groups were hypermetabolic, respectively (p less than .02). CONCLUSIONS: Resting energy expenditure is variable in patients with pancreatitis (77% to 139% of predicted energy expenditure). The Harris-Benedict equations are an unreliable estimate of caloric expenditure. Septic complications are associated with hypermetabolism and may be the most important factor influencing resting energy expenditure in pancreatitis patients.

Acute Disease↗
PubMed1991

Have hospital inpatient cost containment programs contributed to the growth in outpatient expenditures? Analysis of the substitution effect associated with hospital utilization review.

The rapid increase in outpatient expenditures has been the focus of growing attention in recent years. This increase has corresponded with public and private efforts to contain hospital inpatient costs, prompting some analysts to suggest that outpatient expenditure growth is the result of a substitution effect; that is, the substitution of outpatient for inpatient care associated with hospital cost containment programs. Claims data on 43 privately insured groups that adopted utilization review (UR) during the latter part of 1984 or early 1985 were analyzed, comparing outpatient expenditures before and after adoption of hospital inpatient UR to quantify the substitution effect associated with UR. UR was not associated with higher physician office expenditures nor with higher outpatient diagnostic expenditures. UR was related to significantly higher hospital outpatient department expenditures. On average, these expenditures were approximately 20% higher (P = 0.01) after the adoption of UR. However, outpatient department expenditures of the groups analyzed represented a fairly small percentage of total medical expenditures; hence, the absolute expenditure increase was quite modest, on the order of $9 per insured person per year. This analysis, admittedly limited in scope, suggests that UR is associated with a measurable substitution effect. It is likely that inpatient hospital cost containment programs have resulted in some substitution of outpatient for inpatient care and thus have played a role in fostering outpatient expenditure growth during recent years.

Cost Control↗
PubMed1991

Expenditures and sources of funds for mental health organizations: United States and each state, 1988.

Expenditures. Expenditures by the 8 types of mental health organizations covered in this report totaled $23.1 billion in 1988 in the United States and territories. Three States (California, New York, and Pennsylvania) accounted for 30 percent of this total. Nationally, State and county mental hospitals (hereafter called State mental hospitals) accounted for the largest proportion of all expenditures (30 percent, down from 34 percent in 1986). Private psychiatric hospitals and multiservice mental health organizations had the next largest expenditures, each accounting for 20 percent of the total, followed by the separate psychiatric services of non-Federal general hospitals at 16 percent. Department of Veterans Affairs (VA) mental health services, residential treatment centers (RTCs) for emotionally disturbed children, freestanding psychiatric outpatient clinics, and freestanding psychiatric partial care organizations accounted for 6 percent, 6 percent, 3 percent, and less than one-half percent of total expenditures, respectively. State mental hospitals represented the largest expenditures of any single type of mental health organization in 23 States; expenditures of private psychiatric hospitals were largest in 12 States; and expenditures of multiservice mental health organizations were the largest in 10 States. The $23.1 billion total for 1988 represented a 25 percent increase over the 1986 figure but, when adjusted for inflation, the estimated increase (expressed in constant dollars) was only 10 percent overall and 8 percent on a per capita basis. Constant dollar expenditures of most types of mental health organizations increased between 1986 and 1988, with the largest increase occurring among private psychiatric hospitals (54 percent). In contrast, constant dollar expenditures decreased for State mental hospitals and VA mental health services. Sources of Funds In 1988, the funds received by mental health organizations totaled $23.4 billion. Of this total, $8.8 billion (38 percent) was provided directly by State governments, predominantly by State mental health agencies. Direct Federal funds, plus Medicare and Medicaid (including the State and local share of Medicaid), provided $6.5 billion (28 percent) of total funding. Fees from clients (including private insurance) provided $5.2 billion (22 percent); direct local government funds provided 7 percent; and all other sources, 5 percent. State governments provided 77 percent of the funds received by State mental hospitals and were also the largest single source of funds for multiservice mental health organizations (51 percent) and freestanding psychiatric partial care organizations (44 percent). VA mental health services were funded by the Federal government, while 62 percent of funding for private psychiatric hospitals came from client fees (including private insurance).(ABSTRACT TRUNCATED AT 400 WORDS)

Community Mental Health Services↗
PubMed1992

[Factors affecting the increase in hospitalized medical care expenditure in Japan: analysis of national data in all 47 prefectures].

To clarify factors affecting the increase in annual expenditure for hospitalized medical care in Japan, the effects of the following four variables in all 47 prefectures were analyzed: (1) the hospitalized medical care expenditure per day per inpatient, (2) the number of admissions per population base, (3) average length of stay of patients in hospital per year and (4) the number of hospital beds per population base. The annual expenditure for hospitalized medical care per population base was correlated most significantly with the number of hospital beds per population base. The annual expenditure was also significantly correlated positively with the number of admissions per population base and average length of stay of patients in hospital per year, and inversely with the hospitalized medical care expenditure per day per inpatient. Hospitalized medical care expenditure per day per inpatient was inversely correlated with average length of stay of patients in hospital and the number of hospital bed per population base. Results from stepwise multiple regression analysis indicated that the number of hospital bed per population base and the hospitalized medical care expenditure per day per inpatient are the only two variables which have significant effects on the annual expenditure for hospitalized medical care per population base. The annual rate of increase for annual expenditure for hospitalized medical care per population base from 1980 to 1986 was 6.1%. Similarly, the rate of increase in the hospitalized medical care expenditure per day per inpatient was 3.5%; that of the number of admissions per population base was 3.1%.(ABSTRACT TRUNCATED AT 250 WORDS)

Health Care Costs↗
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↗
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↗