Expenditure For Use Research Articles

Endotherms trade body temperature regulation for the stress response.

Responding to perceived threats is energetically expensive and can require animals to curtail somatic repair, immunity, and even reproduction to balance energy ledgers. In birds and mammals, energetic demands of thermoregulation are often immense, yet whether homeostatic body temperatures are also compromised to aid the stress response is not known. Using data sourced from over 60 years of literature and 24 endotherm species, we show that exposure to non-thermal challenges (e.g. human interaction, social threats) caused body temperatures to decrease in the cold and increase in the warmth, but particularly when species-specific costs of thermoregulation were high and surplus energy low. Biophysical models revealed that allowing body temperature to change in this way liberated up to 24% (mean = 5%) of resting energy expenditure for use towards coping. While useful to avoid energetic overload, these responses nevertheless heighten risks of cold- or heat-induced damage, particularly when coincident with cold- or heatwaves.

Annual out-of-pocket expenditure associated with healthcare use among Australian older women with osteoporosis: a cross-sectional study

Osteoporosis is a common skeletal condition among women that has a considerable impact on quality of life. The purpose of this study is to determine the prevalence of healthcare use and to estimate associated out-of-pocket expenditure for the management of osteoporosis in older Australian women. Data was obtained from 393 Australian women from the 45 and Up Study who had osteoporosis. The women were asked about healthcare use for their osteoporosis, including conventional medicine, complementary medicine, and self-care practices or self-care products, and associated out-of-pocket expenditure for that use over 12months. The average age of participants was 72.0years. Over a 12-month period, the majority of participants (72%) consulted a doctor for their osteoporosis, 24% consulted an allied health practitioner, and 20% consulted a complementary medicine practitioner. Participants had a mean of 6.8 consultations with healthcare practitioners in the previous 12months for the osteoporosis. In addition, 46% participants used three or more types of complementary medicine products/practices in the previous 12months. Overall, the participants incurred a (arithmetic) mean ofAU$594 (median = $350; inter-quartile range = $450) in out-of-pocket expenditure for healthcare use over the 12-month period. Women with osteoporosis use a wide range of healthcare services that are associated with significant annual out-of-pocket expenditure. Preventive strategies can help decrease the cost burden of osteoporosis on the healthcare system.

Did the Number of Older People Requiring Long-Term Care and Expenditure Increase after the 2011 Great East Japan Earthquake? Analysis of Changes over Six Years.

On 11 March 2011, the great earthquake hit Japan, resulting in 15,895 deaths, 6156 serious injuries, and 2539 missing persons. This event affected the health and lives of older residents, and reports showed an increase in the number of people eligible for long-term care afterward. In this study, among the places affected by the 2011 Great East Japan Earthquake and tsunami, we focused on 15 municipalities, including designated municipalities based on the Special Act on Nuclear Evacuation in Fukushima Prefecture, and aimed to clarify the medium-term effects (six years post-disaster) on the long-term care certification rate and expenditure for provision of services. We used the Ministry of Health, Labour, and Welfare Monthly Status Report on Long-Term Care Insurance and the Ministry of Internal Affairs and Communications Population Register for 2011, 2014, and 2017. In 2011, we found no intergroup differences among the 15 Fukushima municipalities and other municipalities in either the long-term care certification rate or the per-person expenditure for use of services. In 2014, after the earthquake, the long-term care certification rate was 5.4% higher in the 15 Fukushima municipalities than in other municipalities for those aged 75 years or older. The rate of 2014–2017 has not increased significantly, partly because of stability after the disaster and change in the population structure. Nevertheless, the long-term care certification rate in the 15 Fukushima municipalities is higher than that of the other two groups even after six years since the earthquake. Similarly, the per-person expenditure for use of services for one month was 11,800 yen higher in the 15 Fukushima municipalities than in other municipalities in 2014, and this trend continued into 2017. Strong, ongoing governmental support is needed, especially for those aged 75 or older, following a disaster.

New type of fluxgate magnetometer for the heart’s magnetic fields detection

Abstract The application area of fluxgate sensors is limited by their sensitivity. Medical researches create high demand on the magnetometers with the characteristics of high accuracy and sensibility for measuring weak magnetic fields produced by the human body, such as the heart‘s magnetic field. Due to the insufficient sensitivity of fluxgate sensors, superconducting magnetometers (SQUID) take the dominant position for the cardiomagnetic measurements. They have to be cooled by liquefied gases and it leads to high service costs. Therefore an idea of creating a high sensitive sensor based on fluxgate principles and known methods of measurement is attractive and up to date. This paper is dedicated to the modified flux-gate sensors based on Racetrack technology with a new approach of signal demodulation. The improved fluxgate sensor system provides detection of the heart‘s magnetic field without additional expenditures for use.

Techniques to measure free-living energy expenditure during pregnancy - A guide for clinicians and researchers.

As maternal overweight and obesity increase in prevalence, the need to optimise gestational weight gain has entered the forefront due to the well-documented poor fetal and maternal outcomes associated with excess adipose tissue. Measurements of changes in energy expenditure form crucial components of effective weight management programmes, and they are also important for clarifying the energy requirements of pregnancy. This review evaluates the primary techniques for measuring free-living energy expenditure for use in pregnancy, with special consideration of the dynamic physiological changes that occur in this state. The methods that will be discussed include the doubly labelled water method, activity recall and activity logs, heart rate monitors and motion sensors. This article may be useful for clinicians seeking to implement active gestational weight management by enabling advice on increases in caloric intake linked to measured changes in energy expenditure, and for researchers studying energy metabolism in pregnancy.

Pre-test of questions on health-related resource use and expenditure, using behaviour coding and cognitive interviewing techniques

BackgroundValidated instruments collecting data on health-related resource use are lacking, but required, for example, to investigate predictors of healthcare use or for health economic evaluation.The objective of the study was to develop, test and refine a questionnaire collecting data on health-related resource use and expenditure in patients with diabetes.MethodsThe questionnaire was tested in 43 patients with diabetes mellitus types 1 and 2 in Germany. Response behaviour suggestive of problems with questions (item non-response, request for clarification, comments, inadequate answer, “don’t know”) was systematically registered. Cognitive interviews focusing on information retrieval and comprehension problems were carried out.ResultsMany participants had difficulties answering questions pertaining to frequency of visits to the general practitioner (26%), time spent receiving healthcare services (39%), regular medication currently taken (35%) and out of pocket expenditure on medication (42%). These difficulties seem to result mainly from poor memory. A number of comprehension problems were established and relevant questions were revised accordingly.ConclusionThe questionnaire on health-related resource use and expenditure for use in diabetes research in Germany was developed and refined after careful testing. Ideally, the questionnaire should be externally validated for different modes of administration and recall periods within a variety of populations.

Development of a compendium of energy expenditures for youth.

BackgroundThis paper presents a Compendium of Energy Expenditures for use in scoring physical activity questionnaires and estimating energy expenditure levels in youth.Method/ResultsModeled after the adult Compendium of Physical Activities, the Compendium of Energy Expenditures for Youth contains a list of over 200 activities commonly performed by youth and their associated MET intensity levels. A review of existing data collected on the energy cost of youth performing activities was undertaken and incorporated into the compendium. About 35% of the activity MET levels were derived from energy cost data measured in youth and the remaining MET levels estimated from the adult compendium.ConclusionThe Compendium of Energy Expenditures for Youth is useful to researchers and practitioners interested in identifying physical activity and energy expenditure values in children and adolescents in a variety of settings.

The Effects and Expense of Augmenting Usual Cancer Clinic Care With Telephone Problem-Solving Counseling

This study was done to assess the effectiveness and efficiency of individualized, problem-solving counseling provided by baccalaureate nurses over the telephone to prevent the onset of depression in persons with breast, lung, or prostate cancer. Of 175 persons randomized, 149 completed the 8-month follow-up. The primary outcome measures were changes in the Jalowiec Coping Scale, the Centre for Epidemiologic Studies in Depression Scale, and the Derogotis Psychosocial Adjustment to Illness Scale. In addition, expenditures for people's use of all health and social services were computed at baseline and follow-up. Telephone counseling improved the use of more favorable coping behaviors, prevented a clinically important but not statistically significant decline into depression, and poor psychosocial adjustment in a group of people with mixed cancer. These results were associated with a greater total per person per annum expenditure for use of all other health and social services in the community compared with the control group. In a situation of limited resources and a service producing more effect for more costs, one needs either to examine what services to forgo to offer this service or to carefully target the new service to those most likely to benefit.

Economic evaluations of community-based care: lessons from twelve studies in Ontario.

A series of 12 studies (five historic cohort and seven randomized trials) examined clients in community settings in Southern Ontario suffering from a variety of chronic physical and mental health conditions. These studies are appraised using a framework for evaluating possible outcomes of economic evaluation. In the 12 studies, sample composition and size varied. Each study was designed to quantify the well-being outcomes and expenditures associated with different community-based approaches to care provided in the context of a system of national health insurance. As a collective, these studies represent increasing methodological rigour. Multiple-perspective client well-being outcome measures were used. In two studies, caregiver burden also was analysed. A common approach to quantification and evaluation of expenditures for service consumption was used in all 12 studies. The nature of community-based health services (health vs. disease care orientation) was found to have direct and measurable impact on total expenditures for health service utilization and client well-being outcomes. In most cases, a recurring pattern of equal or better client outcomes, yet lower expenditures for use of community based health services, was associated with well-integrated health oriented services. Integrated services aimed at factors which determine health are superior when compared to individual, fragmented, disease oriented, and focused approaches to care. The main lessons from the 12 studies are that it is as or more effective and as or less expensive to offer complete, proactive, community health services to persons living with chronic circumstance than to provide focused, on-demand, piecemeal services. Complete services would have a psychosocial and mental health focus included with the physical care approach. Furthermore, people with coexisting risk factors (age, living arrangements, mental distress and problem-solving ability) are the ones who most benefit at lower expense from health oriented, proactive interventions.