Influence of inhalation injury on energy expenditure in severely burned children

ObjectiveDetermine the effect of inhalation injury on burn-induced hypermetabolism in children.DesignProspective study comparing hypermetabolism (i.e., resting energy expenditure and oxygen consumption) in burned children with and without inhalation injury during acute hospitalization.SettingSingle pediatric burn center.PatientsEighty-six children (1–18 years) with ≥40% total body surface area burns were stratified to two groups: no inhalation injury and inhalation injury.InterventionsNone.Main measurements and resultsInhalation injury was diagnosed based on bronchoscopic evaluation. At admission, PaO₂:FiO₂ ratios (an index of respiratory distress) were significantly higher in patients with no inhalation injury than in patients with inhalation injury. No differences were detected in resting energy expenditure or percent of the predicted basal metabolic rate between groups. Additionally, oxygen consumption did not significantly differ between groups.ConclusionsInhalation injury does not augment the burn-induced hypermetabolic stress response in children, as reflected by resting energy expenditure and oxygen consumption.     

卫生总费用和GDP的增长率关系

在完美医疗状态下，建立相应的数学模型，对卫生总费用及其增长进行推算。结果显示：卫生总费用随社会经济水平的发展而增加，但增长率低于GDP增长率，且满足规定的域值。可见，当符合完美医疗状态时，医疗卫生不会造成一个国家或地区的灾难，也不会造成许多民众的健康保障缺失；由此提出未来国家卫生服务体系的改进目标是完美医疗。     

Health expenditure data for policy: Health accounts,national accounts or both?

Compatibility of statistical frameworks and comparability of data are aspects of statistical quality. This paper explores comparability of data from National Accounts (NA) and Care Accounts/health accounts (CA&HA) of the Netherlands. Although based on the same sources, differences result from specificities of each framework, making data adjustments necessary. Data comparison of major aggregates and household spending is a means for verification and for triangulation of sources. Monitoring household spending on health is one of the Sustainable Development Goals. The usability of NA data for household consumption estimates is key to judge plausibility of household spending levels. However, definitions, coverage and valuation in NA and CA&HA should be understood to benefit from the use of NA data for HA. More than in the concepts used the strength of NA is the way NA are usually produced compared with HA. Key is the integrated analysis including supply and demand to verify the comprehensiveness and consistency. It is concluded that SUT data of NA on consumption of human health and social care can be used for judging plausibility of HA household spending estimates, and, in the absence of the latter, NA data can directly be used. The case of the Netherlands shows that policy measures can have a large impact on the validity of using NA for the estimation of household spending.     

Comparison of wrist-worn and hip-worn activity monitors under free living conditions

Purpose: Current recommendations state that individuals engage in 150?min of moderate or 75?min of vigorous intensity physical activity (PA) each week. Commercial PA monitors are becoming popular for everyday use. The accuracy of these devices, however, is not well understood. We sought to examine the accuracy of two commercial devices, one wrist and one hip-worn, under free-living conditions.

Methods: Twenty-two subjects wore two commercially available devices and one ActiGraph (AG) for seven consecutive days under normal activity.

Results: Mean steps per day between all three devices differed significantly. No differences were found in moderate-to-vigorous intensity physical activity (MPVA). Daily energy expenditure (EE) also differed significantly between the AG and the commercial devices. Bland–Altman analysis found poor agreement between the AG and the commercial devices with regards to steps and EE, but good agreement in MVPA.

Conclusion: Results suggest that the commercial devices are less accurate in estimating steps and EE. These devices did show good agreement with regards to MVPA, suggesting that they may provide useful feedback for individuals seeking to achieve the current PA guidelines for MVPA. Improvements are needed with regards to steps and EE estimation.     

Pharmacotherapy of obesity

The growing recognition of the health risks of obesity coupled with the difficulties in treating it successfully by lifestyle modification predicates a need for effective drug treatment. The history of drug treatment in the second half of the 20th century is, however, one of disappointment and concern over drug toxicity. However, the advances in our understanding of the mechanism of weight control, together with improved ways of evaluating anti-obesity drugs, has resulted in two effective compounds, sibutramine and orlistat, becoming available for clinical use. Sibutramine has actions on both energy intake and expenditure and had been shown to enhance weight loss and weight maintenance achieved by diet, in simple obesity as well as when accompanied by complications of diabetes or hypertension. About 50-80% of patients can achieve a >5% loss, significantly more than if patients receive the same lifestyle intervention with placebo. Orlistat, which acts peripherally to block the absorption of dietary fat, has had similar results in clinical trials; a recent study (XENDOS) has just reported results which show that the enhanced, albeit modest, weight loss achieved with orlistat delays the development of diabetes over a 4-year period. A number of other compounds are expected to complete or enter clinical trials over the next decade. There is considerable optimism that we will soon have the pharmacological tools needed to make the treatment of obesity feasible.     

Resting energy expenditure in patients with alcoholic chronic pancreatitis

The aim of this study was to assess resting energy expenditure in patients with chronic pancreatitis; 33 patients with alcohol-related chronic pancreatitis (group 1: 13 normal weight, group 2: 20 underweight) and 11 undernourished patients without identifiable disease (group 3) were studied. Body composition was determined by bioelectric impedance analysis and energy expenditure by indirect calorimetry. The percentage of body weight occupied by fat-free mass was similar among the three groups (76.4±1.5%, 78.6±1.3% and 76.8±2.1% for groups 1, 2, and 3, respectively). The measured resting energy expenditure (REE) was higher than the predicted EE (Harris and Benedict formula and Cunningham's equation) for the underweight patients with chronic pancreatitis (group 2) (P<0.05), but not for the two other groups. According to Cunningham's equation, 65% of the group 2 patients were hypermetabolic (REE>110% of predicted EE) versus 23.1% and 20% in groups 1 and 3. When adjusted for fat free mass, REE was significantly (P<0.01) higher in group 2 (35.0±0.9 kcal/kg/24 hr) than in the other two groups (30.1±0.7 kcal/kg/24 hr and 30.8±1.4 kcal/kg/24 hr in groups 1 and 3, respectively). During chronic pancreatitis, weight loss is accompanied by hypermetabolism, which should be taken into consideration during nutritional support.     

Effect of intermittent versus continuous energy restriction on weight loss,maintenance and cardiometabolic risk: A randomized 1-year trial

Background & aims

Long-term adherence to conventional weight-loss diets is limited while intermittent fasting has risen in popularity. We compared the effects of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk factors in adults with abdominal obesity and ≥1 additional component of metabolic syndrome.