Evolución de la eficiencia y la productividad del sistema de salud público chileno entre 2010 y 2019 / Efficiency and productivity of the Chilean public health system between 2010 and 2019

Introducción Frente al fuerte incremento del gasto en salud, es necesario indagar si ha venido acompañado de aumentos proporcionales en la producción de atenciones de salud dirigidas a los beneficiarios del Fondo Nacional de Salud. Métodos En esta investigación observacional, descriptiva y longitudinal retrospectiva estimamos la eficiencia técnica del Sistema Nacional de Servicios de Salud a través del costo medio de producción y la productividad media del trabajo en el periodo de 2010 a 2019. Resultados Durante la década estudiada, la producción ha aumentado en torno al 6% anual; la dotación de trabajadores aumentó (mayormente en el estamento médico) 61%; el gasto en remuneraciones aumentó 106% real; el gasto en bienes y servicios de consumo ha aumentado 25% real; la eficiencia del gasto ha disminuido 21% y la productividad es el elemento menos dinámico del sistema con 0,6% de crecimiento medio anual. Tras sustraer el componente de exámenes diagnósticos, el escenario empeora. Conclusiones Los resultados muestran que el mayor gasto en salud no ha venido aparejado de aumentos proporcionales en producción, traduciéndose en una caída en la eficiencia del gasto sanitario y aumentos magros o caídas en productividad, según cómo se mida la producción. Esto hace que la estrategia de crecimiento del sector público dependa principalmente de aumentos en la dotación de trabajadores. Esta baja productividad constituye una limitante seria para mejorar el acceso de los beneficiarios del Fondo Nacional de Salud a las atenciones de salud y contribuye a incrementar las listas de espera. Especial atención debiera brindarse a los costos medios de producción y a la productividad media del trabajo en un escenario de menor dinamismo en el crecimiento del gasto público en salud y de reforma del sistema de salud.

Introduction In view of the strong increase in health expenditure, it is necessary to investigate whether proportional increases in healthcare production for the beneficiaries of the National Health Fund have corresponded to this increase. Methods In this observational, descriptive, and retrospective longitudinal research, we estimate the technical efficiency of the National Health Services System through the average cost of production and average labor productivity in the period from 2010 to 2019. Results During the studied decade, production has increased by approximately 6% annually; the number of workers increased (mostly physicians) by 61%; spending on salaries increased by 106% in real terms; spending on consumer goods and services has increased by 25% in real terms; the efficiency of spending has decreased by 21%, and productivity is the least dynamic element of the system with an average annual growth rate of 0.6%. After subtracting the diagnostic tests component, this scenario worsens. Conclusions The results show that higher health expenditure has not been matched by commensurate increases in output, translating into a fall in the efficiency of healthcare expenditure and meager increases or falls in productivity, depending on how the output is measured. This means that the public sector's growth strategy depends mainly on increases in the number of workers. This low productivity is a serious constraint to improving healthcare access for National Health Fund beneficiaries and contributes to increasing waiting lists. Special attention should be paid to average production costs and average labor productivity in a scenario of less dynamic growth in public health spending and health system reform.

Cost of screening, out-of-pocket expenditure & quality of life for diabetes & hypertension in India

Background & objectives: The Government of India has initiated a population based screening (PBS) for noncommunicable diseases (NCDs). A health technology assessment agency in India commissioned a study to assess the cost-effectiveness of screening diabetes and hypertension. The present study was undertaken to estimate the cost of PBS for Type II diabetes and hypertension. Second, out-of-pocket expenditure (OOPE) for outpatient care and health-related quality of life (HRQoL) among diabetes and hypertension patients were estimated. Methods: Economic cost of PBS of diabetes and hypertension was assessed using micro-costing methodology from a health system perspective in two States. A total of 165 outpatients with diabetes, 300 with hypertension and 497 with both were recruited to collect data on OOPE and HRQoL. Results: On coverage of 50 per cent, the PBS of diabetes and hypertension incurred a cost of ? 45.2 per person screened. The mean OOPE on outpatient consultation for a patient with diabetes, hypertension and both diabetes and hypertension was ? 4381 (95% confidence interval [CI]: 3786-4976), ? 1427 (95% CI: 1278-1576) and ? 3932 (95% CI: 3614-4250), respectively. Catastrophic health expenditure was incurred by 20, 1.3 and 14.8 per cent of patients with diabetes, hypertension and both diabetes and hypertension, respectively. The mean HRQoL score of patients with diabetes, hypertension and both was 0.76 (95% CI: 0.72-0.8), 0.89 (95% CI: 0.87-0.91) and 0.68 (95% CI: 0.66-0.7), respectively. Interpretations & conclusions: The findings of our study are useful for assessing cost-effectiveness of screening strategies for diabetes and hypertension.

Out of Pocket Expenditure among Cancer Patients Availing Treatment at A Tertiary Care Centre in Hyderabad, India

Background: The expenses that the patient or the family pays directly to the health care provider, without a third-party (insurer or State) is known as 'Out of Pocket Expenditure' (OOPE). These expenses could be medi-cal and non-medical. About 150 million people face financial catastrophe every year due to health care pay-ments and cancer is one of the leading causes of high OOPE. Objectives: This study was conducted to estimate the OOPE among cancer patients and to determine the OOPE in relation to type of cancer and treatment modality.Methodology: A cross sectional study was conducted at a tertiary care centre in Hyderabad during August and September,2022 with a total study population of 400 cancer patients. After consenting the participants, data was collected via face-to-face interview using a semi structured questionnaire. Results: The mean OOPE per patient was found to be $1032.65 (₹84,643.20). This includes the medical and non-medical costs. Leukaemia was found to have the highest OOPE amongst all cancers followed by colon cancer. Similarly, radiotherapy + surgery was found to have the highest OOPE followed by chemotherapy + radiotherapy + surgery.Conclusion And Interpretation- This study is unique in its way that no other study has considered OOPE for different cancers in single research. We would like to highlight the quantification of OOPE among various types of cancers and its variation based on treatment modality used. It is necessary that future government in-itiatives consider the importance of mitigating the OOPE along with provision of cancer care.

Tasa metabólica en reposo por calorimetría indirecta y ecuaciones de predicción en deportistas con amputación: Análisis de concordancia

La Tasa Metabólica en Reposo (TMR) suele calcularse utilizando ecuaciones de predicción por su fácil acceso y bajo costo. Sin embargo, estas ecuaciones no se encuentran validadas en población deportista con amputación. Objetivo: determinar la concordancia entre la medición de la TMR realizada por Calorimetría Indirecta (CI) y la calculada por ecuaciones de predicción en deportistas con amputación de miembros inferiores en Bogotá. Sujetos y métodos: Este estudio evaluó 16 deportistas adultos masculinos, con amputación de miembro inferior. La TMR se midió con CI y se calculó con las ecuaciones de predicción de Harris-Benedict, Cunningham, Mifflin -St. Jeor, Schofield y Oxford. Se utilizaron dos variables diferentes de masa corporal: masa corporal total (MCT) y masa magra (MM) determinada por Absorciometría de doble energía de rayos X (DEXA) y por el método antropométrico de fraccionamiento de masas en cinco componentes (5C). La concordancia se determinó a través del coeficiente de correlación intraclase (CCI) y se graficó mediante el método de Bland- Altman. Resultados y conclusión: La TMR determinada por la ecuación de Cunningham a partir de MM evaluada por DEXA, mostró la mejor concordancia con la CI (CCI= 0,709), seguida por Harris-Benedict con MCT (CCI= 0,697) y Cunningham con MM calculada por 5C (CCI= 0,693). La ecuación de Cunningham y Harris Benedict parecen ser las más adecuadas para calcular la TMR, sin embargo, se requieren más estudios con muestras mayores, lo cual permitirá obtener resultados más precisos.

Prediction equations for calculating resting metabolic rate (RMR) are widely used given their accessibility and low cost. However, they have not been yet validated in the amputee athlete population. Objective: to determine the concordance between the RMR measured by Indirect Calorimetry (IC) and that calculated by prediction equations in athletes with lower limb amputation in Bogota. Subjects and methods: sixteen adult male athletes with lower limb amputation were included. The RMR was measured with IC and calculated with the Harris-Benedict, Cunningham, Mifflin-St. Jeor, Schofield, and Oxford prediction equations. Three different body mass variables were used: total body mass (TBM) and lean body mass (LBM) determined by Dual Energy X-ray Absorptiometry (DEXA) and by the anthropometric method of mass fractionation into five components (5C). The agreement was determined by intraclass correlation coefficient (ICC) and plotted using the Bland-Altman method. Results and conclusions: RMR determined by the Cunningham equation from LBM assessed by DEXA showed the best agreement with CI (ICC= 0.709), followed by Harris-Benedict with MCT (ICC= 0.697) and Cunningham with LBM calculated by 5C (ICC= 0.693). The Cunningham and Harris-Benedict equation seems to be the most suitable for calculating RMR. However, more studies with larger samples are needed to obtain more accurate results.

Impacto del Aseguramiento en Salud en la Economía de los Hogares Peruanos, 2010-2019

Objetivo : Determinar el impacto del aseguramiento en salud en la economía de los hogares peruanos en el periodo 2010-2019. Materiales y Métodos : Estudio analítico transversal, que utilizó la base de datos de la Encuesta Nacional de Hogares de los años 2010, 2014 y 2019 para analizar el impacto del aseguramiento en salud en términos de gasto de bolsillo en salud, gasto catastrófico y empobrecimiento de los hogares peruanos, así como determinar qué otros factores se encuentran asociados. Resultados : Durante el periodo de estudio se observó que los hogares peruanos presentaron una disminución del gasto de bolsillo en salud promedio mensual (S/.119,9 en 2010 a S/.107,9 en 2019), así como del porcentaje de hogares con gasto catastrófico en salud (4,06 % en 2010 a 3,47 % en 2019) y del porcentaje de hogares que empobrecen por gastos de bolsillo en salud (1,78 % en 2010 a 1,51 % en 2019). Los factores asociados al gasto catastrófico en salud y al empobrecimiento fueron el menor nivel de escolaridad del jefe del hogar, la presencia de miembros con enfermedad crónica y el área de residencia rural. La ausencia de aseguramiento en salud se asoció significativamente a un mayor riesgo de gasto de bolsillo en salud catastrófico, mas no al empobrecimiento. Conclusiones : El aumento de la cobertura de aseguramiento en salud contribuye a la protección financiera de los hogares peruanos frente al gasto de bolsillo en salud; sin embargo, las barreras para el acceso efectivo a los servicios de salud y otros factores socioeconómicos pueden limitar significativamente su impacto.

Objective : To determine the impact of health insurance in the economy of Peruvian households during the 2010-2019 period. Material and Methods : This is a cross-sectional analytical study that used the database of the National Peruvian Household Surveys from years 2010, 2014, and 2019, aiming to analyze the impact of health insurance in terms of pocket money spending for health issues, catastrophic healthcare spending, and impoverishment in Peruvian households, and also to determine the presence of other associated factors. Results : During the study period, it was observed that Peruvian households reduced their monthly average pocket money spending for health issues (119.9 PEN in 2010 and 107.9 PEN in 2029), as well as the percentage of household with catastrophic healthcare expenses (4.06% in 2010 to 3.47% in 2019), and the percentage of households who became impoverished because of pocket money expenses for health issues (1.78% in 2020 to 1.51% in 2019). Factors associated to catastrophic healthcare expenses and to impoverishment were lower educational level for the household leader, the presence of family members with chronic diseases, and living in a rural area. The absence of health insurance was significantly associated to a greater risk for catastrophic healthcare expenses, but not to impoverishment. Conclusions : Increased healthcare insurance coverage contributes to financial protection of Peruvian households against pocket money spending for health issues; however, barriers for effective access to healthcare services, and other socioeconomical factors may significantly limit this impact.

Expenditure Incurred by Patients of Pulmonary and Extrapulmonary Tuberculosis Under Revised National Tuberculosis Control Programme in District Tuberculosis Center, Jammu

Background: Tuberculosis (TB) patients suffer enormously due to huge cost on diagnosis and treatment. This study aims to assess the total expenditure and its predictors among patients of TB. Methodology: A longitudinal study was conducted among TB Patients registered in first quarter of 2018 at District Tuberculosis Center, Jammu. Data was collected by interviewing the patients and their attendants. Statistical significance of median expenditure between patients of pulmonary and extrapulmonary TB in rela-tion to various predictors was assessed using nonparametric tests followed by Multiple Linear Regression. Results: Total median cost, median direct and indirect cost incurred by a TB patient were recorded as USD 489.55, USD 246.55 and USD 229.5 respectively. Treatment costs were slightly higher in patients of pulmo-nary TB in comparison to extrapulmonary TB (p>0.05). On bivariate analysis, upper class, previously treated patients, Category 2 patients, with chronic illnesses, with guardians and who were employed expended signif-icantly higher amounts on their treatment, but on multivariate analysis, only formal employment, current earning and being reimbursed significantly predicted the total cost (p < .001, adjusted R square = 0.56). Conclusion: Huge direct costs incurred by patients is a matter of great concern, more so as the Indian gov-ernment has made all diagnostics and treatment free since the inception of the RNTCP.

Correlation analysis between muscle CT measurement parameters, energy expenditure and risk of acute exacerbation in patients with stable chronic obstructive pulmonary disease / 中国医师进修杂志

Objective:To explore the correlation between muscle CT measurement parameters, energy expenditure and acute exacerbation in patients with stable chronic obstructive pulmonary disease (COPD).Methods:The clinical data of 146 patients with stable COPD from March 2020 to November 2021 in Lu′an Hospital Affiliated to Anhui Medical University (Lu′an People′s Hospital) were retrospectively analyzed. The clinical data were recorded; the lung function was measured by bronchodilator test. The cross-sectional area and CT value of the pectoral muscle were measured by reconstructed CT images of the mediastinum; the total energy consumption was calculated by Weir formula. Acute exacerbations within 3 and 12 months were recorded. Multivariate Logistic regression was used to analyze the independent risk factors for acute exacerbation in patients with stable COPD. The receiver operating characteristic (ROC) curve was used to analyze the efficacy of total energy expenditure, pectoral muscle cross-sectional area and pectoral muscle CT value for predicting acute exacerbation in patients with stable COPD.Results:Among 146 patients with stable COPD, 38 cases (26.03%) developed acute exacerbation within 3 months (acute exacerbation group), and 108 cases (73.97%) did not develop acute exacerbation (non-acute exacerbation group). The proportion of age<60 years old, rate of acute exacerbation within 12 months and rate of pulmonary function grading Ⅲ to Ⅳ in acute exacerbation group were significantly higher than those in non-acute exacerbation group: 71.05% (27/38) vs. 47.22% (51/108), 52.63% (20/38) vs. 30.56% (33/108) and 63.16% (24/38) vs. 37.96% (41/108), the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value were significantly lower than those in non-acute exacerbation group: (2 036.28 ± 163.13) J/d vs. (2 389.59 ± 204.71) J/d, (28.79 ± 3.45) cm 2 vs. (31.61 ± 4.56) cm 2 and (29.79 ± 3.06) HU vs. (34.52 ± 4.38) HU, and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis result showed that age ≥60 years old, lower total energy expenditure, smaller pectoral muscle cross-sectional area and lower pectoral muscle CT value were independent risk factors for acute exacerbation in patients with stable COPD ( OR = 26.493, 1.015, 1.245 and 1.437; 95% CI 3.745 to 187.405, 1.008 to 1.022, 1.002 to 1.546 and 1.109 to 1.861; P<0.01 or <0.05). The ROC curve analysis result showed that combined prediction of the total energy consumption, pectoral muscle cross-sectional area and pectoral muscle CT value for acute exacerbation in patients with stable COPD had the largest area under the curve (0.962), with a sensitivity of 86.1%, a specificity of 80.8%, and the optimal cutoff values of 2 206.12 J/d, 32.39 cm 2 and 31.63 HU, respectively. Conclusions:The elderly age, smaller pectoral muscle cross-sectional area, lower pectoral muscle CT value and lower total energy expenditure are independent risk factors for acute exacerbation in patients with stable COPD. The combination of pectoral muscle cross-sectional area, pectoral muscle CT value and total energy expenditure has a good predictive effect on the risk of acute exacerbation in patients with stable COPD, and relevant indexes can be paid attention to in clinical treatment.

A clinical cross-sectional study of resting energy expenditure in children with cerebral palsy / 中华实用儿科临床杂志

Objective:To investigate the characteristics of resting energy expenditure (REE) in children with cerebral palsy (CP) graded with different levels of Gross Motor Function Classification System (GMFCS), and to evaluate the accuracy and association of commonly used REE prediction formulas in children with CP.Methods:It was a retrospective study involving 36 children with CP aged 24-144 months who visited the Third Affiliated Hospital of Zhengzhou University between September 2021 and August 2022.REE was measured by the indirect calorimetry.Based on the GMFCS, children with CP were divided into grade Ⅰ-Ⅱ group (20 cases), grade Ⅲ group (6 cases) and grade Ⅳ-Ⅴ group(10 cases). During the same period, 11 age-matched healthy children were included in control group.The measured REE (MREE) between children with CP and healthy controls was compared.Predicted REE (PREE) calculated by the Harris-Benedict, WHO, Schofield-W, Schofield-WH and Oxford prediction formulas were compared with MREE in children for their consistency and correlation.Independent samples were analyzed using t-test or Mann- Whitney U test, and categorical data were analyzed using Chi- square test.Using paired t-test and Pearson linear correlation analysis to analyze the correlation between MREE and PREE.The accuracy of PREE values calculated by different formulas was assessed using the root mean square error. Results:The MREE in control group and children with CP were (952.18±270.56) kcal/d and (801.81±201.89) kcal/d, respectively.There was no significant difference in the MREE between grade Ⅰ-Ⅱ group versus control group[(868.30±194.81) kcal/d vs.(952.18±270.56) kcal/d, P>0.05], and grade Ⅲ group versus control group [(813.17±192.48) kcal/d vs.(952.18±270.56) kcal/d, P>0.05]. The MREE was significantly lower in grade Ⅳ-Ⅴ group than that of control group [666.00(513.50, 775.50) kcal/d vs.(952.18±270.56) kcal/d, P=0.011]. There were no significant difference between MREE and PREEs calculated by Harris-Benedict, WHO, Schofield-W, Schofield-WH, and Oxford (all P>0.05). The correct classification fraction calculated by the 5 formulas were 33.3%, 47.2%, 41.7%, 47.2%, and 41.7%, respectively.The r values of the consistency of PREE calculated by the 5 formulas were 0.585, 0.700, 0.703, 0.712, and 0.701, respectively.The Blande-Altman Limits of Agreement were (-297.77, 359.22), (-245.60, 326.94), (-250.62, 316.05), (-242.22, 177.36) and (-241.28, 325.81), respectively.The clinically acceptable range was -80.18 to 80.18 kcal/d.The root mean square error were 168.09 kcal/d, 149.64 kcal/d, 146.24 kcal/d, 144.23 kcal/d and 148.77 kcal/d, respectively. Conclusions:The MREE values decreased significantly in children with CP classified as CMFCS grade Ⅳ and Ⅴ.When REE cannot be regularly monitored by indirect calorimetry to develop nutritional support programs, children with CP may be prioritized to estimate REE using the prediction formula of Schofield-WH.

Measurement of the Thermic Effect of Food in a Chinese Mixed Diet in Young People / 生物医学与环境科学（英文）

OBJECTIVE@#To determine the thermic effect of food (TEF) in a Chinese mixed diet in young people.@*METHODS@#During the study, the participants were weighed and examined for body composition every morning. The total energy expenditure (TEE) of the participants was measured by the doubly labeled water method for 7 days, and during this period, basal energy expenditure was measured by indirect calorimetry and physical activity energy expenditure was measured by an accelerometer. The value obtained by subtracting basal energy expenditure and physical activity energy expenditure from TEE was used to calculate TEF.@*RESULTS@#Twenty healthy young students (18-30 years; 10 male) participated in the study. The energy intake of the participants was not significantly different from the Chinese Dietary Reference Intake of energy ( P > 0.05). The percentage of energy from protein, fat and carbohydrate were all in the normal range. The intakes of fruits, milk and dietary fiber of the participants were significantly lower than those in the Chinese Dietary Guidelines ( P < 0.05). There was no significant difference in the body weight of the participants during the experiment ( P > 0.05). When adjusted for body weight, there was no significant difference in either TEE or basal energy expenditure between the male and female participants ( P > 0.05). In addition, there was no significant difference in physical activity energy expenditure and TEF between the male and female participants ( P > 0.05). The percentage of TEF in TEE was 8.73%.@*CONCLUSION@#The percentage of TEF in TEE in a Chinese mixed diet in young people was significantly lower than 10% ( P < 0.001). A value of 10% is usually considered to be the TEF in mixed diets as a percentage of TEE.

Por trás da leptina: uma revisão de literatura / Behind the leptin: a literature review / Detrás de leptin: una revisión de la literatura

A obesidade é uma doença crônica, multifatorial, que afeta todas as idades e classes sociais. Esta comorbidade tem avançado em decorrência de diversos fatores e sua prevalência está ancorada em diferentes dimensões como as biológicas, sociais, históricas, comportamentais, saúde pública e política. O presente estudo tem como objetivo caracterizar o gene da leptina, seu produto e de seus receptores, assim como os mecanismos que corroboram com o desenvolvimento da obesidade e seu envolvimento com distúrbios alimentares. A leptina é uma proteína secretada principalmente nos adipócitos, ela reduz o apetite por meio da inibição da formação de neuropeptídeos relacionados ao apetite, como o neuropeptídeo Y e eleva a expressão de neuropeptídeos anorexígenos, como o hormônio liberador de corticotropina, por isso que os altos níveis de leptina reduzem a ingestão alimentar, em contraste com os níveis baixos que induzem hiperfagia. Como a leptina realiza o controle da saciedade e regulação do gasto energético, o indivíduo com disfunção neste gene não desenvolve essa função corretamente. Isso se deve aos SNPs, que de acordo com estudos aumentam a susceptibilidade à obesidade. Além do mais, a leptina pode estar envolvida com processo patológico de alguns distúrbios alimentares, predispondo o paciente às condições como anorexia nervosa e bulimia.

Obesity is a chronic, multifactorial disease that affects all ages and social classes. This comorbidity has advanced as a result of several factors and its prevalence is anchored in different dimensions such as biological, social, historical, behavioral, public health and political. The present study aims to characterize the leptin gene, its product and its receptors, as well as the mechanisms that corroborate the development of obesity and its involvement with eating disorders. Leptin is a protein secreted mainly in adipocytes, it reduces appetite by inhibiting the formation of appetite-related neuropeptides such as neuropeptide Y and elevates the expression of anorexic neuropeptides such as corticotropin-releasing hormone, so high levels of leptin reduce dietary intake, in contrast to low levels that induce hyperphagia. As leptin performs satiety control and regulation of energy expenditure, the individual with dysfunction in this gene does not develop this function properly. This is due to SNPs, which according to studies increase susceptibility to obesity. Furthermore, leptin may be involved with the pathological process of some eating disorders, predisposing the patient to conditions such as anorexia nervosa and bulimia.

La obesidad es una enfermedad crónica multifactorial que afecta a todas las edades y clases sociales. Esta comorbilidad ha avanzado como resultado de diversos factores y su prevalencia está anclada en diferentes dimensiones, como la biológica, la social, la histórica, la conductual, la salud pública y la política. El objetivo de este estudio es caracterizar el gen de la leptina, su producto y sus receptores, así como los mecanismos que corroboran el desarrollo de la obesidad y su participación en los trastornos alimentarios. La leptina es una proteína secretada principalmente en los adipocitos, reduce el apetito inhibiendo la formación de neuropéptidos relacionados con el apetito, como el neuropéptido Y y eleva la expresión de neuropéptidos anorexógenos, como la hormona que libera la corticotropina, razón por la cual los altos niveles de leptina reducen la ingesta dietética, en contraste con los bajos niveles inducir hiperagia. Como la leptina lleva a cabo el control de la saciedad y la regulación del gasto energético, el individuo con disfunción en este gen no desarrolla esta función correctamente. Esto se debe a los SNP, que según los estudios aumentan la susceptibilidad a la obesidad. Además, la leptina puede estar implicada en el proceso patológico de algunos trastornos alimentarios, predisponiéndose al paciente a condiciones tales como anorexia nerviosa y bulimia.

Association between total available nutritional quality and food expenditure in Peruvian households, 2019-2020 / Asociación entre la calidad nutricional total disponible y el gasto con alimentos en los hogares peruanos, 2019-2020 / Associação entre a qualidade nutricional total disponível e o gasto com alimentos em domicílios peruanos, 2019-2020

Abstract: Evidence points to a direct relationship between nutritional quality and food expenditure. However, food expenditure is highly susceptible to changes, and nutritional quality of household food presents limited evidence. The aim of this study was to assess the relationship between nutritional quality available and total food expenditure in Peruvian households, and whether there were differences by area (urban and rural) and between years of the COVID-19 pandemic. For this, we used Peru's National Household Survey (ENAHO) from 2019 and 2020. We assessed total food expenditure in US dollars per day, whereas household nutritional quality available was assessed based on dietary diversity and compliance with the household calorie requirements, percentage of food expenditure, and potential confounders. We used the Student's t-test, analysis of variance (ANOVA), linear regression, and the Wald test to assess the interaction effect. Households with adequate total/partial nutritional quality available by area were found to spend, on average, USD 2.00 more in urban than in rural areas and, by year, they presented 7.1% more percentage of food expenditure in 2020 than in 2019. Despite associations existing between nutritional quality available and total food expenditure by year and study area, the effect modification was only present by study area. In multivariable model, households with adequate total/partial nutritional quality available consistently presented a lower total food expenditure by year, with a lower total food expenditure in urban areas. An inverse relationship was found between nutritional quality available and total food expenditure, in contrast to the direct relationship of studies assessing dietary cost and nutritional quality. Our results reflect the nutritional deficit in the food purchases of Peruvian households.

Resumen: Las evidencian existentes indican una relación directa entre la calidad nutricional y el gasto con alimentos. Sin embargo, los gastos son muy susceptibles a los cambios. Por otro lado, hay pruebas limitadas sobre la calidad nutricional de los alimentos domésticos disponibles. El objetivo de este estudio fue evaluar la relación entre la calidad nutricional disponible y el gasto total en alimentos en los hogares peruanos, y si hubo diferencias por área (urbana y rural) y entre los años de la pandemia del COVID-19. Para ello, se utilizó la Encuesta Nacional de Hogares del Perú (ENAHO) de 2019 y 2020. Se evalúo el gasto total en alimentos en dólares estadounidenses por día, la calidad nutricional disponible por hogar basado en la diversidad dietética y el cumplimiento de los requisitos calóricos por hogar, teniendo en cuenta el porcentaje de gasto alimentario y los posibles factores de confusión. La prueba t de Student, el análisis de varianza (ANOVA), la regresión lineal y la prueba de Wald se utilizaron para evaluar el efecto de interacción. Se encontró que los hogares con la calidad nutricional disponible total/parcial adecuada por área gastan en promedio USD 2,00 más en áreas urbanas que en áreas rurales, y que por año tuvieron el porcentaje de gasto alimentario 7,1% más grande en 2020 que en 2019. Si bien hubo una asociación entre calidad nutricional disponible y gasto total en alimentos por año y área de estudio, la modificación del efecto solo estuvo presente por área de estudio. En el modelo multivariable, los hogares con la calidad nutricional disponible total/parcial adecuada tuvieron consistentemente un gasto total en alimentos más bajo por año, de la misma manera que en áreas urbanas. Se encontró una relación inversa entre calidad nutricional disponible y gasto total en alimentos en contraste con la relación directa de los estudios que evaluaron el costo de la dieta y la calidad nutricional. Los resultados apuntan al déficit nutricional en las compras de alimentos de los hogares peruanos.

Resumo: Evidências revelam uma relação direta entre a qualidade nutricional e os gastos com alimentação. No entanto, essas despesas são altamente suscetíveis a mudanças. Por outro lado, há uma limitação de evidências sobre a qualidade nutricional dos alimentos domésticos disponíveis. O objetivo deste estudo foi avaliar a relação entre a qualidade nutricional disponível e o gasto total com alimentos em domicílios peruanos, e se havia diferenças por área (urbana e rural) e entre os anos da pandemia de COVID-19. Para isso, foi utilizada a Pesquisa Nacional de Domicílios do Peru (ENAHO) de 2019 e 2020. Foram avaliados o gasto total com alimentos em dólares americanos por di e a qualidade nutricional disponível domiciliar com base na diversidade dietética e no cumprimento das necessidades calóricas domiciliares, considerando o percentual de gasto com alimentos e potenciais fatores de confusão. Utilizou-se o teste t de Student, a análise de variância (ANOVA), a regressão linear e o teste de Wald para avaliar o efeito de interação. Os domicílios com a qualidade nutricional disponível total/parcial adequada por área gastaram, em média, USD 2,00 a mais nas áreas urbanas do que nas rurais e tiveram um percentual de gasto com alimentos 7,1% maior em 2020 do que em 2019. Embora tenha sido encontrada uma associação entre a qualidade nutricional disponível e o gasto total com alimentos por ano e área de estudo, a modificação do efeito só estava presente por área de estudo. No modelo multivariável, os domicílios com a qualidade nutricional disponível total/parcial adequada apresentaram consistentemente um gasto total com alimentos menor por ano, assim como em áreas urbanas. Foi encontrada uma relação inversa entre a qualidade nutricional disponível e o gasto total com alimentos, em contraste com a relação direta dos estudos que avaliaram o custo da dieta e a qualidade nutricional. Esses resultados refletem o déficit nutricional nas compras de alimentos das famílias peruanas.

Resting energy expenditure depends on energy intake during weight loss in people with obesity: a retrospective cohort study

Abstract Objective: Resting energy expenditure (REE) decreases if there is reduced energy intake and body weight (BW). The decrease in REE could make it difficult for patients with obesity to maintain decreased BW. This study aimed to investigate the correlation among changes in REE, energy intake, and BW during the weight loss process in patients with obesity. Materials and methods: We conducted a retrospective cohort study of patients hospitalized for the treatment of obesity in Japan. Patients received fully controlled diet during hospitalization and performed exercises if able. REE was measured once a week using a hand-held indirect calorimetry. Energy intake was determined by actual dietary intake. Results: Of 44 inpatients with obesity, 17 were included in the analysis. Their BW decreased significantly after 1 week (−4.7 ± 2.0 kg, P < 0.001) and 2 weeks (−5.7 ± 2.2 kg, P < 0.001). The change in REE after 1 and 2 weeks was positively correlated with the energy intake/energy expenditure ratio (r = 0.66, P = 0.004 at 1 week, r = 0.71, P = 0.002 at 2 weeks). Using a regression equation (y = 0.5257x - 43.579), if the energy intake/energy expenditure ratio within the second week was 82.9%, the REE after 2 weeks was similar to the baseline level. There was no significant correlation between the change in REE and BW. Conclusions: Our data suggest that changes in REE depend on energy intake/energy expenditure ratio and that the decrease in REE can be minimized by matching energy intake to energy expenditure, even during the weight loss process.

Patients living with HIV have quantitatively inadequate food consumption

ABSTRACT Objective: The objective of the current study was to estimate energy expenditure and compare it with the usual food consumption of PLWH, and to determine whether duration of high-potency antiretroviral therapy (HAART) influenced nutritional intake and adequacy. Materials and methods: Anthropometric measurements and bioelectrical impedance analysis (BIA) provided data for estimating resting energy expenditure (REE) using Melchior's equations. Dietary Reference Intakes (DRIs) and 24-Hour Recall were used to verify if reported food intake aligned with energy, macro and micronutrient recommendations. Results: Sixty one patients with a mean age of 52 ± 9.4 years and who had a high frequency of diabetes mellitus (24.5%), hypertension (54%), and dyslipidemia (90.1%) were evaluated. Estimated REE of female and male patients with less than 10 years of HAART was 1791 (1717.5; 1887.2) and 1941 (1808; 2335.6), and their estimated energy intake was 900.5 (847;1221.9) and 2095.4 (1297.5; 2496.4), respectively. The estimated REE for female and male patients with more than 10 years of HAART was 1796.20 (1598.9;1820.7) and 2105 (1913.4; 2308), and their estimated energy intake was 1566 (1353.1; 1764.3) and 1999.7 (1706.5; 2508.1), respectively. Being on HAART for more than 10 years was associated with increased energy intake (533 (95% CI 3; 1063) kcals), but not with meeting energy requirements. Conclusion: Patients had an atherogenic metabolic profile, inadequate dietary pattern, and a similar REE, regardless of HAART duration, contributing even more to the increased risk of cardiovascular diseases.

Use of the activPAL® triaxial accelerometer to estimate total energy expenditure in low-income women: differences between body mass index classifications

ABSTRACT Objective: This study aimed to assess the agreement between the total energy expenditure (TEE) estimated by the activPAL® triaxial accelerometers (ACC) and the TEE measured by the doubly labeled water method (DLW), as well as to assess if these values differ between the classifications of body mass index (BMI). Materials and methods: This is a cross-sectional study. Low-income adult women (19-45y) with BMI ≥ 18.5 kg/m2 were included. Accelerometry data (activPAL®) were collected over 7 consecutive days, which were used to calculate TEE-ACC and compared with DLW data. The Bland-Altman method, concordance correlation coefficient and root mean square error were used to assess agreement between methods. Results: The sample consisted of 55 women with a mean age of 31 ± 5 years. The agreement between TEE-ACC and TEE-DLW showed a bias of -142.5 kcal (-7.1%). Among the BMI classifications, participants with normal weight show a bias of -417.1 kcal (-21.0%), participants with overweight, -87.5 kcal (-3.9%) and participants with obesity, 97.5 kcal (4.3%). Furthermore, the bias between the methods showed a significant and positive correlation with the body weight (r = 0.49; p < 0.01). Conclusion: The TEE-ACC estimates from activPAL® were reasonably accurate when compared to the TEE-DLW, especially in women with overweight and obesity, being much less accurate in individuals with normal weight.

Comparison of three different measurement methods to determine resting energy expenditure in patients with decompensated hepatitis B cirrhosis / 中华肝脏病杂志

Objective: To compare the differences to determine resting energy expenditure (REE) measured with indirect calorimetry and REE predicted by formula method and body composition analyzer in patients with decompensated hepatitis B cirrhosis, so as to provide theoretical guidance for the implementation of precision nutrition intervention. Methods: Patients with decompensated hepatitis B cirrhosis who were admitted to Henan Provincial People's Hospital from April 2020 to December 2020 were collected. REE was determined by the body composition analyzer and the H-B formula method. Results: were analyzed and compared to REE measured by the metabolic cart. Results A total of 57 cases with liver cirrhosis were included in this study. Among them, 42 were male, aged (47.93 ± 8.62) years, and 15 were female aged (57.20 ± 11.34) years. REE measured value in males was (1 808.14 ± 201.47) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.002 and 0.003, respectively). REE measured value in females was (1 496.60 ± 131.28) kcal/d, compared with the results calculated by the H-B formula method and the measured result of body composition, and the difference was statistically significant (P = 0.016 and 0.004, respectively). REE measured with the metabolic cart had correlation with age and area of visceral fat in men (P = 0.021) and women (P = 0.037). Conclusion: Metabolic cart use will be more accurate to obtain resting energy expenditure in patients with decompensated hepatitis B cirrhosis. Body composition analyzer and formula method may underestimate REE predictions. Simultaneously, it is suggested that the effect of age on REE in H-B formula should be fully considered for male patients, while the area of visceral fat may have a certain impact on the interpretation of REE in female patients.

Analysis of factors influencing the medical insurance balance of hospitalization expenses for gastric cancer surgery patients under DRG payment / 中华医院管理杂志

Objective:To analyze the influencing factors of the medical insurance balance of hospitalization expenses for gastric cancer surgery patients under DRG payment, for reference for promoting the reform of DRG payment in public hospitals and controlling hospitalization expenses reasonably.Methods:The gastric cancer patients enrolled in the gastroenterology department of a tertiary comprehensive hospital from January to July 2022 were selected as the research subjects. The indicators such as patient age, medical insurance balance, hospitalization expenses and their composition were extracted from the hospital information management system and the medical insurance settlement system a certain city. Descriptive analysis was conducted for all data, and stepwise multiple linear regression was used to analyze the influencing factors of patients′ medical insurance balance. Monte Carlo simulation method was used to simulate different combination scenarios of various influencing factors to analyze the probability of medical insurance balance.Results:A total of 205 patients were contained, including 117 in the medical insurance balance group and 88 in the loss group. The difference in hospitalization expenses and medical insurance balance between the two groups of patients were statistically significant ( P<0.05). The intervention of medical insurance specialists, correct DRG enrollment, parenteral nutrition preparation costs, anti infective drug costs, examination costs, and consumables costs were the influencing factors of patient medical insurance balance ( P<0.05). Through Monte Carlo simulation verification, patients with different cost parenteral nutrition preparations, or different anti infective drug schemes had the higher probability of medical insurance balance in the scenario where the medical insurance commissioner intervenes and the DRG enrollment was correct. Conclusions:The hospital adopted interventions from medical insurance specialists to ensure the correct DRG enrollment of patients, accurate use of parenteral nutrition and anti infective drugs, and reasonable control the cost of examinations and consumables, which could increase the probability of medical insurance balance for gastric cancer surgery patients. In the future, hospitals should further promote the procurement of drug consumables in bulk, reduce unnecessary examinations, develop standardized perioperative nutritional interventions and anti infection treatment pathways, ensure the accuracy of DRG enrollment, optimize clinical diagnosis and treatment pathways to improve the efficiency of medical insurance fund utilization and provide high-quality medical services for patients.

Health insurance coverage and out-of pocket expenditure: A study among rural and urban households of Faridabad, Haryana

Introduction: Catastrophic health spending is one of the major factors pushing people into poverty. Reducing “out-of-pocket expenditure (OOPE)” on health through health insurance coverage is an effective approach. The objectives of this study are (1) to estimate health insurance coverage among rural and urban households (HHs) and (2) to determine the proportion of income spent on health as OOPE among the selected HHs. Material and Methods: A cross-sectional study was conducted in rural and urban parts of district Faridabad, Haryana. A sample of 374 were taken from rural and urban areas. The unit of the study was HHs in both the areas. The proportion of income spent on health care (both direct and indirect expenses included) as OOPE was taken as outcome variable. Results: Health insurance coverage was higher among urban HHs (58.0%) as compared to the rural (38.5%). The rural population was availing of private consultation, laboratory, and pharmacy services to a greater extent than the urban; hence, they were spending a substantial proportion of their income on health-care services. The majority of the HHs in the rural and urban areas spent up to 20% of their income on health care. Conclusion: Universal health coverage without health insurance is unlikely.

A Retrospective Cohort study on Utilization of Rashtriya Bal Swasthya Karyakra (RBSK) Services among Children Screened at an Urban Health Centre (UHC) ofAhmedabad Municipal Corporation (AMC)

Introduction : Rashtriya Bal Swasthya Karyakram (RBSK) is a systemic approach of 4‘D’s (Defect, Diseases, Deficiency, Developmental delay) for early identification and linkage with care, support and treatment. (1) Document utilization of RBSK services within a year of referral, (2) Assess reasonsObjectives : for non-utilization of services and (3) Assess out of pocket expenditure (OOPE) among users and non-users of the program. Retrospective Cohort Study was conducted at an Urban Health Centre (UHC) takingMethod: two cohorts of children referred for 4‘D’s during April 2018-March 2020 under RBSK. A total of 102 cases were sampled. Probability Proportionate to size (PPS) method was used to ensure proportionate representation of each of 4‘D’s in the sample. Required number of participants in each category were selected randomly. Out of 102 sampled cases, 97 were covered. Utilization of services was 50.5%; majorResults: reasons for non-utilization were preference for private providers and reluctance to stay at Comprehensive Malnutrition Treatment Centre (CMTC). Mean OOPE in users was Rs. 21545, significantly less (p <.05) than Rs. 70198 in non-users. After referral by RBSK team, only half utilized the services. Among users,Conclusion: OOPE was less for total cost incurred and also for direct cost incurred like consultation charges, medicines, consumables etc. Counselling those parents whose children are detected with any of 4Ds, to visit Child Malnutrition Treatment Center (CMTC)/ District Early Intervention Center (DEIC) remains a challenge.

Gastos com o esporte na gestão 2012-2015 do governo do Pará: quando a prioridade não foi a garantia do direito social / Sports expenditure in the 2012-2015 administration of the government of Pará: when the priority was not to ensure social rights

O artigo objetiva analisar o financiamento público para o esporte no estado do Pará durante a gestão 2012-2015 no tocante aos investimentos direcionados para as dimensões do esporte, afim de identificar as prioridades das políticas executadas. Para tanto desenvolveu-se pesquisa documental e bibliográfica. A coleta de dados foi realizada em documentos oficiais da gestão. Para a análise dos dados utilizou-se a técnica proposta por Boschetti (2009), e desenvolvida segundo o indicador direcionamento dos gastos. Os resultados revelam que há uma centralidade do financiamento e dos gastos com a dimensão do esporte de alto rendimento, com foco na realização dos grandes eventos esportivos e na infraestrutura, com destaque para reforma do estádio olímpico, o que evidencia a prioridade com uma dimensão esportiva que não responde a possibilidade do acesso universalizado à maioria da população.

This article aims to analyze public funding for sport in the state of Pará during the administration of the 2012-2015 with regard to investments targeted to the dimensions of sport, in order to identify the priorities of the implemented policies. To this end, documentary and bibliographic research was developed. Data collection conducted in official administration documents. For the analysis of the data, the technique proposed by Boschetti (2009) was used, and developed according to the expenditure targeting indicator. The results reveal that there is a centrality of financing and expenditure with the dimension of high-performance sport, with a focus on the holding of major sporting events and their infrastructure, with emphasis on the reform of the Olympic stadium, the venue of major sporting events, which shows the priority with a sporting dimension that does not respond to the possibility of universal access to the majority of the population.

Physical activity and energy expenditure among older adults

Physical activity and exercise for older helps improve mental and physical health, both of which will help you maintain your independence as you age. This study aimed find the type and level of physical activity and energy expenditure from physical activities done by older adults. 42 participants were approached from different residential area of Surat and IPAQ (Guajarati) was used to measure Physical activity in adults and for energy expenditure. Energy expenditure was measured by using equation EE = MET x 3.5 x Weight (kilograms)/200. For total vigorous activity PA ± EE were 7260 (MET-min/week) ± 648.75 (Kcal/week), total moderate activity PA was 72382.5 (MET-min/week) and EE was 624 (Kcal/week), total walking activity PA and EE were 31775 (MET-min/week) and 404.49 (Kcal/week) respectively, total sitting activity PA ± EE were 136800 (MET-min/week) ± 96.12 (Kcal/week) and total driving activity PA and EE were 5410 (MET-min/week) and 96.11 (Kcal/week) respectively. In older adults, sitting and walking have found most common type of PA with less EE and more EE found with less vigorous and moderate activity.