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Concept: Cost

475

Physical activity (PA) has an established favorable impact on cardiovascular disease (CVD) outcomes and quality of life. In this study, we aimed to estimate the economic effect of moderate-vigorous PA on medical expenditures and utilization from a nationally representative cohort with and without CVD.

Concepts: Medicine, Disease, Life, Cardiovascular disease, Economics, Non-infectious disease, Cost

204

Stairway climbing provides a ubiquitous and inconspicuous method of burning calories. While typically two strategies are employed for climbing stairs, climbing one stair step per stride or two steps per stride, research to date has not clarified if there are any differences in energy expenditure between them. Fourteen participants took part in two stair climbing trials whereby measures of heart rate were used to estimate energy expenditure during stairway ascent at speeds chosen by the participants. The relationship between rate of oxygen consumption ([Formula: see text]) and heart rate was calibrated for each participant using an inclined treadmill. The trials involved climbing up and down a 14.05 m high stairway, either ascending one step per stride or ascending two stair steps per stride. Single-step climbing used 8.5±0.1 kcal min(-1), whereas double step climbing used 9.2±0.1 kcal min(-1). These estimations are similar to equivalent measures in all previous studies, which have all directly measured [Formula: see text] The present study findings indicate that (1) treadmill-calibrated heart rate recordings can be used as a valid alternative to respirometry to ascertain rate of energy expenditure during stair climbing; (2) two step climbing invokes a higher rate of energy expenditure; however, one step climbing is energetically more expensive in total over the entirety of a stairway. Therefore to expend the maximum number of calories when climbing a set of stairs the single-step strategy is better.

Concepts: Cost, Stairway

178

Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase.

Concepts: United States, Poverty in the United States, U.S. state, Cost, At-large, Chinese language, Unemployment, Ansel Adams

177

It has recently been recommended that sedentary behavior be defined as sitting or reclining activities expending less than 1.5 metabolic equivalents (METs), which is distinct from the traditional viewpoint based on insufficient moderate-vigorous activity or formal exercise. This study was designed to determine the energy expenditure associated with common sedentary behaviors. Twenty-five African American adults (BMI 27.8±5.5) participated in the metabolic chamber study. Participants entered the metabolic chamber in the morning and their basal metabolic rate was estimated. They were fed breakfast and then engaged in four different sedentary behaviors sequentially, lasting 30 minutes each. The activities included reclining, watching TV, reading, and typing on a computer. In the afternoon, the participants were fed lunch and then the activities were repeated. The results show that the energy expenditure values between the morning and afternoon sessions were not significantly different (p = .232). The mean energy expenditure of postprandial reclining (0.97 METs) was slightly, but significantly, lower than postprandial watching TV (p = .021) and typing (p<.001). There were no differences in energy cost (1.03-1.06 METs) between the seated (i.e., reading, typing, watching TV) sedentary activities. The energy expenditure of several common sedentary behaviors was approximately 1.0 METs in the postprandial state. The results support the conclusion that the average energy cost of common sedentary behaviors is narrowly banded around 1.0 METs in the postprandial state.

Concepts: Metabolism, Energy, Costs, Arithmetic mean, Cost, Basal metabolic rate, Metabolic equivalent

171

BACKGROUND: Tuberculosis (TB) is known to disproportionately affect the most economically disadvantaged strata of society. Many studies have assessed the association between poverty and TB, but only a few have assessed the direct financial burden TB treatment and care can place on households. Patient costs can be particularly burdensome for TB-affected households in sub-Saharan Africa where poverty levels are high; these costs include the direct costs of medical and non-medical expenditures and the indirect costs of time utilizing healthcare or lost wages. In order to comprehensively assess the existing evidence on the costs that TB patients incur, we undertook a systematic review of the literature. METHODS: PubMed, EMBASE, Science Citation Index, Social Science Citation Index, EconLit, Dissertation Abstracts, CINAHL, and Sociological Abstracts databases were searched, and 5,114 articles were identified. Articles were included in the final review if they contained a quantitative measure of direct or indirect patient costs for treatment or care for pulmonary TB in sub-Saharan Africa and were published from January 1, 1994 to Dec 31, 2010. Cost data were extracted from each study and converted to 2010 international dollars (I$). RESULTS: Thirty articles met all of the inclusion criteria. Twenty-one studies reported both direct and indirect costs; eight studies reported only direct costs and one study reported only indirect costs. Depending on type of costs, costs varied from less than I$1 to almost I$600 or from a small fraction of mean monthly income for average annual income earners to over 10 times the annual income that the average person in the income-poorest 20% of the population earns. Out of the eleven types of TB patient costs identified in this review, the costs for hospitalization, medication, transportation, and care in the private sector were largest. CONCLUSION: TB patients and households in sub-Saharan Africa often incurred high costs when utilizing TB treatment and care, both within and outside of Directly Observed Therapy Short-course (DOTS) programs. It is likely that for many households, TB treatment and care-related costs were “catastrophic” because the TB patient costs commonly amounted to 10% or more of per-capita incomes in the countries where the primary studies included in this review were conducted. Our results suggest that policies to decrease direct and indirect TB patient costs are urgently needed to prevent poverty due to TB treatment and care for those affected by the disease.

Concepts: Africa, Tuberculosis, Cost, Science Citation Index, Household income in the United States, Citation index, Social Sciences Citation Index

167

A high-quality gold standard is vital for supervised, machine learning-based, clinical natural language processing (NLP) systems. In clinical NLP projects, expert annotators traditionally create the gold standard. However, traditional annotation is expensive and time-consuming. To reduce the cost of annotation, general NLP projects have turned to crowdsourcing based on Web 2.0 technology, which involves submitting smaller subtasks to a coordinated marketplace of workers on the Internet. Many studies have been conducted in the area of crowdsourcing, but only a few have focused on tasks in the general NLP field and only a handful in the biomedical domain, usually based upon very small pilot sample sizes. In addition, the quality of the crowdsourced biomedical NLP corpora were never exceptional when compared to traditionally-developed gold standards. The previously reported results on medical named entity annotation task showed a 0.68 F-measure based agreement between crowdsourced and traditionally-developed corpora.

Concepts: Costs, Linguistics, Gold, Cost, Task, Gold standard, Web 2.0, Natural language processing

165

Few autism spectrum disorder (ASD) studies have estimated non-medical costs for treatment or addressed possible differences in provision of services across gender, race-ethnic, age or demographic or expenditure categories, especially among adults.

Concepts: Costs, Autism, Pervasive developmental disorder, Cost, Asperger syndrome, Autism spectrum, PDD-NOS

158

This study investigated the energy intake and expenditure of professional adolescent academy-level soccer players during a competitive week. Over a seven day period that included four training days, two rest days and a match day, energy intake (self-reported weighed food diary and 24-h recall) and expenditure (tri-axial accelerometry) were recorded in 10 male players from a professional English Premier League club. The mean macronutrient composition of the dietary intake was 318 ± 24 g·day(-1) (5.6 ± 0.4 g·kg(-1) BM) carbohydrate, 86 ± 10 g·day(-1) (1.5 ± 0.2 g·kg(-1) BM) protein and 70 ± 7 g·day(-1) (1.2 ± 0.1 g·kg(-1) BM) fats, representing 55% ± 3%, 16% ± 1%, and 29% ± 2% of mean daily energy intake respectively. A mean daily energy deficit of -1302 ± 1662 kJ (p = 0.035) was observed between energy intake (9395 ± 1344 kJ) and energy expenditure (10679 ± 1026 kJ). Match days (-2278 ± 2307 kJ, p = 0.012) and heavy training days (-2114 ± 2257 kJ, p = 0.016) elicited the greatest deficits between intake and expenditure. In conclusion, the mean daily energy intake of professional adolescent academy-level soccer players was lower than the energy expended during a competitive week. The magnitudes of these deficits were greatest on match and heavy training days. These findings may have both short and long term implications on the performance and physical development of adolescent soccer players.

Concepts: Economics, Arithmetic mean, Developmental psychology, Cost, Premier League, Weighted mean, Deficit, Deficit spending

125

Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care.

Concepts: Antiretroviral drug, HIV, AIDS, Health care, Health economics, Costs, Economics, Cost

119

Tiered formularies, in which patients pay copays or coinsurance out-of-pocket (OOP), are used to manage costs and encourage more efficient health care resource use. Formulary tiers are typically based on the cost of treatment rather than the medical appropriateness for the patient. Cost sharing may have unintended consequences on treatment adherence and health outcomes. Use of higher-cost, higher-tier medications can be due to a variety of factors, including unsuccessful treatment because of lack of efficacy or side effects, patient clinical or genetic characteristics, patient preferences to avoid potential side effects, or patient preferences based on the route of administration. For example, patients with rheumatoid arthritis may be required to fail low-cost generic treatments before obtaining coverage for a higher-tier tumor necrosis factor alpha inhibitor for which they would have a larger financial burden. Little is known about stakeholders' views on the acceptability of greater patient cost sharing if the individual patient characteristics lead to the higher-cost treatments.

Concepts: Health care provider, Pharmacology, Medicine, Patient, Illness, Ethics, Cost, Tumor necrosis factor-alpha