Using Chronic Kidney Disease as a Model Framework to Estimate Healthcare-Related Environmental Impact.

Introduction: While the economic and clinical burden of chronic diseases are well documented, their environmental impact remains poorly understood. We developed a framework to estimate the environmental impact of a disease care pathway using chronic kidney disease (CKD) as an example.

Methods: A life cycle assessment framework was developed for the CKD care pathway and validated by experts.

Cost-consequence analysis of COPD treatment according to NICE and GOLD recommendations compared with current clinical practice in the UK.

Objectives: The objective of this study was to model the clinical and economic impact of adapting current clinical practice in the management of patients with chronic obstructive pulmonary disease (COPD) to treatment according to national and international guideline recommendations.

Design: Treatment mapping was undertaken to hypothetically redistribute patients from current clinical practice, representing actual prescribing patterns in the UK, to an alternative recommendation-based treatment scenario, representing prescribing in accordance with either National Institute for Health and Care Excellence (NICE) guidance [NG115] or Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 strategy.

Setting: Primary care practices in the UK (1-year time horizon).

Costs and Clinical Consequences of Compliance with COPD GOLD Recommendations or National Guidelines Compared with Current Clinical Practice in Belgium, Germany, Sweden, and the United States.

Purpose: The objective of this study was to assess the clinical and cost benefits of treating patients with chronic obstructive pulmonary disease (COPD) according to global and national guidelines compared to real-life clinical practice in the United States and three European countries (Belgium, Germany, Sweden).

Patients And Methods: A cost-consequence model was developed to compare current prescribing patterns with two alternative scenarios, the first aligned with the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2022) recommendations and the second with national guidelines. Costs and clinical outcomes were modeled for these alternative scenarios over a time horizon of one year, based on real-world evidence and health insurance data.

Cost-Consequences Analysis of Increased Utilization of Triple-Chamber-Bag Parenteral Nutrition in Preterm Neonates in Seven European Countries.

The safety of parenteral nutrition (PN) remains a concern in preterm neonates, impacting clinical outcomes and health-care-resource use and costs. This cost-consequence analysis assessed national-level impacts of a 10-percentage point increase in use of industry-prepared three-chamber bags (3CBs) on clinical outcomes, healthcare resources, and hospital budgets across seven European countries. A ten-percentage-point 3CB use-increase model was developed for Belgium, France, Germany, Italy, Portugal, Spain, and the UK.

Cost-Effectiveness of Take-Home Naloxone for the Prevention of Overdose Fatalities among Heroin Users in the United Kingdom.

Background: Heroin overdose is a major cause of premature death. Naloxone is an opioid antagonist that is effective for the reversal of heroin overdose in emergency situations and can be used by nonmedical responders.

Objective: Our aim was to assess the cost-effectiveness of distributing naloxone to adults at risk of heroin overdose for use by nonmedical responders compared with no naloxone distribution in a European healthcare setting (United Kingdom).

Use of opioid substitution therapies in the treatment of opioid use disorder: results of a UK cost-effectiveness modelling study.

Aims: This study investigated the cost-effectiveness of buprenorphine maintenance treatment (BMT) and methadone maintenance treatment (MMT) vs no opioid substitution therapy (OST) for the treatment of opioid use disorder, from the UK National Health Service (NHS)/personal social services (PSS) and societal perspectives over 1 year.

Methods: Cost-effectiveness of OST vs no OST was evaluated by first replicating and then expanding an existing UK health technology assessment model. The expanded model included the impact of OST on infection rates of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection.

Estimation of Free-Living Energy Expenditure by Heart Rate and Movement Sensing: A Doubly-Labelled Water Study.

Background: Accurate assessment of energy expenditure (EE) is important for the study of energy balance and metabolic disorders. Combined heart rate (HR) and acceleration (ACC) sensing may increase precision of physical activity EE (PAEE) which is the most variable component of total EE (TEE).

Objective: To evaluate estimates of EE using ACC and HR data with or without individual calibration against doubly-labelled water (DLW) estimates of EE.

Energy balance and physical demands during an 8-week arduous military training course.

This study assessed soldier's physical demands and energy balance during the Section Commanders' Battles Course (SCBC). Forty male soldiers were monitored during the 8-week tactics phase of the SCBC. Energy expenditure was measured using the doubly labeled water method.

Two new meal- and web-based interactive food frequency questionnaires: validation of energy and macronutrient intake.

Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies.

Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q.

Maternal physical activity and insulin action in pregnancy and their relationships with infant body composition.

Objective: We sought to assess the association between maternal gestational physical activity and insulin action and body composition in early infancy.

Research Design And Methods: At 28-32 weeks' gestation, pregnant women participating in an observational study in Sweden underwent assessments of height, weight, and body composition, an oral glucose tolerance test, and 10 days of objective physical activity assessment. Thirty mothers and infants returned at 11-19 weeks postpartum.

Comparison of the physical demands of single-sex training for male and female recruits in the British Army.

This study compared the physical demands and progression of basic training for male and female British Army recruits in single-sex platoons. Thirty male and 30 female recruits were monitored for energy expenditure (EE) (doubly labeled water), physical activity (3-dimensional accelerometry) and cardiovascular strain (percent heart rate reserve) during 6 weeks over the 14-week course. First time pass rate was similar for male (60%) and female (57%) recruits.

Active-Q: validation of the web-based physical activity questionnaire using doubly labeled water.

Background: Increased use of the Internet provides new opportunities for collecting data in large studies. The aim of our new Web-based questionnaire, Active-Q, is to assess total physical activity and inactivity in adults. Active-Q assesses habitual activity during the past year via questions in four different domains: (1) daily occupation, (2) transportation to and from daily occupation, (3) leisure time activities, and (4) sporting activities.

Health, fitness, and responses to military training of officer cadets in a Gulf Cooperation Council country.

Objective: To quantify the health, fitness, and physiological responses to military training of Officer Cadets from a Gulf Cooperation Council country.

Methods: One hundred and nineteen Officer Cadets volunteered; body composition, core body temperature, aerobic fitness, hydration status (urine osmolality), cardiovascular strain, physical activity (3-dimensional accelerometry), and energy expenditure (doubly labelled water) were measured over 5-days of Basic Training (BT), Army Training (AT), Navy Training (NT), and Air Force Training (AFT).

Results: There were no differences between courses for body mass index (mean all courses: 24.

Estimation of daily energy expenditure in pregnant and non-pregnant women using a wrist-worn tri-axial accelerometer.

Background: Few studies have compared the validity of objective measures of physical activity energy expenditure (PAEE) in pregnant and non-pregnant women. PAEE is commonly estimated with accelerometers attached to the hip or waist, but little is known about the validity and participant acceptability of wrist attachment. The objectives of the current study were to assess the validity of a simple summary measure derived from a wrist-worn accelerometer (GENEA, Unilever Discover, UK) to estimate PAEE in pregnant and non-pregnant women, and to evaluate participant acceptability.

Physical activity, sedentary behaviors, and estimated insulin sensitivity and secretion in pregnant and non-pregnant women.

Background: Overweight and obesity during pregnancy raise the risk of gestational diabetes and birth complications. Lifestyle factors like physical activity may decrease these risks through beneficial effects on glucose homeostasis. Here we examined physical activity patterns and their relationships with measures of glucose homeostasis in late pregnancy compared to non-pregnant women.

Accuracy and validity of a combined heart rate and motion sensor for the measurement of free-living physical activity energy expenditure in adults in Cameroon.

Background: The increasing burden of non-communicable diseases in sub-Saharan Africa (SSA) warrants rigorous studies of contributing lifestyle factors. Combined heart rate (HR) and movement monitoring make it possible to objectively measure physical activity in free-living individuals. We examined the validity of a combined HR and motion sensor in estimating physical activity energy expenditure (PAEE) in free-living adults in rural and urban Cameroon compared with doubly-labelled water (DLW) as criterion.

Physical activity energy expenditure of adolescents in India.

Physical activity (PA) has rarely been quantified in adolescent populations undergoing economic transition; therefore relationships with disease still remain uncertain. This study assessed whether absolute PA energy expenditure (PAEE), PAEE/kg, and PAEE/kg(FFM) could be accurately estimated using accelerometry and a questionnaire in Indian adolescents and how these values compared to those of other populations. PAEE was assessed using doubly labeled water (DLW) in 30 adolescents from Chennai, India, over seven consecutive days, simultaneous with the measurement of PA using accelerometry and a previous-week recall questionnaire.

Predicting physical activity energy expenditure using accelerometry in adults from sub-Sahara Africa.

Lack of physical activity may be an important etiological factor in the current epidemiological transition characterized by increasing prevalence of obesity and chronic diseases in sub-Sahara Africa. However, there is a dearth of data on objectively measured physical activity energy expenditure (PAEE) in this region. We sought to develop regression equations using body composition and accelerometer counts to predict PAEE.

Is it possible to assess free-living physical activity and energy expenditure in young people by self-report?

Background: It is unclear whether it is possible to accurately estimate physical activity energy expenditure (PAEE) by self-report in youth.

Objective: We assessed the validity and reliability of 4 self-reports to assess PAEE and time spent at moderate and vigorous intensity physical activity (MVPA) over the previous week in British young people between 4 and 17 y of age.

Design: PAEE and MVPA were derived from the Children's Physical Activity Questionnaire, Youth Physical Activity Questionnaire, and Swedish Adolescent Physical Activity Questionnaire; a lifestyle score indicative of habitual activity was derived from the Child Heart and Health Study in England Questionnaire.

Year-round high physical activity levels in agropastoralists of Bolivian Andes: results from repeated measurements of DLW method in peak and slack seasons of agricultural activities.

By the repeated use of the doubly labeled water method (DLW), this study aimed to investigate (1) the extent of changes in energy expenditure and physical activity level (PAL) in response to increased agricultural work demands, and (2) whether the seasonal work demands induce the changes in the fairly equitable division of work and similarity of energy needs between men and women observed in our previous study (Phase 1 study; Kashiwazaki et al., 1995: Am J Clin Nutr 62: 901-910). In a rural small agropastoral community of the Bolivian Andes, we made the follow-up study (Phase 2, 14 adults; a time of high agricultural activity) of the Phase 1 study (12 adults; a time of low agricultural activity).

Validity of impedance-based predictions of total body water as measured by 2H dilution in African HIV/AIDS outpatients.

Measurements of body composition are crucial in identifying HIV-infected patients at risk of malnutrition. No information is available on the validity of indirect body composition methods in African HIV-infected outpatients. Our first aim was to test the validity of fifteen published equations, developed in whites, African-Americans and/or Africans who were or not HIV-infected, for predicting total body water (TBW) from bioelectrical impedance analysis (BIA) in HIV-infected patients.

Quantification of lean and fat tissue repletion following critical illness: a case report.

Introduction: Muscle wasting is a recognised feature of critical illness and has obvious implications for patient rehabilitation and recovery. Whilst many clinicians believe lean tissue repletion to be a slow process following critical illness, and a probable explanation for poor functional recovery of patients many months after resolution of the illness, we have found no studies quantifying body composition changes during patient recovery.

Methods: A combination of assessment techniques were used to monitor changes in body composition (that is, fat, water, protein and mineral), following intensive care unit (ICU) discharge, in a 38-year-old female recovering from extrapontine myelinolysis.

An investigation of a novel three-dimensional activity monitor to predict free-living energy expenditure.

The aim of this study was to assess the capability of the 3dNX accelerometer to predict energy expenditure in two separate, free-living cohorts. Twenty-three adolescents and 14 young adults took a single dose of doubly labelled water and wore a 3dNX activity monitor during waking hours for a 10-day period while carrying out their normal routines. Multiple linear regression with backward elimination was used to establish the strength of the associations between various indices of energy expenditure, physical activity counts, and anthropometric variables.

Validation of a quantitative magnetic resonance method for measuring human body composition.

Objective: To evaluate a novel quantitative magnetic resonance (QMR) methodology (EchoMRI-AH, Echo Medical Systems) for measurement of whole-body fat and lean mass in humans.

Methods And Procedures: We have studied (i) the in vitro accuracy and precision by measuring 18 kg Canola oil with and without 9 kg water (ii) the accuracy and precision of measures of simulated fat mass changes in human subjects (n = 10) and (iii) QMR fat and lean mass measurements compared to those obtained using the established 4-compartment (4-C) model method (n = 30).

Results: (i) QMR represented 18 kg of oil at 40 degrees C as 17.

Use of stable-isotope techniques to validate infant feeding practices reported by Bangladeshi women receiving breastfeeding counseling.

Background: The World Health Organization recommends exclusive breastfeeding until age 6 mo. Studies relying on mothers' self-reported behaviors have shown that lactation counseling increases both the rate and duration of exclusive breastfeeding.

Objective: We aimed to validate reported infant feeding practices in rural Bangladesh; intakes of breast milk and nonbreast-milk water were measured by the dose-given-to-the mother deuterium dilution technique.