Aim The overall objective of this thesis was to increase the knowledge and validate methods for assessment of total daily energy expenditure (TEE), energy requirement and energy intake (EI) in women with COPD. We also investigated the relationship of BMI with clinical characteristics of COPD in a population-based study. Due to the substantial and increasing morbidity in women with COPD, special attention was given to this group. Methods Resting metabolic rate (RMR) was measured by indirect calorimetry (IC). TEE was measured by criterion method, doubly labeled water (DLW) (Paper I-III) during a 14-day period. TEE was simultaneously assessed by SenseWear Armband, software version 5.1 and 6.1 (SWA5 respectively SWA6), and ActiHeart (paper I). EI was assessed by diet history interview and 7-day food diary (paper II), and energy requirement was predicted using pedometer-determined physical activity level (paper III). Energy requirement data was also acquired from studies concerning TEE measured by DLW in patients with COPD (paper IV). BMI and other characteristics in subjects with COPD were compared with non-COPD subjects in a population-based study, Obstructive Lung disease in Norrbotten study (OLIN) (paper V). Results There was a large variation in RMR and TEE measured by DLW in this group of women with COPD. The results of energy expenditure study showed that the SWA5 assessed TEE with good accuracy over a 14-day period in free-living women with COPD. However, the SWA6 and ActiHeart methods tend to underestimate TEE. A higher proportion of women were within ± 5% of the TEE individually measured with the DLW method using SWA5 than SWA6 and AH (63%, 47%, 37% respectively). The agreement between the TEE measured by DLW and SWA5 was strong, and with SWA6 and ActiHeart it was lesser. Bland-Altman plots revealed no systematic bias for TEE. The reported EI was underestimated by 28% respectively 20 % when assessed by diet, and the 7-day food diary compared with the criterion method, DLW. More women were identified as valid-reporters based on their 7- day food diaries than on their diet histories (63% vs 32%). The accuracy of reported EI was only related to BMI. The agreement between the DLW and the EI methods was weak. The Bland-Altman plots revealed a slight systematic bias for both methods. The energy requirement predicted by pedometer-determined PAL multiplied by six different RMR equations was within a reasonable accuracy (±10%) of the measured TEE for all equations except one. The agreement between the DLW and four of six predicted TEE methods was strong. The Bland– Altman plots revealed no systematic bias for predicted energy requirement except for one. Estimated PAL from the pedometer was lower by 14 % than the measured criterion PAL. The energy requirement calculation based on available TEE data measured by DLW varied by BW and FFM. Compared to men, women had a lower RMR and TEE/kg BW/day, and higher RMR and TEE/kg FFM/day. The correlates of RMR/kg BW were gender and forced expiratory volume in 1st second (FEV1) % of predicted value, of TEE/ kg BW the correlates were age and gender, and of TEE/kg FFM were age and FEV1 % predicted. BMI decreased significantly with increase in disease severity and correlated significantly to forced expiratory volume in 1st second % predicted. In the population-based study (OLIN), subjects with COPD had lower BMI and a higher prevalence of underweight than in non-COPD, and its sub-groups namely, normal lung function and restrictive spirometry pattern subjects. There was an independent association between COPD and low BMI. Fewer COPD subjects were obese than in the non-COPD, normal lung function and restrictive spirometry pattern groups. Among the subjects with COPD, women had a lower mean BMI and a higher proportion were under-weight than men. In COPD women with under-weight, FEV1 % predicted values increased with an increase in BMI. Conclusion Compared with the gold standard DLW method, the total daily energy expenditure can be assessed reliably by SenseWear Armband 5 in women with COPD, while other devices underestimated TEE. The energy intake was underestimated by diet history and 7-day food diary methods, and energy requirement was predicted with reasonable accuracy using pedometer-determined PAL and common RMR equations, compared with DLW. Furthermore, the energy requirement was determined per kg BW/day and per kg FFM/day, using DLW based TEE data in patients with COPD. In the population-based study (OLIN), subjects with COPD had lower BMI and higher prevalence of under-weight than subjects without COPD. There was a gender difference, which was particularly significant in COPD, for women to have lower mean BMI and a higher prevalence of under-weight. The present findings indicate that low BMI is common in COPD and needs to be intervened. For a successful nutritional treatment, it is imperative to assess the patient’s ener / Bakgrund/Syfte Kroniskt obstruktiv lungsjukdom (KOL) är en av de stora folksjukdomarna där dödligheten ökar mest globalt sett. I Sverige är ökningen av KOL mest uttalad för kvinnor. Viktminskning är vanligt vid KOL. Låg kroppsvikt, låg andel fettfrimassa och lågt kroppsmasseindex (BMI) är dessutom riskfaktorer för ökad sjuklighet och dödlighet. Det finns därför behov av att ge anpassad kostbehandling for att motverka viktnedgång eller för att uppnå viktuppgång. För framgångsrik kostbehandlingen behövs metoder som på ett tillförlitligt sätt kan bedöma den totala energiförbrukningen, energiintag, och energibehov., Dessa metoder har ännu inte utvärderats väl hos KOL patienter. Det övergripande syftet därför med denna avhandling var att validera och öka kunskaperna om metoder som är tillförlitliga för att kunna bedöma energiförbrukning, energiintag och energibehov hos patienter med KOL. Vidare, jämfördes BMI och kliniska egenskaper mellan personer med och utan KOL in en populations-baserad studie. Metoder Viloenergiförbrukning mättes med indirekt kalorimeter hos kvinnor med KOL. Den totala energiförbrukningen mättes hos dessa kvinnor med dubbelmärktvatten metoden (DLW) (Arbete 1-3) under en 14-dagars period. Samtidigt bedömdes energiförbrukningen med två aktivitetesmätare, SenseWear Armband, mjukvaruversion 5.1 och 6.1 (SWA5 respektive SWA6), och ActiHeart (arbete 1). Energiintaget bedömdes med kostanamnes och 7-dagars matdagbok (arbete 2); energibehovet beräknades med olika viloenergiförbruknings formler och fysisk aktivitetsnivå uppskattad med en stegräknare (arbete 3). En sammanställning och en analys genomfördes av energibehovet baserad på data från flera studier som har mätt TEE med DLW hos KOL patienter (Arbete 4). BMI och kliniska egenskaper jämfördes mellan personer med och utan KOL i ett stort populationsbaserat material från Obstruktiv Lungsjukdom i Norrbotten (OLIN) studien (Arbete 5). Resultat Det fanns en stor variation in viloenergiförbrukningen och energiförbrukning mätt med DLW hos kvinnor med KOL. Energiförbrukningen mätt med aktivitetsmätare SWA5 visade hög tillförlitlighet både på grupp- och individnivå, medan SWA6 och ActiHeart metoderna underskattade energiförbrukningen. Energiintaget bedömd med kostanamnes och 7-dagars matdagbok visade en underskattning med 28% respektive 20% jämfört med DLW metoden. Det rapporterade energiintaget stämde för flertalet kvinnor bättre mot DLW metoden när energiintaget bedömdes med 7-dagars matdagbok jämfört med kostanamnes (63% mot 32%). Det beräknade energibehovet från stegräknare och från fem av sex olika RMR ekvationer låg inom en rimlig marginal (± 10%) jämfört med den uppmätta energiförbrukningen med DLW. Beräkning av energibehov baserat på tillgänglig data om energiförbrukning mätt med DLW varierade utifrån kroppsvikt och fettfrimassa hos patienter med KOL. Kvinnor hade en lägre viloenergiförbrukning och energiförbrukning per kg kroppsvikt och dag, och högre daglig viloenergiförbrukning och energiförbrukning per kg fettfrimassa och dag jämfört med män. I den populationsbaserade studien hade personer med KOL signifikant lägre BMI och högre prevalens av undervikt än personer utan KOL. Det fanns ett oberoende samband mellan KOL och lågt BMI. Färre personer med KOL var överviktiga än personer som inte hade KOL. Kvinnor med KOL hade både lägre BMI och högre andel med undervikt än män med KOL. Slutsats SenseWear Armband med programvaran 5.1 visar sig kunna beräkna den totala energiförbrukningen på ett tillförlitligt sätt hos kvinnor med KOL. Energiintaget beräknat utifrån kostanamnes och 7-dagars matdagbok underskattades. Energibehovet kan beräknas med en rimlig precision med hjälp av stegräknare och viloenergiförbrukningsformler hos dessa kvinnor. De sammanställda data om energiförbrukning mätt med DLW kan användas för att beräkna energibehov per kg- kroppsvikt och fettfri massa hos patienter med KOL i kliniskt syfte. I det populationsbaserade materialet från OLIN-studien noterades ett lägre BMI och högre prevalens av undervikt hos personer med KOL, och detsamma resultat förekom hos kvinnor med KOL jämfört med män med KOL.

The aim of this study was to determine energy expenditure and to find relations between resting energy expenditure (REE) and selected parameters in 14 polytraumatic patients in the ICU of University Hospital in Hradec Kralove, which were easily measurable and usable for REE prediction. In this study 7 men (age 36 ± 18 years) and 7 women (age 58 ± 28 years) with polytrauma were examined. The assessment of REE was measured via indirect calorimetry (IC) method. The examination also included bioimpedance analysis (BIA). BIA was useful especially for obtaining values of overhydration (OH), lean tissue mass (LTM) and metabolically active body cell mass (BCM). Average REE-IC (measured by IC) was 2116 ± 516 kcal·day-1 in men and 1450 ± 407 kcal·day-1 in women (P = 0.018). Statistically significant difference between men's and women's population was also found in these relations: calculation of basal energy expenditure according to Harris-Bennedict equation without (P = 0.001) and with deduction of OH from body weight (P = 0.001), at "breathing energy expenditure" (REE related to respiratory rate) (P = 0.018) and at (REE related to heart rate) "heart rate energy expenditure" (P = 0.038). REE-IC related to kilogram of BCM with and without deduction of overhydration was shown as statistically significant...

An exercise-induced energy deficit may affect post-exercise energy intake, physical activity energy expenditure (PAEE) and energy balance hormones. Therefore, the objective of this thesis was to investigate the impact of a single bout of exercise either of moderate (40% O2max) or high (70% O2max) intensity on post-exercise energy intake, physical activity energy expenditure and energy balance hormones in both sedentary and active males. Physical activity energy expenditure increased between 38 and 62 hours following moderate intensity exercise in sedentary males (Chapters 3 and 4). This was due to increased light intensity energy expenditure (2.4-4.79 METs) such as standing and walking activities (Chapter 4). The Change in PAEE was not associated with circulating leptin and adiponectin concentrations. There was no impact of a single bout of exercise on post-exercise energy intake in sedentary males during a buffet meal (Chapter 4). Chapter 5 aimed to determine whether changes in PAEE, energy intake, and energy balance hormones were related to physical activity status. Interestingly, plasma acylated ghrelin concentration was suppressed while total peptide YY (PYY) concentration tended to be elevated after high intensity exercise in active males (Chapter 5). However, there was no impact of either moderate or high intensity exercise on PAEE and post-exercise energy intake in active males. The final study (Chapter 6) determined whether high intensity exercise in the fed state after a few days of food restriction had an impact on circulating energy balance hormones. Circulating postprandial total PYY and pancreatic polypeptide (PP) were increased for one hour after high intensity exercise in active men. There was no change in PAEE and post-exercise energy intake after exercise.

This thesis consists of four studies, presented in three main essays, empirically linking economic growth to public expenditure and telecommunication infrastructure using four different sample groups of countries with data from 1972-2012. In the second chapter, in Study 1, the permanent growth effects of fiscal policy are investigated across countries with different income levels using the public-policy endogenous growth model, where public spending is classified by function. The endogeneity problems associated with taxes and investment are taken into account, as is a possible non-linear relationship between government expenditure and economic growth. The results have shown that gross capital formation is the only control variable that has a significant positive coefficient in all growth regressions, while the evidence of conditional convergence hypothesis is reaffirmed. An increase in transportation and communication spending is conducive to growth in both developing and high-income countries, whereas other types of spending are not. In the third chapter, in Study 2, we firstly consider the relationship between public spending and growth with a government budget constraint. The evidence for productive expenditure being conducive to growth only exists in high-income OECD countries. Distortionary taxes are shown to have growth-deteriorating effects in both the developing country and the high-income OECD country groups. When considering the relationship between public spending and long-run GDP per capita level in Study 3, it was found that an increase in total spending financed by non-distortionary taxes enhances the per capita level of GDP in high-income OECD countries. Regardless of implicit financing elements, increases in total spending in developing countries cannot promote long-run increases in GDP per capita levels. In developing countries, increases in the shares of health care and general public services in spending can improve long-run GDP per capita. In high-income OECD countries, increasing in the share of education in spending is conducive to increasing per capita GDP in the long-run. In the fourth chapter, in Study 4, we assess the link between telecommunication infrastructure and economic development. The system of equations is used while considering stationarity and cointegration of variables in the models. The output dividend of fixed telephones in the period from 1975 to 1990 for the group of high-income OECD countries is higher than for developing countries. When considering mobile phone infrastructure, an increase in penetration has positive effects on aggregate output in developing countries for the period from 1990 to 2012. There is only weak evidence that increased mobile phone penetration in high-income OECD countries has a negative effect. When fixed telephone penetration is low, an increase in mobile phone penetration enhances aggregate output. When fixed telephone penetration is already high, an increase in mobile phone penetration might have deteriorating effects. The results have shown that mobile phone and fixed telephone infrastructures are, in fact, substitutes for one another rather than complements.

This study addresses some of the widely debated issues in the empirical education and trade literature in the context of India. Chapter 3 examines the impact of public education expenditure and trade openness on economic growth of India using aggregate or country level data. The estimation results indicate that public education expenditure has a positive effect on growth but the impact is not very robust and sensitive to different estimation methods. The major contribution of this chapter to the existing literature has been to establish the dynamism in India’s trade-growth nexus. The nature of the relationship between trade openness and economic growth of India has changed following the change in policy regime since the 1980s. In Chapter 4, I investigate the trade-growth nexus further by employing disaggregated level analysis. Firstly, I disaggregate GDP by agriculture, manufacturing and services sectors and try to check which sector benefitted most from trade openness. Secondly, I try to assess whether trade openness affects manufacturing sector growth at the Indian state level. The latter analysis has been conducted using panel model analysis for 22 states. Econometric analysis indicates that the effect of trade openness has been heterogeneous across sectors. Only the services sector seemed to have reaped the benefits of increasing openness, so far. Consequently, no significant relationship could be found between agricultural sector performance and trade openness. It seems that the agricultural sector suffers from gross underinvestment and its performance still relies heavily on the monsoon cycles. At the country level, manufacturing sector failed to take advantage of the trade openness but the picture of stagnancy is not uniformly true when we look at the state-level manufacturing performance. I therefore re-estimate the relationship between state-level manufacturing performance and state-level trade openness using state level data. The most notable contribution of this chapter to the existing literature has been the construction of trade openness indices for major Indian states. Overall, I find that there is a robust association between trade openness and manufacturing sector performance at the Indian state level. However, this relationship seems to be driven solely by the performance of the unregistered segment of Indian manufacturing. In Chapter 5, I disaggregate the public education expenditure data by primary, secondary and tertiary sectors and examine the nature of the relationship between each sectoral expenditure and growth. None of the sectoral education expenditure had any impact on growth when the analysis is carried out for the entire time period 1951-2011. Both school and tertiary education expenditure started to exert a positive impact on Indian GDP growth once the country started to shift from a state-led growth model to a pro-business regime from the early 1980s. Finally, I examine the determinants of public education expenditure by the state governments using panel data for 16 Indian states. The economic variables such as NSDP per capita and tax revenue came out to be statistically significant indicating that richer states spend more on education compared to their poorer counterparts. States with smaller child population share (0-14 years, as percentage of total population) managed to allocate more funds towards education than those with larger shares. No significant evidence was found to suggest that political factors such as corruption and political ideology of the ruling party affect education spending decisions in Indian states.

Magister Commercii - MCom / 1. Taxes are an important source of government revenue (income). A failure by the government to collect sufficient taxes to cover for its ever increasing expenditures, engenders fiscal problems. Amongst others the government is compelled to borrow to finance its budget short fall. In this instance, should the government borrow domestically or offshore to finance its short fall . 2. Amongst the theories discussed in this paper, are the views of the Neoclassical Keynesian and the Ricardi an schools of thought. Further more, South African theories on government debt are also discussed. 3. There is a considerably large number of indicators that can be used to determine an appropriate level of both domestic and foreign debt of a country. Certain well establish criteria such as the ratio of foreign interest payments to exports, the ratio of foreign debt to gross domestic product, the ratio of·govemment debt to gross domestic product and the ratio of foreign debt to exports, are amongst the pool of indicators that can be used. However, the following indicators have been identified as the most commonly used in the analysis of budget deficits, and they are; ratio of deficit before borrowing and debt repayment to GDP, the ratio of government debt to GDP, the ratio of interest payments to government expenditure, the level of real interest rates relative to economic growth and the net asset value or net worth of the government. 4. Deficit financing refer to the ways in which the budgetary gap is financed. Overreliance on domestic borrowing may mean high real interest rates and falling investment, and overreliance on foreign borrowing can cause appreciating real exchange rates and unsustainable external indebtedness, amongst others. 5. Amongst the available remedies for debt ills in this country, is the suggestion to significantly cut government expenditure. However, realities currently confronting the authorities, like the increase in public servants as a result of the abolishment of homelands and the constitutionally guaranteed employment of civil servants from the old order, automatically put pressure on public consumption. 6. On the international front, South Africa is underborrowed. In this regard favour should go more for offshore borrowing. Certainly South Africa has to generate the means of meeting debt obligations by running a surplus of exports over imports of goods and services. The bulk of the country's debt is of domestic origin which account for well over 90 % of total debt. The current anti inflationary monetary policy with its concomitant high interest rates, makes domestic borrowing more costly.

This thesis investigates the influence of nutrition support on a set of critically ill patients after the administration of parenteral nutrition by measuring their energy expenditure and substrate oxidation. The study was performed on 8 spontaneously breathing patients during the 2nd-5th day of polytrauma and the variables were obtained by Indirect calorimetry. The mean age of the patients was 42 ± 16 years. Four patients were obese, three were overweight and one had normal weight in the examined group. The measurement was conducted on 7 patients after hypocaloric nutrition administration (1323 ± 281 kcal/day) and 1 patient after hypercaloric nutrition administration (3400 kcal/day). Statistical analysis revealed that the administered nutritional support had no significant effect on energy expenditure and the substrate oxidation preference. However, correlations between the values of energy expenditure, nutrients oxidation, and values of some of the laboratory parameters were observed. The energy expenditure of polytraumatic patients measured at least 4 hours after nutritional administration was 2139 ± 518 kcal/day and 24.6 ± 3.5 kcal/kg/day. This energy expenditure was covered by oxidation of proteins (31%), by lipids (46%) and by carbohydrates (23%). Large variability was found among the results...

Purpose: To examine the relationship between hand rim propulsion power and energy expenditure during wheelchair locomotion. Methods: Fourteen individuals who used manual wheelchairs were included in this study. Each participant performed five different locomotion activities in a wheelchair with a PowerTap hub built into the rear wheel. The activities included wheeling on a level surface that elicited a low rolling resistance at three different speeds (4.5, 5.5, and 6.5 km∙hr-1), wheeling on a rubberized 400m track that elicited a higher rolling resistance at one speed (5.5 km∙hr-1), and wheeling on a sidewalk course that included uphill and downhill segments at their self-selected speed. Energy expenditure was measured using a portable indirect calorimetry system. In addition, each subject wore an Actical and a SenseWear activity monitor on the right wrist and upper arm, respectively. Stepwise, linear regression was performed to predict energy expenditure from power output variables. A repeated measures ANOVA was used to compare the measured energy expenditure to the estimates from the power models, the Actical, and the SenseWear. Bland-Altman plots were used to assess the agreement between the criterion values and the predicted values. Results: The relationship between energy expenditure and power was significantly correlated (r = 0.694, p < 0.001). Stepwise, linear regression analysis yielded three significant prediction models utilizing measured power; measured power and speed; and measured power, speed, and heart rate. A repeated measures ANOVA demonstrated a significant main effect between measured energy expenditure and estimated energy expenditure (p < 0.01). There were no significant differences between the criterion method and the power models or the Actical. The SenseWear significantly overestimated energy expenditure when wheeling at 4.5 km·hr-1, 5.5 km·hr-1, 6.5 km·hr-1, and during self-paced sidewalk wheeling (p < 0.05). Conclusion: Energy expenditure can be accurately and precisely estimated based on wheelchair propulsion power. These results indicate that wheelchair power could be used as a method to assess physical activity in people who use wheelchairs.

Globalization has brought health concerns to the forefront. Moreover, governments, policymakers, and health officials are paying more attention to these health concerns. With the increased cross-national interaction, diseases have more pathways to spread than ever. As countries attempt to ensure access to care and control health expenditure, monitoring and improving the quality of health care is a pressing issue. This paper uses linear regressions to analyze the relationship between prevention and public health expenditure and the rate of measles immunizations in member countries of the Organisation of Economic Co-operation and Development (OECD). There is a weak negative relationship between the expenditure and rates of measles immunizations for both private and public expenditure data, suggesting that the higher the expenditure the lower the rates of measles immunizations. Several possible reasons for this phenomenon is discussed in conjunction with the role of health educators as it relates to the use of theory based interventions to improve rates of measles immunizations.

The main purpose of this study was to examine the constructs of the theory of planned behaviour (TPB) in two different exercise settings structured versus unstructured. Owing to the assumption that individuals may perceive less volitional control in a structured setting versus an unstructured setting, it was hypothesized that perceived behavioural control would be a stronger predictor of exercise behaviour in the structured setting. A secondary purpose of the current study was to assess the utility of using two different exercise outcomes energy expenditure and exercise frequency to assess exercise behaviour. Participants (N = 207) were recruited from a first-year kinesiology university class. Data collection occurred over two time periods, nine days apart, and was conducted during class periods. During the first testing session, participants were provided with a questionnaire that assessed TPB constructs and physical activity level in the two settings (structured versus unstructured) using the Modifiable Activity Questionnaire (MAQ). Half of the participants were requested to complete the TPB constructs using energy expenditure as the outcome measure and half were requested to complete the constructs using exercise frequency as the outcome measure. In the second testing session, all participations were asked to report their exercise levels over the previous seven days using the MAQ. In terms of predicting intention, hierarchical regression analyses revealed that, contrary to the hypothesis, perceived behavioural control was more predictive in the unstructured setting versus the structured setting. Although not predicted, it also was found that subjective norms were a significant predictor of activity intention in the structured but not the unstructured setting. The results using the two different outcome measures (e.g., energy expenditure versus frequency) also revealed differences; however, no consistent pattern emerged. One relationship that did emerge was the finding that perceived behavioural control was found to be a stronger predictor of intention in the unstructured setting using energy expenditure as an outcome versus exercise frequency. <p> Finally, the results revealed little support for the TPB constructs predicting self-reported physical activity behaviour. Practical implications and future directions are discussed.