Relation between Energy Intake, Dietary Intake and Energy Density

It is observed that consumption of diet having low energy density by adults reflects consumption of higher amount of food (on the basis of weight). But at the same time, the above category of adults has lesser energy intake as compared to people who consume diet with higher value of energy density . Energy density relating to a range of patterns of diets which include higher amounts of fats can be reduced with the addition of vegetables and fruit. Research reports give support to hypothesis that relation does exist between consumption of diet with obesity and energy density apart from providing evidence to the importance of vegetable and fruit consumption for the management of weight .

Using Energy Intake, Dietary Intake and Energy Density as predictor of obesity

For losing weight effectively, one needs to take either foods with lesser kilojoules than the person is currently consuming or the person needs to exercise well to burn the extra amount of kilojoules. The perfect combination for manageable fat and long-term fat loss is the balance for good nutrition along with active lifestyle. The importance of exercise to equation for calculating fat loss is not considered in most of the cases. Exercise helps in increasing the metabolic rate of the body in order to accelerate the energy amount that is burnt up during the exercise process. The resistance training specifically helps in increasing the RMR or the resting metabolic rate of a person. This is because of the increase in the ratio of lean muscle (mass) to that of fat mass.

The cardio is highly helpful in burning the fats stored in the body. This matches with program related to weights that can increase the metabolism or lean tissue. This combination is required for fat loss which can be long lasting. Fat burns more during sleep. Investigations from laboratory give an indication that food consumption having low values of energy density in kcal/g reduces the value of energy intake.

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Calculation of Energy Intake, Dietary Intake and Energy Density

D1. Calculation of Energy Intake

For calculating energy intake, the following steps have to be followed.

1.)    The person has to find out his BMR or basal metabolic rate in accordance with weight and age.

2.)    In the second step , the BMR has to be multiplied in accordance with the activity level(The tables of BMR, Exercise activity/minute and Activity level have to be taken into consideration). The equation goes as  BMR *[Activity level]= -----------

3.)    The fat loss (recommended)  can be multiplied by 20%  to give the requisite amount of the maintenance eating.    Level of fat loss (recommended) * 20% = maintenance intake (recommended) ---------------.

4.)    One of the exercise activities is to be selected that is in /min rates and multiply it by the number of minutes spent in training.

5.)    To finally reach the energy intake in calories, divide the value in step 4 by 4.18

D2. Calculation of Dietary Intake

      The dietary intake calculator can be used for working out a person’s recommended intake on day-to-day basis.

1.)    The daily activity level of a person should be found out that is not having any activity (bedridden) or whether he/she is pursuing

§         Sedentary activities like reading

§         Light activity like occasional walking

§         Moderate activity like standing work or walking

§         Heavy activity like those of farmers or athletes with high-performance.

§         Very heavy activity like strenuous activity or sports-related activity in addition to sedentary/moderate/light activities as mentioned above.

The intakes on daily basis can be taken from Reference Values of Nutrients for New Zealand and Australia.

In the dietary calculator, the values that have to be applied are to be selected with respect to the age group. The energy variance that is the percent of values of Daily Intake utilized in the calculator are based on the average diet of an adult. Different people require different quantum of the energy of food at different stages of their lives due to varying activity levels. An example for this is that of an active teenager who requires greater energy from food as compared to a aged person who is sedentary. Additionally a dietary advice from an Accredited and professional practicing dietician can be found on the website of Australian Dietitians Association.

 

D3. Calculation of Energy Density

            For calculating energy density from the Panel of Nutrition Facts from food label, the calories have to be divided by weight.

Energy Density= (Calories per weight)/ (serving per weight)

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Energy Intake, Dietary Intake & Energy Density

A. Energy Intake

Energy intake is considered to be part of diet that is mainly regulated by the hunger of a person and the energy that is consumed by him/her. It is difficult to measure a person’s energy intake. The reason for this is that though a human being consumes varied amounts of every component of their daily diet, all the components in the food consumed do not provide energy. An example for this can be cited to be that of a person eating cake. The butter or eggs that are consumed are not likely to weigh the same each time. This is applicable to each vegetable or fruit that is consumed . A fruit of a specific category or from same tree is not expected to have the same energy (calorific) value. There are differences in sizes and the sugar proportions change as the ripening of fruit progresses. Components of a specific food which are digested, absorbed and required for usage in the processes of the body are termed as nutrients. Nutrients are further divided into categories-macronutrients (carbohydrates, proteins and fats) and micronutrients(minerals and vitamins) and water. While macronutrients, provide the requisite energy, micronutrients are the food groups that are required for the functioning of the body and are not the sources of energy in the body .

B. Dietary Intake

            Dietary intake includes all beverages and foods consumed orally. It is also defined as the average of the daily intake of a food or nutrient in the long-run . The dietary intake (recommended) relates to a particular quantity of specific type of nutrients which are required in single day for good health. Items which are not taken to be in the foods category like condiments and dietary supplements and those that contain nutrients or energy are included as part of energy intake. But this does not happen always. This is because the above items are not included in the dietary assessment intake . It is due to problems with information missing about their composition, quantification or identification.

C. Energy Density

            The amount of the energy stored in a specific region/system of the space /unit volume is termed as ‘Energy Density’ . In most of the cases energy that is useful/ extractable will be quantified while energy that is inaccessible chemically like the mass energy at rest will be ignored. Quantifiable energy is the energy that is quantified with respect to magnitude in terms of related units. The foods having lesser energy density do provide lesser calories/gram compared to foods having higher value of energy density. A person can consume greater portion of food for the same calories that is having lesser energy density as compared to foods having higher value of energy density.

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Medical assignment help-Short answer Questions set1

1. Briefly describe the term "medical billing".

Medical billing is the name for the entire process of submitting and pursuing the claims with insurance companies in order to obtain payments for the services given by a health care provider to a patient. The entire process is called by the name billing cycle and may take even months in some cases.

2. Identify the two parties that are typically involved in the "Billing Process". Identify the person that typically creates and updates the patient's medical record.

The healthcare provider and the insurance company are the two parties involved in the billing process. The doctor treating the patient is the person who creates and updates the patient’s medical record.

3. Explain the process of determining the five digit procedure code and the factors that are taken into consideration. What is the abbreviation for the code? Identify each word that is abbreviated in the code.

The five digit procedure code is called the CPT code. The abbreviation CPT stands for Current Procedural Terminology Code. The extent of physical examination, the nature of the diagnosis and the background details of the patient as received from the patient are all evaluated to decide over the level of medical service, which will be used to file claims for insurance. This level of service once finalised by the qualified staff is converted into a standardised five digit procedure code obtained from Current Procedural Terminology (CPT) database.

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Using Genetic Engineering to cure Human Diseases and Clone Human Body Parts

Using Genetic Engineering to cure Human Diseases

                   Using genetic engineering to cure human diseases is a virtual boon to mankind. Gene therapy which is the offspring of genetic engineering involves treatment of diseases by repair or replacement of defective genes or introduction of therapeutic genes to fight the disease. As a result of this therapy many autoimmune diseases as well as cardiac problems could be effectively treated. Some rare diseases like ALS, Huntington’s disease and cystic fibrosis which are due to defective genes could be cured by gene therapy. Gene therapy also enables pregnant women to get their fetuses screened for finding out any genetic defects. Genetic Engineering for curing of human diseases is highly desirable (“What are the benefits of human genetic engineering?”, 2011).

 Genetic Engineering to Clone Human Body Parts

Use of geneticengineering to clone human parts for transplant is going to totally revolutionise medicine. The technology enables us to produce identical cells for the purpose of regenerative medicine. Organs and tissues required for transplantation. Areas such as treatment of burns and cosmetic and reconstructive surgery are going to immensely benefit, because of this technology (Eigen, 2010).

It is a common spectacle that many patients die for want of replacement of damaged parts. Such instances can be avoided by use by cloning for producing human parts for transplant (Eigen, 2010).

References

Eigen,D.L. (2010). "Scriptamus, Human Clones May Be Among Us Now! Who Is Ready?". Retrieved January 14,2011from  http://scriptamus.wordpress.com/2010/01/03/human-clones-may-be-among-us-now-who-is-ready

“What are the benefits of human genetic engineering?”(2011). AllAboutPopularIssues.org. Retrieved January 14,2011 from  http://www.allaboutpopularissues.org/benefits-of-human-genetic-engineering-faq.htm.

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Using Genetic Engineering to Develop Better Farm Animals

Using Genetic Engineering to Develop Better Farm Animals

              The processes using genetic engineering to develop better farm animals lead  to producing transgenic animals , which acquire better resistance to disease, ability to grow faster, ability to turnout better work and better reproductive capacity. Thus for example transgenic sheep can be developed for yielding better wool and transgenic cows to yield more milk and better meat. It is also possible that the animals can be made to be non-sentient in that they don’t feel and suffer from pain(Perzigian,2003).

            While all the above seem desirable, use of genetic engineering for developing farm animals is likely to infuse a sense of indifference towards many species which are not directly useful to mankind. Their existence and survival in nature is however necessary for maintaining the biodiversity required for ecological balance. Use of too much of genetic engineering for animal farming should not be allowed to disturb ecological balance(Perzigian,2003).

Reference

Perzigian,B.A.(2003). “Genetic Engineering and Animals: A Short Summary of the Legal Terrain and Ethical Implications”, Animal Legal and Historical Center, Michigan State University--Detroit College of Law. Retrieved January 14, 2011 from

http://www.animallaw.info/articles/ovusgeneticengineering.htm.

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Views on Genetically Modified Plants

Genetically Modified Plants                                                        

            The genetically modified plants are those whose DNA is changed using some techniques from genetic engineering. By using such techniques a new quality is introduced into those plants which enable them to be sturdier and withstand diseases and pests, which normal plants cannot withstand (Bock, 2010).

            Even though there is a stubborn resistance to the introduction of genetically modified plants in a number of countries, their utility cannot be totally written off. Due to acute pollution and global warming, there are many unpredictable changes in climate, which normal and natural plants are not able to withstand. Because of such climatic changes new types of pests are targeting plant life, causing huge destruction. Genetic changes in plants enable them to be resistant to diseases and pests and also ensure longer shelf life(Bock,2010).

            Human needs are increasing day by day particularly on the food front. It is becoming more and more difficult to get the necessary crop yields from natural plants. Genetically modified plants can offer solution to this problem. However care should be taken that these genetically modified plants do not give rise to new environmental problems(Bock,2010).

Reference

Bock, R. (2010). "The give-and-take of DNA: horizontal gene transfer in plants". Trends in plant science, 15 (1): 11–22. doi:10.1016/j.tplants.2009.10.001. PMID 19910236.

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Reliability and Stability of Dutch version of Roland -Morris Disability Questionnaire (RM-24) for CLBP patients

Brouwer et al.(2004) have conducted study to analyse the reliability of the test or retest of Dutch version of RMDQ in a sample size of  30 CLBP patients. The RMDQ of the Dutch language version displayed good reliability having an ICC (Interclass Correlation Coefficient) of 0.91( acceptable range of reliability has ICC greater than or equal to 0.75). This RMDQ of Dutch language version proves to be reliable in measuring the functional status in patients with CLBP. But the natural variation should be taken into consideration when this RMDQ is used clinically.

Brouwer et al.(2004) have conducted study to analyse the stability of the test or retest of Dutch version of RMDQ in a sample size of 30 patients suffering from CLBP (Chronic Low Back Pain). While calculating the agreement limits for quantifying the stability, a higher quantity of natural variation was found which is of  ± 5.4 and this is relative to the range of total score which is in between 0-24.

Reference:

Brouwer,S Kuijer1,W , Dijkstra PU, Göeken LNH ,  GroothoffJW and  Geertzen JHB(2004).Reliability and stability of the Roland Morris Disability Questionnaire: intra class correlation and limits of agreement, Disabil Rehabil.,February,Vol. 26, No. 3 , pp.162-5.

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Sensitivity and Specificity of Roland-Morris Disability Questionnaire(RM-24) by Osteloa et al. (2004)

Osteloa etal. (2004)  studied the properties of measurement of questionnaire basing on population samples on which there will be usage of the measurements. The study’s purpose is to establish is to establish an evidence which is based on the recommendation of the use of questionnaires regarding functional use in the patients after a lumbar disc surgery by the direct comparison of responsiveness and reproducibility. There was assessment of the properties of measurement of 6 status questionnaires of functional nature .In this study, (1) RDQ-24(Roland-Morris Disability Questionnaire), (2.) MRDQ(Modified Roland-Morris Disability Questionnaire), (3.) RM-18 or short Roland-Morris Disability (4.) Physical functioning Scale , (5.)SF-36 Role Limitations and main complaint (MC) subjects who still suffered from complaints for 6 weeks after the  lumbar disc surgery. The questionnaires were completed before and 3 months of treatment. Suggestions were made for the usage of RDQ-24 in popele post-surgery.It was found that the optimal cut-off point for the RDQ-24 minimizing the classification error was found to be 3.5 with 88.2% as specificity.

In the studies by Osteloa et al. (2004) ,regarding measurement properties of six types of questionnaires which are based on population samples, the sensitivity for RDQ-24 was found to be 94.6%.

Reference

Osteloa,R.W.J.G., Veta,H.C.W., Knola,D.L. & van den Brandtb,P.A.(2004).24-item Roland-Morris Disability Questionnaire was preferred out of six functional status questionnaires for post-lumbar disc surgery.Journal of Clinical Epidemiology,Elsevier, vol.57,pp.268–276.

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Reliability and Validity of Brazilian-Portuguese version of Roland-Morris questionnaire(RM-24) for CLBP patients

Nasbaum et al. (2001) proposed a study on RM questionnaire which is to be translated into the Brazilian-Portuguese in a sample size of 30 CLBP patients. After the original version was translated to Brazilian-Portuguese, the discrepancies after being taken to discussion were solved by a panel of three rheumatologists to establish the final version of Brazilian RM questionnaire or the Brazil-RM. In the session for pretesting, the patient understood all the questions. The average time for administration of questionnaire was 4 min and 53s. The ICC and SCC (SpearmanCorrelation Coefficient) were 0.94 and 0.88(P<0.01) respectively for the reliability of the test / retest and 0.95 and 0.86(P<0.01) correspondingly for the reliability of interobserver. It can be concluded that there was successful translation of Brazil-RM and it was adapted for application to the patients in Brazil with reliability of satisfactory level.

 The validation of Brazilian-Portuguese RM questionnaire by Nasbaum et al. (2001) was done after translating and adapting it  on 30 patients suffering from CLBP who are consecutively selected from outpatient clinic for disorders related to spine. The validity of the cross-sectional construct was calculated by the SCC. The coefficient of correlation was 0.80(P<0.01) between the score of Brazil –RM and PS score and 0.79(P<0.01) between Brazil-RM score and VAS. It can be concluded that there was successful translation of Brazil-RM and it was adapted for application to the patients in Brazil with validity of cross-sectional construct.

 Reference:

Nusbaum L, Natour J, Ferraz MB, Goldenberg J.( 2001), Translation, adaptation and validation of the Roland-Morris questionnaire--Brazil Roland-Morris . Braz J Med Biol Res. Feb, Vol.34, no.2, pp.203-10.

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Translations and Modifications of the Roland- Morris Disability Questionnaire(RM-24)Tool

The Roland- Morris Disability Questionnaire(RM-24) was initially  available in 12 languages but now it is available in 36 languages. The RMDQ translations can also be used without the permission from either the authors or from journal Spine. If any other translations are done, they may be sent to any author (MR) with details of the process of translation, so that these translations can be included in the content of Spine website. Among the modifications proposed for RMDQ by various researchers, one modification was to change the questionnaire’s wording that is to change each statement’s terminal phrase from “ because of my back” to “because of my back or leg problem”. This change is more suited for sciatica patients and the modifications are very acceptable (Patrick etal., 1995). Stratford & Binkley (1997) have suggested that large number of items were made redundant and there could be improvement to the questionnaire by reducing the items to 18. Patrick et al.(1995) have removed 5 redundant items that are potential . They have suggested that there could be increase in responsiveness by additional of four more additional items which are connected to daily work, sexual function, expression of concern to other people, and the requirement to hold or rub the areas that hurt. Over all the modifications seem to give only minor improvement on original version. A group of international experts have suggested that more of the original version should be used as it is widely used in various countries. A modification was suggested by Underwood et al.(1999) which asked of each item of the RDQ on the no of days the patient was affected in the previous month. This version if not validated and it attempts to incorporate the time people are influenced by the back pain which often varies. But there was not much performance of it apart from the modification of the questionnaire of Von Korff(Underwood e tal. , 1999).

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Development of Roland-Morris Disability Questionnaire – 24 (RM-24 Tool)

The Roland– Morris Disability questionnaire is a measure for health status that is designed to be completed by patients for assessing the physical disability that can be caused due to low back pain. It was originally designed for usage in research by Roland and Morris in the year 1983 for measuring outcomes in clinical trials but at the same time it was also found helpful for patient-monitoring in clinical practice. Initially it was designed for primary care in United Kingdom but at the same time was used in other settings. In 2000, review of the papers relating to the questionnaire was done. The derivation of RMDQ was done from SIP (Sickness Impact Profile) which is a measure of 136-items of health status (Beaton et al., 2000) covering all areas of mental and physical functions. The original authors have selected 24 items from SIP as they are mainly related to the physical functions which are mainly influenced by low back pain.  Every item was tagged with a phrase “because of my back pain” for distinguishing the disability due to back pain from the other disabilities. This is a distinction that the patients generally will able do without any difficulty (Ren, 1998).There is a pain-rating consisting of 6-point scale that the original RMDQ contains in pain thermometer form. But the present authors give recommendation for the SF-36 pain scale (Von Korff et al., 2000). The RMDQ is simple and short to complete and very well taken up by patients. Stratford et al.(1994) found ambiguous or incomplete responses to RMDQ as compared to Oswestry questionnaire.

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24 Items of Roland-Morris Disability Questionnaire(RM-24)

DISABILITY RATING SCALE FOR LOW BACK PAIN

US English version of the Roland-Morris disability questionnaire from MAPI 2005

The cultural adaptation process described in section 1.2 at the end of the questionnaire.

 (Source: US English Version from http://www.rmdq.org/)

When your back hurts, you may find it difficult to do some of the things you normally do.

This list contains some sentences that people have used to describe themselves when they have back pain. When you read them, you may find that some stand out because they describe you today. As you read the list, think of yourself today. When you read a sentence that describes you today, mark the box next to it. If the sentence does not describe you, then leave the space blank and go on to the next one. Remember, only mark the sentence if you are sure that it describes you today.

1.              I stay at home most of the time because of the pain in my back.

2.              I change position frequently to try and make my back comfortable.

3.              I walk more slowly than usual because of the pain in my back.

4.              Because of the pain in my back, I am not doing any of the jobs that I usually do around the house.

5.              Because of the pain in my back, I use a handrail to get upstairs.

6.              Because of the pain in my back, I lie down to rest more often.

7.              Because of the pain in my back, I have to hold on to something to get out of a reclining chair.

8.              Because of the pain in my back, I ask other people to do things for me.

9.              I get dressed more slowly than usual because of the pain in my back.

10.          I only stand up for short periods of time because of the pain in my back.

11.          Because of the pain in my back, I try not to bend or kneel down.

12.          I find it difficult to get out of a chair because of the pain in my back.

13.          My back hurts most of the time.

14.          I find it difficult to turn over in bed because of the pain in my back.

15.          My appetite is not very good because of the pain in my back.

16.          I have trouble putting on my socks (or stockings) because of the pain in my back.

17.          I only walk short distances because of the pain in my back.

18.          I sleep less because of the pain in my back.

19.          Because of the pain in my back, I get dressed with help from someone else.

20.          I sit down for most of the day because of the pain in my back.

21.          I avoid heavy jobs around the house because of the pain in my back.

22.          Because of the pain in my back, I am more irritable and bad tempered with people.

23.          Because of the pain in my back, I go upstairs more slowly than usual.

24.          I stay in bed most of the time because of the pain in my back.

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