Fluid intake and regulation are implicated in the control of energy balance and appetite. The studies in this thesis have examined the effects of fluid manipulation on appetite and energy intake. Fifty-eight young, predominantly Caucasian males were recruited to five studies. The age, height and body mass of the subjects were: 24.9 ± 3.8 y, 1.79 ± 0.1 m, 80.1 ± 14.8 kg (mean ± SD) respectively. In Chapter 3, 13 h of hypohydration after exercise in the heat did not influence energy intake at an ad-libitum buffet meal (P=0.436) compared to a euhydrated trial, although greater thirst (P < 0.001) and lower fullness (P < 0.01) was reported in the hypohydration trial. Chapter 4 demonstrated that there was no difference in energy intake or appetite after 24 h of hypohydration either with or without fluid during a semi-solid ad-libitum breakfast. Thirst and fluid intake were greater during the hypohydrated with fluid (HYPO-F; 618 (251) mL) than the euhydrated with fluid (EU-F; 400 (247) mL) trials (P < 0.01). Chapter 5 and 6 showed that a bolus of water (500 mL) immediately before an ad-libitum porridge breakfast reduced energy intake in both healthy and overweight and obese subjects (P < 0.001). The water preload increased fullness and decreased hunger compared to pre-trial in both studies (P < 0.001). In Chapter 7, 75 minutes before an ad-libitum lunch a post-exercise milk (MILK) based drink reduced energy intake (6746 (2035) kJ) compared to an isoenergetic flavoured carbohydrate (CHO) and water based drink (7762 (1921) kJ; 7672 (2005) kJ) (P < 0.05). This thesis has shown that when subjects are hypohydrated, either after exercise or after 24 h of fluid restriction energy intake is not different at an ad-libitum meal. However, there is an increased thirst and subsequent fluid intake before an ad-libitum meal (chapter 3 and 4). This effect was more acutely displayed when a bolus of water was provided immediately before an ad-libitum breakfast meal and subsequently decreased energy intake in both normal and overweight/ obese subjects (chapter 5 and 6). The possible mechanism for this was gastric fill and distension creating satiety before a meal. Chapter 7 has showed that when subjects consume isoenergetic drinks with different energy densities (milk vs CHO and water), before an ad-libitum lunch, energy intake was decreased when milk was consumed. Milk having an increased energy density due to larger protein fractions (casein) may further explain the decrease in energy intake found in chapters 5 and 6 by a similar mechanism. Therefore, gastric fill before a meal decreases ad-libitum energy intake by either the intake of water immediately before a meal or by milk as a more delayed response (75 min). The hydration status however, did not affect energy intake directly in our finding, although it did affect subsequent fluid ingestion, which may have affected findings in chapters 3 and 4.

Rate of readmission among hospitalized heart failure (HF) patients is used as an indicator of quality and efficiency of healthcare. A low sodium diet is a component of the accepted treatment for HF. Instruction by dietitians may help reduce dietary sodium without negatively affecting quality of life. The effect of low sodium diet education on hospital readmission within 30 and 45 days of discharge for HF patients (N=52) was conducted. Chi-square analysis determined education did not significantly affect remittance within 30 (P=.143) or 45 days (P=.474). Patients readmitted within 30 days were older (P=.005). Men were more likely to be readmitted than women within 30 (P=.021) and 45 days (P=.019). Higher NT-proBNP levels were observed in individuals readmitted within 30 (P=.011) and 45 days (P=.010). Low sodium diet education did not affect readmission but older age, male sex, and higher NT-proBNP values increased the rate of readmission.

Introduction: Nurses and other health care professionals meet patients with heart failure (HF) who report they are thirsty. Thirst is described by the patients as a concern, and it is distressing. Currently there are no standardized procedures to identify patients with increased thirst or to help a patient to manage troublesome thirst and research in the area of thirst is scarce. In order to prevent and relieve troublesome thirst more knowledge is needed on how thirst is experienced and what factors cause increased thirst. Aim: The aim of this thesis was to describe the thirst experience of patients with HF and describe the relationship of thirst with physiologic, psychologic and situational factors. The goal was to contribute to the improvement of the care by identifying needs and possible approaches to prevent and relieve thirst in patients with HF. Methods: The studies in this thesis used a cross-sectional design (Study I) and prospective observational designs (II-IV). Studies include data from patients with HF who were admitted to the emergency department for deterioration in HF (I, IV) or visited an outpatient HF clinic for worsening of HF symptoms (III); others were patients who were following up after HF hospitalization (II), and patients with no HF diagnosis who sought care at the emergency department for other illness (I). Patients completed questionnaires on thirst intensity, thirst distress, HF self-care behaviour, feeling depressive and feeling anxious. Data on sociodemographic, clinical characteristics, pharmacological treatment and prescribed fluid restriction were retrieved from hospital medical records and by asking the patients. Data were also collected from blood, urine and saliva samples to measure biological markers of dehydration, HF severity and stress. Results: Thirst was prevalent in 1 out of 5 patients (II) and 63% of patients with worsening of HF symptoms experienced moderate to severe thirst distress at hospital admission (IV). Patients at an outpatient HF clinic who reported thirst at the first visit were more often thirsty at the follow-up visits compared to patients who did not report thirst at the first visit (II). Thirst intensity was significantly higher in patients hospitalized with decompensated HF compared to patients with no HF (median 75 vs. 25 mm, visual analogue scale [VAS] 0-100 mm; P &lt; 0.001) (I). During optimization of pharmacological treatment of HF, thirst intensity increased in 67% of the patients. Thirst intensity increased significantly more in patients in the high thirst intensity group compared to patients in the low thirst intensity group (median +18 mm vs. -3 mm; P &lt; 0.001) (III). Patients who were admitted to the hospital with high thirst distress continued to have high thirst distress over time (IV). A large number of patients were bothered by thirst and feeling dry in the mouth when they were thirsty (III, IV). Patients with a fluid restriction had high thirst distress over time and patients who were feeling depressed had high thirst intensity over time (IV). Thirst was associated with fluid restriction (III-IV), a higher serum urea (IIIII), and depressive symptoms (II). Conclusions: A considerable amount of patients with HF experiences thirst intensity and thirst distress. Patients who reported thirst at the first follow-up more often had thirst at the subsequent follow-ups. The most important factors related to thirst intensity or thirst distress were a fluid restriction, a higher plasma urea, and depressive symptoms. Nurses should ask patients with HF if they are thirsty and measure the thirst intensity and thirst distress, and ask if thirst is bothering them. Each patient should be critically evaluated if a fluid restriction really is needed, if the patient might be dehydrated or needs to be treated for depression.

It is known that during fluid restriction, obligatory water losses continue and hypohydration develops and that restricted energy intake leads to a concomitant restriction of all other dietary components, as well as hypohydration, but the specific effects of periods of fluid and/ or energy restriction on fluid balance, electrolyte balance and exercise performance have not been systematically described in the scientific literature. There were two main aims of this thesis. Firstly, to describe the effects of periods of severe fluid and/ or energy restriction on fluid and electrolyte balance; secondly, to determine the effect of electrolyte supplementation during and after energy restriction on fluid and electrolyte balance as well as energy exercise performance. The severe restriction of fluid and/ or energy intake over a 24 h period all resulted in body mass loss (BML) and hypohydration, but whilst serum osmolality increases during fluid restriction (hypertonic hypohydration), serum osmolality does not change during energy restriction (isotonic hypohydration), despite similar reductions in plasma volume (Chapter 3). These differences in the tonicity of the hypohydration developed are most likely explainable by differences in electrolyte balance, with fluid restriction resulting in no change in electrolyte balance over 24 h (Chapter 3) and energy restriction (with or without fluid restriction) producing significant reductions in electrolyte balance by 24 h (Chapter 3; Chapter 4; Chapter 5; Chapter 6; Chapter 7). Twenty four hour combined fluid and energy restriction results in large negative balances of both sodium and potassium, and whilst the addition of sodium chloride to a rehydration solution ingested after fluid and energy restriction increases drink retention, the addition of potassium chloride to a rehydration solution does not (Chapter 4). Supplementation of sodium chloride and potassium chloride during periods of severe energy restriction reduces the BML observed during energy restriction and maintains plasma volume at pre-energy restriction levels (Chapter 5; Chapter 6; Chapter 7). iv These responses to electrolyte supplementation during energy restriction appear to be related to better maintenance of serum osmolality and electrolyte concentrations and a consequential reduction in urine output (Chapter 5; Chapter 6; Chapter 7). Additionally, 48 h energy restriction resulted in a reduction in exercise capacity in a hot environment and an increase in heart rate and core temperature during exercise, compared to a control trial providing adequate energy intake. Whilst electrolyte supplementation during the same 48 h period of energy restriction prevented these increases in heart rate and core temperature and exercise capacity was not different from the control trial Chapter 8). In conclusion, 24-48 h energy restriction results in large losses of sodium, potassium and chloride in urine and a large reduction in body mass and plasma volume and supplementation of these electrolytes during energy restriction reduces urine output, attenuates the reduction in body mass and maintains plasma volume and exercise capacity.

No description available.

The impact of end-stage renal disease (ESRD) on healthcare costs is significant. In 2013, the cost of providing care for the ESRD patient population was 7.1% of total Medicare expenses. ESRD patients' non-adherence with the medical plan is a reason for the high cost of care and poor patient outcomes. Staff education can have a positive impact on patient adherence in terms of the management of chronic illnesses, such as ESRD. This DNP project was an education program for hemodialysis (HD) staff regarding empowering patients to learn about self-care strategies aimed at improving ESRD patients' adherence to fluid restriction and treatment schedules. The staff education project was developed using Malcolm Knowles' adult learning theory and Dorothea Orem's self-care theory. Three in-center hemodialysis (ICHD) clinics located in a large southeast inner city of the United States with predominantly African American patients participated in the DNP project. All the participating clinics were selected based on their underperformance in missed patient treatments and fluid goals. The goal of the educational program was to teach staff current evidence-based practice self-care strategies for patients to improve adherence to required fluid restrictions and treatment schedules. The program was delivered through 5 different sessions over 3 days at 2 locations. Thirty staff members participated in the program. Missed treatment rates and the intradialytic weight gain (IDWG) percent showed improvement 1-month post education for each of the 3 clinics. This project has the potential to promote social change through staff education on patient self-care strategies for adherence to fluid and treatment plans, thus improving patient outcomes and quality of life.

Sugarcane is a C4 plant that can be grown in tropical and subtropical regions adapt to different soil types and climatic conditions, especially for its large and broad utility operation, and raw material for various products such as molasses, molasses, sugar and ethanol. However, the production of cane sugar is being affected by poor rainfall distribution and the reduction of presipitation in some regions. Thus, this study aimed to characterize (field capacity) and evaluate the performance of genotypes of sugar cane submitted to water restriction and rehydration, using physiological indicators. The study was conducted in two experiments conducted at the Department of Agricultural Engineering, Federal University of Sergipe (UFS) in the municipality of São Cristovão - SE. The seedlings used for both studies were transplanted at 45 days for vessels of 18 dm3. The first experiment was performed to characterize the genotypes, in which they were carried out at field capacity, rated to 154 days after the transplan, between 10:30 and 12h00h, analyzing the variables: chlorophyll a fluorescence, content of chlorophyll a, be total levels of proline, water potential, transpiration, leaf temperature and air humidity, when the main plant, stem diameter, leaf number and leaf area. The experimental design was randomized blocks with four treatments (genotype 698B, 712B, 260B and 3B), four replications and one plant as a plot. In terms of field capacity 3B genotype showed the highest levels of chlorophyll a, b and total, Fv / Fm, height of main stem and leaf water potential, especially also in number of leaves and leaf area. In relation to transpiration, leaf temperature and diameter, no difference was observed between genotypes. To determine the physiological performance under water restriction was interrupted irrigation for 154 days, being rehydrated, the media showed that the genotypes leaves only +1 or +2 expanded with at least 20% of the leaf green. The evaluations were performed every five days, and analyzed the following parameters: chlorophyll fluorescence, chlorophyll content, a, b and total levels of proline, water potential, transpiration, leaf temperature and air humidity, height of stem principal, number of leaves and leaf area of the main plant, dry weight and fresh shoot and root system, these last being held at the end of the experiment. The evaluations were performed between 10:30 and 12:00. The experiment was a factorial 4 x 9 (genotype 698B, 712B, 260B and 3B-nine evaluations during periods of water restriction and rehydration), four replications and one plant as a useful parcel Fluid restriction induced a decrease for the variables analyzed in all genotypes, and the 3B and 698B were less tolerant, and rehydrated in 10 and 15 days restriction. Already 260B and 698B were more tolerant, where they were rehydrated in 25 days of restriction. It was also noted that during the restriction of proline accumulation obtained for all genotypes, whereas 698B and 3B showed higher values compared with the other. After rehydration of this amino acid was reduced in all genotypes, so that no significant differences. As to recovery after rehydration, the highlights were the genotypes 260B and 3B. In general, the 260B had the highest tolerance with higher results for the variables analyzed. / A Cana-de-açúcar é uma planta C4 que pode ser cultivada em regiões tropicais e subtropicais adaptando-se a diferentes tipos de solos e condições climáticas, destacando-se pela sua grande exploração e a ampla utilidade, sendo matéria prima para diversos produtos, como melaço, rapadura, açúcar e etanol. No entanto, a produção da cana-de-açúcar está sendo afetada pela má distribuição das chuvas e a redução da pressipitação em algumas regiões. Assim, o presente trabalho teve como objetivo caracterizar (capacidade de campo) e avaliar o desempenho de genótipos de cana-de-açúcar submetidos à restrição hídrica e reidratação, utilizando indicadores fisiológicos. O trabalho foi realizado em dois experimentos conduzido no Departamento de Engenharia Agronômica da Universidade Federal de Sergipe (UFS) localizada no município de São Cristóvão-SE. As mudas usadas para ambos os estudos, foram transplantadas aos 45 dias para vasos de 18 dm3. No primeiro experimento foi realizada a caracterização dos genótipos, em que os mesmos foram conduzidos em capacidade de campo, avaliados aos 154 dias após o transplatio, entre as 10h30min e as 12h00h, analisando as variáveis: fluorescência da clorofila a, teores de clorofila a, b e total, teores de prolina, potencial hídrico, transpiração, temperatura da folha e do ar, umidade relativa, altura da planta principal, diâmetro do colmo, número de folhas e área foliar. O delineamento experimental foi de blocos ao acaso, com quatro tratamentos (genótipos 698B, 712B, 260B e 3B), quatro repetições e uma planta como parcela útil. Em condições de capacidade de campo o genótipo 3B apresentou os maiores teores de clorofila a, b e total, de Fv/Fm, altura do colmo principal e potencial hídrico, destacando-se também em número de folha e área foliar. Em relação à transpiração, temperatura foliar e diâmetro, não foi observado diferença estatística entre os genótipos. Para a determinação do desempenho fisiológico sob restrição hídrica foi interrompida a irrigação aos 154 dias, sendo reidratadas a medida que os genótipos apresentavam apenas as folhas +1 ou +2 expandidas com no mínimo 20% do limbo foliar verde. As avaliações foram realizadas a cada cinco dias, sendo analisados os seguintes parâmetros: fluorescência da clorofila a, teores de clorofila a, b e total, teores de prolina, potencial hídrico, transpiração, temperatura da folha e do ar, umidade relativa, altura do colmo principal, número de folha e área foliar da planta principal, massa seca e fresca da parte aérea e do sistema radicular, sendo as duas ultimas realizadas no final do experimento. As avaliações foram realizadas entre as 10h30min e as 12h00min. O experimento foi realizado em esquema fatorial 4 x 9 (genótipo 698B, 712B, 260B e 3B e nove avaliações durante os períodos de restrição hídrica e reidratação), quatro repetições e uma planta como parcela útil. A restrição hídrica induziu um decréscimo para as variáveis analisadas em todos os genótipos, sendo que 3B e 698B foram menos tolerantes, sendo reidratadas no 10º e 15ºdia de restrição. Já 260B e 698B foram mais tolerantes, onde foram reidratadas no 25º dia de restrição. Também foi observado durante a restrição acúmulo de prolina em todos os genótipos, visto que o 698B e 3B apresentaram os maiores valores comparados com os demais. Após a reidratação houve redução deste aminoácido em todos os genótipos, de modo que não apresentaram diferenças significativas. Quanto à recuperação após a reidratação, destacaram-se os genótipos 260B e 3B. De maneira geral, 260B apresentou a maior tolerância apresentando os maiores resultados para as variáveis analisadas.