Syfte: Att kartlägga likheter och skillnader i åtgärder och hjälpmedel mot dehydrering hos äldre i teori och praktik. Metod: Initialt utfördes litteraturstudier via universitetsbibliotekets söktjänst OneSearch. Tre intervjuer utfördes på undersköterskor på gruppboende, demensboende och hemtjänst. Dessa erbjuder en inblick i den praktiska verksamheten. Resultat: Följande faktorer av betydelse för att förebygga eller motverka dehydrering identifierades samstämmigt i litteratur och vid intervjuer: (1) kunskap om den äldre via dokumentation, (2) anpassning av tillvägagångssätt vid servering av dryck efter den äldres preferenser och tillstånd, (3) hemtrevlig miljö med sociala interaktioner, (4) bedömning av vätskeintag, väskebalans och riskfaktorer via uppmärksamhet, vätskeregistrering och med hjälp av flera andra yrkesgrupper samt med hänsyn till den äldres historik, (5) påminnelser (särskilt vid demens) och en stor mängd lättabsorberade drycker som intas succesivt vid diarré och kräkningar, (6) lättanvända och specialutformade hjälpmedel. Följande metoder särskilde sig: (1) utbildning för vårdare; begränsad på de undersökta platserna, (2) tekniska hjälpmedel och sväljterapi (kostmodifieringar, anpassade huvudpositioner, sväljträning) vid dysfagi; kostmodifieringar används på de undersökta platserna, (3) färgsättning av koppar och kannor, vilket visats kunna ha betydelse för intag. Slutsats: Skillnader fanns gällande utbildning och användning av sväljterapi, tekniska hjälpmedel och infusioner. Utbildning av personalen, mer frekvent vätskeregistrering och fullständig sväljterapi utgör förbättringsmöjligheter. Vissa av dessa åtgärder kräver ökade resurser och/eller tydliga riktlinjer. Acceptans för tekniska hjälpmedel är inte en självklarhet. Undersökningar gällande möjligheterna i att med färgval och design av dryckeskärl stimulera de äldre att dricka mer kan vara värt att undersöka vidare. Intervjuerna syftade främst till att ge en inblick i den praktiska verksamheten och generaliserbarheten av erhållna resultat är begränsad. De flesta åtgärder som har identifierats är ”mjuka” till sin karaktär. Det är svårt att få en klar bild av olika metoders effektivitet. Några av metoderna som har utvärderats med goda resultat vid dysfagi och som därför kan förbättra vätskeintaget är sväljterapi och stimulering av sväljmuskulatur. / Objective: To identify similarities and differences in methods and aids used to prevent dehydraton in the elderly as identified from the scientific literature and from interviews with caretakers. Method: Literature studies was performed through the University Library search service ”OneSearch” and further from references in key papers. Three interviews were conducted on nursing assistants in two retirement homes and home care services, to offer some insight into the practical activities. Results : The following factors were identified as important in both literature and interviews: (1) knowledge of the elderly through documentation, (2) adapted approach when serving drinks after the elderly person's preferences and condition, (3) a homely environment with social interactions, (4) assessments of fluid intake, fluid balance and risk factors through attention, fluid registration and with the help of several other professional groups, and given the history of the elderly, (5) reminders for dementia and a accessibility of large amount of easily absorbed beverages consumed gradually during diarrhea and vomiting, (6) easy-to-use and specially designed drinking aids. For the following factors differences were obeserved between literature survey and interviews: (1) education for caregivers; limited to the investigated sites, (2) technical aids and swallowing therapy (dietary modifications, adapted head positions, swallowing training) in dysphagia; diet modification is used at the investigated sites (3) the importance of cup and jug colours; blue cups used in practice, no support in literature. Conclusions: Differences were found in terms of education and the use of swallowing therapy, assistive technology and infusions. Education, more frequent fluid registration and a complete swallowing therapy are improvement opportunites, some of them requires extra resources and/or clear guidelines. Acceptance of technical aids is not self-evident. Investigation of the effect of cup color and design that can encourage the elderly to drink could potentially be a way forward. The results of the interviews are not generalizable because they only aimed to give an insight into the practical activities. Most of the strategies that have been identified are "soft" in nature. It is difficult to get a clear picture of the efficiency of different methods. Methods that have been evaluated with good results in dysphagia and therefore offer potential to improve liquid intake, are swallowing therapy and stimulation of swallowing musculature.

abstract: Water makes up about 45-70% of a human body's total weight. It is estimated that 80% of the human brain's tissue is composed of water. Cognitive productivity is altered when the body is in a mere 2% dehydrated state. Several cognitive functions impacted by dehydration include: visual motor tracing, short-term recall, attentiveness, and mathematic efficiency. It is estimated that 80% of the U.S. adult population endures the majority of their day in a mildly dehydrated state. Participants were employees working full-time jobs with Arizona State University or Tri Star Motor Company. Employees had to be 18 or older were invited to join the study. Employees participating in the study lived within the the greater Phoenix area. Participants of all races, genders, activity statuses, and BMIs were encouraged to join. A one-arm, pre-test, post-test study design was utilized. We examined whether the hydration status of participants in the intervention improved or worsened during the course of the intervention, and then attributed any such improvement or deterioration to the intervention. Urine collections from an afternoon sample were gathered before and after the one-week intervention. For the intervention, the participating offices received a water dispensing system in close proximity to employee desk spaces. A reusable water bottle was also given to each participant. Urine specific gravity (USG) was assessed in all urine samples to indicate hydration status, and all participants completed water intake surveys before and after the intervention. From this study, the overall change in water intake over the course of the one-week intervention was 143 ounces/day. This is an average of adding two and a half 8 oz glasses of water each day of the week per participant. USG also decreased significantly at the end of the intervention in comparison to the baseline value. In the greater body of research, this study strengthens the viability of inputting a hydration station and offering reusable water bottles to employees. This cost-effective method is an easy way to incorporate employee wellness in the workplace. The benefit of employees to drink more water is numerous, including increased focus, mental reactivity, and overall mood and wellness. / Dissertation/Thesis / Masters Thesis Nutrition 2018

No description available.

Adequate fluid consumption is central to human survival. Previous literature suggests that there some misconceptions regarding hydration and fluid balance in some populations. Available data also show that the role of thirst sensations in maintaining fluid balance in different settings is also equivocal. Therefore, this thesis aimed to examine the perception of hydration, thirst and fluid intake in freeliving populations, to examine the feasibility of thirst as a marker of hydration status and to investigate the effect of thirst related sensations on fluid balance in resting and exercising individuals under different ambient temperatures. The findings in this thesis (Chapter 3) show that individuals who work within the fitness industry demonstrated substantial knowledge about drinking practices, hydration status and health consequences of water consumption, but lack understanding on the type of beverages that adequately hydrate the body. Further, thirst perception and mood states did not affect (P>0.05) the fluid intake in free living individuals (Chapter 4) and resting individuals under cool and warm exposure (Chapter 6), but some other factors such as subjective feelings of mouth dryness and the extent of hydration status might influence the fluid intake behaviour in these populations. In addition, following ingestion of flavoured carbohydrate drinks, thirst sensations was rated lower over time (P<0.05) during exercise in the cool, but was higher over time in the warm temperature (Chapter 7). Moreover, subjective feelings related to dehydration such as mouth dryness, thirst perception, desire to drink (water pleasantness) and hunger rating could be used as index of hydration status to signify at least a 1% body mass loss due to food and fluid restriction in resting individuals (Chapter 5). In conclusion, the findings in this thesis provide some new insight with respect to hydration, thirst and fluid balance in different populations under different settings. Nevertheless, some inconclusive findings regarding the role of thirst related sensations in fluid balance require further investigations.

Adequacy of nutritional intake during the postoperative period, as measured by a change in weight-for-age z-scores from surgery to the time of discharge, was evaluated in infants (n = 58) diagnosed with a congenital heart defect and admitted for surgical intervention at Miami Children’s Hospital using a prospective observational study design. Parental consent was obtained for all infants who participated in the study. Forty patients had a weight available at hospital discharge. The mean preoperative weight-for-age z-score was -1.3 ±1.43 and the mean weight-for-age z-score at hospital discharge was -1.89 ±1.35 with a mean difference of 0.58 ±0.5 (P Nutritional intake during the postoperative period was inadequate based on a decrease in weight-for-age z-scores from the time of surgery until discharged home. Our findings suggested that limited fluid volume for nutrition likely contributes to suboptimal nutritional delivery during the postoperative period; however, inadequate nutrition prescription may also be an important contributing factor. Development of a nutrition protocol for initiation and advancement of nutrition support may reduce the delay in achieving patient’s nutritional goals and may attenuate the observed decrease in z-scores during the postoperative period.

La cantidad de líquido ingerido y el porcentaje de peso perdido fue medido en jugadores profesionales de fútbol sala durante la disputa de seis partidos oficiales. El análisis por puestos demostró que son los porteros quienes sufren una mayor deshidratación, alcanzando un valor medio de porcentaje de peso perdido del 1,31±0,63%, seguidos por atacantes con un 1,25±1,08%, siendo los defensores con un 0,55±1,04% los que desprenden los valores más bajos de deshidratación. En el caso de porteros y atacantes, los niveles de deshidratación alcanzados podrían suponer una reducción en su rendimiento. Las estrategias de reposición hídrica deberán estar basadas en las características individuales de cada jugador, puesto que existe gran variabilidad en los resultados dentro de un mismo deporte, e incluso dentro de un mismo puesto específico. / Fluid intake and body mass loss was assessed in elite futsal players during six official matches. Goalkeepers reached the highest dehydration (1,31±0,63%), followed by forwards (1,25±1,08%) and defenders (0,55±1,04%). Goalkeepers and forwards finished the matches with levels of dehydration which give raise to a reduction of performance, while defenders keep the euhydration. Fluid replacement strategies should be based on individual characteristics of players, it has been shown that there is variability of results within the same sport, even within a specific position.

Made available in DSpace on 2016-06-02T19:22:58Z (GMT). No. of bitstreams: 1 5255.pdf: 814726 bytes, checksum: 0e3f245d1d018cf30cdf30bf84e42fed (MD5) Previous issue date: 2013-05-13 / Universidade Federal de Sao Carlos / The reactive oxygen species (ROS), produced endogenously in central areas may act by modulating autonomic and behavioral responses. Recent studies have shown that a reactive oxygen species, hydrogen peroxide (H2O2), injected into the lateral ventricle (LV) reduces pressor response induced by central injection of angiotensin II. In the present study we investigated the effects of H2O2 on the dipsogeni and pressor responses and on the changes in renal excretion induced by the increases in plasma osmolality by intragastric administration (ig) of 2 M NaCl (2 ml). Holtzman rats (280 - 320 g) with stainless steel cannula implanted in the LV were used. H2O2 or PBS injections were made in the LV. Injections of H2O2 (2.5 or 5 &#956;mol/1 &#956;l) in the LV reduced water intake induced by ig 2 M NaCl (3.1 ± 0.7 and 3.5 ± 1.1 ml, vs. PBS: 8.6 ± 1.0 and 7.6 ± 0.5 ml/2h, P <0.05, respectively) and natriuresis (609.2 ± 82.9 and 1290.7 ± 80.5, vs. PBS: 876.4 ± 129.5 and 1443.6 ± 67.5 &#956;Eq/2 h, p < 0.05, respectively). However, diuresis and pressor response after ig 2 M NaCl were not altered by the pre-treatment with H2O2. The present data suggest a inhibitory role of central H2O2 in water intake and natriuresis without changing the pressor response induced by plasma hyperosmolarity. / As espécies reativas de oxigênio (EROs), produzidas endogenamente podem atuar em áreas centrais modulando respostas autonômicas e comportamentais. Estudos recentes demonstraram que uma espécie reativa de oxigênio, o peróxido de hidrogênio (H2O2), injetado no ventrículo lateral (VL) reduz resposta pressora induzida pela injeção central de angiotensina II. No presente estudo investigamos os efeitos do H2O2 sobre a resposta dipsogênica, pressora e sobre as alterações na excreção renal induzidas por aumento da osmolaridade plasmática pela administração intragástrica (ig) de NaCl 2 M (2 ml) . Ratos Holtzman (280 320 g) com cânulas de aço inoxidável implantadas no VL foram utilizados. Injeções de H2O2 ou PBS foram realizadas no VL. As injeções de H2O2 (2,5 ou 5 &#956;mol/1 &#956;l) no VL reduziu a ingestão de água induzida por NaCl 2 M ig (3,1 ± 0,7 e 3,5 ± 1,1 ml, vs. PBS: 8,6 ± 1,0 e 7,6 ± 0,5 ml/2 h, p < 0,05, respectivamente) e a natriurese (609,2 ± 82,9 e 1290,7 ± 80,5, vs. PBS: 876,4 ± 129,5 e 1443,6 ± 67,5 &#956;Eq/2 h, p < 0,05, respectivamente). Por outro lado a diurese e a resposta pressora após gavagem de NaCl 2 M não foram alteradas pelo tratamento prévio com H2O2. Nossos dados sugerem um papel inibitório para o H2O2 agindo centralmente na ingestão de água e na natriurese, sem alterar a resposta pressora induzida por hiperosmolaridade plasmática.

Suite à une centaine de publications sur la réduction de la PIO post-exercice, il est connu que parmi un grand nombre de programme d'exercices de différentes durées et intensités, les effets hypotenseurs de l'exercice sur la PIO sont atténués chez les sujets en bonne condition physique. Le mécanisme proposé est l'augmentation potentielle de l'efficacité du système parasympathique avec l'activité physique. Le principal objectif de cette thèse est d'identifier les facteurs contribuants à la réduction de la PIO post-exercice et d'élucider les différents mécanismes possibles. L'étude 1, une méta-analyse, a été menée afin de quantifier les contributions relatives de l'intensité et de la durée de l'effet de l'exercice sur la PIO et la mesure dans laquelle ces variables affectent les sujets sédentaires et normalement actifs. La tendance ressortant des résultats est que la diminution de la PIO suite à de l'exercice aérobie est plus élevée chez les sujets sédentaires que les sujets en bonne condition physique. (ES = -4.198 mm Hg et -2.340 mm Hg, respectivement). L'absence d'un contrôle des liquides ingérés avant l'activité physique est à souligné dans cette étude. L'hyperosmolarité (un effet secondaire de la déshydratation) est l'un des mécanismes proposés influant l'effet hypotenseur de l'exercice. L'étude 2 comparait la réduction de la PIO dans deux conditions, soit hypohydraté et hyperhydraté, avant, pendant et après un effort de 90 minutes sur un ergocycle. Après une diminution initiale pour les deux conditions, la PIO revient aux valeurs de départ pour la condition hypohydratée malgré une perte de poids significative et elle augmente pour la condition hyperhydratée (résultat du protocole d'hydratation). Étant donné le niveau élevé de participants en bonne condition physique dans l'étude 2, la troisième étude a été conçue afin de etude la relation entre la PIO et la condition physique. À l'aide d'analyses corrélationnelles il a été possible d'observer la relation entre le test de vo2max et la moyenne des mesures de PIO prises sur un intervalle de huit semaines. Une relation significative n'existait que pour les participants se situant dans la portion supérieure du continuum de la condition physique. Conclusion: Les résultats de la présente étude suggèrent que l'effet hypotenseur de l'exercice sur la PIO est probablement une réponse homéostatique à la dérégulation de l'humeur aqueuse causée par l'initiation de l'exercice et le protocole d'ingestion de fluides pré-exercice. / After over 100 papers on post exercise reductions in IOP it is known that under a vast number of exercise protocols, of differing intensities and durations, the hypotensive effects of exercise on IOP are attenuated in the physically fit. A proposed mechanism is the parasympathetic nervous system that potentially increases in efficacy with physical training. The general objective of this thesis was to further tease apart those factors that contribute to post exercise reductions in IOP and to elucidate possible mechanisms. Study 1, a meta-analysis, was conducted to quantify the relative contributions of intensity and duration to the effect of exercise on IOP and the degree to which these variables affect sedentary and normally active populations. A pattern of results emerged such that those persons who are Sedentary experience a greater drop in IOP after aerobic exercise than those who are physically fit (ES = -4.198 mm Hg and -2.340 mm Hg, respectively). A lack of pre-exercise control over covariates such as fluid ingestion was also observed. Hyperosmolarity (a side effect of dehydration) is one of the proposed mechanisms driving the hypotensive effect of exercise. Study 2 compared reductions in IOP in both a hypo-hydrated (water restricted) and hyper-hydrated condition before, during and after an ergocycle ride of 90 minutes. After an initial decrease in both conditions, IOP returned to baseline in the Hypo-hydrated condition despite a significant loss of bodyweight and increased in the Hyper-hydrated condition as a result of the hydration protocol. Given the high level of physical fitness among our participants in Study 2, Study 3 was designed to further elucidate the relationship between physical conditioning and IOP. Using correlational analyses we observed the relationship between a test of VO2max and an average of IOP measurements made over the course of eight weeks. A significant relationship existed only for those participants in the upper range of the fitness continuum. Conclusion. The results of the current study suggest that the hypotensive effect of exercise on IOP is likely a homeostatic response to dysregulation of the aqueous humor caused by the initiation of exercise and pre-exercise fluid intake protocols.

This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective. The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate. The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings. Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake. In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload. This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.

This thesis is comprised of four studies and concerns haemodialysis patients’ confidence in being able to manage fluid intake between treatment sessions, and whether the fluid intake is influenced by certain modifiable characteristics of the persons in question. The overall aim was to study aspects of excessive fluid overload and haemodialysis patients’ self-regulation of fluid allotment from a bio-psychosocial and behavioural medicine perspective. The extent of non-adherence to fluid allotment was described in Study I. National registry data were used. Three out of ten Swedish haemodialysis patients had excessive fluid overload and one out of five was at risk for treatment related complications due to too rapid ultrafiltration rate. The objective in Study II was to develop and psychometrically evaluate a self-administered scale to measure situation-specific self-efficacy to low fluid intake. The measure (the Fluid Intake Appraisal Inventory) was found to be reliable and valid in haemodialysis settings. Subgroups based on individual profiles of self-efficacy, attentional style and depressive symptoms were explored in Study III using a cluster analytic approach. Three distinct subgroups were found and the subgroup structure was validated for clinical relevance. The individuals’ profile concerning self-efficacy, attentional style and depressive symptoms has to be taken into account in nursing interventions designed to reduce haemodialysis patients’ fluid intake. In Study IV, an intervention designed to reduce haemodialysis patients’ fluid intake was introduced and its acceptability, feasibility and efficacy were evaluated and discussed. Acceptability of such an intervention was confirmed. Addressing beliefs, behaviours, emotions and physical feelings is clinically feasible and may reduce haemodialysis patient’s excessive fluid overload. This thesis indicates that there is a potential for improvement in the fluid management care of haemodialysis patients. Behavioural nursing strategies that aim to assist patients to achieve fluid control should be applied more extensively. Cognitive profiles of the patients should be taken into account when targeted nursing intervention aiming to encourage and maintain the patient’s fluid control is introduced.