Reproduction de : Mémoire de Sage-femme : Médecine : Nantes : 2009. / Bibliogr.

Little is known about the effects of protein-energy malnutrition (PEM) developing after stroke on brain recovery. The goal of this project was to develop two experimental models in the adult rat to allow evaluation of nutritional effects on post-stroke recovery: (1) a PEM model, and (2) a photothrombotic stroke model. Experiment 1 examined the hypothesis that a diet containing either 1% or 0.5% protein will produce an acute state of mild-moderate PEM in adult rats. Male, Sprague-Dawley rats (16 wk) were trained in the Montoya staircase before being randomized to diets containing 0.5% (n=8), 1% (n=8), or 12.5% protein (n=10 [CON]) for 31d. Both low protein diets increased liver lipid content (p< 0.001) and decreased food intake (p= 0.005) and body weight (p< 0.001) compared to the 12.5% protein diet. The 0.5% protein group best mimicked the stroke patient, as judged by decreased serum albumin (p= 0.018) and an acute decrease in mean (±SEM) body weight (g) by d7 (0.5%= 424±15; 1%= 428±14; CON= 477±10; p = 0.011). Increased concentrations of the positive acute phase proteins, alpha-2-macroglobulin and alpha-1-acid glycoprotein, were greatest in the 0.5% group (p< 0.001). No differences were observed in the Montoya test on d3, 15, or 30 (p= 0.26). Values on d30 were: 0.5%= 109.5±4.4% of pre-diet performance; 1%= 97.2±5.5%; CON= 98.5±10.2%. Experiment 2 tested the hypothesis that targeted laser irradiation and 30 mg/kg of rose Bengal injection will cause an infarct in the forepaw region of the cortex with accompanying functional deficits. Male adult rats trained in the Montoya staircase were randomized to ISCHEMIA (n=15) or SHAM (n=3) surgery. A cortical infarct occurred in 86% of rats, with some misplacement and variability in volume (5.7-12.8 mm3). Forepaw impairments were confirmed by decreased performance in the staircase at d3 (34.3±7.3 % of pre-stroke performance, p<0.001) and diminished use in the cylinder test (30.3±4.0% affected limb use versus 53.9±1.93% prestroke, p< 0.001). At d30, mean recovery was incomplete in the staircase (p< 0.001). These experimental models, with additional refinements, can be used to address the hypothesis that deteriorating nutritional status after a stroke interferes with brain recovery.

A piglet model of gastrointestinal inflammation (INF) and protein energy malnutrition (PEM) was developed to determine the mechanisms responsible for growth retardation and muscle wasting during inflammatory stress. Acute PEM decreased liver and plasma protein fractional synthesis rates (FSR), measured by stable isotope (2H3-leucine) incorporation. Conversely, both rates increased during PEM+INF at the expense of growth and muscle FSR. INF increased plasma protein synthesis by 77% in PEM without increasing its plasma concentration, demonstrating that the measurement of plasma protein concentration alone underestimates the metabolic impact of INF. INF during PEM results in a re-prioritization of amino acids from muscle protein synthesis and growth to hepatic synthesis of plasma proteins to support the acute phase response. This underscores the critical role of adequate protein-energy nutrition during inflammation in preventing muscle wasting and growth failure. This new piglet model can be applied to investigate nutritional and therapeutic interventions in inflammatory bowel disease.

<p><font face="Times New Roman"> <p align="left">The aim of this study is to evaluate the management of severe malnutrition in the two selected hospitals in North West Province.</p> </font></p>

Sammanfattning Bakgrund: På grund av att människor lever längre så kommer antal personer med demens också att öka. Med stigande ålder och ökad närvaro av kroniska sjukdomar så som demenssjukdom, blir det även en ökning av undernäringsproblematik hos den äldre befolkningen.   Syftet: Föreliggande litteraturstudies syfte var att beskriva hinder och möjligheter för att sjuksköterskan ska kunna uppmärksamma, förhindra och minimera undernäring hos äldre dementa på äldreboenden. Syftet var också att granska artiklarnas kvalitét utifrån den metodologiska aspekten urval. Metod: En litteraturstudie med deskriptiv ansats genomfördes baserat på 16 vetenskapliga artiklar som söktes i databaserna Pubmed, Chinal och Scopus. Resultat: Studien visar att demenssjukdomens tre stadier orsakar nutritionsproblem. Bristande kommunikation och interaktion, utebliven måltidsträning och biverkningar av vissa läkemedel påverkade dementa äldres nutrition på ett negativt sett. Uteblivna bedömningar och bristande utbildning/kunskap hindrar sjuksköterskan att uppmärksamma undernäringar. Sjuksköterskan kan använda sig av mätinstrument till hjälp för att upptäcka undernäring och de med risk för undernäring. Sjuksköterskan kan ändra i miljön samt sätta in hjälpinsatser så som näringsdrycker, så det ska gynna nutritionen bättre. Måltidsträning har visat sig hjälpa personer med demens att minska sina ätsvårigheter och öka i vikt. Näringskunskapen visade sig vara högre bland dem med högre utbildning. Slutsats: Sjuksköterskor som arbetar på äldreboenden för dementa äldre, har ett ansvar att se till att näringsbehoven blir uppfyllda. Nutritionsvård är ett teamarbete. I en del av sjuksköterskans arbetsområde ingår rollen som ledare, vilket innebär att utbilda och informera övrig vårdpersonal i nutritionsvård. Det finns mycket forskning kring demens och undernäring, men få studier har genomförts utifrån den dementa personens perspektiv. Därför är ytterligare forskning baserat på intervjuer med dementa personer relevant. / Abstract. Background: Because people live longer the number of people with dementia will also increase. With old age and increasing presence of chronic diseases such as dementia, it will also be an increase in the malnutrition problem in the elderly population. Aim: The present study’s aim was to describe the obstacles and opportunities for the nurse to pay attention to, prevent and minimize malnutrition in elderly demented in geriatric care. The aim was also to scrutinize the quality of the articles based on the methodological aspect selection. Method: A literature review with a descriptive approach was conducted based on 16 research articles that were searched in PubMed, Scopus and Chinal. Results: The study shows that the three stages of dementia causes nutritional problems. Lack of communication and interaction in the eating environment, lack of mealtime training and side effects of certain drugs affected the nutrition of people with dementia negatively. Lack of assessments and the lack of education / knowledge hinders the nurse to detect malnutrition. The nurse can use instruments to help to detect malnutrition and those at risk of malnutrition. The nurse may also change in the environment and put into relief efforts such as nutritional beverages, so that it benefits the nutrition better. Mealtime training has been shown to help people with dementia to reduce their eating difficulties and gain weight. Nutritional knowledge was found to be higher among those with higher education Conclusion: Nurses, who work in nursing homes for older people with dementia, have a responsibility to ensure that nutritional needs are met. Nutritional care is a team work. Parts of the nurse’s work include the role of being a leader, which means to educate and inform other healthcare professionals in nutritional care. There is extensive research on dementia and malnutrition, but few studies have been conducted using the demented person's perspective. Therefore, further research based on interviews with people with dementia is relevant.

Several years ago a ten year child with a disability died from "severe malnutrition" according to a Coroners Service inquest jury. The inquest evidence shows that approximately one week prior to this child's death three health care providers conducted individual assessments of the child. Using institutional ethnography as a theoretical and methodological framework, the author conducts a textual analysis of the health care providers' documents generated during their provision of service to this child. Obtained as public documents from the Coroners Service, this data includes: the hospital form, the hospice society records and home care nursing records. / Graduate / 0566

No description available.

Thesis (M.A.) -- Mahidol University, 1978.

Thesis (M.A.) -- Mahidol University, 1978.

Thesis (Ph. D.)--Florida State University, 2005. / Advisor: Dr. Janet E. Kodras, Florida State University, College of Social Science, Dept. of Geography. Title and description from dissertation home page (viewed June 16, 2005). Document formatted into pages; contains xiv, 349 pages. Includes bibliographical references.