Pain measurement and management in elderly patients : Clinical studies in long term hospital care and after cardiac surgery

The proportion of patients over 75 years of age, receiving all different types of healthcare, is constantly increasing. The elderly undergo surgery and anaesthetic procedures more often than middle-aged patients. Poor pain management in the elderly is still an issue. Although the elderly consumes the greatest proportion of prescribed medicines in Western Europe, most clinical pharmacological studies have been performed in healthy volunteers or middle-aged patients. The aim of this study was to investigate pain measurement and management in cognitively impaired patients in long term hospital care and in cognitively normal elderly patients after cardiac surgery. This thesis incorporated 366 patients, including 86 home-dwelling or hospitalized elderly with chronic pain and 280 patients undergoing cardiac surgery with acute pain. The mean age of patients was 77 (SD ± 8) years and approximately 8400 pain measurements were performed with four pain scales: Verbal Rating Scale (VRS), the Visual Analogue Scale (VAS), the Red Wedge Scale (RWS), and the Facial Pain Scale (FPS). Cognitive function, depression, functional ability in daily life, postoperative sedation and postoperative confusion were assessed with MMSE, GDS, Barthel Index, RASS, and CAM-ICU, respectively. The effects and plasma concentrations of fentanyl and oxycodone were measured in elderly (≥ 75 years) and middle-aged patients (≤ 60 years) and the opioid-sparing effect of pregabalin was studied after cardiac surgery. The VRS pain scores after movement correlated with the Barthel Index. The VRS was most successful in the groups of demented patients (MMSE 17-23, 11-16 and ≤ 10) and in elderly patients on the first day after cardiac surgery. The elderly had a higher plasma concentration of fentanyl at the end of surgery than younger patients. The plasma concentrations of oxycodone were comparable between the groups. Pain intensity on the VRS was lower and the sedation scores were higher in the elderly. Total oxycodone consumption during five postoperative days was reduced by 48% and the CAM-ICU scores were higher on the first postoperative day in the pregabalin group. The incidence of postoperative pain during movement was lower in the pregabalin group three months after surgery. This investigation demonstrates that chronic pain did not seem to impair daily activities in home-dwelling Finnish elderly. The VRS appeared to be applicable for elderly patients with clear cognitive dysfunction (MMSE ≤17) and it was the most feasible pain scale for the early postoperative period after cardiac surgery. After cardiac surgery, plasma concentrations of fentanyl in elderly were elevated, although oxycodone concentrations were at similar level compared to middle-aged patients. The elderly had less pain and were more sedated after doses of oxycodone. Therefore, particular attention must be given to individual dosing of the opioids in elderly surgical patients, who often need a smaller amount for adequate analgesia than middle-aged patients. The administration of pregabalin reduced postoperative oxycodone consumption after cardiac surgery. Pregabalin-treated patients had less confusion, and additionally to less postoperative pain on the first postoperative day and during movement at three months post-surgery. Pregabalin might be a new alternative as analgesic for acute postoperative and chronic pain management in the elderly. Its clinical role and safety remains to be verified in large-scale randomized and controlled studies. In the future, many clinical trials in the older category of patients will be needed to facilitate improvements in health care methods.

Preliminary studies on food and feeding habits of Polypterus endlicheri and Polypterus senegalus in Lake Chad

The food and feeding habits of Polyprerus cncllicheri and Polypterus senegalus was carried out in the months of September to October. The food of 33 Polypierus endlicheri as observed include Tilapia species (89.3%), Eutropius niloticus (28.6%), Mayfly nymph (39.3%), Dragon fly larva (56.6%) fish remains (21.4%) and detritus (7.1%). The food of27 Polypterus senegalus as observed include Tilapia sp (88.4%), Eutropius niloticus (27.9%), may fly nymph (23.3%), Dragonfly nymph (34.9%) remains (21.1%) detritus (23.3%). (9 page document) The percentage occurrence of food item found in the stomach of Polypterus endlieheri is 93.3% while that of Polyprerus senegalus is 67.4%. The dominance of Tilapia sp was establish in the study, and there is no significant difference between the feeding habit of Polypterus endlicheri and Polyprerus senegalus.

The food and feeding habits of the anchoveta, Cetengraulis mysticetus, in the Gulf of Panama

ENGLISH:The gill rakers of both juvenile and adult anchovetas are long and numerous, with many fine processes which make a very efficient straining apparatus. The stomach is modified into a gizzard. The intestine undergoes heteronomous growth, and attains about eight times the standard length in adults. The stomach contents of 39 samples of juvenile fish and 120 adult fish were examined. Diatoms were the principal food of all the sizes of fish examined, from 29 to 153 millimeters. Silicoflagellates, dinoflagellates, pollen grains, formaniferans, rotifer shells, crustaceans, and eggs, probably of crustaceans, were also found in small amounts. Coscinodiscus, a diatom, was the most important item found in the stomachs of the juvenile fish. No strong differences were observed in the feeding habits of different sizes of juveniles. Even taking into account their smaller size, the juveniles had smaller volumes of material and lesser numbers of organisms in their stomachs than did the adults. The stomachs of the adult fish, unlike those of the juveniles, usually contained considerable quantities of mud. Melosira, Coscinodiscus, and Thalassionema, all diatoms, were the most important organisms found in the stomachs of the adults. The incidence of Melosira was much higher in the stomachs of fish from the areas to the east of the entrance of the Panama Canal than from those to the west. No seasonal differences in the food were observed. The volume of material in the stomachs ranged from almost none to nearly 1.0 milliliter, with an average of a little more than 0.2 milliliter. Twenty-six bottom samples were examined; the organisms found corresponded very closely to those encountered in the stomachs of the adult fish. It is concluded that the juvenile anchovetas are chiefly or entirely filter feeders of the pelagic zone. The adults, however, are mostly iliophagous feeders, but possibly do some feeding upon plankton as well. SPANISH:Las branquispinas de las anchovetas, tanto en las juveniles como en las adultas, son largas y numerosas, can varias protuberancias finas que hacen de ellas un aparato filtrador muy eficiente. El estómago está modificado en una molleja. El intestino está sometido a un crecimiento heterónomo, llega a alcanzar unas oeho veces la longitud estandar en las adultas. Fué examinado el contenido estomacal de 39 ,muestras de peces juveniles y de 120 adultos. Las diatomeas fueron el alimento principal de todos los peces que fueron examinados cuyo tamaño varió entre los 29 y 153 milimetros. Se encontraron también en cantidades silicoflagelados, dinoflagelados, granos de polen, foraminíferos, conchas de rotiferos, crustáceos y huevos, probablemente de crustáceos. Coscinodiscus, una diatomea, fué el alimento más importante encontrado en los estómagos de los peces juveniles. No se observaron mayores diferencias en los hábitos de alimentación en los juveniles de diferentes tamaños. Aún tomando en cuenta su tamaño menor, los juveniles tenian volúmenes más pequeños de material y un número menor de organismos en sus estómagos que los adultos. Los estómagos de los peces adultos, diferentes a los de los juveniles, contenían por lo general considerables cantidades de fango. Melosira, Coscinodiscus, y Thalassionema, todas ellas diatomeas, fueron los organismos más importantes encontrados en los estómagos de los adultos. La contribuciónde Melosira fué mucho más alta en los estómagos de los peces procedentes de las áreas al este de la entrada del Canal de Panamá que la de aquellos provenientes del oeste. No se observaron diferencias estacionales en la alimentacion. El volúmen de material en los estómagos varió de casi cero a cerca de 1.0 mililitros, con un promedio de un poco mas de 0.2 mili1itros. Se examinaron 26 muestras de fonda; los organismos encontrados correspondieron muy cercanamente a los hallados en los estómagos de los peces adultos. Se ha llegado a la conclusión de que las anchovetas juveniles son principalmente ó enteramente filtradoras de alimentos de la zona pelágica. Las adultas, sin embargo, son en su mayoria iliófagas, pero posiblemente se alimentan también de plancton.

Food and feeding habits of Tilapia zilli (Pisces: Cichlidae) in Ondo State University fish farm

The food and feeding habits of Tilapia zillii in the fish farm of Ondo State University, Akungba - Akoko, Nigeria, were studied by gut analysis. Examinations of 150 specimens showed that Nymphea formed the main bulk of food consumed. Spirogyra, Pithophora and Compsopogon occurred frequently while Pistia detritus and plant remains featured less frequently. Variation in the frequency of occurrence of the various food items was observed among the various sizes of samples. The samples within the middle - size group fed on both higher plant and filamentous algae while the young and higher fish consumed exclusively filamentous algae. On the basis of food items found in the gut, Tilapia zillii was classified as primary consumers

Food and feeding habits of Heterotis niloticus from River Kaduna floodplain

A total of 61 Heterotis niloticus specimen were examined and evaluated to determine the food and feeding habits using the frequency of occurrence, point and dominance methods. The specimens had mean standard length of 27.09 plus or minus 4.73cm, total length of 33.40cm body weight of 90-900g. The gut length ranges from 34-104cm while the gut weight range from 2.79-130g. It was observed that the fish fed mostly on plankton with rotifers and polyscysits having the highest number of frequency and dominant value with mean value of 43.03 plus or minus 4.12 and 11.73 plus or minus 1.15, 37.45 plus or minus 3.27 and 8.32 plus or minus 0.38 respectively. Arcella had the least mean frequency of occurrence of 3.27 plus or minus 17. Amoeba sp had the least mean dominance value of 7.06 plus or minus 50 and Aphnocapsa sp had the least mean frequency of occurrence of 1.10 plus or minus 0.29 and Navicula sp had the least mean dominance value of 4.31 plus or minus 1.11. Heterotis niloticus of River Kaduna flood plain is therefore considered to be predominantly planktivorous

Effects of international trade of food and feed and human diet shifts on food security and environmental safety: integrating scales

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Review of aquaculture and fish consumption in Bangladesh

Fish play a crucial role in the Bangladeshi diet, providing more than 60% of animal source food, representing a crucial source of micro-nutrients, and possessing an extremely strong cultural attachment. Fish (including shrimp and prawn) is the second most valuable agricultural crop, and its production contributes to the livelihoods and employment of millions. The culture and consumption of fish therefore has important implications for national food and nutrition security, poverty and growth. This review examines the current state of knowledge on the aquaculture sector and fish consumption in Bangladesh, based on extensive analysis of secondary sources (including unpublished data unavailable elsewhere), consultation with various experts and specially conducted surveys.

The future for fish in the food and livelihoods of the poor in Asia

This article is based on the study, Strategies and Options for Increasing and Sustaining Benefits from Fisheries and Aquaculture Production to Benefit Poor Households in Asia carried out under ADB-RETA 5945, and implemented by the WorldFish Center in partnership with nine participating Asian countries.

Food and feeding habits of Synodontis nigrita from the Osun River, SW Nigeria

An investigation was conducted into the food and feeding habits of Synodontis nigrita from the Osun River near Epe, Lagos, Nigeria. The food items in the stomach of the S. nigrita covered a wide spectrum, ranging from various types of plankton to invertebrates and plants. A seasonal variation was also noted in the stomach contents of S. nigrita over the period of investigation. The predominant food items found in the stomach were Polycystis spp., Closterium spp., Oedogonium spp., plant tissues, insect parts and detritus. This suggests that S. nigrita is an omnivore.

Edible seaweeds: an important source of food and income to indigenous Fijians

The increasing harvest of 7 edible seaweeds in Fiji and their importance to the economy of indigenous Fijians are discussed. Traditional methods in the collection, preparation and consumption of seaweeds by the Fijians are also presented.

Política Municipal de Alimentação e Nutrição da Cidade do Rio de Janeiro: uma narrativa sobre seu processo de formulação

Em junho de 2009, deflagrou-se oficialmente o processo de formulação da Política Municipal de Alimentação e Nutrição (PMAN) do Rio de Janeiro. Liderada pelo Instituto de Nutrição Annes Dias (INAD), órgão da Secretaria Municipal de Saúde (SMS) e Área Técnica de Alimentação e Nutrição desse município, o documento foi finalizado em dezembro de 2011. Foi então encaminhado à aprovação pela SMS, o que ainda não ocorreu. Este trabalho analisou o processo de formulação da PMAN, buscando caracterizar o contexto político-institucional de sua elaboração. Partindo de uma visão construcionista sobre ciência, foram realizadas análise documental e entrevistas com atores inseridos nesta trajetória. Os documentos analisados foram diários de campo, advindos da participação da pesquisadora como colaboradora deste processo; registros de reuniões; versões do documento nas diversas fases de sua elaboração; entre outros. As entrevistas incluíram gestores do INAD e da SMS, profissionais de diversas áreas e representantes da sociedade civil e dos Conselhos Municipais de Saúde e de Segurança Alimentar e Nutricional (SAN). A análise revela o reconhecimento da singularidade do INAD como área técnica e de sua consolidada trajetória na área de alimentação e nutrição, protagonizando ricos processos de discussão no município. Aponta, ainda, uma relativa autonomia decisória para implementação de suas ações. No entanto, paralelamente, as entrevistas revelaram que o INAD parece enfrentar, especialmente na gestão atual da SMS, certa fragilidade institucional, expressa por possíveis mudanças em sua inserção formal no arranjo institucional da Prefeitura; pela atual posição no organograma da SMS, aquém de suas atribuições, e também pela morosidade na aprovação da PMAN. Este contexto político-institucional não foi um fator determinante para a formulação da PMAN, embora as entrevistas sugiram que foi considerado para pensar o processo de construção no sentido de fortalecer uma rede de apoio político. Apesar de a opção inicial do INAD ter sido por um processo coletivo de participação, as entrevistas revelaram baixo nível de informação sobre o documento final da PMAN e sobre o andamento de sua aprovação, o que parece sinalizar que o processo decisório sobre as propostas apresentadas pelos atores centralizou-se no INAD no decorrer do tempo. Apesar da demora na aprovação da PMAN, não parece haver uma rede de pressão pela sua assinatura por parte dos atores envolvidos, dependendo exclusivamente das mediações internas do INAD na SMS. A análise desta experiência permite identificar dificuldades e tensões que instituições com caráter intersetorial podem enfrentar, tendo em vista o limite setorial no qual estão inseridas, num dado contexto político-institucional. Além disso, aponta as estratégias políticas que atores sustentam nos processos de militância e os desafios para fomentar a participação social.