ESPEN Guidelines on Enteral Nutrition: Geriatrics

Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.

El sector agropecuario en la región de Los Lagos y el paradigma "Chile potencia alimentaria" : Desafíos para la política agraria nacional

La reestructuración del modelo económico en Chile a mediados de los setenta impactó a todos los sectores productivos y el sector agropecuario no fue una excepción. Se iniciaba así el comienzo de la "Era agroexportadora", que fomentaba aquellas orientaciones productivas con claras ventajas competitivas en los mercados internacionales. El paradigma agrícola chileno se ha caracterizado por funcionar sobre la base de salarios bajos, disponibilidad de mano de obra y tipo de cambio favorable. En 2006, y en este escenario, se ha implementado la política pública denominada "Chile Potencia Alimentaria 2020", que buscar reforzar la fórmula anterior. Esta iniciativa considera estrategias de crecimiento que invisibilizan la estructura bimodal agraria presente en el país. A lo anterior se suma el agravante de que territorios (como la Región de Los Lagos en el sur de Chile) con orientaciones productivas tradicionales (ganaderas específicamente) presentan posiciones manifiestamente vulnerables, especialmente de aquellos grupos de productores que se caracterizan por funcionar con racionalidades distintas de la empresarial.

El sector agropecuario en la región de Los Lagos y el paradigma "Chile potencia alimentaria" : Desafíos para la política agraria nacional

La reestructuración del modelo económico en Chile a mediados de los setenta impactó a todos los sectores productivos y el sector agropecuario no fue una excepción. Se iniciaba así el comienzo de la "Era agroexportadora", que fomentaba aquellas orientaciones productivas con claras ventajas competitivas en los mercados internacionales. El paradigma agrícola chileno se ha caracterizado por funcionar sobre la base de salarios bajos, disponibilidad de mano de obra y tipo de cambio favorable. En 2006, y en este escenario, se ha implementado la política pública denominada "Chile Potencia Alimentaria 2020", que buscar reforzar la fórmula anterior. Esta iniciativa considera estrategias de crecimiento que invisibilizan la estructura bimodal agraria presente en el país. A lo anterior se suma el agravante de que territorios (como la Región de Los Lagos en el sur de Chile) con orientaciones productivas tradicionales (ganaderas específicamente) presentan posiciones manifiestamente vulnerables, especialmente de aquellos grupos de productores que se caracterizan por funcionar con racionalidades distintas de la empresarial.

El sector agropecuario en la región de Los Lagos y el paradigma "Chile potencia alimentaria" : Desafíos para la política agraria nacional

La reestructuración del modelo económico en Chile a mediados de los setenta impactó a todos los sectores productivos y el sector agropecuario no fue una excepción. Se iniciaba así el comienzo de la "Era agroexportadora", que fomentaba aquellas orientaciones productivas con claras ventajas competitivas en los mercados internacionales. El paradigma agrícola chileno se ha caracterizado por funcionar sobre la base de salarios bajos, disponibilidad de mano de obra y tipo de cambio favorable. En 2006, y en este escenario, se ha implementado la política pública denominada "Chile Potencia Alimentaria 2020", que buscar reforzar la fórmula anterior. Esta iniciativa considera estrategias de crecimiento que invisibilizan la estructura bimodal agraria presente en el país. A lo anterior se suma el agravante de que territorios (como la Región de Los Lagos en el sur de Chile) con orientaciones productivas tradicionales (ganaderas específicamente) presentan posiciones manifiestamente vulnerables, especialmente de aquellos grupos de productores que se caracterizan por funcionar con racionalidades distintas de la empresarial.

Advances and challenges in oral health after a decade of the “Smiling Brazil” Program

ABSTRACT OBJECTIVE To analyze oral health work changes in primary health care after Brazil’s National Oral Health Policy Guidelines were released. METHODS A literature review was conducted on Medline, LILACS, Embase, SciELO, Biblioteca Virtual em Saúde, and The Cochrane Library databases, from 2000 to 2013, on elements to analyze work changes. The descriptors used included: primary health care, family health care, work, health care policy, oral health care services, dentistry, oral health, and Brazil. Thirty-two studies were selected and analyzed, with a predominance of qualitative studies from the Northeast region with workers, especially dentists, focusing on completeness and quality of care. RESULTS Observed advances focused on educational and permanent education actions; on welcoming, bonding, and accountability. The main challenges were related to completeness; extension and improvement of care; integrated teamwork; working conditions; planning, monitoring, and evaluation of actions; stimulating people’s participation and social control; and intersectorial actions. CONCLUSIONS Despite the new regulatory environment, there are very few changes in oral health work. Professionals tend to reproduce the dominant biomedical model. Continuing efforts will be required in work management, training, and permanent education fields. Among the possibilities are the increased engagement of managers and professionals in a process to understand work dynamics and training in the perspective of building significant changes for local realities.

Challenges in packaging waste management: A case study in the fast food industry

The main research problem of this thesis is to find out the means of promoting the recovery of packaging waste generated in thefast food industry. The recovery of packaging waste generated in the fast food industry is demanded by the packaging waste legislation and expected by the public. The means are revealed by the general factors influencing the recovery of packaging waste, analysed by a multidisciplinary literature review and a case study focusing on the packaging waste managementof McDonald's Oy operating in Finland. The existing solid waste infrastructure does not promote the recovery ofpackaging waste generated in the fast food industry. The theoretical recovery rate of the packaging waste is high, 93 %, while the actual recovery rate is only 29 % consisting of secondary packaging manufactured from cardboard. The total recovery potential of packaging waste is 64 %, resulting in 1 230 tonnes ofrecoverable packaging waste. The achievable recovery potential of 33 %, equalling 647 tonnes of packaging waste could be recovered, but is not recovered mainly because of non-working waste management practises. The theoretical recovery potential of 31 %, equalling 583 tonnes of packaging waste can not be recovered by the existing solid waste infrastructure because of the obscure status of commecial waste, the improper operation ofproducer organisations, and the municipal autonomy. The sorting experiment indicated that it is possible to reach the achievable recovery potential inthe existing solid waste infrastructure. The achievement is promoted by waste producer -oriented waste management practises. The theoretical recovery potential can be reached by increasing the consistency of the solid waste infrastructure through governmental action.

Astringency and other oral sensations : biological sources of individual variation and association with food and beverage behaviour

Orosensory perception strongly influences liking and consumption of foods and beverages. This thesis examines the influence of biological sources of individual variation on the perception of prototypical orosensory stimuli, food liking, self-reported alcohol liking and consumption, and indices of health. Two orosensory indices were examined: propylthiouracil (PROP) responsiveness, a genetically-mediated index of individual variation associated with enhanced responsiveness to orosensory stimuli often expressed as PROP taster status (PTS); and thermal taster status (TTS), a recently reported index of orosensory responsiveness. Taster status in PTS and/or TTS confers greater responsiveness to most orosensory stimuli. Gender, age, ethnicity, and fungiform papillae (FP) density were not associated with orosensory responsiveness to tastants, an astringent, and a flavour. Unlike PROP responsiveness, FP density was not associated with TTS. Both PROP responsiveness and TTS were associated with increased responsiveness to orosensory stimuli, including temperature and astringency. For PROP, this association did not hold when stimuli were presented at cold or warm temperatures, which are ecologically valid since most foods and beverages are not consumed at ambient temperature. Thermal tasters (TTs), who perceive 'phantom' taste sensations with lingual thermal stimulation, were more responsive to stimuli at both temperatures than thermal non-tasters (TnTs). While PTS, TIS, and gender affected self-reported liking and consumption of some alcoholic beverages, gender associated with the greatest number of beverage types and consumption parameters, with males generally liking and consuming alcoholic beverages more than females. Age and gender were the best predictors of alcoholic beverageAiking and consumption. As expected, .. liking of bitter and fatty foods and cream was inversely related to PROP responsiveness. TTS did not associate with body mass index or waist circumference, and contrary to previous studies, neither did PROP responsiveness. Taken together, TnTs' greater liking of cooked fruits and vegetables and high alcohol, and astringent alcoholic beverages than TTs suggests differences between TTS groups may be driven by perceived temperature and texture. Neither an interaction between PTS and TTS nor a TTS effect on PROP responsiveness was observed, suggesting these two indices of individual variation exert their influences on orosensory perception independently.

Climate change and hunger as the challenges in the global food system

In the last decades, there has been a growing tendency towards international trade and globalisation, particularly leading to a significant increase in flows of agricultural commodities worldwide. From a macroeconomic perspective, the commodity projections are more optimistic than the previous years and the long run tendency shows an increasing demand for feedstock. However, the strong shifts of shocks and fluctuations (in terms of prices and volumes) are a concern to global food security, with the number of hungry people rising to nearly one billion. Agriculture is a main user of natural resources, and it has a strong link with rural societies and the environment. Forecasted impacts from climate change, limited productive endorsements and emerging rivals on crop production, such bio-energy, aggravate the panorama on food scarcity. In this context, it is a great challenge on farming and food systems to reduce global hunger and produce in sustainable ways adequate supplies for food, feed, and non-food uses. The main objective of this work is to question the sustainability of food and agriculture systems. It is particularly interesting to know its role and if it will be able to respond to a growing population with increasing food demand in a world where pressure on land, water and other natural resources are already evident, and, moreover, climate change will also condition and impact the outcome. Furthermore, a deeper focus will be set on developing countries, which are expected to emerge and take a leading role in the international arena. This short paper is structured as follows: Section I, “Introduction”, describes the social situation regarding hunger, Section II, “Global Context”, attempts to summarise the current scenario in the international trading scheme and present the emerging rivals for primary resources, and in Section III, “Climate Change”, presents an overview of possible changes in the sector and future perspectives in the field. Finally, in Section IV, “Conclusion”, the main conclusions are presented.

Bioactive peptides from food proteins: new opportunities and challenges

Food proteins such as milk and soy are a rich source of bioactive peptides. In the last decade, research into this area has intensified and new bioactive peptide sequences have been discovered with a range of apparent biological functions; for example, antihypertensive, antioxidant, and antimicrobial effects and opiate-like qualities have been reported. These peptides could therefore lead to the development of important functional food products and ingredients for the prevention and even treatment of chronic diseases such as cardiovascular disease and cancer. Peptides can be produced by fermentation with dairy starters for instance, and by enzymatic hydrolysis with pancreatic and microbial enzymes. Further purification is typically carried out by membrane filtration and/or chromatographic methods. The production of novel bioactive peptides and their incorporation into functional food products poses several technological challenges as well as regulatory and marketing issues. Proof of efficacy is of paramount importance; this should be verified by conducting appropriate tests in vivo in animals and in humans. In addition, tests for cytotoxicity and allergenicity must be conducted. Despite all of these hurdles, scientific evidence is increasingly demonstrating the health benefits of diet-based disease prevention, and therefore new developments in this area are likely to continue both at the research and the commercialisation level.