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Etiologies for aspiration are described. Noninvasive procedures to eliminate aspiration are outlined including postural techniques, variations in bolus volume, viscosity, taste and temperature, methods to enhance oral sensation, swallow maneuvers and exercise programs to improve neuromotor control for swallow. Specific disorders for which each procedure is appropriate are defined.
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Male rats offered a quinine-adulterated diet after receiving either ventromedial hypothalamic or sham lesions displayed nearly identical periods of anorexia before maintaining their body weight at a stable but reduced level. When starved prior to surgery to a body weight below this reduced maintenance level, both ventromedial hypothalamic and control animals displayed an intial period of rapid weight gain on the quinine-adulterated diet. When subsequently offered only this diet for an 8-wk period, both groups, after castration, maintained the same reduced level of body weight. Thus, ventromedial hypothalamic animals overeat and become obese on palatable diets, but defend the same lower weight level as controls when challenged with unpalatable diets. Impairment of a mechanism setting the upper, but not the lower, weight limits is responsible for the greatly expanded range of body weights generated in the ventromedial hypothalamic animal by manipulation of diet palatability.
The interactions of cancer and malnutrition are discussed with the focus on aging. To establish whether the elderly are more likely to develop cancer cachexia and its complications, this review encompasses the pathogenesis of malnutrition in cancer; the age-related alterations of appetite, gastrointestinal function, energy expenditure, and protein turnover; the diagnosis of malnutrition; and the effectiveness of nutritional support in the elderly. Although metabolic and physiologic changes induced by cancer and age appear synergistic in causing cachexia, more frequent complications of malnutrition have not been observed in the geriatric cancer patients. This may be due to only a small proportion of the elderly with cancer being enrolled in clinical studies or to a reduced cachexia-inducing ability of tumors in these patients. A limited number of studies indicate nutritional replenishment is obtainable in malnourished elderly by hyperalimentation. As restoration of the lean body mass may be slower in older patients, early institution of nutritional support is recommended in malnourished elderly or elderly at risk for malnutrition during neoplastic treatment.
Successive negative taste contrast in humans was demonstrated with a common taste stimulus, i.e., cherry-flavored Kool-Aid. A total of 31 male and female college-aged participants rated a 7% sucrose solution which was cherry-flavored as less sweet when it was preceded by a 28% rather than a 7% sucrose solution which was cherry-flavored. Because drugs such as the benzodiazepines affect taste contrast in rats and act as anxiolytics in humans, the present experiment also examined whether several self-reported measures of anxiety were related to taste contrast in humans. Neither scores on Taylor's Manifest Anxiety Survey nor those on the State-Trait Anxiety Inventory were related to "sweetness" ratings or contrast effects.
BACKGROUND: The aim of the present study was to analyze whether alcohol as an unconditioned stimulus is capable of supporting associative learning in near-term fetuses. METHODS: In experiment 1, we determined pharmacokinetic profiles of alcohol and of an aromatic substance (cineole) in amniotic fluid and maternal blood during late gestation. The results obtained through gas chromatographic analysis allowed a second experiment in which we explicitly paired peak levels of cineole with peak levels of alcohol in amniotic fluid and blood, by intragastrically administering cineole and ethanol to the dams during gestational days 17 through 20 (paired condition). Control groups were dams given cineole 4 hr before commencement of an acute state of alcohol intoxication (long-delay group) or were only exposed to water administrations (water control group). The progeny were evaluated during postnatal day 16 in terms of behavioral responsiveness to intraorally infused solutions (cineole or alcohol presented in milk vehicle, or milk alone). RESULTS: Mouthing responsiveness to cineole was strongly affected by the nature of prenatal treatments. Pups in the paired prenatal condition mouthed significantly less than did long-delay and water controls. Physical and behavioral measures allowed us to reject the possibility that these effects were due to teratogenic effects of alcohol during late gestation. CONCLUSIONS: These results indicate that before birth, rat fetuses are capable of acquiring associative memories supported by the unconditioned properties of alcohol. This associative memory can be expressed during infancy through a significant reduction in mouth movements in the presence of the specific orosensory cue explicitly paired with alcohol interoceptive effects in utero.
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Various conditions of the oral mucosa can give rise to a burning sensation. Candidosis, geographic tongue (erythema migrans), mucocutaneous conditions and stomatitis can all cause mouth burns with visible changes to the oral mucosa. The so-called 'burning-mouth syndrome' (BMS) is a fairly rare but extremely unpleasant condition characterised by a bilateral burning sensation of the oral mucosa in the absence of clinically visible mucosal changes. Frequently-associated symptoms include dry mouth and loss or change of taste. The aetiology is unknown, even though most of the literature focuses on the role of a possible underlying psychogenic disorder. Several mucosal disorders can cause symptoms similar to BMS. Therefore, careful oral examination is required before establishing the diagnosis of BMS. Additional laboratory tests or a specialist examination rarely yield abnormal findings of relevance. Reassurance and understanding are important keywords in the management of patients suffering from BMS. Unless clearly indicated dental or medical treatment should be avoided, even if the patient insists on it, since such treatment is rarely effective.
Health professionals concerned with improving the nutritional status of populations are facing numerous problems ranging from emaciation to overnutrition. This review article addresses the complexity, the relative significance and the interaction of factors leading to the nutritional profile of specific groups and individuals. When availability of food is threatened, the programs designed to reduce the incidence of malnutrition must balance the food supply with energy resources and population needs as well as encourage economic improvement of food distribution systems. For those persons having access to an abundant food supply, social forces and technological factors may affect food patterns, resulting in unbalanced diets associated with chronic diseases. Misinterpretation of reliable scientific findings is a major cause of abnormal nutrition behaviour. Overreaction to health messages may precipitate such conditions as anorexia nervosa or nutrient toxicity. Adverse food reactions, real or imagined, lead to restrictions in food selection. Excessive austerity in food use negates the pleasure of eating, a useful mechanism in food choice ensuring food diversity.
OBJECTIVE: The relation between being deprived of a food and intake and craving for that food was investigated in restrained and unrestrained eaters. METHOD: For 1 week, 103 female undergraduate students were assigned to be chocolate deprived, vanilla deprived, or nondeprived. Only chocolate deprivation was expected to elicit cravings, as chocolate is not easily substituted, whereas vanilla is. RESULTS: The main effect of chocolate deprivation on consumption was qualified by an interaction with restraint. Chocolate-deprived restrained eaters consumed more chocolate food than did any other group. Restrained eaters experienced more food cravings than did unrestrained eaters and were more likely to eat the craved food. Moreover, restrained eaters deprived of chocolate spent the least time doing an anagram task before a "taste-rating task" in which they expected that chocolate foods might be available. CONCLUSION: Converging measures of craving indicate that deprivation causes craving and overeating, but primarily in restrained eaters.
Four supplement mixtures using whole wheat, pearl millet, bengal gram, green gram, groundnuts and amaranth leaves were developed employing roasting and malting techniques. Malting used in the formation of the supplements reduced significantly hot paste viscosity of all the four supplements and increased their nutrient density per unit volume. The organoleptic trials conducted on rural mothers revealed that taste, texture, colour, aroma, appearance and overall acceptability of all the four supplements were found to be excellent with mean overall acceptability. Children did not develop any GIT disorders after consuming the products. Trained panelists found all the four supplements acceptable as indicated by a nine point hedonic scale.
BACKGROUND: Mental health literacy is a prerequisite for early recognition and intervention in mental disorders. The aims of this paper are to determine whether a sample of university students recognise different symptoms of depression and schizophrenia and to reveal factors influencing correct recognition. METHODS: Bivariate and correspondence analyses of the results from an online survey among university students (n = 225). RESULTS: Most participants recognised the specific symptoms of depression. The symptoms of schizophrenia were acknowledged to a lower extent. Delusions of control and hallucinations of taste were not identified as symptoms of schizophrenia. Repeated revival of a trauma for depression and split personality for schizophrenia were frequently mistaken as symptoms of the respective disorders. Bivariate analyses demonstrated that previous interest in and a side job related to mental disorders, as well as previous personal treatment experience had a positive influence on symptom recognition. The correspondence analysis showed that male students of natural science, economics and philosophy are illiterate in recognising the symptoms depression and schizophrenia. CONCLUSION: Among the educational elite, a wide variability in mental health literacy was found. Therefore, it's important for public mental health interventions to focus on the different recognition rates in depression and schizophrenia. Possibilities for contact must be arranged according to interest and activity (e.g., at work). In order to improve mental health literacy, finally, education and/or internship should be integrated in high school or apprenticeship curricula. Special emphasis must be given towards the effects of gender and stereotypes held about mental illnesses.
The ability to taste the bitter compound phenylthiocarbamide (PTC) and related chemicals is bimodal, and all human populations tested to date contain some people who can and some people who cannot taste PTC. Why this trait has been maintained in the population is uncertain but this polymorphism may influence food selection, nutritional status or thyroid metabolism. The gene product that gives rise to this phenotype is unknown, and its characterization would provide insight into the mechanism of bitter taste perception. Although this trait is often considered a simple Mendelian trait, i.e. one gene two alleles, a recent linkage study found a major locus on chromosome 5p15 and evidence for an additional locus on chromosome 7. The development of methods to identify these genes will provide a good stepping-stone between single-gene disorders and polygenic traits.
There is evidence that a strong, unpalatable, sour bolus improves swallowing in neurogenic dysphagia. It is not known whether other tastes may alter swallowing physiology. This study investigated the effect of moderate versus high taste concentrations (sweet, sour, salty, bitter) and barium taste samples on lingual swallowing pressure in ten healthy young adults, using a three-bulb lingual pressure array secured to the hard palate. Palatability of the samples was analyzed using the nine-point hedonic scale. Results showed that moderate sucrose, high salt, and high citric acid elicited significantly higher lingual swallowing pressures compared with the pressures generated by water. Pressures in the anterior bulb were significantly higher than those recorded from the middle or posterior bulb. There was no significant effect of palatability on lingual swallowing pressures. High salt and citric acid are known to elicit chemesthesis mediated by the trigeminal nerve. These results suggest that chemesthesis may play a crucial role in swallowing physiology. If true, dysphagia diet recommendations that include trigeminal irritants such as carbonation may be beneficial to individuals with dysphagia. However, before this recommendation more research is needed to examine how food properties and their perception affect swallowing in individuals with and without dysphagia.
OBJECTIVE: To characterize the relationship between allergic rhinitis, the severity and duration of nasal disease, olfactory function, and self-reported olfactory symptoms, including fluctuations or distortions in odor perception. DESIGN: Assessment of olfactory function and symptoms of 90 patients with allergic rhinitis. SETTING: A clinic of a university teaching hospital and research facility. PATIENTS: Sixty patients who presented to the Taste and Smell Clinic who had positive allergy test results and 30 patients who presented to the Allergy-Immunology Clinic. The Taste and Smell Clinic patients were grouped by nasal-sinus disease status (30 without chronic rhinosinusitis or nasal polyps, 14 with chronic rhinosinusitis but without polyps, and 16 with nasal polyps). MAIN OUTCOME MEASURES: Subjective olfactory symptom questionnaire and objective olfactory function tests. RESULTS: The Allergy-Immunology Clinic patients were diagnosed as being normosmic and the Taste and Smell Clinic patients as being hyposmic or anosmic with olfactory loss that increased significantly with nasal-sinus disease severity. Comparisons with normative data confirm that olfactory scores observed in all groups were significantly lower than expected because of the aging process alone. The self-reported duration of olfactory loss increased significantly with nasal-sinus disease severity. The Taste and Smell Clinic patients without chronic rhinosinusitis or nasal polyps reported the greatest incidence of olfactory distortions and olfactory loss associated with upper respiratory tract infections. CONCLUSIONS: There appears to be a continuum of duration and severity of olfactory loss in allergic rhinitis that parallels increasing severity of nasal-sinus disease. As a result of the increased frequency of respiratory infection associated with allergic rhinitis, these patients are at risk for damage to the olfactory epithelium.
BACKGROUND: Despite good evidence that ethanol abuse in adulthood is more likely the earlier human adolescents begin drinking, it is unclear why the early onset of drinking occurs in the first place. A review of experimental studies with animals complemented by clinical, epidemiologic and experimental studies with humans supports the idea that precipitating conditions for ethanol abuse occur well before adolescence, in terms of very early exposure to ethanol as a fetus or infant. Experimental studies with animals indicate, accordingly, that ethanol intake during adolescence or adulthood is potentiated by much earlier exposure to ethanol as a fetus or infant. METHODS: Two broad theoretical frameworks are suggested to explain the increase in affinity for ethanol that follows very early exposure to ethanol, one based on effects of mere exposure and the other on associative conditioning. Studied for 50 years or more in several areas of psychology, "effects of mere exposure" refers to enhanced preference expressed for flavors, or just about any stimuli, that are relatively familiar. An alternative framework, in terms of associative conditioning, is guided by this working hypothesis: During ethanol exposure the fetus or infant acquires an association between ethanol's orosensory (odor/taste) and pharmacological consequences, causing the animal subsequently to seek out ethanol's odor and taste. RESULTS AND CONCLUSIONS: The implication that ethanol has rewarding consequences for the fetus or young infant is supported by recent evidence with perinatal rats. Paradoxically, several studies have shown that such early exposure to ethanol may in some circumstances make the infant treat ethanol-related events as aversive, and yet enhanced intake of ethanol in adolescence is nevertheless a consequence. Alternative interpretations of this paradox are considered among the varied circumstances of early ethanol exposure that lead subsequently to increased affinity for ethanol.
A cohort of manic-depressive patients given prophylactic lithium treatment were examined before treatment started and at intervals during treatment for up to 7 years. The mean lithium dosage was 23.2 mmol/d and the mean serum lithium concentration 0.68 mmol/l. About 40% of the patients were entirely free of side effects, as compared with 10% among patients treated previously with higher lithium doses and serum lithium concentrations. Tremor complaints were presented by 5% of the patients before and by 15% during lithium treatment. The frequency fell with continued treatment, and after a few years it was not higher than before treatment started. Tremor complaints were positively correlated with age and with the use of neuroleptics and antidepressants. The tremorigenic effects of lithium and antidepressants seemed to potentiate each other. Tremor complaints were more frequent at serum lithium levels over than under 0.7 mmol/l. Body weight increased during the first 1-2 years of lithium treatment and then remained constant. The average gain was 4 kg. Weight gain was positively correlated with the patients' body weight before treatment and with the concurrent administration of antidepressant drugs. The frequency of diarrhea complaints (loose stools, defecation urge) rose from 1% to 6% during the first 6 months of lithium treatment and then leveled off. The frequency rose steeply at serum lithium values over 0.8 mmol/l. During lithium administration about one tenth of the patients had psychological complaints, which might or might not have been caused by the treatment: memory impairment and concentrating difficulty, tiredness and "greyness of life", in a few cases altered taste or lowered libido and potency.
We studied the frequency and clinical characteristics of aura phenomena in 60 patients with cardiac and 40 subjects with vasovagal syncopes. The majority (93%) of all syncope patients recalled having experienced an aura. Aura phenomena were similar in both groups and were mostly compound auras comprising epigastric, vertiginous, visual, or somatosensory experiences, but were more detailed in the noncardiac group. The localizing significance of auras preceding a syncope was generally poor. Although hard to distinguish from epileptic auras from their structure and shape, syncope-related auras lacked symptoms that are commonly reported after epileptic seizures such as tastes, smells, déjà vu phenomena, scenic visual perceptions, and speech impairments. A detailed anamnestic exploration of auras seems worthwhile in unexplained disorders of consciousness.