An integrative sensor of body states: how the mushroom body modulates behavior depending on physiological context.

The brain constantly compares past and present experiences to predict the future, thereby enabling instantaneous and future behavioral adjustments. Integration of external information with the animal's current internal needs and behavioral state represents a key challenge of the nervous system. Recent advancements in dissecting the function of the Drosophila mushroom body (MB) at the single-cell level have uncovered its three-layered logic and parallel systems conveying positive and negative values during associative learning. This review explores a lesser-known role of the MB in detecting and integrating body states such as hunger, thirst, and sleep, ultimately modulating motivation and sensory-driven decisions based on the physiological state of the fly. State-dependent signals predominantly affect the activity of modulatory MB input neurons (dopaminergic, serotoninergic, and octopaminergic), but also induce plastic changes directly at the level of the MB intrinsic and output neurons. Thus, the MB emerges as a tightly regulated relay station in the insect brain, orchestrating neuroadaptations due to current internal and behavioral states leading to short- but also long-lasting changes in behavior. While these adaptations are crucial to ensure fitness and survival, recent findings also underscore how circuit motifs in the MB may reflect fundamental design principles that contribute to maladaptive behaviors such as addiction or depression-like symptoms.

Fluid transitions.

Water is critical for survival and thirst is a powerful way of ensuring that fluid levels remain in balance. Overconsumption, however, can have deleterious effects, therefore optimization requires a need to balance the drive for water with the satiation of that water drive. This review will highlight our current understanding of how thirst is both generated and quenched, with particular focus on the roles of angiotensin II, glucagon like-peptide 1, and estradiol in turning on and off the thirst drive. Our understanding of the roles these bioregulators play has benefited from modern behavioral analyses, which have improved the time resolution of intake measures, allowing for attention to the details of the patterns within a bout of intake. This has led to behavioral interpretation in ways that are helpful in understanding the many controls of water intake and has expanded our understanding beyond the dichotomy that something which increases water intake is simply a "stimulator" while something that decreases water intake is simply a "satiety" factor. Synthesizing the available information, we describe a framework in which thirst is driven directly by perturbations in fluid intake and indirectly modified by several bioregulators. This allows us to better highlight areas that are in need of additional attention to form a more comprehensive understanding of how the system transitions between states of thirst and satiety.

[The Comparative Effectiveness of Using Cold Water Oral Spray and Cold Saline Oral Spray for Thirst Relief in Patients With Endotracheal Intubation in the Intensive Care Unit].

BACKGROUND: Thirst is a common symptom among patients with endotracheal intubation in the intensive care unit (ICU), with an estimated prevalence of 88%. PURPOSE: This study was designed to compare the effectiveness of cold saline spray and cold water spray in alleviating thirst, and to explore the maintenance and sustained effects of both groups in relieving thirst among patients with endotracheal intubation in the ICU. METHODS: Patients with indwelling tracheal tubes in the medical ICU were recruited from one medical center in northern Taiwan and randomly assigned to either the cold saline (n = 18) or cold water (n = 18) group. The cold saline group received three rounds of cold saline spray at a temperature of 2°C - 8°C. Each round consisted of 10 sprays directed toward each of the four surfaces of the oral cavity followed by a 5-minute wait period. This process was repeated three times, with 30-minute intervals between interventions. The cold water group received the same intervention steps using a cold water spray at 2°C - 8°C. Thirst intensity was measured using a numeric rating scale before and after each of the three interventions in both groups. Demographic and relevant physiological data were collected on the participants by reviewing their medical records. RESULTS: Both of the interventions were found to effectively alleviate thirst intensity, with no significant difference between the two groups in terms of thirst intensity reduction after each intervention detected. Only the cold water spray had a maintenance effect, while the two groups had a continuous sustained effect in alleviating thirst intensity. CONCLUSIONS: Both of the interventions effectively alleviated thirst, and the cold water spray had both maintenance and sustained effects in alleviating thirst intensity. Based on the results, the cold water spray method may be considered as the priority treatment for thirst alleviation by healthcare providers in the clinical management of patients with tracheal intubation.

The relationship between fatigue, pruritus, and thirst distress with quality of life among patients receiving hemodialysis: a mediator model to test concept of treatment adherence.

Hemodialysis is a conservative treatment for end-stage renal disease. It has various complications which negatively affect quality of life (QOL). This study aimed to examine the relationship between fatigue, pruritus, and thirst distress (TD) with QOL of patients receiving hemodialysis, while also considering the mediating role of treatment adherence (TA). This cross-sectional study was carried out in 2023 on 411 patients receiving hemodialysis. Participants were consecutively recruited from several dialysis centers in Iran. Data were collected using a demographic information form, the Fatigue Assessment Scale, the Thirst Distress Scale, the Pruritus Severity Scale, the 12-Item Short Form Health Survey, and the modified version of the Greek Simplified Medication Adherence Questionnaire for Hemodialysis Patients. Covariance-based structural equation modeling was used for data analysis. The structural model and hypothesis testing results showed that all hypotheses were supported in this study. QOL had a significant inverse association with fatigue, pruritus, and TD and a significant positive association with TA. TA partially mediated the association of QOL with fatigue, pruritus, and TD, denoting that it helped counteract the negative association of these complications on QOL. This model explained 68.5% of the total variance of QOL. Fatigue, pruritus, and TD have a negative association with QOL among patients receiving hemodialysis, while TA reduces these negative associations. Therefore, TA is greatly important to manage the associations of these complications and improve patient outcomes. Healthcare providers need to assign high priority to TA improvement among these patients to reduce their fatigue, pruritus, and TD and improve their QOL. Further studies are necessary to determine the most effective strategies for improving TA and reducing the burden of complications in this patient population.

Effects of cold spray on thirst, frequency of oral care, and pain of general surgery intensive care unit patients.

This study aims to investigate the effects of intraoral cold water spray on thirst, frequency of oral care and postoperative period pain at surgical incision site in patients having abdominal surgery. The study was carried out as a randomized controlled trial, registered under Clinical Trial Number: NCT05940818. The study involved 110 participants, divided equally into two groups (n = 55): the experimental group and the control group. Data were collected using patient information form, NRS, Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS) and Visual Analog Scale (VAS). The severity of thirst at 1st, 8th, 16th h of post-operative period (p < 0.01) and the frequency of oral care application at 16th h were statistically significantly decreased in the experimental group when compared to the control group (p < 0.01).There wasn't statistically significant difference between the patients in the experimental and control groups in terms of pain at surgical incision site (p > 0.05). The patient's thirst and need for frequent oral care in the postoperative period were reduced by the application of a cold water spray. In patients undergoing abdominal surgery, the use of cold water spray application may be recommended to reduce thirst and the need for frequency of oral care application.

Thirst and drugs: A study in the World Health Organization's pharmacovigilance database.

Thirst is a complex physiological compensatory mechanism but could also be associated with drugs. This association was poorly investigated previously. Using the WHO global pharmacovigilance database, Vigibase®, disproportionality analyses potential associations between exposure to drugs and thirst reports were performed. All reports of thirst in adults between 01/01/2000 and 31/12/2023 were included. Results are expressed as reporting odds ratio (ROR). Analysis of the 3186 reports of thirst (978 'serious') allowed, first, to confirm the association between thirst and exposure to vasopressin antagonists (tolvaptan), lithium, gliflozins (dapagliflozin, empagliflozin), pregabalin and antimuscarinic drugs (glycopyronium, oxybutynin, tiotropium). Second, new safety signals were described with monoamine reuptake inhibitors (antidepressants: duloxetine, venlafaxine; anti-obesity agent: sibutramine), antipsychotic (olanzapine), glucocorticoid (prednisolone), diuretic (furosemide) drugs as well with ribavirin or sodium oxybate. This study is the first to offer a list of drugs associated with thirst in humans.

Non-pharmacological interventions to reduce thirst in patients with heart failure or hemodialysis: A systematic review and meta-analysis.

BACKGROUND: Thirst is a frequent and burdening symptom in many patients, especially in patients with chronic heart failure (CHF) and/or receiving hemodialysis (HD). As drug therapies are not feasible, non-pharmacological strategies are needed to reduce thirst and thirst-related burden. OBJECTIVES: To identify non-pharmacological interventions aiming to reduce thirst in patients with CHF and/ or HD, to describe intervention components, and to evaluate the effectiveness of these interventions. METHODS: In February 2024, we completed a systematic search in MEDLINE via PubMed, Livivo, CINAHL, Cochrane Library and Web of Science. Two reviewers independently screened titles, abstracts, and full texts, performed critical appraisal and data extraction. We checked risk of bias with the checklists of the Joanna Briggs Institute and the Cochrane Risk of Bias tool and calculated meta-analyses for sufficiently homogeneous studies using fixed-effects models. RESULTS: We included 15 intervention studies applying non-pharmacological interventions including chewing gum (n = 8), low-sodium diet (n = 2), acupressure (n = 1), frozen strawberries (n = 1), fluid timetables (n = 1), ice cubes and mouthwash (n = 1), and a psychological intervention (n = 1). Sample sizes varied between 11 and 88 participants. Eleven intervention studies showed a reduction of thirst as intervention effect. Meta-analyses for chewing gum showed no significant effect on thirst using a visual analogue scale (IV: -2,32 [-10.37,5.73]; p = 0.57) or the dialysis thirst inventory (IV: -0.26 [- 1.83, 1.30]; p = 0.74). Quality of studies was moderate to low. CONCLUSION: Results indicate that various non-pharmacological interventions could be helpful to reduce thirst in patients with CHF or HD, but important uncertainty remains.

Brain sodium sensing for regulation of thirst, salt appetite, and blood pressure.

The brain possesses intricate mechanisms for monitoring sodium (Na) levels in body fluids. During prolonged dehydration, the brain detects variations in body fluids and produces sensations of thirst and aversions to salty tastes. At the core of these processes Nax , the brain's Na sensor, exists. Specialized neural nuclei, namely the subfornical organ (SFO) and organum vasculosum of the lamina terminalis (OVLT), which lack the blood-brain barrier, play pivotal roles. Within the glia enveloping the neurons in these regions, Nax collaborates with Na+ /K+ -ATPase and glycolytic enzymes to drive glycolysis in response to elevated Na levels. Lactate released from these glia cells activates nearby inhibitory neurons. The SFO hosts distinct types of angiotensin II-sensitive neurons encoding thirst and salt appetite, respectively. During dehydration, Nax -activated inhibitory neurons suppress salt-appetite neuron's activity, whereas salt deficiency reduces thirst neuron's activity through cholecystokinin. Prolonged dehydration increases the Na sensitivity of Nax via increased endothelin expression in the SFO. So far, patients with essential hypernatremia have been reported to lose thirst and antidiuretic hormone release due to Nax -targeting autoantibodies. Inflammation in the SFO underlies the symptoms. Furthermore, Nax activation in the OVLT, driven by Na retention, stimulates the sympathetic nervous system via acid-sensing ion channels, contributing to a blood pressure elevation.

The efficacy and safety of modified ultraearly oral hydration for alleviating thirst in patients after thoracoscopic surgery: a prospective randomized controlled trial.

OBJECTIVE: Postoperative fasting following thoracoscopic surgery can cause intense thirst and oral discomfort. However, there is currently no research on ultraearly oral hydration (UEOH) in middle-aged or elderly patients after thoracoscopic surgery. The aim of this study was to investigate the effectiveness and safety of UEOH for improving oral discomfort after thoracoscopic surgery. METHODS: This single-center prospective double-blind randomized controlled trial was conducted from April 2022 to November 2023. A total of 64 middle-aged and elderly patients who underwent the first thoracoscopic surgery on the day were enrolled at our institution. Postoperatively, in the Postanesthesia Care Unit (PACU), patients were randomly assigned at a 1:1 ratio to either the UEOH group or the standard care (SC) group. The primary outcome was the patient's thirst score at 6 h after surgery. Secondary outcomes included the incidence of postoperative oral discomfort; pain scores; the occurrence of adverse reactions such as nausea, vomiting, regurgitation and aspiration; anxiety scores on the first postoperative day; the time to first flatus; and recovery satisfaction scores. RESULTS: The demographic and surgical characteristics were similar between the two groups. Patients in the UEOH group had lower thirst scores 6 h after surgery than did those in the SC group(16.1 ± 6.70 vs. 78.4 ± 8.42, P < 0.01). The incidence of postoperative oral discomfort (P < 0.01), anxiety scores on the first postoperative day (P<0.05), and time to first flatus (P<0.05) were better in the UEOH group. Additionally, the incidences of adverse reactions, such as postoperative nausea, vomiting, regurgitation and aspiration, were similar between the two groups (P>0.05). CONCLUSION: For middle-aged and elderly patients undergoing thoracoscopic surgery, the use of a modified UEOH protocol postoperatively can improve thirst and promote gastrointestinal recovery without increasing complications. TRIAL REGISTRATION: This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 07/12/2023 with the registration number ChiCTR2300078425.

The effect of ice-cold water spray following the model for symptom management on postoperative thirst in patients admitted to intensive care unit: A randomized controlled study.

BACKGROUND: Postoperative thirst is common in patients admitted to the intensive care unit. Existing methods like wet cotton swabs or oral care prove ineffectual or operationally intricate. Currently, an efficacious postoperative thirst alleviation method remains elusive. Exploring a prompt, safe, and efficacious solution is of paramount importance. OBJECTIVE: To assess the effect of ice-cold water spray applied following a symptom management model on postoperative thirst and to establish a framework for mitigating thirst in intensive care unit patients. RESEARCH DESIGN: Single-center randomized controlled study. SETTING: Surgical intensive care unit in a university-affiliated hospital. MAIN OUTCOME MEASURES: 56 intensive care unit patients were selected and equally randomized. The experimental group received ice-cold water spray in conjunction with eight symptom management strategies, while the control group underwent standard care involving wet cotton swabs. Thirst intervention was initiated 0.5 hours after postoperative extubation, followed by subsequent interventions at 2-hour, 4-hour, and 6-hour intervals post-extubation. Thirst intensity, oral comfort, and the duration of relief from thirst were assessed and compared between groups before and 0.5 hours after each thirst intervention. RESULTS: Across different interventions, the experimental group exhibited superior scores in thirst intensity and oral comfort compared to the control group. Additionally, the nursing time required to alleviate thirst in the experimental group was significantly shorter than that in the control group (P < 0.01). CONCLUSION: Ice-cold water spray following the model for symptom management can effectively mitigate the postoperative thirst intensity in intensive care unit patients, improve oral comfort, and reduce the nursing time for relieving thirst. IMPLICATIONS FOR CLINICAL PRACTICE: Clinical nurses can employ ice-cold water spray following the model for symptom management to ameliorate postoperative thirst intensity in ICU patients while enhancing oral comfort. Furthermore, the utilization of ice-cold water spray can reduce the nursing time required for relieving postoperative thirst in intensive care unit patients.

Parent-offspring similarity in hunger and thirst sensations.

The internal (i.e., interoceptive) sensations that characterise hunger vary between people, and this may also be the case for thirst, although it has not been so well explored. There are probably both heritable and learning-based causes for this interoceptive variability. Consequently, it would seem plausible that parents and their offspring would have more similar patterns of hunger and thirst than pairs of strangers. We tested this idea, in addition to exploring its potential moderating variables, by studying the similarity of self-reported hunger and thirst sensations in 170 students and their primary caregivers from childhood. Both students and caregivers completed the same online-survey, covering hunger and thirst sensations, beliefs about the causes of hunger and thirst, the Three Factor Eating Questionnaire (revised) and demographic data. We find evidence of robust student-caregiver similarity in interoceptive hunger and thirst sensations (medium effect sizes), with these being moderated by caregiver beliefs about the homeostatic nature of each state (medium effect sizes). This suggests a potential role for caregivers in the development of their offspring's interoceptive cues for hunger and for thirst. In addition, thirst, like hunger, appears to be multidimensional, and varies between people. The implications of these findings are discussed.

Validation of a popsicle as a clear fluid to abbreviate preoperative fasting.

BACKGROUND & AIMS: This study is based on the development and validation of a popsicle to reduce preoperative fasting time. METHODS: The study was carried out in two stages, pre-clinical and clinical validation. The first stage consisted of producing a water-based, fat-free, high-calorie fruit-flavored popsicle, characterized by proximal composition and sensory analysis. In the second stage, clinical validation was performed in patients aged between 18 and 65 years before elective surgery, evaluating the incidence of aspiration during anesthesia and the patient's experience in relation to hunger, thirst, anxiety and palatability of the popsicle. RESULTS: The results of the study showed that the use of popsicle 2 h before the surgical procedure did not cause any adverse reaction in patients and in the anesthetic procedure. Furthermore, the full acceptability of the product by the participants and the control of thirst and satiety during the preoperative period were observed. CONCLUSIONS: The present study showed that with the use of popsicles it was possible to reduce safely the preoperative fasting time to up to 2 h before the surgical procedure.

Human hunger as a memory process.

Hunger refers to (1) the meaning of certain bodily sensations; (2) a mental state of anticipation that food will be good to eat; and (3) an organizing principal, which prioritizes feeding. Definitions (1) and (2) are the focus here, as (3) can be considered their consequent. Definition (1) has been linked to energy-depletion models of hunger, but these are no longer thought viable. Definition (2) has been linked to learning and memory (L&M) models of hunger, but these apply just to palatable foods. Nonetheless, L&M probably forms the basis for hunger generally, as damage to declarative memory can eradicate the experience of hunger. Currently, there is no general L&M model of hunger, little understanding of how physiology intersects with a L&M approach, and no understanding of how Definitions (1) and (2) are related. We present a new L&M model of human hunger. People learn associations between internal (e.g., tummy rumbles) and external cues (e.g., brand names) and food. These associations can be to specific foods (episodic memories) or food-related categories (semantic memories). When a cue is encountered, it may lead to food-related memory retrieval. If retrieval occurs, the memory's affective content allows one to know if food will be good to eat now-hunger-a cognitive operation learned in childhood. These memory processes are acutely inhibited during satiety, and chronically by multiple biological parameters, allowing physiology to modulate hunger. Implications are considered for the process of making hunger judgments, thirst, the cephalic phase response, and motivational and lay theories of hunger. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

"Quenching the thirst of others while suffering": Embodied experiences of water vendors in Ghana and Kenya.

Informal water sellers (commonly known as water vendors) have emerged as part of urban water infrastructure systems in many low- and middle-income countries to meet the water needs of unserved urban populations. These vendors include water tanker operators, those who sell water from private standpipes and boreholes, and those who use hand carts, bicycles, tricycles to transport water around for sale. However, we know little about the embodied impacts of their work on their health and wellbeing. In this article, we consider how embodied experience can add to our understandings of water access and decent work in urban centers in Sub-Saharan Africa. The study examines health risks associated with informal water vending in three cities, Accra and Wa (Ghana) and Kisumu (Kenya), where close to 48%, 65%, and 26% of residents respectively rely on vendors for their drinking water needs. We used in-depth interviews to explore the lived experiences of 59 water vendors and perspectives of 21 local stakeholders. Water vendors were mostly exposed to injury, environmental pollution, stigma, and work-life balance. Vendors who transport water in containers using bicycles or hand-pushed carts and those who carry water around complained about harsh weather conditions, poor physical terrain, and abuse from customers. Female water vendors also complained about pregnancy complications, baldness and water related diseases. Female water vendors experience unique physical threats that may put them at greater risk for chronic health and safety impacts. Gaining a better understanding of the health risks faced by these water vendors will provide policy makers with greater insight into how water vendors can be better supported to provide more improved services to enhance greater access to safe water. Findings from this work are also important for contributing to social protection policies, promoting inclusive growth, and designing empowerment programs for women.

Is increased subjective thirst associated with greater interdialytic weight gains, extracellular fluid and dietary sodium intake?

BACKGROUND: Some previous studies have reported an effect of increasing subjective thirst and interdialytic weight gains (IDWG), and that this may be influenced by nonadherence to dietary sodium restrictions, whereas others reported no such association. As such we wished to review the effect of self-reported thirst on IDWGs and dietary sodium intake. METHODS: Dialysis patients were asked to complete visual analogues thirst, distress thermometer (DT) scores and complete a sodium food frequency questionnaire (SFFQ). IDWG and pre and post dialysis volumes were measured with multifrequency bioelectrical impedance. RESULTS: One hundred and eleven patients completed the questionnaires and had bioimpedance measurements: 63% male, mean age 63.8 ± 16.1 years, 33% diabetic with a median thirst score 3 (0-5) and SFFQ 52.0 ± 18, and IDWG 2.1 ± 1.3%. Thirst was associated with DT (r = 0.28, p = 0.004) and negatively with age (r = -0.31, p < 0.001), but not SFFQ, IDWG, extracellular water, or dialysate sodium, or dialysate to plasma gradient. Patients with higher thirst scores were younger (58.0 ± 15.2 vs. 69.4 ± 15.0 years, p < 0.001) with higher DT scores (5 [2-7] vs. 2 [0-5], p < 0.001). On multivariate logistic analysis, only age was associated with self-reported thirst (odds ratio 0.95, 95% confidence limits 0.92-0.98, p < 0.001). CONCLUSION: We found that subjective thirst was greater for younger patients and those who reported higher levels of distress, but no association with IDWGs, dietary sodium intake, or dialysate sodium. However, most of our patients followed the dietary advice, as evidenced by the low SFFQ scores and % IDWGs. Whether thirst increases distress or distress increases subjective thirst remains to be determined.

Evaluation of thirst severity, death anxiety, and complementary and supportive therapy use as predictors of urinary incontinence-related quality of life in older adults.

PURPOSE: This correlational survey study aimed to evaluate thirst severity, death anxiety, and the use of complementary and supportive therapy as predictors of urinary incontinence-related quality of life in older adults. METHODS: The study included 368 participants aged 60 or older. Data were collected by face-to-face interviews using a participant information form, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Visual Analog Scale for thirst severity, Death Anxiety Scale, a modified version of the Mini Mental State Examination, and questions about their use of complementary and supportive therapies. RESULTS: The participants had a mean age of 70.5 ± 6.9 years (54.9% female). Mean ICIQ-SF score was significantly correlated with daytime frequency of urine leakage and thirst severity score. Multiple linear regression analysis indicated that thirst severity was a significant predictor of urinary incontinence-related quality of life. Most of the older adults said they had never used complementary or supportive therapies for urinary incontinence. CONCLUSION: Thirst severity should be assessed in older adults with urinary incontinence in addition to other factors that may affect ICIQ-SF scores.