[Frequency of falls among clients of home care services : The importance of care-related and social risk factors]. / Häufigkeit von Stürzen unter Klienten ambulanter Pflegedienste : Die Bedeutung pflegerischer und sozialer Risikofaktoren.

BACKGROUND: Among the elderly falls frequently result in injuries, increase the need for long-term care and pose a challenge for the quality assurance in nursing care. We describe the frequency and risk factors of falls among care-dependent persons using home care services in Germany. METHODS: The participants of the study "Nursing-related health problems in home care" (n = 880) were recruited based on a list of the officially accredited nursing services. Data collection followed a standardized study protocol. Proportions were calculated and adjusted odds ratios and predicted probabilities were estimated using binary logistic regression. RESULTS: Falls are a frequent occurrence among care-dependent persons who are cared for by home care services: Almost every tenth care-dependent person suffers from a fall within a period of 2 weeks. Falls are mainly associated with social and care-related factors. Besides a low educational status this comprises certain living and care arrangements: People living alone or having infrequent contact to their nursing service as well as clients that, according to their carers, should receive more support have a significantly higher chance of falling. Multimorbidity is a medical risk factor while neurological diseases as well as polypharmacy present increased risks only in interaction with living and care arrangements. CONCLUSION: Nursing staff and physicians should maintain an overview of the social and health conditions of people in need of long-term care. If care-dependent persons live alone or are infrequently cared for, additional medical problems considerably increase the risk for falling; therefore, preventive interventions and follow-up assessments of actual need levels should be promptly considered if health conditions or living arrangements change.

[Current Status of Medical Care for Nursing Home Residents in Germany - Results of an Empirical Study]. / Zur Entwicklung der ärztlichen Versorgung in stationären Pflegeeinrichtungen ­ Ergebnisse einer empirischen Untersuchung.

Following recent studies revealing deficits in general and specialised medical care of nursing home residents in Germany, the discussion on the quality of medical care of residents in residential care facilities has intensified in the past years. As a result, political efforts have been undertaken to facilitate improvements in this context. We collected data on the health status and medical care of 778 residents from 8 nursing homes in order to investigate the current situation regarding medical care for nursing home residents in Germany. Most of them were multimorbid, taking several prescribed medications. Our results showed that about 91% of the residents had personal contact to general practitioners or internists quarterly and only 1.3% had no such contacts within a year. The frequency of contacts to other medical specialists was comparably low. For example, within a year, only 18.9% of the residents had contact to urologists; only 16.7% had contact to ophthalmologists; only 39.6% had contact to dentists and only 10.6% of the female residents had contact to gynaecologists. Despite the fact that many of the residents showed specific medical care needs, these rates were below the utilisation rates of older population groups not living in long-term care homes. This leads to the conclusion that previous efforts to optimise medical care in nursing homes were only partially successful. Well known deficits are still remaining. Considering potential consequences for residents, further and consequent actions are required to improve the general and specialised medical care in institutionalised long-term care.

[Patients with pain in outpatient care. A nationwide cross-sectional survey with path model]. / Schmerz bei Patienten in der ambulanten Pflege. Eine bundesweite Querschnittsstudie mit Pfadmodell.

BACKGROUND: There is limited knowledge on the degree of pain and pain-related impairments in home care clients. This study was carried out to provide data on the prevalence of pain and pain-related impairments in home care patients and to investigate the impact on activities of daily living and on classification into the three levels of care as defined by the statutory German long-term care insurance. MATERIAL AND METHODS: In 2012 a representative cross-sectional multicenter study was conducted among clients of 100 German home care services. The stepwise sampling procedure included a random selection of 9 home care services in each of the 16 federal states and a randomized sampling among the clients of the participating home care services. The total sample consisted of 878 home care clients (inclusion criteria ≥ 18 years). The subjective pain intensity was measured using an 11-step Likert scale ranging from 0 (no pain) to 10 (most severe pain). Pain-related impairments were rated on a 6-step Likert scale (0 = no impairments to 5 = complete impairment) assessing the level of independence in household chores, mobility, personal hygiene, dressing and social participation. Furthermore, multimorbidity (number of diagnoses) and level of care according to the current classification in the German long-term care insurance were registered. The predictive significance of latent variables was determined by structural equation modelling. RESULTS: Of the subjects surveyed 68.5 % (n = 672) reported suffering from pain. The average intensity of pain was 2.9 (standard deviation SD 2.8) and pain-related impairments had the greatest effect on mobility (78.2 %). Path analysis revealed that a higher degree of pain-related impairments (ß = + 0.31) and a higher number of diagnoses (ß = + 0.19) were associated with classification to higher levels of care as defined in the German long-term care insurance. However, stronger pain and higher age were related to a classification to a lower level of care (ß = - 0.21). No relevant gender differences were identified except for the finding that old age in women had no significant effect on the classification to the level of care, whereas in men both old age and pain intensity did have an impact. CONCLUSION: Even though the majority of home care clients in this representative study suffered from pain, the degree of pain intensity only becomes an issue in home care if it concurs with impairments in daily living and a corresponding classification to higher levels of care dependency. These findings suggest that pain and pain management should receive more attention in home care, irrespective of observable impairments in daily living. In practice, nurses in home care services should regularly assess the level of pain intensity among home care clients and the results of these regular pain assessments should be taken into account for the identification of individual care needs.

[The drinking water ordinance--successful or requiring revision?]. / Die Trinkwasserverordnung 2001--bewährt oder revisionsbedürftig?

The current regulatory approach in Germany combines regulations defined in the Drinking Water Ordinance with a comprehensive catalogue of technical rules as well as with guidelines and recommendations by the Federal Environment Agency and the Drinking Water Commission. This approach has proven successful in practice. Some parts would benefit from revision. The regulator is currently contemplating some revision in order to take experience of federal, state and local authorities as well as of water suppliers with implementation of the current Ordinance into account. The intention is improvement particularly towards reducing bureaucracy without compromising the current high level of public health protection through drinking water hygiene in Germany.

Phloem-specific expression of the pumpkin fruit trypsin inhibitor.

Vascular exudates of Cucurbita maxima (Duch.) contain a group of highly conserved serine proteinase inhibitors collectively called Pumpkin Fruit Trypsin Inhibitors (PFTIs) that prevent proteolytic activity of trypsin or chymotrypsin. Polyclonal antibodies raised against PFTIs were used to immunolocalize these low-molecular-weight proteins within the phloem tissue and to study their developmental expression. The inhibitors were translocated throughout the transport phloem and were present in vascular exudates collected from both source and sink tissues throughout the plant. During the early stages of vascular development, PFTIs accumulated specifically in sieve element-companion cell complexes of the phloem tissue. Transcripts were initially detected by reverse transcription-polymerase chain reaction in seedlings 1 d after germination and the protein detected 24 h later. Pumpkin fruit trypsin inhibitors were present in both cell types of differentiating and translocating sieve element-companion cell complexes. The inhibitors were detected in the phloem of the bicollateral vascular bundles, but the protein was most consistently localized within the cortical and bundle-associated extrafascicular phloem.

Modulation of acetylcholine and 5-hydroxytryptamine release in hippocampal slices of rats with fimbria-fornix lesions and intrahippocampal grafts containing cholinergic and/or serotonergic neurons.

Three-month-old Long-Evans female rats sustained aspirative lesions of the dorsal septohippocampal pathways and, 2 weeks later, received intrahippocampal suspension grafts containing fetal cells from the mesencephalic raphe (rich in serotonergic neurons; RAPHE), the medial septum and the diagonal band of Broca (rich in cholinergic neurons; SEPT), or a mixture of both (COTR). Lesion-only (LES) and sham-operated rats (SHAM) were used as controls. Hippocampal slices of these rats (5-9 month after surgery) were preincubated with [3H]choline or [3H]5-HT, superfused continuously (in the presence of hemicholinium-3 or fluvoxamine) and stimulated electrically (360 pulses, 2 ms, 3 Hz, 26-28 mA) in order to study the presynaptic modulation of acetylcholine (ACh) and serotonin (5-HT) release. The accumulation of [3H]choline and the evoked overflow of [3H]ACh were significantly reduced in slices from LES and RAPHE rats, but reached a close-to-normal level in SEPT and COTR rats. As to accumulation and overflow of [3H]5-HT, the lesion-induced reduction was compensated for only in RAPHE and COTR rats. The relative amount of evoked [3H]5-HT release (in % of tissue-3H) was significantly increased in LES and SEPT rats. Only slight differences (group LES) were found in the sensitivity of muscarinic and serotonergic autoreceptors towards oxotremorine and CP 93,129, respectively. Moreover, CP 93,129 induced a significantly weaker inhibition of ACh release in slices of COTR rats than in all other groups. Using the 5-HT1A receptor agonist 8-OH-DPAT and antagonist Way 100,635, no evidence for a modulatory influence of 5-HT1A receptors was found in RAPHE and COTR rats. It is concluded that despite substantial lesion- and graft-induced changes in the amount of ACh and 5-HT released by hippocampal slices of lesion-only or grafted rats, the presynaptic modulation of these transmitters is only slightly affected by changes in the neuronal environment.

The potentiation of amphetamine-induced hyperlocomotion by fimbria-fornix lesions in rats is abolished by intrahippocampal grafts rich in serotonergic neurons.

Three-month old Long-Evans female rats were submitted to aspirative lesions of the fimbria-fornix and intrahippocampal grafts of a cell suspension prepared from a region of the fetal brain including the septum and the diagonal band of Broca (rich in cholinergic neurons) or the raphe (rich in serotonergic neurons). A group of lesioned rats was grafted with both suspensions mixed. Lesion-only and sham-operated rats served as controls. Four months after the lesions, all rats were tested daily for locomotor activity in their home cage, 1 day without being injected, 2 days with an injection of NaCl and 5 days with an injection of 1 mg/kg (i.p.) d-amphetamine. The effects of the lesions and grafts were assessed by measuring the accumulation of [3H]-choline or [3H]-5-hydroxytryptamine (5-HT) by hippocampal slices, and the electrically-evoked release of tritium. Amphetamine injections produced hyperlocomotion which was potentiated by the lesion. This lesion-induced potentiation was also found in rats with septal grafts, but not in those with raphe or co-grafts. The uptake and electrically-evoked release of [3H]-acetylcholine or [3H]-5-HT were reduced in hippocampal slices from lesion-only rats. In rats which received grafts of septal cells or co-grafts, but not in those with raphe grafts, uptake and release of [3H]-acetylcholine were close to normal. Uptake and release of [3H]-5-HT were close to normal in rats with raphe grafts or with co-grafts, but not in those with septal grafts. Altogether, these data suggest that damage to the serotonergic afferents of the hippocampus might play some role in the potentiation of amphetamine-induced hyperlocomotion associated with fimbria-fornix lesions.

Estrogen synthetase inhibitors. 2. Comparison of the in vitro aromatase inhibitory activity for a variety of nitrogen heterocycles substituted with diarylmethane or diarylmethanol groups.

The preparation and in vitro aromatase inhibitory activity of a wide variety of heterocyclic (4,4'-dichlorodiphenyl)methanes and -methanols are described. The choice of the two diaryl-bearing moieties as a vehicle for the evaluation of the heterocycles was made by the comparison of series of imidazole and pyridine-derived compounds with similar pyrimidine compounds reported previously. A structural model for the most active compounds is also presented. The activity of a related series of the compounds which contain two heterocyclic moieties was found to be consistent with the model. Many of the compounds evaluated, including representatives of the pyridine, imidazole, pyrimidine, pyrazole, triazole, thiazole, and isothiazole classes, exhibit EC50 potencies for aromatase inhibition at low nanomolar levels. These compounds are at least as potent as other nonsteroidal aromatase inhibitors reported previously.