Time use of caregivers of impaired elders before and after institutionalization.

Time use was examined by means of time budgets obtained from 165 caregivers of older persons recruited from nursing home waiting lists and state nursing home assessment programs. "Yesterday interviews" were done at baseline (T1) and, again, an average of 5 months later when the elder had either entered a nursing home (n = 77) or was still awaiting entry (n = 88). Caregivers who provided more help (particularly instrumental assistance) to their elder were more likely to see that person placed in a nursing home at follow-up. More caregiving time was reported by those living with the elderly person and by nonworking and lower income caregivers; the elders being cared for by these groups were also more impaired. Less caregiving time (a total gain of 1 hour 47 minutes) was reported by caregivers following admission of the older person to the nursing home. The gained time was allocated to a significant degree to family interaction, recreation, and time outside the home.

Mixed inhibitors of angiotensin-converting enzyme (EC 3.4.15.1) and enkephalinase (EC 3.4.24.11): rational design, properties, and potential cardiovascular applications of glycopril and alatriopril.

Angiotensin-converting enzyme (ACE) and enkephalinase, two cell surface metallopeptidases, are responsible for angiotensin II formation and atrial natriuretic factor (ANF) degradation, respectively, and thereby play a critical role in the metabolism of hormonal peptides exerting essentially opposite actions in cardiovascular regulations. To affect simultaneously both hormonal systems by a single molecular structure, we have designed glycoprilat and alatrioprilat [(S)-N-[3-(3,4-methylene-dioxyphenyl)-2-(mercaptomethyl)-1-oxoprop yl] glycine and -alanine, respectively]. In vitro the two compounds inhibit both ACE and enkephalinase activities with similar, nanomolar potencies, and in vivo, glycopril and alatriopril, the corresponding diester prodrugs, occupy the two enzyme molecules in lung at similar low dosages (0.2-0.5 mg/kg of body weight, per os). The high potency of these compounds is attributable to interaction of the methylenedioxy group with the S1 subsite of ACE and of the aromatic ring with the S1' subsite of enkephalinase. In rodents, low doses of these mixed inhibitors exert typical actions of ACE inhibitors--i.e., prevention of angiotensin I-induced hypertension--as well as of enkephalinase inhibitors--i.e., protection from 125I-ANF degradation or enhancement of diuresis and natriuresis following acute extracellular volume expansion. In view of the known counterbalanced physiological actions of the two hormonal peptides, whose metabolism is controlled by ACE and enkephalinase, mixed inhibitors of the two peptidases show promise for the treatment of various cardiovascular and salt-retention disorders.

Enantiomers of thiorphan and acetorphan: correlation between enkephalinase inhibition, protection of endogenous enkephalins and behavioral effects.

The relationships between various properties of inhibitors of enkephalinase (membrane metalloendopeptidase, EC 3.4.24.11) i.e., enzyme inhibition, protection of endogenous enkephalins, antinociceptive activity and stimulation of locomotor activity was investigated by comparing the relative potencies of the two enantiomers of Thiorphan and acetorphan, its parenterally active prodrug. In vitro (R)- and (S)-Thiorphan were almost equipotent in inhibiting enkephalinase activity (Ki, 1.7 and 2.2 nM, respectively) or thermolysin activity (Ki, 13 and 6 microM, respectively) whereas the (R)-isomer was 44-fold less potent than the (S)-isomer on ACE activity (Ki 4800 and 110 nM, respectively). When tested on slices of rat globus pallidus in the presence of bestatin, to block the aminopeptidase pathway of enkephalin degradation, both Thiorphan enantiomers ensured a complete protection of endogenous (Met5)enkephalin released by depolarization and a suppression of the increase in the extracellular levels of Tyr-Gly-Gly, a characteristic enkephalin metabolite. These two effects occurred at EC50 values of the two enantiomers (10 nM in both cases), consistent with the idea that they were due to enkephalinase inhibition. After i.v. administration of the acetorphan enantiomers to mice, the enkephalinase activity of a rapidly prepared striatal membrane fraction was reduced in a dose-dependent manner with similar "ex vivo" ED50 values (1.0 and 0.3 mg/kg for the (R)- and (S)-isomer, respectively). In contrast the ACE activity of the same preparation was reduced in a significant manner only by (S)-acetorphan (ED50 value of 11 mg/kg).(ABSTRACT TRUNCATED AT 250 WORDS)

Leukotriene B4 and 12-hydroxyeicosatetraenoic acid stimulate epidermal proliferation in vivo in the guinea pig.

Epidermal proliferation was studied in the guinea-pig ear in vivo using the incorporation of [3H]thymidine into DNA as a measure of cell proliferation. Twenty-four-hour pretreatment of the skin topically with nanomolar amounts of either leukotriene B4 (LTB4), 12-hydroxyeicosatetraenoic acid, ionophore A23187, or the epidermal mitogen 12-O-tetradecanoylphorbol-13-acetate induced dose-dependent increases in epidermal proliferation. The stimulatory effect of LTB4 was stereospecific since a number of biologically inactive LTB4 stereoisomers had no effect.

[Patient motivation by application of an individual intensive program for obtaining oral health]. / Motivation des patients avec application individuelle d'un programme intensif pour l'obtention de la santé buccale.

The failure of group and individual dental prophylaxis based upon an authoritarian relationship between doctors and patients is demonstrated. In a new information and motivation program, the Hygiene Intensive Program (HIP), the patient's attention is focused on gingival bleeding as an unmistakable warning symptom of oral disease. The degree of marginal inflammation is scored using the Papillary Bleeding Index (PBI). The HIP is designed to introduce trust and confidence into the cooperative efforts of the dentist and the patient. The patient can see the increasing success of the dentist's work and judge the effect of his personal oral hygiene efforts. The possibilities for the cooperation of the increasingly involved third party of the dental "Troika", the actual purchaser of dental services (health insurance, social welfare system, etc.) in the HIP are discussed.