["Pflegestützpunkte": Care Support Centers in Germany. Where are We Heading? Results of the Evaluation of all 48 Care Support Centers in Baden-Württemberg]. / Pflegestützpunkte in Deutschland. Quo vadis? Ergebnisse der Evaluation aller baden-württembergischen Pflegestützpunkte.

"Pflegestützpunkte", care support centers in Germany. Where are we heading? Results of the evaluation of all 48 care support centers in Baden-Württemberg. Objectives: The quantitative part of the study was based on an analysis of the structures and concepts as well as the type of services and demand for counseling services for elderly and vulnerable people of all 48 care support centers in Baden-Württemberg. The qualitative part included interviews of employees of the care support centers on the underlying concepts of their organization. Objectives: The counseling infrastructure for elderly and vulnerable people needs to be improved in terms of transparency, networking and coordination of its services. According to the German Care Reform, care support centers, known as "Pflegestützpunkte," should solve this problem by placing all relevant counseling services under one roof. The objective of this study was to distinguish between the various care models of care support centers currently in existence and to investigate how different models meet legal requirements. Results and Conclusions: An evaluation of the interviews and surveys shows that not all legal requirements are met. The 4 main models of care support centers vary widely and are partially incomprehensible. It also remains unclear what role the care support centers play in counseling by health and nursing insurances. These needs for further development should be kept in mind in the planned expansion of care support centers.

[Provision of services and demand for care support centers. Results of the evaluation of all care support centers in Baden-Württemberg]. / Angebot und Nachfrage von Pflegestützpunkten. Ergebnisse der Evaluation aller baden-württembergischen Pflegestützpunkte.

BACKGROUND: The counseling infrastructure for elderly and vulnerable people is characterized by overuse, underuse and misuse. According to the German care reform, care support centers should solve this problem by putting all relevant counseling services under one roof. OBJECTIVE: The aim of this study was to analyze the type of services and demand of German care support centers 5 years after the German care reform came into force. MATERIAL AND METHODS: The study was based on an analysis of the documentation of all 48 care support centers in Baden-Württemberg after the German care reform came into force and of counseling services for elderly and vulnerable people. RESULTS AND CONCLUSION: The results of the evaluation of all care support centers in Baden-Württemberg showed that they offer a wide range of services ranging from counseling services for simple assistance to promoting self-help, up to comprehensive case management. The wide variety of counseling services offered also showed that these care support centers can meet the many different needs and requirements of the clientele. Findings from this study enabled a positive conclusion about the demand to be drawn. It became clear that the services offered are used by many people of all ages who are already in need of care or who are trying to prevent this need from occurring. A consensus about the conceptual development of care provision models employed by care support centers has not yet been achieved in Germany. Findings from this study could be useful in highlighting the need to further develop the care support centers.

Uncertainty analysis of the use of a retailer fidelity card scheme in the assessment of food additive intake.

The feasibility of using a retailer fidelity card scheme to estimate food additive intake was investigated in an earlier study. Fidelity card survey information was combined with information provided by the retailer on levels of the food colour Sunset Yellow (E110) in the foods to estimate a daily exposure to the additive in the Swiss population. As with any dietary exposure method the fidelity card scheme is subject to uncertainties and in this paper the impact of uncertainties associated with input variables including the amounts of food purchased, the levels of E110 in food, the proportion of food purchased at the retailer, the rate of fidelity card usage, the proportion of foods consumed outside of the home and bodyweights and with systematic uncertainties was assessed using a qualitative, deterministic and probabilistic approach. An analysis of the sensitivity of the results to each of the probabilistic inputs was also undertaken. The analysis identified the key factors responsible for uncertainty within the model and demonstrated how the application of some simple probabilistic approaches can be used quantitatively to assess uncertainty.

Use of retailer fidelity card schemes in the assessment of food additive intake: Sunset Yellow a case study.

The feasibility of using a retailer fidelity card scheme to estimate food additive intake was investigated using the Swiss retailer MIGROS's Cumulus Card and the example of the food colour Sunset Yellow (E 110). Information held within the card scheme was used to identify a sample of households purchasing foods containing Sunset Yellow over a 15 day period. A sample of 1204 households was selected for interview, of which 830 households were retained in the study following interview. Interviews were conducted to establish household structure, patterns of consumption by different individuals within the household, and the proportion of foods containing Sunset Yellow habitually purchased at the retailer and/or consumed outside the home. Information provided by the retailer on levels of Sunset Yellow in the foods was combined with the information obtained at interview to calculate the per-capita intake of Sunset Yellow by members of participating households. More than 99% of consumers (n = 1902) of foods containing Sunset Yellow were estimated to consume less than 1 mg Sunset Yellow kg(-1) body weight day(-1). The method proved to be a simple and resource-efficient approach to estimate food additive intake on the basis of actual consumer behaviour and thus reports results more closely related to the actual consumption of foods by individuals.

First European conference on aspartame: putting safety and benefits into perspective. Synopsis of presentations and conclusions.

A Conference was held in Paris in 2006 to review the safety and benefits arising from the replacement of sucrose with the intense sweetener aspartame. The intakes of aspartame are only about 10% of the acceptable daily intake, even by high consumers, so that the safety margin is about 3 orders of magnitude. The safety of aspartame was confirmed in the EFSA Opinion of a recent controversial rodent cancer bioassay. There is increasing evidence that even modest reductions in the intake of calories can reduce the risk factors associated with a number of diseases, such as diabetes and cardiovascular disease. A key issue addressed at the conference was whether the replacement of sucrose with aspartame could result in a prolonged decrease in calorie intake that was of similar magnitude to that necessary to produce a health benefit. A recent meta-analysis of published data showed that an adequate, prolonged weight reduction could be achieved with aspartame. It was recognised that risk assessment alone gave an unbalanced impression to regulators and consumers, and that in the future quantitative risk-benefit analyses should be able to provide more comprehensive advice.

Mathematical modelling and quantitative methods.

The present review reports on the mathematical methods and statistical techniques presently available for hazard characterisation. The state of the art of mathematical modelling and quantitative methods used currently for regulatory decision-making in Europe and additional potential methods for risk assessment of chemicals in food and diet are described. Existing practices of JECFA, FDA, EPA, etc., are examined for their similarities and differences. A framework is established for the development of new and improved quantitative methodologies. Areas for refinement, improvement and increase of efficiency of each method are identified in a gap analysis. Based on this critical evaluation, needs for future research are defined. It is concluded from our work that mathematical modelling of the dose-response relationship would improve the risk assessment process. An adequate characterisation of the dose-response relationship by mathematical modelling clearly requires the use of a sufficient number of dose groups to achieve a range of different response levels. This need not necessarily lead to an increase in the total number of animals in the study if an appropriate design is used. Chemical-specific data relating to the mode or mechanism of action and/or the toxicokinetics of the chemical should be used for dose-response characterisation whenever possible. It is concluded that a single method of hazard characterisation would not be suitable for all kinds of risk assessments, and that a range of different approaches is necessary so that the method used is the most appropriate for the data available and for the risk characterisation issue. Future refinements to dose-response characterisation should incorporate more clearly the extent of uncertainty and variability in the resulting output.

Protective effects of O-(beta-hydroxyethyl)-rutosides (HR) against adriamycin-induced toxicity in rats.

Adriamycin (Adriablastine), administered weekly at the dose of 5 mg/kg i.p. for 3 weeks in rats, produced a general decrease of vitality associated with a decrease of body weight, hypothermia, decreases of stroke volume and cardiac output. Hematocrit was decreased. Renal blood flow decreased whereas pulmonary blood flow increased. Mean blood pressure and heart rate remained unaffected. Biochemical evaluations revealed a decrease of blood urea and serum creatinine, which might be related to decreased food intake and protein metabolism. Morphological changes in the heart tissue could not be appreciated. Venoruton (HR), administered at the dose of 300 mg/kg p.o. daily for 28 days (5 days before and 23 days after the first injection of adriamycin), improved adriamycin-induced clinical signs and symptoms (loss of body weight, hypothermia and decreased general vitality). It tended to increase cardiac output and stroke volume.

Grip strength test and infrared thermometry as non-invasive methods to complement acute toxicity data in mice.

Acute toxicity testing in-vivo seeks a new approach minimising the number of animals used and increasing the number of quantitative and qualitative observations. The measurement of grip strength of mice (forelimbs), a classical tool for the evaluation of muscular force and the emitted heat measurement, as a tool for evaluation of basic metabolism, have been used. The aim of acute toxicity was, up to now, to determine LD50 level or eventually a minimal lethal dose. These non-invasive tests give an idea of general health condition and allow the determination of the minimal toxic dose while in the search for the minimal lethal dose. A computer-assisted grip strength test and an infrared thermometry test have been developed and calibrated with Na+ pentobarbital, theophylline and diazepam given once orally or intraperitoneally to 10 male NMRI (MAI) mice/dose. The tests were performed within one hour after administration and daily until the values of the surviving animals went back to normal. Dose-response curves were obtained and plotted against control animals (n = 10). Oral and intraperitoneal administration in ascending doses of Na+-pentobarbital, theophylline and diazepam (i.p. only) up to the lethal level have a parallel influence on grip strength and heat emission; the correlation with mortality is clear for Na+-pentobarbital and diazepam but not for theophylline.

Influence of 3-methoxy 5,7,3',4'-tetrahydroxyflavan (ME) on experimental periodontitis in the golden hamster.

Experimental periodontal disease was induced in golden hamsters by feeding the animals with a Keyes 2 000 diet. The aim of the present study was to investigate the effect of 3-methoxy 5,7,3',4'-tetrahydroxyflavan (ME), a flavanoid derivative, on periodontally induced changes by this diet which was fed ad libitum to half of the animals for 2 months prior to the start of drug therapy. The animals were then divided into 4 groups: A) control animals on normal diet; B) ME-treated (200 mg/kg 3 times a week i.p.) animals on normal diet; C) animals on Keyes 2 000 diet; D) ME-treated (200 mg/kg 3 times a week i.p.) animals on Keyes 2 000 diet. ME inhibited the diminution of bone volume as measured morphometrically. The growth of dental plaque as evaluated by a sensitive index (PII) appeared to be retarded by ME. The average PII in the ME-treated animals reached after 2 months of diet remained unchanged during the drug therapy period (4 months); whereas it was significantly increased in the group C hamsters. The biochemical data further suggest that the resorption process of the alveolar bone was decreased by ME.

Hemodynamic studies in acute venous stasis edema in rats.

An increase in venous pressure in the rat tail is known to result in acute edema. Acute venous stasis edema of the rat tail was induced by applying a force-controlled banding of standard tension (200 g) proximally for a period of 6-12 h. The hemodynamic changes of acute venous stasis edema were evaluated using non-invasive plethysmography, fluorescence angiography, computer thermography and invasive radioactive microsphere techniques. It is shown here that reduction of tail circulation to 40% of the control value is followed by prolonged vascular disorder characterized by genesis of reversible edema, increased total blood flow to the tail and decreased local cutaneous blood flow, without affecting the general hemodynamics. The cutaneous circulation (decreased blood flow) seems to be principally involved in the edemogenic response, whereas the deeper vessels (hyperemia) may or may not play a determinant role in acute experimental venous stasis edema in rats.