Global Prevalence of Elder Abuse: A Meta-analysis and Meta-regression.

OBJECTIVE: Elder abuse is increasingly recognised as a global public health and social problem. There has been limited inter-study comparison of the prevalence and risk factors for elder abuse. This study aimed to estimate the pooled and subtype prevalence of elder abuse worldwide and identify significant associated risk factors. METHODS: We conducted a meta-analysis and meta-regression of 34 population-based and 17 non-population-based studies. RESULTS: The pooled prevalences of elder abuse were 10.0% (95% confidence interval, 5.2%-18.6%) and 34.3% (95% confidence interval, 22.9%-47.8%) in population-based studies and third party- or caregiver-reported studies, respectively. Being in a marital relationship was found to be a significant moderator using random-effects model. CONCLUSIONS: This meta-analysis revealed that third parties or caregivers were more likely to report abuse than older abused adults. Subgroup analyses showed that females and those resident in non-western countries were more likely to be abused. Emotional abuse was the most prevalent elder abuse subtype and financial abuse was less commonly reported by third parties or caregivers. Heterogeneity in the prevalence was due to the high proportion of married older adults in the sample. Subgroup analysis showed that cultural factors, subtypes of abuse, and gender also contributed to heterogeneity in the pooled prevalence of elder abuse.

The preparedness of Hong Kong medical students towards advance directives and end-of-life issues.

OBJECTIVES: To explore the preparedness of medical students towards advance directives and related end-of-life issues, and to examine background factors such as knowledge, attitudes, and experience concerning advance directives and related end-of-life issues. METHODS: In 2007, 448 medical students in years 3 to 5 were surveyed at the Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong. Their knowledge, attitudes, and experiences of advance directives and related end-of-life issues, and their self-perceived preparedness to discuss these matters with patients were evaluated. RESULTS: A total of 220 (49%) of the eligible students responded, of whom 79% supported the use of advance directives. Only 65 (30%) students were certain of what advance directives meant and 198 (90%) students felt that their knowledge of advance directives was inadequate. Also, 197 (90%) students felt unprepared about advance directives and end-of-life issues. Factors associated with positive attitude towards advance directives included religion and knowledge. No factors were found to be associated with self-perceived preparedness towards advance directives or end-of-life issues. CONCLUSIONS: Most of the medical students surveyed demonstrated a positive attitude towards advance directives and recognised the importance of advance directives. However, they felt that they were unprepared and lacking in knowledge and experience of advance directives and end-of-life issues. Wider range and more depth of education is needed to better equip medical students for future practice.

Changes in the microtubule proteins in the developing and transected spinal cords of the bullfrog tadpole: induction of microtubule-associated protein 2c and enhanced levels of Tau and tubulin in regenerating central axons.

The distribution of tubulin, microtubule-associated protein 2 and Tau in the spinal cords of bullfrog tadpoles during development and after transection was studied. alpha-Tubulin or beta-tubulin immunoreactivity was present in the axons, neuronal perikarya and dendrites, as revealed by immunocytochemistry. The axonal staining intensity of the tubulins in the tadpoles was significantly stronger than that in the adult bullfrog. Microtubule-associated protein 2 immunoreactivity was localized largely to dendrites and expanded from distal to proximal dendrites with time; a high-molecular-weight microtubule-associated protein 2 was seen on the immunoblots of cord homogenates throughout development Tau1 stained mainly the axons. Two-dimensional gel immunoblotting disclosed that the tadpole contained a greater number of isoforms of Tau than the frog. Complete transection of the spinal cords of stage IV tadpoles was followed by regeneration of the damaged cord region. The levels of tubulin and Tau immunoreactivity in the regenerating axons of the ventral fasciculi were generally increased. Strikingly, microtubule-associated protein 2 immunoreactivity appeared in the regenerating axons and the chromatolytic cell bodies of axotomized motor neurons, paralleling the induction of microtubule-associated protein 2c in the regenerating cord segment shown by immunoblotting. The chromatolytic cell bodies were also markedly labeled by Tau1, whereas the high-molecular-weight microtubule-associated protein 2 diminished on the immunoblots, in accordance with the reduced level of staining for the dendrites. It is apparent that the changes in the cytoskeletal proteins in the regenerating axons mostly recapitulated their developmental patterns. Moreover, the data indicate a close relationship between tubulin and microtubule-associated proteins in axonal growth as well as providing evidence for similar molecular mechanisms underlying successful regeneration for central and peripheral axons.