Prevalence of elder abuse in the community and care settings: An umbrella review.

OBJECTIVE: Elder abuse, an important human rights issue and public health problem, contributes to increased disability and mortality. In the last decades, several reviews have synthesized primary studies to determine its prevalence. This umbrella review aimed to estimate the worldwide overall prevalence rate of elder abuse in the community and care setting. METHODS: Following prospective registration at PROSPERO (CRD42021281866) we conducted a search of eight electronic databases to identify systematic reviews from inception until 17 January 2023. The corrected covered area was calculated to estimate the potential overlap of primary studies between reviews. The quality of the selected reviews was assessed using a modified AMSTAR-2 instrument. We extracted data on the prevalence of any type of elder (people aged 60 years old or older) abuse in the community and care setting. RESULTS: There were 16 systematic reviews retrieved between 2007 and 2022, out of which ten captured prevalence globally, three in Iran, one in Turkey, one in China and one in Brazil. The 16 reviews included 136 primary studies in total between 1988 and 2020. The overlapping of studies between reviews was found to be moderate (5.5%). The quality of reviews was low (2, 12.5%) or critically low (14, 87.5%). The estimated range of global prevalence of overall elder abuse was wide (1.1-78%), while the estimations of specific abuse prevalence ranged from 0-81.8% for neglect, 1.1-78.9% for psychological abuse, 0.7-78.3% for financial abuse, 0.1-67.7% for physical abuse, and 0-59.2% for sexual abuse. CONCLUSIONS: Although the low quality of the evidence and the heterogeneity of the phenomenon makes it hard to give precise prevalence data, it is without a question that elder abuse is a prevalent problem with a wide dispersion. The focus of attention should shift towards interventions and policymaking to prevent this form of abuse.

Proprioceptive elbow training reduces pain and improves function in painful lateral epicondylitis-a prospective trial.

BACKGROUND: In painful epicondylitis, previous studies reported deficiencies in elbow proprioception. In line, proprioceptive training of the lower limb has been reported substantial beneficial in a number of indications. Therefore, we have asked if a specified proprioceptive training using training devices that are capable of activating the deep musculature in the upper limb is able to reduce the symptoms of epicondylitis. MATERIALS AND METHODS: We included 71 patients with painful lateral epicondylitis > 3 months. INTERVENTIONS: Group A: Proprioceptive training intervention with a Flexibar® (9 min daily for 12 weeks). Group B: at least 40 min running or walking/week with the XCO® in addition to the proprioceptive training with the Flexibar® (9 min daily for 12 weeks), follow-up for 12 weeks. Primary end point: Pain on visual analogue scale (VAS, 0-10); secondary end points: DASH-Score (0 = very good, 100 = very poor), grip strength according to Jamar dynamometer (kg), vibration sensation measured with a 128 Hz tuning fork. RESULTS: The pain on VAS in group A was reduced significantly. 3.6 ± 2.0 to 2.4 ± 2.1 (-33%, p = 0.013), and from 3.7 ± 2.4 to 2.2 ± 1.9 (-41%, p = 0.004) in group B after 12 weeks. There was no significant difference between A and B (p = 0.899). In both groups, there was a significant improvement of the DASH-Score (A: 32 ± 15 to 14 ± 12, -56%, p < 0.001; B: 27 ± 12 to 12 ± 11, -55%, p = 0.001) without any difference between groups A and B (p = 0.339). Grip strength improvement in group A from 24 ± 12 to 33 ± 11 kg (+38%, p < 0.001), and from 29 ± 14 to 34 ± 11 kg (+15%, p < 0.001) in group B. In line, vibration sensation improved in both groups (A: 6.3 ± 0.6 to 6.5 ± 0.5, p = 0.0001; B: 6.3 ± 0.7 to 6.6 ± 0.5, p = 0.003). CONCLUSION: A 12-week proprioceptive training with the Flexibar® improves pain, quality of life, grip strength and vibration sensation in patients with painful lateral epicondylitis. LEVEL OF EVIDENCE: Ib, randomised clinical trial TRIAL REGISTRATION: German Clinical Trials Register, DRKS00024857 , registered on 25 March 2021-retrospectively registered, http://apps.who.int/trialsearch/.

Comparison of peripheral quantitative computed tomography forearm bone density versus DXA in rheumatoid arthritis patients and controls.

Rheumatoid arthritis (RA) has been associated with osteoporosis. Quantitative computed tomography (QCT) is capable of assessing bone density and composition. We found lower bone density in RA compared to controls. Age and RA duration influenced bone density. QCT may be useful to assess bone metabolism in RA. INTRODUCTION: RA is associated with generalized and periarticular osteoporosis. In addition to DXA that determines areal bone mineral density (BMD), peripheral QCT also detects volumetric BMD. QCT differentiates between total, trabecular, and cortical BMD. Here, we compared DXA and QCT in RA patients and healthy controls. METHODS: BMD of 57 female RA patients and 32 age-matched healthy female controls were assessed by DXA. QCT of the forearm ultradistal region was also performed. Densitometry data were correlated with age, disease duration, disease activity, serum CRP, and anti-CCP levels. RESULTS: Total bone density (310.4 ± 79.7 versus 354.0 ± 54.1 mg/cm3; p = 0.007) and attenuation (0.37 ± 0.05 versus 0.40 ± 0.03 1/cm; p = 0.001), trabecular density (157.6 ± 57.0 versus 193.8 ± 48.7 mg/cm3; p = 0.005) and attenuation (0.28 ± 0.03 versus 0.32 ± 0.04 1/cm; p < 0.0001), and cortical density (434.3 ± 115.8 versus 492.5 ± 64.0 mg/cm3; p = 0.006) and attenuation (0.44 ± 0.07 versus 0.47 ± 0.04 1/cm; p = 0.004) were significantly lower in RA. Both lumbar and femoral neck BMD, as well as T-scores, were significantly lower in RA versus controls (p < 0.001 in all cases). In RA, total and cortical QCT attenuation and density were associated with age, the presence of RA, and their combination. In contrast, trabecular density and attenuation were only affected by the presence of the disease but not by age. Also in RA, total trabecular and cortical density as determined by QCT significantly correlated with lumbar and/or femoral neck BMD as measured by DXA. Finally, anti-CCP seropositivity was associated with lower trabecular density and attenuation. CONCLUSIONS: Both DXA and QCT may be suitable to study bone metabolism in RA. Areal BMD determined by DXA may correlate with volumetric bone density measured by QCT. Moreover, trabecular osteoporosis may be associated by the underlying autoimmune-inflammatory disease, while cortical osteoporosis may rather be age-related.

Comparison of the kidney fungal burden in experimental disseminated candidiasis by species of the Candida parapsilosis complex treated with fluconazole, amphotericin B and caspofungin in a temporarily neutropenic murine model.

BACKGROUND: The efficacy of fluconazole (FLU), amphotericin B (AMB) and caspofungin (CAS) was tested against three Candida orthopsilosis, three C. metapsilosis and two C. parapsilosis sensu stricto isolates in neutropenic mice. METHODS: Mice were immunosuppressed by 200 mg/kg cyclophosphamide. Five-day intraperitoneal treatment was started 24 h after infection. Kidney burden was analyzed using the Kruskal-Wallis test. RESULTS: FLU 10 and 20 mg/kg as well as AMB 1 mg/kg significantly decreased the fungal burden (p < 0.05) for all eight isolates of the three species. CAS 2 and 5 mg/kg were efficacious against all C. orthopsilosis and C. metapsilosis isolates (p < 0.05), but only 5 mg/kg CAS was effective against C. parapsilosis isolates (p < 0.05). CONCLUSIONS: The efficacy of FLU and AMB against the three species was comparable. Though the activity of CAS was higher against C. orthopsilosis and C. metapsilosis, the current treatment guidelines for C. parapsilosis sensu stricto seem to be applicable to other 'psilosis' species.

First observation of two hyperfine transitions in antiprotonic He.

We report on the first experimental results for microwave spectroscopy of the hyperfine structure of p¯3He+. Due to the helium nuclear spin, p¯3He+ has a more complex hyperfine structure than p¯4He+, which has already been studied before. Thus a comparison between theoretical calculations and the experimental results will provide a more stringent test of the three-body quantum electrodynamics (QED) theory. Two out of four super-super-hyperfine (SSHF) transition lines of the (n,L)=(36,34) state were observed. The measured frequencies of the individual transitions are 11.12559(14) GHz and 11.15839(18) GHz, less than 1 MHz higher than the current theoretical values, but still within their estimated errors. Although the experimental uncertainty for the difference of these frequencies is still very large as compared to that of theory, its measured value agrees with theoretical calculations. This difference is crucial to be determined because it is proportional to the magnetic moment of the antiproton.

Efficacy of a single 6 mg/kg versus two 3 mg/kg caspofungin doses for treatment of disseminated candidiasis caused by Candida albicans in a neutropenic mouse model.

We compared the efficacy of single six mg/kg and 2x3 mg/kg caspofungin doses to the traditional one mg/kg daily against C. albicans in a neutropenic murine model. In lethality experiments, all regimens improved survival (p<0.0014 for all three isolates); differences among the treated groups were not statistically significant. We calculated kidney fungal burdens on each study day for six days postinfection using two isolates in two experiments. In the first three days, only the six mg/kg dose produced significant decrease on all study days (p<0.05-0.001), but differences between the three treatment arms disappeared by 4-6 days postinfection (p<0.05 for all isolates on all days).

Inhibition of cardiac leptin expression after infarction reduces subsequent dysfunction.

Leptin is known to exert cardiodepressive effects and to induce left ventricular (LV) remodelling. Nevertheless, the autocrine and/or paracrine activities of this adipokine in the context of post-infarct dysfunction and remodelling have not yet been elucidated. Therefore, we have investigated the evolution of myocardial leptin expression following myocardial infarction (MI) and evaluated the consequences of specific cardiac leptin inhibition on subsequent LV dysfunction. Anaesthetized rats were subjected to temporary coronary occlusion. An antisense oligodesoxynucleotide (AS ODN) directed against leptin mRNA was injected intramyocardially along the border of the infarct 5 days after surgery. Cardiac morphometry and function were monitored by echocardiography over 11 weeks following MI. Production of myocardial leptin and pro-inflammatory cytokines interleukin (IL)-1ß and IL-6 were assessed by ELISA. Our results show that (1) cardiac leptin level peaks 7 days after reperfused MI; (2) intramyocardial injection of leptin-AS ODN reduces early IL-1ß and IL-6 overexpression and markedly protects contractile function. In conclusion, our findings demonstrate that cardiac leptin expression after MI could contribute to the evolution towards heart failure through autocrine and/or paracrine actions. The detrimental effect of leptin could be mediated by pro-inflammatory cytokines such as IL-1ß and IL-6. Our data could constitute the basis of new therapeutic approaches aimed to improve post-MI outcome.

Liquid helium-free cryostat and hermetically sealed cryogenic microwave cavity for hyperfine spectroscopy of antiprotonic helium.

The design and properties of a new cryogenic set-up for laser-microwave-laser hyperfine structure spectroscopy of antiprotonic helium - an experiment performed at the CERN-Antiproton Decelerator (AD), Geneva, Switzerland - are described. Similar experiments for (4)He have been performed at the AD for several years. Due to the usage of a liquid helium operated cryostat and therefore necessary refilling of coolants, a loss of up to 10% beamtime occurred. The decision was made to change the cooling system to a closed-circuit cryocooler. New hermetically sealed target cells with minimised (3)He gas volume and different dimensions of the microwave resonator for measuring the (3)He transitions were needed. A new set-up has been designed and tested at Stefan Meyer Institute in Vienna before being used for the 2009 and 2010 beamtimes at the AD.

Synthesis of cold antihydrogen in a cusp trap.

We report here the first successful synthesis of cold antihydrogen atoms employing a cusp trap, which consists of a superconducting anti-Helmholtz coil and a stack of multiple ring electrodes. This success opens a new path to make a stringent test of the CPT symmetry via high precision microwave spectroscopy of ground-state hyperfine transitions of antihydrogen atoms.

Heterozygous disruption of Flk-1 receptor leads to myocardial ischaemia reperfusion injury in mice: application of affymetrix gene chip analysis.

This study addresses an important clinical issue by identifying potential candidates of vascular endothelial growth factor (VEGF) signalling through the Flk-1 receptor that trigger cardioprotective signals under ischaemic stress. Isolated working mouse hearts of both wild-type (WT) and Flk-1(+/-) were subjected to global ischaemia (I) for 30 min. followed by 2 hrs of reperfusion (R). Flk-1(+/-) myocardium displayed almost 50% reduction in Flk-1 mRNA as examined by quantitative real-time RT-PCR at the baseline level. Flk-1(+/-) mouse hearts displayed reduction in left ventricular functional recovery throughout reperfusion (dp/dt 605 versus 884), after 2 hrs (P<0.05). Coronary (1.9 versus 2.4 ml) and aortic flow (AF) (0.16 versus 1.2 ml) were reduced in Flk-1(+/-) after 2 hrs of reperfusion. In addition, increased infarct size (38.4%versus 28.41%, P<0.05) and apoptotic cardiomyocytes (495 versus 213) were observed in Flk-1(+/-) knockout (KO) mice. We also examined whether ischaemic preconditioning (PC), a novel method to induce cardioprotection against ischaemia reperfusion injury, through stimulating the VEGF signalling pathway might function in Flk-1(+/-) mice. We found that knocking down Flk-1 resulted in significant reduction in the cardioprotective effect by PC compared to WT. Affymetrix gene chip analysis demonstrated down-regulation of important genes after IR and preconditioning followed by ischaemia reperfusion in Flk-1(+/-) mice compared to WT. To get insight into the underlying molecular pathways involved in ischaemic PC, we determined the distinct and overlapping biological processes using Ingenuity pathway analysis tool. Independent evidence at the mRNA level supporting the Affymetrix results were validated using real-time RT-PCR for selected down-regulated genes, which are thought to play important roles in cardioprotection after ischaemic insult. In summary, our data indicated for the first time that ischaemic PC modifies genomic responses in heterozygous VEGFR-2/Flk-1 KO mice and abolishes its cardioprotective effect on ischaemic myocardium.

Determination of the antiproton-to-electron mass ratio by precision laser spectroscopy of pHe+.

A femtosecond optical frequency comb and continuous-wave pulse-amplified laser were used to measure 12 transition frequencies of antiprotonic helium to fractional precisions of (9-16)x10(-9). One of these is between two states having microsecond-scale lifetimes hitherto unaccessible to our precision laser spectroscopy method. Comparisons with three-body QED calculations yielded an antiproton-to-electron mass ratio of Mp/me=1836.152674(5).

Observation of cold, long-lived antiprotonic helium ions.

Cold, two-body antiprotonic helium ions p 4He2+ and p 3He2+ with 100-ns-scale lifetimes, occupying circular states with the quantum numbers ni=28-32 and li=ni-1 have been observed. They were produced by cooling three-body antiprotonic helium atoms in an ultra-low-density helium target at temperature T approximately 10 K by atomic collisions, and then removing their electrons by inducing a laser transition to an autoionizing state. The lifetimes of p 3He2+ against annihilation induced by collisions were shorter than those of p 4He2+, and decreased for larger-ni states.

Confinement of a large number of antiprotons and production of an ultraslow antiproton beam.

We have used a radio frequency quadrupole decelerator to decelerate antiprotons emerging from the CERN Antiproton Decelerator from MeV- to keV-scale energy, and collected five decelerated pulses in a multiring trap. Some 5 x 10(6) antiprotons were stacked in this way. Cooling of the trapped antiprotons by a simultaneously trapped electron plasma was studied nondestructively via shifts in plasma mode frequencies. We have also demonstrated the first step in extracting a 10-500 eV antiproton beam from the trap.

Direct measurement of transition frequencies in isolated pHe+ atoms, and new CPT-violation limits on the antiproton charge and mass.

A radio frequency quadrupole decelerator and achromatic momentum analyzer were used to decelerate antiprotons and produce p4He+ and p3He+ atoms in ultra-low-density targets, where collision-induced shifts of the atomic transition frequencies were negligible. The frequencies at near-vacuo conditions were measured by laser spectroscopy to fractional precisions of (6-19) x 10(-8). By comparing these with QED calculations and the antiproton cyclotron frequency, we set a new limit of 1 x 10(-8) on possible differences between the antiproton and proton charges and masses.

Hyperfine structure of antiprotonic helium revealed by a laser-microwave-laser resonance method.

Using a newly developed laser-microwave-laser resonance method, we observed a pair of microwave transitions between hyperfine levels of the (n,L)=(37,35) state of antiprotonic helium. This experiment confirms the quadruplet hyperfine structure arising from the interaction of the antiproton orbital angular momentum, the electron spin and the antiproton spin as predicted by Bakalov and Korobov. The measured frequencies of nu(+)(HF)=12.895 96+/-0.000 34 GHz and nu(-)(HF)=12.924 67+/-0.000 29 GHz agree with recent theoretical calculations on a level of 6x10(-5).

Primary populations of metastable antiprotonic (4)He and (3)He atoms.

Initial distributions of metastable antiprotonic (4)He and (3)He atoms over principal (n) and angular momentum (l) quantum numbers have been deduced using laser spectroscopy experiments. The regions n = 37-40 and n = 35-38 in the two atoms account for almost all of the observed fractions [(3.0 +/- 0.1)% and (2.4 +/- 0.1)%] of antiprotons captured into metastable states.

Sub-ppm laser spectroscopy of antiprotonic helium and a CPT-violation limit on the antiprotonic charge and mass.

Six laser-resonant transitions have been detected in metastable antiprotonic helium atoms produced at the CERN Antiproton Decelerator. They include UV transitions from the last metastable states in the v = n-l-1 = 0 and 1 cascades. Zero-density frequencies were obtained from measured pressure shifts with fractional precisions between 1.3 x 10(-7) and 1.6 x 10(-6). By comparing these with QED calculations and the antiproton cyclotron frequency, we deduce that the antiproton and proton charges and masses agree to within 6 x 10(-8) with a confidence level of 90%.

[Complications of laparoscopic cholecystectomy]. / Laparoszkópos cholecystectomiák szövódményei.

Number of bile duct injuries is rising with the spreading of laparoscopic cholecystectomy. Authors analyse the complications in the last 8 years, especially the bile duct injuries. During this period 1657 laparoscopic cholecystectomies were performed. Complication occurred in 28 cases during the intra- and postoperative period (1.68%). Main bile duct injury was detected in 7 cases (0.42%), while leakage from a Luschka's duct appeared in 10 patients. Three bleeding complications, 2 injuries of the duodenum and in 3 cases severe intraabdominal infection was observed. Four patients died (0.24%).

[Follow up examination of the endometrium during tamoxifen therapy]. / Az endometrium ellenörzése tamoxifen kezelés alatt.

Tamoxifen is a non-steroidal estrogen antagonist used mainly in the adjuvant therapy of breast cancer. Tamoxifen acts primarily as an antiestrogen, but also carries estrogenic effect, mainly to the endometrium. Although diverse pathological uterine findings has been described in connection with the long term use of this drug, there is no widely accepted protocol for the monitoring of the endometrium in these patients. All patients referred for gynecologic examination at the Department of Obstetrics and Gynecology University Medical School Debrecen, Hungary with previous treatment for breast cancer were involved in a screening programme. The gradual screening programme consists of: transvaginal sonography, color doppler imaging, hysteroscopy, and endometrial curettage or sampling. If any of the first steps proved to be negative, further evaluation could be avoided. Altogether 31 patients were referred for examination and transvaginal sonography alone excluded endometrial abnormality in 9 cases, while the rest of the patients went through further evaluation. The ratio of false positive results using transvaginal sonography alone was high and could be lowered with additional color doppler imaging. Endometrial pathology could be excluded in about 50% of cases without tissue sampling. Positive histology was found in 25% of patients receiving Tamoxifen. The most frequent pathological finding was endometrial polyp. In conclusion endometrial changes found by transvaginal sonography, should be further evaluated. The gradual screening procedures enable us to the proper use of more invasive procedures.