Goal: 16 - Barış, Adalet ve Güçlü Kurumlar
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Barış, Adalet ve Güçlü Kurumlar
Sürdürülebilir kalkınma için barışçıl ve kapsayıcı toplumlar tesis etmek, herkes için adalete erişimi sağlamak ve her düzeyde etkili, hesap verebilir ve kapsayıcı kurumlar oluşturmak.
Barış, istikrar, insan hakları ve hukukun üstünlüğüne dayalı etkin yönetim olmadan, sürdürülebilir kalkınma olmasını bekleyemeyiz. Gittikçe artan ölçüde bölünmüş bir dünyada yaşıyoruz. Bazı bölgelerde barış, güvenlik ve refah sürekli iken, diğer bazı bölgelerde ise bitmek bilmeyen çatışma ve şiddet sarmalı var. Ancak bu, hiçbir şekilde kaçınılmaz sonuç değildir ve mutlaka çözümlenmelidir.
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Publication Open Access Orthostatic hypotension and health outcomes: an umbrella review of observational studies(2019-11-07) Veronese, Nicola; Smith, Lee; Torbahn, Gabriel; Jackson, Sarah E.; Yang, Lin; SOYSAL, PINAR; Rivasi, Giulia; Rafanelli, Martina; Petrovic, Mirko; Maggi, Stefania; Isik, Ahmet Turan; Demurtas, Jacopo; SOYSAL, PINARPurpose Orthostatic hypotension (OH) is associated with older age and many negative clinical outcomes in geriatric practice. We aimed to capture the breadth of outcomes that have been associated with the presence of OH and systematically assess the quality, strength and credibility of these associations using an umbrella review with integrated meta-analyses. Methods We systematically searched several major databases from their commencements through to 16th May 2019 for meta-analyses of observational studies of OH and any health-related outcome. We used these metrics to categorize the strength of evidence of significant outcomes (p < 0.05) from class I (convincing) to class IV (weak), according to the pre-established criteria. Results From 975 abstracts, seven meta-analyses of 12 outcomes were included. For each outcome, the median number of studies was four, and the median number of participants was 46,493, with a median of 3630 incident cases. There was suggestive (class III) evidence that OH was associated with significantly higher risk of coronary heart disease (HR = 1.32, 95% CI 1.12-1.56), stroke (HR = 1.22, 95% CI 1.08-1.38), congestive heart failure (HR = 1.30, 95% CI 1.09-1.55), all-cause mortality (RR = 1.50, 95% CI 1.24-1.81), falls (OR = 1.84, 95% CI 1.39-2.44), and dementia (HR = 1.22, 95% CI 1.11-1.35). Conclusion The current evidence base indicates that OH is significantly associated with a range of adverse cardiovascular, cognitive, and mortality outcomes in older people, although the strength of this evidence remains only suggestive. Further research in larger samples and with lower risk of bias is required to build a fuller picture of the impact of OH on health.Publication Metadata only Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis(2016-12-01T00:00:00Z) Soysal, PINAR; Isik, Ahmet Turan; Stubbs, Brendon; Solmi, Marco; Volpe, Marco; Luchini, Claudio; D'Onofrio, Grazia; Pilotto, Alberto; Manzato, Enzo; Sergi, Giuseppe; Schofield, Patricia; Veronese, Nicola; SOYSAL, PINARWe conducted a systematic review and meta-analysis investigating the influence of acetylcholinesterase inhibitors (AChEIs) therapy on nutritional status and weight across observational and interventional studies. Two authors searched major electronic databases from inception until 10/14/2015 for longitudinal, open-label and randomised double-blind placebo controlled (randomised controlled trials (RCTs)) studies of AChEIs in patients with dementia reporting nutritional status outcome data. Out of 3551 initial hits, 25 studies (12 open-label trials, 9 RCTs and 4 longitudinal studies) including 10 792 patients with dementia were metaanalysed. In longitudinal studies (median follow-up 6 months), a significant cumulative incidence of weight loss between baseline and follow-up evaluation was observed (studies= 2; 5%; 95% CI 1% to 34%, p< 0.0001; I2= 95%). These findings were confirmed in open-label trials (6%; 95% CI 4% to 7%, p< 0.0001; I-2= 78%). In 9 RCTs (median followup 5 months), those taking AChEIs more frequently experienced weight loss than participants taking placebo (OR= 2.18; 95% CI 1.50 to 3.17, p< 0.0001; I-2= 29%). AChEIs therapy contributes to weight loss in patients with dementia, with a 2-fold increased risk observed in the meta-analysis of RCTs. Clinicians should carefully consider the benefit and risk of prescribing AChEIs. Nutritional status should be routinely evaluated in patients with dementia treated with AChEIs.Publication Open Access Association between urinary incontinence and frailty: a systematic review and meta-analysis(2018-10-01T00:00:00Z) Veronese, Nicola; SOYSAL, PINAR; Stubbs, Brendon; Marengoni, Alessandra; Demurtas, Jacopo; Maggi, Stefania; Petrovic, Mirko; Verdejo-Bravo, Carlos; SOYSAL, PINARPurposeUrinary incontinence (UI) and frailty are common geriatric syndromes. Although literature increasingly supports a relationship between these two conditions, no systematic review and meta-analysis has been performed on this topic. Therefore, we aimed to investigate the potential association between UI and frailty, through a meta-analytic approach.MethodsA systematic search in major databases was undertaken until 15th March 2018 for studies reporting the association between UI and frailty. The prevalence of UI in people with frailty (vs. those without) was pooled through an odds ratio (OR) and 95% confidence intervals (CIs), with a random-effects model. The other outcomes were summarized descriptively.ResultsAmong 828 papers, 11 articles were eligible, including 3784 participants (mean age 78.2years; 55.1% women). The prevalence of UI was 39.1% in people with frailty and 19.4% in those without. A meta-analysis with five studies (1540 participants) demonstrated that UI was over twice as likely in frail people versus those without (OR 2.28; 95% CI 1.35-3.86; I-2=61%). One cross-sectional study, adjusting for potential confounders and one longitudinal study confirmed that UI is significantly associated with frailty. In two cross-sectional studies, using adjusted analyses, frailty was more common in people with UI.ConclusionUrinary incontinence is twice as common in older people with frailty compared to older people without frailty. Screening and the development of interventions for UI and frailty could prove useful for this common comorbidity.Publication Open Access Dietary Protein Intake and Falls in Older People: Longitudinal Analyses From the Osteoarthritis Initiative(2019-05-01) SOYSAL, PINAR; Veronese, Nicola; STUBBS, Brendon; Maggi, Stefania; Jackson, Sarah E; DEMURTAS, Jacopo; Celotto, S.; KOYANAGI, AI; Bolzetta, F.; Smith, Lee; SOYSAL, PINARPublication Open Access Sarcopenia and health-related outcomes: an umbrella review of observational studies(2019-12-01) Veronese, Nicola; Demurtas, Jacopo; SOYSAL, PINAR; Smith, Lee; Torbahn, Gabriel; Schoene, Daniel; Schwingshackl, Lukas; Sieber, Cornel; Bauer, Jurgen; Cesari, Matteo; Bruyere, Oliviere; Reginster, Jean-Yves; Beaudart, Charlotte; Cruz-Jentoft, Alfonso J.; Cooper, Cyrus; Petrovic, Mirko; Maggi, Stefania; SOYSAL, PINARKey summary pointsAimTo investigate associations of sarcopenia with adverse health-related outcomes, through an umbrella review method.FindingsSarcopenia appears to be significantly associated with several adverse outcomes in older people, with a strong evidence for increased risk of mortality, disability, and falls.MessageSarcopenia is associated with several adverse health-related outcomes in older people, indicating the need of assessing this condition in daily practice. AbstractBackgroundThe clinical relevance of sarcopenia has increasingly been recognized. However, whether it is associated with the development of other medical conditions is still unclear. Therefore, we aimed to capture the scale of outcomes that have been associated with the presence of sarcopenia and systematically assess the quality, strength, and credibility of these associations using an umbrella review methodology.MethodsA systematic review in several databases was carried out, until 20th February 2019. For each association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity (I-2), evidence for small-study effect, evidence for excess significance bias, and 95%-prediction intervals were estimated. We used these metrics to categorize the evidence of significant outcomes (p<0.05) from class I (convincing) to class IV (weak), according to pre-established criteria.ResultsFrom 358 abstracts, 6 meta-analyses with 14 associations were included. Sarcopenia was associated with higher risk of other comorbidities and mortality in 11 of 14 outcomes explored. However, only 3 outcomes (i.e., association between sarcopenia and increased risk of death in community-dwelling older people [odds ratio, OR=3.60; 95% CI 2.96-4.37; n=14,305], disability [OR=3.04; 95% CI 1.80-5.12; n=8569], and falls [OR=1.60; 95% CI 1.31-1.97; n=12,261]) presented a highly suggestive evidence (class II). Other association was classified as having only a weak evidence.ConclusionSarcopenia is associated with several adverse health-related outcomes in older people, and its associations with mortality, disability, and falls are supported by a highly suggestive evidence. The effect of interventions on sarcopenia to improve these outcomes needs to be investigated.Publication Open Access Prospective associations between alcohol use, binge drinking and sexual activity in older adults: the English Longitudinal Study Of Ageing(2019-11-08) Grabovac, Igor; Koyanagi, Ai; Yang, Lin; SOYSAL, PINAR; McDermott, Daragh; Isik, Ahmet Turan; Veronese, Nicola; Smith, Lee; SOYSAL, PINARThe present study aimed to investigate associations between alcohol consumption and sexual activity. Data were from 1,622 men and 2,195 women aged >= 50 years participating in the English Longitudinal Study of Ageing. Adjusted multivariable logistic regression was used to assess associations between baseline frequency of alcohol use in the last year or binge drinking in the last week and sexual activity at 8-year follow-up. Regular alcohol consumption in the last year at baseline was associated with 111% higher odds (95% CI 1.36-3.27) of any past-year sexual activity at follow-up in men and 76% higher odds (95% CI 1.26-2.46) in women. Frequent alcohol consumption was associated with 175% higher odds (95% CI 1.75-4.32) of sexual activity in men and 100% higher odds (95% CI 1.38-2.89) in women, relative to drinking alcohol never or rarely. Binge drinking was positively associated with sexual activity at follow-up, with odds of being sexually active at follow-up 52% higher (95% CI 1.07-2.15) among men who reported binge drinking at baseline and 57% higher (95% CI 1.11-2.23) among females. These findings do not outweigh the health risks associated with excessive alcohol consumption. Health practitioners should consider these findings when encouraging older adults to reduce their alcohol consumption.