Goal: 03 - Sağlık ve Kaliteli Yaşam
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AMAÇ 3: SAĞLIKLI BİREYLER
Çocuk ölüm oranlarının azaltılması, anne sağlığının iyileştirilmesi, HIV/AIDS, sıtma ve diğer hastalıklar ile mücadelede büyük aşama kaydetmiş durumdayız. 1990 yılından bu yana, önlenebilir çocuk ölümlerinde dünya genelinde %50’yi aşan azalma olmuştur. Anne ölümleri de dünya genelinde %45 azalmıştır. 2000 ile 2013 arasında HIV/AIDS bulaşma oranı %30 azalmış, 6,2 milyonu aşkın insan sıtmadan kurtarılmıştır.
Bu ölümler; önleme ve tedavi, eğitim, aşı kampanyaları, cinsel ve üreme sağlığı hizmetleri vasıtasıyla önlenebilir. Sürdürülebilir Kalkınma Amaçları; AIDS, verem, sıtma ve diğer bulaşıcı hastalık salgınlarını 2030 yılına kadar ortadan kaldırmaya yönelik cesur bir taahhüttür. Amaç, herkesin genel sağlık hizmeti, güvenli ve erişilebilir ilaç ve aşıya kavuşmasını sağlamaktır. Aşı araştırma ve geliştirmelerinin desteklenmesi, bu sürecin vazgeçilmez bir parçasıdır.
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Publication Open Access An umbrella review of systematic reviews with meta-analyses evaluating positive and negative outcomes of hydroxychloroquine and chloroquine therapy.(2020-12-11T00:00:00Z) Celotto, Stefano; Veronese, Nicola; Barbagallo, Mario; Ometto, Francesca; Smith, Lee; Pardhan, Shahina; Barnett, Yvonne; Ilie, Petre Cristian; Soysal, PINAR; Lagolio, Erik; Kurotschka, Peter Konstantin; Tonelli, Roberto; Demurtas, Jacopo; SOYSAL, PINARBackground & aims: Hydroxychloroquine (HCQ) and chloroquine (CQ) are anti-malarial drugs frequently used in the rheumatologic field. They were recently identified as potential therapeutic options for Coronavirus Disease (COVID-19). The present study aims to map and grade the diverse health outcomes associated with HCQ/CQ using an umbrella review approach. Methods: Umbrella review of systematic reviews of observational and intervention studies. For observational studies, random-effects summary effect size, 95% confidence interval, and 95% prediction interval were estimated. We also assessed heterogeneity, evidence for small-study effect, and evidence for excess significance bias. The quality of evidence was then graded using validated criteria from highly convincing to weak. The evidence from randomized controlled trials (RCTs) was graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. Results: From 313 articles returned in the literature search, six meta-analyses were included (n = 25 outcomes). Among meta-analyses (MAs) of observational studies, HCQ/CQ are weakly associated with a reduced risk for cardiovascular events and diabetes when used for autoimmune diseases and with spontaneous abortion; they are also associated with a higher risk of death in COVID-19 patients. Among MAs of RCTs, HCQ/CQ are associated with an improvement of articular manifestations of rheumatic diseases. Conclusions: There is high evidence of the efficacy of HCQ/CQ in the rheumatologic field. The lack of evidence for efficacy and the risk of death associated with the use of HCQ/CQ for COVID-19 indicate the inappropriateness of their inclusion in recent COVID-19 therapy guidelines and the urgent need for RCTs to determine eventual appropriateness as a COVID-19 therapy. Keywords: COVID-19; Chloroquine; Hydroxychloroquine; umbrella review.Publication Open Access STEM CELLS FOR TREATMENT OF CARDIOVASCULAR DISEASES: AN UMBRELLA REVIEW OF RANDOMIZED CONTROLLED TRIALS.(2021-01-09T00:00:00Z) Demurtas, Jacopo; Fanelli, Giuseppe Nicolò; Romano, Simone Lorenzo; Solari, Marco; Yang, Lin; Soysal, Pınar; Sánchez, Guillermo F López; Grabovac, Igor; Smith, Lee; Zorzi, Alessandro; Luchini, Claudio; Veronese, Nicola; SOYSAL, PINARAIMS Stem cells are a promising therapy for various medical conditions. The literature regarding their adoption for the clinical care of cardiovascular diseases (CVD) is still conflicting. Therefore, our aim is to assess the strength and credibility of the evidence on clinical outcomes and application of stem cells derived from systematic reviews and meta-analyses of intervention studies in CVD. METHODS and RESULTS Umbrella review of systematic reviews with meta-analyses of randomized controlled trials (RCTs) using placebo/no intervention as control group. For meta-analyses of RCTs, outcomes with a random-effect p-value< 0.05, the GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment was used, classifying the evidence from very low to high. From 184 abstracts initially identified, 11 meta-analyses (for a total of 34 outcomes) were included. Half of the outcomes were statistically significant (p < 0.05), indicating that stem cells are more useful than placebo. High certainty of evidence supports the associations of the use of stem cells with a better left ventricular end systolic volume and left ventricular ejection fraction (LVEF) in acute myocardial infarction; improved exercise time in refractory angina; a significant lower risk of amputation rate in critical limb ischemia; a higher successful rate in complete healing in case of lower extremities ulcer; and better values of LVEF in systolic heart failure, as compared to placebo. CONCLUSION and RELEVANCE The adoption of stem cells in clinical practice is supported by a high certainty of strength in different CVD, with the highest strength in acute myocardial infarction and refractory angina.Publication Open Access What is the Optimal Body Mass Index Range for Older Adults?(2022-03-01T00:00:00Z) Kıskaç, Muharrem; Soysal, PINAR; Smith, Lee; Capar, Emre; Zorlu, Mehmet; SOYSAL, PINARBackground: Obesity is pathophysiologically complex in older adults compared to that in young and middle-aged adults. The aim of the present study was to determine the appropriate body mass index (BMI) range based on geriatric evaluation parameters in which complications can be minimized in older adults. Methods: A total of 1,051 older adult patients who underwent comprehensive geriatric assessment were included. The patients’ demographic characteristics, comorbid diseases, number of drugs, BMI, basic and instrumental activities of daily living (BADL and IADL), Tinetti balance and walking scale, Mini Nutritional Assessment, Geriatric Depression Scale-15, Mini-Mental State Examination, Time Up and Go test, and handgrip strength measurement were extracted from patient records. Results: Of the patients who took part, 73% were female, and the mean age was 77.22±7.10 years. The most negative results were observed in those with a BMI <25 kg/m2 and in those with a BMI >35 kg/m2 . Receiver operating characteristic (ROC) analysis of the optimum BMI cutoff levels to detect the desirable values of geriatric assessment parameters was found to be 31–32 and 27–28 kg/m2 for female and male, respectively. Conclusion: Older adults with BMI <25 and >35 kg/m2 were at a higher risk of a decrease in functional capacity, and experienced gait and balance problems, fall risk, decrease in muscle strength, and malnutrition. Data from this study suggest that the optimum range of BMI levels for older adults is 31–32 and 27–28 kg/m2 for female and male, respectively.Publication Open Access Associations between recently diagnosed conditions and hospitalization due to COVID-19 in patients aged 50 years and older- A SHARE-based analysis.(2021-07-12T00:00:00Z) López-Bueno, Rubén; Torres-Castro, Rodrigo; Koyanagi, Ai; Smith, Lee; Soysal, PINAR; Calatayud, Joaquín; SOYSAL, PINARBackground: Only a few studies have been carried out with a large sample size on the relationship between chronic conditions and hospitalization for coronavirus disease 2019 (COVID-19), and there is no research examining recently diagnosed conditions. Our purpose was to evaluate this association in a large sample including the older population from Europe and Israel. Method: Data from the Survey of Health, Ageing and Retirement in Europe COVID-19 Survey, a representative survey of individuals aged 50 or older residing in 27 European countries and Israel, were retrieved. Associations between recently diagnosed chronic conditions (ie, conditions detected over the last 3 years) (exposure) and hospitalization due to COVID-19 (outcome) were assessed using multivariable logistic regression. Results: A total of 51 514 participants on average 71.0 (SD = 9.2) years old were included. Participants with multimorbidity (ie, 2 or more recently diagnosed conditions) had significantly higher odds for COVID-19 hospitalization (adjusted odds ratio [AOR] = 3.91 [95% CI = 2.14-7.12]). Independent conditions such as lung disease (AOR = 16.94 [95% CI = 9.27-30.95]), heart disease (AOR = 3.29 [95% CI = 1.50-7.21]), or cancer (AOR = 3.45 [95% CI = 1.26-9.48]) showed particularly high odds for hospitalization due to COVID-19. Conclusions: People with recently diagnosed diseases, and in particular those having lung disease, heart disease, or cancer, were significantly more likely to be hospitalized for COVID-19.Publication Open Access The Association Between Sedentary Behavior and Sarcopenia Among Adults Aged >= 65 Years in Low- and Middle-Income Countries(2020-03-01T00:00:00Z) Smith, Lee; Tully, Mark; Jacob, Louis; Blackburn, Nicole; Adlakha, Deepti; Caserotti, Paolo; SOYSAL, PINAR; Veronese, Nicola; Lopez Sanchez, Guillermo F.; Vancampfort, Davy; Koyanagi, Ai; SOYSAL, PINARThe present study aimed to assess the association between sedentary behavior and sarcopenia among adults aged >= 65 years. Cross-sectional data from the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Self-reported sedentary behavior was assessed as a continuous variable (hours per day) and also as a categorical variable (0-= 11 hours/day). Multivariable logistic regression was conducted to assess the association between sedentary behavior and sarcopenia. Analyses using the overall sample and country-wise samples were conducted. A total of 14,585 participants aged >= 65 years were included in the analysis. Their mean age was 72.6 (standard deviation, 11.5) years and 55% were females. Compared to sedentary behavior of 0-= 11 hours/day was significantly associated with 2.14 (95% CI = 1.06-4.33) times higher odds for sarcopenia. The country-wise analysis showed that overall, a one-hour increase in sedentary behavior per day was associated with 1.06 (95% CI = 1.04-1.10) times higher odds for sarcopenia, while the level of between-country heterogeneity was low (I-2 = 12.9%). Public health and healthcare practitioners may wish to target reductions in sedentary behavior to aid in the prevention of sarcopenia in older adults.Publication Open Access Association between sarcopenia and diabetes: a systematic review and meta-analysis of observational studies(2019-10-01) Veronese, Nicola; Pizzol, Damiano; Demurtas, Jacopo; Smith, Lee; Sieber, Cornel; Strandberg, Timo; Bourdel-Marchasson, Isabelle; Sinclair, Alan; Petrovic, Mirko; Maggi, Stefania; SOYSAL, PINARAbstract Purpose Sarcopenia and diabetes are two common conditions in older people. Some recent literature has proposed that these two conditions can be associated. However, to date, no attempt has been made to collate this literature. Therefore, we aimed to summarize the prevalence of sarcopenia in diabetes (and vice versa) and the prevalence of sarcopenia in people with diabetes complications, through a systematic review and meta-analysis. Methods Two authors searched major electronic databases from inception until March 2019 for case control/cross-sectional/longitudinal studies investigating sarcopenia and diabetes. The strength of the reciprocal associations between sarcopenia and diabetes was assessed through odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for potential confounders, where possible. Results From 953 potential eligible articles, 20 were included in the systematic review, with 17 providing data for meta-analysis. Overall, 54,676 participants were included (mean age = 65.4 years). Diabetic participants had an increased prevalence of sarcopenia compared to controls (n = 10; OR = 1.635; 95% CI 1.204-2.220; p = 0.002; I-2 = 67%), whilst, after adjusting for potential confounders, sarcopenia was associated with an increased odds of having diabetes (OR = 2.067; 95% CI 1.396-3.624; p < 0.0001; I-2 = 0%). In 1868 diabetic participants with a complication, there was an increased prevalence of sarcopenia (OR = 2.446; 95% CI 1.839-3.254; p < 0.0001; I-2 = 0%), as compared with those with no complication. Very limited data existed regarding studies with a longitudinal design. Conclusions Our study suggests a bidirectional association between diabetes and sarcopenia, particularly when diabetic complications are present.Publication 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 Cognitive and metabolic outcomes of vildagliptin addition to the therapy in patients with type 2 diabetes mellitus: 26 week follow-up study(2020-05-01T00:00:00Z) Bulut, Esra Ates; Alak, Zehra Yagmur Sahin; Dokuzlar, Ozge; Kocyigit, Suleyman Emre; SOYSAL, PINAR; Smith, Lee; IŞIK, AHMET TURAN; SOYSAL, PINARAims: Type 2 Diabetes Mellitus(DM) is a well-known risk factor for cognitive impairment. Recent evidences suggest that Dipeptidyl peptidase-4(DPP-4) inhibitors might have neuroprotective effects. Therefore, this study aimed to investigate vildagliptin, a DPP-4 inhibitor, effects on cognitive function in older patients with DM.Publication Open Access Associations between cataract and multimorbidity: a cross-sectional study of 23,089 adults from Spain(2020-05-13T04:00:00Z) Jacob, Louis; Lopez-Sanchez, Guillermo F.; Yang, Lin; Maria Haro, Josep; Shin, Jae Ii; Veronese, Nicola; SOYSAL, PINAR; Gorely, Trish; Koyanagi, Ai; Smith, Lee; SOYSAL, PINARBackground Little is known about the association between cataract and multimorbidity. Therefore, the aim of the present study was to examine the relationship between cataract and chronic conditions and multimorbidity in a large representative sample of Spanish adults. Methods This study used data from the Spanish National Health Survey 2017, a cross-sectional sample of 23,089 adults aged >= 15 years from Spain [54.1% female; mean (standard deviation) age 53.4 (18.9) years]. Cataract and 30 other physical and mental chronic conditions were self-reported. Multimorbidity was defined as the presence of at least two physical and/or mental chronic conditions (excluding cataract). Control variables included sex, age, marital status, education, smoking, and alcohol consumption. Multivariable logistic and negative binomial regression analyzes were conducted to assess associations. Results The prevalence of cataract and multimorbidity was 12.5% and 56.5%, respectively. All chronic conditions were significantly more frequent in individuals with than in those without cataract. Overall, there was a positive relationship between cataract and multimorbidity [odds ratio (OR) = 2.77; 95% confidence interval (CI): 2.39-3.21]. In addition, cataract was significantly associated with the number of chronic conditions in the whole population [incidence rate ratio (IRR) = 1.34; 95% CI: 1.29-1.38]. Conclusions Cataract is positively associated with chronic conditions and multimorbidity in adults. Interventions specifically designed for those with cataract to reduce or manage co-occurring chronic conditions and multimorbidity are urgently required.Publication Open Access The Effects of COVID-19 lockdown on neuropsychiatric symptoms in patients with dementia or mild cognitive impairment: A systematic review and meta-analysis.(2022-02-06T00:00:00Z) Soysal, PINAR; Smith, Lee; Trott, Mike; Alexopoulos, Panagiotis; Barbagallo, Mario; Tan, Semen Gokce; Koyanagi, Ai; Shenkin, Susan; Veronese, Nicola; SOYSAL, PINARThe COVID-19 pandemic may have a disproportionate impact on people with dementia/mild cognitive impairment (MCI) due to isolation and loss of services. The aim of this systematic review was to investigate the effects of the COVID-19 lockdown on neuropsychiatric symptoms (NPS) in people living with dementia/MCI. Two authors searched major electronic databases from inception to June 2021 for observational studies investigating COVID-19 and NPS in people with dementia/MCI. Summary estimates of mean differences in NPS scores pre- versus post-COVID-19 were calculated using a random-effects model, weighting cases using inverse variance. Study quality and risk of bias were assessed by the Newcastle-Ottawa Scale. From 2730 citations, 21 studies including 7139 patients (60.0% female, mean age 75.6 ± 7.9 years, 4.0% MCI) with dementia were evaluated in the review. Five studies found no changes in NPS, but in all other studies, an increase in at least one NPS or the pre-pandemic Neuropsychiatric Inventory (NPI) score was found. The most common aggravated NPS were depression, anxiety, agitation, irritability, and apathy during lockdown, but 66.7% of the studies had a high bias. Seven studies including 420 patients (22.1% MCI) yielded enough data to be included in the meta-analysis. The mean follow-up time was 5.9 ± 1.5 weeks. The pooled increase in NPI score before compared to during COVID-19 was 3.85 (95% CI:0.43 to 7.27; P = 0.03; I2 = 82.4%). All studies had high risk of bias. These results were characterized by high heterogeneity, but there was no presence of publication bias. There is an increase in the worsening of NPS in people living with dementia/MCI during lockdown in the COVID pandemic. Future comparative studies are needed to elucidate whether a similar deterioration might occur in people without dementia/MCI.