Person: SOYSAL, PINAR
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Publication Open Access Association between physical multimorbidity and sleep problems in 46 low-and middle-income countries(2022-06-01T00:00:00Z) Smith, Lee; Il Shin, Jae; Jacob, Louis; Schuch, Felipe; Oh, Hans; Tully, Mark A.; Lopez Sanchez, Guillermo F.; Veronese, Nicola; SOYSAL, PINAR; Yang, Lin; Butler, Laurie; Barnett, Yvonne; Koyanagi, Ai; SOYSAL, PINARBackground: Little is known about the association between multimorbidity (i.e., two or more chronic conditions) and sleep problems in the general adult populations of low- and middle-income countries (LMICs). Thus, we aimed to assess this association among adults from 46 LMICs, and to quantify the extent to which anxiety, depression, stress, and pain explain this association. Methods: Cross-sectional, predominantly nationally representative, community-based data from the World Health Survey were analyzed. Nine chronic physical conditions (angina, arthritis, asthma, chronic back pain, diabetes, edentulism, hearing problems, tuberculosis, visual impairment) were assessed. To be included in the analysis, sleep problems had to have been experienced in the past 30 days and to have been severe or extreme; they included difficulties falling asleep, waking up frequently during the night or waking up too early in the morning. Multivariable logistic regression and mediation analyses were conducted to explore the associations. Results: Data on 237,023 individuals aged ≥18 years [mean (SD) age 38.4 (16.0) years; 49.2% men] were analyzed. Compared with no chronic conditions, having 1, 2, 3, and ≥4 conditions was associated with 2.39 (95%CI=2.14, 2.66), 4.13 (95%CI=3.62, 4.71), 5.70 (95%CI=4.86, 6.69), and 9.99 (95%CI=8.18, 12.19) times higher odds for sleep problems. Pain (24.0%) explained the largest proportion of the association between multimorbidity and sleep problems, followed by anxiety (21.0%), depression (11.2%), and stress (10.4%). Conclusions: Multimorbidity was associated with a substantially increased odds for sleep problems in adults from 46 LMICs. Future studies should assess whether addressing factors such as pain, anxiety, depression,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 Metadata only Body mass index categories and anxiety symptoms among adults aged ≥ 50 years from low and middle income countries.(2021-10-18T00:00:00Z) Smith, Lee; Pizzol, Damiano; López-Sánchez, Guillermo F; Oh, Hans; Jacob, Louis; Yang, Lin; Veronese, Nicola; Soysal, PINAR; McDermott, Daragh; Barnett, Yvonne; Butler, Laurie; Koyanagi, Ai; SOYSAL, PINARPublication 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 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 Excessive daytime sleepiness is associated with an increased frequency of falls and sarcopenia.(2021-04-20T00:00:00Z) Soysal, PINAR; Smith, Lee; Tan, Semen Gokce; Capar, Emre; Veronese, Nicola; Yang, Lin; SOYSAL, PINARPublication Metadata only Anxiety symptoms among informal caregivers in 47 low- and middle-income countries: a cross-sectional analysis of community-based surveys.(2021-11-14T00:00:00Z) Smith, Lee; Shin, Jae Il; Oh, Hans; López Sánchez, Guillermo F; Underwood, Benjamin; Jacob, Louis; Veronese, Nicola; Soysal, PINAR; Butler, Laurie; Barnett, Yvonne; Tully, Mark A; Koyanagi, Ai; SOYSAL, PINARPublication 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 Metadata only Body Mass Index and Mild Cognitive Impairment Among Middle-Aged and Older Adults from Low- and Middle-Income Countries.(2021-12-10T00:00:00Z) Smith, Lee; Shin, Jae Il; Oh, Hans; Carmichael, Christina; Jacob, Louis; Stefanac, Sinisa; Lindsay, Rosie K; Soysal, PINAR; Veronese, Nicola; Tully, Mark A; Butler, Laurie; Barnett, Yvonne; Koyanagi, Ai; SOYSAL, PINARBackground: The effect of weight modification on future dementia risk is currently a subject of debate and may be modified by age. Objective: The aim of the present study was to investigate the association between body mass index (BMI) status with mild cognitive impairment (MCI) (a preclinical stage of dementia) in middle-aged and older adults residing in six low- and middle-income countries using nationally representative data. Methods: Cross-sectional data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. BMI (kg/m2) was based on measured weight and height and categorized as: underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). Multivariable logistic regression analysis and meta-analysis were conducted to assess associations. Results: Data on 32,715 individuals aged ≥50 years with preservation in functional abilities were analyzed [mean (SD) age 62.1 (15.6) years; 51.7% females]. Among those aged 50-64 years, compared to normal weight, underweight (OR = 1.44; 95% CI = 1.14-1.81), overweight (OR = 1.17; 95% CI = 1.002-1.37), and obesity (OR = 1.46; 95% CI = 1.09-1.94) were all significantly associated with higher odds for MCI. In those aged ≥65 years, underweight (OR = 0.71; 95% CI = 0.54-0.95) and overweight (OR = 0.72; 95% CI = 0.55-0.94) were associated with significantly lower odds for MCI, while obesity was not significantly associated with MCI. Conclusion: The results of the study suggest that the association between BMI and MCI is likely moderated by age. Future longitudinal studies are required to confirm or refute the present findings before recommendations for policy and practice can be made.Publication Open Access Physical activity and exercise in dementia: an umbrella review of intervention and observational studies(2020-12-26T00:00:00Z) Demurtas, Jacopo; Schoene, Daniel; Torbahn, Gabriel; Petrovic, Mirko; Maggi, Stefania; Marengoni, Alessandra; Cesari, Matteo; Lamb, Sarah; Soysal, Pınar; Sieber, Cornel; Shenkin, Susan; Grande, Giulia; Schwingshack, Lukas; Smith, Lee; Veronese, Nicola; SOYSAL, PINARObjectives The aim of this umbrella review was to determine the effect of physical activity/exercise on improving cognitive and noncognitive outcomes in people with MCI (mild cognitive impairment) and dementia. Design Umbrella review of systematic reviews (SR), with or without meta-analyses (MAs), of randomized controlled trials (RCTs) and observational studies. Settings and Participants People with MCI or dementia, confirmed through validated assessment measures. Any form of physical activity/exercise was included. As controls, we included participants not following any prespecified physical activity/exercise intervention or following the same standard protocol with the intervention group. Methods The protocol was registered in PROSPERO (CDR 164197). Major databases were searched until December 31, 2019. The certainty of evidence of statistically significant outcomes was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. SRs' findings, without a formal MA, were reported descriptively. Results Among 1160 articles initially evaluated, 27 SRs (all of RCTs, 9 without MA) for a total of 28,205 participants with MCI/dementia were included. In patients with MCI, mind-body intervention (standardized mean difference [SMD] = 0.36; 95% confidence intervals [CI] 0.20–0.52; low certainty) and mixed physical activity interventions (SMD = 0.30; 95% CI 0.11–0.49; moderate certainty) had a small effect on global cognition, whereas resistance training (SMD = 0.80; 95% CI 0.29–1.31; very low certainty) had a large effect on global cognition. In people affected by dementia, physical activity/exercise was effective in improving global cognition in Alzheimer disease (SMD = 1.10; 95% CI 0.65–1.64; very low certainty) and in all types of dementia (SMD = 0.48; 95% CI 0.22–0.74; low certainty). Finally, physical activity/exercise improved noncognitive outcomes in people with dementia including falls, and neuropsychiatric symptoms. Conclusions and Implications Supported by very low-to-moderate certainty of evidence, physical activity/exercise has a positive effect on several cognitive and noncognitive outcomes in people with MCI and dementia, but RCTs, with low risk of bias/confounding, are still needed to confirm these relationships.