Definition: To what extent does the study allow us to draw conclusions about a causal effect between two or more constructs? Issues: Selection, maturation, history, mortality, testing, regression towrd the mean, selection by maturation, treatment by mortality, treatment by testing, measured treatment variables Increase: Eliminate the threats, above all do experimental manipulations, random assignment, and counterbalancing.

Reliability and validity

Growth differentiation factor 11 (GDF11) and myostatin (or GDF8) are closely related members of the transforming growth factor β superfamily and are often perceived to serve similar or overlapping roles. Yet, despite commonalities in protein sequence, receptor utilization and signaling, accumulating evidence suggests that these 2 ligands can have distinct functions in many situations. GDF11 is essential for mammalian development and has been suggested to regulate aging of multiple tissues, whereas myostatin is a well-described negative regulator of postnatal skeletal and cardiac muscle mass and modulates metabolic processes. In this review, we discuss the biochemical regulation of GDF11 and myostatin and their functions in the heart, skeletal muscle, and brain. We also highlight recent clinical findings with respect to a potential role for GDF11 and/or myostatin in humans with heart disease. Finally, we address key outstanding questions related to GDF11 and myostatin dynamics and signaling during development, growth, and aging.

Biochemistry and Biology of GDF11 and Myostatin: Similarities, Differences, and Questions for Future Investigation.

There has been a rapid escalation of type 2 diabetes (T2D) in developing countries, with varied prevalence according to rural vs urban habitat and degree of urbanization. Some ethnic groups (eg, South Asians, other Asians, and Africans), develop diabetes a decade earlier and at a lower body mass index than Whites, have prominent abdominal obesity, and accelerated the conversion from prediabetes to diabetes. The burden of complications, both macro- and microvascular, is substantial, but also varies according to populations. The syndemics of diabetes with HIV or tuberculosis are prevalent in many developing countries and predispose to each other. Screening for diabetes in large populations living in diverse habitats may not be cost-effective, but targeted high-risk screening may have a place. The cost of diagnostic tests and scarcity of health manpower pose substantial hurdles in the diagnosis and monitoring of patients. Efforts for prevention remain rudimentary in most developing countries. The quality of care is largely poor; hence, a substantial number of patients do not achieve treatment goals. This is further amplified by a delay in seeking treatment, "fatalistic attitudes", high cost and non-availability of drugs and insulins. To counter these numerous challenges, a renewed political commitment and mandate for health promotion and disease prevention are urgently needed. Several low-cost innovative approaches have been trialed with encouraging outcomes, including training and deployment of non-medical allied health professionals and the use of mobile phones and telemedicine to deliver simple health messages for the prevention and management of T2D.

Diabetes in developing countries

Abstract Objectives To identify data availability, gaps, and patterns for population level prevalence of loneliness globally, to summarise prevalence estimates within World Health Organization regions when feasible through meta-analysis, and to examine temporal trends of loneliness in countries where data exist. Design Systematic review and meta-analysis. Data sources Embase, Medline, PsycINFO, and Scopus for peer reviewed literature, and Google Scholar and Open Grey for grey literature, supplemented by backward reference searching (to 1 September 2021) Eligibility criteria for selecting studies Observational studies based on nationally representative samples (n≥292), validated instruments, and prevalence data for 2000-19. Two researchers independently extracted data and assessed the risk of bias using the Joanna Briggs Institute checklist. Random effects meta-analysis was conducted in the subset of studies with relatively homogeneous research methods by measurement instrument, age group, and WHO region. Results Prevalence data were available for 113 countries or territories, according to official WHO nomenclature for regions, from 57 studies. Data were available for adolescents (12-17 years) in 77 countries or territories, young adults (18-29 years) in 30 countries, middle aged adults (30-59 years) in 32 countries, and older adults (≥60 years) in 40 countries. Data for all age groups except adolescents were lacking outside of Europe. Overall, 212 estimates for 106 countries from 24 studies were included in meta-analyses. The pooled prevalence of loneliness for adolescents ranged from 9.2% (95% confidence interval 6.8% to 12.4%) in South-East Asia to 14.4% (12.2% to 17.1%) in the Eastern Mediterranean region. For adults, meta-analysis was conducted for the European region only, and a consistent geographical pattern was shown for all adult age groups. The lowest prevalence of loneliness was consistently observed in northern European countries (2.9%, 1.8% to 4.5% for young adults; 2.7%, 2.4% to 3.0% for middle aged adults; and 5.2%, 4.2% to 6.5% for older adults) and the highest in eastern European countries (7.5%, 5.9% to 9.4% for young adults; 9.6%, 7.7% to 12.0% for middle aged adults; and 21.3%, 18.7% to 24.2% for older adults). Conclusion Problematic levels of loneliness are experienced by a substantial proportion of the population in many countries. The substantial difference in data coverage between high income countries (particularly Europe) and low and middle income countries raised an important equity issue. Evidence on the temporal trends of loneliness is insufficient. The findings of this meta-analysis are limited by data scarcity and methodological heterogeneity. Loneliness should be incorporated into general health surveillance with broader geographical and age coverage, using standardised and validated measurement tools. Systematic review registration PROSPERO CRD42019131448.

/pdf/the-prevalence-of-loneliness-across-113-countries-systematic-kgf2kl8i.pdf

The prevalence of loneliness across 113 countries: systematic review and meta-analysis

COPD is associated with a progressive loss of muscle mass and function. However, there is an unmet need to define and standardise methods to estimate the prevalence of sarcopenia in COPD patients.We performed a systematic review and meta-analysis of the prevalence of this extrapulmonary manifestation in COPD patients. We searched Embase, Medline (Ovid), CINAHL (EBSCO), Web of Science, Scopus and Google Scholar for studies published up to January 17, 2019, assessing sarcopenia in COPD patients based on low muscle mass and decreased muscle function. Interventional studies, in vitro experiments, protocols or reviews and meta-analyses were excluded. We estimated heterogeneity (I2) and assessed significance (Q) using a Chi-squared test for estimates obtained from random-effects models.4465 articles were initially identified. After removing the duplicates and applying the selection criteria, we reviewed 62 full-text articles. Finally, 10 articles (n=2565 COPD patients) were included in this systematic review and meta-analyses. Overall, the prevalence of sarcopenia in patients with COPD was 21.6% (95% CI 14.6-30.9%, I2=94%), ranging from 8% in population-based to 21% in clinic-based studies, and 63% in COPD patients residing in nursing homes.Sarcopenia is frequently observed in COPD patients, with varying prevalence across population settings. Sarcopenia in COPD should be assessed using standardised tests and cut-off points from sarcopenia consensus criteria for clinical practice and international comparisons.

https://err.ersjournals.com/content/errev/28/154/190049.full.pdf

Sarcopenia in COPD: a systematic review and meta-analysis.

Life in lockdown: Social Isolation, Loneliness and Quality of Life in the Elderly During the COVÍD-19 Pandemic: A Scoping Review

Prevalence and risk factors of sarcopenia in elderly nursing home residents

Objectives The purpose of the present study was to examine the knowledge and attitudes of Turkish nursing students about pain management. Methods The participants in this cross-sectional study were 190 nursing students who were studying at a nursing faculty in western Turkey. The research data were collected between March and June of the academic year 2015-2016, using a Student Description Form and the Nurses' Knowledge and Attitudes Survey Regarding Pain (NKASRP). Results The mean age of the students in the study sample was 23.06+-1.44 years. In all, 83.7% were female, 96.8% were unmarried, 94.7% were working as a nurse, and all had social security. The mean score of the NKASRP was 15.85+-3.25%. A comparison of the knowledge scores with student characteristics revealed that only the status of current employment as a nurse demonstrated a significant difference. No significant difference was detected between the NKASRP score and variables such as age and the score of the worst pain ever experienced (p>0.05). Conclusion It was determined that the students had a generally poor level of pain knowledge. It will improve the quality of life of patients if pain management is given a greater place in undergraduate education.

Knowledge and attitudes of nursing students about pain management.

OBJECTIVE To analyse the use of herbal supplements by individuals with diabetes mellitus. METHODS This cross-sectional study was carried out in the endocrinology clinics of two hospitals in Izmir, Turkey, between June and August 2016. The sample consisted of diabetic patients. Data was collected through face-to-face interviews guided by a questionnaire. SPSS 17 was used to analyse the data. RESULTS There were 455 subjects with a mean age of 47.02±16.6 years. Of the total, 373(82%) were female, and 352(77.4%) were diagnosed with type-2 diabetes. Overall, 262(57.6%) subjects used herbal supplements like cinnamon, sage, thyme, turmeric and ginseng. Significant differences in the use of herbal supplements were found according to gender, marital status, and duration of diabetes (p<0.05 each). CONCLUSIONS About half of the diabetic patients used herbal supplements.

The use of herbal supplements by individuals with diabetes mellitus.

Introduction: One of the genetic contributors to sarcopenia predisposition is Myostatin (MSTN), which in humans encodes myostatin, a 376 amino acid growth factor protein that negatively regulates muscle growth. The aim of this study was to investigate MSTN polymorphisms in an elderly sarcopenic population in Turkey and determine how they relate to sarcopenia. Materials and Methods: The study included nursing home residents who were aged ≥65 years. Sarcopenia screening was performed using “The European Working Group on Sarcopenia in Older People” guidelines. Blood sample was taken from each participant and DNA was obtained from the peripheral blood. MSTN polymorphisms were genotyped by polymerase chain reaction and restriction fragment length polymorphism methods. Results: A total of 152 elderly patients were included in the study. The rate of sarcopenia was determined to be 41.4%. The DNA nucleotide sequence of all three MSTN exons was determined for each study participant. Among the 152 patients, only 6 ...

Emine Karaman

Papers

Life in lockdown: Social Isolation, Loneliness and Quality of Life in the Elderly During the COVÍD-19 Pandemic: A Scoping Review

Prevalence and risk factors of sarcopenia in elderly nursing home residents

Knowledge and attitudes of nursing students about pain management.

The use of herbal supplements by individuals with diabetes mellitus.

Myostatin Gene Polymorphism in an Elderly Sarcopenic Turkish Population