Efficacy, safety, and potential industry bias in using deoxycholic acid for submental fat reduction ‒ A systematic review and meta-analysis of randomized clinical trials.

Lipolytic substance injections to reduce localized fat have been extensively used because it is a low-invasive method. This review aimed to evaluate the efficacy and safety of deoxycholic acid in submental fat reduction compared to a placebo and investigate the potential industry sponsorship bias in the results of randomized clinical trials on this topic. Ten electronic databases were extensively searched for randomized clinical trials without restriction on language and year of publication. Two reviewers extracted the data and assessed the individual risk of bias in the studies with the RoB 2.0 tool. The industry sponsorship bias was evaluated according to citations in the articles regarding industry funding/sponsorship throughout the texts. Fixed and random effects meta-analyses were performed, and the results were reported in Risk Ratio (RR) at a 95% Confidence Interval (95% CI). The initial search provided 5756 results, of which only five were included. Only two studies had a low risk of bias. All studies showed a potential industry bias. The meta-analysis showed that patients treated with deoxycholic acid had significant positive results for all efficacy outcomes and a higher risk of fibrosis, pain, erythema, numbness, swelling, edema, pruritus, nodules, headache, and paresthesia. The low to moderate certainty of evidence found allows concluding that deoxycholic acid is effective in submental fat reduction, causing well-tolerated adverse effects. However, all eligible studies showed a potential industry bias.

Efficacy, safety, and potential industry bias in using deoxycholic acid for submental fat reduction - A systematic review and meta-analysis of randomized clinical trials

Abstract Lipolytic substance injections to reduce localized fat have been extensively used because it is a low-invasive method. This review aimed to evaluate the efficacy and safety of deoxycholic acid in submental fat reduction compared to a placebo and investigate the potential industry sponsorship bias in the results of randomized clinical trials on this topic. Ten electronic databases were extensively searched for randomized clinical trials without restriction on language and year of publication. Two reviewers extracted the data and assessed the individual risk of bias in the studies with the RoB 2.0 tool. The industry sponsorship bias was evaluated according to citations in the articles regarding industry funding/sponsorship throughout the texts. Fixed and random effects meta-analyses were performed, and the results were reported in Risk Ratio (RR) at a 95% Confidence Interval (95% CI). The initial search provided 5756 results, of which only five were included. Only two studies had a low risk of bias. All studies showed a potential industry bias. The meta-analysis showed that patients treated with deoxycholic acid had significant positive results for all efficacy outcomes and a higher risk of fibrosis, pain, erythema, numbness, swelling, edema, pruritus, nodules, headache, and paresthesia. The low to moderate certainty of evidence found allows concluding that deoxycholic acid is effective in submental fat reduction, causing well-tolerated adverse effects. However, all eligible studies showed a potential industry bias.

Salivary changes in chronic kidney disease and in patients undergoing hemodialysis: a systematic review and meta-analysis.

OBJECTIVES: This study is aimed at describing changes in salivary flow rate and ionic composition present in the saliva of chronic kidney disease (CKD) patients by assessing the pH, calcium, phosphate, and phosphorus concentrations and comparing them to healthy individuals, along with exploring the influence of hemodialysis on these parameters. METHODS: The bibliographical search was performed in nine databases to find all types of studies, including observational clinical studies, without restrictions regarding publication year or language. Two reviewers selected the studies, extracted the data, and assessed the risk of bias using JBI tools. Random-effect meta-analysis was performed with the standardized mean difference (SMD) as effect estimate, at a 95% confidence interval. RESULTS: Thirty-three studies were included in the qualitative synthesis and 31 studies were included in the meta-analysis. Chronic kidney disease patients presented lower salivary flow rate (SMD: - 1.73; 95% CI = - 2.14; - 1.31), higher pH (SMD: 1.57; 95% CI = 1.11; 2.03), and higher phosphorus concentration (SMD: 0.86; 95% CI = 0.63; 1.09) in saliva. Concurrently, salivary flow rate and pH presented significant changes after hemodialysis, with higher salivary flow rate (SMD: 0.53; 95% CI = 0.25; 0.81) and lower pH (SMD: - 0.53; 95% CI = - 0.88; - 0.19) in patients on hemodialysis treatment. CONCLUSION: Chronic kidney disease patients present reduced salivary flow rate and increased pH and phosphorus concentration in saliva. Hemodialysis can increase the salivary flow rate of these patients.

Quality of life of Family Health Strategy professionals: a systematic review

ABSTRACT BACKGROUND: Individuals' quality of working life and motivation are directly related to their satisfaction and wellbeing. Although studies on the quality of life of family health workers have been conducted, there are none correlating these professionals' wellbeing with this work model. OBJECTIVE: To review the scientific literature in order to identify the levels of quality of life, in their dimensions, of Family Health Strategy workers. DESIGN AND SETTING: Systematic review of observational studies developed through a partnership between two postgraduate schools (Piracicaba and Uberlândia). METHODS: The review followed the PRISMA recommendations and was registered in the PROSPERO database. Ten databases were used, including the "grey literature". Two evaluators selected the eligible studies, collected the data and assessed the risk of biases, independently. The JBI tool was used to assess the risk of bias. A complementary statistical analysis was conducted on the means and standard deviations of the results from the WHOQOL-100 and WHOQOL-bref questionnaires. RESULTS: The initial search presented 1,744 results, from which eight were included in the qualitative analysis. The studies were published between 2007 and 2018. The total sample included 1,358 answered questionnaires. All the studies presented low risk of bias. The complementary analysis showed that the environmental factor (mean score 56.12 ± 2.33) had the most influence on the quality of life of community health workers, while physical health (mean score 14.29 ± 0.21) had the most influence on graduate professionals. CONCLUSION: Professionals working within the Family Health Strategy had dimensions of quality of life that varied according to their professional category.

Quality of life of Family Health Strategy professionals: a systematic review.

BACKGROUND: Individuals' quality of working life and motivation are directly related to their satisfaction and wellbeing. Although studies on the quality of life of family health workers have been conducted, there are none correlating these professionals' wellbeing with this work model. OBJECTIVE: To review the scientific literature in order to identify the levels of quality of life, in their dimensions, of Family Health Strategy workers. DESIGN AND SETTING: Systematic review of observational studies developed through a partnership between two postgraduate schools (Piracicaba and Uberlândia). METHODS: The review followed the PRISMA recommendations and was registered in the PROSPERO database. Ten databases were used, including the "grey literature". Two evaluators selected the eligible studies, collected the data and assessed the risk of biases, independently. The JBI tool was used to assess the risk of bias. A complementary statistical analysis was conducted on the means and standard deviations of the results from the WHOQOL-100 and WHOQOL-bref questionnaires. RESULTS: The initial search presented 1,744 results, from which eight were included in the qualitative analysis. The studies were published between 2007 and 2018. The total sample included 1,358 answered questionnaires. All the studies presented low risk of bias. The complementary analysis showed that the environmental factor (mean score 56.12 ± 2.33) had the most influence on the quality of life of community health workers, while physical health (mean score 14.29 ± 0.21) had the most influence on graduate professionals. CONCLUSION: Professionals working within the Family Health Strategy had dimensions of quality of life that varied according to their professional category.

Saliva as a tool for monitoring hemodialysis: a systematic review and meta-analysis

Abstract This study aimed to assess whether the reductions in serum urea and creatinine levels are different from the reductions in salivary urea and creatinine levels that occur after hemodialysis in chronic renal patients. The systematic review protocol was registered in the PROSPERO database. Eight databases were searched to identify pretest-posttest studies of chronic kidney disease patients undergoing hemodialysis, with no language or year restrictions. The JBI Critical Appraisal Tool was used to assess the risk of bias. Meta-analyses using random-effect models were conducted to compare salivary and serum correlations and to pooled mean and proportion differences from pre- to posthemodialysis urea and creatinine levels by subgroup analysis. The I2 test was used to assess heterogeneity, and a meta-regression was performed to statistically assess correlations and differences in the pooled effects pre- and postdialysis. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. The search resulted in 1404 records, and only six studies (n = 252 participants) fulfilled the eligibility criteria and were included. The studies were published between 2013 and 2018. All studies showed a significant reduction in both salivary and serum urea/creatinine levels. All eligible studies presented a low risk of bias. The meta-analysis shows a moderate to high correlation between salivary and blood levels of urea (r: 0.79; 95% CI: 0.56-1.00) and creatinine (r: 0.64; 95%CI: 0.16-1.00), with a very low level of certainty. The reductions in salivary urea and creatinine levels are similar to and correlated with the reductions in blood urea and creatine levels after hemodialysis among chronic kidney disease patients.

Saliva as a tool for monitoring hemodialysis: a systematic review and meta-analysis.

This study aimed to assess whether the reductions in serum urea and creatinine levels are different from the reductions in salivary urea and creatinine levels that occur after hemodialysis in chronic renal patients. The systematic review protocol was registered in the PROSPERO database. Eight databases were searched to identify pretest-posttest studies of chronic kidney disease patients undergoing hemodialysis, with no language or year restrictions. The JBI Critical Appraisal Tool was used to assess the risk of bias. Meta-analyses using random-effect models were conducted to compare salivary and serum correlations and to pooled mean and proportion differences from pre- to posthemodialysis urea and creatinine levels by subgroup analysis. The I2 test was used to assess heterogeneity, and a meta-regression was performed to statistically assess correlations and differences in the pooled effects pre- and postdialysis. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. The search resulted in 1404 records, and only six studies (n = 252 participants) fulfilled the eligibility criteria and were included. The studies were published between 2013 and 2018. All studies showed a significant reduction in both salivary and serum urea/creatinine levels. All eligible studies presented a low risk of bias. The meta-analysis shows a moderate to high correlation between salivary and blood levels of urea (r: 0.79; 95% CI: 0.56-1.00) and creatinine (r: 0.64; 95%CI: 0.16-1.00), with a very low level of certainty. The reductions in salivary urea and creatinine levels are similar to and correlated with the reductions in blood urea and creatine levels after hemodialysis among chronic kidney disease patients.

Prevalence of mental disorders among elderly men: a systematic review and meta-analysis.

BACKGROUND: Elderly men have been characterized as a group vulnerable to suicide, motivated by loneliness, loss of loved ones and feelings of uselessness to family members. OBJECTIVES: To ascertain the prevalence of different mental disorders among elderly men who attempted suicide. DESIGN AND SETTING: Systematic review of observational studies developed as a result of a partnership between two postgraduate schools (Lagarto and Uberlândia). METHODS: An electronic search was performed in eight electronic databases, including "grey literature", in January 2019. Observational studies that assessed mental disorders among men older than 60 years who attempted suicide were eligible for inclusion. RESULTS: Among the disorders evaluated, mood disorders had the highest prevalence (42.0%; 95% confidence interval, CI: 31.0-74.0%; I2: 0.0%; P = 0.763), followed by substance use-related disorders (41.0%; 95% CI: 8.0-74.0%; I2: 96.4; P < 0.001) and, lastly, schizophrenic disorders (5.0%; 95% CI: 0.0%-14.0%; I2: 80.3%; P = 0.024). CONCLUSIONS: It seems that mood disorders and substance use-related disorders are quite prevalent among elderly men with mental disorders who attempted suicide. It is important to consider the role of healthcare services in making early diagnoses of mental disorders among elderly men, in order to diminish the chances of suicide attempts among them. SYSTEMATIC REVIEW REGISTRATION: CRD42018105981.

Saliva as an alternative to blood in the determination of uremic state in adult patients with chronic kidney disease: a systematic review and meta-analysis.

OBJECTIVES: To assess whether salivary urea and creatinine levels accurately reflect their serum levels in blood samples of adults to detect chronic kidney disease. MATERIALS AND METHODS: A systematic review was conducted in eight electronic databases. The protocol was registered in PROSPERO. Only diagnostic test studies were included. The JBI critical appraisal tools assessed the risk of bias. A meta-analysis of proportions was performed. The GRADE tool assessed the quality of evidence and strength of recommendation across the studies included. RESULTS: Eight studies met the eligibility criteria and were included. Six studies assessed salivary urea, and six studies assessed salivary creatinine. All studies presented moderate risk of bias. The meta-analysis depicted an overall sensitivity of 93.3% (95% CI = 88.6; 97.9) for salivary creatinine levels and 87.5% (95% CI = 83.2; 91.8) for salivary urea levels, while the overall specificity was 87.1% (95% CI = 82.8; 91.3) and 83.2% (95% CI = 65.0; 101.4) for salivary creatinine and urea levels, respectively. The overall accuracy of salivary creatinine was 5.2 percentage points higher compared with salivary urea levels (90.8% vs. 85.6%). According to the GRADE tool, the analysed outcomes were classified as having low to moderate level of certainty. CONCLUSION: Compared with blood samples, salivary urea and creatinine levels presented high diagnostic values for chronic kidney disease screening, but should not be considered equivalent to levels obtained from blood at stages three, four, or five of the disease. CLINICAL SIGNIFICANCE: Chronic kidney disease patients could receive a clinically significant benefit from replacing blood with saliva for potentially monitoring renal function. Saliva collection presents greater simplicity, comfort, safety, and lower collection cost.

Organização curricular, evasão e repetência no curso de odontologia: um estudo longitudinal / Curriculum organization elopement and failure in a dentistry school: a longitudinal study

A evasão escolar origina problemas em qualquer etapa do ensino, principalmente em escolas públicas, pois as vagas ociosas acarretam prejuízo a toda sociedade. Neste estudo retrospectivo objetivou-se analisar o índice de evasão de acadêmicos que ingressaram entre 1992 e 1999 na Faculdade de Odontologia de Araçatuba (UNESP) e o índice de repetência por disciplina entre 1992 e 2002, por meio de documentos - como listas de matrícula e boletins de notas dos acadêmicos - disponíveis no setor de graduação da Instituição. Os resultados são expressos em valores absolutos e relativos valendo-se da análise estatística descritiva. Constatou-se que, de um total de 640 acadêmicos que ingressaram entre 1992 e 1999, o índice médio de evasão foi de 2,19% (14), concentrado na primeira e na segunda série do curso, 50 e 42,86% do total respectivamente. Nas 30.904 matrículas em todas as disciplinas do curso entre 1992 e 2002, o índice de repetência em, pelo menos, uma delas foi de 1,68% (518), também concentrado na primeira e na segunda série, 39,18 e 43,46% do total, respectivamente. O índice de evasão encontrado pode ser considerado baixo quando comparado ao de outras áreas do conhecimento, conforme relatado em literatura; no entanto, essa taxa poderia ainda ser diminuída com a reorganização curricular, que viesse a adotar um modelo que integrasse as disciplinas básicas e clínicas logo no início do curso, além de um atendimento especial aos alunos das primeiras séries, no sentido de fixação ao ideário vocacional .

School elopement causes problems in any phase of teaching, mainly in public schools, as idle vacancies bring about impairment to all the society. In this retrospective study, the purpose was to evaluate the elopement rate of undergraduates that entered the School of Dentistry at Araçatuba's São Paulo State (UNESP) between 1992 and 1999, and the failure rate per school subject matter between 1992 and 2002 through documents - such as enrollment lists and students' reports - available at the institutions' graduation sector. The results are shown in absolute and relative values by using descriptive statistic analysis. It was possible to notice that out of the 640 undergraduates that entered college between 1992 and 1999, the average elopement rate was 2.19% (14), concentrated on the freshman and sophomore years, 50 and 42.86% of the total, respectively. As for the 30,904 registrations in all subject matters of the course between 1992 and 2002, the failure rate was, at least in one of them, 1.68% (518), also concentrated on the freshman and sophomore years, 39.18 and 43.46% of the total, respectively. The elopement rate found can be considered low when it is compared to other areas of knowledge, according to literature reports; nevertheless, this rate could still be diminished by establishing a curriculum reorganization, adopting a model that integrates basic and clinical subject matters right from the beginning of the course, and also further special service to freshmen in order to inculcate the vocational ideal .

Saúde coletiva nas estruturas curriculares dos cursos de odontologia do Brasil / Public Health Dentistry in the curricular structure of dental courses in Brazil

A área da Saúde Coletiva tem papel fundamental na formação do profissional com o perfil exigido pelas Diretrizes Curriculares Nacionais do curso de Odontologia,implementadas em 2002. O objetivo da pesquisa foi analisar as características das disciplinas da área da saúde coletiva nos currículos dos cursos de Odontologia do País, no que se refere a carga horária, duração em semestres, nomenclatura, formato, metodologia de ensino e formas de avaliação. Foram enviadas correspondências para 123 cursos que tinham formado pelo menos uma turma até o ano de 2003, solicitando a estrutura curricular do curso e os planos de ensino das disciplinas. Cinqüenta cursos enviaram o material (40,65 por cento). A carga horária destinada à saúde coletiva variou de 75 a 699 horas, sendo que 44,18 por cento está na faixa de 200 a 324 horas. Os cursos pesquisados destinam de 1 a 8 semestres para a área, destacando-se a concentração em 2 e 3 semestres (20,93 por cento cada) e em 4 semestres (27,91 por cento). Odontologia Social e Preventiva foi a nomenclatura mais citada (30 por cento) para designar a área da Saúde Coletiva. Todas as disciplinas são de caráter teórico-prático. As metodologias de ensino mais citadas foram aulas expositivas (100 por cento) e seminários (71,88 por cento). As formas de avaliação mais utilizadas foram provas escritas (100 por cento) e prova prática (80 por cento). Conclui-se para a maioria dos cursos que a carga horária da área é de 75 a 324 horas ministradas de 2 a 4 semestres; a nomenclatura mais utilizada foi odontologia social e preventiva; todas são de caráter( teórico --prático; as metodologias de ensino mais citadas foram aulas expositivas e seminários; e, como forma de avaliação, a prova escrita e a prova prática foram as mais citadas nos planos de ensino