The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease worldwide and the leading cause of liver-related morbidity and mortality. We aimed to predict the burden of NAFLD by examining and estimating the temporal trends of its worldwide prevalence and incidence. METHODS: In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, Scopus, and Web of Science without language restrictions for reports published between date of database inception and May 25, 2021. We included observational cross-sectional or longitudinal studies done in study populations representative of the general adult population, in whom NAFLD was diagnosed using an imaging method in the absence of excessive alcohol consumption and viral hepatitis. Studies were excluded if conducted in paediatric populations (aged <18 years) or subgroups of the general population. Summary estimates were extracted from included reports by KR and independently verified by HA using the population, intervention, comparison, and outcomes framework. Primary outcomes were the prevalence and incidence of NAFLD. A random-effects meta-analysis was used to calculate overall and sex-specific pooled effect estimates and 95% CIs. FINDINGS: The search identified 28 557 records, of which 13 577 records were screened; 299 records were also identified via other methods. In total, 72 publications with a sample population of 1 030 160 individuals from 17 countries were included in the prevalence analysis, and 16 publications with a sample population of 381 765 individuals from five countries were included in the incidence analysis. The overall prevalence of NAFLD worldwide was estimated to be 32·4% (95% CI 29·9-34·9). Prevalence increased significantly over time, from 25·5% (20·1-31·0) in or before 2005 to 37·8% (32·4-43·3) in 2016 or later (p=0·013). Overall prevalence of NAFLD was significantly higher in men than in women (39·7% [36·6-42·8] vs 25·6% [22·3-28·8]; p<0·0001). The overall incidence of NAFLD was estimated to be 46·9 cases per 1000 person-years (36·4-57·5); 70·8 cases per 1000 person-years (48·7-92·8) in men and 29·6 cases per 1000 person-years (20·2-38·9) in women (p<0·0001). There was considerable heterogeneity between studies of both NAFLD prevalence (I2=99·9%) and NAFLD incidence (I2=99·9%). INTERPRETATION: Worldwide prevalence of NAFLD is considerably higher than previously estimated and is continuing to increase at an alarming rate. Incidence and prevalence of NAFLD are significantly higher among men than among women. Greater awareness of NAFLD and the development of cost-effective risk stratification strategies are warranted to address the growing burden of NAFLD. FUNDING: Canadian Institutes of Health.

Under the knife: medical student perceptions of intimidation and mistreatment.

BACKGROUND: The progression from classroom to clinical setting can be a difficult transition for medical students. Experience in the operating room is anticipated as one of the most challenging environments for a novel medical learner. We sought to identify common concerns before exposure in this learning environment and examine the experience of final-year medical students on their surgical clerkship rotation in an effort to identify areas where improvements can be made. METHODS: A 20-question survey was developed after a focus group met to identify potential issues that medical students encounter during their surgical clerkship. Personal and anecdotal experiences guided the development of the survey. It was distributed to final-year medical students and recent graduates (350 individuals) using SurveyMonkey. A quality improvement ethics application was completed before the commencement of the survey, as were participant consent forms. Responses were grouped and common themes were identified in the experiences reported by 2 investigators. RESULTS: A total of 72 individuals responded to the survey, providing a 21% response rate. Subjects were asked how confident they were in their understanding of what was expected during a surgical rotation. Of them, 52 (72%) responded that they were "unsure" or "very unsure," whereas only 12 and 3 felt "somewhat confident" and "very confident," respectively. Most of the learners felt nervous (96%) and feared appearing incompetent (89%). Common concerns included insufficient knowledge and technical skill, anticipated negative experiences, and feelings of uncertainty regarding medical student expectations. CONCLUSION: We present common themes stemming from medical student experiences during their surgical clerkship. We comment on perception of intimidation and abuse, the rationalization behind such behavior, and perceived lack of guidance. The intention of this analysis was to identify weaknesses in our surgical training so that a quality improvement plan can be implemented.