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Introduction: A prognostic model to predict liver severity in people with metabolic dysfunction-associated steatotic liver disease (MASLD) is very important, but the accuracy of the most commonly used tools is not yet well established. Objective: The meta-analysis aimed to assess the accuracy of different prognostic serological biomarkers in predicting liver fibrosis severity in people with MASLD. Methods: Adults ≥18 years of age with MASLD were included, with the following: liver biopsy and aspartate aminotransferase-to-platelet ratio (APRI), fibrosis index-4 (FIB-4), non-alcoholic fatty liver disease fibrosis score (NFS), body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes score (BARD score), FibroMeter, FibroTest, enhanced liver fibrosis (ELF), Forns score, and Hepascore. Meta-analyses were performed using a random effects model based on the DerSimonian and Laird methods. The study's risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. Results: In total, 138 articles were included, of which 86 studies with 46,514 participants met the criteria for the meta-analysis. The results for the summary area under the receiver operating characteristic (sAUROC) curve, according to the prognostic models, were as follows: APRI: advanced fibrosis (AF): 0.78, any fibrosis (AnF): 0.76, significant fibrosis (SF): 0.76, cirrhosis: 0.72; FIB-4: cirrhosis: 0.83, AF: 0.81, AnF: 0.77, SF: 0.75; NFS: SF: 0.81, AF: 0.81, AnF: 0.71, cirrhosis: 0.69; BARD score: SF: 0.77, AF: 0.73; FibroMeter: SF: 0.88, AF: 0.84; FibroTest: SF: 0.86, AF: 0.78; and ELF: AF: 0.87. Conclusion: The results of this meta-analysis suggest that, when comparing the scores of serological biomarkers with liver biopsies, the following models showed better diagnostic accuracy in predicting liver fibrosis severity in people with MASLD: FIB-4 for any fibrosis, FibroMeter for significant fibrosis, ELF for advanced fibrosis, and FIB-4 for cirrhosis.Clinical trial registration: [https://clinicaltrials.gov/], identifier [CRD 42020180525].
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OBJECTIVES: To assess the prevalence of and factors associated with the lifetime medical diagnosis of depression in Brazil. DESIGN: Population-based, cross-sectional study. SETTING: Analysis of data from the 2019 Brazilian National Health Survey. PARTICIPANTS: 90 846 individuals aged ≥15 years were included. OUTCOME MEASURE: The self-reported medical diagnosis of depression at some point in one's life was the main outcome. Prevalence ratios (PRs) with 95% CIs were calculated by Poisson regression with robust variance. The independent variables included the geographical area of residence, sociodemographic characteristics, current smoking status, alcohol abuse, daily screen time, and the presence of physical disorders and mental health comorbidities. RESULTS: The self-reported lifetime prevalence of medical diagnosis of depression was 9.9% (95% CI 9.5% to 10.2%). The probability of having received a medical diagnosis of depression was higher among urban residents (PR 1.23; 95% CI 1.12 to 1.35); females (2.75; 2.52 to 2.99); those aged 20-29 years (1.17; 0.91 to 1.51), 30-39 years (1.73; 1.36 to 2.19), 40-49 years (2.30; 1.81 to 2.91), 50-59 years (2.32; 1.84 to 2.93) and 60-69 years (2.27; 1.78 to 2.90) compared with those under 20 years; white-skinned people (0.69 (0.61 to 0.78) for black-skinned people and 0.74 (0.69 to 0.80) for indigenous, yellow and brown-skinned people compared with white-skinned people); those with fewer years of education (1.33(1.12 to 1.58) among those with 9-11 years, 1.14 (0.96 to 1.34) among those with 1-8 years and 1.29 (1.11 to 1.50) among those with 0 years compared with those with ≥12 years of education); those who were separated/divorced (1.43; 1.29 to 1.59), widowed (1.06; 0.95 to 1.19) and single (1.01; 0.93 to 1.10) compared with married people; smokers (1.26; 1.14 to 1.38); heavy screen users (1.31; 1.16 to 1.48) compared with those whose usage was <6 hours/day; those with a medical diagnosis of a physical disorder (1.80; 1.67 to 1.97); and individuals with a medical diagnosis of a mental health comorbidity (5.05; 4.68 to 5.46). CONCLUSION: This nationwide population-based study of self-reported lifetime medical diagnosis of depression in Brazil showed that the prevalence was almost 10%. Considering the current Brazilian population, this prevalence corresponds to more than 2 million people who have been diagnosed with depression at some point in their lives.
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Depression , Female , Humans , Self Report , Depression/diagnosis , Depression/epidemiology , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Health SurveysABSTRACT
Introdução: O processamento artificial de alimentos tem sido considerado um fator de risco importante na saúde. O objetivo deste estudo é revisar a literatura científica quanto à definição da classificação dos alimentos referente ao seu grau de processamento industrial. Métodos: revisão narrativa de artigos publicados nas bases de dados indexadas MEDLINE (PubMed) e LILACS e guias alimentares disponíveis na página online da Food and Agriculture Organization of the United Nations (FAO). A estratégia de busca utilizada compreendeu os seguintes descritores: Processed food OR Unprocessed food OR Artisanal food OR Minimally processed food OR Highly processed OR Ultra-processed food OR Industrial food processing. Não houve restrição quanto ao idioma utilizado nas publicações. Resultados: foram identificados 1301 artigos nas bases de dados PubMed e LILACS e 35 na página da FAO. Definições de alimentos processados ou ultraprocessados foram encontradas em diretrizes de apenas 8 dos 34 países avaliados nessa revisão. Apenas três diretrizes eram baseadas na classificação NOVA, utilizada no Brasil. Os demais países que utilizam classificações baseadas no grau de processamento industrial se pautam em definições variadas, baseadas na quantidade de aditivos, açucares, gorduras e outras substâncias. Além disso, apenas quatro países utilizam a classificação de ultraprocessados para alimentos altamente industrializados. Conclusões: apesar dos riscos já evidenciados em relação ao consumo destes alimentos, as evidências demonstram que o conceito em relação ao grau de processamento industrial de alimentos não apresenta uma definição padronizada.
Introduction: artificial food processing has been considered a major health risk factor. The objective of this study is to review the scientific literature regarding the definition of food classification related to its degree of industrial processing. Methods: narrative review. Articles published in MEDLINE (PubMed) and LILACS indexed databases and food guides available on the Food and Agriculture Organization of the United Nations (FAO) website were evaluated. The search strategy used included the following descriptors: Processed food OR Unprocessed food OR Artisanal food OR Minimally processed food OR Highly processed OR Ultra-processed food OR Industrial food processing. There was no restriction on the language used in the publications. Results: 1301 articles in the PubMed and LILACS databases and 35 on the FAO website were identified. Food classifications based on the degree of industrial processing were found in only 8 of 34 countries included in this review. Of those, only three guidelines were based on the NOVA classification, currently used in Brazil. Other countries with food classifications based on industrial processing used definitions characterized by the addition of sugars, chemical additives, fats and other substances. Furthermore, only four countries used definitions for ultraprocessed foods specifically. Conclusion: the evidence demonstrates the concept in relation to industrial processing does not present a standard definition, despite the risks already evidenced in relation to the consumption of these.
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Industrialized Foods , Food/classification , Food, Processed/classification , HealthABSTRACT
El traumatismo de tórax constituye una de las causas más comunes de consulta en el Servicio de Cirugía General del HEALF, siendo la toracostomía la principal terapia en pacientes con hemoneumotórax traumático. Las pautas para su manejo aún varían ampliamente en cuanto a utilización de antibióticos, radiografías y criterios de retiro del tubo de tórax. En dicho cewntro, en el período junio 2003 a marzo 2005 se estandarizó un protocolo de manejo de la toracostomía tubo de tórax conectado a succión continua y luego a sello de agua, uso de antibióticos profilácticos, realización de menos radiografías de control y reducción de la estancia hospitalaria, comparándolo con los pacientes tratados de forma convencional (sello de agus únicamente). La diferencia entre grupos fue evaluada con las pruebas de Chi Cuadrado y Mann Withney "U" test. Fueron 25 pacientes en el grupo experimental y 30 pacientes en el grupo de control. En el primer grupo la estancia hospitalaria logró reducirse a dos días o menos y a dos radiografías de control. En ambos se observó igual número de complicaciones; perpo con un importante ahorro ecnómico de aproximadamente 45, 000 córdobas en el grupo experimental