Mycobacterium tuberculosis latent infection in healthcare students: systematic review of prevalence / Infecção latente por Mycobacterium tuberculosis em estudantes da área da saúde: revisão sistemática de prevalência / Infección latente por Mycobacterium tuberculosis en estudiantes de la salud: revisión sistemática de la prevalencia

ABSTRACT Objective: The aim of this study was to synthesize the evidence on the prevalence of latent Mycobacterium tuberculosis infection (LTBI) among undergraduate health care students. Methods: A systematic review of prevalence with meta-analysis was conducted. Prospective and retrospective cohorts and cross-sectional studies involving probable exposure to M. tuberculosis during undergraduate education, along with the tuberculin skin test (TST) or interferon-γ release assay (IGRA) for investigation of latent tuberculosis were searched. Searches were conducted in MEDLINE, CINAHL, EMBASE, LILACS, Scopus, and Web of Science databases. Independent reviewers were responsible for the selection and inclusion of studies. Data were extracted, critically appraised, and synthesized using the JBI approach. PRISMA was used to report the study. Results: Twenty-two studies were analyzed. The overall prevalence in healthcare undergraduate students was 12.53%. Conclusion: The prevalence of LTBI in undergraduate health students was high for such a highly educated population. Screening with TST and/or IGRA and chemoprophylaxis, when necessary, should be provided to undergraduate health students when in contact with respiratory symptomatic patients.

RESUMO Objetivo: O objetivo deste estudo foi sintetizar as evidências sobre a prevalência de infecção de Mycobacterium tuberculosis (ILTB) entre estudantes de graduação da área da saúde. Método: Foi realizada uma revisão sistemática de prevalência com metanálise. Coortes prospectivas e retrospectivas e estudos transversais envolvendo provável exposição a M. tuberculosis durante a graduação, juntamente com o teste tuberculínico (TT) ou ensaio de liberação de interferon-γ (IGRA) para investigação de tuberculose latente foram pesquisados. As buscas foram realizadas nas bases de dados MEDLINE, CINAHL, EMBASE, LILACS, Scopus e Web of Science. Revisores independentes foram responsáveis pela seleção e inclusão dos estudos. Os dados foram extraídos, avaliados criticamente e sintetizados utilizando a abordagem JBI. PRISMA foi usado para relatar o estudo. Resultados: Vinte e dois estudos foram analisados. A prevalência geral em estudantes de graduação da área da saúde foi de 12,53%. Conclusão: A prevalência de ILTB em estudantes de graduação em saúde foi alta para uma população com alto nível de escolaridade. Triagem com TT e/ou IGRA e quimioprofilaxia, quando necessária, deve ser fornecida aos estudantes de graduação da área da saúde quando em contato com pacientes sintomáticos respiratórios.

RESUMEN Objetivo: El objetivo de este estudio fue sintetizar la evidencia sobre la prevalencia de infección latente por Mycobacterium tuberculosis (ILTB) entre estudiantes universitarios de la salud. Métodos: Se realizó una revisión sistemática de la prevalencia con metanálisis. Cohortes prospectivas y retrospectivas y estudios transversales que involucran exposición probable a M tuberculosis durante la educación universitaria, junto con la prueba cutánea de tuberculina (TST) o el ensayo de liberación de interferón-γ (IGRA) para la investigación de tuberculosis latente. Las búsquedas se realizaron en las bases de datos MEDLINE, CINAHL, EMBASE, LILACS, Scopus y Web of Science. Revisores independientes fueron responsables de la selección e inclusión de los estudios. Los datos se extrajeron, se evaluaron críticamente y se sintetizaron utilizando el enfoque JBI. Se utilizó PRISMA para informar el estudio. Resultados: Se analizaron veintidós estudios. La prevalencia global en estudiantes universitarios en salud fue del 12,53%. Conclusión: La prevalencia de LTBI en estudiantes universitarios de salud fue alta para una población con un nivel educativo tan alto. Se debe proporcionar tamizaje con TST y/o IGRA y quimioprofilaxis, cuando sea necesario, a los estudiantes universitarios en salud cuando estén en contacto con pacientes sintomáticos respiratorios.

Common mental disorders in the perinatal period in Primary Healthcarein Latin America: A Systematic review and meta-analysis

Existe un riesgo estadísticamente mayor de desarrollar comorbilidades mentales en el período perinatal. Existe un vacío científico en el análisis de la ocurrencia de problemas de salud mental en el período perinatal entre países de ingresos medios y bajos en el contexto de la Atención Primaria de Salud. Así, el objetivo de este estudio fue revisar la ocurrencia de trastornos mentales comunes en el período perinatal en la Atención Primaria de Salud en América Latina. Se identificó una estimación global del 37 % (IC 95 %: 32 %-43 %) de trastornos mentales comunes durante todo el período perinatal. A pesar de las altas frecuencias identificadas para los síntomas de comorbilidad mental, no hubo estudios en otros países de América Latina con excepción de Brasil, lo que impide un análisis sobre la salud mental de las mujeres latinas en el período perinatal[AU]

Existe um risco estatisticamente maior de desenvolver comorbidades mentais no período perinatal. Existe uma lacuna científica na análise da ocorrência de problemas de saúde mental no período perinatal entre famílias de média e baixa renda países no contexto da Atenção Primária à Saúde. Assim, o objetivo deste estudo foi revisar a ocorrência de transtornos mentais comuns no período perinatal em Atenção Primária à Saúde na América Latina. Uma estimativa geral de 37% (95% CI:32%-43%) de transtornos mentais comuns foram identificados durante todo o período perinatal período. Apesar das altas frequências identificadas para sintomas de comorbidade mental, não houve estudos em outros países latino-americanos com exceção de Brasil, impossibilitando uma análise sobre a saúde mental das mulheres latinas no período perinatal[AU]

There is a statistically higher risk for developing mental comorbidities in the perinatal period. There is a scientific gap in the analysis of the occurrence of mental health problems in the perinatal period among middle and low-income countries in the context of Primary Healthcare. Thus, the objective of this study was to review the occurrence of common mental disorders in the perinatal period in Primary Healthcare in Latin America. An overall estimate of 37% (95%CI: 32%-43%) of common mental disorders was identified for the entire perinatal period. Despite the high frequencies identified for mental comorbidity symptoms, there were no studies in other Latin American countries with the exception of Brazil, preventing an analysis on the mental health of Latino women in the perinatal period[AU]

The efficacy and safety of Emblica officinalis aqueous fruit extract among adult patients with dyslipidemia: A systematic review and meta-analysis

Background@#Flavonoids from Emblica officinalis effectively reduced serum and tissue lipid levels through their inhibitory effect on the hepatic β-hydroxy-β-methylglutaryl coenzyme A reductase activity. This study aimed to determine the efficacy and safety of E. officinalis extract in adults with dyslipidemia.@*Methods@#We searched the following electronic databases: MEDLINE (PubMed), MEDLINE (Ovid), Google Scholar, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, and ClinicalTrials.gov from inception until January 31, 2022. Two reviewers independently screened the abstracts, reviewed full-text papers, and critically appraised the quality of included studies. Meta-analysis was performed using the random-effects model. Our primary outcomes were total cholesterol, LDL-C, serum triglycerides, and HDL-C levels, while secondary outcomes included adverse events.@*Results@#A total of four randomized trials (N = 227) were included in the final analysis. There were statistically significant decreases in total cholesterol levels (SMD = -21.23 mg/dL, 95% CI: -34.22, -8.25; P = 0.001) and LDL-C levels (SMD = -25.12 mg/dL, 95% CI: -40.24, -10.00; P = 0.001) and significant increase in HDL-C levels (SMD = 4.74 mg/dL, 95% CI: 0.40, 9.07; P = 0.03) after 12 weeks of intervention favoring the use of the Emblica extract over placebo. However, there were no statistically significant difference in the serum triglycerides levels following 12 weeks of treatment (SMD = -22.28 mg/dL, 95% CI: -53.33, 8.76; P = 0.16). There was high heterogeneity noted across all outcomes: total cholesterol (P = 0.01, I2 = 72%), LDL-C (P = 0.0004, I2 = 83%), HDL-C (P < 0.00001, I2 = 91%) and serum triglycerides (P < 0.00001, I2 = 93 %). The intervention was well tolerated and adverse events reported in the three of four studies were all mild: dyspepsia (7 events – treatment), mild diarrhea (3 events – placebo), fever (1 event – placebo), headache (1 event – placebo).@*Conclusion@#Compared to placebo, Emblica officinalis fruit extract resulted in lower total cholesterol and LDL-C levels and increased HDL-C levels but with no effect on serum triglyceride levels based on low certainty of evidence. Trials with a larger sample size that directly compare E. officinalis extract to statins, preferably local data, are needed to support its use in patients with dyslipidemia further.

Clinical efficacy of traditional Chinese medicine therapy for female stress urinary incontinence: a meta-analysis / Eficácia clínica da terapia da medicina tradicional chinesa para a incontinência urinária de esforço feminina: uma meta-análise / Eficacia clínica de la terapia de medicina tradicional china para la incontinencia urinaria de esfuerzo femenina: un metaanálisis

ABSTRACT Objectives: To investigate the efficacy of traditional Chinese medicine (TCM) in the treatment of female stress urinary incontinence (SUI). Method: PubMed, Cochrane, Web of Science, Embase, CNKI, Wanfang, and VIP databases were searched for articles published up to September 2022. Variables were analyzed using weighted mean difference (WMD), standardized mean difference (SMD), odds ratios (OR), and 95% confidence interval (CI). Results: Eight studies containing 744 patients were included in this study. The results demonstrate that TCM therapy had more advantages in improving the clinical outcome of SUI patients (OR = 2.90, 95%CI:1.92-4.37, P = 0.000), reducing the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) score (WMD = -2.41, 95%CI:-2.83- -1.98, P = 0.000), reducing 1-h urinary pad leakage urine volume (WMD = -1.86, 95%CI:-2.23- -1.49, P = 0.000) and increasing Maximum urethral closure pressure (MUCP) (SMD = 0.86, 95%CI: 0.61-1.11, P = 0.000). Conclusion: TCM therapy is effective in improving urinary incontinence symptoms, urodynamics, and quality of life in patients with SUI. This article provides a reference for the application of TCM therapy in women with urinary incontinence.

RESUMEN Objetivo: Investigar la eficacia de la medicina tradicional china (MTC) en el tratamiento de la incontinencia urinaria de esfuerzo (IUE) femenina. Método: Se llevaron a cabo búsquedas de artículos publicados hasta septiembre de 2022 en las bases de datos PubMed, Cochrane, Web of Science, Embase, CNKI, Wanfang y VIP. Las variables se analizaron mediante la diferencia de medias ponderada (DMP), la diferencia de medias estandarizada (DME), la razón de momios (RM) y el intervalo de confianza (IC) del 95%. Resultados: Este estudio incluyó ocho investigaciones con la participación de 744 pacientes. Los resultados indican que la terapia de medicina tradicional china (MTC) presentó mejoras significativas en los resultados clínicos de pacientes con incontinencia urinaria de esfuerzo (IUE) (RM = 2.90, IC del 95%: 1.92-4.37, P = 0.000), al reducir la puntuación del Cuestionario Internacional sobre la Incontinencia y su impacto en la calidad de vida (ICIQ-SF) (DMP = -2.41, IC del 95%: -2.83- -1.98, P = 0.000), así como la disminución del volumen de orina a la 1 hora de fuga de la almohadilla urinaria (DMP = -1.86, IC del 95%: -2.23- -1.49, P = 0.000) y el aumento de la presión de cierre uretral máxima (PCUM) (DME = 0.86, IC del 95%: 0.61-1.11, P = 0.000). Conclusión: La terapia de medicina tradicional china (MTC) resulta efectiva en la mejora de los síntomas de la incontinencia urinaria, la urodinámica y la calidad de vida en pacientes con incontinencia urinaria de esfuerzo (IUE). Este artículo ofrece una referencia para la aplicación de la terapia de MTC en mujeres con incontinencia urinaria.

RESUMO Objetivo: Investigar a eficácia da medicina tradicional chinesa (MTC) no tratamento da incontinência urinária de esforço (IUE) feminina. Método: Foram realizadas pesquisas de artigos publicados até setembro de 2022 nas bases de dados PubMed, Cochrane, Web of Science, Embase, CNKI, Wanfang e VIP. As variáveis foram analisadas por meio da diferença de média ponderada (DMP), da diferença média padronizada (DMP), da razão de chances (RC) e do intervalo de confiança (IC) de 95%. Resultados: Esta pesquisa envolveu oito estudos, contando com a participação de 744 pacientes. Os resultados indicam que a terapia da medicina tradicional chinesa (MTC) apresentou melhorias significativas nos resultados clínicos de pacientes com incontinência urinária de esforço (IUE) (RM = 2.90, IC de 95%: 1.92-4.37, P = 0.000), ao reduzir a pontuação do Questionário Internacional sobre a Incontinência Urinária - Versão Breve (ICIQ-SF) (Diferença de Média Ponderada = -2.41, IC de 95%: -2.83- -1.98, P = 0.000), assim como na diminuição do volume de urina na 1 hora de vazamento do absorvente urinário (Diferença de Média Ponderada = -1.86, IC de 95%: -2.23- -1.49, P = 0.000) e no aumento da pressão máxima de encerramento uretral (PMCU) (Diferença Média Padronizada = 0.86, IC de 95%: 0.61-1.11, P = 0.000). Conclusão: A terapia da medicina tradicional chinesa (MTC) é eficaz na melhoria dos sintomas da incontinência urinária, na urodinâmica e na qualidade de vida em pacientes com incontinência urinária de esforço (IUE). Este artigo fornece uma referência para a aplicação da terapia da MTC em mulheres com incontinência urinária.

Mouthwash use and oral cancer: a systematic review and meta-analysis

ABSTRACT OBJECTIVE This study aimed to investigate the effect of mouthwash use on the development of oral cancer. METHODS Observational studies with adult/older adult populations that have examined the association between mouthwash use and oral cancer were included. Electronic search was performed in July 2022, with no time or language restrictions. PubMed/Medline, Embase, and Web of Science databases were used, and the search was extended to theses and dissertations libraries, Google Scholar, reference lists, and other sources. Methodological quality was assessed using the Newcastle-Ottawa Scale and quantitative data synthesis was performed by random effects meta-analysis, with different subgroup analyses and meta-regression. This revision was registered in Prospero (CRD42020143307). RESULTS Of the 4,094 studies identified in the search, 15 case-control studies were included in the review, totaling 6,515 cases and 17,037 controls. The meta-analysis included 17 measures of effect from 15 case-control studies. The pooled OR was 1.00 (95%CI: 0.79-1.26, n = 17 studies), but it was 2.58 (95%CI: 1.38-4.82, n = 2 studies) among those who had used mouthwashes three times or more times a day, and 1.30 (95%CI: 1.10-1.54, n = 4 studies) among those who had used mouthwashes for more than 40 years. CONCLUSIONS We found evidence that a high frequency of mouthwash use may be associated with an increased risk of oral cancer. However, despite the biological plausibility for this association, we suggest caution upon interpretation of our findings due to the few number of studies that have investigated the mouthwash use frequency, which should be considered. Therefore, we recommend that future studies assess, in detail, the frequency, duration, and content of mouthwashes to increase the strength of evidence for a possible dose-response effect of mouthwashes on oral cancer risk.

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a metaanalysis of randomised controlled trials

Abstract Objective: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. Methods: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. Results: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to Clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02-208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55-185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25-238.58; I2 = 99%; GRADE approach evidence-high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60-2.41 ; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63-10.66; I2 = %). Conclusion: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than Clonidine.

Impacto do metilfenidato no estresse oxidativo e na plasticidade cerebral / Methylphenidate impact on oxidative stress and brain plasticity

Esse estudo avaliou o impacto do tratamento com cloridrato de metilfenidato (MFD) em crianças com Transtorno de Déficit de Atenção e Hiperatividade. O estudo incluiu metodologia variada, contendo estudo de revisão sobre efeito de metilfenidato sobre BDNF e estudo de coorte experimental. O estudo de revisão seguiu as diretrizes do PRISMA e foi registrado no PROSPERO. No estudo experimental, coorte aberta de centro único foi desenhada, com amostra de conveniência recrutada entre os anos de 2020 e 2022, no ambulatório de ensino da faculdade de Medicina da Universidade Federal de Viçosa (MG). Amostra de 62 crianças, 6 a 14 anos incompletos, sem tratamento prévio, diagnosticadas por psiquiatra infantil segundo os critérios do Manual Diagnóstico e Estatístico dos Transtornos Mentais (DSM5). Média de 8 consultas de acompanhamento clínico realizadas, com coletas de amostras biológicas em 3 delas: antes do início do MFD, com 12 e 24 semanas após uso da medicação. Amostra caracterizada quanto a dados sociodemográficos, sintomas de TDAH, avaliações clínica e psiquiátrica e testagem de inteligência pela psicologia. Amostras biológicas para dosagens séricas de marcadores oxidativos (níveis de capacidade antioxidante total -FRAP -, atividade de superóxido dismutase ­ SOD-, catalase ­ CAT -, glutathione -S-transferase -GST-, níveis de peroxidação lipídica e de proteínas carboniladas) foram coletadas de cada criança nos três momentos da avaliação. Metilfenidato de liberação imediata foi administrado na dosagem de média de 0,65mg/kg/dia. Usou-se o teste de Shapiro-Wilk e Kolmogorov-Smirnov para análise de normalidade. Frequências absolutas e relativas foram determinadas para as variáveis numéricas que foram descritas por suas médias e desvios padrões. Para comparações múltiplas dos parâmetros oxidativos foi realizado pós teste paramétrico de Tukey e para as demais variáveis análise de variância ANOVA (f). Análises dos parâmetros oxidativos foram realizadas no programa GraphPad Prism 7.0 (GraphPad Software, Inc. San Diego, CA, USA) e dos dados sociodemográficos e clínicos no software SPSS (versão 23.0 para Windows). Significância estatística foi considerada com p <0.05. Os resultados mostram: Sexo masculino predominante (71%), idade média 8,58 ± 1,91, predominância de apenas um cuidador - mãe e/ou pai biológico como chefe de família e maior frequência de tipo combinado de TDAH. Pressão arterial sistólica, frequência cardíaca e temperatura corporal alterações significativas, porém sem significância clínica. Índice massa corporal com diferença estatística, 37%, 19,3% e 21% das crianças apresentaram IMC acima do esperado para idade na avaliação 1, 2 e 3 respectivamente. Adesão ao tratamento medicamentoso permaneceu acima de 93,5% na 24ª semana. Durante o tratamento: FRAP não se alterou; atividade de SOD reduziu na 12ª semana em comparação à linha de base; atividade de CAT aumento significativo à 24ª em comparação 12ª semana; aumento significativo dos níveis de peroxidação lipídica à 24ª semana em comparação à 12ª semana. Aumento significativo das proteínas carboniladas na linha de base em comparação aos níveis da 12ª e 24ª semanas. O metilfenidato parece influenciar os parâmetros redox de crianças com TDAH, aumentando o estresse oxidativo. Porém, mecanismos cerebrais tamponam e desconhecemos o resultado dessas interações na estrutura cerebral. Níveis de BDNF não foram influenciados significativamente por metilfenidato em crianças com TDAH, quando comparados a controles em nossa metanálise.

This study evaluated the impact of methylphenidate hydrochloride (MFD) treatment (MFD) in children with Attention Deficit Hyperactivity Disorder. The study included varied methodology, including a review study about methylphenidate effects on BDNF and an experimental cohort study. The review study followed the PRISMA guidelines and was registered in PROSPERO. In the experimental study, a single-center open cohort was designed, with a convenience sample recruited between the years 2020 and 2022, at the teaching outpatient clinic of the Faculty of Medicine at Viçosa Federal University (UFV-MG). Sample with 62 children, 6 to 14 years old, without previous treatment, diagnosed by a child psychiatrist according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM5). Eight clinical follow-up visits were carried out, and biological samples were collected in 3 visits: before MFD beginning and after 12- and 24-weeks medication. Sociodemographic data, ADHD symptoms, clinical and psychiatric assessments were performed, as well as intelligence testing by psychology. Biological samples for oxidative markers serum dosages (total antioxidant capacity levels -FRAP -, superoxide dismutase activity - SOD-, catalase - CAT -, glutathione S transferase -GST-, lipid peroxidation and carbonyl proteins levels) were collected of each child in the 3 evaluation moments. Immediate-release methylphenidate was administered at approximately 0.65mg/kg/day. The Shapiro-Wilk and Kolmogorov-Smirnov test was used for normality analysis. Absolute and relative frequencies were used for numeric variables that were described by their means and standard deviations. Tukey's parametric test and variance analysis ANOVA (f) were performed for multiple comparisons in redox parameters and other variables respectively. Redox parameters analysis was performed using GraphPad Prism 7.0 program (GraphPad Software, Inc. San Diego, CA, USA) and other variables using SPSS software (version 23.0 for Windows). Statistical significance was considered at p<0.05. Male was predominant (71%), with a mean age of 8.58 ± 1.91, mother and/or biological father were the householder in most homes. Systolic blood pressure, heart rate and body temperature had significant changes, but without clinical significance. Body mass index showed a statistical difference, with 37%, 19.3% and 21% of the children having a BMI above the expected for their age in assessment 1, 2 and 3 respectively. Combined-ADHD occurred in 58.1% of the children, inattentive in 32.3% and hyperactive/impulsive in 9.7%. Drug treatment adherence was 98.4% (12th week) and 93.5% (24th week). There were no changes in FRAP levels; SOD activity had significant decreased at week 12 compared to baseline activity; CAT activity showed a significant increase at the 24th week compared to 12th week; Significant increase in lipid peroxidation levels at 24th week compared to 12th week. Significant increase in protein carbonyls levels at baseline (before methylphenidate use) compared to levels at 12 and 24 weeks. Methylphenidate can influence the oxidative and antioxidative parameters of ADHD children, increasing oxidative stress. However, buffer brain mechanisms may act and the result of these interactions in brain structure is not completely known. BDNF levels were not significantly affected by methylphenidate treatment in ADHD children and do not differ from controls in our meta-analysis.

Metanálises em psicologia: uma introdução conceitual e prática / Meta-analyses in psychology: a conceptual and hands-on introduction / Metanálisis en psicología: una introducción conceptual y práctica

Metanálise consiste em um conjunto de técnicas estatísticas que visa integrar os resultados de dois ou mais estudos primários. Ela permite produzir estimativas pontuais e intervalares de algum parâmetro populacional, geralmente uma medida de tamanho de efeito. Este artigo tem como objetivo apresentar conceitos fundamentais sobre metanálise e suas aplicações para psicólogos e estudantes de psicologia. O artigo: (1) introduz a lógica da metanálise, seus potenciais e as críticas a ela endereçadas; (2) apresenta dois modelos de metanálise comumente usados por pesquisadores; e (3) aborda dois tópicos importantes para a interpretação correta dos resultados: heterogeneidade e análise de subgrupos. Um exemplo fictício ilustra os conceitos ao longo do artigo. Os Materiais Suplementares contêm equações dos modelos apresentados no texto, resultados comentados de uma síntese metanalítica, código na linguagem R para reproduzir resultados e figuras desse artigo e uma breve lista comentada de fontes adicionais sobre metanálise. (AU)

Meta-analysis consists of a set of statistical techniques that aims to combine the results of two or more primary studies. It enables the calculation of point and interval estimates of some population parameter, usually a measure of effect size. The aim of this article is to introduce fundamental concepts of meta-analysis and its applications for psychologists and psychology students. The article: (1) introduces the logic of meta-analysis, its uses and common criticisms levied against it; (2) presents two computational models of meta-analysis commonly used by researchers; and (3) addresses two issues associated with the correct interpretation of results from meta-analyses: heterogeneity and subgroup analysis. A worked example illustrates the concepts throughout the article. The Supplementary Materials contain a worked example of the models presented in the text, a script in R language that allows the reader to reproduce the results, and a commented list of additional sources. (AU)

El metanálisis consiste en un conjunto de técnicas estadísticas que tiene como objetivo integrar los resultados de dos o más estudios primarios. Permite producir estimaciones puntuales y de intervalo de algún parámetro de población, generalmente una medida del tamaño del efecto. Este artículo presenta conceptos fundamentales sobre el metanálisis y sus aplicaciones para psicólogos y estudiantes de psicología. El artículo: (1) introduce la lógica del metanálisis, sus potencialidades y las críticas que se le dirigen; (2) presenta dos modelos de metanálisis comúnmente utilizados por los investigadores; y (3) aborda dos temas importantes para la correcta interpretación de los resultados: heterogeneidad y análisis de subgrupos. Un ejemplo ficticio ilustra los conceptos a lo largo del artículo. Los Materiales Suplementarios contienen ecuaciones de los modelos presentados en el texto, resultados comentados de una síntesis metanalítica, código en el lenguaje R para reproducir los resultados y las figuras de este artículo, y una breve lista comentada de fuentes adicionales. (AU)

The burden of healthcare-associated infection in Moroccan hospitals: systematic review and meta-analysis

Healthcare-associated infections (HAI), also referred to as nosocomial infections, is defined as an infection acquired in a hospital setting. This infection is considered a HAI if it was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. HAI are a major patient safety measure to be considered in hospitals.

The accuracy of widal test for typhoid fever diagnosis in Ethiopia: Systematic review and meta-analysis

Introduction: Widal agglutination test is a serologic investigation that is used to diagnose typhoidfever. This is an easy, fairly inexpensive, and readily available test it'ith questionable reliability. The test performance differs from setting to setting depending on the technique used and otherfactors. The accuracy ofthis test in Ethiopia is poorly understood. So, the aim of this scientific work was to analyze the accuracy of Widal agglutination in diagnosing typhoidfever in Ethiopia. Methods: We performed a systematic review and meta-analysis. Two electronic databases (PubMed/Medline and Google scholar) were searched using preset search strategv to find relevant studies. The methodological quality of the studies included was evaluated "'ith a QUADAS-2. We extracted important variables from the eligible articles. Statistical analysis was conducted using STATA version 14. The protocol of our systematic review and metaanalysis is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the record number CRD42020194252. Results: The electronic quests yielded 42 papers of which 8 "'ere eligible for analysis. The quality of these studies was rated to be moderate based on the QUADAS-2. The pooled sensitivity, specificity, and negative, andpositive predicthe values ofthe Widal test were 80.8%, 53.0%, 98.5%, and 2.1% respecth'ely. Conclusion: The "'idal agglutination test has average specificity, ven good negative predicth'e value, and ven poor positive predictive value for the diagnosis of typhoidfever. Depending on Widal to diagnose typhoid fever may lead to over-diagnosis of typhoid fever and related complications including inappropriate use of antibiotics. There is an urgent needfor quick and dependable tests for diagnosing typhoidfever, particularly in settings like Ethiopia M'here doing timely culture is notfeasible.

Effectiveness of family-focused intervention in patients with schizophrenia in family and community practice – A meta-analysis study

Background@#Schizophrenia is a pervasive, chronic mental disorder that negatively impacts the biological, socioeconomic and family well being of the patient. Active involvement of family members and other significant individuals appears to benefit overall management.@*Objective@#To determine the effectiveness of family-focused intervention in improving symptoms of schizophrenia.@*Methods@#The authors searched for eligible clinical trials in the PubMed, Cochrane Central Register of Controlled Trials, Research Gate, Google Scholar and grey literature databases. Participants should be patients diagnosed to have schizophrenia and interventions should involve the family or be labeled as ‘family therapy.’ The primary outcome considered was symptom improvement based on the Positive and Negative Symptom Scale (PANSS). Secondary outcomes included quality of life, family functioning and subjective experience of the treatment process. The authors used the RevMan 5.4 software for data analysis. Bias, subgroup and sensitivity analyses were performed. Strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.@*Results@#A total of 1,794 trials were initially identified, of which three publications were included in the review. Two studies used psychosocial approaches whereas one used cognitive behavioral therapy in conjunction with family intervention. Meta-analysis revealed the studies to be heterogeneous based on p values <0.10 and I2 >50%. Subgroup analysis by type of intervention showed no difference between the intervention and control groups, although there was a positive trend in favor of psychosocial intervention for improvement in PANSS score. Family-based intervention had a significant positive effect on quality of life. @*Conclusion@#Family-based interventions are effective in the management of schizophrenia, helping to improve quality of life, potentially reducing symptom burden and serving as an adjunct to health institution-based management.

Maternal and newborn impact of epidural dexamethasone as an adjuvant for labor analgesia: A meta-analysis

Background@#Dexamethasone, an anti-inflammatory drug, has an assumed analgesic effect when given epidurally, with less side effects5,7. Although numerous studies have evaluated dexamethasone, there is a paucity of studies assessing its intrapartum use.@*Objectives@#To determine the effectiveness of epidural dexamethasone when used as an adjuvant for labor analgesia.@*Materials and Methods@#A meta-analysis guided by the Cochrane handbook was performed. Articles were searched through PubMed, MEDLINE, CENTRAL, Google Scholar and ClinicalTrials.gov using search strategies such as keywords and MeSH terms. Cochrane version 2 risk-of-bias tool for randomized trials (RoB 2) was used to assess for quality. Quantitative data were pooled and analyzed using Review Manager 5.4.1.@*Results@#A total of five trials involving 309 women in labor were analyzed. The pooled mean difference showed prolonged duration of epidural analgesia on patients who received epidural dexamethasone; pooled risk ratio between the experimental and control group demonstrated no significant maternal adverse events such as nausea and vomiting, shivering, hypotension, and fever. Pooled risk ratio and mean difference also showed that epidural dexamethasone had no significant effect on the neonatal APGAR and neonatal umbilical pH.@*Conclusion@#Present data demonstrated the potential role of dexamethasone as an adjuvant to epidural solution during labor analgesia on providing local anesthetic dose sparing effect through prolongation of the duration of epidural analgesia, with limited maternal and neonatal adverse events. These results should be interpreted with caution before adopting this technique in routine clinical practice.

Health education interventions on knowledge and self-care practices for hypertensive disorders during pregnancy: systematic review and meta-analysis protocol / Intervenciones en educación para la salud sobre conocimientos y prácticas de autocuidado para los trastornos hipertensivos durante el embarazo: protocolo de revisión sistemática y meta análisis / Intervenções em educação para a saúde sobre conhecimento e práticas de autocuidado para os distúrbios hipertensivos durante a gravidez: protocolo de revisão sistemática e meta- análise

Introduction: Hypertensive disorders during pregnancy are a global health problem. Health education is a strategy that provides pregnant women with knowledge and skills for self-care. Objective: evaluate the effect of health education interventions on pregnant women's knowledge and self-care practices for hypertensive disorders in pregnancy, compared to standard prenatal care. Materials and Methods: Systematic review and meta-analysis protocol. The study record can be consulted in PROSPERO (CRD42021252401). The search will be conducted in the following databases, PubMed/MEDLINE, CENTRAL, LILACS, CINAHL, EMBASE, and WoS. Additionally, clinical trial records in ClinicalTrials and grey literatura in OpenGrey and Google Scholar. The search will include studies of health education intervention in knowledge and self-care practices about hypertensive disorders in pregnancy. All statistical analysis will be carried out with the Review Manager software. Data will be combined using random-effects models, binary data with odds ratios or relative risks, and continuous data using mean differences. Heterogeneity between studies will be assessed using the Q-Cochran test to measure the significance and the l2 statistic to measure magnitude. Discussion: This study will contribute to the knowledge of health interventions that are effective in guiding and educating pregnant women about the disease and self-care practices. Conclusion: The results of this study will be used to provide recommendations in the management of maternal perinatal care, that promote comprehensive care in accordance with the Primary Health Care policy.

Introducción: Los trastornos hipertensivos durante el embarazo constituyen un problema de salud a nivel mundial. La educación para la salud es una estrategia que brinda a la mujer embarazada conocimientos y habilidades para el autocuidado. Objetivo: evaluar el efecto de intervenciones en educación para la salud sobre el conocimiento y las prácticas de autocuidado de mujeres embarazadas ante los trastornos hipertensivos en el embarazo, en comparación con la atención estándar del control prenatal. Materiales y Métodos: Protocolo de revisión sistemática y metaanálisis. El registro del estudio puede ser consultado en PROSPERO (CRD42021252401). La búsqueda se realizará en las siguientes bases de datos, PubMed/MEDLINE, CENTRAL, LILACS, CINAHL, EMBASE y WoS. Adicionalmente, registros de ensayos clínicos en ClinicalTrials y literatura gris en OpenGrey y Google Scholar. La búsqueda incluirá estudios de intervenciones en educación para la salud sobre conocimientos y prácticas de autocuidado ante los trastornos hipertensivos del embarazo. Los análisis estadísticos se llevarán a cabo con el software Review Manager. Los datos se combinarán mediante modelos de efectos aleatorios, los datos binarios con odds ratios o riesgos relativos y los datos continuos mediante diferencia de medias. La heterogeneidad entre los estudios se evaluará mediante la prueba Q-Cochran para medir la significancia y el estadístico l2 para medir la magnitud. Discusión: Este estudio aportará en el conocimiento de las intervenciones en salud que son efectivas para orientar y educar a las mujeres embarazadas sobre la enfermedad y prácticas de autocuidado. Conclusión: Los resultados de este estudio servirán para proporcionar recomendaciones en la gestión del cuidado materno perinatal, que promuevan atención integral acorde con la política de Atención Primaria en Salud.

Introdução: Os distúrbios hipertensivos durante a gravidez são um problema de saúde globalA educação em saúde é uma estratégia que proporciona às gestantes conhecimentos e habilidades para o autocuidado. Objetivo: avaliar o efeito das intervenções de educação em saúde no conhecimento e nas práticas de autocuidado das gestantes para os distúrbios hipertensivos na gravidez, em comparação com o pré-natal padrão. Materiais e Métodos: Protocolo de revisão sistemática e meta-análise.O registro do estudo pode ser consultado no PROSPERO (CRD42021252401). A busca será realizada nas seguintes bases de dados, PubMed/MEDLINE, CENTRAL, LILACS, CINAHL, EMBASE e WoS. Além disso, registros de ensaios clínicos no ClinicalTrials e literatura cinzenta no OpenGrey e Google Scholar. A pesquisa incluirá estudos de intervenção de educação em saúde no conhecimento e nas práticas de autocuidado sobre as doenças hipertensivas na gravidez. Todas as análises estatísticas serão realizadas com o software Review Manager. Os dados serão combinados usando modelos de efeitos aleatórios, dados binários com razões de chances ou riscos relativos e dados contínuos usando diferenças médias. A heterogeneidade entre os estudos será avaliada utilizando o teste Q-Cochran para medir a significância e a estatística l2 para medir a magnitude. Discussão: Este estudo contribuirá para o conhecimento de intervenções em saúde eficazes na orientação e educação das gestantes sobre a doença e as práticas de autocuidado. Conclusão: Os resultados deste estudo serão utilizados para fornecer recomendações na gestão da atenção perinatal materna, que promovam a integralidade da atenção de acordo com a política de Atenção Primária à Saúde.

Asociación entre tiroiditis linfocítica crónica y carcinoma papilar de tiroides: Revisión sistemática y metaanálisis de estudios en especímenes quirúrgicos / Association between chronic lymphocityc thyroiditis and papillary thyroid carcinoma: Systematic review and meta-analysis of studieson surgical specimens

Introducción. Existen resultados inconsistentes con relación al planteamiento de la hipótesis que sugiere una mayor probabilidad de documentar un carcinoma papilar de tiroides en especímenes quirúrgicos con cambios compatibles con tiroiditis linfocítica crónica. En los metaanálisis existentes se han incluido estudios no comparables metodológicamente y no se proponen claras fuentes de sesgo, justificación para la realización del presente metaanálisis. Métodos. Se realizó una búsqueda bibliográfica en Pubmed y Embase. Fueron obtenidos estudios retrospectivos donde se comparaba la prevalencia de carcinoma papilar de tiroides en especímenes con y sin cambios por tiroiditis linfocítica crónica. La evidencia recolectada fue sintetizada estadísticamente. Resultados. Un total de 22 artículos fueron incluidos. La población estuvo conformada por 63.548 especímenes. El OR combinado fue 1,81 (IC95%: 1,51-2,21). Hubo heterogeneidad entre la distribución de las razones de oportunidad entre los estudios (I2= 91 %; p>0,00001). La forma del gráfico en embudo de los estudios incluidos en el análisis parece estar simétrica, lo que indica la ausencia del sesgo atribuible a los estudios pequeños. Conclusiones. La literatura actual sugiere que existe un mayor riesgo de documentar un carcinoma papilar de tiroides en especímenes quirúrgicos en los que se observan cambios compatibles con tiroiditis linfocítica crónica; sin embargo, existen fuentes de sesgo que no será posible controlar en estudios retrospectivos, por lo que recomendamos estudiar la hipótesis que sugiere una mayor probabilidad de diagnosticar un carcinoma papilar de tiroides en especímenes con cambios compatibles con tiroiditis linfocítica crónica mediante metodologías prospectivas

Introduction. Inconsistent results exist in the literature regarding the hypothesis statement suggesting an increased likelihood of documenting papillary thyroid carcinoma (PTC) in surgical specimens with changes compatible with chronic lymphocytic thyroiditis. Existing meta-analyses have included studies that are not methodologically comparable and do not propose clear sources of bias, thus, this is justification for the present meta-analysis. Methods. A literature search in Pubmed and Embase was performed from January 1, 1950 to December 31, 2020. Retrospective studies comparing the prevalence of papillary thyroid carcinoma in specimens with and without chronic lymphocytic thyroiditis changes were obtained. The collected evidence was statistically analyzed. Results. A total of 22 articles were included. The study population consisted of 63,548 surgical specimens. The pooled OR, based on the studies, was 1.81 (95% CI: 1.51-2.21). There was heterogeneity between the distribution of prevalence ratios and opportunity ratios across studies (I²= 91%; p>0.00001). The funnel plot shape of the studies included in the analysis appears to be symmetrical, indicating the absence of bias attributable to small studies. Conclusions. The current literature suggests that there is an increased risk of documenting papillary thyroid carcinoma in surgical specimens in which chronic lymphocytic thyroiditis-compatible changes are observed; however, there are sources of bias that will not be possible to control for in retrospective studies, so we recommend studying the hypothesis suggesting an increased likelihood of diagnosing PTC in specimens with chronic lymphocytic thyroiditis-compatible changes using prospective methodologies

Comorbilidades infecciosas en la gravedad y mortalidad por Covid-19: análisis del aporte científico en The Lancet Publishing Group / Infectious comorbidities in severity and mortality from Covid-19: analysis of the scientific contribution in The Lancet Publishing Group

El número de casos totales de la enfermedad coronavirus-2019 (Covid-19) sigue aumentando rápidamente, amenazando a miles o millones de personas con condiciones crónicas preexistentes que se ven afectados de manera desproporcionada. Hasta el 2020, el centro de recursos de coronavirus de la Universidad Johns Hopkins informó que en todo el mundo más de 180 países han sido afectados con Covid-19 con más de doce millones de casos confirmados y más de 500,000 muertes. A medida que continúa la investigación relacionada con los posibles factores de riesgo de mortalidad por Covid-19, se hace evidente que las personas con comorbilidades subyacentes, como enfermedades cardiovasculares, hipertensión, diabetes, insuficiencia cardíaca congestiva, enfermedad cerebrovascular, enfermedad renal crónica, enfermedad hepática crónica, cáncer, enfermedad pulmonar obstructiva crónica, el asma y el VIH/SIDA pueden tener un mayor riesgo de muerte por Covid-19. El objetivo de este trabajo es determinar las comorbilidades infecciosas en la gravedad y mortalidad por Covid-19 especialmente asociadas con VIH/SIDA y tubercolosis, respodiendo a la siguiente pregunta: ¿La comunidad científica mundial se ha preocupado por la comorbilidad infecciosa en casos de covid-19 severos y fatales?. Un análisis hecho al grupo de referencias The Lancet Publishing Group fue realizado para dar repuesta a dicha pregunta(AU)

The number of total cases of coronavirus disease-2019 (COVID-19) continues to rise rapidly, threatening thousands or millions of people with pre-existing chronic conditions who are disproportionately affected. As of 2020, the Johns Hopkins University Coronavirus Resource Center reported that worldwide more than 180 countries have been affected with COVID-19 with more than twelve million confirmed cases and more than 500,000 deaths. As research related to potential risk factors for mortality from COVID-19 continues, it becomes clear that people with underlying comorbidities, such as cardiovascular disease, hypertension, diabetes, congestive heart failure, cerebrovascular disease, chronic kidney disease, chronic liver disease, cancer, chronic obstructive pulmonary disease, asthma, and HIV/AIDS may be at increased risk of death from COVID-19. The objective of this work is to determine the infectious comorbidities in severity and mortality from Covid-19, especially associated with HIV/AIDS and tuberculosis, answering the following question: Has the world scientific community been concerned about infectious comorbidity in covid-19 severe and fatal cases? An analysis made to the reference group The Lancet Publishing Group was carried out to answer this question(AU)

Revisión sistemática con metaanálisis. Iodo povidona / Systematic Review with Meta-Analysis. Povidone Iodine

Introducción: La descontaminación preoperatoria de la piel es parte de la práctica quirúrgica estándar. La infección del sitio quirúrgico implica un gasto adicional a los sistemas de salud y un incremento en la morbilidad y mortalidad de los pacientes sometidos a cirugía. El iodo povidona es un desinfectante muy utilizado para eliminar la carga bacteriana cutánea. Objetivo: Constatar si el iodo povidona es mejor que otros desinfectantes cutáneos en la reducción de las infecciones del sitio quirúrgico. Métodos: Se realizó una búsqueda en Google Académico, PubMed y Embase utilizando los términos Mesh; iodo povidona, infección del sitio quirúrgico, cirugía, antisépticos locales, unidos por el operador booleano AND y los filtros Adultos, desde 2015, y ensayos clínicos controlados. Se aplicó la escala de Jadad para riesgo de sesgos y el Consort 2010 y la lista de chequeo PRISMA para determinar la calidad del estudio. El riesgo relativo fue la medida de efecto para un IC95 y un error de 0,05. Se incluyeron 8 ensayos clínicos controlados, n= 4800 casos, con la distribución de eventos en los grupos experimental 140/2402 y control 141/2398, para una diferencia no significativa p=0,444. La heterogeneidad fue I2=62,57 por ciento. Conclusiones: No existieron diferencias entre el iodo povidona y el resto de los desinfectantes para disminuir el porcentaje de infecciones del sitio quirúrgico en este estudio(AU)

Introduction: Preoperative skin decontamination is part of standard surgical practice. Surgical site infection implies an additional cost to health systems and an increase in morbidity and mortality of patients undergoing surgery. Povidone iodine is a widely used disinfectant to eliminate the bacterial load on the skin. Objective: To verify if povidone iodine is better than other skin disinfectants in reducing surgical site infections. Methods: A search of articles and controlled clinical trials published since 2015 was carried out in Google Scholar, PubMed and Embase and using terms of the Mesh such as povidone iodine, surgical site infection, surgery, local antiseptics, joined by the Boolean operator AND in addition to Adult filters. The Jadad scale for risk of bias and Consort 2010 and PRISMA checklist were applied to determine the quality of the study. Relative risk was the measure of effect for CI95 and an error of 0.05. Eight controlled clinical trials were included, n= 4800 cases, with the distribution of events in the experimental groups 140/2402 and control 141/2398, for a non-significant difference p=0.444. Heterogeneity was I2=62.57 percent. Conclusions: There were no differences between povidone iodine and the rest of the disinfectants to reduce the percentage of surgical site infections in this study(AU)

Terapia endocrina para la prevención primaria del cáncer de seno: Revisión sistemática y metaanálisis actualizado / Endocrine therapy for primary prevention of breast cancer: Systematic review and updated meta-analysis

Introducción. Debido a que el cáncer de seno es una enfermedad asociada a una significativa tasa de morbilidad y mortalidad cuando se diagnostica en el período sintomático, se han hecho enormes esfuerzos orientados hacia la prevención primaria de esta enfermedad. Métodos. Se realizó una búsqueda de todos los experimentos clínicos aleatorizados que evaluaran la eficacia de la terapia endocrina para la reducción del riesgo de desarrollar cáncer de seno. La calidad metodológica de los estudios seleccionados fue valorada utilizando la herramienta de la Colaboración Cochrane para medir el riesgo de sesgo en ensayos aleatorizados. Se evaluó la heterogeneidad de los estudios primarios elegibles utilizando los estadísticos T², I², H². El sesgo de publicación fue evaluado mediante el test de Harbord y mediante la gráfica de funnel plot. La medida de efecto utilizada en este metaanálisis fue el riesgo relativo (RR) con el cálculo de los intervalos de confianza (IC) del 95%. Resultados. Encontramos doce experimentos clínicos aleatorizados que reclutaron a 68.180 mujeres, las cuales fueron asignadas al azar para recibir algún tipo terapia endocrina para reducir el riesgo de desarrollar cáncer de seno o placebo. La terapia endocrina en conjunto redujo el riesgo proporcional de cáncer de seno (invasivo más in situ) en un 42 %, resultado estadísticamente significativo RR 0,58 (IC95% 0,50 ­ 0,69). Conclusiones. La terapia endocrina es el manejo estándar de prevención en mujeres sanas con riesgo de desarrollar cáncer de seno no hereditario.

Introduction. Because breast cancer is a disease associated with a significant morbidity and mortality rate when diagnosed in the symptomatic period, enormous efforts have been made towards the primary prevention of this disease. Methods. A search was conducted for all randomized clinical trials evaluating the efficacy of endocrine therapy in reducing the risk of developing breast cancer. The methodological quality of the selected studies was assessed using the Cochrane Collaboration tool to assess risk of bias in randomized trials. Heterogeneity of eligible primary studies was assessed using the T², I², H² statistics. Publication bias was evaluated using the Harbord test and the funnel plot. The effect measure used in this meta-analysis was the relative risk (RR) with the calculation of the 95% confidence intervals (CI).Results. We found twelve randomized clinical trials that recruited 68,180 women who were randomly assigned to receive some type of endocrine therapy to reduce the risk of developing breast cancer or placebo. Endocrine therapy as a whole reduced the proportional risk of breast cancer (invasive plus in situ) by 42%, a statistically significant result RR 0.58 (95% CI 0.50 - 0.69). Conclusions. Endocrine therapy is the standard preventive management in healthy women at risk of developing non-hereditary breast cancer.

A meta-analysis on the effectiveness of postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl as neuraxial adjuvants in cesarean section

@#<p><strong>Background: </strong>Inadequately treated postoperative pain can contribute significantly to morbidity in women undergoing cesarean section.  Recent studies showed that nalbuphine and fentanyl has promising result as neuraxial adjuvants in terms of postoperative analgesia and with lower incidents of adverse effect when use in cesarean section. </p><p><strong>Objective: </strong>To determine the effectiveness of postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl as neuraxial adjuvants in cesarean section. </p><p><strong>Methods</strong>:  A meta-analysis following the PRISMA guidelines was performed.  Articles were searched through the Cochrane Library, PubMed.Gov and Pubmed Central, Google Scholar, HERDIN, WPRIM and ProQuest Guideline Central using different search strategies such as keywords and MeSH term.  Cochrane version 2 risk-of-bias tool for randomized trials (RoB 2) was used to assess for quality.  Quantitative data were pooled and analyzed using Review Manager 5.4. </p><p><strong>Results: </strong>A total of four trials, involving 425 full term pregnant women were analyzed. The pooled mean difference showed significantly longer duration of postoperative analgesia (MD=21.12 minutes, 95%CI=11.13,31.11, I2=73%), pooled risk ratio showed lesser risk for pruritus (RR=0.09, 95%CI=0.02,0.50, I2 = 0%) and postoperative nausea and vomiting (RR=0.38, 95%CI= 0.19,0.78, I2 = 11%) who received intrathecal nalbuphine compared to intrathecal fentanyl. </p><p><strong>Conclusions</strong>: The results of this meta-analysis demonstrates that the use of intrathecal nalbuphine appears to have a better outcome in increasing the duration of postoperative analgesia and with lesser incidence of PONV and pruritus than fentanyl.  However, due to the presence of heterogeneity it warrants that the results should be treated with caution especially with the possibility of publication bias. </p><p><strong>Recommendations: </strong>Better literature search through inclusion of high-quality studies from relevant databases and strict adherence on the uniformity of the dosage and <strong>methods</strong> used are very crucial to achieve the target clinical outcomes and minimize the publication bias. </p>

Custo-benefício da fluoretação da água de abastecimento público / Cost-benefit analysis of community water fluoridation

OBJETIVO: Analisar potenciais fatores ligados à qualidade da fluoretação da água de abastecimento público, seu custo-benefício e custo-efetividade em diferentes portes populacionais e grupos etários no Brasil. MÉTODO: Foi realizado um estudo de avaliação econômica, em que tanto consumo de recursos, quanto os benefícios em saúde foram medidos. Inicialmente, foi realizado um estudo ecológico para avaliar fatores associados a qualidade da fluoretação, utilizando regressão de Poisson. Os custos com a medida foram analisados por meio de um estudo de caso e, foram considerados dados referentes aos custos de instalação inicial, do produto químico, da operacionalização do sistema e do controle dos teores de flúor. Para análise da efetividade da fluoretação, foi realizado uma revisão sistemática com estudos brasileiros que comparam a experiência de cárie em áreas fluoretadas e não fluoretadas. A avaliação econômica foi conduzida na perspectiva da sociedade, foram calculados o custo-efetividade e custo-benefício, e foram incluídos os custos diretos e indiretos dos procedimentos que poderiam ser evitados, com uma taxa de desconto de 3,5%. Foi realizada análise de sensibilidade para avaliar a robustez dos resultados. RESULTADOS: Os fatores associados a qualidade da fluoretação foram, porte populacional do município, conformidade da concentração de cloro, renda per capita e tipo de empresa de saneamento. O custo per capita anual da fluoretação variou de US$ 7,32 para o porte com menos de 2 mil habitantes a US$ 0,14 para o porte com cerca de 520 mil habitantes. Nos sistemas que servem até 30 mil habitantes, o custo de operacionalização foi responsável por maior parte dos gastos, variando de 98,20 a 84,00%. No porte de 520 mil habitantes, os custos com o produto químico corresponderam a 74,7% dos gastos. A diferença média do ceod entre áreas fluoretadas e não fluoretadas foi -2,28 (IC95% -3,26; -1,30) para crianças de 5 a 8 anos e -1,12 (IC95% CI -1,93; -0,32) para 3 a 12 anos. A diferença média no CPOD foi -0.61 (IC95% -0,80; -0,42) e a prevalência de cárie foi 1,4 vezes e 57% menor na dentição decídua e permanente, respectivamente. Os custos evitados decorrentes da fluoretação foram de US$ 174,40 e US$ 85,67 para crianças de 5-8 e 3-12 anos, respectivamente, e US$ 46,66 para crianças de 7-12 anos. Os resultados do custo-efetividade e custobenefício foram favoráveis em todos os cenários onde o tamanho da população atendida foi de 6.000 ou mais habitantes. Cenários desfavoráveis foram observados apenas em tamanho até 2.000 habitantes. CONCLUSÃO: A fluoretação se mantem como uma medida de baixo custo per capita e efetiva contra a cárie dentária mesmo com o amplo uso do dentifrício fluoretado. Além disso, é economicamente vantajosa principalmente em áreas mais populosas, tanto na dentição decídua quanto permanente. Como o processo de tomada de decisão no campo das políticas públicas sofre múltiplas influências em torno de diferentes alternativas de políticas, conhecer os fatores relacionados a qualidade da fluoretação, seus custos e sua efetividade é essencial para uma tomada de decisão informada.

OBJECTIVE: To analyze potential factors associated to the quality of fluoridation of public water supply, its cost-effectiveness and cost-effectiveness in different population sizes and age groups in Brazil. METHOD: An economic evaluation study was carried out, in which both resource consumption and health benefits were measured. Initially, an ecological study was carried out to evaluate factors associated with the quality of fluoridation, using Poisson regression. A case study was carried out to analyze the costs of fluoridation, and data referring to the costs of initial installation, chemical product, system operationalization and control of fluoride levels were considered. To analyze the effectiveness of fluoridation, a systematic review was carried out with Brazilian studies comparing the experience of caries in fluoridated and non-fluoridated areas. The economic evaluation was conducted from the perspective of society, cost-effectiveness and cost-benefit were calculated, and direct and indirect costs of procedures that could be avoided were included, with a discount rate of 3.5%. Sensitivity analysis was performed to assess the robustness of the results. RESULTS: The factors associated with the quality of fluoridation were population size of the municipality, compliance with chlorine concentration, per capita income, and type of sanitation company. The annual per capita cost of fluoridation ranged from US$ 7.32 for municipalities with less than 2 thousand inhabitants to US$ 0.14 for municipalities with approximately 520 thousand inhabitants. In systems that serve up to 30 thousand inhabitants, the cost of operation was responsible for most of the expenses, ranging from 98.2 to 84%. In the size of 520 thousand inhabitants, the costs with the chemical product corresponded to 74.7% of the expenses. The mean difference in dmft between fluoridated and nonfluoridated areas was -2.28 (95%CI -3.26; -1.30) for children aged 5 to 8 years and - 1.12 (95%CI -1.93; -0.32) for 3 to 12 years. The mean difference in DMFT was -0.61 (95%CI -0.80; -0.42) and caries prevalence was 1.4 times and 57% lower in primary and permanent dentition, respectively. Avoided costs from fluoridation were US$174.40 and US$85.67 for children aged 5-8 and 3-12 years, respectively, and US$46.66 for children aged 7-12 years. The cost-effectiveness and cost-benefit results were favorable in all scenarios where the population size served was 6,000 or more inhabitants. Unfavorable scenarios were observed only in size up to 2,000 inhabitants. CONCLUSION: Fluoridation remains a low-cost per capita and effective measure against dental caries even with the widespread use of fluoride toothpaste. In addition, it is economically advantageous mainly in more populated areas, both in deciduous and permanent dentition. As the decision-making process in the field of public policies is complex and decision-makers suffer multiple influences around different policy alternatives, knowing the factors related to the quality of fluoridation, its costs and its effectiveness is essential for an informed decision making.

Levantamento metodológico de revisões sistemáticas de estudos de intervenção em periodontia utilizando AMSTAR 2 e ROBIS / Methodological survey of systematic reviews of intervention studies in periodontology using AMSTAR 2 and ROBIS

Este estudo teve o objetivo de avaliar a qualidade metodológica e risco de viés das revisões sistemáticas e metanálises de estudos de intervenção (randomizados e não randomizados) na área de Periodontia. Buscas foram realizadas nas bases de dados: MedLine (PubMed), Embase (Elsevier), Web of Science, Scopus, Cochrane Library e LILACS para artigos de revisão sistemática, com ou sem metanálise, indexados no ano 2019 a 2020. Adicionalmente, foram realizadas buscas na literatura cinzenta, nas referências dos artigos selecionados e nos principais periódicos de área. As avaliações da qualidade metodológica e risco de viés foram realizadas através das ferramentas AMSTAR 2 e ROBIS, respectivamente. Os dados foram importados para o software IBM SPSS Statistics for Windows versão 25. Análises descritivas de frequência relativa e absoluta foram realizadas nas variáveis categóricas. Análises descritivas de média, desvio padrão e mínima/máxima foram realizadas nas variáveis contínuas. Cento e vinte e sete revisões sistemáticas cumpriram os critérios de elegibilidade e foram avaliadas. Na avaliação geral pelo ROBIS, 113 (90,6%) das revisões apresentaram alto risco de viés, 11 (7,1%) baixo risco de viés e 3 (2,4%) risco de viés indefinido. Segundo o AMSTAR 2, a qualidade metodológica foi alta em 13 revisões (10,2%), moderada em 1 (0,8%), baixa em 31 (24,4%) e criticamente baixa em 82 (64,6%). No geral, a qualidade das revisões sistemáticas de estudos de intervenção na área de Periodontia foi considerada baixa. Sugere-se que os pesquisadores que pretendam realizar revisões sistemáticas utilizem ao menos um dos dois instrumentos no processo de desenvolvimento do protocolo da revisão. Este simples processo, se respeitado e seguido em conjunto o PRISMA, tem o potencial de resultar na criação de protocolos mais completos e, consequentemente, em revisões de melhor qualidade.

This study aimed to assess the methodological quality and risk of bias of systematic reviews and meta-analyses of intervention studies (randomized and nonrandomized studies) in periodontics. The following databases were searched: MedLine (PubMed), Embase (Elsevier), Web of Science, Scopus, Cochrane Library, and LILACS for systematic review articles, with or without meta-analysis, indexed between 2019 to 2020. Additionally, we searched on grey literature, and a manually searched the references of selected articles and main journals in the area. AMSTAR 2 and ROBIS tools were used to assess the methodological quality and risk of bias, respectively. Data were imported into the IBM SPSS Statistics for Windows version 25 software. Categorical variables were descriptively analyzed by relative and absolute frequency. Continuous variables were analyzed by mean, standard deviation, and minimum/maximum. One-hundred twenty-seven systematic reviews were included and were evaluated. In the overall ROBIS assessment, 113 (90.6%) were at high risk of bias, 11 (7.1%) were at low risk of bias, and 3 (2.4%) had unclear risk of bias. According to AMSTAR 2, 13 reviews (10.2%) had high methodological quality, 1 (0.8%) moderate, 31 (24.4%) low and 82 (64.6%) critically low. Overall, the quality of systematic reviews of intervention studies in the field of periodontics was low. Systematic review authors could use at least one between both tools before creating the study protocol. This simple process, if followed together with PRISMA, has the potential aid authors in the creation of more complete protocols and, consequently, better quality reviews.