UK

UK
  • 文章类型: Journal Article
    背景:在神经退行性疾病中,帕金森病被认为是发病率增长最快的疾病。目前尚不清楚这是否仅仅是由于全球人口老龄化造成的。随着几个环境因素越来越多地影响患病率的变化。大型数据集已在全国和全球范围内用于帮助预测未来的疾病负担。然而,这些来源的可靠性对于帕金森氏病还不清楚。
    结论:本综述讨论了迄今为止所有已发表的英国患病率研究中使用的方法。由于病例确定和诊断方法的差异,无法直接比较从10项讨论的患病率研究中获得的患病率数字。年龄调整后的估计数从105/100,000到168/100,000不等。
    结论:这些研究表明,在1961年至2007年间,患病率数字没有总体变化趋势。对于生活在农村或城市地区的人群,患病率趋势没有差异。种族之间的差异,例如,仍然是一个探索不足的地区。
    BACKGROUND: Of the neurodegenerative diseases, Parkinson\'s disease is recognised to have the fastest growing prevalence. It is unclear whether this is due to the ageing global population alone, with several environmental factors increasingly implicated in changing prevalence rates. Large data sets have been used nationally and globally to help predict future disease burden. However, the reliability of such sources is yet unknown for Parkinson\'s disease.
    CONCLUSIONS: This review discusses the methods used in all published UK prevalence studies conducted to date. Direct comparison between prevalence figures obtained from the 10 to discussed prevalence studies is precluded due to differences in methodology for case ascertainment and diagnosis. Age adjusted estimates vary from 105/100,000 to 168/100,000.
    CONCLUSIONS: These studies demonstrate no overall trend in changing prevalence figures between 1961 and 2007. No difference in prevalence trends were seen for those living in rural or urban areas. Differences between ethnic groups, for example, remains an under explored area.
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  • 文章类型: Systematic Review
    背景:在COVID-19大流行期间,远程医疗成为医疗保健提供的基本组成部分。对远程医疗相关满意度的评估有助于该服务开发更可行的应用程序。这篇评论评估了医疗保健用户和提供者的满意度以及他们将来使用这种方式的意愿。方法:按照系统评价和Meta分析的首选报告项目进行研究。在“PubMed”和“Scopus”数据库上搜索了2020年3月至2022年12月之间发布的经验文章。报告患者满意度的调查结果,家庭和照顾者以及临床医生被提取和分析。评估纳入研究的质量。在应用纳入和排除标准后,审查包括27项符合条件的研究.结果:数据来自初级的各种急诊和非急诊部门,次要,和专业医疗保健。几乎所有研究都是在NHS内进行的。有许多工具可以衡量满意度。医疗保健接受者的满意度很高,评分为9-10,评分为0-10,或范围为73.3%至100%。在所检查的每个专业中,便利性都被评为很高。尽管连接失败并且担心信息的机密性,但整个专业的临床医生满意度很高。尽管如此,研究报告认为,脆弱患者获得治疗的障碍和不平等现象增加,尤其是老年人.总的来说,受者和医疗保健提供者未来使用远程医疗的意愿很高。结论:COVID-19大流行改变了英国的医疗保健,并推动了远程医疗应用的革命。医疗保健的接受者和提供者的满意度都很高。远程医疗在整个大流行期间设法提供了持续的护理,同时保持了社会距离。当前的审查提供了值得称赞的证据,以鼓励不同的专业从事远程医疗应用。
    Background: Telemedicine became a fundamental part of healthcare provision during COVID-19 pandemic. An evaluation of telemedicine-associated satisfaction helps the service develop more viable applications. This review evaluated the satisfaction of healthcare users and providers and their willingness to use this modality in future.Methods: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search on empirical articles published between March 2020 and December 2022 was performed on \'PubMed\' and \'Scopus\' databases. Findings that reported on satisfaction of patients, families and caregivers as well as clinicians were extracted and analysed. Quality of included studies was assessed. After applying inclusion and exclusion criteria, the review included 27 eligible studies.Results: Data was found from a variety of emergency and non-emergency departments of primary, secondary, and specialised healthcare. Almost all studies were undertaken within the NHS. There were many tools that measured satisfaction. Satisfaction was high among recipients of healthcare, scoring 9-10 on a scale of 0-10 or ranging from 73.3% to 100%. Convenience was rated high in every specialty examined. Satisfaction of clinicians was high throughout the specialities despite connection failure and concerns about confidentiality of information. Nonetheless, studies reported perception of increased barriers to accessing care and inequalities for vulnerable patients especially in older people. In general, willingness to use telemedicine in future was high in the recipients as well as the providers of healthcare.Conclusion: COVID-19 pandemic has transformed healthcare in the UK and promoted a revolution in telemedicine applications. Satisfaction was high among both recipient and provider of healthcare. Telemedicine managed to provide a continued care throughout the pandemic while maintaining social distance. The current review presented commendable evidence to encourage different specialities to engage in telemedicine application.
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  • 文章类型: Journal Article
    国际人类移民的快速增长使英国在2022年成为全球前五名国家,有940万移民。这些移民来自低收入和中等收入国家,尤其面临发展为结核病的风险。在英国,结核病的数量一直在增加,移民的涌入可能是一个促成因素。
    这篇综述旨在绘制英国移民中肺结核的负担图,并调查相关因素。它还回顾了英国移民中的结核病管理方法。
    该研究利用PRISMA指南在电子数据库(PubMed和EMBASE)中搜索了2000年至2022年发表的有关移民结核病患病率和因素的文章,并探索了政府网站的结核病管理策略。
    包含了530篇最初确定的文章中的19篇。纳入的研究报告,移民中的结核病患病率为0.04%至52.1%,随着时间的推移,负担有所减轻。此外,在来自亚洲地区的移民中观察到更多的结核病例,特别是来自南亚的移民,其次是撒哈拉以南非洲。耻辱,对疾病的误解,语言障碍,缺乏机密性,对移民不友好的医疗保健系统是移民结核病负担的主要驱动因素。英国的结核病管理方法包括活动性结核病的入境前筛查,针对特定人群的LTBI测试,和抗菌治疗3-6个月的结核病患者。
    英国在降低移民结核病患病率方面的控制和预防努力表现出乐观,但挑战依然存在。主要改进包括医疗保健服务,结核病改善计划,以及解决耻辱和患者保密问题的政策。
    UNASSIGNED: The rapid growth of international human migration has positioned the UK in the top five countries in the world with 9.4 million immigrants in 2022. These immigrants originate from low- and middle-income countries and remain particularly at risk of developing TB. In the UK, the number of TB cases has been increasing, and the influx of immigrants could be a contributing factor.
    UNASSIGNED: This review aims to map the burden of pulmonary TB among immigrants in the UK and investigate associated factors. It also reviews the TB management approaches among immigrants in the UK.
    UNASSIGNED: The study utilized PRISMA guidelines to search electronic databases (PubMed and EMBASE) for articles published from 2000 to 2022 on TB prevalence and factors in immigrants and explored government websites for TB management strategies.
    UNASSIGNED: Nineteen out of 530 initially identified articles were included. The included studies reported a prevalence rate of TB among immigrants ranging from 0.04 to 52.1%, showing a decrease in the burden over time. Additionally, a higher number of TB cases were observed among immigrants from the Asian region, particularly immigrants from South Asia, followed by those from sub-Saharan Africa. Stigma, misconception about the disease, language barrier, lack of confidentiality, and unfriendly healthcare system for immigrants were the main drivers of the TB burden among immigrants. The TB management approaches in the UK include pre-entry screening for active TB, LTBI testing for a specific population group, and antibacterial therapy for 3-6 months for TB patients.
    UNASSIGNED: The UK\'s control and prevention efforts in reducing tuberculosis prevalence among immigrants show optimism, but challenges persist. Key improvements include healthcare delivery, TB improvement programs, and policies addressing stigma and patient confidentiality.
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  • 文章类型: Journal Article
    摘要本研究分析了血管组之间的关系(小,中等,和大型)以及英国渔船的伤亡或损失类型,基于2013年至2020年英国渔船上发生的人员伤亡和损失的信息摘要。它确定失去控制是所有渔船伤亡事件的主要原因。Further,洪水/沉没是造成小于24米渔船损失的主要原因,搁浅/搁浅是造成渔船损失24米或更长时间的主要原因。15米以下的渔船构成了大部分伤亡和损失,而中型船只(15米或更长,但不到24米)是每艘船对伤亡的平均贡献最高的。
    This study analyses the relationship between vessel groups (small, medium and large) and casualty or loss type of UK fishing vehicles based on a summary of information concerning casualties and losses that occurred on fishing vessels in the UK from 2013 to 2020. The study establishes loss of control as the main cause of casualty occurrences for all fishing vessels. Further, flooding/foundering is the main contributor to the loss of fishing vessels smaller than 24 m in length, and grounding/stranding is the main contributor to the loss of fishing vessels 24 m or longer. Fishing vessels below 15 m in length comprise the majority of casualties and losses, while medium-size vessels (15 m or longer, but less than 24 m) make the highest average contribution per vessel to casualties.
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  • 文章类型: Review
    COVID-19大流行导致了健康行为的改变,包括饮食模式和营养,吸烟,酒精消费,睡眠模式,身体活动和久坐行为。缺乏证据报告COVID-19对布莱克健康行为的影响,亚洲和少数民族(BAME)社区。这项范围审查综合了有关COVID-19对英国BAME社区健康行为变化影响的现有证据。
    遵循关键字策略,在16个电子数据库中搜索符合筛选标准的文章。然后对这些文章进行了全文回顾。评估英国BAME社区与COVID-19相关健康行为变化的实证研究,在2020年7月至2021年8月的COVID-19大流行期间进行,以英语出版,被设定为纳入标准。在选定的数据库中确定了最初的2160项研究。在删除重复项并筛选2154项研究的标题和摘要后,仅选择了4项研究进行审查,因为它们符合纳入标准.纳入的研究采用了不同的样本量,范围从N=47到N=30,375,并报告了几种健康行为变化。在纳入的4项研究中,3项研究将其样本中的BAME组作为亚组,而一项研究专门针对BAME组。
    范围审查发现,与白人种族相比,BAME人群的体力活动水平较低。大约41.7%的BAME组报告饮酒比平时少,而白人为34%。与白人背景的研究参与者相比,来自BAME背景的研究参与者对购买更健康食物的决定影响最大,而白人背景的研究参与者对购买更健康食物的决定影响最小。一些参与者报告说,由于COVID-19大流行,积极的卫生习惯有所增加。
    COVID-19对BAME组的健康行为产生了重大影响,特别是在封锁期间,因为他们报告了行为的变化,如体育活动水平低。因此,提高BAME群体的健康意识以鼓励健康生活非常重要.此外,应实施有利于BAME团体的健身活动等计划,例如,BAME妇女的步行团体鼓励来自BAME背景的人从事体育活动。此外,健康食品计划,如食品包裹,可以提供给来自BAME背景的人,他们由于COVID-19的影响而买不起健康食品。尽管如此,COVID-19大流行增加了BAME人群的积极卫生,这对预防其他疾病和感染很重要。
    The COVID-19 pandemic has led to changes in health behaviours, which include eating patterns and nutrition, smoking, alcohol consumption, sleeping patterns, physical activity and sedentary behaviour. There is a dearth of evidence reporting the impact of COVID-19 on the health behaviour of Black, Asian and minority ethnic (BAME) communities. This scoping review synthesises the available evidence on the impact of COVID-19 on the changes in health behaviours among BAME communities in the UK.
    Following a keyword strategy, 16 electronic databases were searched for articles that met the screening criteria. These articles were then reviewed in full text. Empirical studies that assessed COVID-19 related health behaviour changes among BAME communities in the UK, conducted during the COVID-19 pandemic between July 2020 and August 2021 and published in English language, were set as inclusion criteria. An initial 2160 studies were identified in the selected databases. After removing duplications and screening the title and abstracts of the 2154 studies, only 4 studies were selected to be reviewed as they met the inclusion criteria. The included studies employed different sample sizes which ranged from N = 47 to N = 30,375 and reported several health behaviour changes. Out of the 4 included studies, 3 studies included BAME groups within their sample as a subgroup while one study focused specifically on BAME groups.
    The scoping review found that there were lower levels of physical activity among BAME groups compared to the White ethnic groups. About 41.7% of BAME groups reported drinking less alcohol than usual compared to their white counterparts who were 34%. Study participants from BAME backgrounds had the greatest effect of COVID-19 on decisions to purchase healthier food compared to those from white backgrounds whose decisions on purchasing healthier food were least affected. Some participants reported an increase in positive hygiene practices due to the COVID-19 pandemic.
    COVID-19 had a significant impact on the health behaviours of BAME groups especially during the lockdowns as they reported changes to behaviour such as low levels of physical activities. Hence, it is important to promote health awareness among BAME groups to encourage healthy living. In addition, programmes such as physical fitness activities that favour BAME groups should be put in place, for example BAME women\'s walking groups to encourage people from BAME backgrounds to engage in physical activities. Furthermore, healthy food programmes such as food parcels can be given to people from BAME backgrounds who are not able to afford healthy food due to the impact of COVID-19. Nonetheless, the COVID-19 pandemic has increased positive hygiene among BAME groups which is important in preventing other diseases and infections.
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  • 文章类型: Journal Article
    背景:以前的研究结果表明,自我伤害和自杀率不同,与英国的白人相比,南亚人的风险和保护因素不同。大量的定性研究探索了南亚人自我伤害和自杀的经验。
    目的:该研究旨在回顾英国南亚社区自我伤害和自杀行为的现有定性证据。
    方法:在Medline上进行了系统搜索,EMBASE,PsycINFO,CINAHL,公开论文和大英图书馆Ethos数据库。我们从期刊和灰色文献中选择了定性研究,其中包括居住在英国的南亚参与者,并提出了自我伤害和/或自杀行为的看法或经验。分析是基于元人种学方法进行的。
    结果:15项研究纳入分析。从三个方面探讨了自我伤害的经验:自我伤害的背后,自我伤害和自我伤害恢复的功能。“自我伤害背后”指的是与自我伤害和自杀有关的因素。“自我伤害的功能”抓住了自我伤害和自杀的含义。“从自我伤害中恢复”包含个人和专业帮助,并对完善精神卫生服务提出切实可行的建议。
    结论:尽管与大多数白人存在一些相似之处,在制定卫生政策时,也有关键的差异需要考虑,改善获得卫生服务的机会,并针对英国南亚社区的自我伤害和自杀制定具有文化敏感性的心理社会干预措施。
    BACKGROUND: Previous findings have indicated that self-harm and suicide are associated with different rates, and different risk and protective factors in South Asian people compared with White people in the UK. Substantial qualitative research has explored experiences of self-harm and suicide in South Asian people.
    OBJECTIVE: The study aims to review the existing qualitative evidence on self-harm and suicidal behaviours in South Asian communities in the UK.
    METHODS: Systematic searches were conducted on Medline, EMBASE, PsycINFO, CINAHL, Open Dissertations and the British Library Ethos databases. We selected qualitative studies from both journals and grey literature that included South Asian participants who were resident in the UK and presented perceptions or experiences of self-harm and/or suicidal behaviour. Analysis was undertaken based on the meta-ethnographic approach.
    RESULTS: Fifteen studies were included in the analysis. Experience of self-harm was discussed based on three aspects: behind self-harm, functions of self-harm and recovery from self-harm. \'Behind self-harm\' refers to factors associated with self-harm and suicide. \'Functions of self-harm\' captures the meaning attributed to self-harm and suicide. \'Recovery from self-harm\' encapsulates personal and professional help, and practical suggestions for the improvement of mental health services.
    CONCLUSIONS: Although some similarities with the majority White population were present, there were also crucial differences that need consideration when shaping health policies, improving access to health services and developing culturally sensitive psychosocial interventions for self-harm and suicide specific to South Asian communities in the UK.
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  • 文章类型: Systematic Review
    背景:在全球范围内,酒精使用率因性取向和性别认同(SOGI)而异,但英国政府关于LGBTQ+人群饮酒的统计数据缺失。
    目的:本系统范围审查确定了英国性别和性少数群体中饮酒的患病率。
    方法:从2010年开始的英国实证研究报告了与异性恋/顺性人群相比,SOGI中酒精使用的患病率。在MEDLINE中搜索,Embase,WebofScience,PsycINFO,CINAHL,科克伦图书馆,谷歌学者,Google,慈善网站和系统评价于2021年10月进行,使用SOGI,酒精和流行术语。引文检查是由两位作者完成的,通过讨论解决分歧。数据提取由一个作者(CM)完成,并由另一个作者(LZ)检查。质量评估通过研究设计进行,样本类型和结果统计分析。将叙述性综合与结果的表格形式定性地结合在一起。
    结果:数据库和网站搜索发现6607条潜在相关引文,并对505篇全文进行了审查,包括20项研究,在21种出版物和灰色文献报告中发现。大多数人都有性取向,包括12个来自大型队列研究。LGBTQ+人群的有害酒精使用量高于英国的异性恋人群,结果与其他国家相似。定性数据反映了酒精作为情感支持的作用。与异性恋者相比,无性饮酒的人更少,并且没有关于双性人的数据。
    结论:资助的队列研究和服务提供商应定期收集SOGI数据。SOGI和酒精使用的标准化报告将提高研究之间的可比性。
    BACKGROUND: globally, alcohol use rates vary by sexual orientation and gender identity (SOGI), but UK government statistics on alcohol use in the LGBTQ+ population are missing.
    OBJECTIVE: this systematic scoping review determined the prevalence of alcohol use amongst gender and sexual minority people in the UK.
    METHODS: empirical UK studies from 2010 onwards reporting the prevalence of alcohol use in SOGI compared with heterosexual/cisgender people were included. Searches in MEDLINE, Embase, Web of Science, PsycINFO, CINAHL, Cochrane Library, Google Scholar, Google, charity websites and systematic reviews were conducted in October 2021, using SOGI, alcohol and prevalence terms. Citation checking was done by two authors, with disagreements resolved through discussion. Data extraction was done by one author (CM) and checked by another (LZ). Quality assessment was performed by study design, sample type and statistical analysis of results. A narrative synthesis was qualitatively combined with a tabular presentation of results.
    RESULTS: database and website searches found 6607 potentially relevant citations, and 505 full texts were reviewed with 20 studies included, found in 21 publications and grey literature reports. Most were on sexual orientation, including 12 from large cohort studies. Harmful alcohol use is higher in LGBTQ+ people than heterosexual people in the UK, a result similar to that found in other countries. Qualitative data reflected alcohol\'s role as emotional support. Fewer asexual people drank alcohol compared with allosexual people, and there were no data available regarding intersex people.
    CONCLUSIONS: funded cohort studies and service providers should routinely collect SOGI data. Standardized reporting of SOGI and alcohol use would improve comparability across studies.
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  • 文章类型: Systematic Review
    指示性证据表明,少数民族群体发展多种长期疾病(MLTC)的风险更高,并且比大多数白人人口更早。虽然有证据表明,在单一健康状况和合并症方面存在种族不平等,没有任何评论试图从MLTC的角度来看待这些问题。因此,我们目前对MLTC患病率中种族不平等的程度有不完全了解.Further,人们对种族运作方式的差异以及这如何阻碍我们对健康不平等的理解提出了担忧。在本系统综述中,我们旨在1)描述提供种族和MLTC患病率证据的文献生活在英国,2)总结各族裔对MLTC的患病率估计,3)评估将种族概念化和操作化的方式。我们专注于之前的证据状态,在大流行的早期阶段。我们在PROSPERO(CRD42020218061)上注册了协议。在2020年10月至12月之间,我们搜索了ASSIA,科克伦图书馆,EMBASE,MEDLINE,PsycINFO,PubMed,ScienceDirect,Scopus,WebofScience,OpenGrey,以及关键研究/评论的参考清单。主要结果是至少一个少数民族的MLTC患病率估计,与大多数白人相比。我们纳入了在英国进行的关于MLTC种族和患病率的报告研究。为了总结各族裔对MLTC的患病率估计,我们仅包括对MLTC的研究,这些研究提供了至少对年龄进行了调整的估计。两名评审员从随机研究样本中筛选和提取数据(10%)。使用叙事合成来合成数据。在确定的7949项研究中,84符合纳入标准。其中,七个促成了MLTC种族不平等的证据。七项研究中的五项指出,与白人相比,至少一个少数民族中的MLTC患病率更高。由于研究之间的健康状况的数量/类型不同,并且某些种族人群被汇总或省略,这些发现可能无法准确反映种族不平等的真实程度。未来的研究应该考虑关键的解释因素,包括宏观层面的(例如种族主义,歧视),因为它们可能在不同种族的MLTC的发展和严重程度中发挥作用。还需要进行研究,以确定COVID19大流行在多大程度上加剧了这些不平等。
    Indicative evidence suggests that minoritised ethnic groups have higher risk of developing multiple long-term conditions (MLTCs), and do so earlier than the majority white population. While there is evidence on ethnic inequalities in single health conditions and comorbidities, no review has attempted to look across these from a MLTCs perspective. As such, we currently have an incomplete understanding of the extent of ethnic inequalities in the prevalence of MLTCs. Further, concerns have been raised about variations in the way ethnicity is operationalised and how this impedes our understanding of health inequalities. In this systematic review we aimed to 1) describe the literature that provides evidence of ethnicity and prevalence of MLTCs amongst people living in the UK, 2) summarise the prevalence estimates of MLTCs across ethnic groups and 3) to assess the ways in which ethnicity is conceptualised and operationalised. We focus on the state of the evidence prior to, and during the very early stages of the pandemic. We registered the protocol on PROSPERO (CRD42020218061). Between October and December 2020, we searched ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, Web of Science, OpenGrey, and reference lists of key studies/reviews. The main outcome was prevalence estimates for MLTCs for at least one minoritised ethnic group, compared to the majority white population. We included studies conducted in the UK reporting on ethnicity and prevalence of MLTCs. To summarise the prevalence estimates of MLTCs across ethnic groups we included only studies of MLTCs that provided estimates adjusted at least for age. Two reviewers screened and extracted data from a random sample of studies (10%). Data were synthesised using narrative synthesis. Of the 7949 studies identified, 84 met criteria for inclusion. Of these, seven contributed to the evidence of ethnic inequalities in MLTCs. Five of the seven studies point to higher prevalence of MLTCs in at least one minoritised ethnic group compared to their white counterparts. Because the number/types of health conditions varied between studies and some ethnic populations were aggregated or omitted, the findings may not accurately reflect the true level of ethnic inequality. Future research should consider key explanatory factors, including those at the macrolevel (e.g. racism, discrimination), as they may play a role in the development and severity of MLTCs in different ethnic groups. Research is also needed to ascertain the extent to which the COVID19 pandemic has exacerbated these inequalities.
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  • 文章类型: Meta-Analysis
    目的:本研究评估了英国少数民族和白人人群COVID-19感染临床结局的差异。
    方法:系统评价和荟萃分析。
    方法:本研究纳入了确诊为COVID-19感染的英国成年居民。本研究评估的结果是死亡率,重症监护病房(ICU)入院和有创机械通气(IMV)。比较了来自少数民族的个人和来自白人背景的个人之间的结果数据。MEDLINE,Embase,科克伦,搜索了medRxiv和PROSPERO在2020年5月至2021年4月之间发表的文章。使用纽卡斯尔-渥太华量表检查表评估偏倚风险。
    CRD42021248117。
    结果:本综述包括14项研究(767,177名参与者)。在调整后的分析中,Black感染COVID-19后死亡率的合并比值比(OR)更高(OR1.83,95%置信区间[CI]:1.21-2.76,研究数量[k]=6),与白人相比,亚洲(OR1.16,95%CI:0.85-1.57,k=6)和混合和其他(MO)种族(OR1.12,95%CI:1.04-1.20,k=5)。许多少数民族的ICU入院调整后和未调整后的OR值是白人种族的OR值的两倍以上(黑人种族=OR2.32,95%CI:1.73-3.11,k=5;亚洲种族=OR2.34,95%CI:1.89-2.90,k=5;和MO种族=OR2.26,95%CI:1.64-3.11,k=4)。在调整后的IMV分析中,与白人族群相比,少数民族族群的OR值也显著升高(黑人伦理族群=OR2.03,95%CI:1.80~2.29,k=3;亚洲族群=OR1.84,95%CI:1.20~2.80,k=3;MO族群=OR2.09,95%CI:1.35~3.22,k=3).
    结论:这篇综述发现,在英国,黑色,与大多数白人族群相比,亚洲族群和MO族群的COVID-19相关疾病严重程度和死亡率增加。
    OBJECTIVE: This study evaluated the differences in clinical outcomes of COVID-19 infection between ethnic minorities and the White ethnic group in the UK.
    METHODS: Systematic review and meta-analysis.
    METHODS: This study included adult residents in the UK with confirmed COVID-19 infection. The outcomes evaluated in this study were mortality, intensive care unit (ICU) admission and invasive mechanical ventilation (IMV). Outcome data were compared between individuals from ethnic minority groups and individuals from a White ethnic background. MEDLINE, Embase, Cochrane, medRxiv and PROSPERO were searched for articles published between May 2020 and April 2021. The risk of bias was evaluated using the Newcastle-Ottawa Scale checklist.
    UNASSIGNED: CRD42021248117.
    RESULTS: Fourteen studies (767,177 participants) were included in the current review. In the adjusted analysis, the pooled odds ratio (OR) for mortality following COVID-19 infection was higher for Black (OR 1.83, 95% confidence interval [CI]: 1.21-2.76, number of studies [k] = 6), Asian (OR 1.16, 95% CI: 0.85-1.57, k = 6) and Mixed and Other (MO) ethnic groups (OR 1.12, 95% CI: 1.04-1.20, k = 5) compared with the White ethnic group. The adjusted and unadjusted ORs of ICU admission for many of the ethnic minority groups were more than double the OR values for the White ethnic group (Black ethnic group = OR 2.32, 95% CI: 1.73-3.11, k = 5; Asian ethnic group = OR 2.34, 95% CI: 1.89-2.90, k = 5; and MO ethnic group = OR 2.26, 95% CI: 1.64-3.11, k = 4). In the adjusted analysis for IMV, the ORs were similarly significantly raised in ethnic minority groups compared with the White ethnic group (Black ethic group = OR 2.03, 95% CI: 1.80-2.29, k = 3; Asian ethnic group = OR 1.84, 95% CI: 1.20-2.80, k = 3; and MO ethnic group = OR 2.09, 95% CI: 1.35-3.22, k = 3).
    CONCLUSIONS: This review found that in the UK, Black, Asian and MO ethnic groups experienced increased COVID-19-related disease severity and mortality compared with the White ethnic group majority.
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  • 文章类型: Journal Article
    体外受精是一种广泛使用的生殖技术,可以在有或没有卵胞浆内精子注射的情况下进行。子宫内膜划伤程序是体外受精的“附加”,有时在第一个体外受精周期之前提供,但缺乏证据支持其使用。
    (1)为了评估临床疗效,与进行首次体外受精周期(“子宫内膜刮伤试验”)的女性常规治疗相比,子宫内膜刮伤的安全性和成本效益比较,(2)进行系统评价,将子宫内膜刮伤试验的结果与先前在首次体外受精周期前提供子宫内膜刮伤的试验结果相结合.
    务实,多中心,优越性,开放标签,平行组,个别随机对照试验。参与者通过基于网络的系统进行随机分组(1:1),以接受子宫内膜刮伤或治疗。系统审查涉及搜索电子数据库(于2020年1月进行)和clinicaltrials.gov(于2020年9月进行)进行相关试验。
    16个英国生育单位。
    18-37岁女性,包容性,正在经历他们的第一个体外受精周期。排除标准包括重度子宫内膜异位症,体重指数≥35kg/m2和先前对子宫内膜的创伤。
    在体外受精之前,在月经周期的黄体中期进行子宫内膜刮伤,并涉及将移液管插入子宫腔并旋转并将其抽出三到四次。然后子宫内膜划痕组接受常规体外受精治疗。照常治疗组仅接受常规体外受精。
    主要结局是在采卵后10.5个月内完成24周妊娠后的活产。次要结果包括植入,怀孕,异位妊娠,流产,手术的疼痛和耐受性,不良事件和治疗费用。
    一千四十八名(30.3%)女性被随机分配接受常规治疗(n=525)或子宫内膜划痕(n=523),并在2016年7月至2019年10月期间进行了随访,并纳入意向治疗分析。在子宫内膜划痕组中,453名(86.6%)妇女接受了子宫内膜刮伤手术。照常治疗组中共有494名(94.1%)妇女和子宫内膜划痕组中的497名(95.0%)妇女进行了体外受精。照常治疗组的活产率为37.1%(195/525),子宫内膜划痕组为38.6%(202/523):未经调整的绝对差异为1.5%(95%置信区间-4.4%至7.4%;p=0.621)。次要结果无统计学差异。安全性事件在各组之间具有可比性。没有新生儿死亡记录。成功活产的成本为每名妇女11.90英镑(95%置信区间-134英镑至127英镑)。该试验和8项类似试验的汇总结果没有发现子宫内膜划痕对增加活产率具有显著影响的证据(比值比1.03,95%置信区间0.87至1.22)。
    未进行假子宫内膜刮伤手术,但是这样做不太可能会影响结果,作为使用客观生育结果。总共9.2%随机接受子宫内膜刮伤的女性没有接受手术,这可能稍微稀释了治疗效果。
    我们发现没有证据支持这样的理论,即在接受第一次体外受精周期的女性中,在黄体中期进行子宫内膜划伤可以显着提高活产率。尽管该程序耐受性良好且安全。我们建议在该人群中不进行子宫内膜划痕。
    本试验注册为ISRCTN23800982。
    该项目由国家卫生研究所(NIHR)卫生技术评估计划资助,并将在《卫生技术评估》中全文发表。26号10.有关更多项目信息,请参阅NIHR期刊库网站。
    子宫内膜划伤是一个简单的过程,涉及“划伤”子宫内膜(子宫内膜)。一些小型研究表明,在第一个体外受精周期之前进行这项研究可能会提高活产率;然而,其他研究与此相矛盾。进行这项大型研究是为了确认与进行“常规”体外受精治疗的妇女(称为“对照”组)相比,在第一个体外受精周期之前子宫内膜划伤是否会增加活产妇女的数量。我们收集了怀孕的信息,流产,死产,过程中的疼痛和治疗费用,以找出是否有任何有意义的差异。共有1048名年龄介乎18至37岁的妇女被随机分配到两组,所以参与者有50%的机会出现子宫内膜划痕。在整个怀孕期间对妇女进行随访,以确定其体外受精周期的结果。尽管子宫内膜划痕组(38.6%)的活产率比对照组(37.1%)高1.5%,差异不足以显示该手术的任何益处.两组之间的其他结果没有显着差异。然而,该程序是安全和可耐受的。我们发现治疗的费用是,平均而言,接受子宫内膜刮伤组的每位参与者比对照组高316英镑;差异还不足以表明接受子宫内膜刮伤更具成本效益。我们将这项试验的结果与以前的试验结果相结合,这些试验旨在回答类似的问题,发现,总的来说,子宫内膜刮伤手术不会增加活产的机会.我们得出的结论是,首次体外受精前的子宫内膜刮伤并不能改善治疗结果,我们建议在体外受精的第一个周期之前不要进行此程序。
    In vitro fertilisation is a widely used reproductive technique that can be undertaken with or without intracytoplasmic sperm injection. The endometrial scratch procedure is an in vitro fertilisation \'add-on\' that is sometimes provided prior to the first in vitro fertilisation cycle, but there is a lack of evidence to support its use.
    (1) To assess the clinical effectiveness, safety and cost-effectiveness of endometrial scratch compared with treatment as usual in women undergoing their first in vitro fertilisation cycle (the \'Endometrial Scratch Trial\') and (2) to undertake a systematic review to combine the results of the Endometrial Scratch Trial with those of previous trials in which endometrial scratch was provided prior to the first in vitro fertilisation cycle.
    A pragmatic, multicentre, superiority, open-label, parallel-group, individually randomised controlled trial. Participants were randomised (1 : 1) via a web-based system to receive endometrial scratch or treatment as usual using stratified block randomisation. The systematic review involved searching electronic databases (undertaken in January 2020) and clinicaltrials.gov (undertaken in September 2020) for relevant trials.
    Sixteen UK fertility units.
    Women aged 18-37 years, inclusive, undergoing their first in vitro fertilisation cycle. The exclusion criteria included severe endometriosis, body mass index ≥ 35 kg/m2 and previous trauma to the endometrium.
    Endometrial scratch was undertaken in the mid-luteal phase of the menstrual cycle prior to in vitro fertilisation, and involved inserting a pipelle into the cavity of the uterus and rotating and withdrawing it three or four times. The endometrial scratch group then received usual in vitro fertilisation treatment. The treatment-as-usual group received usual in vitro fertilisation only.
    The primary outcome was live birth after completion of 24 weeks\' gestation within 10.5 months of egg collection. Secondary outcomes included implantation, pregnancy, ectopic pregnancy, miscarriage, pain and tolerability of the procedure, adverse events and treatment costs.
    One thousand and forty-eight (30.3%) women were randomised to treatment as usual (n = 525) or endometrial scratch (n = 523) and were followed up between July 2016 and October 2019 and included in the intention-to-treat analysis. In the endometrial scratch group, 453 (86.6%) women received the endometrial scratch procedure. A total of 494 (94.1%) women in the treatment-as-usual group and 497 (95.0%) women in the endometrial scratch group underwent in vitro fertilisation. The live birth rate was 37.1% (195/525) in the treatment-as-usual group and 38.6% (202/523) in the endometrial scratch group: an unadjusted absolute difference of 1.5% (95% confidence interval -4.4% to 7.4%; p = 0.621). There were no statistically significant differences in secondary outcomes. Safety events were comparable across groups. No neonatal deaths were recorded. The cost per successful live birth was £11.90 per woman (95% confidence interval -£134 to £127). The pooled results of this trial and of eight similar trials found no evidence of a significant effect of endometrial scratch in increasing live birth rate (odds ratio 1.03, 95% confidence interval 0.87 to 1.22).
    A sham endometrial scratch procedure was not undertaken, but it is unlikely that doing so would have influenced the results, as objective fertility outcomes were used. A total of 9.2% of women randomised to receive endometrial scratch did not undergo the procedure, which may have slightly diluted the treatment effect.
    We found no evidence to support the theory that performing endometrial scratch in the mid-luteal phase in women undergoing their first in vitro fertilisation cycle significantly improves live birth rate, although the procedure was well tolerated and safe. We recommend that endometrial scratch is not undertaken in this population.
    This trial is registered as ISRCTN23800982.
    This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 10. See the NIHR Journals Library website for further project information.
    The endometrial scratch is a simple procedure that involves ‘scratching’ the lining of the womb (the endometrium). Several small studies have shown that undertaking this before the first in vitro fertilisation cycle may improve live birth rates; however, other studies have contradicted this. This large study was carried out to confirm whether or not having an endometrial scratch before the first in vitro fertilisation cycle would increase the number of women having a live birth compared with those having ‘usual’ in vitro fertilisation treatment (known as the ‘control’ group). We collected information about pregnancy, miscarriage, stillbirth, pain during the procedure and costs of treatment to find out if there were any meaningful differences. A total of 1048 women aged between 18 and 37 years were randomly allocated to the two groups, so participants had a 50% chance of having the endometrial scratch. Women were followed up throughout their pregnancy to ascertain the outcome of their in vitro fertilisation cycle. Although the live birth rate was 1.5% higher in the endometrial scratch group (38.6%) than in the control group (37.1%), the difference was not large enough to show any benefit of having the procedure. Other outcomes did not differ significantly between the two groups. However, the procedure was safe and tolerable. We found that the cost of treatment was, on average, £316 per participant higher in the group that received endometrial scratch than in the control group; the difference was not large enough to show that receiving endometrial scratch was more cost-effective. We combined the results of this trial with those of previous trials that looked to answer a similar question, and found that, overall, the endometrial scratch procedure does not enhance the chances of achieving a live birth. We conclude that endometrial scratch before first-time in vitro fertilisation does not improve the outcome of treatment, and we recommend that this procedure is not undertaken prior to a first cycle of in vitro fertilisation.
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