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The Cochrane Database of Systematic... Dec 2010Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews... (Review)
Review
BACKGROUND
Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews to consider effects on health equity is cited by decision-makers as a limitation to their ability to inform policy and program decisions.
OBJECTIVES
To systematically review methods to assess effects on health equity in systematic reviews of effectiveness.
SEARCH STRATEGY
We searched the following databases up to July 2 2010: MEDLINE, PsychINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Index to Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on October 7 2010.
SELECTION CRITERIA
We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities.
DATA COLLECTION AND ANALYSIS
Data were extracted using a pre-tested form by two independent reviewers. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.
MAIN RESULTS
Thirty-four methodological studies were included. The methods used by these included studies were: 1) Targeted approaches (n=22); 2) gap approaches (n=12) and gradient approach (n=1). Gender or sex was assessed in eight out of 34 studies, socioeconomic status in ten studies, race/ethnicity in seven studies, age in seven studies, low and middle income countries in 14 studies, and two studies assessed multiple factors across health inequity may exist.Only three studies provided a definition of health equity. Four methodological approaches to assessing effects on health equity were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (all 34 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (12/34 studies); 3) analytic approaches (10/34 studies); and 4) applicability assessment (11/34 studies). Both analytic and applicability approaches were not reported transparently nor in sufficient detail to judge their credibility.
AUTHORS' CONCLUSIONS
There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to assess and report effects on health equity in systematic reviews.
Topics: Age Factors; Developing Countries; Ethnology; Health Status Disparities; Humans; Racial Groups; Research Design; Review Literature as Topic; Sex Factors; Socioeconomic Factors
PubMed: 21154402
DOI: 10.1002/14651858.MR000028.pub2 -
Health Expectations : An International... Oct 2015Eliciting patients' views of type 2 diabetes self-management provides insights on how policy and services might better support the needs of this population. (Review)
Review
CONTEXT
Eliciting patients' views of type 2 diabetes self-management provides insights on how policy and services might better support the needs of this population.
OBJECTIVE
To synthesize black and ethnic minority patients' views on the barriers and facilitators influencing the self-management of type 2 diabetes.
SEARCH STRATEGY
A systematic search of international literature published in nine electronic databases was undertaken in 2008. Search strategies used both MeSH and free-text terms. Two relevant journals were also hand searched.
INCLUSION CRITERIA
Any primary empirical study published in the English language since 1986 that reported black and ethnic minority patients' views on type 2 diabetes self-management.
DATA EXTRACTION AND SYNTHESIS
Data were extracted and study quality was formally assessed. Data were analysed using thematic synthesis.
MAIN RESULTS
Fifty-seven studies were included, of qualitative (n = 54), mixed-method (n = 2) or quantitative (n = 1) design. Studies were from North America (n = 41), Europe (n = 14) and Australia (n = 2), including 1735 participants in total. Three analytical themes emerged: 'Importance of identity'; 'Being understood by others' and 'Making sense of condition', all linked conceptually under the overarching theme 'Sense of self'. The quality of the studies varied.
DISCUSSION AND CONCLUSIONS
The findings provide insight into what black and minority ethnic people regard as the barriers to, and facilitators of self-management, as opposed to what health professionals, policy makers and trial researchers may have assumed. Recognition of the views of people with diabetes is essential for the design and delivery of patient-centred care and policies.
Topics: Diabetes Mellitus, Type 2; Ethnicity; Humans; Minority Groups; Qualitative Research; Self Care
PubMed: 23710892
DOI: 10.1111/hex.12080 -
Scientific Reports May 2015Associations between elevated C-reactive protein (CRP) and breast cancer risk have been reported for many years, but the results remain controversial. To address this... (Meta-Analysis)
Meta-Analysis Review
Associations between elevated C-reactive protein (CRP) and breast cancer risk have been reported for many years, but the results remain controversial. To address this issue, a meta-analysis was therefore conducted. Eligible studies were identified by searching the PubMed and EMBASE up to December 2014. Study-specific risk estimates were combined using a random-effects model. Altogether fifteen cohort and case-control studies were included in this meta-analysis, involving a total of 5,286 breast cancer cases. The combined OR per natural log unit change in CRP for breast cancer was 1.16 (95% CI: 1.06-1.27). There was moderate heterogeneity among studies (I(2) = 45.9%). The association was stronger in Asian population (OR = 1.57, 95% CI: 1.25-1.96) compared to European (OR = 1.12, 95% CI: 1.02-1.23) and American (OR = 1.08, 95% CI: 1.01-1.16). Prediagnostic high-sensitivity CRP concentrations (OR = 1.22, 95% CI: 1.10-1.35) was superior to common CRP (OR = 1.08, 95% CI: 1.01-1.15) in predicting breast cancer risk. The meta-analysis indicated that elevated CRP levels was associated with increased risk of breast cancer. Further research effort should be performed to identify whether CRP, as a marker of inflammation, plays a direct role in breast carcinogenesis.
Topics: Asian People; Breast Neoplasms; C-Reactive Protein; Databases, Factual; Female; Humans; Odds Ratio; Risk Factors; White People
PubMed: 26001129
DOI: 10.1038/srep10508 -
Vaccine Apr 2021Widespread uptake of COVID-19 vaccines will be essential to controlling the COVID-19 pandemic. Vaccines have been developed in unprecedented time and quantifying levels... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Widespread uptake of COVID-19 vaccines will be essential to controlling the COVID-19 pandemic. Vaccines have been developed in unprecedented time and quantifying levels of hesitancy towards vaccination among the general population is of importance.
METHODS
Systematic review and meta-analysis of studies using large nationally representative samples (n ≥ 1000) to examine the percentage of the population intending to vaccinate, unsure, or intending to refuse a COVID-19 vaccine when available. Generic inverse meta-analysis and meta-regression were used to pool estimates and examine time trends. PubMed, Scopus and pre-printer servers were searched from January-November 2020. Registered on PROSPERO (CRD42020223132).
FINDINGS
Twenty-eight nationally representative samples (n = 58,656) from 13 countries indicate that as the pandemic has progressed, the percentage of people intending to vaccinate decreased and the percentage of people intending to refuse vaccination increased. Pooled data from surveys conducted during June-October suggest that 60% (95% CI: 49% to 69%) intend to vaccinate and 20% (95% CI: 13% to 29%) intend to refuse vaccination, although intentions vary substantially between samples and countries (I > 90%). Being female, younger, of lower income or education level and belonging to an ethnic minority group were consistently associated with being less likely to intend to vaccinate. Findings were consistent across higher vs. lower quality studies.
INTERPRETATION
Intentions to be vaccinated when a COVID-19 vaccine becomes available have been declining across countries and there is an urgent need to address social inequalities in vaccine hesitancy and promote widespread uptake of vaccines as they become available.
FUNDING
N/A.
Topics: COVID-19; COVID-19 Vaccines; Cross-Sectional Studies; Ethnicity; Female; Humans; Intention; Male; Minority Groups; Pandemics; Vaccination; Vaccination Refusal
PubMed: 33722411
DOI: 10.1016/j.vaccine.2021.02.005 -
BMC Public Health Aug 2007Socioeconomic and racial/ethnic factors strongly influence cardiovascular disease outcomes and risk factors. C-reactive protein (CRP), a non-specific marker of... (Review)
Review
BACKGROUND
Socioeconomic and racial/ethnic factors strongly influence cardiovascular disease outcomes and risk factors. C-reactive protein (CRP), a non-specific marker of inflammation, is associated with cardiovascular risk, and knowledge about its distribution in the population may help direct preventive efforts. A systematic review was undertaken to critically assess CRP levels according to socioeconomic and racial/ethnic factors.
METHODS
Medline was searched through December 2006 for population-based studies examining CRP levels among adults with respect to indicators of socioeconomic position (SEP) and/or race/ethnicity. Bibliographies from located studies were scanned and 26 experts in the field were contacted for unpublished work.
RESULTS
Thirty-two relevant articles were located. Cross-sectional (n = 20) and cohort studies (n = 11) were included, as was the control group of one trial. CRP levels were examined with respect to SEP and race/ethnicity in 25 and 15 analyses, respectively. Of 20 studies that were unadjusted or adjusted for demographic variables, 19 found inverse associations between CRP levels and SEP. Of 15 similar studies, 14 found differences between racial/ethnic groups such that whites had the lowest while blacks, Hispanics and South Asians had the highest CRP levels. Most studies also included adjustment for potential mediating variables in the causal chain between SEP or race/ethnicity and CRP. Most of these studies showed attenuated but still significant associations.
CONCLUSION
Increasing poverty and non-white race was associated with elevated CRP levels among adults. Most analyses in the literature are underestimating the true effects of racial/ethnic and socioeconomic factors due to adjustment for mediating factors.
Topics: Adult; Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Demography; Health Status Indicators; Humans; Racial Groups; Social Class; Socioeconomic Factors
PubMed: 17705867
DOI: 10.1186/1471-2458-7-212 -
The International Journal of Behavioral... Jul 2017Physical activity and sedentary behaviour are associated with health and wellbeing. Studies indicate that ethnic minority groups are both less active and more sedentary... (Review)
Review
BACKGROUND
Physical activity and sedentary behaviour are associated with health and wellbeing. Studies indicate that ethnic minority groups are both less active and more sedentary than the majority population and that factors influencing these behaviours may differ. Mapping the factors influencing physical activity and sedentary behaviour among ethnic minority groups living in Europe can help to identify determinants of physical activity and sedentary behaviour, research gaps and guide future research.
METHODS
A systematic mapping review was conducted to map the factors associated with physical activity and sedentary behaviour among ethnic minority groups living in Europe (protocol PROSPERO ID = CRD42014014575). Six databases were searched for quantitative and qualitative research published between 1999 and 2014. In synthesizing the findings, all factors were sorted and structured into clusters following a data driven approach and concept mapping.
RESULTS
Sixty-three articles were identified out of 7794 returned by the systematic search. These included 41 quantitative and 22 qualitative studies. Of these 58 focused on physical activity, 5 on both physical activity and sedentary behaviour and none focused on sedentary behaviour. The factors associated with physical activity and sedentary behaviour were grouped into eight clusters. Social & cultural environment (n = 55) and Psychosocial (39) were the clusters containing most factors, followed by Physical environment & accessibility (33), Migration context (15), Institutional environment (14), Social & material resources (12), Health and health communication (12), Political environment (3). An important finding was that cultural and religious issues, in particular those related to gender issues, were recurring factors across the clusters.
CONCLUSION
Physical activity and sedentary behaviour among ethnic minority groups living in Europe are influenced by a wide variety of factors, especially informed by qualitative studies. More comparative studies are needed as well as inclusion of a wider spectrum of the diverse ethnic minority groups resettled in different European countries. Few studies have investigated factors influencing sedentary behaviour. It is important in the future to address specific factors influencing physical activity and sedentary behaviour among different ethnic minority groups in order to plan and implement effective interventions.
Topics: Ethnicity; Europe; Exercise; Health Behavior; Humans; Islam; Minority Groups; Sedentary Behavior; Social Environment
PubMed: 28738832
DOI: 10.1186/s12966-017-0554-3 -
Nutrients Jun 2023The United States (US) School Breakfast Program provides Breakfast After The Bell (BATB) to alleviate hunger, provide nutrition, and ensure students have a healthy start... (Review)
Review
Alternative School Breakfast Service Models and Associations with Breakfast Participation, Diet Quality, Body Mass Index, Attendance, Behavior, and Academic Performance: A Systematic Review.
The United States (US) School Breakfast Program provides Breakfast After The Bell (BATB) to alleviate hunger, provide nutrition, and ensure students have a healthy start to the day. This study aims to review the evidence regarding the impact of BATB on students' diet and academic outcomes, including participation, diet quality and consumption, body mass index (BMI) and weight status, attendance, classroom behavior, and academic performance. The articles were extracted from three electronic databases and published since the start of the literature through December 2022. Studies were peer-reviewed; quantitative research articles or government reports; and conducted in public or private elementary, middle, and high schools. Quality was assessed using the Newcastle-Ottawa Scale. Thirty-seven studies were included in this review. This review found BATB increased school breakfast participation, improved diet quality, and improved classroom behavior particularly among students from racial and ethnic minority backgrounds and students eligible for free or reduced-price meals. The impact of BATB on BMI and weight status, academic achievement and attendance was mixed. This review is particularly timely given free school meals and updated school nutrition standards are being prioritized over the next decade in the US. Thus, it is important to evaluate the nutritional and educational outcomes of BATB. (PROSPERO registration: CRD42021289719).
Topics: Humans; United States; Body Mass Index; Breakfast; Ethnicity; Minority Groups; Diet; Food Services
PubMed: 37447277
DOI: 10.3390/nu15132951 -
Frontiers in Public Health 2023This study aims to summarize the relevant evidence on the association between eye exercises and myopia in children and adolescents in China. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aims to summarize the relevant evidence on the association between eye exercises and myopia in children and adolescents in China.
METHODS
The meta-analysis pooled the results of 12 studies, with a total of 134,201 participants. Another five studies (no OR for myopia as an outcome and meeting inclusion criteria) were reported in the systematic review. We searched PubMed, Web of Science, CNKI, Wan Fang, and reference lists of retrieved studies. Association estimates were pooled using random-effects meta-analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) for eye exercises and myopia were pooled from a meta-analysis.
RESULTS
After standardizing the reference values, a pooled OR of the univariate analysis showed a 24% reduction in myopia in children and adolescents who performed eye exercises (OR = 0.76; 95% CI: 0.62-0.89). After adjusting the covariate, a pooled OR of multiple logistic analysis for myopia (OR = 0.87; 95% CI: 0.72-1.02) showed that there is no significance between eye exercises and myopia. However, in subgroup studies of the multivariate analysis, the large sample (OR = 0.84; 95% CI: 0.74-0.94) and Chinese database (OR = 0.80; 95% CI: 0.67-0.93) subgroup showed modest protective effects. In addition, five studies in the systematic review also evaluated the risk of myopia events, and Chinese eye exercises had a modest protective effect on myopic control, but the incorrect performance of and attitude toward eye exercises posed negative effects on their eyesight health.
CONCLUSION
Chinese eye exercises have a modest protective effect on myopic control, but considering that the incorrect performance of and attitude toward eye exercises have a significant influence on the effect of eye exercises, the effect of eye exercises may not be enough to prevent the progress of myopia in the long term, and more standardized eye exercises need to be conducted.
Topics: Humans; Child; Adolescent; East Asian People; Myopia; Exercise Therapy; Exercise; Asian People
PubMed: 36969666
DOI: 10.3389/fpubh.2023.950700 -
Journal of Orthopaedic Surgery and... Jan 2023To collect the data of pedicle width and height in different areas, and to investigate the difference and variation rule of pedicle width and height. (Review)
Review
OBJECTIVE
To collect the data of pedicle width and height in different areas, and to investigate the difference and variation rule of pedicle width and height.
METHODS
Comprehensive search of PubMed, Ovid Medline, and Web of science databases was performed. Collected data were imported into SPSS, and one-way ANOVA test and post hoc test were used to determine whether there were statistical differences in pedicle width and height between the different regions.
RESULTS
Oceania had the largest pedicle width and height, followed by Americans. West Asian had the largest pedicle width in Asia, followed by East and Southeast Asian, and Chinese and South Asian had similar pedicle width. Different from the variation pattern of pedicle width, the pedicle height of Chinese, East and Southeast Asian and West Asian in Asian range is similar, but the pedicle height of South Asian is significantly smaller than the first three, and has statistical significance.
CONCLUSIONS
People in different regions have similar patterns of variation in pedicle width and height even though they belong to different ethnic groups. This phenomenon is particularly prominent and pronounced in populations in geographically close areas, which may be related to inter-ethnic integration due to population movement between adjacent areas. There is a relationship between the morphological characteristics of the human lumbar pedicle and geographical location.
Topics: Humans; Tomography, X-Ray Computed; Ethnicity; Asian People; West Asian People; Lumbar Vertebrae
PubMed: 36631862
DOI: 10.1186/s13018-023-03499-w -
BMC Public Health Nov 2022Structural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources....
Structural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 29 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that affect the structural determinants of health and health inequities and improve daily living conditions.
Topics: Female; Pregnancy; Humans; Racial Groups; Population Health; Racism; Policy; Educational Status
PubMed: 36424559
DOI: 10.1186/s12889-022-14603-w