Abstract:
BACKGROUND:Induced abortion is a common procedure. However, there is marked variation in accessibility of services across England. Accessing abortion services may be difficult, particularly for women who live in remote areas, are in the second trimester of pregnancy, have complex pre-existing conditions or have difficult social circumstances. OBJECTIVE AND RATIONALE:This article presents a two-part review undertaken for a new National Institute of Health and Care Excellence guideline on abortion care, and aiming to determine: the factors that help or hinder accessibility and sustainability of abortion services in England (qualitative review), and strategies that improve these factors, and/or other factors identified by stakeholders (quantitative review). Economic modelling was undertaken to estimate cost savings associated with reducing waiting times. SEARCH METHODS:Ovid Embase Classic and Embase, Ovid MEDLINE(R) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R), PsycINFO, Cochrane Library via Wiley Online, Cinahl Plus and Web of Science Core Collection were searched for articles published up to November 2018. Studies were included if they were published in English after 2001, conducted in Organization for Economic Co-operation and Development (OECD) countries and were: qualitative studies reporting views of patients and/or staff on factors that help or hinder the accessibility and sustainability of a safe abortion service, or randomized or non-randomized studies that compared strategies to improve factors identified by the qualitative review and/or stakeholders. Studies were excluded if they were conducted in OECD countries where abortion is prohibited altogether or only performed to save the woman's life. One author assessed risk of bias of included studies using the following checklists: Critical Appraisal Skills Programme checklist for qualitative studies, Cochrane Collaboration quality checklist for randomized controlled trials, Newcastle-Ottawa scale for cohort studies, and Effective Practice and Organization of Care risk of bias tool for before-and-after studies.Qualitative evidence was combined using thematic analysis and overall quality of the evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Confidence in the Evidence from Reviews of Qualitative Research (CERQual). Quantitative evidence was analysed in Review Manager 5.3 and overall quality of evidence was assessed using GRADE. OUTCOMES:Eight themes (service level barriers; financial barriers; logistical barriers; personal barriers; legal and policy barriers; privacy and confidentiality concerns; training and education; community prescribing and telemedicine introduce greater flexibility) and 18 subthemes were identified from 23 papers (n = 1016) included in the qualitative review. The quality of evidence ranged from very low to high, with evidence for one theme and seven subthemes rated as high quality. Nine studies (n = 7061) were included in the quantitative review which showed that satisfaction was better (low to high quality evidence) and women were seen sooner (very low quality evidence) when care was led by nurses or midwives compared with physician-led services, women were seen sooner when they could self-refer (very low quality evidence), and clinicians were more likely to provide abortions if training used an opt-out model (very low quality evidence). Economic modelling showed that even small reductions in waiting times could result in large cost savings for services. WIDER IMPLICATIONS:Self-referral, funding for travel and accommodation, reducing waiting times, remote assessment, community services, maximizing the role of nurses and midwives and including practical experience of performing abortion in core curriculums, unless the trainee opts out, should improve access to and sustainability of abortion services.
journal_name
Hum Reprod Updatejournal_title
Human reproduction updateauthors
O'Shea LE,Hawkins JE,Lord J,Schmidt-Hansen M,Hasler E,Cameron S,Cameron ITdoi
10.1093/humupd/dmaa026subject
Has Abstractpub_date
2020-11-01 00:00:00pages
886-903issue
6eissn
1355-4786issn
1460-2369pii
5876548journal_volume
26pub_type
杂志文章abstract:UNLABELLED:BACKGROUND; Combined oral contraceptives (COCs) reduce levels of androgen, especially testosterone (T), by inhibiting ovarian and adrenal androgen synthesis and by increasing levels of sex hormone-binding globulin (SHBG). Although this suppressive effect has been investigated by numerous studies over many ye...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析,评审
doi:10.1093/humupd/dmt038
更新日期:2014-01-01 00:00:00
abstract::Pregnancy induces physiological alterations in thyroid function which may make difficult the interpretation of results of thyroid hormone measurement. A state of hyperstimulation of the thyroid gland is common in early pregnancy. In a few cases, thyroid hormone values will deviate from the normal range, which correspo...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh008
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND:Zika virus (ZIKV) is an arthropod-borne virus of the family Flaviviridae, genus Flavivirus. ZIKV is currently the focus of an ongoing pandemic and worldwide public health emergency. Although originally isolated in 1947, its pathogenesis was poorly known and very few documented infections were published until...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmx024
更新日期:2017-11-01 00:00:00
abstract::Cryopreservation of testicular tissue might benefit prepubertal boys who must undergo chemotherapy or radiotherapy. Cryopreservation of testicular tissue and testicular cells for intracytoplasmic sperm injection (ICSI) is feasible and widely applied. Testicular tissue from prepubertal boys can also be frozen, by apply...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.4.378
更新日期:2001-07-01 00:00:00
abstract::The long-term clinical effects of ethinyl estradiol and the impact on environmental safety of the alkylated estrogen components used in combined contraceptive pills remain the subject of debate. The development of improved methods for the use of progestogen-only contraception would represent a viable and desirable opt...
journal_title:Human reproduction update
pub_type: 共识发展会议,杂志文章,评审
doi:10.1093/humupd/dmb025
更新日期:2003-07-01 00:00:00
abstract::Hormonal contraception has become more effective and more widely used, while the world population has grown from 3000 million in 1960 to 6000 million in 2000. There is a need for improved contraception, because legal abortion is used in a high proportion of pregnancies and illegal abortion continues to be common in so...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/8.4.359
更新日期:2002-07-01 00:00:00
abstract::The use of physical techniques such as scanning electron microscopy and microprobe analysis permits the analysis of valuable details of the structure of dried samples of mid-cycle cervical mucus during the period of maximum ferning. From a crystallographic point of view, particular attention was paid to the location, ...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/3.4.347
更新日期:1997-07-01 00:00:00
abstract::Uterine malformations consist of a group of miscellaneous congenital anomalies of the female genital system. Their mean prevalence in the general population and in the population of fertile women is approximately 4.3%, in infertile patients approximately 3.5% and in patients with recurrent pregnancy losses approximate...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.2.161
更新日期:2001-03-01 00:00:00
abstract::Following its benchmark discovery, nitric oxide (NO) is now known to play important functional roles in a variety of physiological systems. Within the vasculature, NO induces vasodilation, inhibits platelet aggregation, prevents neutrophil/platelet adhesion to endothelial cells, inhibits smooth muscle cell proliferati...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.1.3
更新日期:1998-01-01 00:00:00
abstract::The signals and mechanisms that synchronize the timing of human parturition remain a mystery and a better understanding of these processes is essential to avert adverse pregnancy outcomes. Although our insights into human labor initiation have been informed by studies in animal models, the timing of parturition relati...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmw022
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND:Mast cells (MCs) are the classical mediators of allergy, however, their importance in the development of innate and adaptive immune responses is increasingly being recognized. Herein, the present MC literature is summarized, with particular focus on studies of MCs in the endometrium and myometrium, and their...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmq053
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Genetic testing of preimplantation embryos has been used for preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS). Microarray technology is being introduced in both these contexts, and whole genome sequencing of blastomeres is also expeted to become possible soon. The amount of...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmt009
更新日期:2013-07-01 00:00:00
abstract::During the last decade oocyte donation has been highly successful for treating women previously thought to be hopelessly infertile. The pregnancy rate after oocyte donation is among the highest reported for any fertility-enhancing procedure. Most investigators have noted an increased rate of obstetric complications in...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.1.28
更新日期:2001-01-01 00:00:00
abstract::Great progress had been achieved during the last 20 years in the field of ovulation induction in patients with polycystic ovary syndrome (PCOS). Clomiphene citrate remains the first line of treatment for all anovulatory women with PCOS, since in properly selected patients the cumulative pregnancy rate approaches that ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/3.3.235
更新日期:1997-05-01 00:00:00
abstract::Significant association between endometriosis, including minor endometriosis, and infertility (or strictly subfertility) is shown by prevalence studies, but a causal relationship has not been established. This review focuses on evidence for pituitary-ovarian dysfunction as a cause for the subfertility. A methodologica...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/6.1.56
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Clinical trials yield discrepant information about the impact of hormone therapy on verbal memory and executive function. This issue is clinically relevant because declines in verbal memory are the earliest predictor of Alzheimer's disease and declines in executive function are central to some theories of no...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmp022
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Uterine leiomyomas (fibroids) are highly prevalent benign smooth muscle tumors of the uterus. In the USA, the lifetime risk for women developing uterine leiomyomas is estimated as up to 75%. Except for hysterectomy, most therapies or treatments often provide only partial or temporary relief and are not succe...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmv030
更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:Every year 30% of individuals above age 65 fall, and falls are the principal cause of bone fractures. To reduce fracture incidence requires both prevention of falls and maintenance of bone strength. METHODS:PubMed searches were performed, for studies of the epidemiology of fractures, bone physiology, endocr...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmq008
更新日期:2010-11-01 00:00:00
abstract:BACKGROUND:The prevalence of congenital uterine anomalies in high-risk women is unclear, as several different diagnostic approaches have been applied to different groups of patients. This review aims to evaluate the prevalence of such anomalies in unselected populations and in women with infertility, including those un...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmr028
更新日期:2011-11-01 00:00:00
abstract::The wide use of assisted conception methods has risen dramatically. The greater proportion of singletons, twins and high order of multiplicity conceived by those methods have already focused the medical community to various obstetric complications. Recently, there have been suggestions that the levels of mid-gestation...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/5.5.530
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:Although fertility preservation (FP) treatment options have increased, the existing evidence suggests that many women with cancer do not feel well supported in making these decisions, but find them stressful and complex and fail to take up fertility care at this crucial time. Whilst existing reviews have all...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmx009
更新日期:2017-07-01 00:00:00
abstract:BACKGROUND:The effect of postmenopausal hormone therapy (HT) on cardiovascular disease (CVD) risk remains controversial. OBJECTIVE AND RATIONALE:We aimed to systematically review the evidence regarding the role of dose, route of hormone administration, timing of initiation and duration of HT on cardiovascular risk amo...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/dmy039
更新日期:2019-03-01 00:00:00
abstract::Contraception is one of the keystones of reproductive health. The availability of effective contraception has helped to change dramatically the structure of the world's population during the last 50 years, through a demographic transition involving lower fertility rates and longer survival. As the transition evolves m...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmi019
更新日期:2005-09-01 00:00:00
abstract:BACKGROUND:Infertility affects ∼7% of all men. Despite much progress, mainly in genetics, its etiology remains obscure in ∼50% of cases. To fill this gap, imaging of the male genital tract (MGT) has progressively expanded, providing useful information in the assessment of MGT abnormalities. METHODS:A critical, systema...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmu042
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:Because of the substantial energy demands of reproduction, the brain must temper the fertility of individuals to match nutritional availability. Under-nutrition is associated with infertility in humans and animals. The brain uses adipose- and gut-derived hormones, such as leptin, insulin and ghrelin, to modu...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dms004
更新日期:2012-05-01 00:00:00
abstract::Operative hysteroscopy is a relatively new technique that has significantly improved the diagnosis and therapy of abnormal uterine bleeding. At first, the success of operative hysteroscopy in controlling this bleeding seemed extremely high but, with long-term follow-up, a significant failure rate became evident requir...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.4.350
更新日期:1998-07-01 00:00:00
abstract::As soon as leptin was discovered four years ago, its potential as a player in the polycystic ovary syndrome (PCOS) was explored in a primitive way, though little light was shed on the enigma that is PCOS. As a second wave of leptin research is now available, we review how the expanded role of the cytokine in reproduct...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/5.2.166
更新日期:1999-03-01 00:00:00
abstract::The improved long-term survival of adolescents and young women treated for cancer has resulted in an increased focus on the effects of chemotherapy on ovarian function and its preservation. These women may seek advice and treatment regarding their reproductive status, including ways of preserving their fertility and p...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh052
更新日期:2005-01-01 00:00:00
abstract::Cancer treatment modalities are increasingly more effective in achieving complete remission and cure. Aggressive chemotherapy and radiotherapy, as well as bone marrow transplantation, results in >90% cure in many cancers of children and young women. As a result of this success however, a new problem has arisen. Many y...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.6.526
更新日期:2001-11-01 00:00:00
abstract:BACKGROUND:With the recent development of CRISPR (clustered regularly interspaced short palindromic repeats)/Cas9 genome editing technology, the possibility to genetically manipulate the human germline (gametes and embryos) has become a distinct technical possibility. Although many technical challenges still need to be...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmw005
更新日期:2016-06-01 00:00:00