Publications
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Majeed A, 2022, Let patients self-refer to lifestyle management services for osteoarthritis, BMJ: British Medical Journal, Vol: 377, Pages: 1-1, ISSN: 0959-8138
Abbas-Hanif A, Modi N, Majeed A, 2022, Long term implications of covid-19 in pregnancy, BMJ: British Medical Journal, Vol: 377, ISSN: 0959-535X
Haagsma JA, Charalampous P, Ariani F, et al., 2022, The burden of injury in Central, Eastern, and Western European sub-region: a systematic analysis from the Global Burden of Disease 2019 Study, Archives of Public Health, Vol: 80, Pages: 1-14, ISSN: 0778-7367
BackgroundInjury remains a major concern to public health in the European region. Previous iterations of the Global Burden of Disease (GBD) study showed wide variation in injury death and disability adjusted life year (DALY) rates across Europe, indicating injury inequality gaps between sub-regions and countries. The objectives of this study were to: 1) compare GBD 2019 estimates on injury mortality and DALYs across European sub-regions and countries by cause-of-injury category and sex; 2) examine changes in injury DALY rates over a 20 year-period by cause-of-injury category, sub-region and country; and 3) assess inequalities in injury mortality and DALY rates across the countries.MethodsWe performed a secondary database descriptive study using the GBD 2019 results on injuries in 44 European countries from 2000 to 2019. Inequality in DALY rates between these countries was assessed by calculating the DALY rate ratio between the highest-ranking country and lowest-ranking country in each year.ResultsIn 2019, in Eastern Europe 80 [95% uncertainty interval (UI): 71 to 89] people per 100,000 died from injuries; twice as high compared to Central Europe (38 injury deaths per 100,000; 95% UI 34 to 42) and three times as high compared to Western Europe (27 injury deaths per 100,000; 95%UI 25 to 28). The injury DALY rates showed less pronounced differences between Eastern (5129 DALYs per 100,000; 95% UI: 4547 to 5864), Central (2940 DALYs per 100,000; 95% UI: 2452 to 3546) and Western Europe (1782 DALYs per 100,000; 95% UI: 1523 to 2115). Injury DALY rate was lowest in Italy (1489 DALYs per 100,000) and highest in Ukraine (5553 DALYs per 100,000). The difference in injury DALY rates by country was larger for males compared to females. The DALY rate ratio was highest in 2005, with DALY rate in the lowest-ranking country (Russian Federation) 6.0 times higher compared to the highest-ranking country (Malta). After 2005, the DALY rate ratio between the lowest- and the highest-ranki
Li E, Tsopra R, Jimenez G, et al., 2022, General practitioners’ perceptions of using virtual primary care during the COVID-19 pandemic: An international cross-sectional survey study, PLOS Digital Health, Vol: 1, Pages: 1-23, ISSN: 2767-3170
With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June–September 2020. GPs’ perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients’ preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.
El-Osta A, Webber I, Alaa A, et al., 2022, What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study, BMJ Open, Vol: 12, ISSN: 2044-6055
Objective: Assess the suitability of clinical vignettes in benchmarking the performance of online symptom checkers (OSCs).Design: Observational study using a publicly available free OSC.Participants: Healthily OSC, which provided consultations in English, was used to record consultation outcomes from two lay and four expert inputters using 139 standardised patient vignettes. Each vignette included three diagnostic solutions and a triage recommendation in one of three categories of triage urgency. A panel of three independent general practitioners interpreted the vignettes to arrive at an alternative set of diagnostic and triage solutions. Both sets of diagnostic and triage solutions were consolidated to arrive at a final consolidated version for benchmarking.Main outcome measures: Six inputters simulated 834 standardised patient evaluations using Healthily OSC and recorded outputs (triage solution, signposting, and whether the correct diagnostic solution appeared first or within the first three differentials). We estimated Cohen’s kappa to assess how interpretations by different inputters could lead to divergent OSC output even when using the same vignette or when compared with a separate panel of physicians.Results: There was moderate agreement on triage recommendation (kappa=0.48), and substantial agreement on consultation outcomes between all inputters (kappa=0.73). OSC performance improved significantly from baseline when compared against the final consolidated diagnostic and triage solution (p<0.001).Conclusions: Clinical vignettes are inherently limited in their utility to benchmark the diagnostic accuracy or triage safety of OSC. Real-world evidence studies involving real patients are recommended to benchmark the performance of OSC against a panel of physicians.
Webb J, Peerbux S, Ang A, et al., 2022, Long-term effectiveness of a clinician-assisted digital cognitive behavioral therapy intervention for smoking cessation: secondary outcomes from a randomized controlled trial, Nicotine and Tobacco Research, Vol: 24, Pages: 1763-1772, ISSN: 1462-2203
INTRODUCTION: This study evaluated the secondary effectiveness outcomes for Quit Genius, a digital clinician-assisted cognitive behavioral therapy (CBT) intervention for smoking cessation. METHODS: Adult smokers (N=556) were randomly assigned to Quit Genius (n=277), a digital, clinician-assisted CBT intervention or Very Brief Advice (VBA) to stop smoking, an evidence-based, 30-second intervention designed to facilitate quit attempts, coupled with referral to a cessation service (n=279). Participants were offered combination nicotine replacement therapy (patches and gum) tailored to individual nicotine dependence. Analyses (N=530), by intention-to-treat, compared Quit Genius and VBA at 4, 26, and 52 weeks post-quit date. The primary outcome was self-reported seven-day point prevalence abstinence at 4 weeks post-quit date. Consecutive seven-day point-prevalence abstinence, defined as abstinent at two or more consecutive timepoints, was examined at weeks 26 and 52 to indicate long-term effectiveness. Abstinence was verified using a random sample of participants with carbon monoxide breath testing of <5 parts per million (n=280). RESULTS: Self-reported consecutive seven-day point prevalence abstinence at weeks 26 and 52 for Quit Genius was 27.2% and 22.6% respectively, compared to VBA which was 16.6% and 13.2% (RR=1.70,95% CI,1.22-2.37;p=0.003, 26 weeks; RR=1.71,95% CI,1.17-2.50; p=0.005, 52 weeks). Biochemically verified abstinence was significantly different at 26- (p=0.03) but not 52 weeks (p=0.16). Quit Genius participants were more likely to remain abstinent than those who received VBA (RR=1.71,95% CI 1.17-2.50;p=0.005). CONCLUSIONS: This study provides secondary evidence for the long-term effectiveness of Quit Genius in comparison with VBA. Future trials of digital interventions without clinician support and comparisons with active treatment are needed. IMPLICATIONS: The long-term effectiveness of clinician-assisted digital smoking cessation interventions has n
Fadahunsi P, Wark P, Mastellos N, et al., 2022, Clinical information quality of digital health technologies: protocol for an international eDelphi study, BMJ Open, Vol: 12, ISSN: 2044-6055
Introduction Digital health technologies (DHTs) such as electronic health records, clinical decision support systems and electronic prescribing systems are widely used in healthcare. While adoption of DHTs can improve healthcare delivery, information quality (IQ) problems associated with DHTs can compromise quality and safety of care. The clinical information quality (CLIQ) framework for digital health is a novel approach to assessing the quality of clinical information from DHTs. This study aims to appraise the CLIQ framework by exploring clinicians’ perspectives on the relevance, definition and assessment of IQ dimensions as defined in the framework. This study will adapt the CLIQ framework to the needs of clinical information users—the clinicians. The contextualised CLIQ framework will offer a pragmatic approach to assessing clinical information from DHTs and may help to forestall IQ problems that can compromise quality and safety of care.Methods and analysis The electronic Delphi (eDelphi) approach will be used to engage a heterogeneous group of clinicians with patient-facing and/or information governance roles recruited through purposive and snowball sampling techniques. A semi-structured online questionnaire will be used to explore clinicians’ perspectives on relevance, definition and assessment of IQ dimensions in the CLIQ framework. Survey responses on the relevance of dimensions will be summarised using descriptive statistics to inform decisions on retention of dimensions and termination of the study, based on pre-specified rules. Analysis of the free-text responses will be used to revise definition and assessment of dimensions.Ethics and dissemination Ethics approval has been obtained from the Imperial College Research Governance and Integrity Team (Imperial College Research Ethics Committee (ICREC) Reference number: 20IC6396). The results of the study will be published in a peer-reviewed journal and presented at scientific conferences.
Nakubulwa MA, Greenfield G, Pizzo E, et al., 2022, To what extent do callers follow the advice given by a non-emergency medical helpline (NHS 111): A retrospective cohort study, PLoS One, Vol: 17, ISSN: 1932-6203
National Health Service (NHS) 111 helpline was set up to improve access to urgent care in England, efficiency and cost-effectiveness of first-contact health services. Following trusted, authoritative advice is crucial for improved clinical outcomes. We examine patient and call-related characteristics associated with compliance with advice given in NHS 111 calls. The importance of health interactions that are not face-to-face has recently been highlighted by COVID-19 pandemic. In this retrospective cohort study, NHS 111 call records were linked to urgent and emergency care services data. We analysed data of 3,864,362 calls made between October 2013 and September 2017 relating to 1,964,726 callers across London. A multiple logistic regression was used to investigate associations between compliance with advice given and patient and call characteristics. Caller’s action is ‘compliant with advice given if first subsequent service interaction following contact with NHS 111 is consistent with advice given. We found that most calls were made by women (58%), adults aged 30–59 years (33%) and people in the white ethnic category (36%). The most common advice was for caller to contact their General Practitioner (GP) or other local services (18.2%) with varying times scales. Overall, callers followed advice given in 49% of calls. Compliance with triage advice was more likely in calls for children aged <16 years, women, those from Asian/Asian British ethnicity, and calls made out of hours. The highest compliance was among callers advised to self-care without the need to contact any other healthcare service. This is one of the largest studies to describe pathway adherence following telephone advice and associated clinical and demographic features. These results could inform attempts to improve caller compliance with advice given by NHS 111, and as the NHS moves to more hybrid way of working, the lessons from this study are key to the development of remote heal
Cicek M, Hayhoe B, Otis M, et al., 2022, Depression and unplanned secondary healthcare use in patients with multimorbidity: a systematic review, PLoS One, Vol: 17, ISSN: 1932-6203
Background:Growing numbers of people with multimorbidity have a co-occurring mental health condition such as depression. Co-occurring depression is associated with poor patient outcomes and increased healthcare costs including unplanned use of secondary healthcare which may be avoidable.Aim:To summarise the current evidence on the association between depression and unplanned secondary healthcare use among patients with multimorbidity.Methods:We conducted a systematic review by searching MEDLINE, EMBASE, PsychINFO, Web of Science, CINAHL, and Cochrane Library from January 2000 to March 2021. We included studies on adults with depression and at least one other physical long-term condition that examined risk of emergency hospital admissions as a primary outcome, alongside emergency department visits or emergency readmissions. Studies were assessed for risk of bias using The National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool. Relevant data were extracted from studies and a narrative synthesis of findings produced.Results:Twenty observational studies were included in the review. Depression was significantly associated with different outcomes of unplanned secondary healthcare use, across various comorbidities. Among the studies examining these outcomes, depression predicted emergency department visits in 7 out of 9 studies; emergency hospital admissions in 19 out of 20 studies; and emergency readmissions in 4 out of 4 studies. This effect increased with greater severity of depression. Other predictors of unplanned secondary care reported include increased age, being female, and presence of greater numbers of comorbidities.Conclusion:Depression predicted increased risk of unplanned secondary healthcare use in individuals with multimorbidity. The literature indicates a research gap in identifying and understanding the impact of complex multimorbidity combinations, and other patient characteristics on unplanned care in patients wit
Palladino R, More A, Greenfield G, et al., 2022, Evaluation of the North West London Diabetes Foot Care Transformation Project: a mixed-methods evaluation, International Journal of Integrated Care, Vol: 22, Pages: 1-9, ISSN: 1568-4156
Introduction: Diabetes foot ulceration (DFU) presents an enormous burden to those living with diabetes and to the local health systems and economies. There is an increasing interest in implementing integrated care models to enhance the quality of care for people living with diabetes and related complications and the value of co-production approaches to achieve sustainable change. This paper aims to describe the evaluation methodology for the North West London (NWL) Diabetes Foot Care Transformation project. Description: A mixed methods design including: i) a quasi-experimental quantitative analysis assessing the impact of the implementation of the local secondary care multi-disciplinary diabetes foot team clinics on service utilisation and clinical outcomes (amputations and number of healed patients); ii) a phenomenological, qualitative study to explore patient and staff experience; and iii) a within-trial cost-effectiveness analysis (pre and post 2017) to evaluate the programme cost-effectiveness.Discussion and Conclusion: Demonstrating the impact of multidisciplinary, integrated care models and the value of co-production approaches is important for health providers and commissioners trying to improve health outcome. Evaluation is also needed to identify strategies to overcome barriers which might have reduced the impact of the programme and key elements for improvement.
Razai MS, Majeed A, 2022, General practice in England: the current crisis, opportunities, and challenges, Journal of Ambulatory Care Management, Vol: 45, Pages: 135-139, ISSN: 0148-9917
General practice or family medicine has historically been lauded as the "jewel in the crown" of the English National Health Service (NHS) (M. Marshall, 2015). General practice, at the heart of primary care, has continued to contribute to the high ranking of the NHS in international comparisons (M. S. Razai & A. Majeed, 2021) and evidence from several decades of research has shown that general practice in the UK has improved the nation's health (Royal College of General Practitioners, 2013). Furthermore, it has provided equitable, cost-effective, and accessible care for all with the flexibility to adapt rapidly to a changing society and political climates, such as during the COVID-19 pandemic when there was rapid implementation of remote consultation models (Royal College of General Practitioners, 2013). However, this much-admired public sector service has recently come under unprecedented political and media spotlight instigated by the pressures of the current pandemic on the NHS (M. S. Razai & A. Majeed, 2021). This coupled with collapsing morale among general practitioners (GPs), a shrinking GP workforce, inexorable demands, increasing workload, and decreasing real-terms per capita funding have caused many to sound alarm on a general practice in "crisis" (C. Gerada, 2021). In this article, we describe the evolving nature of general practice and the current crisis, as well as potential solutions and opportunities going forward.
Majeed A, 2022, Author's reply to Hodges, BMJ: British Medical Journal, Vol: 377, Pages: o840-o840, ISSN: 0959-535X
Majeed A, Tessier E, Stowe J, et al., 2022, How data from the United Kingdom has guided covid-19 vaccine policies, BMJ: British Medical Journal, Vol: 376, Pages: o839-o839, ISSN: 0959-535X
Tudor Car L, Poon S, Kyaw BM, et al., 2022, An evidence map, a conceptual framework and a research agenda for health professions digital education (Preprint), Journal of Medical Internet Research, Vol: 24, Pages: 1-21, ISSN: 1438-8871
BackgroundHealth professions education has undergone major changes with the advent and adoption of digital technologies worldwide. To enable robust and relevant research in digital health professions education, it is essential to map the existing evidence, identify gaps and research priorities.MethodsWe searched for systematic reviews on digital education of practicing and student healthcare professionals. We searched Medline, Embase, Cochrane Library, ERIC, CINAHL, and grey literature sources from January 2014 to July 2020. Two authors independently screened the studies, extracted the data, and synthesized the findings. We outlined the key characteristics of the included reviews, the quality of the evidence they synthesized, and recommendations for future research. We mapped the empiric findings and research recommendations against a newly developed conceptual framework. ResultsWe identified 77 eligible systematic reviews. All included experimental studies and evaluated the effectiveness of digital education interventions in different healthcare disciplines or of different digital education modalities. Most reviews included studies on various digital education modalities (N=22), virtual reality (N=19) and online education (N=10). Most reviews focused on health professions education in general (N=36), surgery (N=13) and nursing (N=11). The reviews mainly assessed participants’ skills (N=51) and knowledge (N=49) and included data from high-income countries (N=53). Our novel conceptual framework of digital health professions education comprises six key domains (context, infrastructure, education, learners, research, and quality improvement) and 16 subdomains. Finally, we identified in these reviews 61 unique questions for future research; these mapped to framework domains of education (29 recommendations), context (17), infrastructure (9), learners (3), and research (3). Conclusions We have identified a large number of research questions regarding digital educat
Palladino R, Alfano R, Moccia M, et al., 2022, Association between institutional affiliations of academic editors and authors in medical journals, Journal of General Internal Medicine, Vol: 37, Pages: 2911-2913, ISSN: 0884-8734
Carter J, Mehrotra A, Knights F, et al., 2022, “We don’t routinely check vaccination background in adults”: A national qualitative study of barriers and facilitators to vaccine delivery and uptake in adult migrants through UK primary care, Publisher: Cold Spring Harbor Laboratory
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The COVID-19 pandemic has highlighted shortfalls in the delivery of vaccine programmes to some adult migrant groups; however, little is known around care pathways and engagement of these older cohorts in routine vaccinations in primary care, including catch-up programmes. Guidelines exist, but the extent to which they are put into practice and prioritised is unclear.</jats:p></jats:sec><jats:sec><jats:title>Objectives</jats:title><jats:p>To explore the views of primary care professionals around barriers and facilitators to catch-up vaccination in adult migrants (defined as foreign born; over 18 years) with incomplete or uncertain vaccination status and for routine vaccines to inform development of future interventions to improve vaccine uptake in this group and improve coverage.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Qualitative interview study with purposive sampling and thematic analysis</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>UK primary care, 50 included practices.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>64 primary care professionals (PCPs): 48 clinical including GPs, Practice Nurses and healthcare assistants (HCAs); 16 administrative staff including practice managers and receptionists (mean age 45 years; 84.4% female; a range of ethnicities).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Participants highlighted direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK’s vaccine schedule, from both a personal and service-delivery level, with themes
Kusuma D, 2022, Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study, BMJ: British Medical Journal, Vol: 376, Pages: e068208-e068208, ISSN: 0959-535X
Objectives To use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to estimate mortality and disability trends for the population aged ≥70 and evaluate patterns in causes of death, disability, and risk factors.Design Systematic analysis.Setting Participants were aged ≥70 from 204 countries and territories, 1990-2019.Main outcomes measures Years of life lost, years lived with disability, disability adjusted life years, life expectancy at age 70 (LE-70), healthy life expectancy at age 70 (HALE-70), proportion of years in ill health at age 70 (PYIH-70), risk factors, and data coverage index were estimated based on standardised GBD methods.Results Globally the population of older adults has increased since 1990 and all cause death rates have decreased for men and women. However, mortality rates due to falls increased between 1990 and 2019. The probability of death among people aged 70-90 decreased, mainly because of reductions in non-communicable diseases. Globally disability burden was largely driven by functional decline, vision and hearing loss, and symptoms of pain. LE-70 and HALE-70 showed continuous increases since 1990 globally, with certain regional disparities. Globally higher LE-70 resulted in higher HALE-70 and slightly increased PYIH-70. Sociodemographic and healthcare access and quality indices were positively correlated with HALE-70 and LE-70. For high exposure risk factors, data coverage was moderate, while limited data were available for various dietary, environmental or occupational, and metabolic risks.Conclusions Life expectancy at age 70 has continued to rise globally, mostly because of decreases in chronic diseases. Adults aged ≥70 living in high income countries and regions with better healthcare access and quality were found to experience the highest life expectancy and healthy life expectancy. Disability burden, however, remained constant, suggesting the need to enhance public health and intervent
Clarke J, Beaney T, Majeed A, 2022, UK scales back routine covid-19 surveillance, BMJ: British Medical Journal, Vol: 376, Pages: 1-2, ISSN: 0959-535X
Majeed A, Hodes S, 2022, Has the covid pandemic changed the debate about nationalising GPs?, BMJ: British Medical Journal, Vol: 376, Pages: 1-2, ISSN: 0959-535X
Nakubulwa M, Junghans C, Novov V, et al., 2022, Factors associated with accessing long-term adult social care in people aged 75 and over: a retrospective cohort study., Age and Ageing, Vol: 51, Pages: 1-9, ISSN: 0002-0729
BACKGROUND: An ageing population and limited resources have put strain on state provision of adult social care (ASC) in England. With social care needs predicted to double over the next 20 years, there is a need for new approaches to inform service planning and development, including through predictive models of demand. OBJECTIVE: Describe risk factors for long-term ASC in two inner London boroughs and develop a risk prediction model for long-term ASC. METHODS: Pseudonymised person-level data from an integrated care dataset were analysed. We used multivariable logistic regression to model associations of demographic factors, and baseline aspects of health status and health service use, with accessing long-term ASC over 12 months. RESULTS: The cohort comprised 13,394 residents, aged ≥75 years with no prior history of ASC at baseline. Of these, 1.7% became ASC clients over 12 months. Residents were more likely to access ASC if they were older or living in areas with high socioeconomic deprivation. Those with preexisting mental health or neurological conditions, or more intense prior health service use during the baseline period, were also more likely to access ASC. A prognostic model derived from risk factors had limited predictive power. CONCLUSIONS: Our findings reinforce evidence on known risk factors for residents aged 75 or over, yet even with linked routinely collected health and social care data, it was not possible to make accurate predictions of long-term ASC use for individuals. We propose that a paradigm shift towards more relational, personalised approaches, is needed.
Hibino M, Otaki Y, Kobeissi E, et al., 2022, Blood pressure, hypertension and the risk of aortic dissection incidence and mortality: results from the Japan-specific health checkups study, the UK biobank study and a metaanalysis of cohort studies, Circulation, Vol: 145, Pages: 633-644, ISSN: 0009-7322
Background: Hypertension or elevated blood pressure (BP) is an important risk factor for aortic dissection (AD); however, few prospective studies concerning this topic have been published. We investigated the association between hypertension/elevated BP and AD in two cohorts and conducted a meta-analysis of published prospective studies, including these two studies.Methods: We analyzed data from the Japan Specific Health Checkups (J-SHC) Study and UK Biobank, which prospectively followed 534,378 and 502,424 participants, respectively. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association of hypertension/elevated BP with AD incidence in the UK Biobank and AD mortality in the J-SHC Study. In the meta-analysis, summary relative risks (RRs) were calculated using random effects models. A potential nonlinear dose-response relationship between BP and AD was tested using fractional polynomial models, and the best-fitting second-order fractional polynomial regression model was determined.Results: In the J-SHC Study and UK Biobank, there were 84 and 182 ADs during 4- and 9-year follow-up, and the adjusted HRs of AD were 3.57 (95% CI, 2.17-6.11) and 2.68 (95% CI: 1.78-4.04) in hypertensive individuals, 1.33 (95% CI: 1.05-1.68) and 1.27 (95% CI: 1.11-1.48) per 20-mmHg increase in systolic BP (SBP), and 1.67 (95% CI: 1.40-2.00) and 1.66 (95% CI: 1.46-1.89) per 10-mmHg increase in diastolic BP (DBP), respectively. In the meta-analysis, the summary RRs were 3.07 (95% CI 2.15-4.38, I2=76.7%, n=7 studies, 2,818 ADs, 4,563,501 participants) for hypertension and 1.39 (95% CI: 1.16-1.66, I2=47.7%, n=3) and 1.79 (95% CI: 1.51-2.12, I2=57.0%, n=3) per 20-mmHg increase in SBP and per 10-mmHg in DBP, respectively. The AD risk showed a strong, positive dose-response relationship with SBP and even more so with DBP. The risk of AD in the nonlinear dose-response analysis was significant at SBP >132 mmHg and DBP >7
Cousin E, Duncan BB, Stein C, et al., 2022, Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019, The Lancet Diabetes & Endocrinology, Vol: 10, Pages: 177-192, ISSN: 2213-8587
BackgroundDiabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodsWe used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals.FindingsIn 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−
Shemtob L, Asanati K, Majeed A, 2022, Covid-19: ending the legal requirement to self isolate puts vulnerable people at risk, BMJ: British Medical Journal, Vol: 376, Pages: 1-2, ISSN: 0959-8138
Razai MS, McKechnie D, Rao M, et al., 2022, Now is the time for radical action on racial health inequalities, BMJ: British Medical Journal, Vol: 376, Pages: 1-2, ISSN: 0959-8138
Bene B, Ibeneme S, Fadahunsi KP, et al., 2022, Regulatory standards and guidance for the use of health applications for self-management in Africa: scoping review protocol, BMJ Open, Vol: 12, ISSN: 2044-6055
Introduction: Despite health applications becoming ubiquitous and with enormous potential to facilitate self-management, regulatory challenges such as poor application quality, breach of data privacy and limited interoperability have impeded their full adoption. While many countries now have digital health-related policies/strategies, there is also a need for regulatory standards and guidance that address key regulatory challenges associated with the use of health applications. Currently, it is unclear the status of countries in Africa regarding regulatory standards and guidance that address the use of health applications.This protocol describes the process of conducting a scoping review which aims to investigate the extent to which regulatory standards and guidance address the use of health applications for self-management within the WHO African Region countries.Methods: The review will follow the methodological framework for conducting a scoping study by Arksey and O’Malley (2005), and the updated methodological guidance for conducting a Joanna Briggs Institute (JBI) scoping review. Given that regulatory standards and guidance are unlikely to be available in scientific databases, we will search Scopus, Google, OpenGrey, WHO Regional Office for Africa Library (AFROLIB), African Index Medicus (AIM), websites of WHO, ITU and Ministries of Health, repositories for digital health policies. We will also search the reference lists of included documents, and contact key stakeholders in the region. Results will be reported using descriptive qualitative content analysis based on the review objectives. The policy analysis framework by Walt and Gilson (1994) will be used to organise findings. A summary of the key findings will be presented using tables, charts and maps.Ethics and dissemination: The collection of primary data is not anticipated in this study and hence ethical approval will not be required. The review will be published in a peer-reviewed journal while key
Hodes S, Stanley S, Majeed A, 2022, A national vaccination service for the NHS in England: a proposal to be considered with caution, BMJ: British Medical Journal, Vol: 376, Pages: 1-2, ISSN: 0959-8138
Woulfe F, Fadahunsi KP, O'Grady M, et al., 2022, Modification and Validation of an mHealth App Quality Assessment Methodology for International Use: Cross-sectional and eDelphi studies (Preprint), Publisher: JMIR Publications Inc.
<sec> <title>BACKGROUND</title> <p>Over 325,000 mobile health (mHealth) applications (apps) are available to download across various app stores. Quality assurance in this field of medicine remains relatively undefined, however. Globally around 84% of the population have access to mobile broadband networks. Given the potential for mHealth app use in health promotion and disease prevention, their role in medicine world-wide is ever apparent. Quality assurance regulations both nationally and internationally will take time to develop. Frameworks such as the Mobile App Rating Scale (MARS) and Enlight Suite have demonstrated potential for use in the interim. These frameworks require adaptation to be suitable for use in Low and Middle-Income Countries (LMIC) however.</p> </sec> <sec> <title>OBJECTIVE</title> <p>1) Modify the Enlight Suite, an mHealth app quality assessment methodology, to improve its applicability internationally, and 2) to assess the preliminary validity and reliability of this modified tool in practice.</p> </sec> <sec> <title>METHODS</title> <p>A two-round Delphi study involving 7 mHealth experts with varied backgrounds in medicine, health and technology was conducted to modify and adapt the Enlight Suite for international use as well as to improve its content validity. The Modified Enlight suite (MES) was then used by 800 healthcare professionals and healthcare students to assess a COVID-19 tracker app in an online survey form. The reliability of the MES was assessed using the Cronbach alpha while the construct validity was evaluated using the confirmatory factor analysis.</p> </sec> <
GBD 2019 Tuberculosis Collaborators, 2022, Global, regional, and national sex differences in the global burden of tuberculosis by HIV status, 1990-2019: results from the Global Burden of Disease Study 2019, Lancet Infectious Diseases, Vol: 22, Pages: 222-241, ISSN: 1473-3099
BACKGROUND: Tuberculosis is a major contributor to the global burden of disease, causing more than a million deaths annually. Given an emphasis on equity in access to diagnosis and treatment of tuberculosis in global health targets, evaluations of differences in tuberculosis burden by sex are crucial. We aimed to assess the levels and trends of the global burden of tuberculosis, with an emphasis on investigating differences in sex by HIV status for 204 countries and territories from 1990 to 2019. METHODS: We used a Bayesian hierarchical Cause of Death Ensemble model (CODEm) platform to analyse 21 505 site-years of vital registration data, 705 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, and 680 site-years of mortality surveillance data to estimate mortality due to tuberculosis among HIV-negative individuals. We used a population attributable fraction approach to estimate mortality related to HIV and tuberculosis coinfection. A compartmental meta-regression tool (DisMod-MR 2.1) was then used to synthesise all available data sources, including prevalence surveys, annual case notifications, population-based tuberculin surveys, and tuberculosis cause-specific mortality, to produce estimates of incidence, prevalence, and mortality that were internally consistent. We further estimated the fraction of tuberculosis mortality that is attributable to independent effects of risk factors, including smoking, alcohol use, and diabetes, for HIV-negative individuals. For individuals with HIV and tuberculosis coinfection, we assessed mortality attributable to HIV risk factors including unsafe sex, intimate partner violence (only estimated among females), and injection drug use. We present 95% uncertainty intervals for all estimates. FINDINGS: Globally, in 2019, among HIV-negative individuals, there were 1·18 million (95% uncertainty interval 1·08-1·29) deaths due to tuberculosis and 8·50 million (7&midd
Nichols E, Steinmetz JD, Vollset SE, et al., 2022, Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease 2019, LANCET PUBLIC HEALTH, Vol: 7, Pages: E105-E125, ISSN: 2468-2667
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Soljak M, Majeed A, 2022, Reducing the covid-19 isolation period in England: a policy change that needs careful evaluation., BMJ: British Medical Journal, Vol: 376, Pages: o184-o184, ISSN: 0959-535X
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