Imperial College London

PROFESSOR AZEEM MAJEED

Faculty of MedicineSchool of Public Health

Chair - Primary Care and Public Health & Head of Department
 
 
 
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Contact

 

+44 (0)20 7594 3368a.majeed Website

 
 
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Assistant

 

Ms Dorothea Cockerell +44 (0)20 7594 3368

 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

887 results found

Webb J, Peerbux S, Ang A, Siddiqui S, Sherwani Y, Ahmed M, MacRae H, Puri H, Majeed A, Glasner Set 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 Tob Res

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

Journal article

Fadahunsi P, Wark P, Mastellos N, Gallagher J, Majeed F, Car Jet al., 2022, Clinical information quality of digital health technologies: protocol for an international eDelphi study., BMJ Open, ISSN: 2044-6055

Journal article

Crawshaw AF, Farah Y, Deal A, Rustage K, Hayward SE, Carter J, Knights F, Goldsmith LP, Campos-Matos I, Wurie F, Majeed A, Bedford H, Forster AS, Hargreaves Set al., 2022, Defining the determinants of vaccine uptake and undervaccination in migrant populations in Europe to improve routine and COVID-19 vaccine uptake: a systematic review., Lancet Infectious Diseases, ISSN: 1473-3099

Understanding why some migrants in Europe are at risk of underimmunisation and show lower vaccination uptake for routine and COVID-19 vaccines is critical if we are to address vaccination inequities and meet the goals of WHO's new Immunisation Agenda 2030. We did a systematic review (PROSPERO: CRD42020219214) exploring barriers and facilitators of vaccine uptake (categorised using the 5As taxonomy: access, awareness, affordability, acceptance, activation) and sociodemographic determinants of undervaccination among migrants in the EU and European Economic Area, the UK, and Switzerland. We searched MEDLINE, CINAHL, and PsycINFO from 2000 to 2021 for primary research, with no restrictions on language. 5259 data sources were screened, with 67 studies included from 16 countries, representing 366 529 migrants. We identified multiple access barriers-including language, literacy, and communication barriers, practical and legal barriers to accessing and delivering vaccination services, and service barriers such as lack of specific guidelines and knowledge of health-care professionals-for key vaccines including measles-mumps-rubella, diphtheria-pertussis-tetanus, human papillomavirus, influenza, polio, and COVID-19 vaccines. Acceptance barriers were mostly reported in eastern European and Muslim migrants for human papillomavirus, measles, and influenza vaccines. We identified 23 significant determinants of undervaccination in migrants (p<0·05), including African origin, recent migration, and being a refugee or asylum seeker. We did not identify a strong overall association with gender or age. Tailored vaccination messaging, community outreach, and behavioural nudges facilitated uptake. Migrants' barriers to accessing health care are already well documented, and this Review confirms their role in limiting vaccine uptake. These findings hold immediate relevance to strengthening vaccination programmes in high-income countries, including for COVID-19, and suggest

Journal article

Cicek M, Hayhoe B, Otis M, Nicholls D, Majeed A, Greenfield Get 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

Journal article

El-Osta A, Webber I, Alaa A, Bagkeris E, Tagavi Azar Sharabiani M, Mian S, Majeed Aet al., 2022, What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study, BMJ Open, ISSN: 2044-6055

Journal article

Palladino R, More A, Greenfield G, Anokye N, Piggot E, Willis T, Edward G, Majeed F, Kong WMet al., 2022, Evaluation of the North West London Diabetes Foot Care Transformation Project: a mixed-methods evaluation, International Journal of Integrated Care, 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.

Journal article

Foley K, Maile E, Bottle R, Neale F, Viner R, Kenny S, Majeed F, Hargreaves D, Saxena Set al., 2022, Impact of covid-19 on primary care contacts with children and young people aged 0-24 years in England; longitudinal trends study 2015-2020, British Journal of General Practice, ISSN: 0960-1643

Background: The NHS response to covid-19 altered provision and access to primary care.Aim: To examine the impact of covid-19 on general practitioner (GP) contacts with children and young people in England. Design and Setting: Longitudinal trends analysis using electronic health records from the Clinical Practice Research Datalink Aurum database.Methods: We included all children and young people younger than 25 years registered with a GP. We compared the number of total, remote and face-to-face contacts during the first UK lockdown (March to June 2020) with the mean contacts for comparable weeks from 2015 to 2019.Results: We examined 47 607 765 GP contacts with 4 307 120 million children and young people. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1-14 had greater falls in total contacts (>50%) compared with infants and 15-24s. Face-to-face contacts fell by 88% with the greatest falls occurring among children aged 1-14 (> 90%). Remote contacts more than doubled, increasing most in infants (over 2.5 fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote, mitigating the total fall (31%). Conclusion: During the covid-19 pandemic, children and young people’s contact with GPs fell, particularly for face-to-face assessment. This may be explained by a lower incidence of respiratory illnesses due to fewer social contacts and changing health seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.

Journal article

Majeed A, 2022, Author's reply to Hodges., BMJ, Vol: 377, Pages: o840-o840

Journal article

Razai MS, Majeed A, 2022, General Practice in England: The Current Crisis, Opportunities, and Challenges., J Ambul Care Manage, Vol: 45, Pages: 135-139

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.

Journal article

Majeed A, Tessier E, Stowe J, Mokdad AHet al., 2022, How data from the United Kingdom has guided covid-19 vaccine policies., BMJ, Vol: 376, Pages: o839-o839

Journal article

Palladino R, Alfano R, Moccia M, Barone-Adesi F, Majeed A, Triassi M, Millett Cet al., 2022, Association Between Institutional Affiliations of Academic Editors and Authors in Medical Journals, JOURNAL OF GENERAL INTERNAL MEDICINE, ISSN: 0884-8734

Journal article

Carter J, Mehrotra A, Knights F, Deal A, Crawshaw AF, Farah Y, Goldsmith LP, Wurie F, Ciftci Y, Majeed A, Hargreaves Set al., 2022, “<i>We don’t routinely check vaccination background in adults”</i>: A national qualitative study of barriers and facilitators to vaccine delivery and uptake in adult migrants through UK primary care, Preprint

<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

Journal article

Clarke J, Beaney T, Majeed A, 2022, UK scales back routine covid-19 surveillance., BMJ, Vol: 376, Pages: o562-o562

Journal article

Majeed A, Hodes S, 2022, Has the covid pandemic changed the debate about nationalising GPs?, BMJ, Vol: 376, Pages: o406-o406

Journal article

Hibino M, Otaki Y, Kobeissi E, Pan H, Hibino H, Taddese H, Majeed Z, Verma S, Konta T, Yamagata K, Fujimoto S, Tsuruya K, Narita I, Kasahara M, Shibagaki Y, Iseki K, Moriyama T, Kondo M, Asahi K, Watanabe T, Watanabe T, Watanabe M, Aune Det 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

Journal article

Nakubulwa M, Junghans C, Novov V, Lyons-Amos C, Lovett D, Majeed A, Aylin P, Woodcock Tet al., 2022, Factors associated with accessing long-term adult social care in people aged 75 and over: a retrospective cohort study., Age Ageing, Vol: 51

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.

Journal article

Woulfe F, Fadahunsi KP, O'Grady M, Chirambo GB, Mawkin M, Majeed A, Smith S, Henn P, O'Donoghue Jet al., 2022, Modification and Validation of an mHealth App Quality Assessment Methodology for International Use: Cross-sectional and eDelphi studies (Preprint), Preprint

<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> <

Journal article

Sharma A, Lai H, Chang K, Sharabiani M, Bottle A, Valabhji J, Middleton L, Majeed A, Millett C, Vamos Eet al., 2022, A 20-year follow-up of cardiometabolic trajectories amongst individuals with type 2 diabetes before dementia diagnosis by ethnic group, DUK, Publisher: WILEY, ISSN: 0742-3071

Conference paper

Cousin E, Duncan BB, Stein C, Ong KL, Vos T, Abbafati C, Abbasi-Kangevari M, Abdelmasseh M, Abdoli A, Abd-Rabu R, Abolhassani H, Abu-Gharbieh E, Accrombessi MMK, Adnani QES, Afzal MS, Agarwal G, Agrawaal KK, Agudelo-Botero M, Ahinkorah BO, Ahmad S, Ahmad T, Ahmadi K, Ahmadi S, Ahmadi A, Ahmed A, Ahmed Salih Y, Akande-Sholabi W, Akram T, Al Hamad H, Al-Aly Z, Alcalde-Rabanal JE, Alipour V, Aljunid SM, Al-Raddadi RM, Alvis-Guzman N, Amini S, Ancuceanu R, Andrei T, Andrei CL, Anjana RM, Ansar A, Antonazzo IC, Antony B, Anyasodor AE, Arabloo J, Arizmendi D, Armocida B, Artamonov AA, Arulappan J, Aryan Z, Asgari S, Ashraf T, Astell-Burt T, Atorkey P, Atout MMW, Ayanore MA, Badiye AD, Baig AA, Bairwa M, Baker JL, Baltatu OC, Banik PC, Barnett A, Barone MTU, Barone-Adesi F, Barrow A, Bedi N, Belete R, Belgaumi UI, Bell AW, Bennett DA, Bensenor IM, Beran D, Bhagavathula AS, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bijani A, Bikbov B, Birara S, Bodolica V, Bonny A, Brenner H, Briko NI, Butt ZA, Caetano dos Santos FL, Cámera LA, Campos-Nonato IR, Cao Y, Cao C, Cerin E, Chakraborty PA, Chandan JS, Chattu VK, Chen S, Choi J-YJ, Choudhari SG, Chowdhury EK, Chu D-T, Corso B, Dadras O, Dai X, Damasceno AAM, Dandona L, Dandona R, Dávila-Cervantes CA, De Neve J-W, Denova-Gutiérrez E, Dhamnetiya D, Diaz D, Ebtehaj S, Edinur HA, Eftekharzadeh S, El Sayed I, Elgendy IY, Elhadi M, Elmonem MA, Faisaluddin M, Farooque U, Feng X, Fernandes E, Fischer F, Flood D, Freitas M, Gaal PA, Gad MM, Gaewkhiew P, Getacher L, Ghafourifard M, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Gill PS, Ginawi IA, Glushkova EV, Golechha M, Gopalani SV, Guimarães RA, Gupta RD, Gupta R, Gupta VK, Gupta VB, Gupta S, Habtewold TD, Hafezi-Nejad N, Halwani R, Hanif A, Hankey GJ, Haque S, Hasaballah AI, Hasan SS, Hashi A, Hassanipour S, Hay SI, Hayat K, Heidari M, Hossain MBH, Hossain S, Hosseini M, Hoveidamanesh S, Huang J, Humayun A, Hussain R, Hwang B-F, Ibitoye SE, Ikuta KS, Inbaraj LR, Iqbal U, Islam Met 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% (−

Journal article

Shemtob L, Asanati K, Majeed A, 2022, Covid-19: Ending the legal requirement to self isolate puts vulnerable people at risk., BMJ, Vol: 376, Pages: o461-o461

Journal article

Razai MS, McKechnie D, Rao M, Majeed Aet al., 2022, Now is the time for radical action on racial health inequalities., BMJ, Vol: 376, Pages: o424-o424

Journal article

Bene B, Ibeneme S, Fadahunsi KP, Harri BI, Ukor N, Mastellos N, Majeed A, Car Jet 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

Journal article

Hodes S, Stanley S, Majeed A, 2022, A national vaccination service for the NHS in England: a proposal to be considered with caution., BMJ, Vol: 376, Pages: o338-o338

Journal article

Ferrari AJ, Santomauro DF, Herrera AMM, Shadid J, Ashbaugh C, Erskine HE, Charlson FJ, Degenhardt L, Scott JG, McGrath JJ, Allebeck P, Benjet C, Breitborde NJK, Brugha T, Dai X, Dandona L, Dandona R, Fischer F, Haagsma JA, Maria Haro J, Kieling C, Knudsen AKS, Kumar GA, Leung J, Majeed A, Mitchell PB, Moitra M, Mokdad AH, Molokhia M, Patten SB, Patton GC, Phillips MR, Soriano JB, Stein DJ, Stein MB, Szoeke CE, Naghavi M, Hay S, Murray CJL, Vos T, Whiteford HAet al., 2022, Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019, LANCET PSYCHIATRY, Vol: 9, Pages: 137-150, ISSN: 2215-0374

Journal article

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

Journal article

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

Journal article

Zheng B, Su B, Udeh-Momoh C, Price G, Tzoulaki I, Vamos EP, Majeed A, Riboli E, Ahmadi-Abhari S, Middleton LTet al., 2022, Associations of cardiovascular and non-cardiovascular comorbidities with dementia risk in patients with diabetes: results from a large UK cohort study, JPAD-JOURNAL OF PREVENTION OF ALZHEIMERS DISEASE, Vol: 9, Pages: 86-91, ISSN: 2274-5807

BackgroundType 2 diabetes (T2D) is an established risk factor for dementia. However, it remains unclear whether the presence of comorbidities could further increase dementia risk in diabetes patients.ObjectivesTo examine the associations between cardiovascular and non-cardiovascular comorbidities and dementia risk in T2D patients.DesignPopulation-based cohort study.SettingThe UK Clinical Practice Research Datalink (CPRD).Participants489,205 T2D patients aged over 50 years in the UK CPRD.MeasurementsMajor cardiovascular and non-cardiovascular comorbidities were extracted as time-varying exposure variables. The outcome event was dementia incidence based on dementia diagnosis or dementia-specific drug prescription.ResultsDuring a median of six years follow-up, 33,773 (6.9%) incident dementia cases were observed. Time-varying Cox regressions showed T2D patients with stroke, peripheral vascular disease, atrial fibrillation, heart failure or hypertension were at higher risk of dementia compared to those without such comorbidities (HR [95% CI] = 1.64 [1.59–1.68], 1.37 [1.34–1.41], 1.26 [1.22–1.30], 1.15 [1.11–1.20] or 1.10 [1.03–1.18], respectively). Presence of chronic obstructive pulmonary disease or chronic kidney disease was also associated with increased dementia risk (HR [95% CI] = 1.05 [1.01–1.10] or 1.11 [1.07–1.14]).ConclusionsA range of cardiovascular and non-cardiovascular comorbidities were associated with further increases of dementia risk in T2D patients. Prevention and effective management of these comorbidities may play a significant role in maintaining cognitive health in T2D patients.

Journal article

Majeed A, 2022, London is an important barometer for the omicron wave in the United Kingdom., BMJ: British Medical Journal, Vol: 376, Pages: o42-o42, ISSN: 0959-535X

Journal article

Majeed A, 2022, It's time for more targeted use of lateral flow tests for covid-19., BMJ, Vol: 376, Pages: 1-2, ISSN: 1759-2151

Journal article

GBD 2019 Adolescent Young Adult Cancer Collaborators, 2022, The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet Oncology, Vol: 23, Pages: 27-52, ISSN: 1213-9432

BACKGROUND: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. METHODS: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. FINDINGS: There were 1·19 million (95% UI 1·11-1·28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5-65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8-57·9] per 100 000 person-years), while the high

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