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

973 results found

Blaaza M, Shemtob L, Asanati K, Majeed Aet al., 2024, A healing challenge: examining NHS staff sickness absence rates., J R Soc Med

Journal article

Beaney T, Clarke J, Woodcock T, Majeed A, Barahona M, Aylin Pet al., 2024, Effect of timeframes to define long term conditions and sociodemographic factors on prevalence of multimorbidity using disease code frequency in primary care electronic health records: retrospective study., BMJ Med, Vol: 3

OBJECTIVE: To determine the extent to which the choice of timeframe used to define a long term condition affects the prevalence of multimorbidity and whether this varies with sociodemographic factors. DESIGN: Retrospective study of disease code frequency in primary care electronic health records. DATA SOURCES: Routinely collected, general practice, electronic health record data from the Clinical Practice Research Datalink Aurum were used. MAIN OUTCOME MEASURES: Adults (≥18 years) in England who were registered in the database on 1 January 2020 were included. Multimorbidity was defined as the presence of two or more conditions from a set of 212 long term conditions. Multimorbidity prevalence was compared using five definitions. Any disease code recorded in the electronic health records for 212 conditions was used as the reference definition. Additionally, alternative definitions for 41 conditions requiring multiple codes (where a single disease code could indicate an acute condition) or a single code for the remaining 171 conditions were as follows: two codes at least three months apart; two codes at least 12 months apart; three codes within any 12 month period; and any code in the past 12 months. Mixed effects regression was used to calculate the expected change in multimorbidity status and number of long term conditions according to each definition and associations with patient age, gender, ethnic group, and socioeconomic deprivation. RESULTS: 9 718 573 people were included in the study, of whom 7 183 662 (73.9%) met the definition of multimorbidity where a single code was sufficient to define a long term condition. Variation was substantial in the prevalence according to timeframe used, ranging from 41.4% (n=4 023 023) for three codes in any 12 month period, to 55.2% (n=5 366 285) for two codes at least three months apart. Younger people (eg, 50-75% probability for 18-29 years v 1-10% for ≥80 years), people of some minority ethnic groups

Journal article

Carter J, Knights F, Deal A, Crawshaw AF, Hayward SE, Hall R, Matthews P, Seedat F, Ciftci Y, Zenner D, Wurie F, Campos-Matos I, Majeed A, Requena-Mendez A, Hargreaves Set al., 2024, Multi-infection screening for migrant patients in UK primary care: Challenges and opportunities., J Migr Health, Vol: 9

BACKGROUND: Migrants in Europe face a disproportionate burden of undiagnosed infection, including tuberculosis, blood-borne viruses, and parasitic infections and many belong to an under-immunised group. The European Centre for Disease Control (ECDC) has called for innovative strategies to deliver integrated multi-disease screening to migrants within primary care, yet this is poorly implemented in the UK. We did an in-depth qualitative study to understand current practice, barriers and solutions to infectious disease screening in primary care, and to seek feedback on a collaboratively developed digitalised integrated clinical decision-making tool called Health Catch UP!, which supports multi-infection screening for migrant patients. METHODS: Two-phase qualitative study of UK primary healthcare professionals, in-depth semi-structured telephone-interviews were conducted. In Phase A, we conducted interviews with clinical staff (general practitioners (GPs), nurses, health-care-assistants (HCAs)); these informed data collection and analysis for phase B (administrative staff). Data were analysed iteratively, using thematic analysis. RESULTS: In phase A, 48 clinicians were recruited (25 GPs, 15 nurses, seven HCAs, one pharmacist) and 16 administrative staff (11 Practice-Managers, five receptionists) in phase B. Respondents were positive about primary care's ability to effectively deliver infectious disease screening. However, we found current infectious disease screening lacks a standardised approach and many practices have no system for screening meaning migrant patients are not always receiving evidence-based care (i.e., NICE/ECDC/UKHSA screening guidelines). Barriers to screening were reported at patient, staff, and system-levels. Respondents reported poor implementation of existing screening initiatives (e.g., regional latent TB screening) citing overly complex pathways that required extensive administrative/clinical time and lacked financial/expert support. Solutions i

Journal article

Razai MS, Mansour R, Goldsmith L, Freeman S, Mason-Apps C, Ravindran P, Kooner P, Berendes S, Morris J, Majeed A, Ussher M, Hargreaves S, Oakeshott Pet al., 2023, Interventions to increase vaccination against COVID-19, influenza and pertussis during pregnancy: a systematic review and meta-analysis., J Travel Med, Vol: 30

BACKGROUND: Pregnant women and their babies face significant risks from three vaccine-preventable diseases: COVID-19, influenza and pertussis. However, despite these vaccines' proven safety and effectiveness, uptake during pregnancy remains low. METHODS: We conducted a systematic review (PROSPERO CRD42023399488; January 2012-December 2022 following PRISMA guidelines) of interventions to increase COVID-19/influenza/pertussis vaccination in pregnancy. We searched nine databases, including grey literature. Two independent investigators extracted data; discrepancies were resolved by consensus. Meta-analyses were conducted using random-effects models to estimate pooled effect sizes. Heterogeneity was assessed using the I2 statistics. RESULTS: From 2681 articles, we identified 39 relevant studies (n = 168 262 participants) across nine countries. Fifteen studies (39%) were randomized controlled trials (RCTs); the remainder were observational cohort, quality-improvement or cross-sectional studies. The quality of 18% (7/39) was strong. Pooled results of interventions to increase influenza vaccine uptake (18 effect estimates from 12 RCTs) showed the interventions were effective but had a small effect (risk ratio = 1.07, 95% CI 1.03, 1.13). However, pooled results of interventions to increase pertussis vaccine uptake (10 effect estimates from six RCTs) showed no clear benefit (risk ratio = 0.98, 95% CI 0.94, 1.03). There were no relevant RCTs for COVID-19. Interventions addressed the 'three Ps': patient-, provider- and policy-level strategies. At the patient level, clear recommendations from healthcare professionals backed by text reminders/written information were strongly associated with increased vaccine uptake, especially tailored face-to-face interventions, which addressed women's concerns, dispelled myths and highlighted benefits. Provider-level interventions included educating healthcare professionals about vaccines' safe

Journal article

Kerr G, Greenfield G, Hayhoe B, Gaughran F, Halvorsrud K, Pinto da Costa M, Rehill N, Raine R, Majeed A, Costelloe C, Neves AL, Beaney Tet al., 2023, Attendance at remote versus in-person outpatient appointments in an NHS Trust, Journal of Telemedicine and Telecare, Pages: 1357633X231216501-1357633X231216501, ISSN: 1357-633X

INTRODUCTION: With the growing use of remote appointments within the National Health Service, there is a need to understand potential barriers of access to care for some patients. In this observational study, we examined missed appointments rates, comparing remote and in-person appointments among different patient groups. METHODS: We analysed adult outpatient appointments at Imperial College Healthcare NHS Trust in Northwest London in 2021. Rates of missed appointments per patient were compared between remote versus in-person appointments using negative binomial regression models. Models were stratified by appointment type (first or a follow-up). RESULTS: There were 874,659 outpatient appointments for 189,882 patients, 29.5% of whom missed at least one appointment. Missed rates were 12.5% for remote first appointments and 9.2% for in-person first appointments. Remote and in-person follow-up appointments were missed at similar rates (10.4% and 10.7%, respectively). For remote and in-person appointments, younger patients, residents of more deprived areas, and patients of Black, Mixed and 'other' ethnicities missed more appointments. Male patients missed more in-person appointments, particularly at younger ages, but gender differences were minimal for remote appointments. Patients with long-term conditions (LTCs) missed more first appointments, whether in-person or remote. In follow-up appointments, patients with LTCs missed more in-person appointments but fewer remote appointments. DISCUSSION: Remote first appointments were missed more often than in-person first appointments, follow-up appointments had similar attendance rates for both modalities. Sociodemographic differences in outpatient appointment attendance were largely similar between in-person and remote appointments, indicating no widening of inequalities in attendance due to appointment modality.

Journal article

Beaney T, Clarke J, Woodcock T, Majeed F, Barahona M, Aylin Pet al., 2023, Impact and inequalities in the prevalence of multimorbidity using different timeframes to define long term conditions: a retrospective study of disease code frequency in primary care electronic healthcare records, BMJ Medicine, ISSN: 2754-0413

Objective:Multimorbidity is a priority for health systems globally. We aimed to determine the extent to which the choice of timeframe used to define a long-term condition (LTC) impacts on the prevalence of multimorbidity and whether this varies with socio-demographic factors.Methods and Analysis:We used routinely collected general practice electronic healthcare record (EHR) data from Clinical Practice Research Datalink (CPRD) Aurum for patients in England aged 18 years or over registered on 01/01/2020. Multimorbidity was defined as the presence of two or more conditions from a set of 212 LTCs. We compared multimorbidity prevalence using a single code representing a disease diagnosis recorded anywhere in the EHR for each LTC, to prevalence based on four different timeframes for disease duration for 37 conditions where a single disease code could indicate an acute condition: 1) 2 codes at least 3 months apart; 2) two codes at least 12 months apart; 3) 3 codes within any 12-month period; 4) Any code in the last 12 months. We used mixed effects regression to calculate the expected change in multimorbidity status and number of LTCs according to each definition and associations with patient age, gender, ethnicity and socio-economic deprivation.Results:9,718,573 people were included in the study, of whom 73.9% met the definition of multimorbidity where a single code was sufficient to define an LTC. There was substantial variation in the prevalence according to timeframe used, ranging from 41.4% for three codes in the last twelve months, to 55.2% for two codes at least three months apart. Younger people, people of some minority ethnic groups and people living in areas of lower socioeconomic deprivation are more likely to be re-classified as not multimorbid when using definitions requiring multiple codes.Conclusions:Choice of timeframe to define LTCs has a substantial impact on the prevalence of multimorbidity in this nationally representative sample. Different timeframes im

Journal article

Costa Carvalho JM, Li E, Hayhoe B, Beaney T, Majeed A, Greenfield G, Neves ALet al., 2023, Validating a framework to guide the implementation of high-quality virtual primary care: An international eDelphi study protocol, BMJ Open, Vol: 13, ISSN: 2044-6055

Background: There is an urgent need to support primary care organisations in implementing safe and high-quality virtual consultations. We have previously performed qualitative research to capture the views of 1600 primary care physicians across 20 countries on the main benefits and challenges of using virtual consultations. Subsequently, a prototype of a framework to guide the implementation of high-quality virtual primary care was developed.Aim: To explore general practitioners’ perspectives on the appropriateness and relevance of each component of the framework’s prototype, to further refine it and optimise its practical use in primary care facilities.Methods and analysis: Participants will be primary care physicians with active experience providing virtual care, recruited through convenience and snowball sampling. This study will use a systematic and iterative online Delphi research approach (eDelphi), with a minimum of three rounds. A pre-round will be used to circulate items for initial feedback and adjustment. In subsequent rounds, participants will be asked to rate the relevance of the framework’s components. Consensus will be defined as >70% of participants agreeing/strongly agreeing or disagreeing/strongly disagreeing with a component. Data will be collected using structured online questionnaires. The primary outcome of the study will be a list of the essential components to be incorporated in the final version of the framework.Ethics and dissemination: The study has received ethical approval conceded by the Imperial College London Science, Engineering and Technology Research Ethics Committee (SETREC) (reference no .6559176/2023). Anonymous results will be made available to the public, academic organisations and policymakers.

Journal article

Majeed A, 2023, UK government must be proactive about drug shortages., BMJ, Vol: 383, Pages: p2522-p2522

Journal article

Sukriti KC, Tewolde S, Laverty AA, Costelloe C, Papoutsi C, Reidy C, Gudgin B, Shenton C, Majeed A, Powell J, Greaves Fet al., 2023, Uptake and adoption of the NHSApp in England: an observational study, BRITISH JOURNAL OF GENERAL PRACTICE, ISSN: 0960-1643

Journal article

Wu D, Jin Y, Xing Y, Abate MD, Abbasian M, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abd-Allah F, Abdelmasseh M, Abdollahifar M-A, Abdulah DM, Abedi A, Abedi V, Abidi H, Aboagye RG, Abolhassani H, Abuabara K, Abyadeh M, Addo IY, Adeniji KN, Adepoju AV, Adesina MA, Sakilah Adnani QE, Afarideh M, Aghamiri S, Agodi A, Agrawal A, Aguilera Arriagada CE, Ahmad A, Ahmad D, Ahmad S, Ahmad S, Ahmadi A, Ahmed A, Ahmed A, Aithala JP, Ajadi AA, Ajami M, Akbarzadeh-Khiavi M, Alahdab F, AlBataineh MT, Alemi S, Saeed Al-Gheethi AA, Ali L, Alif SM, Almazan JU, Almustanyir S, Alqahtani JS, Alqasmi I, Khan Altaf IU, Alvis-Guzman N, Alvis-Zakzuk NJ, Al-Worafi YM, Aly H, Amani R, Amu H, Amusa GA, Andrei CL, Ansar A, Ansariniya H, Anyasodor AE, Arabloo J, Arefnezhad R, Arulappan J, Asghari-Jafarabadi M, Ashraf T, Atata JA, Athari SS, Atlaw D, Wahbi Atout MM, Aujayeb A, Awan AT, Ayatollahi H, Azadnajafabad S, Azzam AY, Badawi A, Badiye AD, Bagherieh S, Baig AA, Bantie BB, Barchitta M, Bardhan M, Barker-Collo SL, Barone-Adesi F, Batra K, Bayileyegn NS, Behnoush AH, Belgaumi UI, Bemanalizadeh M, Bensenor IM, Beyene KA, Bhagavathula AS, Bhardwaj P, Bhaskar S, Bhat AN, Bitaraf S, Bitra VR, Boloor A, Bora K, Botelho JS, Buchbinder R, Calina D, Cámera LA, Carvalho AF, Kai Chan JS, Chattu VK, Abebe EC, Chichagi F, Choi S, Chou T-C, Chu D-T, Coberly K, Costa VM, Couto RAS, Cruz-Martins N, Dadras O, Dai X, Damiani G, Dascalu AM, Dashti M, Debela SA, Dellavalle RP, Demetriades AK, Demlash AA, Deng X, Desai HD, Desai R, Rahman Dewan SM, Dey S, Dharmaratne SD, Diaz D, Dibas M, Dinis-Oliveira RJ, Diress M, Do TC, Doan DK, Dodangeh M, Dodangeh M, Dongarwar D, Dube J, Dziedzic AM, Ed-Dra A, Edinur HA, Eissazade N, Ekholuenetale M, Ekundayo TC, Elemam NM, Elhadi M, Elmehrath AO, Abdou Elmeligy OA, Emamverdi M, Emeto TI, Esayas HL, Eshetu HB, Etaee F, Fagbamigbe AF, Faghani S, Fakhradiyev IR, Fatehizadeh A, Fathi M, Feizkhah A, Fekadu G, Fereidouni M, Fereshtehnejad S-M, Fernandes JC, Ferrara P, Fetensa Get al., 2023, Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019, eClinicalMedicine, Vol: 64, ISSN: 2589-5370

BackgroundThe causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019.MethodsWe collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends.FindingsIn 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR.InterpretationThe incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate

Journal article

Salman D, Marino K, Griffin S, Shafik A, Fitzpatrick D, Majeed A, Vishnubala Det al., 2023, Concussion in sport: are new guidelines a game changer for primary care?, British Journal of General Practice, Vol: 73, Pages: 440-442, ISSN: 0960-1643

Journal article

Black RJ, Cross M, Haile LM, Culbreth GT, Steinmetz JD, Hagins H, Kopec JA, Brooks PM, Woolf AD, Ong KL, Kopansky-Giles DR, Dreinhoefer KE, Betteridge N, Aali A, Abbasifard M, Abbasi-Kangevari M, Abdurehman AM, Abedi A, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Abu-Zaid A, Adamu K, Addo IY, Adesina MA, Adnani QES, Afzal MS, Ahmed A, Aithala JP, Akhlaghdoust M, Alemayehu A, Alvand S, Alvis-Zakzuk NJ, Amu H, Antony B, Arabloo J, Aravkin AY, Arulappan J, Ashraf T, Athari SS, Azadnajafabad S, Badawi A, Baghcheghi N, Baig AA, Balta AB, Banach M, Banik PC, Barrow A, Bashiri A, Bearne LM, Bekele A, Bensenor IM, Berhie AY, Bhagavathula AS, Bhardwaj P, Bhat AN, Bhojaraja VS, Bitaraf S, Bodicha BBA, Botelho JS, Briggs AM, Buchbinder R, Castañeda-Orjuela CA, Charalampous P, Chattu VK, Coberly K, Cruz-Martins N, Dadras O, Dai X, de Luca K, Dessalegn FN, Dessie G, Dhimal M, Digesa LE, Diress M, Doku PN, Edinur HA, Ekholuenetale M, Elhadi M, El-Sherbiny YM, Etaee F, Ezzeddini R, Faghani S, Filip I, Fischer F, Fukumoto T, Ganesan B, Gebremichael MA, Gerema U, Getachew ME, Ghashghaee A, Gill TK, Gupta B, Gupta S, Gupta VB, Gupta VK, Halwani R, Hannan MA, Haque S, Harlianto NI, Harorani M, Hasaballah AI, Hassen MB, Hay SI, Hayat K, Heidari G, Hezam K, Hill CL, Hiraike Y, Horita N, Hoveidaei AH, Hsiao AK, Hsieh E, Hussain S, Iavicoli I, Ilic IM, Islam SMS, Ismail NE, Iwagami M, Jakovljevic M, Jani CT, Jeganathan J, Joseph N, Kadashetti V, Kandel H, Kanko TK, Karaye IM, Khajuria H, Khan MJ, Khan MAB, Khanali J, Khatatbeh MM, Khubchandani J, Kim YJ, Kisa A, Kolahi A-A, Kompani F, Koohestani HR, Koyanagi A, Krishan K, Kuddus M, Kumar N, Kuttikkattu A, Larijani B, Lim SS, Lo J, Machado VS, Mahajan PB, Majeed A, Malakan Rad E, Malik AA, Mansournia MA, Mathews E, Mendes JJ, Mentis A-FA, Mesregah MK, Mestrovic T, Mirghaderi SP, Mirrakhimov EM, Misganaw A, Mohamadkhani A, Mohammed S, Mokdad AH, Moniruzzaman M, Montasir AA, Mulu GB, Murillo-Zamora E, Murray CJL, Mustafa G, Naghavi Met al., 2023, Global, regional, and national burden of rheumatoid arthritis, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021, The Lancet Rheumatology, Vol: 5, Pages: e594-e610, ISSN: 2665-9913

Journal article

Beaney T, Clarke J, Salman D, Woodcock T, Majeed F, Barahona M, Aylin Pet al., 2023, Identifying potential biases in code sequences in primary care electronic healthcare records: a retrospective cohort study of the determinants of code frequency, BMJ Open, Vol: 13, ISSN: 2044-6055

Objectives To determine whether the frequency of diagnostic codes for long-term conditions (LTCs) in primary care electronic healthcare records (EHRs) is associated with (1) disease coding incentives, (2) General Practice (GP), (3) patient sociodemographic characteristics and (4) calendar year of diagnosis.Design Retrospective cohort study.Setting GPs in England from 2015 to 2022 contributing to the Clinical Practice Research Datalink Aurum dataset.Participants All patients registered to a GP with at least one incident LTC diagnosed between 1 January 2015 and 31 December 2019.Primary and secondary outcome measures The number of diagnostic codes for an LTC in (1) the first and (2) the second year following diagnosis, stratified by inclusion in the Quality and Outcomes Framework (QOF) financial incentive programme.Results 3 113 724 patients were included, with 7 723 365 incident LTCs. Conditions included in QOF had higher rates of annual coding than conditions not included in QOF (1.03 vs 0.32 per year, p<0.0001). There was significant variation in code frequency by GP which was not explained by patient sociodemographics. We found significant associations with patient sociodemographics, with a trend towards higher coding rates in people living in areas of higher deprivation for both QOF and non-QOF conditions. Code frequency was lower for conditions with follow-up time in 2020, associated with the onset of the COVID-19 pandemic.Conclusions The frequency of diagnostic codes for newly diagnosed LTCs is influenced by factors including patient sociodemographics, disease inclusion in QOF, GP practice and the impact of the COVID-19 pandemic. Natural language processing or other methods using temporally ordered code sequences should account for these factors to minimise potential bias.

Journal article

Green C, Beaney T, Salman D, Robb C, de Jager Loots CA, Giannakopoulou P, Udeh-Momoh C, Ahmadi-Abhari S, Majeed A, Middleton LT, McGregor AHet al., 2023, The impacts of social restrictions during the COVID-19 pandemic on the physical activity levels of over 50-year olds: The CHARIOT COVID-19 Rapid Response (CCRR) cohort study., PLoS One, Vol: 18, ISSN: 1932-6203

OBJECTIVES: To quantify the associations between shielding status and loneliness at the start of the COVID-19 pandemic, and physical activity (PA) levels throughout the pandemic. METHODS: Demographic, health and lifestyle characteristics of 7748 cognitively healthy adults aged >50, and living in London, were surveyed from April 2020 to March 2021. The International Physical Activity Questionnaire (IPAQ) short-form assessed PA before COVID-19 restrictions, and up to 6 times over 11 months. Linear mixed models investigated associations between shielding status and loneliness at the onset of the pandemic, with PA over time. RESULTS: Participants who felt 'often lonely' at the outset of the pandemic completed an average of 522 and 547 fewer Metabolic Equivalent of Task (MET) minutes/week during the pandemic (95% CI: -809, -236, p<0.001) (95% CI: -818, -275, p<0.001) than those who felt 'never lonely' in univariable and multivariable models adjusted for demographic factors respectively. Those who felt 'sometimes lonely' completed 112 fewer MET minutes/week (95% CI: -219, -5, p = 0.041) than those who felt 'never lonely' following adjustment for demographic factors. Participants who were shielding at the outset of the pandemic completed an average of 352 fewer MET minutes/week during the pandemic than those who were not (95% CI: -432, -273; p<0.001) in univariable models and 228 fewer MET minutes/week (95% CI: -307, -150, p<0.001) following adjustment for demographic factors. No significant associations were found after further adjustment for health and lifestyle factors. CONCLUSIONS: Those shielding or lonely at pandemic onset were likely to have completed low levels of PA during the pandemic. These associations are influenced by co-morbidities and health status.

Journal article

Majeed A, Molokhia M, 2023, The future role of the GP Quality and Outcomes Framework in England., BJGP Open, Vol: 7

Journal article

Edwards L, Pickett J, Ashcroft DM, Dambha-Miller H, Majeed A, Mallen C, Petersen I, Qureshi N, van Staa T, Abel G, Carvalho C, Denholm R, Kontopantelis E, Macaulay A, Macleod Jet al., 2023, UK research data resources based on primary care electronic health records: review and summary for potential users., BJGP Open, Vol: 7

BACKGROUND: The range and scope of electronic health record (EHR) data assets in the UK has recently increased, which has been mainly in response to the COVID-19 pandemic. Summarising and comparing the large primary care resources will help researchers to choose the data resources most suited to their needs. AIM: To describe the current landscape of UK EHR databases and considerations of access and use of these resources relevant to researchers. DESIGN & SETTING: Narrative review of EHR databases in the UK. METHOD: Information was collected from the Health Data Research Innovation Gateway, publicly available websites and other published data, and from key informants. The eligibility criteria were population-based open-access databases sampling EHRs across the whole population of one or more countries in the UK. Published database characteristics were extracted and summarised, and these were corroborated with resource providers. Results were synthesised narratively. RESULTS: Nine large national primary care EHR data resources were identified and summarised. These resources are enhanced by linkage to other administrative data to a varying extent. Resources are mainly intended to support observational research, although some can support experimental studies. There is considerable overlap of populations covered. While all resources are accessible to bona fide researchers, access mechanisms, costs, timescales, and other considerations vary across databases. CONCLUSION: Researchers are currently able to access primary care EHR data from several sources. Choice of data resource is likely to be driven by project needs and access considerations. The landscape of data resources based on primary care EHRs in the UK continues to evolve.

Journal article

Campbell A, Borek AJ, McLeod M, Tonkin-Crine S, Pouwels KB, Roope LS, Hayhoe BW, Majeed A, Walker AS, Holmes A, STEP-UP teamet al., 2023, Impact of the COVID-19 pandemic on antimicrobial stewardship support for general practices in England: a qualitative interview study., BJGP Open, Vol: 7

BACKGROUND: In England, clinical commissioning group (CCG; now replaced by Integrated Care Systems [ICSs]) and primary care network (PCN) professionals support primary care prescribers to optimise antimicrobial stewardship (AMS). AIM: To explore views and experiences of CCG and PCN staff in supporting AMS, and the impact of COVID-19 on this support. DESIGN & SETTING: Qualitative interview study in primary care in England. METHOD: Semi-structured interviews with staff from CCG and PCNs responsible for AMS were conducted at two timepoints via telephone. These were audio-recorded, transcribed, and analysed thematically. RESULTS: Twenty-seven interviews were conducted with 14 participants (nine CCG, five PCN) in December 2020-January 2021 and February-May 2021. The study found that AMS support was (1) deprioritised in order to keep general practice operational and deliver COVID-19 vaccines; (2) disrupted as social distancing made it harder to build relationships, conduct routine AMS activities, and challenge prescribing decisions; and (3) adapted, with opportunities identified for greater use of technology and changing patient and public perceptions of viruses and self-care. It was also found that resources to support AMS were valued if they were both novel, to counter AMS 'fatigue', and sufficiently familiar to fit with existing and/or future AMS. CONCLUSION: AMS needs to be reprioritised in general practice in the post-pandemic era and within the new ICSs in England. This should include interventions and strategies that combine novel elements with already familiar strategies to refresh prescribers' motivation and opportunities for AMS. Behaviour change interventions should be aimed at improving the culture and processes for how PCN pharmacists voice concerns about AMS to prescribers in general practice and take advantage of the changed patient and public perceptions of viruses and self-care.

Journal article

Campbell K, Greenfield G, Li E, O'Brien N, Hayhoe B, Beaney T, Majeed A, Neves ALet al., 2023, The impact of virtual consultations on the quality of primary care: a systematic review, Journal of Medical Internet Research, Vol: 25, Pages: 1-17, ISSN: 1438-8871

Background: The adoption of virtual consultations, catalysed by the COVID-19 pandemic, has transformed the delivery of primary care services. Due to its rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality.Objective: We evaluated the impact of virtual consultations on the quality of primary care. Methods: Six databases were searched. Studies evaluating the impact of virtual consultations, for any disease, were included. Title and abstract screening, and full-text screening were performed by two pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed.Findings: Thirty studies (5,469,333 participants) were included in the review. Our findings suggest that virtual consultations are equally or more effective than F2F care for the management of conditions including mental illness, excessive smoking, and alcohol consumption. Four studies indicated positive impacts on some aspects of patient-centredness, however, a negative impact was noted on patients’ perceived autonomy support (i.e., the degree to which people perceive others in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care. The evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities between other subgroups depending on contextual factors.Conclusions: Our systematic review has demonstrated that virtual consultations may be equally as effective as F2F care and have a potentially positive impact on the efficiency and timeliness of care However, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centredness

Journal article

Majeed A, 2023, Direct access to cancer diagnostics: the promise and perils of bypassing GPs., BMJ, Vol: 382, Pages: p1917-p1917

Journal article

Chan SCC, Neves AL, Majeed A, 2023, Electronic health records: don't underestimate the importance of implementation and training., BMJ, Vol: 382, Pages: 1915-1915

Journal article

Thomson AM, McHugh TA, Oron AP, Teply C, Lonberg N, Vilchis Tella V, Wilner LB, Fuller K, Hagins H, Aboagye RG, Aboye MB, Abu-Gharbieh E, Abu-Zaid A, Addo IY, Ahinkorah BO, Ahmad A, AlRyalat SAS, Amu H, Aravkin AY, Arulappan J, Atout MMW, Badiye AD, Bagherieh S, Banach M, Banakar M, Bardhan M, Barrow A, Bedane DA, Bensenor IM, Bhagavathula AS, Bhardwaj P, Bhardwaj PV, Bhat AN, Bhutta ZA, Bilalaga MM, Bishai JD, Bitaraf S, Boloor A, Butt MH, Chattu VK, Chu D-T, Dadras O, Dai X, Danaei B, Dang AK, Demisse FW, Dhimal M, Diaz D, Djalalinia S, Dongarwar D, Elhadi M, Elmonem MA, Esezobor CI, Etaee F, Eyawo O, Fagbamigbe AF, Fatehizadeh A, Force LM, Gardner WM, Ghaffari K, Gill PS, Golechha M, Goleij P, Gupta VK, Hasani H, Hassan TS, Hassen MB, Ibitoye SE, Ikiroma AI, Iwu CCD, James PB, Jayaram S, Jebai R, Jha RP, Joseph N, Kalantar F, Kandel H, Karaye IM, Kassahun WD, Khan IA, Khanmohammadi S, Kisa A, Kompani F, Krishan K, Landires I, Lim SS, Mahajan PB, Mahjoub S, Majeed A, Marasini BP, Meresa HA, Mestrovic T, Minhas S, Misganaw A, Mokdad AH, Monasta L, Mustafa G, Nair TS, Narasimha Swamy S, Nassereldine H, Natto ZS, Naveed M, Nayak BP, Noubiap JJ, Noyes T, Nri-ezedi CA, Nwatah VE, Nzoputam CI, Nzoputam OJ, Okonji OC, Onikan AO, Owolabi MO, Patel J, Pati S, Pawar S, Petcu I-R, Piel FB, Qattea I, Rahimi M, Rahman M, Rawaf S, Redwan EMM, Rezaei N, Saddik B, Saeed U, Saheb Sharif-Askari F, Samy AM, Schumacher AE, Shaker E, Shetty A, Sibhat MM, Singh JA, Suleman M, Sunuwar DR, Szeto MD, Tamuzi JJLL, Tat NY, Taye BT, Temsah M-H, Umair M, Valadan Tahbaz S, Wang C, Wickramasinghe ND, Yigit A, Yiğit V, Yunusa I, Zaman BA, Zangiabadian M, Zheng P, Hay SI, Naghavi M, Murray CJL, Kassebaum NJet al., 2023, Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000-2021: a systematic analysis from the Global Burden of Disease Study 2021, The Lancet Haematology, Vol: 10, Pages: e585-e599, ISSN: 2352-3026

BACKGROUND: Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. METHODS: We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures-borrowing strength from predictive covariates and across age, time, and geography-and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). FINDINGS

Journal article

Shin YH, Hwang J, Kwon R, Lee SW, Kim MS, Shin JI, Yon DKet al., 2023, Global, regional, and national burden of allergic disorders and their risk factors in 204 countries and territories, from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019, ALLERGY, Vol: 78, Pages: 2232-2254, ISSN: 0105-4538

Journal article

Azzopardi PS, Kerr JA, Francis KL, Sawyer SM, Kennedy EC, Steer AC, Graham SM, Viner RM, Ward JL, Hennegan J, Pham M, Habito CMD, Kurji J, Cini K, Beeson JG, Brown A, Murray CJL, Abbasi-Kangevari M, Abolhassani H, Adekanmbi V, Agampodi SB, Ahmed MB, Ajami M, Akbarialiabad H, Akbarzadeh-Khiavi M, AL-Ahdal TMA, Ali MM, Samakkhah SA, Alimohamadi Y, Alipour V, Al-Jumaily A, Amiri S, Amirzade-Iranaq MH, Anoushiravani A, Anvari D, Arabloo J, Arab-Zozani M, Arkew M, Armocida B, Asadi-Pooya AA, Asemi Z, Asgary S, Athari SS, Azami H, Azangou-Khyavy M, Azizi H, Bagheri N, Bagherieh S, Barone-Adesi F, Barteit S, Basu S, Belete MA, Belo L, Berhie AY, Bijani A, Bikbov B, Burkart K, Carreras G, Charalampous P, Abebe EC, Cruz-Martins N, Dai X, Dandona L, Dandona R, Degualem SM, Demetriades AK, Demlash AA, Desta AA, Dianatinasab M, Doaei S, Dorostkar F, Effendi DE, Emami A, Bain LE, Eskandarieh S, Esmaeilzadeh F, Faramarzi A, Fatehizadeh A, Ferrara P, Fetensa G, Fischer F, Flor LS, Forouhari A, Foroutan M, Gaihre S, Galehdar N, Gallus S, Gautam RK, Gebrehiwot M, Gebremeskel TG, Getacher L, Getachew ME, Ghamari S-H, Nour MG, Goleij P, Golitaleb M, Gorini G, Gupta VK, Hashemian M, Hassankhani H, Heidari M, Heyi DZ, Isola G, Jaafari J, Javanmardi F, Jonas JB, Jozwiak JJ, Juerisson M, Kabir A, Kabir Z, Kalankesh LR, Kalhor R, Kauppila JH, Kaur H, Kayode GA, Keikavoosi-Arani L, Khammarnia M, AB Khan M, Khatab K, Kashani HRK, Kolahi A-A, Koohestani HR, Koyanagi A, Kumar GA, Kurmi OP, Kyu HH, La Vecchia C, Lallukka T, Lim SS, Loureiro JA, Mahjoub S, Mahmoudi R, Majeed A, Rad EM, Maleki A, Mansour-Ghanaei F, Marjani A, Mathioudakis AG, Mehri F, Mentis A-FA, Mestrovic T, Mirica A, Misganaw A, Mohammadian-Hafshejani A, Mohammed H, Mohammed S, Mokdad AH, Mokhtarzadehazar P, Monasta L, Moradi M, Moradzadeh M, Morovatdar N, Mueller UO, Mulita F, Mulu GBB, Muthupandian S, Naik GR, Nashwan AJJ, Nejadghaderi SA, Netsere HB, Noor NM, Noori M, Oancea B, Oguntade AS, Okati-Aliabad H, Otoiu A, Padron-et al., 2023, The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019, LANCET, Vol: 402, Pages: 313-335, ISSN: 0140-6736

Journal article

Wasan T, Hayhoe B, Cicek M, Lammila-Escalera E, Nicholls D, Majeed A, Greenfield Get al., 2023, The effects of community interventions on unplanned healthcare use in patients with multimorbidity: a systematic review, Journal of the Royal Society of Medicine, Pages: 1-12, ISSN: 0141-0768

OBJECTIVES: To summarise the impact of community-based interventions for multimorbid patients on unplanned healthcare use. The prevalence of multimorbidity (co-existence of multiple chronic conditions) is rapidly increasing and affects one-third of the global population. Patients with multimorbidity have complex healthcare needs and greater unplanned healthcare usage. Community-based interventions allow for continued care of patients outside hospitals, but few studies have explored the effects of these interventions on unplanned healthcare usage. DESIGN: A systematic review was conducted. MEDLINE, EMBASE, PsychINFO and Cochrane Library online databases were searched. Studies were screened and underwent risk of bias assessment. Data were synthesised using narrative synthesis. SETTING: Community-based interventions. PARTICIPANTS: Patients with multimorbidity. MAIN OUTCOME MEASURES: Unplanned healthcare usage. RESULTS: Thirteen studies, including a total of 6148 participants, were included. All included studies came from high-income settings and had elderly populations. All studies measured emergency department attendances as their primary outcome. Risk of bias was generally low. Most community interventions were multifaceted with emphasis on education, self-monitoring of symptoms and regular follow-ups. Four studies looked at improved care coordination, advance care planning and palliative care. All 13 studies found a decrease in emergency department visits post-intervention with risk reduction ranging from 0 (95% confidencec interval [CI]: -0.37 to 0.37) to 0.735 (95% CI: 0.688-0.785). CONCLUSIONS: Community-based interventions have potential to reduce emergency department visits in patients with multimorbidity. Identification of specific successful components of interventions was challenging given the overlaps between interventions. Policymakers should recognise the importance of community interventions and aim to integrate aspects of these into existing healthcare

Journal article

GBD 2021 Diabetes Collaborators, 2023, Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021., The Lancet, Vol: 402, Pages: 203-234, ISSN: 0140-6736

BACKGROUND: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS: Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the com

Journal article

El-Osta A, Riboli Sasco E, Barbanti E, Webber I, Alaa A, Karki M, El Asmar M, Almadi M, Massoud F, Alboksmaty A, Majeed Aet al., 2023, Tools for measuring individual self-care capability: a scoping review, BMC Public Health, Vol: 23, Pages: 1-31, ISSN: 1471-2458

BackgroundOur ability to self-care can play a crucial role in the prevention, management and rehabilitation of diverse conditions, including chronic non-communicable diseases. Various tools have been developed to support the measurement of self-care capabilities of healthy individuals, those experiencing everyday self-limiting conditions, or one or more multiple long-term conditions. We sought to characterise the various non-mono-disease specific self-care measurement tools for adults as such a review was lacking.ObjectiveThe aim of the review was to identify and characterise the various non-mono-disease specific self-care measurement tools for adults. Secondary objectives were to characterise these tools in terms of their content, structure and psychometric properties.DesignScoping review with content assessment.MethodsThe search was conducted in Embase, PubMed, PsycINFO and CINAHL databases using a variety of MeSH terms and keywords covering 1 January 1950 to 30 November 2022. Inclusion criteria included tools assessing health literacy, capability and/or performance of general health self-care practices and targeting adults. We excluded tools targeting self-care in the context of disease management only or indicated to a specific medical setting or theme. We used the Seven Pillars of Self-Care framework to inform the qualitative content assessment of each tool.ResultsWe screened 26,304 reports to identify 38 relevant tools which were described in 42 primary reference studies. Descriptive analysis highlighted a temporal shift in the overall emphasis from rehabilitation-focused to prevention-focused tools. The intended method of administration also transitioned from observe-and-interview style methods to the utilisation of self-reporting tools. Only five tools incorporated questions relevant to the seven pillars of self-care.ConclusionsVarious tools exist to measure individual self-care capability, but few consider assessing capability against all seven pillars of s

Journal article

Lai HTM, Chang K, Sharabiani MTA, Valabhji J, Gregg EW, Middleton L, Majeed A, Pearson-Stuttard J, Millett C, Bottle A, Vamos EPet al., 2023, Twenty-year trajectories of cardio-metabolic factors among people with type 2 diabetes by dementia status in England: a retrospective cohort study, European Journal of Epidemiology, Vol: 38, Pages: 733-744, ISSN: 0393-2990

To assess 20-year retrospective trajectories of cardio-metabolic factors preceding dementia diagnosis among people with type 2 diabetes (T2D). We identified 227,145 people with T2D aged > 42 years between 1999 and 2018. Annual mean levels of eight routinely measured cardio-metabolic factors were extracted from the Clinical Practice Research Datalink. Multivariable multilevel piecewise and non-piecewise growth curve models assessed retrospective trajectories of cardio-metabolic factors by dementia status from up to 19 years preceding dementia diagnosis (dementia) or last contact with healthcare (no dementia). 23,546 patients developed dementia; mean (SD) follow-up was 10.0 (5.8) years. In the dementia group, mean systolic blood pressure increased 16-19 years before dementia diagnosis compared with patients without dementia, but declined more steeply from 16 years before diagnosis, while diastolic blood pressure generally declined at similar rates. Mean body mass index followed a steeper non-linear decline from 11 years before diagnosis in the dementia group. Mean blood lipid levels (total cholesterol, LDL, HDL) and glycaemic measures (fasting plasma glucose and HbA1c) were generally higher in the dementia group compared with those without dementia and followed similar patterns of change. However, absolute group differences were small. Differences in levels of cardio-metabolic factors were observed up to two decades prior to dementia diagnosis. Our findings suggest that a long follow-up is crucial to minimise reverse causation arising from changes in cardio-metabolic factors during preclinical dementia. Future investigations which address associations between cardiometabolic factors and dementia should account for potential non-linear relationships and consider the timeframe when measurements are taken.

Journal article

Woodcock T, Greenfield G, Lalvani A, Majeed A, Aylin Pet al., 2023, Patient outcomes following emergency admission to hospital for COVID-19 compared with influenza: retrospective cohort study, Thorax, Vol: 78, Pages: 706-712, ISSN: 0040-6376

Background We examine differences in posthospitalisation outcomes, and health system resource use, for patients hospitalised with COVID-19 during the UK’s first pandemic wave in 2020, and influenza during 2018 and 2019.Methods This retrospective cohort study used routinely collected primary and secondary care data. Outcomes, measured for 90 days follow-up after discharge were length of stay in hospital, mortality, emergency readmission and primary care activity.Results The study included 5132 patients admitted to hospital as an emergency, with COVID-19 and influenza cohorts comprising 3799 and 1333 patients respectively. Patients in the COVID-19 cohort were more likely to stay in hospital longer than 10 days (OR 3.91, 95% CI 3.14 to 4.65); and more likely to die in hospital (OR 11.85, 95% CI 8.58 to 16.86) and within 90 days of discharge (OR 7.92, 95% CI 6.20 to 10.25). For those who survived, rates of emergency readmission within 90 days were comparable between COVID-19 and influenza cohorts (OR 1.07, 95% CI 0.89 to 1.29), while primary care activity was greater among the COVID-19 cohort (incidence rate ratio 1.30, 95% CI 1.23 to 1.37).Conclusions Patients admitted for COVID-19 were more likely to die, more likely to stay in hospital for over 10 days and interact more with primary care after discharge, than patients admitted for influenza. However, readmission rates were similar for both groups. These findings, while situated in the context of the first wave of COVID-19, with the associated pressures on the health system, can inform health service planning for subsequent waves of COVID-19, and show that patients with COVID-19 interact more with healthcare services as well as having poorer outcomes than those with influenza.

Journal article

Toumpakari Z, Valerino-Perea S, Willis K, Adams J, White M, Vasiljevic M, Ternent L, Brown J, Kelly MP, Bonell C, Cummins S, Majeed A, Anderson S, Robinson T, Araujo-Soares V, Watson J, Soulsby I, Green D, Sniehotta FF, Jago Ret al., 2023, Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study, INTERNATIONAL JOURNAL OF BEHAVIORAL NUTRITION AND PHYSICAL ACTIVITY, Vol: 20

Journal article

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