Kamlesh Khunti

University of Leicester, Leiscester, England, United Kingdom

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Publications (301)1138.58 Total impact

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    ABSTRACT: Hypoglycemia has been associated with an increased risk of cardiovascular (CV) events and all-cause mortality. This study assessed whether, in a nationally representative population, there is an association between hypoglycemia, the risk of CV events, and all-cause mortality among insulin-treated people with type 1 diabetes (T1D) or type 2 diabetes (T2D). This retrospective cohort study used data from the Clinical Practice Research Datalink database, and included all insulin-treated patients (≥30 years of age) with a diagnosis of diabetes. In patients who experienced hypoglycemia, hazard ratios (HRs) for CV events in people with T1D were 1.51 (95% CI 0.83, 2.75; P = ns) and 1.61 (1.17, 2.22), respectively, for those with and without a history of CV disease (CVD) before the index date. In people with T2D, the HRs for patients with and without a history of CVD were 1.60 (1.21, 2.12) and 1.49 (1.23, 1.82), respectively. For all-cause mortality, HRs in people with T1D were 1.98 (1.25, 3.17), and 2.03 (1.66, 2.47), respectively, for those with and without a history of CVD. Among people with T2D, HRs were 1.74 (1.39, 2.18) and 2.48 (2.21, 2.79), respectively, for those with and without a history of CVD. The median time (interquartile range) from first hypoglycemia event to first CV event was 1.5 years (0.5, 3.5 years) and 1.5 years (0.5, 3.0 years), respectively, for people with T1D and T2D. Hypoglycemia is associated with an increased risk of CV events and all-cause mortality in insulin-treated patients with diabetes. The relationship between hypoglycemia and CV outcomes and mortality exists over a long period. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes care. 12/2014;
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    ABSTRACT: The effect of sedentary behaviour on regional fat deposition, independent of physical activity remains equivocal. We examined the cross-sectional associations between objectively measured sedentary time and markers of regional fat distribution (heart, liver, visceral, subcutaneous and total body fat) in a population at a high risk of type 2 diabetes mellitus (T2DM).
    Medicine and science in sports and exercise. 11/2014;
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    ABSTRACT: AimTo explore attitudes towards insulin treatment in an ethnically diverse population of people with Type 2 diabetes.Methods We conducted semi-structured interviews using a topic guide based on a literature review and findings from our previous study, which explored the perspectives of healthcare professionals on insulin initiation and management. Analysis of data involved undertaking an abductive reasoning approach in response to emerging themes.ResultsParticipants discussed not only their concerns about insulin therapy, but also their views and beliefs about the necessity of insulin. Their attitudes to insulin treatment could be mapped into four main typologies. These fitted with an attitudinal scale based on the Necessity-Concerns Framework described in the medication adherence literature, comprising four attitudes: accepting, sceptical, ambivalent and indifferent. Decisions about accepting insulin involved balancing concerns (such as needle size) against the perceived necessity of insulin (generally, inadequacy of oral medication). The South Asian and white participants had similar concerns, but these were sometimes greater in South Asian participants, because of the influence of negative views and experiences of other insulin users.Conclusions When discussing insulin with people with Type 2 diabetes, healthcare providers need to ensure that they explore and contribute to patients’ understanding and interpretation of the necessity of insulin as well as discussing their concerns. Furthermore, they should be aware of how an individual's social context can influence his/her perceptions about the necessity of insulin as well as their concerns, and that this influence may be greater in some South Asian populations.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 11/2014; · 3.24 Impact Factor
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    ABSTRACT: We investigated whether a higher number of fast-food outlets in an individual's home neighbourhood is associated with increased prevalence of type 2 diabetes mellitus and related risk factors, including obesity.
    Public health nutrition. 10/2014;
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    ABSTRACT: Abstract Background: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Materials and Methods: Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Results: Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). Conclusions: A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations.
    Diabetes Technology &amp Therapeutics 10/2014; · 2.21 Impact Factor
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    ABSTRACT: AimsTo compare the effectiveness and acceptability of self-monitoring of blood glucose with self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes.Methods We conducted a multi-site cluster randomized controlled trial with practice-level randomization. Participants attended a structured group education programme, which included a module on self-monitoring using blood glucose or urine glucose monitoring. HbA1c and other biomedical measures as well as psychosocial data were collected at 6, 12 and 18 months. A total of 292 participants with Type 2 diabetes were recruited from 75 practices.ResultsHbA1c levels were significantly lower at 18 months than at baseline in both the blood monitoring group [mean (se) -12 (2) mmol/mol; -1.1 (0.2) %] and the urine monitoring group [mean (se) -13 (2) mmol/mol; -1.2 (0.2)%], with no difference between groups [mean difference adjusted for cluster effect and baseline value = -1 mmol/mol (95% CI -3, 2); -0.1% (95% CI -0.3, 0.2)]. Similar improvements were observed for the other biomedical outcomes, with no differences between groups. Both groups showed improvements in total treatment satisfaction, generic well-being, and diabetes-specific well-being, and had a less threatening view of diabetes, with no differences between groups at 18 months. Approximately one in five participants in the urine monitoring arm switched to blood monitoring, while those in the blood monitoring arm rarely switched (18 vs 1% at 18 months; P<0.001).Conclusions Participants with newly diagnosed Type 2 diabetes who attended structured education showed similar improvements in HbA1c levels at 18 months, regardless of whether they were assigned to blood or urine self-monitoring.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 10/2014; · 3.24 Impact Factor
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    ABSTRACT: Rationale, aims and objectivesContinuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care.Methods Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used.ResultsThe intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2–4 nurse visits and having ≥1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2–4 nurse visits (through systolic blood pressure) and having ≥3 education topics, ≥1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention.Conclusions The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus.
    Journal of Evaluation in Clinical Practice 10/2014; · 1.51 Impact Factor
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    ABSTRACT: The use of lay people to deliver education programmes for people with chronic conditions is a potential method of addressing healthcare staff capacity and increasing the cost efficiency of delivering education. This qualitative substudy is embedded within an equivalence trial (2008-2011 including development stage).
    Postgraduate medical journal. 09/2014;
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    ABSTRACT: We report trends in type 2 diabetes mellitus and obesity in adults residing in the Arabian Gulf States. Among the Saudi population, the prevalence of diabetes increased from 10.6% in 1989 to 32.1% in 2009. Prevalence of the disease increased faster among Saudi men than women, with growth rates of 0.8% and 0.6% per year, respectively.
    Diabetes Research and Clinical Practice 09/2014; · 2.74 Impact Factor
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    ABSTRACT: AimsFailure to intensify treatment in patients with Type 2 diabetes with suboptimal blood glucose control has been termed clinical inertia and has been shown to contribute to poorer patient outcomes. We aimed to identify and explore perceptions about clinical inertia from the perspective of primary healthcare providers.MethodsA qualitative study was conducted in Leicestershire and Northamptonshire, UK. Purposive sampling was based on healthcare providers working in primary care settings with ‘higher’ and ‘lower’ target achievement based on routine data. Twenty semi-structured interviews were conducted, face-to-face or by telephone. Thematic analysis was informed by the constant comparative approach.ResultsAn important broad theme that emerged during the analysis was related to attribution and explanation of responsibility for clinical inertia. This included general willingness to accept a degree of responsibility for clinical inertia. In some cases, however, participants had inaccurate perceptions about levels of target achievement in their primary care centres, as indicated by routine data. Participants sought to lessen their own sense of accountability by highlighting patient-level barriers such as comorbidities and human fallibility, and also system-level barriers, particularly time constraints. Perceptions about ways of addressing the problem of clinical inertia were not seen as straightforward, further emphasizing a complex and cumulative pattern of barriers.Conclusions In order to understand and address the problem of clinical inertia, provider, patient- and system-level barriers should be considered together rather than as separate issues. Acknowledgement of responsibility should be regarded positively as a motivator for change.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 09/2014; · 3.24 Impact Factor
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    ABSTRACT: In the United Kingdom, it is estimated that there are over 300 000 Muslim people with diabetes. Observance of Ramadan is an integral part of being a Muslim that involves abstinence from food and drink from dawn till dusk. In the UK over the next 10 years, Ramadan will fall in the heart of the summer months, resulting in longer fasting periods. For people with diabetes fasting can be problematic, yet few individuals receive advice from health care professionals on how to manage their diabetes during the Ramadan period. A ‘whole systems’ approach, involving community awareness, health care professional training and patient education, was used to develop and implement an educational intervention to address the needs of individuals with type 2 diabetes during the Ramadan period.This practice point paper details this service improvement project and lists a number of recommendations to improve the uptake and sustainability of such interventions to support safer fasting and feasting for people with type 2 diabetes during religious events. Copyright © 2014 John Wiley & Sons, Ltd.
    Practical Diabetes. 09/2014; 31(7).
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    ABSTRACT: Data suggest increased rates of chronic kidney disease (CKD) in those with undiagnosed hypertension (HTN). Our study aimed to determine the prevalence of CKD in undiagnosed hypertensives in a previously unreported subgroup of individuals of South Asian ethnicity. We analysed data from subjects in the ADDITION-Leicester study, a UK based multiethnic, community diabetes screening study. Standard definitions included: HTN-mean recorded BP of ⩾140/90 mm Hg, CKD stage 3 and above-estimated glomerular filtration rate (eGFR) <60 ml min(-1) per 1.73 m(2) and microalbuminuria as albumin creatinine ratio ⩾3 mg mmol(-1). Logistic regression was performed with age, gender and body mass index (kg m(-2)) as co-variates. 6082 individuals (52.5% female, mean age, 57.2 years; White European, 77.8% and South Asian, 22.0%), 31.1% had undiagnosed HTN. Overall, individuals with undiagnosed HTN compared with normotensives had an odds ratio for microalbuminuria of 2.24 (95% confidence interval (CI): 1.72-2.94). For South Asians, the odds ratio was 3.81. (95% CI: 2.24-6.47) for microalbuminuria with a trend towards an eGFR<60 ml min(-1) per 1.73 m(2). Future studies should consider intensified screening for HTN to refine the population suitable for CKD screening, particularly in the South Asian ethnic group.Journal of Human Hypertension advance online publication, 14 August 2014; doi:10.1038/jhh.2014.62.
    Journal of human hypertension. 08/2014;
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    ABSTRACT: To assess the cardiac, vascular, anthropometric, and biochemical determinants of subclinical diastolic dysfunction in younger adults with Type 2 diabetes mellitus (T2DM) using multiparametric contrast-enhanced cardiovascular magnetic resonance (CMR) imaging.
    European Heart Journal – Cardiovascular Imaging 06/2014; · 3.67 Impact Factor
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    ABSTRACT: Aims To externally validate the Leicester Practice Risk Score (LPRS) and the Leicester Risk Assessment score (LRAS) in a young South Asian population. Methods South Asian participants aged 25-39 years inclusive from a population based screening study were included. The risk scores were calculated and compared to the diagnosis of type 2 diabetes mellitus (T2DM) or T2DM and Impaired Glucose Regulation (IGR, including IFG and IGT) using either an oral glucose tolerance test (OGTT) or a HbA1c (≤48 mmol/mol/6.5% and ≤42 mmol/mol/6.0% respectively). Measures of discrimination and calibration were calculated. Results Of the 331 participants 8 (2.4%) had undiagnosed T2DM and 30 (9.1%) had IGR using an OGTT, 11 (3.4%) and 39 (12.1%) were found using HbA1c. Using the LPRS to detect T2DM on an OGTT gives an area under the ROC curve of 0.91 (95% CI 0.86, 0.97), including those with IGR gives an ROC of 0.72 (0.62-0.81), these values are 0.93 (0.88, 0.98) and 0.68 (0.60, 0.77) when using an HbA1c to define outcome. Acceptable levels of calibration were seen. Similar results are found for the LRAS. Conclusions These scores can be used to identify those with undiagnosed T2DM and/or IGR in a young South Asian population. This is the first study to externally validate scores developed for prevalent undiagnosed disease in this age group using both OGTT and HbA1c.
    Diabetes research and clinical practice 06/2014; · 2.74 Impact Factor
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    ABSTRACT: Aims People who experience biochemical hypoglycaemia during an oral glucose tolerance test (OGTT) may be insulin resistant, but this has not been investigated robustly, therefore we examined this in a population-based multi-ethnic UK study. Methods Cross-sectional data from 6478 diabetes-free participants (849 with fasting insulin data available) who had an OGTT in the ADDITION-Leicester screening study (2005-2009) were analysed. People with biochemical hypoglycaemia (2-hour glucose <3.3 mmol/l) were compared with people with normal glucose tolerance (NGT) or impaired glucose regulation (IGR) using regression methods. Results 359 participants (5.5%) had biochemical hypoglycaemia, 1079 (16.7%) IGR and 5040 (77.8%) NGT. Biochemical hypoglycaemia was associated with younger age (P < 0.01), white European ethnicity (P < 0.001), higher HDL cholesterol (P < 0.01), higher insulin sensitivity (P < 0.05), and lower body mass index (P < 0.001), blood pressure (P < 0.01), fasting glucose (P < 0.001), HbA1 C (P < 0.01), and triglycerides (P < 0.01) compared with NGT and IGR separately in both unadjusted and adjusted (age, sex, ethnicity, body mass index, smoking status) models. Conclusions Biochemical hypoglycaemia during an OGTT in the absence of diabetes or IGR was not associated with insulin resistance, but instead appeared to be associated with more favourable glycaemic risk profiles than IGR and NGT. Thus, clinicians may not need to intervene due to biochemical hypoglycaemia on a 2-hour OGTT.
    Diabetes research and clinical practice 06/2014; · 2.74 Impact Factor
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    ABSTRACT: People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Evidence-based strategies for secondary stroke prevention have been established. However, the implementation of prevention strategies could be improved. To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. We searched the Cochrane Stroke Group Trials Register (April 2013), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2013), CENTRAL (The Cochrane Library 2013, issue 3), MEDLINE (1950 to April 2013), EMBASE (1981 to April 2013) and 10 additional databases. We located further studies by searching reference lists of articles and contacting authors of included studies. We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. Two review authors selected studies for inclusion and independently extracted data. One review author assessed the risk of bias for the included studies. We sought missing data from trialists. This review included 26 studies involving 8021 participants. Overall the studies were of reasonable quality, but one study was considered at high risk of bias. Fifteen studies evaluated predominantly organisational interventions and 11 studies evaluated educational and behavioural interventions for patients. Results were pooled where appropriate, although some clinical and methodological heterogeneity was present. The estimated effects of organisational interventions were compatible with improvements and no differences in the modifiable risk factors mean systolic blood pressure (mean difference (MD) -2.57 mmHg; 95% confidence interval (CI) -5.46 to 0.31), mean diastolic blood pressure (MD -0.90 mmHg; 95% CI -2.49 to 0.68), blood pressure target achievement (OR 1.24; 95% CI 0.94 to 1.64) and mean body mass index (MD -0.68 kg/m(2); 95% CI -1.46 to 0.11). There were no significant effects of organisational interventions on lipid profile, HbA1c, medication adherence or recurrent cardiovascular events. Educational and behavioural interventions were not generally associated with clear differences in any of the review outcomes, with only two exceptions. Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes. The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors. We identified a large number of ongoing studies, suggesting that research in this area is increasing. The use of standardised outcome measures would facilitate the synthesis of future research findings.
    Cochrane database of systematic reviews (Online) 05/2014; 5:CD009103. · 5.70 Impact Factor
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    ABSTRACT: Aims/hypothesisTo determine the stability of type 2 diabetes patients’ beliefs about their diabetes over three years, following diagnosis.Methods Data were collected as part of a multicentre cluster randomised controlled trial of a 6 hour self-management program, across 207 general practices in the UK. Participants in the original trial were eligible for follow-up with biomedical data (glycated haemoglobin (HbA1c) levels, blood pressure, weight, blood lipid levels) collected at the practice and questionnaire data collected by postal distribution and return. Psychological outcome measures were depression (HADS) and diabetes distress (PAID). Illness beliefs were assess by scales from the Illness Perceptions Questionnaire- Revised and the Diabetes Illness Representations Questionnaire.ResultsAt 3 year follow-up, all post intervention differences in illness beliefs between intervention and control group remained significant, with perceptions of the duration of diabetes, seriousness of diabetes and perceived impact of diabetes unchanged over the course of the 3 years follow-up. The control group reported greater understanding of diabetes over follow-up, and the intervention group reported decreased responsibility for diabetes outcomes over follow-up. After controlling for 4 month levels of distress and depression, perceived impact of diabetes at 4 months remained a significant predictor of distress and depression at 3-year follow-up.Conclusions/interpretationPeoples’ beliefs about diabetes are formed quickly after diagnosis, and thereafter seem to be relatively stable over extended follow-up. These early illness beliefs are predictive of later psychological distress, and emphasize the importance of initial context and provision of diabetes care in shaping participants’ future well-beingThis article is protected by copyright. All rights reserved.
    Diabetic Medicine 05/2014; · 3.24 Impact Factor
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    ABSTRACT: OBJECTIVE To determine the benefit of multifactorial treatment on microvascular complications among people with type 2 diabetes detected by screening.RESEARCH DESIGN AND METHODS This study was a multicenter cluster randomized controlled trial in primary care with randomization at the practice level. In four centers in Denmark; Cambridge, U.K.; The Netherlands; and Leicester, U.K., 343 general practices participated in the trial. Eligible for follow-up were 2,861 of the 3,057 people with diabetes detected by screening included in the original trial. Biomedical data on nephropathy were collected in 2,710 (94.7%) participants, retinal photos in 2,190 (76.6%), and questionnaire data on peripheral neuropathy in 2,312 (80.9%). The prespecified microvascular end points were analyzed by intention to treat. Results from the four centers were pooled using fixed-effects meta-analysis.RESULTSFive years after diagnosis, any kind of albuminuria was present in 22.7% of participants in the intensive treatment (IT) group and in 24.4% in the routine care (RC) group (odds ratio 0.87 [95% CI 0.72-1.07]). Retinopathy was present in 10.2% of the IT group and 12.1% of the RC group (0.84 [0.64-1.10]), and severe retinopathy was present in one patient in the IT group and seven in the RC group. Neuropathy was present in 4.9% and 5.9% (0.95 [0.68-1.34]), respectively. Estimated glomerular filtration rate increased between baseline and follow-up in both groups (4.31 and 6.44 mL/min, respectively).CONCLUSIONS Compared with RC, an intervention to promote target-driven, intensive management of patients with type 2 diabetes detected by screening was not associated with significant reductions in the frequency of microvascular events at 5 years.
    Diabetes care 05/2014; · 7.74 Impact Factor
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    ABSTRACT: Aims To examine the association between health status, diabetes-specific quality of life (QoL) and glycaemic control among individuals with type 2 diabetes. Methods 1876 individuals with screen-detected diabetes and a mean age of 66 years underwent assessment of self-reported health status (SF-36), diabetes-specific QoL (the Audit of Diabetes Dependent Quality of Life (ADDQoL19)) and glycated haemoglobin (HbA1c) at five years post-diagnosis in the ADDITION-Europe trial. Multivariable linear regression was used to quantify the cross-sectional association between health status, diabetes-specific QoL and HbA1c, adjusting for age, sex, education, alcohol consumption, physical activity, BMI, intake of any glucose-lowering drugs, and trial arm. Results The mean (SD) SF-36 physical and mental health summary scores were 46.2 (10.4) and 54.6 (8.6), respectively. The median average weighted impact ADDQoL score was -0.32 (IQR -0.89 to -0.06), indicating an overall negative impact of diabetes on QoL. Individuals who reported a negative impact of diabetes on their QoL had higher HbA1c levels at five years after diagnosis compared with those who reported a positive or no impact of diabetes (b-coefficient [95% CI]: b = 0.2 [0.1, 0.3]). Physical and mental health summary SF-36 scores were not significantly associated with HbA1c in multivariable analysis. Conclusions Diabetes-specific QoL but not health status was independently associated with HbA1c. Practitioners should take account of the complex relationship between diabetes-specific QoL and glucose, particularly with regard to dietary behaviour. Future research should attempt to elucidate via which pathways this association might act.
    Diabetes research and clinical practice 05/2014; · 2.74 Impact Factor

Publication Stats

4k Citations
1,138.58 Total Impact Points

Institutions

  • 1997–2014
    • University of Leicester
      • • Department of Health Sciences
      • • Department of Cardiovascular Sciences
      Leiscester, England, United Kingdom
  • 2008–2013
    • University Hospitals Of Leicester NHS Trust
      • • Department of Nephrology
      • • Department of Diabetes and Endocrinology
      Leiscester, England, United Kingdom
  • 2012
    • University of Nottingham
      Nottigham, England, United Kingdom
    • Heart of England NHS Foundation Trust
      Birmingham, England, United Kingdom
    • University of Washington Seattle
      • Department of Oral Health Sciences
      Seattle, WA, United States
  • 2011–2012
    • University of Surrey
      • Department of Health Care Management and Policy
      Guildford, ENG, United Kingdom
  • 2007–2012
    • Imperial College London
      • Department of Primary Care and Public Health
      London, ENG, United Kingdom
    • University Medical Center Utrecht
      • Julius Center for Health Sciences and Primary Care
      Utrecht, Provincie Utrecht, Netherlands
  • 2010–2011
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
    • The University of Sheffield
      • School of Health and Related Research (ScHARR)
      Sheffield, ENG, United Kingdom
    • Loyola University Maryland
      • Department of Sociology
      Baltimore, MD, United States
  • 2009–2010
    • St George's, University of London
      • Division of Population Health Sciences and Education
      Londinium, England, United Kingdom
  • 2008–2010
    • The University of Warwick
      • Warwick Medical School (WMS)
      Coventry, England, United Kingdom
  • 2007–2010
    • Loughborough University
      • School of Sport, Exercise and Health Sciences
      Loughborough, England, United Kingdom
  • 2005–2008
    • University of Southampton
      • • Wessex Institute for Health Research and Development
      • • Department of Psychology
      Southampton, ENG, United Kingdom
    • University of Birmingham
      Birmingham, England, United Kingdom
  • 2004
    • Office for National Statistics
      Londinium, England, United Kingdom
  • 2002
    • University College London
      Londinium, England, United Kingdom