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Publications (49)
In the Republic of Georgia, a 2018 national survey estimated that more than 40% of children aged 2–7 years had a blood lead concentration (BLC) of more than 5 µg/dL. The objective of this study was to document the feasibility of employing lead isotope ratios (LIRs) to identify and rank the Pb (lead) exposure sources most relevant to children across...
Background:
Point prevalence surveys are an important surveillance method for determining the burden of healthcare-care associated infections (HCAIs).
Aim:
To outline the key results of two point prevalence surveys in England (2011 and 2016).
Methods:
All NHS and Independent sector hospitals in England were eligible to participate. Data were c...
Background
The UK is rolling out a national childhood influenza immunisation programme for children, delivered through primary care and schools. Behaviourally-informed letters and reminders have been successful at increasing uptake of other public health interventions. Therefore, we investigated the effects of a behaviourally-informed letter on upt...
The incidence of lead (Pb) poisoning in children in Georgia has been identified as a major health concern, with a recent national survey identifying that 41% of children aged 2–7 years had blood lead concentrations (BLCs) greater than the blood lead reference value (BLRV) of ≥5 µg dL−1. This study collected samples of blood, spices, paint, soil, du...
The community pharmacy antimicrobial stewardship intervention (PAMSI) is multi-faceted and underpinned by behavioural science, consisting of the TARGET Antibiotic Checklist, staff e-Learning, and patient-facing materials. This mixed-method study evaluated the effect of PAMSI on community pharmacy staffs’ self-reported antimicrobial stewardship (AMS...
Background:
The protective effect of community water fluoridation (CWF) against dental caries may be modified by secular changes in health behaviour. We aimed to determine the contemporary association between fluoride in public water supplies (PWS) and dental caries indicators and inequalities in England.
Methods:
We estimated exposure to CWF an...
Background
Sending a social norms feedback letter to general practitioners who are high prescribers of antibiotics has been shown to reduce antibiotic prescribing. The 2017-9 Quality Premium for primary care in England sets a target for broad-spectrum prescribing, which should be at or below 10% of total antibiotic prescribing. We tested a social n...
Online supermarket platforms present an opportunity for encouraging healthier consumer purchases. A parallel, double‐blind randomised controlled trial tested whether promoting healthier products (e.g. lower fat and lower calorie) on the Sainsbury's online supermarket platform would increase purchases of those products. Participants were Nectar loya...
Background:
The duration and effectiveness of immunity from infection with and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are relevant to pandemic policy interventions, including the timing of vaccine boosters.
Methods:
We investigated the duration and effectiveness of immunity in a prospective cohort of asy...
Aim
The Chief Medical Officer of England writes an annual social-norms-feedback letter to the highest antibiotic-prescribing GP practices. We investigated whether sending a social-norms-feedback letter to practices whose prescribing was increasing would reduce prescribing.
Subject and methods
We conducted a two-armed randomised controlled trial am...
Background:
Understanding the duration and effectiveness of infection and vaccine-acquired SARS-CoV-2 immunity is essential to inform pandemic policy interventions, including the timing of vaccine-boosters. We investigated this in our large prospective cohort of UK healthcare workers undergoing routine asymptomatic PCR testing.
Methods
We assessed...
In recent years, reports of lead contamination have dramatically increased in Georgia. Given concerns about the exposure of children to lead (Pb), the National Multiple Indicator Cluster Survey (MICS-2018) included a blood sampling component. The results showed that 41% of the children that participated had blood Pb levels (BLL) ≥ 5 µg/dL and that...
Extension of the interval between vaccine doses for the BNT162b2 mRNA vaccine was introduced in the UK to accelerate population coverage with a single dose. At this time, trial data was lacking, and we addressed this in a study of UK healthcare workers. The first vaccine dose induced protection from infection from the circulating alpha (B.1.1.7) va...
BACKGROUND: BNT162b2 mRNA and ChAdOx1 nCOV-19 adenoviral vector vaccines have been rapidly rolled out in the UK from December, 2020. We aimed to determine the factors associated with vaccine coverage for both vaccines and documented the vaccine effectiveness of the BNT162b2 mRNA vaccine in a cohort of health-care workers undergoing regular asymptom...
Background:
BNT162b2 mRNA and ChAdOx1 nCOV-19 adenoviral vector vaccines have been rapidly rolled out in the UK from December, 2020. We aimed to determine the factors associated with vaccine coverage for both vaccines and documented the vaccine effectiveness of the BNT162b2 mRNA vaccine in a cohort of health-care workers undergoing regular asympto...
Background
Increased understanding of whether individuals who have recovered from COVID-19 are protected from future SARS-CoV-2 infection is an urgent requirement. We aimed to investigate whether antibodies against SARS-CoV-2 were associated with a decreased risk of symptomatic and asymptomatic reinfection.
Methods
A large, multicentre, prospectiv...
Children's packed lunches contain more sugar than school-provided meals. Interventions to improve the provision of healthier packed lunches have modest effects on lunch contents. This cluster randomised controlled trial tested an intervention to encourage healthier provision of packed lunches by parents of primary school children in Derby. Schools...
Background: There is an urgent need to better understand whether individuals who have recovered from COVID-19 are protected from future SARS-CoV-2 infection.
Methods: A large multi-centre prospective cohort was recruited from publicly funded hospital staff in the UK. Participants attended regular SARS-CoV-2 PCR and antibody testing (every 2-4 weeks...
Background: Escherichia coli is the commonest cause of urinary tract infections (UTI) in England. Unsuccessful treatment of UTI may allow progression to an invasive bloodstream infection (BSI). An increase in trimethoprim resistance detected in E. coli UTI informed the recommendation to use nitrofurantoin as first-line treatment for uncomplicated U...
In England, 81% of all antibiotic prescriptions originate in primary care/community settings, of which up to 20% are thought to be inappropriate. Community pharmacies are often the first point of community contact for patients with suspected infections; providing an opportunity for community pharmacy teams to promote antimicrobial stewardship (AMS)...
Background:
The NHS Health Check (NHS HC) is a cardiovascular risk assessment to prevent cardiovascular disease. Public Health England (PHE) wants to increase uptake.
Methods:
We explored the impact of behaviourally informed invitation letters and pre-notification and reminder SMS on uptake of NHS HCs. Patients at 28 General Practices in the Lon...
During October and November 2016, over 1,000 customers
and staff reported gastroenteritis after eating
at all 23 branches of a restaurant group in the United
Kingdom. The outbreak coincided with a new menu
launch and norovirus was identified as the causative
agent. We conducted four retrospective cohort studies;
one among all restaurant staff and t...
Aim
To estimate the prevalence, causes and risk factors for presenting distance and near vision impairment (VI) in Trinidad and Tobago.
Methods
This is a national, population-based survey using multistage, cluster random sampling in 120 clusters with probability-proportionate-to-size methods. Stage 1 included standardised, community-based measurem...
Background: Inappropriate prescribing of antibiotics is a driver for resistance. In England, several strategies were implemented from April 2015 aimed at reducing inappropriate prescribing. Previous work has identified an association between social and economic deprivation and antibiotic use. The aim of our study was to explore the relationship bet...
Our study aimed to evaluate changes in the epidemiology of pathogens causing surgical site infections (SSIs) in England between 2000 and 2013 in the context of intensified national interventions to reduce healthcare-associated infections introduced since 2006. National prospective surveillance data on target surgical procedures were used for this s...
Background
Assessing the mortality impact of the 2009 influenza A H1N1 virus (H1N1pdm09) is essential for optimizing public health responses to future pandemics. The World Health Organization reported 18,631 laboratory-confirmed pandemic deaths, but the total pandemic mortality burden was substantially higher. We estimated the 2009 pandemic mortali...
Background:
Short postoperative stays following caesarean section delivery make it difficult to assess accurately the risk of surgical site infection (SSI). Methods of case-finding that minimize variation are required to support effective surveillance systems, especially where used for benchmarking.
Aim:
To evaluate the efficacy of case-finding...
Outbreaks of pseudo-infection due to contamination of specimens have been described, often as localised incidents. From August 2006, several English hospital laboratories began to refer an unusually high number of isolates of the fungus Paecilomyces variotii from clinical specimens to the national mycology reference laboratory for microbiological t...
summaryFor a random component threshold model, the threshold parameters are functions of a linear combination of fixed and random components. This paper describes estimation procedures in terms of composite link functions. The models give a good fit to the frequency of use of medical procedures in the different counties of Washington State, USA. Su...
A new methodology is developed for estimating unemployment or employment characteristics in small areas, based on the assumption that the sample totals of unemployed and employed individuals follow a multinomial logit model with random area effects. The method is illustrated with UK labour force data aggregated by sex-age groups. For these data, th...
Count response data often exhibit departures from the assumptions of standard Poisson generalized linear models. In particular, cluster level correlation of the data and truncation at zero are two common characteristics of such data. This paper describes a random components truncated Poisson model that can be applied to clustered and zero-truncated...
Summary A Fay-Herriot type model with independent area effects is often assumed when small area estimates based on area level data are required. However, under this approach out of sample areas are limited to synthetic estimates. In this paper we relax the independent area effects assumption, allowing area random effects to be spatially correlated....
Summary Models for small area estimation based on a random effects specification typically assume population units in different areas are uncorrelated. However, they can be extended to account for the correlation between areas by assuming that area random effects are spatially correlated. In this paper we suggest a simple variance-covariance struct...
Threshold models for ordinal longitudinal/repeated measurements data need to account for the correlation between observations within each subject. Two variance-covariance structures are introduced for two types of threshold models. Estimation of the parameters in the linear predictor and components of variance are derived in the general form. A sma...
Abstract The degree of customer,satisfaction is measured on an ordinal,scale in evaluating a customer opinion programme. Two random component threshold models are fitted to the results data. Estimation of the parameters in the models and variance components are given by residual maximum likelihood,method. The predicted values of the probability of...
This is the theory component of the report on small area estimation theory that was prepared as part of Southampton's involvement in the EURAREA "Enhancing small area estimation techniques to meet European Needs" project IST 2000-26290 in the European Union's Fifth Research And Technological Development Framework Programme.
Abstract This is the review component,of the report on small,area estimation theory that was prepared as part of Southampton’s involvement,in the EURAREA “Enhancing small area estimation techniques to meet ,European Needs” project IST 2000-26290 in the European,Union’s Fifth Research And Technological, Development ,Framework Programme. S 3
Longitudinal studies with ordinal response data may be fitted by using a threshold response model in which threshold parameters are related to regression variables and also to random components which account for correlations between observations on the same subject. The threshold parameters may be constant or time varying. Residual maximum likeliho...
The degree of non-compliance with a methadone programme is such that a zero is often recorded as the response variable. Such outcome variables cannot be transformed to normality in order to investigate a regression relationship between the response variable and various risk or treatment variables. The presence of a random effect as well in this reg...
Three threshold models, in which the response variable is related to regression variables with fixed coefficients as well as random components, are fitted to ordinal data. Estimation procedures are based on the use of penalized likelihood methods to provide the initial computations for both approximate maximum likelihood and residual maximum likeli...