David Armstrong

• King's College London

Background The health of the gut microbiome is now recognized to be an important component of the gut–brain axis which itself appears to be implicated in pain perception. Antibiotics are known to create dysbiosis in the microbiome, so whether fibromyalgia is more commonly diagnosed after antibiotic prescriptions provides a means of exploring the ro...

According to the World Health Organization (WHO), a virus, SARS-CoV-2, started to spread around the world from its origin in Wuhan, China to create a pandemic that claimed millions of lives . The editor of The Lancet, a leading medical journal, nevertheless suggested that the outbreak in 2020 would be better described as a syndemic , characterised...

As Povinelli shares with us during the interview, her trajectory was constituted in the middle of the 1980s following her life-changing encounter with the elders in Belyuen inthe Australian Northern Territory. In the wake of that encounter, and with urgent issues raised about indigeneity due to changes in Australian law, Povinelli has been working...

In the closing decades of the 20th century, a method of calculating numerical probabilities based on populations-at-risk emerged in public health/epidemiology and then moved into clinical medicine. This new method had its own autonomous social life as it reorganised the fields of clinical perception and clinical practice. This paper documents that...

Background: The current study used data from an ethnically diverse population from South London to examine ethnic differences in physical and mental multimorbidity among working age (18-64 years) adults in the context of depression and anxiety. Method: The study included 44 506 patients who had previously attended Improving Access to Psychologic...

Background The effect of antibiotics on the human microbiome is now well established, but their indirect effect on the related immune response is less clear. The possible association of Herpes zoster, which involves a reactivation of a previous varicella zoster virus infection, with prior antibiotic exposure might indicate a potential link with the...

This article maps the rise and fall of the idea of a (social) group across medicine in the context of contemporary analyses in psychology and sociology. This history shows the early 20th century emergence and growth of group medicine, group therapy and group comparisons. In recent decades, however, the idea that groups constituted the basic units o...

Background Associations between depression and non-communicable disease have been well-described. However, the evidence for its role in the development of infectious disease is less understood. We aimed to examine prospective associations between depression and risk of hospitalisation for infection in middle-aged adults from the UK Biobank (linked...

Objectives The aim of the current study was to identify specific patterns of physical multimorbidity and examine how these patterns associated with changes in social participation over time. Methods We used latent class analysis to identify clusters of physical multimorbidity in 11,391 older adults. Mixed effects regression models were used to ass...

Background An understanding of whether early-life depression is associated with physical multimorbidity could be instrumental for the development of preventive measures and the integrated management of depression. We therefore aimed to map out the cumulative incidence of physical multimorbidity over adulthood, and to determine the association betwe...

Background Feasibility studies are often conducted before committing to a randomised controlled trial (RCT), yet there is little published evidence to inform how useful feasibility studies are, especially in terms of adding or reducing waste in research. This study attempted to examine how many feasibility studies demonstrated that the full trial w...

This article explores the emergence and development of Death Certificates as a means of establishing the cause of death for individuals and populations. The difficulty in choosing which disease caused death when several are described on the Certificate explains why the number of COVID‐19‐related deaths has been difficult to determine. This problem...

Background We aimed to identify specific patterns of physical multimorbidity, defined as the presence of two or more physical long-term conditions, and to examine the extent to which these specific patterns could predict future incident and persistent common mental health disorders (CMDs) in middle-aged adults enrolled in the UK Biobank. Methods W...

This article examines the historical construction of depression over about a hundred years, employing the social life of methods as an explanatory framework. Specifically, it considers how emerging methodologies in the measurement of psychological constructs contributed to changes in epistemological approaches to mental illness and created the cond...

Antibiotics in childhood have been linked with diseases including asthma, juvenile arthritis, type 1 diabetes, Crohn’s disease and mental illness. The underlying mechanisms are thought related to dysbiosis of the gut microbiome. We conducted a systematic review of the association between antibiotics and disruption of the pediatric gut microbiome. S...

Purpose The purpose of this paper is to understand the barriers and enablers to lean implementation as part of an imaging quality improvement programme from a socio-cultural perspective. Design/methodology/approach An in-depth 33 month ethnographic study, using observation and qualitative interviews, examined the process of lean implementation as...

Background To estimate the potential gain in life expectancy from addressing modifiable risk factors for all-cause mortality (excluding suicide and deaths from accidents or violence) across specific serious mental illness (SMI) subgroups, namely schizophrenia, schizoaffective disorders, and bipolar disorders in a Western population. Methods We hav...

Antibiotic use over several decades is believed to be associated with colorectal adenomas. There is little evidence, however, for the effect of more recent antibiotic use on frequency of colorectal cancers. A case control study used the RCGP’s Research and Surveillance Centre cohort of patients drawn from NHS England. In all, 35,214 patients with a...

Background: Blood eosinophil count has been proposed as a predictor of response to inhaled corticosteroid (ICS) in the prevention of acute exacerbations of COPD. An optimal threshold of blood eosinophil count for prescribing ICS has not been agreed. Doubt has been cast on the role by observational studies. The role of inhaled corticosteroids in th...

Weight gain and obesity in prison are, like elsewhere, associated with an increase in caloric intake and reduction in physical activity, but these factors are not solely under the control of a prisoner. Nineteen semistructured interviews were conducted in two male prisons in the United Kingdom to explore participants’ thoughts, beliefs, and feeling...

Prisoners’ weight and waist circumference were measured 6 and 12 months after imprisonment. Variables known to be associated with differences in lifestyle behaviors and obesity were considered as covariates in the study. A total of 367 prisoners were recruited into the study at baseline, with 116 of these having dropped out of the study from the 6-...

Objectives: To test the hypothesis that prior antibiotics influences the risk of developing RA. Methods: A case-control study was conducted over 15 years using the UK's Royal College of General Practitioners Research and Surveillance Centre database. The frequency and type of antibiotic prescription for patients who subsequently developed RA wer...

Background The randomised controlled trial is widely considered to be the gold standard study for comparing the effectiveness of health interventions. Central to its design is a calculation of the number of participants needed (the sample size) for the trial. The sample size is typically calculated by specifying the magnitude of the difference in t...

Over the last two decades diagnostic labels have increasingly been sub-divided based on molecular and genetic ‘signatures’. But this emphasis on disease sub-types defined in molecular terms, elides the central role of population-based predictive technologies in determining these new diagnoses. While molecular diagnostic sub-types might flow from the...

Background Much research attention has been given to the high rates of psychosis diagnosed in the Black community. However, little has been heard about possible reasons for this from Black African and Caribbean mental health service users themselves. Aims To determine how Black African and Caribbean service users perceive and explain these apparen...

Objective There is inconsistent evidence about the association between inflammatory disorders and depression and anxiety onset in a primary care context. The study aimed to evaluate the risk of depression and anxiety within multisystem and organ-specific inflammatory disorders. Methods This is a prospective cohort study with primary care patients...

Recent technological advances such as microprocessors and random-access memory have had a significant role in gathering, storing and processing digital data, but the basic principles underpinning such data management were established in the century preceding the digital revolution. This paper maps the emergence of those older technologies to show t...

Randomised controlled trials are considered to be the best method to assess comparative clinical efficacy and effectiveness, and can be a key source of data for estimating cost effectiveness. Central to the design of a randomised controlled trial is an a priori sample size calculation, which ensures that the study has a high probability of achievin...

Background A key step in the design of a RCT is the estimation of the number of participants needed in the study. The most common approach is to specify a target difference between the treatments for the primary outcome and then calculate the required sample size. The sample size is chosen to ensure that the trial will have a high probability (adeq...

Background A key step in the design of a randomised controlled trial is the estimation of the number of participants needed. The most common approach is to specify a target difference in the primary outcome between the randomised groups and then estimate the corresponding sample size. The sample size is chosen to provide reassurance that the trial...

The aim of this document is to provide practical guidance on the choice of target difference used in the sample size calculation of a randomised controlled trial (RCT). Guidance is provided with a definitive trial, one that seeks to provide a useful answer, in mind and not those of a more exploratory nature. The term “target difference” is taken th...

In the context of avoiding research waste, the conduct of a feasibility study before a clinical trial should reduce the risk that further resources will be committed to a trial that is likely to ‘fail’. However, there is little evidence indicating whether feasibility studies add to or reduce waste in research. Feasibility studies funded by the Nati...

Feasibility study questionnaire. (PDF)

Objectives: To review current studies on obesity and weight within male prisoners. Including assessment of factors which influence obesity and weight change during imprisonment. Study design: A systematic review. Methods: The systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses checkli...

Pharmacogenomics may improve health outcomes in two ways: by more precise and therefore more effective prescribing, tailored to genotype, and by increasing perceived effectiveness of treatments and so motivation for adherence. Little is known about patients' experiences of, and reactions to, receiving pharmacogenomically tailored treatments. The ai...

Background: Antibiotic use can have negative unintended consequences including disruption of the human microbiota, which is thought to protect against pathogen overgrowth. We conducted a systematic review to assess whether there is an association between exposure to antibiotics and subsequent risk of community-acquired infections. Methods: We se...

Background: Antimicrobial resistance in invasive infections is driven mainly by human antimicrobial consump-tion. Limited cross-national comparative evidence exists about variation in antimicrobial consumption and effect on resistance. Methods: We examined the relationship between national community antimicrobial consumption rates (2013) and nation...

Background: : Antimicrobial resistance in invasive infections is driven mainly by human antimicrobial consumption. Limited cross-national comparative evidence exists about variation in antimicrobial consumption and effect on resistance. Methods: We examined the relationship between national community antimicrobial consumption rates (2013) and na...

This study aimed to improve understanding of obesity in prison by investigating prison nurses' perceptions of weight gain and obesity. In-depth semistructured interviews were carried out with 17 nurses who worked in two male prisons in the United Kingdom. Nurses identified a variety of factors that they believed contributed to obesity and weight ga...

Using an analysis of the British Medical Journal over the past 170 years, this article describes how changes in the idea of a population have informed new technologies of medical prediction. These approaches have largely replaced older ideas of clinical prognosis based on understanding the natural histories of the underlying pathologies. The 19(th)...

Aim: The aim of this study was to analyze how working within prison environments can influence the self-identity and professional identity of nurses. Background: The prison environment can be a difficult environment for nurses to deliver care within, with nurses having to carry out activities that seem to go against their professional role, whil...

Open access: http://onlinelibrary.wiley.com/doi/10.1111/hex.12489/full Background: Ethnic and socio-economic inequalities have been reported in the uptake of colorectal cancer (CRC) screening. This study aimed to explore the factors affecting CRC screening participation in an ethnically and socio-economically diverse inner city population. Meth...

Objective Since DSM-5 removed the requirement for a psychosocial formulation, neurologists have been able to make the diagnosis of conversion disorder without psychiatric input. We sought to examine whether neurologists and specialist psychiatrists concurred with this approach. Design We used mixed methods, first surveying all the neurologists in...

Background: Recent research into the role of the human microbiome in maintaining health has identified the potentially harmful impact of antimicrobials. Aim: The association with bacterial and viral meningitis following antimicrobial prescription during the previous year was investigated to determine whether antimicrobials have a deleterious eff...

Background: Concerns about adverse effects on patient satisfaction may be an important obstacle to attempts to curtail antibiotic prescribing. Aim: To determine the relationship between antibiotic prescribing in general practice and reported patient satisfaction. Design and setting: Retrospective cross-sectional study of general practices in E...

There is limited primary-care-based evidence about a potential association between anti-inflammatory therapy and dementia subtypes. The present study addressed this limitation by using electronic health records from a large primary care database. A case-control study was implemented using electronic medical records. Cases had a diagnosis of dementi...

When the Chief Medical Officer, Sally Davies, talks about a ‘ticking time bomb’ and the Prime Minister, David Cameron, warns us of the dangers of going back to ‘the Dark Ages’, you know that the problem is serious. Both were referring to the global threat of antibiotic resistance. Antibiotic resistance is increasing. There are sufficient tales fro...

Typologies of sleep problems have usually relied on identifying underlying causes or symptom clusters. In this study the value of using the patient's own reasons for sleep disturbance are explored. Using secondary data analysis of a nationally representative psychiatric survey the patterning of the various reasons respondents provided for self-repo...

This chapter attempts to describe the emergence of the latter use of agency through contemporary medical, sociological, psychological and ethical writing and argues that the new application of the term reflects more than a change of semantic fashion but rather a fundamental reconstruction of patients' identity that began in the second half of the 2...

This article challenges the generally accepted thesis that the emergence and dominance of chronic illness over the last half century is due to the receding tide of acute infectious diseases and an ageing population. Instead, through an analysis of contemporary reports in the Journal of the American Medical Association, it is argued that the constru...

To evaluate mildly abnormal liver function test (LFT) results in general practice among patients who do not have known liver disease. Prospective cohort study of people with abnormal LFT results identified in primary care. Participants were intensively investigated using a common protocol and followed up for 2 years. Substudies investigated the psy...

Purpose Typologies of sleep problems have usually relied on identifying underlying causes or symptom clusters. The purpose of this paper is to explore the value of using the patient's own reasons for sleep disturbance. Design/methodology/approach Using secondary data analysis of a nationally representative psychiatric survey the patterning of the...

Background Continuing developments in genetic testing technology together with research revealing gene-disease associations have brought closer the potential for genetic screening of populations. A major concern, as with any screening programme, is the response of the patient to the findings of screening, whether the outcome is positive or negative...

Research highlights.

To test the hypothesis that communicating risk of developing Crohn's disease based on genotype and that stopping smoking can reduce this risk, motivates behaviour change among smokers at familial risk. Parallel group, cluster randomised controlled trial. Families with Crohn's disease in the United Kingdom. 497 smokers (mean age 42.6 (SD 14.4) years...

Understanding how primary care clinicians manage depression is a key backdrop to current and future initiatives to improve detection and treatment of depression. We systematically reviewed, identified, and extracted findings from 13 qualitative studies that examined general practitioner (GP) management of depression. We assessed articles for qualit...

The behavioural impact of pharmacogenomics is untested. We tested two hypotheses concerning the behavioural impact of informing smokers their oral dose of NRT is tailored to analysis of DNA. We conducted an RCT with smokers in smoking cessation clinics (N = 633). In combination with NRT patch, participants were informed that their doses of oral NRT...

CONSORT Checklist. (DOCX)

Trial Protocol. (PDF)

The term 'functional' has a distinguished history, embodying a number of physiological concepts, but has increasingly come to mean 'hysterical'. The DSM-V working group proposes to use 'functional' as the official diagnostic term for medically unexplained neurological symptoms (currently known as 'conversion disorder'). This study aimed to explore...

This paper examines the history of population screening through an analysis of contemporary medical journals. The term was first used in the modern sense in the inter-war years to describe the school health examination which sought to identify the early signs of disease and abnormality, a strategy which was extended to new recruits during the Secon...

FryJohn, Lord Hunt of Fawley, and PinsentR. J. F. H. (editors), A history of the Royal College of General Practitioners. The first 25 years, London, MTP Press, 1983, 8vo. pp. xiii, 270, illus., £9.95. - Volume 28 Issue 1 - David Armstrong

The objective of this study was to examine whether a widely available single-item measure of sleep disturbances is an acceptable alternative to a multi-item sleep questionnaire. Data were derived from Finnish Helsinki Health Study postal questionnaires administered in 2000-2002 (n = 7777, response rate 67%). The measures were the 4-item Jenkins Sle...

This article, based on a plenary presentation to the 13th biennial conference of the European Society for Health and Medical Sociology, challenges the implicit theme of the meeting, that radically changing societies have significant impacts on health and well-being. This analysis, it is argued, masks the fact that it is the ways in which we constru...

Objectives The extent to which differences in childhood experiences of public care are related to adult psychosocial outcomes is unknown. This study aimed to estimate associations between childhood experiences of the public care system with emotional and behavioural traits at age 30?years. Methods Participants included 10?895 respondents at the ag...

In this month's issue, we report a survey of members of the Association of British Neurologists, which asked if they viewed chronic fatigue syndrome (CFS) as a neurological condition—84% of respondents did not. This is at odds with current classification in ICD-10. We discuss the difficulties of classifying CFS and myalgic encephalopmeylitis (ME),...

Diagnosis in contemporary medicine is made using an underlying classification system or nosology, the basis of which was first laid down at the end of the 18th century. The International Classification of Disease (ICD) was constructed to formalise this nosology and successive revisions have attempted to capture technical developments and new discov...

Background: Sleep disturbance is a common complaint in the general population. There is, however, little cross-national comparative evidence on the prevalence of sleep disturbance and its association with age. Methods: Cross-sectional data from the third wave of the European Social Survey were used to compare both the prevalence of sleep disturb...

Longitudinal data from the 1970 British Cohort Study were used to examine the long-term adult outcomes of those who, as children, were placed in public care. Multivariate logistic estimation models were used to determine whether public care and placement patterns were associated with adult psychosocial outcomes. Seven emotional and behavioural outc...

Conversion disorder is largely managed by neurologists, for whom it presents great challenges to understanding and management. This study aimed to quantify these challenges, examining how neurologists understand conversion disorder, and what they tell their patients. A postal survey of all consultant neurologists in the UK registered with the Assoc...

Personality-disordered offenders are difficult individuals to manage, and knowledge about effective treatment is sparse. In the UK, novel forensic psychiatric services were recently established for the treatment of offenders with personality disorder. In this paper we report the clinical and economic findings from a 2-year follow-up of a cohort of...

Estimates of the risk of developing Crohn's disease (CD) can be made using DNA testing for mutations in the NOD2 (CARD15) gene, family history, and smoking status. Smoking doubles the risk of CD, a risk that is reduced by stopping. CD therefore serves as a timely and novel paradigm within which to assess the utility of predictive genetic testing to...

The behavioural impact of pharmacogenomics is untested; informing smokers of genetic test results for responsiveness to smoking cessation medication may increase adherence to this medication. The objective of this trial is to estimate the impact upon adherence to nicotine replacement therapy (NRT) of informing smokers that their oral dose of NRT ha...

Monetary incentives are an effective way of increasing response rates to surveys, though they are generally less effective in physicians, and are more effective when the incentive is paid up-front rather than when made conditional on completion. In this study we examine the effectiveness of pre- and post-completion incentives on the response rates...

This paper considers the implications of genetic testing in the case of familial hypercholesterolaemia, drawing on twenty semi-structured interviews with general practitioners (family doctors in primary care), nurses and specialists in hospital clinics (secondary care) in the UK. Though these professionals appear aware of and interested in the gene...

The present study aimed to estimate whether sleep disturbances in adolescence predicted sleep disturbances in later years. Our sample included 7,781 cohort members from the United Kingdom's National Child Development Study. Sleep disturbances at ages 16, 23, 33, and 42 were measured by asking whether cohort members had difficulties in falling/maint...

Questionnaire. Questionnaire to assess GPs' ratings of the study's eight interventions on the clusters of constructs derived from the cluster analysis.

Many interventions shown to be effective through clinical trials are not readily implemented in clinical practice. Unfortunately, little is known regarding how clinicians construct their perceptions of the effectiveness of medical interventions. This study aims to explore general practitioners' perceptions of the nature of 'effectiveness'. The desi...

In recent years a number of public health, prevention and disease management strategies have emerged that depend on changing health-related behaviours. The definition of those behaviours, indeed of the very idea of behaviour, remains unchallenged in these initiatives, as behaviour is a taken-for-granted concept. Yet the idea of a changeable behavio...

Objective: Neurologists face a dilemma when communicating with their conversion disorder patients - whether to be frank, and risk losing the patient's trust, or to disclose less, in the hope of building a therapeutic relationship. This study reports how neurologists in the UK described dealing with this dilemma in their practice. Methods: Practi...

Using two longitudinal and nationally representative datasets, this study employs a cross-cohort analysis to examine age, cohort and period effects in the prevalence of sleep loss through worry for people over the age of 50 in the UK. The likelihood of reporting sleep loss through worry is calculated at two time-points for 7785 respondents from the...

Psychiatry has provided primary care physicians with tools for recognising and labelling mild, moderate or severe 'depression'. General practitioners (GPs) in the UK have been guided to manage depression within primary care and to prescribe anti-depressants as a first-line treatment. The present study aimed to examine how GPs would construct 'depre...

In October 2006, the Chief Medical Officer (CMO) of England asked Professor Sir John Tooke to chair a High Level Group on Clinical Effectiveness in response to the chapter 'Waste not, want not' in the CMOs 2005 annual report 'On the State of the Public Health'. The high level group made recommendations to the CMO to address possible ways forward to...