About
55
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Introduction
I am currently supporting the implementation of an NIHR funded Health Determinants Research Collaboration (HDRC) in Lambeth working with a range of academic and non-academic partners. More can be found out about HDRCs here - https://www.nihr.ac.uk/explore-nihr/support/health-determinants-research-collaborations.htm
Skills and Expertise
Current institution
Publications
Publications (55)
A poster presentation at the UK Public Health Science Conference on Nov 29th 2024 in Cardiff. Summary of poster published in the Lancet
Background
Minoritised populations in the United Kingdom frequently identify in multiple ethnic groupings and therefore little is known of their health needs. There were 136,062 Latin American people recorded in the 2021 UK Census across six different ethnic groups.
Aim
Characterise the incidence of long-term conditions (LTCs) and multiple LTCs (m...
Objectives
This study identifies the most common recorded reason for attendance to primary care for children under 5 years old, including a breakdown via age, ethnicity, deprivation quintile and sex.
Design
Cross-sectional.
Setting
39 of 40 general practices in Lambeth, London, UK.
Participants
22 189 children under 5 years who had attended prim...
Background
Minoritised populations in the United Kingdom frequently identify in multiple ethnic groupings and therefore little is known of their health needs. There were 136,062 Latin American people recorded in the 2021 UK Census across six different ethnic groups.
Aim
Characterise the incidence of long-term conditions (LTCs) and multiple LTCs (m...
Background
‘High-cost’ individuals with multimorbidity account for a disproportionately large share of healthcare costs and are at most risk of poor quality of care and health outcomes.
Aim
To compare high-cost with lower-cost individuals with multimorbidity and assess whether these populations can be clustered based on similar disease patterns....
Objective
Hypertension is a leading preventable cause of mortality, yet high rates of undiagnosed and uncontrolled hypertension continue. The burden falls most heavily on some ethnic minorities and the socially deprived, with the COVID-19 pandemic having further widened inequalities. We sought to determine the prevalence and predictors of unmeasure...
Background
Estimates of chronic pain prevalence using coded primary care data are likely to be substantially lower than estimates derived from community surveys. Most primary care studies have estimated chronic pain prevalence using data searches confined to analgesic medication prescriptions. Increasingly, following recent NICE guideline recommend...
Background:
There is a paucity of research about how under 5-year-olds utilise primary care in the UK, despite having one of the highest consultation rates of any age group. A greater understanding of the factors influencing health within this age group can inform targeted health promotion.
Aim:
This study aims to understand primary care use in...
Background
The COVID-19 pandemic caused rapid changes in primary care delivery in the UK, with concerns that certain groups of the population may have faced increased barriers to access. This study assesses the impact of the response to the COVID-19 pandemic on primary care consultations for individuals with multimorbidity and identifies ethnic ine...
Background
Stroke prevention is essential for patients with atrial fibrillation (AF), but some receive sub-optimal management. We reviewed those with a recorded AF diagnosis assessed with CHA2DS2-VASc stroke risk score (SRS) and socio-demographic determinants of anticoagulation prescribing. The objective was to compare with national guidance recomm...
Background
Social and material deprivation accelerate the development of multimorbidity, yet the mechanisms which drive multimorbidity pathways and trajectories remain unclear. We aimed to examine the association between health inequality, risk factors and accumulation or resolution of LTCs, taking disease sequences into consideration.
Methods
We...
Background
People with multimorbidity have complex healthcare needs. Some co-occurring diseases interact with each other to a larger extent than others and may have a different impact on primary care use.
Aim
To assess the association between multimorbidity clusters and primary care consultations over time.
Design and setting
A retrospective long...
Supplementary graphs and tables to support the research article.
Objective
: To estimate the prevalence and determinants of multimorbidity in an urban, multi-ethnic area over 15-years and investigate the effect of applying resolved/remission codes on prevalence estimates.
Study Design and Setting
: This is a population-based retrospective cross-sectional study using electronic health records of adults registere...
Abstract Background Defining multimorbidity has proved elusive in spite of attempts to standardise definitions. For national studies, a broad definition is required to capture national diversity. For locally based studies, the definition may need to reflect demographic and morbidity patterns. We aimed to define multimorbidity for an inner city, mul...
Background
Concerns have been raised that patients requiring emergency care may not have accessed healthcare services during coronavirus disease 2019 (COVID-19) lockdown.
Methods
This case control study aimed to understand changes in characteristics and diagnosis of patients attending a large UK Emergency Department (ED) during the first wave of t...
Background
Globally, there is increasing research on clusters of multimorbidity, but few studies have investigated multimorbidity in urban contexts characterised by a young, multi-ethnic, deprived populations. This study identified clusters of associative multimorbidity in an urban setting.
Methods
This is a population-based retrospective cross-se...
BACKGROUND: Managing multimorbidity is complex for both patients and healthcare systems. Patients with multimorbidity often use a variety of primary and secondary care services. Country-specific research exploring the healthcare utilisation and cost consequences of multimorbidity may inform future interventions and payment schemes in the UK.
AIM:...
Background:
Socioeconomic, cultural, technological, environment and ecological changes are rapidly transforming how children and young people (CYP) grow up, yet their impacts on CYP are difficult to predict. The traditional ways that Public Health practitioners work may not capture such complex and dynamic change. To address this, Lambeth Council...
Background. People of minority ethnic background may be disproportionately affected by
severe COVID-19 for reasons that are unclear. We sought to examine the relationship between
ethnic background and (1) hospital admission for severe COVID-19; (2) in-hospital mortality.
Methods. We conducted a case-control study of 872 inner city adult residents a...
Objective
To study the social determinants and cardiovascular risk factors for multimorbidity and the acquisition sequence of multimorbidity.
Design
Longitudinal study based on anonymised primary care data.
Setting
General practices in an urban multiethnic borough in London, UK.
Participants
332 353 patients aged ≥18 years.
Main outcome measure...
Aims:
To estimate percentages of patients with undiagnosed hypertension, diagnosed untreated hypertension and diagnosed, treated and uncontrolled hypertension and to identify sociodemographic factors for diagnosed, uncontrolled hypertension and not having a blood pressure (BP) reading recorded.
Methods:
Data from 320 094 patients aged 18 to less...
Background
Uptake of health checks for cardiovascular risk assessment in primary care in England is lower than anticipated. The question-behavior effect (QBE) may offer a simple, scalable intervention to increase health check uptake.
Purpose
The present study aimed to evaluate the effectiveness of enhanced invitation methods employing the QBE, wit...
Background:
A population-based programme of health checks has been established in England. Participants receive postal invitations through a population-based call-recall system but health check providers may also offer health checks opportunistically. We compared cardiovascular risk scores for 'invited' and 'opportunistic' health checks.
Methods:...
Background
A national programme of health checks to identify risk of cardiovascular disease (CVD) is being rolled out but is encountering difficulties because of low uptake.
Objective
To evaluate the effectiveness of an enhanced invitation method using the question–behaviour effect (QBE), with or without the offer of a financial incentive to ret...
Background: A national programme of health checks to identify risk of cardiovascular disease is being rolled out but is encountering difficulties of low uptake. Objective: To evaluate the effectiveness of an enhanced invitation method using the Question-Behaviour Effect (QBE), with or without the offer of a financial incentive to return the QBE que...
Objectives To assess quality of management and determinants in lipid control for secondary prevention of cardiovascular disease (CVD) using multilevel regression models.
Design Cross-sectional study.
Setting Inner London borough, with a primary care registered population of 378 000 (2013).
Participants 48/49 participating general practices with 786...
Background:
To evaluate the effect of NHS Health Checks on cardiovascular risk factor detection and inequalities.
Methods:
Matched cohort study in the Clinical Practice Research Datalink, including participants who received a health check in England between 1 April 2010 and 31 March 2013, together with matched control participants, with linked d...
Hypertension is the most prevalent cardiovascular long-term condition in the UK and is associated with a high rate of multimorbidity (MM). Multimorbidity increases with age, ethnicity and social deprivation. Previous studies have yielded conflicting findings about the relationship between MM and blood pressure (BP) control. Our aim was to investiga...
Background:
This study aimed to evaluate the yield of the NHS Health Checks programme.
Methods:
A cohort study, conducted in the Clinical Practice Research Datalink in England. Electronic health records were analysed for patients aged 40-74 receiving an NHS Health Check between 2010 and 2013.
Results:
There were 65 324 men and 75 032 women rec...
Our aim was to use Lambeth “DataNet” an anonymised primary care dataset to:
1. audit against standards of diabetes management for glycaemic and cardiovascular control; and
2. to conduct regression models to compare compliance to standards between different patient characteristics.
NHS Health Checks is a new program for primary prevention of heart disease, stroke, diabetes, chronic kidney disease, and vascular dementia in adults aged 40 to 74 years in England. Individuals without existing cardiovascular disease or diabetes are invited for a Health Check every 5 years. Uptake among those invited is lower than anticipated.
The...
Background:
Health checks are promoted to evaluate individuals' risk of developing disease and to initiate health promotion and disease prevention interventions. The NHS Health Check is a cardiovascular risk assessment programme introduced in the UK aimed at preventing cardiovascular disease (CVD). Uptake of health checks is lower than anticipated...
Background Population-based diabetes eye screening aims to reduce the occurrence of visual loss from diabetic eye disease. This study evaluated whether repeated non-attendance for diabetes eye screening is associated with risk of sight-threatening diabetic retinopathy (STDR).
Methods A population-based cohort study was conducted using diabetes eye...
This study evaluated whether repeated non-attendance for diabetic eye screening is associated with the risk of sight-threatening diabetic retinopathy (STDR).
This was a cohort study of 6,556 residents with diabetes who were invited for screening between 2008 and 2011 in a population-based eye screening programme in inner London and who attended for...
OBJECTIVE
Annual diabetes eye screening has been implemented in England since 2008. This study aimed to estimate changes in the detection of retinopathy in the first 4 years of the program.RESEARCH DESIGN AND METHODS
Participants included 32,340 patients with type 2 diabetes resident in three London boroughs with one or more screening records betwe...
Background:
To evaluate the organization of the new cardiovascular risk assessment programme, NHS Health Checks, in general practices.
Methods:
All 99 general practices in two inner London boroughs were invited to participate in a cross-sectional survey by completing an online questionnaire.
Results:
Data were analysed for 66/99 (67%) eligible...
To provide estimates of visual impairment in people with diabetes attending screening in a multi-ethnic population in England (United Kingdom).
The Diabetic Retinopathy In Various Ethnic groups in UK (DRIVE UK) Study is a cross-sectional study on the ethnic variations of the prevalence of DR and visual impairment in two multi-racial cohorts in the...
To compare the prevalence of diabetic retinopathy (DR) in people of various ethnic groups with diabetes in the United Kingdom (UK).
The Diabetic Retinopathy In Various Ethnic groups in UK (DRIVE UK) Study is a cross-sectional study on the ethnic variations of the prevalence of DR and visual impairment in two multi-racial cohorts in the UK. People o...
The burden of disease from cardiovascular disease (CVD) remains significant in England. Blood pressure remains an important risk factor. Health gain through public health measures and improving treatment compliance are potentially likely to be high. We assess the impact of known cost-effective interventions in terms of the avoidable CVD burden and...
We aimed to determine whether family practices' achievement of diabetes quality of care targets is associated with diabetic retinal disease in registered patients.
Data for achievement of diabetes quality of care targets, including the proportion of patients with HbA1c < or = 7.5%, for 144 family practices in London UK, for the years 2004/5 to 2007...
We aimed to quantify socio-economic and ethnic inequalities in diabetes retinal screening.
Data were analysed for the retinal screening programme for three South London boroughs for the 18-month period to February 2009. Sight-threatening diabetic retinopathy (STDR) was defined as the occurrence of diabetic maculopathy, severe non-proliferative or p...
This paper uses the Disability Adjusted Life Year (DALY) to estimate disease burden at a local level and relates this to programme budget (PB) data.
We estimated DALY using the global burden of disease (GBD) template. For years of life lost, local mortality data were used and for years of life with disability, the GBD estimates from World Health Or...
To assess uptake of the diabetes retinopathy screening programme in South East London and examine variation in attendance and screening outcomes.
Cross-sectional study of patients on a centralized disease register invited for retinal screening during 2003. The influence of age, gender, deprivation, region of birth and type of diabetes on screening...
Pertussis is well controlled in the UK as a result of an effective vaccination programme. Nevertheless, the disease has not been eliminated, and cases still occur in the most vulnerable group of young infants. Erythromycin chemoprophylaxis has been advocated for use in contacts to prevent secondary cases but the evidence for its use is weak. These...
The objective of the study is to identify the most important local and generalisable issues, and how to achieve improvements in the health status and address health needs of prisoners in London. Combined retro and prospective needs assessments were carried out in eight London prisons, between 1999-2001, using the University of Birmingham's tool kit...
Objective: To audit the management of head lice. Design: Prospective survey. Setting: Community pharmacies in Bromley. Methods: Audit standards were developed using a combination of literature evidence and discussion at an interactive workshop with participating pharmacists. Baseline levels were agreed for some of the standards. A pre-piloted data...
An outbreak of food poisoning caused by Salmonella enteritidis phage type (PT) 6 followed a children's birthday party. Thirty of 37 (attack rate 81%) attendees were ill, with diarrhoea and fever being the most common symptoms. One child required hospital admission for rehydration. No deaths occurred. Stool specimens from 24 out of 25 people who sub...
We assessed the quality of evidence for the use of erythromycin
in preventing secondary
transmission of pertussis to close contacts of primary cases.
A literature search was undertaken
and identified papers were reviewed critically. Thirteen original papers
and 1 manuscript met
the inclusion criteria for review (3 randomized controlled trials,...
