Keith R Neal

Keith R Neal
Public Health England | HPA

About

221
Publications
25,241
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13,610
Citations
Citations since 2017
8 Research Items
4108 Citations
20172018201920202021202220230200400600
20172018201920202021202220230200400600
20172018201920202021202220230200400600
20172018201920202021202220230200400600
Introduction
Keith R Neal currently works at as Consultant Epidemiologist.

Publications

Publications (221)
Article
Background: Preoperative anaemia is common and occurs in 5% to 76% of patients preoperatively. It is associated with an increased risk of perioperative allogeneic blood transfusion, longer hospital stay, and increased morbidity and mortality. Iron deficiency is one of the most common causes of anaemia. Oral and intravenous iron therapy can be used...
Article
Full-text available
Varicella zoster virus (VZV) infection has been implicated in multiple sclerosis (MS), but direct causal involvement has been disputed. Nevertheless, knowledge of VZV exposure is important, given the risk of serious complications of first exposure while undergoing immunosuppressive treatment, in particular with fingolimod. We distributed questionna...
Article
Full-text available
Objective: To compare psychosocial outcomes (follow-up related worries and satisfaction with follow-up related information and support) over 30 months of two alternative management policies for women with low-grade abnormal cervical cytology. Methods: Women aged 20-59 years with low-grade cytological abnormalities detected in the National Health...
Article
Background Uncomplicated acute appendicitis has been managed traditionally by early appendicectomy. However, recently, there has been increasing interest in the potential for primary treatment with antibiotics, with studies finding this to be associated with fewer complications than appendicectomy. The aim of this study was to compare outcomes of a...
Article
Background: Pre-operative anaemia is common and occurs in up to 76% of patients. It is associated with increased peri-operative allogeneic blood transfusions, longer hospital lengths of stay and increased morbidity and mortality. Iron deficiency is one of the most common causes of this anaemia. Oral iron therapy has traditionally been used to trea...
Article
Full-text available
older adults are susceptible to dehydration due to age-related pathophysiological changes. We aimed to investigate the prevalence of hyperosmolar dehydration (HD) in hospitalised older adults, aged ≥65 years, admitted as an emergency and to assess the impact on short-term and long-term outcome. this prospective cohort study was performed on older a...
Article
Dehydration of as little 2% of total body weight may impair physical and cognitive performance. The aim of this study was to investigate the prevalence of dehydration at the start and end of shifts in nurses and doctors on-call. The secondary aims were to assess the relation between hydration status and cognitive function. This prospective cohort s...
Article
A colposcopy examination is the main management option for women with an abnormal cervical screening test result. Although some women experience adverse psychological effects after colposcopy, those at greatest risk are unknown. We investigated predictors of worries about cervical cancer, sex, future fertility and general health during 12 to 30 mon...
Article
Full-text available
Foodborne outbreaks of Salmonella remain a pressing public health concern. We recently detected a large outbreak of Salmonella enterica serovar Enteritidis phage type 14b affecting more than 30 patients in our hospital. This outbreak was linked to community, national and European-wide cases. Hospital patients with Salmonella are at high risk, and r...
Article
We report an outbreak of Salmonella Enteritidis phage type 14b (PT14b) in the United Kingdom (UK) between May and September 2014 where Public Health England launched an investigation to identify the source of infection and implement control measures. During the same period, outbreaks caused by a Salmonella Enteritidis strain with a specific multilo...
Article
This is the protocol for a review and there is no abstract. The objectives are as follows: The primary objective of this systematic review is to evaluate the efficacy of iron therapy (enteral or parenteral) pre-operatively, in reducing the need for allogeneic blood transfusions in patients undergoing surgery. Secondary objectives are to determine t...
Article
Full-text available
Molecular PorA subtyping provides information that increasingly requires the adaptation of standard public health approaches to outbreak management. We report an outbreak of a rare subtype of meningococcal infection not previously identified in the United Kingdom (UK). The outbreak occurred in the Warwickshire area in England between February and J...
Article
Meningococcal conjugate vaccines protect individuals directly, but can also confer herd protection by interrupting carriage transmission. We assessed the effects of meningococcal quadrivalent glycoconjugate (MenACWY-CRM) or serogroup B (4CMenB) vaccination on meningococcal carriage rates in 18-24-year-olds. METHODS: In this phase 3, observer-blin...
Chapter
This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effects of gentamicin-impregnated collagen implants for reducing SSIs, in people undergoing all types of surgery.
Article
Full-text available
Asymptomatic and persistent colonisation of the upper respiratory tract by Neisseria meningitidis occurs despite elicitation of adaptive immune responses against surface antigens. A putative mechanism for facilitating host persistence of this bacterial commensal and pathogen is alterations in expression of surface antigens by simple sequence repeat...
Article
Chronic hepatitis C virus (HCV) infection places a considerable economic burden on health services. Cost-effectiveness analyses of antiviral treatment for patients with chronic HCV infection are dependent on assumptions about cost reductions following sustained virological response (SVR) to therapy. This study quantified the medium-term difference...
Article
Background: An emergent strain (ribotype 027) of Clostridium difficile infection (CDI) has been implicated in epidemics worldwide. Organizational factors such as bed occupancy have been associated with an increased incidence of CDI; however, the data are sparse, and the association has not been widely demonstrated. We investigated the association...
Article
Aim: The aim of this study was to assess changes in trends of meningococcal disease and strain diversity of Neisseria meningitidis in Europe, South America, and Africa over the last 100 years. Methods: Healthcare databases and sources of grey literature were searched in 2012 and records were screened against the protocol eligibility criteria usi...
Article
Full-text available
Neisseria meningitidis is a human nasopharyngeal commensal capable of causing life-threatening septicemia and meningitis. Many meningococcal surface structures, including the autotransporter proteins NalP and MspA, are subject to phase variation (PV) due to the presence of homopolymeric tracts within their coding sequences. The functions of MspA ar...
Data
Distribution of nalP tract lengths in meningococcal isolates. (A) serogroup B strains only (B) serogroup Y strains only (C) all other serogroups. Black bars, carriage; grey bars, invasive. An ON PV state is produced by 7, 10 or 13Cs for nalP. (PPT)
Data
Distribution of mspA tract lengths in meningococcal isolates. (A) serogroup B strains only (B) serogroup Y strains only (C) all other serogroups. Black bars, carriage; grey bars, invasive. An ON PV state is produced by 6, 9 or 12Cs for mspA. (PPT)
Data
Invasive isolates in the Meningitis Research Foundation Meningococcus Genome Library database (containing the genomic DNA sequences of all disease isolates for 2010–11 in England, Wales and Northern Ireland) which lacked nalP. (DOCX)
Data
Invasive isolates in the Meningitis Research Foundation Meningococcus Genome Library database (containing the genomic DNA sequences of all disease isolates for 2010–11 in England, Wales and Northern Ireland) which lacked mspA. (DOCX)
Data
Neisseria meningitidis is a human nasopharyngeal commensal capable of causing life-threatening septicemia and meningitis. Many meningococcal surface structures, including the autotransporter proteins NalP and MspA, are subject to phase variation (PV) due to the presence of homopolymeric tracts within their coding sequences. The functions of MspA ar...
Article
Objectives: The postinfectious irritable bowel syndrome (PI-IBS) suggests that impaired resolution of inflammation could cause IBS symptoms. The authors hypothesised that polymorphisms in genes whose expression were altered by gastroenteritis might be linked to IBS with diarrhoea (IBS-D) which closely resembles PI-IBS. Design: Part 1: 25 healthy...
Article
The Typhoid and Paratyphoid Reference Group (TPRG) was convened by the Health Protection Agency (HPA) and the Chartered Institute of Environmental Health (CIEH) to revise guidelines for public health management of enteric fever. This paper presents the new guidelines for England and their rationale. Methods include literature reviews including grey...
Article
Full-text available
To compare the safety and efficacy of antibiotic treatment versus appendicectomy for the primary treatment of uncomplicated acute appendicitis. Meta-analysis of randomised controlled trials. Randomised controlled trials of adult patients presenting with uncomplicated acute appendicitis, diagnosed by haematological and radiological investigations. A...
Article
Full-text available
We sought to explain seasonality and other aspects of Campylobacter jejuni epidemiology by integrating population genetic and epidemiological analysis in a large 3-year longitudinal, two-centre, population-based study. Epidemiological information was collected for 1505 isolates, which were multilocus sequence-typed. Analyses compared pathogen popul...
Article
Full-text available
Although the prognostic significance of proliferation in early invasive breast cancer has been recognized for a long time, recent gene-expression profiling studies have reemphasized its biologic and prognostic value and the potential application of its assessment in routine practice, particularly to define prognostic subgroups of luminal/hormone re...
Article
Full-text available
Herd immunity is important in the effectiveness of conjugate polysaccharide vaccines against encapsulated bacteria. A large multicenter study investigated the effect of meningococcal serogroup C conjugate vaccine introduction on the meningococcal population. Carried meningococci in individuals aged 15-19 years attending education establishments wer...
Article
Full-text available
To the Editor: Neisseria meningitidis causes septicemia and meningitis (1). Meningococci usually persist on the nasopharyngeal mucosa of asymptomatic carriers (2). Because carriers are the only reservoir of meningococci, carriage in at-risk populations should be monitored. Meningococcal carriage rates have been assessed during 1997-8 for first-year...
Article
Full-text available
Although bloodborne infections are among the most important global health issues, limited data are available on bloodborne infections in athletes. To determine and compare the prevalence of markers of hepatitis B (HBV) and hepatitis C (HCV) viruses and the risk factors for these infections among wrestlers in Tehran and among a control group of athl...
Article
We studied a cross-sectional sample of the population of Kech, a small rural town in Pakistan to determine the prevalence and risk factors for hepatitis C infection. The prevalence of hepatitis C was 110 out of 2000 persons (5·5%, 95% confidence interval 4·5-6·5). Higher rates were identified in males. Independent risk factors identified were age ≥...
Article
Full-text available
A study of meningococcal carriage dynamics was performed with a cohort of 190 first-year students recruited from six residential halls at Nottingham University, United Kingdom. Pharyngeal swabs were obtained on four occasions between November 2008 and May 2009. Direct plating and culture on selective media were succeeded by identification and chara...
Article
Full-text available
Neisseria meningitidis can utilize haem, haemoglobin and haemoglobin-haptoglobin complexes as sources of iron via two TonB-dependent phase variable haemoglobin receptors, HmbR and HpuAB. HmbR is over-represented in disease isolates, suggesting a link between haemoglobin acquisition and meningococcal disease. This study compared the distribution of...
Article
Background and aims: Premature infants have more hospital admissions and stay longer on PICU1,2. As little is known about these PICU admissions, the aim of this study was to investigate the impact NICU infants have upon PICU.Method: A retrospective cohort analysis was performed of 8791 NICU admissions and 3307 PICU admissions at a University Hospit...
Conference Paper
Antigenic variation of meningococcal surface antigens is thought to contribute to persistence during nasopharyngeal carriage. Proposed models suggest that the host immune responses are responsible for producing non-overlapping antigenic repertoires and these, subsequently, facilitate sequential carriage. This study aimed at examining the extent of...
Conference Paper
Full-text available
Objectives: Multiple surface antigens of Neisseria meningitidis are subject to phase variation (PV) due to mutations in tandem DNA repeat tracts. PV is thought to facilitate adaptation of meningococci to fluctuations in host immune responses. Translational phase variation of lgtG mediates...
Article
Anxiety, depression and nongastrointestinal symptoms are often prominent in irritable bowel syndrome (IBS), but their relative value in patient management has not been quantitatively assessed. We modified the Patient Health Questionnaire 15 (PHQ-15) by excluding three gastrointestinal items to create the PHQ-12 Somatic Symptom (PHQ-12 SS) scale. To...
Article
Fatty liver disease (FLD), of either alcoholic (AFLD) or non-alcoholic (NAFLD) aetiologies, is characterised histologically by features that are lobulocentric that typically affect zone 3, in contrast with portal-based inflammation characteristics of other forms of chronic liver disease. The authors aimed to determine the prevalence and significanc...
Article
Full-text available
Recombinant forms of Neisseria meningitidis factor H binding protein (fHBP) are undergoing clinical trials in candidate vaccines against serogroup B meningococcal disease. Little is known, however, about the host response to fHBP during natural carriage and disease. Here we report a longitudinal study of the antibody response to fHBP in healthy men...
Article
The aim of the Enhanced Recovery After Surgery (ERAS) pathway is to attenuate the stress response to surgery and enable rapid recovery. The objective of this meta-analysis was to study the differences in outcomes in patients undergoing major elective open colorectal surgery within an ERAS pathway and those treated with conventional perioperative ca...
Article
Cytology testing in the NHS Cervical Screening Programs in the United Kingdom has identified over a quarter of a million women with precancerous low-grade abnormalities (mild dyskaryosis or borderline nuclear abnormalities [BNA]). Some investigators have suggested that human papillomavirus (HPV) testing could help decide which of these women should...
Article
Full-text available
Infectious intestinal disease (IID), usually presenting as diarrhoea and vomiting, is frequently preventable. Though often mild and self-limiting, its commonness makes IID an important public health problem. In the mid 1990s around 1 in 5 people in England suffered from IID a year, costing around pound0.75 billion. No routine information source des...
Article
Background: Infectious intestinal disease (IID), usually presenting as diarrhoea and vomiting, is frequently preventable. Though often mild and self-limiting, its commonness makes IID an important public health problem. In the mid 1990s around 1 in 5 people in England suffered from IID a year, costing around 0.75 pound billion. No routine informati...
Article
To assess the value of a single human papillomavirus (HPV) test in making decisions on management of women with cervical cytology showing borderline nuclear abnormality (BNA) or mild dyskaryosis. In particular, to determine whether information on high-risk (hr) HPV status would be valuable in the choice between (1) cytological surveillance versus i...
Conference Paper
Background: Since the early 2000s, the NAP1/BI/O27 strain of Clostridium difficile has been implicated in large outbreaks of C difficile-associated disease (CDAD) worldwide. In England this occurred concurrently with the introduction of policies aimed at improving financial efficiency within the National Health Service. These included reductions in...
Article
Full-text available
Antibiotic treatment has been shown to be effective in treating selected patients with acute appendicitis, and three randomized controlled trials (RCTs) have compared the efficacy of antibiotic therapy alone with that of surgery for acute appendicitis. The purpose of this meta-analysis of RCTs was to assess the outcomes with these two therapeutic m...
Article
Objective: Few studies have investigated physical after-effects of colposcopy. We compared post-colposcopy self-reported pain, bleeding, discharge and menstrual changes in women who underwent: colposcopic examination only; cervical punch biopsies; and large loop excision of the transformation zone (LLETZ). Design: Observational study nested with...
Article
Full-text available
In a case-control study of Campylobacter spp. risk factors in England during 2005-2006, we identified recent consumption of commercially prepared chicken as an important risk factor. The risk for illness associated with recent chicken consumption was much lower for persons who regularly ate chicken than in those who did not, which suggests that par...
Article
Objectives: To compare the effectiveness of punch biopsy and selective recall for treatment versus a policy of immediate treatment by large loop excision in the management of women with low grade abnormal cervical cytology referred for colposcopy. Design: Multicentre individually randomised controlled trial, nested within the NHS cervical screen...
Article
Objective: To estimate the cost effectiveness of alternative methods of managing low grade cervical cytological abnormalities detected at routine screening. Design Cost analysis within multicentre individually randomised controlled trial. Setting: Grampian, Tayside, and Nottingham. Participants: 4201 women with low grade abnormalities. Interv...
Article
Objectives: To examine the effectiveness of cytological surveillance in primary care compared with immediate referral for colposcopic examination in women with low grade abnormal results on cervical cytology tests. Design: Multicentre individually randomised controlled trial. Setting: NHS cervical screening programmes in Grampian, Tayside, and...
Article
Autoantibodies are commonly detected in chronic hepatitis C (HCV) but their significance remains uncertain. We assessed the prevalence of anti-nuclear (ANA) and anti-smooth muscle (ASM) antibodies within a cohort of 963 treatment-naïve HCV patients. We also assessed for differences between autoantibody-positive and autoantibody-negative patients in...
Article
Health professionals are in a power category within any social setting so when they identify and label diseases with negative attributes, it can be recognised by society with discriminatory consequences for individuals affected in the community. This article reports how activities of health professionals, as perceived and construed by community mem...
Article
Shama Ahanta East Metropolitan District, Ghana. To explore tuberculosis (TB) stigma and to elucidate how it operates in community settings and within the health care system to affect case finding and treatment adherence. Individual interviews and focus groups with TB patients, health care workers and community members. Ten causes of TB stigma emerg...
Article
Full-text available
We welcome an opportunity to get a glimpse into the black box underlying the recent decisions about human papillomavirus (HPV) vaccination.1 We would like to reflect on the assumptions made. GlaxoSmithKline claims that Cervarix will provide protection longer, which would favour Cervarix. The paper by Jit et al does not reflect this (which is probab...
Article
Full-text available
In 1999, meningococcal serogroup C conjugate (MCC) vaccines were introduced in the United Kingdom for those under 19 years of age. The impact of this intervention on asymptomatic carriage of meningococci was investigated to establish whether serogroup replacement or protection by herd immunity occurred. Multicenter surveys of carriage were conducte...