Martin C Gulliford’s research while affiliated with King's College London and other places

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Publications (436)


Figure 1: Distributions of BMI and waist-to-height ratio, by region The black lines below each distribution show the 2·5%, 25·0%, 75·0%, and 97·5% quantiles of the distributions and the points show the median. The dashed lines show medians across all participants. Regions are ordered by their sex-specific median BMI. See appendix (p 55) for numerical summaries.
Figure 3: Regional BMI adjustment The BMI adjustment shows how much lower BMI in each region should be to achieve an equivalent waist-toheight ratio. The adjustment is shown relative to the population of the high-income western region where most current epidemiological studies have been done; regional ordering and differences across regions would be unchanged if a different reference were used. The bars show 95% CIs of the BMI adjustments. See appendix (pp 90-91) for results using waist circumference.
General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants
  • Article
  • Full-text available

August 2024

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1,456 Reads

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5 Citations

The Lancet

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James E. Bennett

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Aidan P. Wickham

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[...]

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Majid Ezzati

Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension.

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Rate per 10,000 patient-years of foot and ankle consultations in CPRD (2015 to 2020)
Logistic regression model of variables associated with the outcome of repeat consultations for all foot and ankle health encounters within six months during the study period
Foot and ankle problems in children and young people: a population-based cohort study

May 2024

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41 Reads

European Journal of Pediatrics

The aim of this research was to describe the epidemiology, presentation and healthcare use in primary care for foot and ankle problems in children and young people (CYP) across England. We undertook a population-based cohort study using data from the Clinical Practice Research Datalink Aurum database, a database of anonymised electronic health records from general practices across England. Data was accessed for all CYP aged 0–18 years presenting to their general practitioner between January 2015 and December 2021 with a foot and/or ankle problem. Consultation rates were calculated and used to estimate numbers of consultations in an average practice. Hierarchical Poisson regression estimated relative rates of consultations across sociodemographic groups and logistic regression evaluated factors associated with repeat consultations. A total of 416,137 patients had 687,753 foot and ankle events, of which the majority were categorised as “musculoskeletal” (34%) and “unspecified pain” (21%). Rates peaked at 601 consultations per 10,000 patient-years among males aged 10–14 years in 2018. An average practice might observe 132 (95% CI 110 to 155) consultations annually. Odds for repeat consultations were higher among those with pre-existing diagnoses including juvenile arthritis (OR 1.73, 95% CI 1.48 to 2.03). Conclusions: Consultations for foot and ankle problems were high among CYP, particularly males aged 10 to 14 years. These data can inform service provision to ensure CYP access appropriate health professionals for accurate diagnosis and treatment. What is Known: • Foot and ankle problems can have considerable impact on health-related quality of life in children and young people (CYP). • There is limited data describing the nature and frequency of foot and ankle problems in CYP. What is New: • Foot and ankle consultations were higher in English general practice among CYP aged 10 to 14 years compared to other age groups, and higher among males compared to females. • The high proportion of unspecified diagnoses and repeat consultations suggests there is need for greater integration between general practice and allied health professionals in community-based healthcare settings.




Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

February 2024

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3,509 Reads

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493 Citations

The Lancet

Summary Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m²) and obesity (BMI ≥30 kg/m²). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.



Cohort characteristics by NSAID exposure at consultation
Unadjusted and adjusted rate ratios for the association of repeat consultation and hospital admission/death within 30 days with NSAID and antibiotic prescribing exposure for RTI patients
NSAID prescribing and adverse outcomes in common infections: a population-based cohort study

January 2024

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35 Reads

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4 Citations

BMJ Open

Objectives Infections in primary care are often treated with non-steroidal anti-inflammatory drugs (NSAIDs). This study evaluates whether NSAID prescribing is associated with adverse outcomes for respiratory (RTIs) or urinary track (UTI) infections. Objectives To determine whether there is an association between NSAID prescribing and the rate of adverse outcomes for infections for individual consulting in primary care. Design Cohort study of electronic health records. Setting 87 general practices in the UK Clinical Practice Research Datalink GOLD. Participants 142 925 patients consulting with RTI or UTI. Primary and secondary outcome measures Repeat consultations, hospitalisation or death within 30 days of the initial consultation for RTI or UTI. Poisson models estimated the associations between NSAID exposure and outcome. Rate ratios were adjusted for gender, age, ethnicity, deprivation, antibiotic use, seasonal influenza vaccination status, comorbidities and general practice. Since prescribing variations by practice are not explained by case mix—hence, less impacted by confounding by indication—both individual-level and practice-level analyses are included. Results There was an increase in hospital admission/death for acute NSAID prescriptions (RR 2.73, 95% CI 2.10 to 3.56) and repeated NSAID prescriptions (6.47, 4.46–9.39) in RTI patients, and for acute NSAID prescriptions for UTI (RR 3.03; 1.92 to 4.76). Practice-level analysis, controlling for practice population characteristics, found that for each percentage point increase in NSAID prescription, the percentages of hospital admission/death within 30 days increased by 0.32 percentage points (95% CI 0.16 to 0.47). Conclusions In this non-randomised study, prescription of NSAIDs at consultations for RTI or UTIs in primary care is infrequent but may be associated with increased risk of hospital admission. This supports other observational and limited trial data that NSAID prescribing might be associated with worse outcomes following acute infection and should be prescribed with caution.


A multifaceted intervention to reduce antibiotic prescribing among CHIldren with acute COugh and respiratory tract infection: the CHICO cluster RCT

December 2023

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47 Reads

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2 Citations

Health technology assessment (Winchester, England)

Background Clinical uncertainty in primary care regarding the prognosis of children with respiratory tract infections contributes to the unnecessary use of antibiotics. Improved identification of children at low risk of future hospitalisation might reduce clinical uncertainty. A National Institute for Health and Care Research-funded 5-year programme (RP-PG-0608-10018) was used to develop and feasibility test an intervention. Objectives The aim of the children with acute cough randomised controlled trial was to reduce antibiotic prescribing among children presenting with acute cough and respiratory tract infection without increasing hospital admission. Design An efficient, pragmatic open-label, two-arm trial (with embedded qualitative and health economic analyses) using practice-level randomisation using routinely collected data as the primary outcome. Setting General practitioner practices in England. Participants General practitioner practices using the Egton Medical Information Systems ® patient-record system for children aged 0–9 years presenting with a cough or upper respiratory tract infection. Recruited by Clinical Research Networks and Clinical Commissioning Groups. Intervention Comprised: (1) elicitation of parental concerns during consultation; (2) a clinician-focused prognostic algorithm to identify children with acute cough and respiratory tract infection at low, average or elevated risk of hospitalisation in the next 30 days accompanied by prescribing guidance, (3) provision of a printout for carers including safety-netting advice. Main outcome measures Co-primaries using the practice list-size for children aged 0–9 years as the denominator: rate of dispensed amoxicillin and macrolide items at each practice (superiority comparison) from NHS Business Services Authority ePACT2 and rate of hospital admission for respiratory tract infection (non-inferiority comparison) from Clinical Commissioning Groups, both routinely collected over 12 months. Results Of the 310 practices required, 294 (95%) were recruited (144 intervention and 150 controls) with 336,496 registered 0–9-year-olds (5% of all 0–9-year-old children in England) from 47 Clinical Commissioning Groups. Included practices were slightly larger than those not included, had slightly lower baseline dispensing rates and were located in more deprived areas (reflecting the distribution for practice postcodes nationally). Twelve practices (4%) subsequently withdrew (six related to the pandemic). The median number of times the intervention was used was 70 per practice (by a median of 9 clinicians) over 12 months. There was no evidence that the antibiotic dispensing rate in the intervention practices [0.155 (95% confidence interval 0.135 to 0.179)] differed to controls [0.154 (95% confidence interval 0.130 to 0.182), relative risk= 1.011 (95% confidence interval 0.992 to 1.029); p = 0.253]. There was, overall, a reduction in dispensing levels and intervention usage during the pandemic. The rate of hospitalisation for respiratory tract infection in the intervention practices [0.019 (95% confidence interval 0.014 to 0.026)] compared to the controls [0.021 (95% confidence interval 0.014 to 0.029)] was non-inferior [relative risk = 0.952 (95% confidence interval 0.905 to 1.003)]. The qualitative evaluation found the clinicians liked the intervention, used it as a supportive aid, especially with borderline cases but that it, did not always integrate well within the consultation flow and was used less over time. The economic evaluation found no evidence of a difference in mean National Health Service costs between arms; mean difference −£1999 (95% confidence interval −£6627 to 2630). Conclusions The intervention was feasible and subjectively useful to practitioners, with no evidence of harm in terms of hospitalisations, but did not impact on antibiotic prescribing rates. Future work and limitations Although the intervention does not appear to change prescribing behaviour, elements of the approach may be used in the design of future interventions. Trial registration This trial is registered as ISRCTN11405239 (date assigned 20 April 2018) at www.controlled-trials.com (accessed 5 September 2022). Version 4.0 of the protocol is available at: https://www.journalslibrary.nihr.ac.uk/ (accessed 5 September 2022). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (NIHR award ref: 16/31/98) programme and is published in full in Health Technology Assessment ; Vol. 27, No. 32. See the NIHR Funding and Awards website for further award information.


Study work package structure.
MELD-B research collaboration outputs by work package.
Trusted research environment and datasets.
Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) -protocol for a research collaboration

September 2023

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74 Reads

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7 Citations

Journal of Multimorbidity and Comorbidity

Background Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as ‘early onset’). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a research collaboration titled ‘MELD-B’ to understand how wider determinants, sentinel conditions (the first LTC in the lifecourse) and LTC accrual sequence affect risk of early-onset, burdensome MLTC-M, and to inform prevention interventions. Aim Our aim is to identify critical periods in the lifecourse for prevention of early-onset, burdensome MLTC-M, identified through the analysis of birth cohorts and electronic health records, including artificial intelligence (AI)-enhanced analyses. Design We will develop deeper understanding of ‘burdensomeness’ and ‘complexity’ through a qualitative evidence synthesis and a consensus study. Using safe data environments for analyses across large, representative routine healthcare datasets and birth cohorts, we will apply AI methods to identify early-onset, burdensome MLTC-M clusters and sentinel conditions, develop semi-supervised learning to match individuals across datasets, identify determinants of burdensome clusters, and model trajectories of LTC and burden accrual. We will characterise early-life (under 18 years) risk factors for early-onset, burdensome MLTC-M and sentinel conditions. Finally, using AI and causal inference modelling, we will model potential ‘preventable moments’, defined as time periods in the life course where there is an opportunity for intervention on risk factors and early determinants to prevent the development of MLTC-M. Patient and public involvement is integrated throughout.


Fig 2 | Mean and 95% confidence interval of intervention usage (top), dispensing rates (middle), and hospital admission rates (bottom), over course of cHicO trial follow-up period for intervention and control arms. rti=respiratory tract infection
Median number of times intervention was used, per month, over 12 months of follow-up
Multi-faceted intervention to improve management of antibiotics for children presenting to primary care with acute cough and respiratory tract infection (CHICO): efficient cluster randomised controlled trial

April 2023

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45 Reads

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10 Citations

The BMJ

Objective To assess whether an easy-to-use multifaceted intervention for children presenting to primary care with respiratory tract infections would reduce antibiotic dispensing, without increasing hospital admissions for respiratory tract infection. Design Two arm randomised controlled trial clustered by general practice, using routine outcome data, with qualitative and economic evaluations. Setting English primary care practices using the EMIS electronic medical record system. Participants Children aged 0-9 years presenting with respiratory tract infection at 294 general practices, before and during the covid-19 pandemic. Intervention Elicitation of parental concerns during consultation; a clinician focused prognostic algorithm to identify children at very low, normal, or elevated 30 day risk of hospital admission accompanied by antibiotic prescribing guidance; and a leaflet for carers including safety netting advice. Main outcome measures Rate of dispensed amoxicillin and macrolide antibiotics (superiority comparison) and hospital admissions for respiratory tract infection (non-inferiority comparison) for children aged 0-9 years over 12 months (same age practice list size as denominator). Results Of 310 practices needed, 294 (95%) were randomised (144 intervention and 150 controls) representing 5% of all registered 0-9 year olds in England. Of these, 12 (4%) subsequently withdrew (six owing to the pandemic). Median intervention use per practice was 70 (by a median of 9 clinicians). No evidence was found that antibiotic dispensing differed between intervention practices (155 (95% confidence interval 138 to 174) items/year/1000 children) and control practices (157 (140 to 176) items/year/1000 children) (rate ratio 1.011, 95% confidence interval 0.992 to 1.029; P=0.25). Pre-specified subgroup analyses suggested reduced dispensing in intervention practices with fewer prescribing nurses, in single site (compared with multisite) practices, and in practices located in areas of lower socioeconomic deprivation, which may warrant future investigation. Pre-specified sensitivity analysis suggested reduced dispensing among older children in the intervention arm (P=0.03). A post hoc sensitivity analysis suggested less dispensing in intervention practices before the pandemic (rate ratio 0.967, 0.946 to 0.989; P=0.003). The rate of hospital admission for respiratory tract infections in the intervention practices (13 (95% confidence interval 10 to 18) admissions/1000 children) was non-inferior compared with control practices (15 (12 to 20) admissions/1000 children) (rate ratio 0.952, 0.905 to 1.003). Conclusions This multifaceted antibiotic stewardship intervention for children with respiratory tract infections did not reduce overall antibiotic dispensing or increase respiratory tract infection related hospital admissions. Evidence suggested that in some subgroups and situations (for example, under non-pandemic conditions) the intervention slightly reduced prescribing rates but not in a clinically relevant way. Trial registration ISRCTN11405239ISRCTN registry ISRCTN11405239


Citations (77)


... However, the criteria for the Japanese population differ from the WHO criteria: the Japan Society for the Study of Obesity (JASSO) defines obesity as a BMI of 25 kg/m 2 or higher because the BMI associated with the lowest morbidity in the Japanese population is approximately 22 kg/m 2 [17], and the proportion of individuals with obesity (BMI of 30 or higher) is low in Japan [18]. This suggests that Asian populations may be more sensitive to body weight changes than Western populations [19][20][21][22][23]. A study showed that the Japanese BMI cut-off that is associated with cardiovascular risk factors is significantly lower than the American BMI cut-off [24]. ...

Reference:

Body Mass Index and Weight Change as Predictors of Hypertension Development: A Sex-Specific Analysis
General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants

The Lancet

... chronic conditions highlights the importance of self-management. While research has extensively documented the prevalence, mortality rates, and financial burdens of these diseases, the literature includes a relative lack of emphasis on providing effective support for affected individuals and populations [2]. ...

Is multimorbidity a useful concept for public health?
  • Citing Article
  • April 2024

The Lancet Public Health

... O excesso de peso é diagnosticado pelo índice de massa corporal (IMC) e reúne o sobrepeso (IMC = >24,99) e a obesidade (IMC = >29,9) em adultos. 1 Atualmente, 43% da população mundial apresenta excesso de peso. 2 No Brasil, a obesidade atinge 24,3% dos adultos e mais da metade da população (61,4%) convive com excesso de peso. 3 Nas crianças, as taxas de excesso de peso (15,5,16,2 e 31,8%) superam as de baixo peso (5,4, 6,8 e 5,6%), nas faixas etárias de <2 anos, 2 a 4 anos e de 5 a 9 anos, respectivamente. 4 Nas capitais brasileiras, identificou-se que entre 2010 e 2011 a proporção de adultos com excesso de peso e eutrofia passou a ser semelhante, enquanto em 2023 a proporção de indivíduos com sobrepeso e obesidade foi predominante. ...

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

The Lancet

... An example of this approach was the RCT named CHICO, conducted with 294 GPs in the UK. The trial aimed to improve the early identification of children at low risk of future hospitalization to reduce clinical uncertainty [29]. The program utilized a web-based system with a prognostic algorithm to promptly identify children with acute cough and respiratory tract infections at low, average, or elevated risk of hospitalization in the next 30 days, accompanied by prescription guidance. ...

A multifaceted intervention to reduce antibiotic prescribing among CHIldren with acute COugh and respiratory tract infection: the CHICO cluster RCT

Health technology assessment (Winchester, England)

... Nonsteroidal anti-inflammatory medications (NSAIDs) and corticosteroids are the pharmaceuticals most frequently used to treat inflammatory and arthritic disorders (Ryan et al. 2024). NSAIDs have been shown to be effective in treating rheumatoid disorders and inflammation not only because they are prostaglandin antagonists, but also because they have the ability to stabilize cell and lysosomal membranes as well as safeguard intrinsic proteins from denaturation, which can result in the formation of peptides that are thought to be autoantigens triggering rheumatism; however, the greatest drawbacks of the powerful synthetic corticosteroids and NSAIDs now on the market are their toxicity and the recurrence of indications after their use is stopped (Stuart et al. 2024). Currently, organic products are seen as safer than synthetic medications, which are viewed as hazardous to both human health and the environment. ...

NSAID prescribing and adverse outcomes in common infections: a population-based cohort study

BMJ Open

... 34 The Multidisciplinary Ecosystem to study Lifecourse Determinants and Prevention of Early-onset Burdensome Multimorbidity (MELD-B) collaboration aims to address some of these key gaps in the evidence in MLTC-M research by developing a deeper understanding of the lived experience of 'burdensomeness' of multimorbidity, identifying new clusters of burdensome MLTC-M and their key early-life risk factors, mapping trajectories across the lifecourse towards burdensome clusters in those under 65 and modelling prevention scenarios to inform policy. 35 These will be achieved through the analysis of birth cohorts and routinely collected electronic health record (EHR) data sources, using a combination of Artificial-Intelligence. Questions are built around several key areas of inquiry: clustering individuals based on burdensomeness concepts, analysing the determinants of these burdensomeness clusters, examining the sequence of acquisition of burdensomeness features identifying early determinants of health outcomes, analysing the sequence of sentinel conditions (the first LTC acquired in the lifecourse) and subsequent accrual of burden. As well as the LTCs required for MLTC-M research, these burdensomeness concepts include indicators of the 'work' associated with living with MLTC-M such as symptoms, emotions, indicators of financial stress and observable and measurable information relevant to health or healthcare, such as medical diagnoses, blood tests, appointments, hospital admissions and number of medications. ...

Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) -protocol for a research collaboration

Journal of Multimorbidity and Comorbidity

... However, there are only very limited population-based studies analyzing the overall pattern and characteristics of hospitalized people with Down syndrome across age groups. [1][2][3] Notably, a historical population-based study in Denmark analyzed hospitalization rates and primary reasons for hospitalization of people with Down Syndrome from 1977 to 2008 across age groups and compared it to the general population. The same study found higher rate ratios for hospitalizations were found among people with Down syndrome, especially until the age of 20 years. 2 Furthermore, a recently published population-based study from the UK based on records from family practices (outpatient data only), assessed morbidities of people with Down syndrome across the lifespan and found, that compared to the general population, the population with Down syndrome showed significantly increased risk ratios for developing dementia, hypothyroidism, epilepsy, and hematological malignancies. ...

Multiple morbidity across the lifespan in people with Down syndrome or intellectual disabilities: a population-based cohort study using electronic health records
  • Citing Article
  • April 2023

The Lancet Public Health

... Twenty-nine unique data sources were identified in these studies; five studies were conducted with data from the Clinical Practice Research Datalink (CPRD) [19][20][21][22][23] and two obtained data from the same two private family medicine clinics 24,25 EMR data for supporting AMS Six categories of EMR data used for supporting AMS were identified from the studies included in the review. These were, (i) assessing antimicrobial prescribing quality, 23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (ii) measuring the effectiveness of an intervention, 25,28,29,34,37,38,[40][41][42][43][44] (iii) analyzing antimicrobial prescribing trends, [22][23][24]26,27,31,36,37,39,[45][46][47][48][49][50][51][52] , (iv) assessing patient and provider characteristics in prescribing [21][22][23][24]26,27,31,32,36,38,39,47,49,51,52 (v) evaluating novel tools or measures 33,53 , and (vi) measuring specific conditions and outcomes. 19,23,35,48,50,52 The specific conditions and outcomes measured were: serious infection rates due to lower antibiotic prescribing, impetigo incidence, treatment and recurrence, prevalence and documentation quality of beta-lactam allergies, changes in antibiotic prescribing for different patient demographics and indications over time, male urinary tract infection prevalence, and pre-and post-pandemic respiratory tract infection (RTI) presentations. ...

Multi-faceted intervention to improve management of antibiotics for children presenting to primary care with acute cough and respiratory tract infection (CHICO): efficient cluster randomised controlled trial

The BMJ

... The number of children placed under the protection of the state has also increased by 20% between 2010 and 2020 [5]. Among general health indicators, British 5-year old boys are on average 7cm shorter than their European counterparts, a remarkable drop of 30 places in national ranks over 10 years [6]. ...

Diminishing benefits of urban living for children and adolescents’ growth and development

Nature

... Moreover, the diversity of dietary preferences leads to diversification of regional food production, supply and consumption patterns (Miller et al., 2022). Cultures and religions significantly affect animal product consumption. ...

Author Correction: Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity

Nature Food