Serum Uric Acid and Coronary Heart Disease in 9,458 Incident Cases and 155,084 Controls: Prospective Study and Meta-Analysis

BACKGROUND: It has been suggested throughout the past fifty years that serum uric acid concentrations can help predict the future risk of coronary heart disease (CHD), but the epidemiological evidence is uncertain. METHODS AND FINDINGS: We report a “nested” case-control comparison within a prospective study in Reykjavik, Iceland, using baseline values of serum uric acid in 2,456 incident CHD cases and in 3,962 age- and sex-matched controls, plus paired serum uric acid measurements taken at baseline and, on average, 12 y later in 379 participants. In addition, we conducted a meta-analysis of 15 other prospective studies in eight countries conducted in essentially general populations. Compared with individuals in the bottom third of baseline measurements of serum uric acid in the Reykjavik study, those in the top third had an age- and sex-adjusted odds ratio for CHD of 1.39 (95% confidence interval [CI], 1.23–1.58) which fell to 1.12 (CI, 0.97–1.30) after adjustment for smoking and other established risk factors. Overall, in a combined analysis of 9,458 cases and 155,084 controls in all 16 relevant prospective studies, the odds ratio was 1.13 (CI, 1.07–1.20), but it was only 1.02 (CI, 0.91–1.14) in the eight studies with more complete adjustment for possible confounders. CONCLUSIONS: Measurement of serum uric acid levels is unlikely to enhance usefully the prediction of CHD, and this factor is unlikely to be a major determinant of the disease in general populations

From recommendation to action: psychosocial factors influencing physician intention to use Health Technology Assessment (HTA) recommendations

BACKGROUND: Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. The selected recommendations were prioritisation systems for patients on waiting lists for two surgical procedures: hip and knee replacement and cataract surgery. METHODS: Determinants of physician intention to use HTA recommendations for patient prioritisation were assessed by a questionnaire based upon the Theory of Interpersonal Behaviour. A total of 96 physicians from two medical specialties (ophthalmology and orthopaedic surgery) responded to the questionnaire (response rate 44.2%). A multiple analysis of variance (MANOVA) was performed to assess differences between medical specialties on the set of theoretical variables. Given the main effect difference between specialties, two regression models were tested separately to assess the psychosocial determinants of physician intention to use HTA recommendations for the prioritisation of patients on waiting lists for surgical procedures. RESULTS: Factors influencing physician intention to use HTA recommendations differ between groups of specialists. Intention to use the prioritisation system for patients on waiting lists for cataract surgery among ophthalmologists was related to attitude towards the behaviour, social norms, as well as personal normative beliefs. Intention to use HTA recommendations for patient prioritisation for hip and knee replacement among orthopaedic surgeons was explained by: perception of conditions that facilitated the realisation of the behaviour, personal normative beliefs, and habit of using HTA recommendations in clinical work. CONCLUSION: This study offers a model to assess factors influencing the intention to adopt recommendations from health technology assessment into professional practice. Results identify determinant factors that should be considered in the elaboration of strategies to support the implementation of evidence-based practice, with respect to emerging health technologies and modalities of practice. However, it is important to emphasise that behavioural determinants of evidence-based practice vary according to the specific technology considered. Evidence-based implementation of HTA recommendations, as well as other evidence-based practices, should build on a theoretical understanding of the complex forces that shape the practice of healthcare professionals

Caregivers as a proxy for responses of dementia clients in a GPS technology acceptance study

Objective: The objective of this study was to examine the extent to which caregivers can be used to provide proxy responses for dementia clients in a study on the acceptance of GPS technology. Methods: Forty-five client–caregiver dyads used one of three GPS devices. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to create two questionnaires, one for dementia clients and one for caregivers, as proxies. Spearman rho bivariate correlations of responses for each UTAUT construct were used to compare the client and caregiver responses post-usage of the GPS devices. Results: The mean age of the clients was 76.02 years (SD = 11.5). Overall, after using the GPS devices, the responses of the clients and caregivers were correlated and statistically significant (rxy Overall summative scale = 0.550). In addition, 4 out of 6 constructs of the UTAUT were correlated and statistically significant (p and lt; 0.05) (rxy Performance Expectancy = 0.160; rxy Social Influence = 0.478; rxy Behavioural Intention to Use = 0.347; and rxy Actual Use = 0.570). Conclusion: The degree of agreement between the caregivers and clients, especially for the constructs intention to use and actual use of the GPS technology, suggested that caregivers can respond on behalf of dementia clients on technology acceptance questionnaires. © 2018 Informa UK Limited, trading as Taylor and Francis Group

Caregivers as a proxy for responses of dementia clients in a GPS technology acceptance study

Objective: The objective of this study was to examine the extent to which caregivers can be used to provide proxy responses for dementia clients in a study on the acceptance of GPS technology. Methods: Forty-five client–caregiver dyads used one of three GPS devices. The Unified Theory of Acceptance and Use of Technology (UTAUT) was used to create two questionnaires, one for dementia clients and one for caregivers, as proxies. Spearman rho bivariate correlations of responses for each UTAUT construct were used to compare the client and caregiver responses post-usage of the GPS devices. Results: The mean age of the clients was 76.02 years (SD = 11.5). Overall, after using the GPS devices, the responses of the clients and caregivers were correlated and statistically significant (rxy Overall summative scale = 0.550). In addition, 4 out of 6 constructs of the UTAUT were correlated and statistically significant (p and lt; 0.05) (rxy Performance Expectancy = 0.160; rxy Social Influence = 0.478; rxy Behavioural Intention to Use = 0.347; and rxy Actual Use = 0.570). Conclusion: The degree of agreement between the caregivers and clients, especially for the constructs intention to use and actual use of the GPS technology, suggested that caregivers can respond on behalf of dementia clients on technology acceptance questionnaires. © 2018 Informa UK Limited, trading as Taylor and Francis Group

Acceptance of Global Positioning System (GPS) Technology Among Dementia Clients and Family Caregivers

The purpose of this study was to examine the acceptance of Global Positioning System (GPS) used to help people with dementia, who are at risk for wandering in their communities. We used a mixed methods research approach that included use logs, pre and post paper-based questionnaires, and focus groups. Forty-five client-caregiver pairs (dyads) were included to use one of the GPS devices for an average of 5.8 months over a 1-year period. GPS acceptance was high; dyads were likely to continue using the GPS. According to the participants, the GPS provided caregivers peace of mind and reduced anxiety in dyads when clients got lost. © 2017 Taylor and Francis Group, LLC

Acceptance of Global Positioning System (GPS) Technology Among Dementia Clients and Family Caregivers

"The purpose of this study was to examine the acceptance of Global Positioning System (GPS) used to help people with dementia, who are at risk for wandering in their communities. We used a mixed methods research approach that included use logs, pre and post paper-based questionnaires, and focus groups. Forty-five client-caregiver pairs (dyads) were included to use one of the GPS devices for an average of 5.8 months over a 1-year period. GPS acceptance was high; dyads were likely to continue using the GPS. According to the participants, the GPS provided caregivers peace of mind and reduced anxiety in dyads when clients got lost. © 2017 Taylor and Francis Group, LLC.

Meta-Analysis of Prospective Observational Studies of Serum Uric Acid and CHD in Essentially General Populations, Subdivided by Sex

<p>Conventions are the same as in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020076#pmed-0020076-g001" target="_blank">Figure 1</a>. Combined odds ratios and their CIs are indicated by unshaded diamonds for subtotals and shaded diamonds for grand totals. +, adjustment reported only for age and sex; ++, adjustment for these plus smoking; +++, adjustment for these plus some additional established risk factors; ++++, adjustment for these plus existing cardiovascular disease. Study abbreviations: ARIC, Atherosclerosis Risk in Communities; BIRNH, Belgium Interuniversity Research on Nutrition and Health; BRHS, British Regional Heart Study; CHA, Chicago Heart Association Detection Project in Industry; GRIPS, Göttingen Risk Incidence and Prevalence Study; IIHDS, Israeli Ischemic Heart Disease Study; MONICA, World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease; NHANES, National Health and Nutrition Examination Survey; NHEFS, NHANES I Epidemiologic Follow-Up Study; PROCAM, Prospective Cardiovascular Munster Study.</p

Prospective Studies of the Association of Serum Uric Acid and CHD, Grouped by Various Characteristics

<p>Conventions are the same as in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020076#pmed-0020076-g001" target="_blank">Figure 1</a>. *, each sex-specific estimate was treated as a “study”; †, two studies (6 and 13) were drawn from general practice registers; §, risk factors adjusted for included: smoking, blood pressure, total cholesterol, triglycerides, alcohol consumption, obesity, use of cardiovascular medication, history of hypertension, and history of diabetes. PTA, phosphotungstic acid.</p

Associations between Serum Uric Acid and CHD in 2,456 cases and 3,962 Controls in the Reykjavik Study at Different Levels of Established Risk Factors

<p>Squares indicate odds ratios, with the size of the square proportional to the effective sample size.</p