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

Policy and practices in primary care that supported the provision and receipt of care for older persons during the COVID-19 pandemic: a qualitative case study in three Canadian provinces

Abstract Background The effects of the COVID-19 pandemic on older adults were felt throughout the health care system, from intensive care units through to long-term care homes. Although much attention has been paid to hospitals and long-term care homes throughout the pandemic, less attention has been paid to the impact on primary care clinics, which had to rapidly change their approach to deliver timely and effective care to older adult patients. This study examines how primary care clinics, in three Canadian provinces, cared for their older adult patients during the pandemic, while also navigating the rapidly changing health policy landscape. Methods A qualitative case study approach was used to gather information from nine primary care clinics, across three Canadian provinces. Interviews were conducted with primary care providers (n = 17) and older adult patients (n = 47) from October 2020 to September 2021. Analyses of the interviews were completed in the language of data collection (English or French), and then summarized in English using a coding framework. All responses that related to COVID-19 policies at any level were also examined. Results Two main themes emerged from the data: (1) navigating the noise: understanding and responding to public health orders and policies affecting health and health care, and (2) receiving and delivering care to older persons during the pandemic: policy-driven challenges & responses. Providers discussed their experiences wading through the health policy directives, while trying to provide good quality care. Older adults found the public health information overwhelming, but appreciated the approaches adapted by primary care clinics to continue providing care, even if it looked different. Conclusions COVID-19 policy and guideline complexities obliged primary care providers to take an important role in understanding, implementing and adapting to them, and in explaining them, especially to older adults and their care partners

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

A longitudinal analysis of health-related quality of life in survivors of intensive care

Bibliography: p. 155-162

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

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 < 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.El objetivo de este estudio fue examinar hasta qué punto se puede utilizar a los cuidadores para que proporcionen respuestas proxy para los clientes con demencia en un estudio sobre la aceptación de la tecnología GPS. Métodos: Cuarenta y cinco díadas cliente-cuidador utilizaron uno de los tres dispositivos GPS. Se utilizó la Teoría Unificada de Aceptación y Uso de la Tecnología (UTAUT) para crear dos cuestionarios, uno para los clientes con demencia y otro para los cuidadores, como sustitutos. Se utilizaron correlaciones bivariadas de Spearman rho de las respuestas para cada constructo de la UTAUT para comparar las respuestas de los clientes y los cuidadores tras el uso de los dispositivos GPS. Resultados: La edad media de los clientes era de 76,02 años (SD = 11,5). En general, tras el uso de los dispositivos GPS, las respuestas de los clientes y los cuidadores estaban correlacionadas y eran estadísticamente significativas (rxy escala sumativa global = 0,550). Además, 4 de los 6 constructos de la UTAUT estaban correlacionados y eran estadísticamente significativos (p < 0,05) (rxy Expectativa de rendimiento = 0,160; rxy Influencia social = 0,478; rxy Intención de comportamiento de uso = 0,347; y rxy Uso real = 0,570). Conclusiones: El grado de acuerdo entre los cuidadores y los clientes, especialmente para los constructos intención de uso y uso real de la tecnología GPS, sugiere que los cuidadores pueden responder en nombre de los clientes con demencia en los cuestionarios de aceptación de la tecnología

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

Mentoring a health technology assessment initiative in Kazakhstan

Objectives: The aim of this study was to assist in the development of a health technology assessment (HTA) program for the Ministry of Health (MOH) of the Republic of Kazakhstan. Methods: Mentoring of an initial HTA program in Kazakhstan was provided by the Canadian Society for International Health (CSIH) by means of a partnership with the Kazakhstan MOH. HTA materials, courses, and one-on-one support for the preparation of a series of initial HTA reports by MOH HTA staff were provided by a seven-member CSIH team over a 2.5-year project. Results: Guidance documents on HTA and institutional strengthening were prepared in response to an extensive set of deliverables developed by the MOH and the World Bank. Introductory and train-the-trainer workshops in HTA and economic evaluation were provided for MOH staff members, experts from Kazakhstan research institutes and physicians. Five short HTA reports were successfully developed by staff in the Ministry\u27s HTA Unit with assistance from the CSIH team. Challenges that may be relevant to other emerging HTA programs included lack of familiarity with some essential underlying concepts, organization culture, and limited time for MOH staff to do HTA work. Conclusions: The project helped to define the need for HTA and mentored MOH staff in taking the first steps to establish a program to support health policy decision making in Kazakhstan. This experience offers practical lessons for other emerging HTA programs, although these should be tailored to the specific context

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