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Stamp L, Te Karu L, Reid S, Wright DFB, Frampton C, Tuitaupe VS, Dalbeth N. Easing the way to achieving target serum urate in people with gout: protocol for a non-inferiority randomised strategy trial using an allopurinol dosing model in Aotearoa/New Zealand (the Easy-Allo Study). BMJ Open 2024; 14:e084665. [PMID: 39097306 PMCID: PMC11298718 DOI: 10.1136/bmjopen-2024-084665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/19/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Gout is one of the most common forms of arthritis worldwide. Gout is particularly prevalent in Aotearoa/New Zealand and is estimated to affect 13.1% of Māori men, 22.9% of Pacific men and 7.4% of New Zealand European men. Effective long-term treatment requires lowering serum urate to <0.36 mmol/L. Allopurinol is the most commonly used urate-lowering medication worldwide. Despite its efficacy and safety, the allopurinol dose escalation treat-to-target serum urate strategy is difficult to implement and there are important inequities in allopurinol prescribing in Aotearoa. The escalation strategy is labour intensive, time consuming and costly for people with gout and the healthcare system. An easy and effective way to dose-escalate allopurinol is required, especially as gout disproportionately affects working-age Māori men and Pacific men, who frequently do not receive optimal care. METHODS AND ANALYSIS A 12-month non-inferiority randomised controlled trial in people with gout who have a serum urate ≥ 0.36 mmol/l will be undertaken. 380 participants recruited from primary and secondary care will be randomised to one of the two allopurinol dosing strategies: intensive nurse-led treat-to-target serum urate dosing (intensive treat-to-target) or protocol-driven dose escalation based on dose predicted by an allopurinol dosing model (Easy-Allo). The primary endpoint will be the proportion of participants who achieve target serum urate (<0.36 mmol/L) at 12 months. ETHICS AND DISSEMINATION The New Zealand Northern B Health and Disability Ethics Committee approved the study (2022 FULL 13478). Results will be disseminated in peer-reviewed journals and to participants. TRIAL REGISTRATION NUMBER ACTRN12622001279718p.
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Affiliation(s)
- Lisa Stamp
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Leanne Te Karu
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, Aotearoa New Zealand
| | - Susan Reid
- Health Literacy NZ, Auckland, New Zealand
| | - Daniel F B Wright
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | | | - Nicola Dalbeth
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Cross M, Ong KL, Culbreth GT, Steinmetz JD, Cousin E, Lenox H, Kopec JA, Haile LM, Brooks PM, Kopansky-Giles DR, Dreinhoefer KE, Betteridge N, Abbasian M, Abbasifard M, Abedi A, Aboye MB, Aravkin AY, Artaman A, Banach M, Bensenor IM, Bhagavathula AS, Bhat AN, Bitaraf S, Buchbinder R, Burkart K, Chu DT, Chung SC, Dadras O, Dai X, Das S, Dhingra S, Do TC, Edinur HA, Fatehizadeh A, Fetensa G, Freitas M, Ganesan B, Gholami A, Gill TK, Golechha M, Goleij P, Hafezi-Nejad N, Hamidi S, Hay SI, Hundessa S, Iso H, Jayaram S, Kadashetti V, Karaye IM, Khan EA, Khan MAB, Khatatbeh MM, Kiadaliri A, Kim MS, Kolahi AA, Krishan K, Kumar N, Le TTT, Lim SS, Lobo SW, Majeed A, Malik AA, Mesregah MK, Mestrovic T, Mirrakhimov EM, Mishra M, Misra AK, Moberg ME, Mohamed NS, Mohan S, Mokdad AH, Momenzadeh K, Moni MA, Moradi Y, Mougin V, Mukhopadhyay S, Murray CJL, Narasimha Swamy S, Nguyen VT, Niazi RK, Owolabi MO, Padubidri JR, Patel J, Pawar S, Pedersini P, Rafferty Q, Rahman M, Rashidi MM, Rawaf S, Saad AMA, Sahebkar A, Saheb Sharif-Askari F, Saleh MMK, Schumacher AE, Seylani A, Singh P, Smith AE, Solanki R, Solomon Y, Tan KK, Tat NY, Tibebu NSS, You Y, Zheng P, Zitoun OA, Vos T, March LM, Woolf AD. Global, regional, and national burden of gout, 1990-2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. THE LANCET. RHEUMATOLOGY 2024; 6:e507-e517. [PMID: 38996590 PMCID: PMC11263476 DOI: 10.1016/s2665-9913(24)00117-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 04/08/2024] [Accepted: 04/24/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Gout is an inflammatory arthritis manifesting as acute episodes of severe joint pain and swelling, which can progress to chronic tophaceous or chronic erosive gout, or both. Here, we present the most up-to-date global, regional, and national estimates for prevalence and years lived with disability (YLDs) due to gout by sex, age, and location from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, as well as forecasted prevalence to 2050. METHODS Gout prevalence and YLDs from 1990 to 2020 were estimated by drawing on population-based data from 35 countries and claims data from the USA and Taiwan (province of China). Nested Bayesian meta-regression models were used to estimate prevalence and YLDs due to gout by age, sex, and location. Prevalence was forecast to 2050 with a mixed-effects model. FINDINGS In 2020, 55·8 million (95% uncertainty interval 44·4-69·8) people globally had gout, with an age-standardised prevalence of 659·3 (525·4-822·3) per 100 000, an increase of 22·5% (20·9-24·2) since 1990. Globally, the prevalence of gout in 2020 was 3·26 (3·11-3·39) times higher in males than in females and increased with age. The total number of prevalent cases of gout is estimated to reach 95·8 million (81·1-116) in 2050, with population growth being the largest contributor to this increase and only a very small contribution from the forecasted change in gout prevalence. Age-standardised gout prevalence in 2050 is forecast to be 667 (531-830) per 100 000 population. The global age-standardised YLD rate of gout was 20·5 (14·4-28·2) per 100 000 population in 2020. High BMI accounted for 34·3% (27·7-40·6) of YLDs due to gout and kidney dysfunction accounted for 11·8% (9·3-14·2). INTERPRETATION Our forecasting model estimates that the number of individuals with gout will increase by more than 70% from 2020 to 2050, primarily due to population growth and ageing. With the association between gout disability and high BMI, dietary and lifestyle modifications focusing on bodyweight reduction are needed at the population level to reduce the burden of gout along with access to interventions to prevent and control flares. Despite the rigour of the standardised GBD methodology and modelling, in many countries, particularly low-income and middle-income countries, estimates are based on modelled rather than primary data and are also lacking severity and disability estimates. We strongly encourage the collection of these data to be included in future GBD iterations. FUNDING Bill & Melinda Gates Foundation and the Global Alliance for Musculoskeletal Health.
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Stamp LK, Te Karu L. Reframing Gout Management to Empower Those Who Need It Most. Arthritis Rheumatol 2024; 76:507-509. [PMID: 37942922 DOI: 10.1002/art.42740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/15/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
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Pascart T, Wasik KA, Preda C, Chune V, Torterat J, Prud'homme N, Nassih M, Martin A, Le Masson J, Rodière V, Frogier S, Canova G, Pescheux JP, Shan Sei Fan C, Jauffret C, Claeys P, von Baeyer SL, Castel SE, Emde AK, Yerges-Armstrong L, Fox K, Leask M, Vitagliano JJ, Graf S, Norberciak L, Raynal J, Dalbeth N, Merriman T, Bardin T, Oehler E. The gout epidemic in French Polynesia: a modelling study of data from the Ma'i u'u epidemiological survey. Lancet Glob Health 2024; 12:e685-e696. [PMID: 38485432 DOI: 10.1016/s2214-109x(24)00012-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Gout is the most common cause of inflammatory arthritis worldwide, particularly in Pacific regions. We aimed to establish the prevalence of gout and hyperuricaemia in French Polynesia, their associations with dietary habits, their comorbidities, the prevalence of the HLA-B*58:01 allele, and current management of the disease. METHODS The Ma'i u'u survey was epidemiological, prospective, cross-sectional, and gout-focused and included a random sample of adults from the general adult population of French Polynesia. It was conducted and data were collected between April 13 and Aug 16, 2021. Participants were randomly selected to represent the general adult population of French Polynesia on the basis of housing data collected during the 2017 territorial census. Each selected household was visited by a research nurse from the Ma'i u'u survey who collected data via guided, 1-h interviews with participants. In each household, the participant was the individual older than 18 years with the closest upcoming birthday. To estimate the frequency of HLA-B*58:01, we estimated HLA-B haplotypes on individuals who had whole-genome sequencing to approximately 5× average coverage (mid-pass sequencing). A subset of individuals who self-reported Polynesian ancestry and not European, Chinese, or other ancestry were used to estimate Polynesian-ancestry specific allele frequencies. Bivariate associations were reported for weighted participants; effect sizes were estimated through the odds ratio (OR) of the association calculated on the basis of a logistic model fitted with weighted observations. FINDINGS Among the random sample of 2000 households, 896 participants were included, 140 individuals declined, and 964 households could not be contacted. 22 participants could not be weighted due to missing data, so the final weighted analysis included 874 participants (449 [51·4%] were female and 425 [48·6%] were male) representing the 196 630 adults living in French Polynesia. The estimated prevalence of gout was 14·5% (95% CI 9·9-19·2), representing 28 561 French Polynesian adults, that is 25·5% (18·2-32·8) of male individuals and 3·5% (1·0-6·0) of female individuals. The prevalence of hyperuricaemia was estimated at 71·6% (66·7-76·6), representing 128 687 French Polynesian adults. In multivariable analysis, age (OR 1·5, 95% CI 1·2-1·8 per year), male sex (10·3, 1·8-60·7), serum urate (1·6, 1·3-2·0 per 1 mg/dL), uraturia (0·8, 0·8-0·8 per 100 mg/L), type 2 diabetes (2·1, 1·4-3·1), BMI more than 30 kg/m2 (1·1, 1·0-1·2 per unit), and percentage of visceral fat (1·7, 1·1-2·7 per 1% increase) were associated with gout. There were seven heterozygous HLA-B*58:01 carriers in the full cohort of 833 individuals (seven [0·4%] of 1666 total alleles) and two heterozygous carriers in a subset of 696 individuals of Polynesian ancestry (two [0·1%]). INTERPRETATION French Polynesia has an estimated high prevalence of gout and hyperuricaemia, with gout affecting almost 15% of adults. Territorial measures that focus on increasing access to effective urate-lowering therapies are warranted to control this major public health problem. FUNDING Variant Bio, the French Polynesian Health Administration, Lille Catholic University Hospitals, French Society of Rheumatology, and Novartis.
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Affiliation(s)
- Tristan Pascart
- Service de Rhumatologie, Hôpital Saint-Philibert, Lille, France.
| | | | - Cristian Preda
- Department of Methodology and Biostatistics, Hôpital Saint-Philibert, Lille, France
| | - Valérie Chune
- Department of Biology, Centre Hospitalier de Polynésie Française, Pape'ete, Tahiti, French Polynesia
| | - Jérémie Torterat
- Institut de la Statistique de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Nicolas Prud'homme
- Institut de la Statistique de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Maryline Nassih
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France
| | - Agathe Martin
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France
| | - Julien Le Masson
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France
| | - Vahinetua Rodière
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France; Direction de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Sylvain Frogier
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France; Direction de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Georges Canova
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France; Direction de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Jean-Paul Pescheux
- Lille Catholic University and Research Department, Hôpital Saint-Philibert, Lille, France; Direction de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | | | | | - Patrick Claeys
- Department of Biology, Centre Hospitalier de Polynésie Française, Pape'ete, Tahiti, French Polynesia
| | | | | | | | | | - Keolu Fox
- Global Health Program, Department of Anthropology and Indigenous Futures Institute, Division of Design and Innovation, University of California San Diego, San Diego, CA, USA; Native BioData Consortium, Eagle Butte, SD, USA
| | - Megan Leask
- Division of Clinical Rheumatology and Immunology, University of Alabama, Birmingham, AL, USA; Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | | | - Sahara Graf
- Department of Methodology and Biostatistics, Hôpital Saint-Philibert, Lille, France
| | - Laurène Norberciak
- Department of Methodology and Biostatistics, Hôpital Saint-Philibert, Lille, France
| | - Jacques Raynal
- Ministère de la Santé de Polynésie Française, Papeete, Tahiti, French Polynesia
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tony Merriman
- Division of Clinical Rheumatology and Immunology, University of Alabama, Birmingham, AL, USA; Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
| | - Thomas Bardin
- National Institute of Health and Medical Research U1132, Université Paris-Cité, Hôpital Lariboisière, Paris, France
| | - Erwan Oehler
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier de Polynésie Française, Pape'ete, Tahiti, French Polynesia
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Helget LN, Mikuls TR. Health disparities in gout. Curr Opin Rheumatol 2024; 36:120-125. [PMID: 38131351 DOI: 10.1097/bor.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW Gout, the most common type of inflammatory arthritis in the world, is characterized by painful episodes of arthritis linked by asymptomatic intercritical periods of hyperuricemia. Once characterized as a disease of wealthy white men, contemporary evidence demonstrates gout disproportionately afflicts racial/ethnic minorities, Indigenous populations and other underrepresented groups leading to significant health disparities. RECENT FINDINGS Herein, we review the current literature reporting a higher incidence and prevalence of gout in racial/ethnic minorities and Indigenous populations, in addition to a growing gout burden reported in females. We also examine how these population are more likely to receive suboptimal treatment for flares and chronic phases of gout. Additionally, we examine biologic and social health determinants that may be contributing to these findings. SUMMARY Racial/ethnic minorities, Indigenous populations, and females have experienced a disproportionate rise in the prevalence and incidence of gout in recent years, are more likely to seek acute medical care and are less likely to receive optimal long-term care for gout with urate lowering therapy. Mechanisms underpinning these findings appear to be multifactorial and include differences in social determinants of care and in some cases may be due to population differences in select biologic factors such as differences in age, sex, genetics.
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Affiliation(s)
- Lindsay N Helget
- Veterans Affairs Nebraska-Western Iowa Healthcare System
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ted R Mikuls
- Veterans Affairs Nebraska-Western Iowa Healthcare System
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Brooks J, Montgomery A, Dalbeth N, Sapsford M, Ngan Kee R, Cooper A, Quincey V, Bhana S, Gore-Massy M, Hausmann J, Liew J, Machado PM, Sufka P, Sirotich E, Robinson P, Wallace Z, Yazdany J, Grainger R. Omicron variant infection in inflammatory rheumatological conditions - outcomes from a COVID-19 naive population in Aotearoa New Zealand. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 38:100843. [PMID: 37520279 PMCID: PMC10372177 DOI: 10.1016/j.lanwpc.2023.100843] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023]
Abstract
Background Due to geographic isolation and border controls Aotearoa New Zealand (AoNZ) attained high levels of population coronavirus disease-19 (COVID-19) vaccination before widespread transmission of COVID-19. We describe outcomes of SARS-CoV-2 infection (Omicron variant) in people with inflammatory rheumatic diseases in this unique setting. Methods This observational study included people with inflammatory rheumatic disease and SARS-CoV-2 infection in AoNZ between 1 February and 30 April 2022. Data were collected via the Global Rheumatology Alliance Registry including demographic and rheumatic disease characteristics, and COVID-19 vaccination status and outcomes. Multivariable logistic regression was used to explore associations of demographic and clinical factors with COVID-19 hospitalisation and death. Findings Of the 1599 cases included, 96% were from three hospitals that systematically identified people with inflammatory rheumatic disease and COVID-19. At time of COVID-19, 1513 cases (94.6%) had received at least two COVID-19 vaccinations. Hospitalisation occurred for 104 (6.5%) cases and 10 (0.6%) patients died. Lower frequency of hospitalisation was seen in cases who had received at least two vaccinations (5.9%), compared to the unvaccinated (20.6%) or those with a single vaccine dose (10.7%). In multivariable adjusted models, people with gout or connective tissue diseases (CTD) had increased risk of the combined outcome of hospitalisation/death, compared to people with inflammatory arthritis. Glucocorticoid and rituximab use were associated with increased rates of hospitalisation/death. All patients who died had three or more co-morbidities or were over 60 years old. Interpretation In this cohort with inflammatory rheumatic diseases and high vaccination rates, severe outcomes from SARS-CoV-2 Omicron variant were relatively infrequent. The outcome of Omicron variant infection among vaccinated but SARS-CoV-2 infection-naive people with inflammatory rheumatic disease without other known risk factors were favourable. Funding Financial support from the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR) included management of COVID-19 Global Rheumatology Alliance funds.
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Affiliation(s)
- Jonathon Brooks
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Anna Montgomery
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Te Whatu Ora Health New Zealand Te Toka Tumai Auckland, New Zealand
| | - Mark Sapsford
- Te Whatu Ora Health New Zealand Counties Manukau, Auckland, New Zealand
| | - Rachel Ngan Kee
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Amy Cooper
- Department of Medicine, University of Otago Wellington, New Zealand
| | - Vicki Quincey
- Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand
| | | | | | - Jonathan Hausmann
- Program in Rheumatology, Division of Immunology, Boston Children's Hospital, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Jean Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Pedro M. Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | | | - Philip Robinson
- University of Queensland School of Clinical Medicine, Herston, Queensland, Australia
- Department of Rheumatology, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Zachary Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, USA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, New Zealand
- Te Whatu Ora Health New Zealand Capital Coast and Hutt, Wellington, New Zealand
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Gustafson P, Abdul Aziz Y, Lambert M, Bartholomew K, Brown R, Carswell P, Fusheini A, Ratima M, Priest P, Crengle S. Supporting implementation of interventions to address ethnicity-related health inequities: frameworks, facilitators and barriers - a scoping review protocol. BMJ Open 2023; 13:e065721. [PMID: 36759027 PMCID: PMC9923318 DOI: 10.1136/bmjopen-2022-065721] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Health inequities are differences in health between groups of people that are avoidable, unfair and unjust. Achieving equitable health outcomes requires approaches that recognise and account for the differences in levels of advantage between groups. Implementation science, which studies how to translate evidence-based interventions into routine practice, is increasingly recognised as an approach to address health inequities by identifying factors and processes that enable equitable implementation of interventions. This article describes the protocol for a scoping review of the literature relating to the equitable implementation of interventions, focusing on ethnicity-related health inequities. The scoping review aims to identify equity-focused implementation science theories, models and frameworks (TMFs) and to synthesise and analyse the evidence relating to the factors that aid or inhibit equitable implementation of health interventions. METHODS AND ANALYSIS The scoping review is guided by the methodology developed by Arksey and O'Malley and enhanced by Levac and colleagues. Relevant literature will be identified by searching electronic databases, grey literature, hand-searching key journals and searching the reference lists and citations of studies that meet the inclusion criteria. We will focus on literature published from 2011 to the present. Titles, abstracts and full-text articles will be screened independently by two researchers; any disagreements will be resolved through discussion with another researcher. Extracted data will be summarised and analysed to address the scoping review aims. ETHICS AND DISSEMINATION The scoping review will map the available literature on equity-focused implementation science TMFs and the facilitators and barriers to equitable implementation of interventions. Ethical approval is not required. Dissemination of the results of the review will include publications in peer-review journals and conference and stakeholder presentations. Findings from the review will support those implementing interventions to ensure that the implementation pathway and processes are equitable, thereby improving health outcomes and reducing existing inequities.
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Affiliation(s)
- Papillon Gustafson
- Ngāi Tahu Māori Health Research Unit, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Yasmin Abdul Aziz
- Ngāi Tahu Māori Health Research Unit, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, University of Otago Division of Health Sciences, Dunedin, New Zealand
| | - Karen Bartholomew
- Te Whatu Ora - Health New Zealand Waitematā, Takapuna, New Zealand
- Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand
| | - Rachel Brown
- National Hauora Coalition, Auckland, New Zealand
| | | | - Adam Fusheini
- Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | | | - Patricia Priest
- Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, University of Otago Division of Health Sciences, Dunedin, New Zealand
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Stamp LK, Te Karu L. Gout in Indigenous people: inequity and culturally appropriate management. BMJ MEDICINE 2022; 1:e000279. [PMID: 36936590 PMCID: PMC9978684 DOI: 10.1136/bmjmed-2022-000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Leanne Te Karu
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, Auckland, New Zealand
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Abstract
The purpose of gout treatment is to alleviate symptoms of flares, prevent flares from recurring by lowering serum urate, and minimize structural joint damage and functional impairment. In recent years, several new medications to treat gout have been developed, and novel agents continue to be investigated, in addition to several long-established treatments. Although a number of effective therapies are available, optimal management and outcomes are frequently not achieved due to physician under prescribing of urate-lowering therapy (ULT) and poor adherence with therapy when it is prescribed. This article reviews recent developments in the management of gout with reference to recently published clinical guidelines, outlines some important questions regarding the safety and efficacy of particular agents, and remaining gaps in our knowledge about the most effective strategies for using currently available treatments.
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Affiliation(s)
- Lisa K Stamp
- Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Hamish Farquhar
- Department of Medicine, University of Otago Christchurch, PO Box 4345, Christchurch, 8140, New Zealand.
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