•This co-produced study explores how young people experience and conceptualise ‘feeling (mis)understood’ by adults.•Feeling understood by adults has a positive impact on young people’s mental health ...and help-seeking.•When young people feel misunderstood by health and social care professionals, it can negatively impact help-seeking.•Health and social care professionals should help young people to feel understood in to support engagement.
The subjective and emotional experience of feeling (mis)understood by another person is distinct from being literally (mis)understood. While there is literature exploring young people’s experiences of feeling (mis)understood in therapeutic or clinical settings by adults and the impacts thereof, there is limited exploration of young people’s conceptualisations and perspectives of feeling (mis)understood within a range of young person-supporting adult relationships. This paper reports on the first stage of a project that was co-designed and co-produced by young people, exploring how young people experience and conceptualise ‘feeling (mis)understood’ in the context of receiving support from adults in their lives. This initial stage of the project captures young people’s views on what feeling (mis)understood feels like, its impact on their mental health, and how adults can help young people to feel understood. Conceptualisation, design, fieldwork, analysis and writing were all co-produced with peer-researchers. Data for this project was generated through four workshops each held in England, Scotland, Wales and Northern Ireland. A total of 26 participants aged between 16 and 24 years of age took part in these workshops, and each workshop was facilitated by two peer-researchers and a member of university staff. Data was analysed through collaborative thematic analysis. The study found that feeling understood by supporting adults has a very positive impact on young people’s wellbeing, mental health and help-seeking behaviour. Feeling misunderstood was found to have the converse effect, and in addition was found to make young people less likely to seek further support. Young people also identified a number of key actions adults can take to help the young people they support feel better understood. The findings of this research suggest that practitioners in the health and social care sector working with young people should consider the ways in which they can help young people feel better understood.
Febuxostat and allopurinol are urate-lowering therapies used to treat patients with gout. Following concerns about the cardiovascular safety of febuxostat, the European Medicines Agency recommended a ...post-licensing study assessing the cardiovascular safety of febuxostat compared with allopurinol.
We did a prospective, randomised, open-label, blinded-endpoint, non-inferiority trial of febuxostat versus allopurinol in patients with gout in the UK, Denmark, and Sweden. Eligible patients were 60 years or older, already receiving allopurinol, and had at least one additional cardiovascular risk factor. Those who had myocardial infarction or stroke in the previous 6 months or who had severe congestive heart failure or severe renal impairment were excluded. After a lead-in phase in which allopurinol dose was optimised towards achieving a serum urate concentration of less than 0·357 mmol/L (<6 mg/dL), patients were randomly assigned (1:1, with stratification according to previous cardiovascular events) to continue allopurinol (at the optimised dose) or start febuxostat at 80 mg/day, increasing to 120 mg/day if necessary to achieve the target serum urate concentration. The primary outcome was a composite of hospitalisation for non-fatal myocardial infarction or biomarker-positive acute coronary syndrome; non-fatal stroke; or cardiovascular death. The hazard ratio (HR) for febuxostat versus allopurinol in a Cox proportional hazards model (adjusted for the stratification variable and country) was assessed for non-inferiority (HR limit 1·3) in an on-treatment analysis. This study is registered with the EU Clinical Trials Register (EudraCT 2011-001883-23) and ISRCTN (ISRCTN72443728) and is now closed.
From Dec 20, 2011, to Jan 26, 2018, 6128 patients (mean age 71·0 years SD 6·4, 5225 85·3% men, 903 14·7% women, 2046 33·4% with previous cardiovascular disease) were enrolled and randomly allocated to receive allopurinol (n=3065) or febuxostat (n=3063). By the study end date (Dec 31, 2019), 189 (6·2%) patients in the febuxostat group and 169 (5·5%) in the allopurinol group withdrew from all follow-up. Median follow-up time was 1467 days (IQR 1029–2052) and median on-treatment follow-up was 1324 days (IQR 870–1919). For incidence of the primary endpoint, on-treatment, febuxostat (172 patients 1·72 events per 100 patient-years) was non-inferior to allopurinol (241 patients 2·05 events per 100 patient-years; adjusted HR 0·85 95% CI 0·70–1·03, p<0·0001). In the febuxostat group, 222 (7·2%) of 3063 patients died and 1720 (57·3%) of 3001 in the safety analysis set had at least one serious adverse event (with 23 events in 19 0·6% patients related to treatment). In the allopurinol group, 263 (8·6%) of 3065 patients died and 1812 (59·4%) of 3050 had one or more serious adverse events (with five events in five 0·2% patients related to treatment). Randomised therapy was discontinued in 973 (32·4%) patients in the febuxostat group and 503 (16·5%) patients in the allopurinol group.
Febuxostat is non-inferior to allopurinol therapy with respect to the primary cardiovascular endpoint, and its long-term use is not associated with an increased risk of death or serious adverse events compared with allopurinol.
Menarini, Ipsen, and Teijin Pharma Ltd.
Co-production, a form of collaborative working, is guided by principles including valuing all participants, building on individual strengths, blurring distinctions between roles, delivering benefits ...for all participants, building support networks and supporting people to deliver work themselves. This article explores how co-production is understood by young people and researchers and how co-production principles can be applied within a research context. We identify challenges of implementing existing co-production frameworks in research and key areas to consider for future work.
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