ME/CFS Fibromyalgia

The author observed a significant overlap (over 40 percent) when comparing key symptoms for Post Viral Fatigue Syndrome or Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/cfs) with Attention-Deficit/Hyperactivity Disorder (ADHD). The conclusion of the observation is achieved by using simple, patient completed charts and/or patient anecdotes. The problem is that patients struggle even with such simple tasks and it is estimated that approximately 55 percent of ADHD patients develop dementia or other mental illnesses when not diagnosed and treated promptly: "ADHD in adults is perhaps the most prevalent frontal lobe disorder in humans, ultimately impacting upon psychosocial management and treatment strategies."; "Pediatric ADHD is associated with significantly higher rates of all types of pediatric infectious diseases, use of all kinds of antiinfective agents, and primary care physician and specialist visits."; "Epstein-Barr Virus (EBV) seropositivity was associated with learning disability and special education among children. Therefore, if EBV is causally associated with conditions of learning disability and needing special education in childhood, prevention and/or treatment strategies of EBV infection could serve to reduce related conditions in the general US child population." (full research articles on last page). EBV can be transmitted by a single kiss so it is ubiquitous in humans. Because there is no vaccine, approved anti-viral or obvious signs of early reactivation, EBV lies dormant until it awakens to cause mysterious health problems throughout life. The goals of this paper are: to encourage comprehensive medical studies about the causes and treatments of ADHD in children and adults specifically triggered by EBV and/or other herpes viruses; to include patients in such studies (with symptom charts and historical anecdotes) to ensure that their medical cases are documented with recovery protocols so that other patients do not decline and suffer further; to provide ongoing patient support at work, home or in communities for those coping alone with the illness.

Human herpesvirus 6A (HHV-6A) and human herpesvirus 6B (HHV-6B) are associated with a variety of conditions including rash, fever, and encephalitis and may play a role in several neurological diseases. Here luciferase immunoprecipitation systems (LIPS) was used to develop HHV-6 serologic diagnostic tests using antigens encoded by the U11 gene from HHV-6A (p100) and HHV-6B (p101). Analysis of the antibody responses against Renilla luciferase fusions with different HHV-6B p101 fragments identified an antigenic fragment (amino acids 389 to 858) that demonstrated ~86% seropositivity in serum samples from healthy US blood donors. Additional experiments detected a HHV-6A antigenic fragment (amino acids 751-870) that showed ~48% antibody seropositivity in samples from Mali, Africa, a known HHV-6A endemic region. In contrast to the high levels of HHV-6A immunoreactivity seen in the African samples, testing of US blood donors with the HHV-6A p100 antigenic fragment revealed little immunoreactivity. To potentially explore the role of HHV-6 infection in human disease, a blinded cohort of controls (n=59) and chronic fatigue syndrome (CFS) patients (n=72) from the US was examined for serum antibodies. While only a few of the controls and CFS patients showed high level immunoreactivity with HHV-6A, a majority of both the controls and CFS patients showed significant immunoreactivity with HHV-6B. However, no statistically significant differences in antibody levels or frequency of HHV-6A or HHV-6B infection were detected between the controls and CFS patients. These findings highlight the utility of LIPS for exploring the seroepidemiology of HHV-6A and HHV-6B infection, but suggest that these viruses are unlikely to play a role in the pathogenesis of CFS.

Persistent infections with herpes simplex virus types HSV-1 and HSV-2 and human papillomavirus (HPV) depend on immune evasion to maintain lifelong latency or epithelial persistence. Clinical manifestations vary widely, driven by host immune competence, oxidative stress, and inflammatory tone. This report presents two anonymised cases: one individual with recurrent orolabial HSV-1 accompanied by a physician-attributed sensation of intracranial fluid buildup, and another with persistent HPV. Both received Active Hexose Correlated Compound (AHCC) at 1,000 mg weekly, alongside dietary improvements and vitamin supplementation. Symptom frequency and severity decreased, including the resolution of the neurological complaint. Existing evidence supports AHCC's role in enhancing NK-cell activity, T-cell responses, and redox homeostasis, with stronger data for HPV clearance than HSV suppression. These observations, though anecdotal and uncontrolled, suggest that low-dose AHCC may help modulate the host-virus equilibrium. The author hypothesises that similar benefits could extend to EpsteinBarr virus (EBV) based on shared immune-redox mechanisms.

Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) impacts up to 257,000 (1%) in Australia. Whilst various entities purport to represent the ME/CFS community on issues of policy, there has been no specific entity that addresses the specific legal issues that arise for patients, nor a diversified source of legally focuses ME/CFS resources. ME/CFS Legal Resources Ltd is a new charitable entity in the Australian landscape, although one that has been an informal entity for 25 years. This entity is unique throughout the world in its construct and focus. Whilst the entity uses a board structure for governance of its operations, the organisation will be looking to advisory boards to provide expert advice and resources to meet the advocacy and information needs of people within the ME/CFS Community.

Objectives: The objective of this conceptual framework is to propose a structure to guide ME/CFS specific legal entities within other jurisdictions throughout the world.

Methods: ME/CFS Legal explored the literature and examples of advisory boards within the existing business community to identify the benefits of such an approach to boards of directors and the execution of the business plans and objectives.

Results: Advisory boards can be constructed to advise of matters of strategy, community members, users or peers. Advisory boards can provide expertise in a specific area of interest, assist in building networks, improve strategic thinking, create validation and credibility and improve motivation and credibility. When setting up an advisory board, various considerations must be taken into account, including: Defining the purpose and scope of the board; having a strategic and focused approach to recruiting qualified members; establishing clear roles and responsibilities; facilitating effective meetings; establishing evaluation frameworks; managing expectations; taking account of legal and ethical considerations. Given the international reach of ME/CFS and similarity of some issues within the community, members of the advisory board could be drawn from overseas jurisdictions to enhance the ideas and perspectives that influence the board's approaches.

Conclusion: Within ME/CFS, the place of the legal profession is quite important. Aside from the legal nature of legislative instruments, the framework of the justice system for enforcement of rights by people with ME/CFS is quite diverse and complex. With qualified individuals from a legal background, coupled with expertise from the medical, welfare and healthcare sectors, there is a potential to better serve the ME/CFS community through resources, information and advocacy that is better focused and more credible for their needs and interests.
Geoffrey Hallmann
B.Bus.(Hons)(UNE-NR), LLB (Hons)(UON), DipLegPrac (UON), DipFinPlan (Deakin), LLM (Enterprise Governance)(Bond), MClinEpid (UON), MPubHlth (Griffith), MBA (SCU)

Mob: + 61 4 14 014 365
Email: [email protected]

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) impacts up to, if not more than, 257,000 (1%) Australians. Social determinants of health are non-medical factors that influence an individual’s health outcomes.  Such factors include the conditions into which people are situated (eg where they are born, grow, work, live and age) and those forces and systems that shape the conditions of their daily life (eg economic policies and systems, social norms and policies, political systems and development agendas).  The World Health Organisation identifies five key domains of relevance being economic stability, education access and quality, healthcare access and quality, neighbourhood and built environment, and social and community context.

OBJECTIVES: To utilise a modified grounded theory study of persons with ME/CFS in Australia to examine their health issues and experience of interacting with institutions and identify the themes arising from participant lived experiences that are shaped by the social determinants of health.

METHOD: A literature review was conducted to examine the key issues that impact people with ME/CFS and guide potential points of interaction with social institutions.  Ethics approval ECN-08-146 was granted.  A pilot study of 3 interviews was carried out and the questionnaire was refined.  A further 16 participants with ME, CFS or ME/CFS were selected, across a range of severities.  A purposive and snowballing sampling strategy was applied. Participants came from the east coast of Australia between Brisbane and Melbourne.  Recordings were transcribed.  Notes and memorandums were recoded between interviews and preliminary issues/themes and connections evolved.  Saturation was achieved.  Manual open coding occurred, then was carried out within NVIVO.  Following establishment of the tentative core/sub-core codes, selective coding was applied.  Themes and categories were merged and created as required.  Participants were invited to verify the identified themes. Themes, emerging themes and categories were matched against extant and evolving literature to assess validity.  Rigour was maintained via reflexivity, regular peer debriefing and review of transcripts and coding, feedback and cross checking. 

RESULTS: Six themes arose: Barriers to equitable healthcare access; socioeconomic and employment instability; Stigma, dismissal and social judgement; social support and resilience; bureaucratic and institutional power imbalances; Coping strategies and psychological adaptation.

DISCUSSION AND CONCLUSION: The study demonstrates that the social determinants of health significantly shaped the lived experience of the ME/CFS participants.  Four dominant themes arose - being healthcare inequity, socioeconomic precarity, stigma and bureaucratic control.  In contrast two mitigating factors arose to counter these themes, being strong social networks and psychological resilience.  Social determinants are addressed via systemic reform of the key domains impacting the lives of those with ME/CFS, including the promotion of compassionate and inclusive care practices

REFERENCES:
Fukuda, K., Straus, S. E., Hickie, I., Sharpe, M. C., Dobbins, J. G., Komaroff, A.et al (1994). The Chronic Fatigue Syndrome: A comprehensive approach to its definition and study. Annals of internal medicine, 121(12), 953-959. https://doi.org/10.7326/0003-4819-121-12-199412150-00009
Carruthers, B. M., Jain, A. K., De Meirleir, K., Peterson, D. L., Klimas, N. G., Lerner, A. M., et al. (2003). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols. Journal of Chronic Fatigue Syndrome, 11(1), 7-115 https://doi.org/10.1300/J092v11n01_02
Ramsay, A. M. (1986). Post Viral Fatigue Syndrome: The Saga of the Royal Free Disease. London, UK: Gower Medical Publishing
World Health Organization. (2023). Social Determinants of Health. Retrieved from https://www.who.int/health-topics/social-determinants-of-health

Geoffrey Hallmann
B.Bus.(Hons)(UNE-NR), LLB (Hons)(UON), DipLegPrac (UON), DipFinPlan (Deakin), LLM (Enterprise Governance)(Bond), MClinEpid (UON), MPubHlth (Griffith), MBA (SCU)

Ph: + 61 2 66241979
Mob: + 61 4 14 014 365
[email protected]

Jade Barclay, BIT, MPH, MBA, MCounsPsych, PhD
Rosanne Coutts BHMSc(Hons), PhD

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) impacts up to, if not more than, 257,000 (1%) Australians.  The living arrangements of people with ME/CFS is an area where there is a dearth of literature.  Some literature, whilst relevant, addresses indirect issues such as homebound people. quality of life, welfare/benefit interactions and stigma/legitimacy.  Conversely the broader literature on disability and chronic illness accords insight into the role of housing in health outcomes, impact of instability on mental health and illness, stability, accessibility and disadvantage.  As to the specific lived experience of housing and living arrangements in ME/CFS, the literature appears to be silent.

OBJECTIVES: To utilise a modified grounded theory study of persons with ME/CFS in Australia to examine their health issues and experience of interacting with institutions and identify the themes arising from participant lived experiences that are shaped by their housing and living arrangements.

METHOD: A literature review was conducted to examine the key issues that impact people with ME/CFS and guide potential points of interaction with social institutions.  Ethics approval ECN-08-146 was granted.  A pilot study of 3 interviews was carried out and the questionnaire was refined.  A further 16 participants with ME, CFS or ME/CFS were selected, across a range of severities.  A purposive and snowballing sampling strategy was applied. Participants came from the east coast of Australia between Brisbane and Melbourne.  Recordings were transcribed.  Notes and memorandums were recoded between interviews and preliminary issues/themes and connections evolved.  Saturation was achieved.  Manual open coding occurred, then was carried out within NVIVO.  Following establishment of the tentative core/sub-core codes, selective coding was applied.  Themes and categories were merged and created as required.  Participants were invited to verify the identified themes. Themes, emerging themes and categories were matched against extant and evolving literature to assess validity.  Rigour was maintained via reflexivity, regular peer debriefing and review of transcripts and coding, feedback and cross checking. 

RESULTS: Eight broad themes arose: Return to parental or family homes; Housing instability and transience; Financial hardship and access to support; Psychosocial isolation and constrained space; Family support and strain; Dependence on social and welfare systems; Emotional and identity consequences of housing dependence; Lack of accessible or supported housing options.

DISCUSSION AND CONCLUSION: The study demonstrates that there are significant challenges identified by the participants with respect to housing and living arrangements. Such challenges are linked to illness severity, socioeconomic vulnerability and systemic neglect.  The inadequacy of formal care and housing supports is arguably reflective of the broader structural inequalities of the health and welfare systems, whilst a lack of understanding among policy institutions, coupled with inaccessible bureaucratic processes compound the marginalisation of people with ME/CFS.  The consequence of these issues is the reliance on informal networks and inappropriate living arrangements.  The need for housing reforms are strongly indicated to provide stability, dignity and management of people with ME/CFS.

REFERENCES:
Fukuda, K., Straus, S. E., Hickie, I., Sharpe, M. C., Dobbins, J. G., Komaroff, A.et al (1994). The Chronic Fatigue Syndrome: A comprehensive approach to its definition and study. Annals of internal medicine, 121(12), 953-959. https://doi.org/10.7326/0003-4819-121-12-199412150-00009
Carruthers, B. M., Jain, A. K., De Meirleir, K., Peterson, D. L., Klimas, N. G., Lerner, A. M., et al. (2003). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols. Journal of Chronic Fatigue Syndrome, 11(1), 7-115 https://doi.org/10.1300/J092v11n01_02
Ramsay, A. M. (1986). Post Viral Fatigue Syndrome: The Saga of the Royal Free Disease. London, UK: Gower Medical Publishing

Geoffrey Hallmann
B.Bus.(Hons)(UNE-NR), LLB (Hons)(UON), DipLegPrac (UON), DipFinPlan (Deakin), LLM (Enterprise Governance)(Bond), MClinEpid (UON), MPubHlth (Griffith), MBA (SCU)

Ph: + 61 2 66241979
Mob: + 61 4 14 014 365
[email protected]
Geoffrey Hallmann, BBus(Hons), LLB (Hons), DipLegPrac, DipFinPlan, LLMEntGov, MClinEpid, MPH, MBA

Jade Barclay, BIT, MPH, MBA, MCounsPsych, PhD

Rosanne Coutts BHMSc(Hons), PhD

Background: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) impacts up to 257,000 (1%) in Australia. Whilst various entities purport to represent the ME/CFS community on issues of policy, there has been no specific entity that addresses the specific legal issues that arise for patients, nor a diversified source of legally focuses ME/CFS resources. ME/CFS Legal Resources Ltd is a new charitable entity in the Australian landscape, although one that has been an informal entity for 25 years. This entity is unique throughout the world in its construct and focus. Whilst the entity uses a board structure for governance of its operations, the organisation will be looking to advisory boards to provide expert advice and resources to meet the advocacy and information needs of people within the ME/CFS Community.

Objectives: The objective of this conceptual framework is to propose a structure to guide ME/CFS specific legal entities within other jurisdictions throughout the world.

Methods: ME/CFS Legal explored the literature and examples of advisory boards within the existing business community to identify the benefits of such an approach to boards of directors and the execution of the business plans and objectives.

Results: Advisory boards can be constructed to advise of matters of strategy, community members, users or peers. Advisory boards can provide expertise in a specific area of interest, assist in building networks, improve strategic thinking, create validation and credibility and improve motivation and credibility. When setting up an advisory board, various considerations must be taken into account, including: Defining the purpose and scope of the board; having a strategic and focused approach to recruiting qualified members; establishing clear roles and responsibilities; facilitating effective meetings; establishing evaluation frameworks; managing expectations; taking account of legal and ethical considerations. Given the international reach of ME/CFS and similarity of some issues within the community, members of the advisory board could be drawn from overseas jurisdictions to enhance the ideas and perspectives that influence the board's approaches.

Conclusion: Within ME/CFS, the place of the legal profession is quite important. Aside from the legal nature of legislative instruments, the framework of the justice system for enforcement of rights by people with ME/CFS is quite diverse and complex. With qualified individuals from a legal background, coupled with expertise from the medical, welfare and healthcare sectors, there is a potential to better serve the ME/CFS community through resources, information and advocacy that is better focused and more credible for their needs and interests.
Geoffrey Hallmann
B.Bus.(Hons)(UNE-NR), LLB (Hons)(UON), DipLegPrac (UON), DipFinPlan (Deakin), LLM (Enterprise Governance)(Bond), MClinEpid (UON), MPubHlth (Griffith), MBA (SCU)

Mob: + 61 4 14 014 365
Email: [email protected]

We describe a group of patients with Epstein-Barr virus (EBV) infection and joint involvement. Between February 2011 and January 2012, there were six cases in our unit. Two presented with a pattern similar to rheumatoid arthritis, three had polyarthralgia with an inflammatory pattern and only one patient had asymmetrical oligoarthritis of large joints. They were all women aged between 25 and 75 (4 were of childbearing potential). Diagnosis in all the cases was made by exclusion of other possible causes and negative IgM were obtained for the rest of the "Herpesviridae" family viruses. In our series, EBV joint involvement was more common in women of childbearing potential. Clinical presentation was heterogeneous but was predominantly in the form of inflammatory joint pain. When it presents in the form of symmetrical polyarthritis, it can become chronic and require the use of disease-modifying anti-rheumatic drugs.

We describe a group of patients with Epstein-Barr virus (EBV) infection and joint involvement. Between February 2011 and January 2012, there were six cases in our unit. Two presented with a pattern similar to rheumatoid arthritis, three had polyarthralgia with an inflammatory pattern and only one patient had asymmetrical oligoarthritis of large joints. They were all women aged between 25 and 75 (4 were of child-bearing potential). Diagnosis in all the cases was made by exclusion of other possible causes and negative IgM were obtained for the rest of the "Herpesviridae" family viruses. In our series, EBV joint involvement was more common in women of childbearing potential. Clinical presentation was heterogeneous but was predominantly in the form of inflammatory joint pain. When it presents in the form of symmetrical polyarthritis, it can become chronic and require the use of disease-modifying anti-rheumatic drugs.

Gammaretroviruses of three distinct host range tropisms have been isolated from the laboratory mouse. These viruses differ in receptor usage, distribution among wild mouse species and strains of laboratory mice, pathogenicity and sensitivity to host restriction factors. Two of these three host range groups, the xenotropic and polytropic mouse leukemia viruses (together termed XP-MLVs) are widely distributed in house mouse species, mice that live in closest contact with humans. XP-MLVs rely on the XPR1 receptor for entry into cells as does the xenotropic murine leukemia virus-related virus (XMRV) initially identified in human patient samples. Despite their initial description as viruses incapable of infecting mouse cells, the xenotropic viruses have the broadest host range of the MLVs. Nearly all nonrodent mammals are susceptible to X-MLVs, as are all wild mouse species and some inbred strains of laboratory mice. Their XPR1 receptor is highly polymorphic, and there are 5 functional variants of Xpr1 in Mus species and laboratory mouse strains that differ in their ability to support entry of XMRV and various isolates of XP-MLVs. The distribution of XP-MLVs and Xpr1 variants in wild mouse populations provides a good example of how diversifying selection can be driven by genetic conflicts. Restrictive receptor variants evolved in Eurasian house mouse populations exposed to XP-MLV infection suggesting that positive selection favors antiviral alleles in virus-infected species. The ecotropic and polytropic MLVs have long been linked to disease induction in mice, and the discovery that all wild mice and some laboratory strains are also susceptible to X-MLV has made it possible to examine the disease inducing potential of these viruses in mice as well as in other model systems. X-MLVs are capable of establishing infection in mice carrying permissive XPR1 alleles, but X-MLV does not induce or accelerate disease in mice with permissive receptors inoculated as adults or neonates, and X-MLVs do not readily establish productive infection in monkeys. Host factors that restrict retroviruses effectively limit virus spread and disease induction in mice and other species.

The main findings reported in the PACE trial were that cognitive behavioral therapy (CBT) and graded exercise therapy (GET) were moderately effective treatments for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and fear avoidance beliefs constituted the strongest mediator of both therapies. These findings have been challenged by patients and, more recently, a number of top scientists, after public health expert Tuller, highlighted methodological problems in the trial. As a doctor who has been bedridden with severe ME for a long period, I analyzed the PACE trial and its follow-up articles from the perspectives of a doctor and a patient. During the PACE trial the eligibility criteria, both subjective primary outcomes, and most of the recovery criteria were altered, creating an overlap of the eligibility and recovery criteria; consequently, 13% of patients were considered "recovered," with respect to 1 or 2 primary outcomes, as soon as they entered the trial. In addition, 46% of patients reported an increase in ME/CFS symptoms, 31% reported musculoskeletal and 19% reported neurological adverse events. Therefore the proportion negatively affected by CBT and GET would be between 46% and 96%, most likely estimated at 74%, as shown in a large survey recently conducted by the ME Association. Medication with such high rates of adverse events would be withdrawn with immediate effect. There was no difference in long-term outcomes between adaptive pacing therapy, CBT, GET and specialist medical care, and none of them were effective, invalidating the biopsychosocial model and use of CBT and GET for ME/CFS. The discovery that an increase in exercise tolerance did not lead to an increase in fitness means that an underlying physical problem prevented this; validates that ME/CFS is a physical disease and that none of the treatments studied addressed this issue.

Fibromialgia (FM) este o afecțiune caracterizată prin dureri musculo-scheletale generalizate cronice, dureri asociate cu stări de oboseală (fatigabilitate), tulburări de somn, tulburări de memorie (scăderea performanțelor de memorie), tulburări de dispoziție (tendință la anxietate și depresie, inclusiv la ipohondrie), cefalee, sindrom de colon iritabil etc.
Neurofeedback-ul (NFB) este o metodă neinvazivă de biofeedback  prin care pacienții își pot vizualiza în timp real actitvitatea electrică cerebrală (sub forma așa-numitei electroencefalograme/ EEG): NFB antrenează pacientul în auto-controlul unor parametri ai EEG prin feedback(/întărire) pozitiv(/ă) a acelor tipuri dorite de activitate cerebrală.
S-a demonstrat că NFB poate ameliora anxietatea, depresia, sănătatea generală și severitatea simptomelor FM. NFB a fost clar demonstrată că poate crește semnificativ calitatea vieții pacienților cu FM, inclusiv prin modificări ale conectivității creierului pe termen lung.

, Tlf. 5142-1123 Denne publikation kan downloades via vbn.aau.dk Publikationen er et såkaldt workingpaper, hvor vi mere end gerne modtager forslag og kommentarer til forbedringer. Der er i publikationen en raekke aktive links til publikationer m.v. De er i workingpaperet fremhaevet med kursiv skrifttype.

Neurogenic autonomic dysfunction (NAD) and polyneuropathy occur in common conditions like diabetes and alcoholism. However, it can also be seen in rare diseases like in this case report of amyloid light-chain amyloidosis: primary amyloidosis. A 56-year-old man presented with polyneuropathy, a sympathetic dysfunction causing orthostatic intolerance, syncope, parasympathetic dysfunction and involvement of the enteric nervous system. The report illustrates, that routine screening can be insufficient in diagnosing amyloidosis. NAD and polyneuropathy without clear aetiology may require a multidisciplinary elucidation of more rare diseases.

De Barsy syndrome is a recessive progeroid disease classified under the group of cutis laxa syndromes. The disease is attributed to loss-of-function mutations inPYCR1orALDH18A1, leading to premature skin aging. Here we report fivePYCR1pathogenic alleles and a mouse knockout model of the disease. Through these investigations, we have confirmed the key role of PYCR1 in preventing dermal thinning and other connective tissue abnormalities. However, it remains unknown whether endogenous PYCR1 levels undergo changes during normal aging. To address this query, we examined its levels in cultured human cutaneous fibroblasts subjected to induced or replicative senescence. In both instances, PYCR1 levels dropped and correlated with the loss of proliferative capacity. Furthermore, we validated the relevance of these findings in vivo, by comparing young and chronologically aged human skin, and found that the levels of in the dermis, but not the epidermis, significantly decreased with age. Our re...

ABSTRACTBackgroundTrends in urbanization contribute to the growing global demand for raw construction materials. The health effects of load carrying among occupational groups that mine and carry sand and stone used for construction of roads and buildings remains poorly understood.MethodsWe conducted an exploratory cross-sectional study among a convenience sample of sand miners working at an excavation site on the Seti River in Pokhara, Nepal. Load carrying weight, duration, and frequency were used to categorize miners as having “low” or “high” load-carrying exposures. Probable musculoskeletal disorders (MSDs) were identified using self-reported symptoms of moderate to severe musculoskeletal pain, as well as physical examinations.ResultsThe average loads carried by female and male sand miners weighed 66.3 kg and 87.3 kg, respectively. Among all participants (N=42), 45.2% reported moderate to severe musculoskeletal pain in at least one body region and 16 (38.1%) had probable MSDs iden...

Background: Given the risks inherent in care transitions, it is imperative that patients discharged from hospital to home receive the integrated care services necessary to ensure that the transition is successful. Despite efforts by the health care sector to develop health system solutions to improve transitions, problems persist. Research on transitional support has predominantly focused on services delivered by health care professionals; the evidence for services provided by lay navigators or volunteers in supporting people transitioning from hospital to home has not been synthesized to guide practice, policy or future research. Aim: This is a protocol for a scoping review that will examine the role and contributions of voluntary sector personnel and services to support transitions from hospital to home. Methods: Using the well-established scoping review methodology outlined by Arksey and OMalley a six-stage study is outlined (1) identifying the research question, (2) identifying ...

Laparoscopy is a cornerstone of modern surgical care. Despite clear advantages for the patients, it has been associated with inducing upper body musculoskeletal disorders amongst surgeons due to the propensity of non-neutral postures. Furthermore, there is a perception that patients with obesity exacerbate these factors. Therefore, novice, intermediate and expert surgeon upper body posture was objectively quantified using inertial measurement units and the LUBA ergonomic framework was used to assess the subsequent postural data during laparoscopic training on patient models that simulated BMI’s of 20, 30, 40 and 50 kg/m2. In all experience groups, the posture of the upper body significantly worsened during simulated surgery on the BMI 50 kg/m2 model as compared to on the baseline BMI model of 20 kg/m2. These findings suggest that performing laparoscopic surgery on patients with severe obesity increases the prevalence of non-neutral upper body posture and may further increase the ris...

INTRODUCTIONPerceived diagnostic uncertainty can leave adolescents confused about their condition and impede their ability to understand“what’s wrong with me”. Our aim is to develop credible explanations (trustworthy and understandable explanation of the condition) for adolescents suffering from chronic non-traumatic knee pain.METHODSThis multiple-method study integrated findings from a systematic literature search of qualitative studies, an Argumentative Delphi with international experts (n=16) and think-aloud sessions with adolescents (n=7). Experts provided feedback with arguments on how to communicate credible explanations to meet adolescents’ needs. We analyzed feedback using thematic analysis before tailoring explanations to end-users.RESULTSWe screened 3.239 titles/abstracts and included 16 papers which explored diagnostic uncertainty from adolescents’ and parents’ perspectives. Five themes emerged: (1) Understanding causes and contributors to the pain experience, (2) Feeling...

Praktiske råd og saerlige patientovervejelser 1.4 Baggrund for valg af spørgsmål 1.5 Litteratur 1.6 Gennemgang af evidens 1.7 Summary of Findings-tabel 1.8 Arbejdsgruppens overvejelser 1.9 Rationale for anbefaling 2 Vaginal eller konventionel laparoskopisk hysterektomi ved benign sygdom 2.1 Fokuseret spørgsmål 2 2.2 Anbefaling 2.3 Praktiske råd og saerlige patientovervejelser 2.4 Baggrund for valg af spørgsmål 2.5 Litteratur 2.6 Gennemgang af evidens 2.7 Summary of Findings-tabel 2.8 Arbejdsgruppens overvejelser 2.9 Rationale for anbefaling 3 Robotassisteret laparoskopisk hysterektomi ved benign sygdom 3.1 Fokuseret spørgsmål 3 3.2 Anbefaling 3.3 Praktiske råd og saerlige patientovervejelser 3.4 Baggrund for valg af spørgsmål 3.5 Litteratur 3.6 Gennemgang af evidens 3.7 Summary of Findings-tabel 3.8 Arbejdsgruppens overvejelser 3.9 Rationale for anbefaling 4 Morcellering/deling af livmoderen i forbindelse med hysterektomi 4.1 Fokuseret spørgsmål 4 4.2 Anbefaling 4.3 Praktiske råd og saerlige patientovervejelser 4.4 Baggrund for valg af spørgsmål 4.5 Litteratur 4.6 Arbejdsgruppens overvejelser 4.7 Rationale for anbefaling 5 Fjernelse af aeggelederne i forbindelse med hysterektomi 5.1 Fokuseret spørgsmål 5 5.2 Anbefaling 5.3 Praktiske råd og saerlige patientovervejelser 5.4 Baggrund for valg af spørgsmål 4 / 5.5 Litteratur 5.6 Gennemgang af evidens 5.7 Summary of Findings-tabel 5.8 Arbejdsgruppens overvejelser 5.9 Rationale for anbefaling 6 Suspension af vaginaltoppen i forbindelse med hysterektomi

Objective: COVID-19 affects cardiorespiratory and muscular systems, causing dysfunctions that may persist after recovery from the acute infection and treatment. The aim of this study was to evaluate cardiorespiratory fitness and neuromuscular performance in these patients. Methods: Patients recovered from mild (n=31) and severe (n=17) COVID-19 were evaluated and compared to healthy subjects (n=15). All volunteers underwent a maximal cardiopulmonary exercise test with simultaneous acquisition of electromyography (EMG). Power output, oxygen uptake (VO2), pulse oxygen (O2Pulse), cardiovascular efficiency ({Delta}HR/{Delta}VO2), ventilation (VE), breathing reserve (BR) and ventilatory efficiency (VE/VCO2 slope) were analyzed. From EMG, power output for type Ia and IIa activation as well as total neuromuscular efficiency ({Delta}watts/{Delta}%RMS) were determined. Results: Patients with severe COVID-19 presented lower VO2, O2Pulse and VE than mild COVID-19 patients and healthy subjects (...

ABSTRACTIntroductionWe sought to evaluate the cost effectiveness of newborn screening (NBS) versus no NBS for 5q spinal muscular atrophy (SMA) in England.MethodsA cost-utility analysis using a combination of decision tree and Markov model structures was developed to estimate the lifetime health effects and costs of NBS for SMA, compared with no NBS, from the perspective of the National Health Service (NHS) in England. A decision tree was designed to capture NBS outcomes, and Markov modelling was used to project long-term health outcomes and costs for each patient group following diagnosis. Model inputs were based on existing literature, local data, and expert opinion. Sensitivity and scenario analyses were conducted to assess the robustness of the model and the validity of the results.ResultsThe introduction of NBS for SMA in England is estimated to identify approximately 56 (96% of cases) infants with SMA per year. Base-case results indicate that NBS is dominant (less costly and mo...

ABSTRACTShoulder pain (SP) is the third most common musculoskeletal disorder worldwide and its prevalence ranges from 5 to 47%.However, the clinical presentation of signs and symptoms may hide other serious conditions; the so-called Red Flags (RFs).For these reasons, clinicians dealing with neuro-musculoskeletal shoulder disorders should pay particular attention during the medical history and clinical examination screening and identifying signs that may cause probable referred symptoms.Considering the variety of clinical presentations of SP and the importance of the screening for referral, identifying and summarizing the possible gastrointestinal and hepatic diseases among these patients may give a comprehensive overview to the clinicians and consequently may improve the overall management.To the authors knowledge, there are no published studies on the topic and, in this context, a scoping review is strongly required and corresponded to the objectives of this project.

BackgroundLiterature already confirmed that chronic pain is not only correlated to functional deficits, structural problems or neural alterations, but it is also strongly influenced by the presence of psychological and social factors. It was also observed that those factors can have an impact on the subject even after many years: in fact, pain experiences and traumatic events during childhood can lead to changes in stress and pain neural network area and to maladaptive behaviors that concur to develop chronic pain. The main purpose of this review is to identify the bio-psycho-social risk factors in developmental age that could lead to musculoskeletal chronic pain in adulthood.Inclusion criteriaEvery study about risk factors in developmental age (0-18) for the onset of musculoskeletal chronic pain in adulthood will be included. This scoping review will consider studies conducted in any context.MethodsThe proposed scoping review will be conducted in accordance with the Joanna Briggs I...

ABSTRACTObjectiveTo examine the role of physical function impairments on the change in urinary incontinence symptoms after pelvic floor muscle training in older women.MethodsThis is a prospective cohort study of 70 community-dwelling women, older than 70 years, with at least moderate incontinence symptoms. A comprehensive assessment of pelvic floor and physical function was done at baseline. Individualized PFM training prescriptions with behavioral management strategies to reduce incontinence episodes were provided for 12 weeks. Baseline physical function was determined using the Short Physical Performance Battery (total score of ≤9/12 defined impairment). A 3-day bladder diary established daily incontinence episodes. The change in urinary incontinence episodes based on presence of physical function impairment was our primary outcome. Descriptive analyses compared important demographic and clinical characteristics. Longitudinal mixed model linear regression analyses were used to ass...

Amaç: Bu çalışmada fibromiyalji sendromlu (FMS) kadın hastalarda nöropatik ağrının değerlendirilmesi ve obezitenin fibromiyalji semptomları, yaşam kalitesi ve nöropatik ağrı üzerine etkisinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: 40 normal kilolu ve 40 obez fibromiyalji sendromlu kadın hasta çalışmaya dahil edildi. Hastaların tümü ACR 1990 VE 2010 ACR sınıflama kriterlerini karşılıyordu. LANSS(Leeds asseessment of neuropathic symptoms and signs) ve DN4(Douleur neuropathique 4 questions) skalaları hastalarda nöropatik ağrı değerlendirmesi için kullanıldı. FIQ(Fibromyalgia impact questionnaire) skalası hastaların sağlık durumu değerlendirmeleri için kullanıldı. Bulgular: Nöropatik ağrı LANSS skalasına göre %56,3, DN4 skalasına göre %78 hastada saptandı. Nöropatik ağrı oranı normal kilolu FMS lu grupta %42,5, obez FMS'lu grupta %70 oranındaydı ve obez grupta istatiksel olarak anlamlı olarak daha yüksekti. FIQ skorları ile yaşam kalitesi skorları açısından iki grup arasında anlamlı farklı saptanmadı. Sonuç: Nöropatik ağrı obez kadın FMS hastalarında normal kilolu kadın FMS hastalarına göre anlamlı daha yüksek çıkmıştır. Bu nedenle FMS'lu kadın hastalarda obez olanlarda nöropatik ağrı açısından daha dikkatli olunmalıdır.

We have developed a new technique of Feature Importance, a topic of machine learning, to analyze the possible causes of the Covid-19 pandemic based on country data. This new approach works well even when there are many more features than countries and is not affected by high correlation of features. It is inspired by the Gram-Schmidt orthogonalization procedure from linear algebra. We study the number of deaths, which is more reliable than the number of cases at the onset of the pandemic, during Apr/May 2020. This is while countries started taking measures, so more light will be shed on the root causes of the pandemic rather than on its handling.The analysis is done against a comprehensive list of roughly 3,200 features. We find that globalization is the main contributing cause, followed by calcium intake, economic factors, environmental factors, preventative measures, and others. This analysis was done for 20 different dates and shows that some factors, like calcium, phase in or ou...

Respiratory failure is a well-documented potential presentation of inherited isolated remethylation disorders (IRDs). It appears to be a combination of both central and peripheral neuropathy and has previously often been considered to herald an irreversible neurological decline. We present three patients, one with methionine synthase (cblG) and two with methyltetrahydrofolate reductase deficiency (MTHFR). One patient with MTHFR presented in infancy, and other patients in later childhood. All three patients required intubation for respiratory failure but in all three, this was totally reversed by the initiation of medical therapy. This consisted of betaine and folinic acid supplementation in all three, methionine in two and cobalamin supplementation in two. The rate of respiratory improvement was variable, though two of the cases were successful extubated within a week of commencement of medical therapy. We document their subsequent clinical, biochemical and electrophysiological prog...

Fibromyalgia (FM) is a rheumatic disease which affects fibrous tissues and muscles; it is characterized by chronic pain and it is often associated with craniomandibular disorders (CMD). 31 patients were assessed from March 2012 to October 2012 through the administration of specific questionnaires and following neurologic and gnatologic assessment. A relevant corre-lation between FM and CMD emerges from the present study, as 80.6% of our patients report CMD symptoms with high prevalence of myofascial pain (84%). Multivariate regression analysis revealed that the patients in the present study did not differ in score of quality of life questionnaires from patients with fibromyalgia. The neuropathic pain diagnostic question-naire (DN4) scores were positively affected by belonging to group II of Research Diagnostic Criteria of Temporomandibular Disorders (RDC/ TDM) classification, suggesting the possibility of a neuropathic component in chronic pain in this CMD group, as already speculat...

Neurogenic autonomic dysfunction (NAD) and polyneuropathy occur in common conditions like diabetes and alcoholism. However, it can also be seen in rare diseases like in this case report of amyloid light-chain amyloidosis: primary amyloidosis. A 56-year-old man presented with polyneuropathy, a sympathetic dysfunction causing orthostatic intolerance, syncope, parasympathetic dysfunction and involvement of the enteric nervous system. The report illustrates, that routine screening can be insufficient in diagnosing amyloidosis. NAD and polyneuropathy without clear aetiology may require a multidisciplinary elucidation of more rare diseases.

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and controversial clinical condition without having established causative factors. Increasing numbers of cases during past decade have created awareness among patients as well as healthcare professionals. Chronic viral infection as a cause of ME/CFS has long been debated. However, lack of large studies involving well-designed patient groups and validated experimental set ups have hindered our knowledge about this disease. Moreover, recent developments regarding molecular mechanism of pathogenesis of various infectious agents cast doubts over validity of several of the past studies. This review aims to compile all the studies done so far to investigate various viral agents that could be associated with ME/CFS. Furthermore, we suggest strategies to better design future studies on the role of viral infections in ME/CFS.

Fredningsstyrelsen afgav i en sag, der var til behandling i overfredningsnaevnet, en udtalelse til naevnets formand, weekenden for overfredningsnaevnet afholdt besigtigelse og afsluttende mode i sagen. Udtalelsen, der blev afgivet i form af to handskrevne notater, blev oplaest af formanden ved besigtigelsens afslutning.  Udtalt, at det havde vaeret onskeligt, om fredningsstyrelsen havde klargjort sit standpunkt i sagen pa et tidligere tidspunkt, saledes at sagens ovrige parter fik lejlighed til over for overfredningsnaevnet at tage til genmaele mod fredningsstyrelsens synspunkter.  Jeg fandt det endvidere uheldigt, at styrelsen, nar den besluttede sig for at afgive udtalelse til brug for overfredningsnaevnets behandling af sagen, da valgte at gore det i en form og under omstaendigheder, der fortsat kunne efterlade tvivl om styrelsens stilling til sagens realitet.  (J. nr. 1983-842-140).

Objective: The purpose of this study is to highlight the evidence of signs and symptoms of craniomandibular disorders (CMD) in patients suffering from fibromyalgia. Materials and Method: The study has been carried out from May 2011 to May 2015, recruiting a sample of fibromyalgia patients at the Department of Neurophysiopathology at the hospital Policlinico in Bari. Among the 150 examined patients, 60 of them have been diagnosed to suffer from fibromyalgia and 27 accepted to be investigated with a gnathologic examination at the Dental School at the University of Bari. Results: 24 patients (88.9%) were women and 3 (11.1%) men; from 26 to 66 years old (average age, 39). 14 patients (51.9%) were affected by primary fibromyalgia, the remaining 13 (48.1%) by secondary fibromyalgia, mainly associated with hypothyroidism (29.6%). VAS average score was about 8 ± 1.85. The frequency of pain was daily in 15 patients (55.6%); twice a week in 10 patients (37.03%) and a few times a month in 2 pa...

ABSTRACT: Myalgic encephalomyelitis (ME) is a complex and debilitating condition characterized by chronic fatigue that does not improve with rest, affecting millions of people around the world. With more recent studies, investigating social and pathophysiological profiles, the association of immunological and inflammatory dysfunction as possible causes for BD can be noted. In addition, projecting specificity at the time of diagnosis, changes were observed in the cytokine profiles and plausible 23 genes, in order to find a biomarker for the purposes of further research, aiding in better technologies for diagnosis, as well as for treatments of BD. GOAL: The current article aims to highlight the updated panorama about BD, analyzing new studies that demonstrate advances on the disease, clarifying its possible pathophysiology, clinical presentation, diagnoses and treatments. METHODS: This is a literature review on an overview of myalgic encephalomyelitis. Articles from SciElo, PubMed, MEDLINE and Lilacs databases were used. Considering the criterion of year of publication between 2016 and 2021. FINAL CONSIDERATIONS: Although described since 1869, there is still little progress in its panorama since its discovery, making more advanced research necessary to find a biological marker for the disease and thus direct the best treatment for the patient.

ObjectiveTo estimate COVID-19 infection incidence rate with severe affectation (requiring hospitalization) in patients with biological treatment due to rheumatoid arthritis (RA), psoriatic arthritis (PsA), spondyloarthritis (SpA), psoriasis (Ps), and inflammatory bowel disease (IBD) and compare it with incidence rate in the general population.MethodsRetrospective observational study based on information provided by two administrative databases. One of these two databases contains information on all patients seen in our hospital and diagnosed with COVID-19 infection between March 4th 2020 and April 26th 2020. The other database contains data from patients seen at Rheumatology, Dermatology and Digestive Departments in our hospital who are currently receiving biological therapy. We calculated the crude and age and sex adjusted incidence in both groups. To compare both groups we calculated the Incidence Rate Ratio.ResultsThere was a total of 2,182 patients with COVID-19 requiring hospit...

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) [1],[2],[3] impacts up to 257,000 (1%) Australians. People with ME/CFS interact with social institutions on a daily basis which throw up legal issues that can impact health outcomes. This study identified issues with respect to health justice and impacts upon health outcomes.

ME/CFS: Stigma Arising from Online News Media Images and Stock Image Platforms
Geoffrey Hallmann*, Penelope McMillan^, Penelope Del Fante^ and Jade Barclay#
*Griffith University
# Sydney University
^ME/CFS Australia Ltd, ME/CFS South Australia Inc.

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) impacts up to 257,000 (1%) Australians. The media has the power to influence perceptions and views across all facets of society and images are a significant element of that influence.  Images commonly used by the media to represent ME/CFS do not authentically represent the condition and perpetuate the stigma that surrounds the condition. Stigma is a significant determinant of health that impacts health outcomes.  No previous study has examined the authenticity of images used by media articles, nor those available from the image platforms through which stock images are often sourced.

OBJECTIVES: To review the concept of stigma in the context of ME/CFS and using visual framing analysis, assess the perpetuation of that stigma by images purportedly representing ME/CFS that are present on online media articles and stock image platforms.

METHOD: A review was conducted to identify literature examining of identifying stigma issues.  Link and Phelan’s 5 conceptualisation of stigma allowed the identification and grouping of issues drawn out of the literature within each interrelated components.  The news media images for the analysis were drawn from the four search engines that provided preview images, being Bing News, DuckDuckGo News, Google News and USearch News, and the stock images were sources from Getty Images, Shutter Stock and UnSplash.  A Rodriguez and Dimitrova’s 4-tiered visual framing analysis model provided the typology through which the unique attributes (content, style, symbolism and ideology) of each sample image was distinguished.      With the assistance of 3 community researchers (within the limits of their health), a codebook was created and tested to ensure reliability during coding.  Within tier 1, a number of themes evolved out of the identified frames, and quantitative content analysis was used to tabulate the frequency of each frame.  The second-tier analysis identified stylistic-semiotic frames that were quantitatively tabulated.  Link and Phelan’s 5 components of stigma provided the tier 3 themes (symbolism) through which images could be analysed.  A number of frames were identified under each them, and the occurrence of each frame was tabulated.  In the fourth tier, the ideological frames were identified and tabulated. 

RESULTS: Using the search string ‘chronic fatigue syndrome’ 452 images were identified among the 4 news media search engines and 3,400 images were returned from the search among the stock image platforms.  Tier 1 identified 5 themes, being images that were ‘authentic’, ‘inauthentic’, ‘gender’, ‘social setting’, and ‘neutral’. Articles with ‘no image’ were coded and removed from image totals.  Neutral images numbered 25.2% (114) within media images and 8.7% (297) in stock images.  51.3% (232; 2.5:1 females to males) of media and 68.3% (2,323; 2.2:1 females to males) of stock images were gendered.  45.1% (204) of news images and 63.0% (2075) of the stock images, depicted an individual alone.  Only 13.5% (61) of the news images were authentic representations of ME/CFS, with none among the stock images.  Tier 2 revealed 14 frames.  36.8% (166) of media images and 23.0% (782) of stock images portrayed the subject in a subordinate position.  Suffering was portrayed in 30.8% (139) of the media images and 57.4% (1950) of the stock images.  At tier 3, 30 frames were distributed across the 5 components of stigma – ‘labelling’, ‘stereotyping’, ‘separation/prejudice’, ‘discrimination’ and ‘power’.  The ‘power’ theme contained 8 frames with 7 frame of media images ranging from 44.2% (200) to 50.4% (228) of the images, and the same 7 frames of the stock images ranging from 97.5% (3,116) to 100% (3,400) of the images.  The ‘separation/prejudice’ theme demonstrated significant negative stigma, with 6 of 6 frames ranging from 36.5% (165) to 43.8% (198) within the media images and 43.4% (1,475) to 96.5% (3,316) in the stock images.  Tier 4 revealed 6 ideological frames.  The dominant frames in the media frames were ‘political’, ‘medical patriarchy’, ‘oppression’ and ‘marginalisation’ and ranged from 37.2% (200) to 41.6% (224) of the images.  Within the stock images, the same four dominated, and ranged from 73.4% (2,497) to 73.6% (2,501).  The ‘biopsychosocial’ frame was highly represented in the stock images at 64.5% (2,192) compared to 25.8% (139) of the media images.  Only 9.1% (49) of media images fell within the ‘biomedical’ frame, compared to 64.5% (2,192) of the stock images. 

CONCLUSION: The media and stock images demonstrated a perpetuation of the drivers of stigma that surround ME/CFS.  Depiction of authentic images of ME/CFS within the media were quite poor, and the availability of authentic images within stock images was non-existent.  Given the influence of media and power of images to significantly influence views and perceptions, an improvement in authentic representations of ME/CFS holds potential to decrease the drivers of stigma and help create an environment that holds potential to improve the health outcomes for people with ME/CFS. 


Geoffrey Hallmann
B.Bus.(Hons)(UNE-NR), LLB (Hons)(Newcastle), DipLegPrac (Newcastle), DipFinPlan (Deakin), LLM (Enterprise Governance)(Bond), MClinEpid (Newcastle), MPH (Griffith)

Ph: + 61 2 66241979
Mob: + 61 4 14 014 365
[email protected]

Australian ME/CFS Research: A Primer for Social and Public Health Issues
Geoffrey Hallmann*
* Chair, ME/CFS Australia

OBJECTIVES: The health and well-being of patients are impacted by the social determinants of health.  The drivers of health within vulnerable populations have a major impact on health, function and quality-of-life outcomes and risks.  Social determinants are the environmental conditions (or place) in which people are located.  Conditions include elements such as the social, economic, and physical factors. 
The place in which people live are impacted by material attributes, patterns of social engagement and the sense of security and well-being a person experiences.  Resources that enhance quality of life also impact health.  Understanding relationships between how vulnerable people experience place and its impact of health is therefore fundamental

The objective of this presentation is to present a primer for the type of research that is needed to improve the quality of life for people with ME/CFS in Australia.

METHOD: A brief literature review was conducted of the key issues with respect to ME/CFS and combined with the experience of the author.

RESULTS: The literature reveals a significant number of issues that are congruent with the social determinant of health that are relevant to ME/CFS.  Most of the ME/CFS literature is focused on the biomedical and psychological elements. Public health literature focuses on social determinants of health – the factors that can be influenced by social policies and therefore shape health outcomes in a significant way
Such factors can be found within public health and social research
Presently Australian research is limited with respect to current social and public health issues impacting ME/CFS International research of public health and social issues is limited.  Aside from research gaps, international research does not necessarily translate to the Australian experience of people with ME/CFS .

Australia has its own unique environment.  Australian government policies towards ME/CFS have shaped the way in which assistance for ME/CFS is limited. Healthcare, social programs, social insurance, social housing,  welfare safety nets and disability access share some commonalities with other countries whilst others are distinctly Australian.  These components are important drivers behind the health outcomes experienced by Australians with ME/CFS. Health outcomes of people with ME/CFS are poor and change is long overdue. Research that focuses on the Australian social determinants of health is therefore required to inform change

CONCLUSION: There are a number of actions that are required:

* Co-design with Patients and Carers
* Problem Identification
* Partner Engagement
* Strategic Planning
* Funding
* Researcher Design, Conduct, Recruiting, and Publication
* Distribution of Results (eg Media)
* Translation into Practice

The potential areas of focus are:

* Policy
* Health Care
* Health Care Issues
* Social Support
* Funding
* Violence, Abuse, Neglect and Exploitation
* Legal Issues
* Carer Issues
* Patient Lived Experiences
* Volunteering
* Social Determinants


Geoffrey Hallmann
B.Bus.(Hons)(UNE-NR), LLB (Hons)(Newcastle), DipLegPrac (Newcastle), DipFinPlan (Deakin)

Ph: + 61 2 66241979
Mob: + 61 4 14 014 365
[email protected]

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex and controversial clinical condition without having established causative factors. Increasing numbers of cases during past decade have created awareness among patients as well as healthcare professionals. Chronic viral infection as a cause of ME/CFS has long been debated. However, lack of large studies involving well-designed patient groups and validated experimental set ups have hindered our knowledge about this disease. Moreover, recent developments regarding molecular mechanism of pathogenesis of various infectious agents cast doubts over validity of several of the past studies. This review aims to compile all the studies done so far to investigate various viral agents that could be associated with ME/CFS. Furthermore, we suggest strategies to better design future studies on the role of viral infections in ME/CFS.

Objective: COVID-19 affects cardiorespiratory and muscular systems, causing dysfunctions that may persist after recovery from the acute infection and treatment. The aim of this study was to evaluate cardiorespiratory fitness and neuromuscular performance in these patients. Methods: Patients recovered from mild (n=31) and severe (n=17) COVID-19 were evaluated and compared to healthy subjects (n=15). All volunteers underwent a maximal cardiopulmonary exercise test with simultaneous acquisition of electromyography (EMG). Power output, oxygen uptake (VO2), pulse oxygen (O2Pulse), cardiovascular efficiency ({Delta}HR/{Delta}VO2), ventilation (VE), breathing reserve (BR) and ventilatory efficiency (VE/VCO2 slope) were analyzed. From EMG, power output for type Ia and IIa activation as well as total neuromuscular efficiency ({Delta}watts/{Delta}%RMS) were determined. Results: Patients with severe COVID-19 presented lower VO2, O2Pulse and VE than mild COVID-19 patients and healthy subjects (...

BackgroundAnesthesia practitioners are at inherent risk for percutaneous injuries by blood-contaminated needles and sharp objects. These exposures may result in transmission of HIV and hepatitis viruses. Data about this occupational hazard from contaminated needles and sharp devices is limited and decades old. We conducted a web-based survey to assess the occurrence, reporting, characteristics, and outcome of contaminated percutaneous injuries (CPI) in anesthesia residents, fellows, and attendings.MethodsAfter institutional research board approval, an email was sent to 217 anesthesia practitioners requesting their participation in an online survey about contaminated percutaneous injuries. Responses were collected from February through March 2020. Results are reported as absolute numbers and proportions with 95% confidence interval (CI).ResultsThe overall survey response rate was 51% (110/217). 59% (65/110) (95% CI, 50–68) of participants reported having one or more contaminated perc...

The main findings reported in the PACE trial were that cognitive behavioral therapy (CBT) and graded exercise therapy (GET) were moderately effective treatments for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and fear avoidance beliefs constituted the strongest mediator of both therapies. These findings have been challenged by patients and, more recently, a number of top scientists, after public health expert Tuller, highlighted methodological problems in the trial. As a doctor who has been bedridden with severe ME for a long period, I analyzed the PACE trial and its follow-up articles from the perspectives of a doctor and a patient. During the PACE trial the eligibility criteria, both subjective primary outcomes, and most of the recovery criteria were altered, creating an overlap of the eligibility and recovery criteria; consequently, 13% of patients were considered "recovered," with respect to 1 or 2 primary outcomes, as soon as they entered the trial. In addition, 46% of patients reported an increase in ME/CFS symptoms, 31% reported musculoskeletal and 19% reported neurological adverse events. Therefore the proportion negatively affected by CBT and GET would be between 46% and 96%, most likely estimated at 74%, as shown in a large survey recently conducted by the ME Association. Medication with such high rates of adverse events would be withdrawn with immediate effect. There was no difference in long-term outcomes between adaptive pacing therapy, CBT, GET and specialist medical care, and none of them were effective, invalidating the biopsychosocial model and use of CBT and GET for ME/CFS. The discovery that an increase in exercise tolerance did not lead to an increase in fitness means that an underlying physical problem prevented this; validates that ME/CFS is a physical disease and that none of the treatments studied addressed this issue.

BackgroundStress urinary incontinence (SUI) in females is a common gynecological issue that impedes lifestyle. Exercise had a significant effect; however, studies did not determine the exercise frequency and intensity for pelvic floor stabilization in stress urinary incontinence.AimThe aim of the study is to determine if maximum repetition of pelvic stabilization exercise impacts the management of stress urinary incontinence in females.MethodologyOne arm quasi-experimental study design was used. 40 patients having SUI and associated musculoskeletal complaints were recruited from the outpatient unit of Physiotherapy department of the Centre for the Rehabilitation of the Paralysed (CRP), Bangladesh. The study was conducted over 4weeks. Outcome measurement was included pelvic floor and abdominal muscle strength, endurance, and incontinence measurement.ResultPelvic floor muscle and abdominal strength, and endurance had a positive and significant result in maximum repetition (P .001). Pe...