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Krabbe SH, Bjorbækmo WS, Mengshoel AM, Sveen U, Groven KS. A suffering body, hidden away from others: The experience of being long-term bedridden with severe myalgic encephalomyelitis/chronic fatigue syndrome in childhood and adolescence. Nurs Inq 2024; 31:e12625. [PMID: 38280185 DOI: 10.1111/nin.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/29/2024]
Abstract
In this article, we present findings from a qualitative study examining how young women experience being long-term bedridden with myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), during childhood and adolescence. The aim is to explore how young women who fell ill with ME/CFS during childhood and adolescence look back on their lived experience of being long-term bedridden from the vantage point of being fully or partially recovered. Informed by a phenomenological theoretical perspective, the researchers applied a narrative methodological approach involving the analysis of interviews with 13 women, aged 16-29 years at the time of the interview. Attention was particularly paid to how participants structured their narratives and to the events (telling moments) they identified as important. Four major storylines were developed: Ambivalent responses to the presence of others; A body on the edge of life; An eternity in the dark; and Recasting painful memories of being bedridden and alone. Based on our findings, we argue that the experience of being long-term bedridden with ME/CFS during childhood and adolescence can be understood and communicated as a plot in which individuals find themselves pushed to the extreme limit of suffering and loneliness.
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Affiliation(s)
- Silje Helen Krabbe
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Children's Surgical Department, Division of Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Anne Marit Mengshoel
- Department for Interdisciplinary Health Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Unni Sveen
- Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Physical Medicine & Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Karen Synne Groven
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Sandes, Norway
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Angelhoff C, Duchen K, Ertzgaard P, Rytterström P. Navigating an unfamiliar world - Parents' experiences of having a child with post COVID-19. J Pediatr Nurs 2024; 77:e565-e572. [PMID: 38796360 DOI: 10.1016/j.pedn.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/18/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Post COVID-19 diagnosis in children has been difficult as there has been a lack of knowledge within the healthcare system, leading to uncertainty concerning how these children should be assessed and treated. To understand the aspects of how parents experience seeking care for their child with an array of symptoms and how the child's symptoms affect their everyday life and family situation, we need to listen to the parents' stories about having a child living with post COVID-19. PURPOSE To describe parents' experiences of seeking professional care for their child with post COVID-19 symptoms and what kinds of impacts there are on their children's daily life. DESIGN AND METHODS A qualitative study with an inductive and exploratory approach including seventeen parents of children with post COVID-19. Face-to-face interviews were conducted between October 2022 and March 2023 and analyzed with thematic analysis. RESULTS The findings describe how the parents' constant struggle for their child and how the child's symptoms affect their daily life and their family situation in three themes: Navigating the unknown, Navigating life with post COVID-19, and Navigating between fear and hope for an uncertain future. CONCLUSIONS This study corroborates the parents' struggle for acceptance of the children's problems in the health system. PRACTICE IMPLICATIONS It is important that health care focuses on the everyday world and the problems that the child and parents express to understand the family's perspective and the problems that arise in everyday life.
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Affiliation(s)
- Charlotte Angelhoff
- Allergy Center in Linköping and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Karel Duchen
- Allergy Center in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Ertzgaard
- Department of Rehabilitation Medicine in Linköping and Department of Health, Medicine and Caring Sciences, Linkoping University, Linköping, Sweden
| | - Patrik Rytterström
- Department of Health, Medicine and Caring Sciences, Division of Nursing Science, Linköping University, Norrköping, Sweden
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3
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McTaggart J, Beeden E, Farooq A. Lost in research: children, healthcare and epistemic injustice. Arch Dis Child 2024; 109:433-435. [PMID: 37400230 DOI: 10.1136/archdischild-2023-325745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Affiliation(s)
- James McTaggart
- Educational Psychology Service, Highland Council, Inverness, UK
- School of Humanities, Social Sciences and Law, University of Dundee, Dundee, UK
| | - Emma Beeden
- Patient Liaison Group, British Medical Association, London, UK
| | - Aishah Farooq
- Children and Young People's Transformation Programme, NHS England and NHS Improvement London, London, UK
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Pricoco R, Meidel P, Hofberger T, Zietemann H, Mueller Y, Wiehler K, Michel K, Paulick J, Leone A, Haegele M, Mayer-Huber S, Gerrer K, Mittelstrass K, Scheibenbogen C, Renz-Polster H, Mihatsch L, Behrends U. One-year follow-up of young people with ME/CFS following infectious mononucleosis by Epstein-Barr virus. Front Pediatr 2024; 11:1266738. [PMID: 38304441 PMCID: PMC10830704 DOI: 10.3389/fped.2023.1266738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/20/2023] [Indexed: 02/03/2024] Open
Abstract
Background Infectious mononucleosis after primary infection with Epstein-Barr virus (EBV-IM) has been linked to the development of myalgic encephalomyelitis/chronic fatigue-syndrome (ME/CFS) in children, adolescents, and young adults. Here, we present clinical phenotypes and follow-up data from a first German cohort of young people with ME/CFS following EBV-IM. Methods 12 adolescents and 13 young adults were diagnosed with IM-triggered ME/CFS at our specialized tertiary outpatient service by clinical criteria requiring post-exertional malaise (PEM) and a history of confirmed EBV primary infection as triggering event. Demographic information, laboratory findings, frequency and severity of symptoms, physical functioning, and health-related quality of life (HRQoL) were assessed and re-evaluated 6 and 12 months later. Results Young adults displayed more severe symptoms as well as worsening of fatigue, physical and mental functioning, and HRQoL throughout the study, compared to adolescents. After one year, 6/12 (54%) adolescents no longer met the diagnostic criteria for ME/CFS while all young adults continued to fulfill the Canadian consensus criteria. Improvement in adolescents was evident in physical functioning, symptom frequency and severity, and HRQoL, while young adults showed little improvement. EBV serology and EBV DNA load did not correlate with distinct clinical features of ME/CFS, and clinical chemistry showed no evidence of inflammation. Remarkably, the median time from symptom onset to ME/CFS diagnosis was 13.8 (IQR: 9.1-34.9) months. Conclusions ME/CFS following EBV-IM is a severely debilitating disease often diagnosed late and with limited responses to conventional medical care, especially in adults. Although adolescents may have a better prognosis, their condition can fluctuate and significantly impact their HRQoL. Our data emphasize that biomarkers and effective therapeutic options are also urgently needed to improve medical care and pave the way to recovery.
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Affiliation(s)
- Rafael Pricoco
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Paulina Meidel
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Tim Hofberger
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Hannah Zietemann
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Yvonne Mueller
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Katharina Wiehler
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Kaja Michel
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Johannes Paulick
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Ariane Leone
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Matthias Haegele
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Sandra Mayer-Huber
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Katrin Gerrer
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Kirstin Mittelstrass
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Carmen Scheibenbogen
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | - Herbert Renz-Polster
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg, Germany
| | - Lorenz Mihatsch
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
| | - Uta Behrends
- MRI Chronic Fatigue Center for Young People (MCFC), Children’s Hospital, TUM School of Medicine, Technical University of Munich and Munich Municipal Hospital Schwabing, Munich, Germany
- German Center for Infection Research (partner site Munich), Munich, Germany
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Gréaux M, Moro MF, Kamenov K, Russell AM, Barrett D, Cieza A. Health equity for persons with disabilities: a global scoping review on barriers and interventions in healthcare services. Int J Equity Health 2023; 22:236. [PMID: 37957602 PMCID: PMC10644565 DOI: 10.1186/s12939-023-02035-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/11/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Persons with disabilities experience health inequities in terms of increased mortality, morbidity, and limitations in functioning when compared to the rest of the population. Many of the poor health outcomes experienced by persons with disabilities cannot be explained by the underlying health condition or impairment, but are health inequities driven by unfair societal and health system factors. A synthesis of the global evidence is needed to identify the factors that hinder equitable access to healthcare services for persons with disabilities, and the interventions to remove these barriers and promote disability inclusion. METHODS We conducted a scoping review following the methodological framework proposed by Arksey and O'Malley, Int J Soc Res Methodol 8:19-32. We searched two scholarly databases, namely MEDLINE (Ovid) and Web of Science, the websites of Organizations of Persons with Disabilities and governments, and reviewed evidence shared during WHO-led consultations on the topic of health equity for persons with disabilities. We included articles published after 2011 with no restriction to geographical location, the type of underlying impairments or healthcare services. A charting form was developed and used to extract the relevant information for each included article. RESULTS Of 11,884 articles identified in the search, we included 182 articles in this review. The majority of sources originated from high-income countries. Barriers were identified worldwide across different levels of the health system (such as healthcare costs, untrained healthcare workforces, issues of inclusive and coordinated services delivery), and through wider contributing factors of health inequities that expand beyond the health system (such as societal stigma or health literacy). However, the interventions to promote equitable access to healthcare services for persons with disabilities were not readily mapped onto those needs, their sources of funding and projected sustainability were often unclear, and few offered targeted approaches to address issues faced by marginalized groups of persons with disabilities with intersectional identities. CONCLUSION Persons with disabilities continue to face considerable barriers when accessing healthcare services, which negatively affects their chances of achieving their highest attainable standard of health. It is encouraging to note the increasing evidence on interventions targeting equitable access to healthcare services, but they remain too few and sparce to meet the populations' needs. Profound systemic changes and action-oriented strategies are warranted to promote health equity for persons with disabilities, and advance global health priorities.
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Affiliation(s)
- Mélanie Gréaux
- Faculty of Education, University of Cambridge, Cambridge, UK.
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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Krabbe SH, Mengshoel AM, Schrøder Bjorbækmo W, Sveen U, Groven KS. Bodies in lockdown: Young women's narratives of falling severely ill with ME/CFS during childhood and adolescence. Health Care Women Int 2023; 44:1155-1177. [PMID: 35404768 DOI: 10.1080/07399332.2022.2043862] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 10/18/2022]
Abstract
Thirteen women (16-30 years) storied their experiences about the process of falling severely ill with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome during childhood and adolescence. We performed a narrative analysis informed by phenomenology which yielded three central themes: The active and meaningful life I used to live; gradually developing unhomeliness and feeling pushed toward the edge; and left abandoned on the sidelines. Out of the incomprehensible and unpredictable emerges an understanding of the scale of their ordeal, along with advice that may have made it worse. This portrays a gradual developing uncertain, unhomely life situation with no outlooks for future recovery.
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Affiliation(s)
- Silje Helen Krabbe
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Children's Surgical Department, Division of Head, Neck and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
| | - Anne Marit Mengshoel
- Department for Interdisciplinary Health Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Unni Sveen
- Faculty of Health Sciences, Department of Occupational Therapy, Prosthetics and Orthotics, Oslo Metropolitan University, Oslo, Norway
- Department of Physical Medicine & Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Karen Synne Groven
- Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Faculty of Health Studies, VID Specialized University, Sandes, Norway
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Dolp R, Wardle DP, Khalid-Khan S. The role of psychiatry in diagnosis and treatment of paediatric chronic fatigue syndrome - a scoping literature review. Int J Adolesc Med Health 2023; 0:ijamh-2023-0030. [PMID: 37336592 DOI: 10.1515/ijamh-2023-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Paediatric Chronic Fatigue Syndrome (pCFS) is a common condition that significantly disrupts a healthy psychosocial development. Psychiatric symptoms associated with pCFS are conceptualized as either part of its complex etiology, its consequence, or as a comorbidity. However, patients with this condition are rarely seen by psychiatrists. This scoping review aims to explore the role of psychiatry in the diagnosis and treatment of pCFS. CONTENT A scoping review of literature was conducted using MEDLINE, EMBASE, Cochrane and PsycINFO. Databases were searched for articles describing psychiatric involvement in the diagnosis or treatment of children and adolescents (age ≤ 18) with pCFS. A grey literature search was also conducted to identify additional guidelines and national recommendations to identify the role of psychiatry in the diagnosis and treatment of pCFS. SUMMARY The search provided 436 articles of which 16 met inclusion criteria. Grey literature search identified 12 relevant guidelines. Most studies and guidelines did not include any psychiatric involvement in the care of patients with pCFS. If psychiatry was mentioned, it was used interchangeably with psychological interventions or in the context of treating distinct psychiatric comorbidities and suicidal ideation. OUTLOOK The role of psychiatry in diagnosis and treatment of pCFS is poorly defined. Future research is required to understand how psychiatrists can contribute to the care of patients with pCFS.
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Affiliation(s)
- Reinhard Dolp
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
- North Bay Regional Health Centre, North Bay, ON, Canada
- Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - David Pr Wardle
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
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Webb CM, Collin SM, Deave T, Haig-Ferguson A, Spatz A, Crawley E. Correction: What stops children with a chronic illness accessing health care: a mixed methods study in children with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). BMC Health Serv Res 2023; 23:443. [PMID: 37147675 PMCID: PMC10163761 DOI: 10.1186/s12913-023-09485-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Affiliation(s)
- Carly M Webb
- St George's University of London, Cranmer Terrace, London, UK
| | - Simon M Collin
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Toity Deave
- Centre for Child and Adolescent Health, University of the West of England, Bristol, UK
| | - Andrew Haig-Ferguson
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Amy Spatz
- St George's University of London, Cranmer Terrace, London, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK.
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Brigden A, Shaw A, Barnes R, Anderson E, Crawley E. "The child's got a complete circle around him". The care of younger children (5-11 years) with CFS/ME. A qualitative study comparing families', teachers' and clinicians' perspectives'. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2179-2189. [PMID: 32519359 DOI: 10.1111/hsc.13029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/01/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
Society needs to improve the care of children with complex needs. Guidelines recommend integrating care across health and educational settings, however, there is little research on whether this is achieved or how this can be done in practice. Our aim was to address this gap by examining how the care of children (aged 5-11 years) with Chronic Fatigue Syndrome/ Myalgic Encephalomyelitis (CFS/ME) is shared across home, education and health settings, in order to generate recommendations for integrating care. We undertook semi-structured interviews with families (22 participants), teachers (11 participants) and healthcare providers (9 participants), analysing the data thematically and comparatively. Our analysis of the data was informed by a socio-ecological perspective as we sought to understand the complexity of the relationships and systems around the child. The first theme focuses on the child ("individual level"); child-centred care is seen as essential whilst acknowledging that the child has limited capacity to manage their own care. The second theme presents the distinct roles of parents, teachers and clinicians ("interpersonal and organisational levels"). The third describes how these three levels interact in the management of the child's care, in the context of the health and education systems and policies ("policy levels"). The fourth explores optimal ways to integrate care across home, school and clinical settings. In conclusion, there is opportunity to support a child with complex health needs by targeting the systems around the child; parents, teachers and clinicians, as well as education and health policy that can enable shared-care. Involving schools in assessment, communicating diagnosis across settings and using a stepped-care approach to integrated care may be beneficial. Further work is needed to explore these recommendations, with attention to the policy factors that may act as barriers and enablers.
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Affiliation(s)
- Amberly Brigden
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Shaw
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca Barnes
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma Anderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Crawley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Collard SS, Murphy J. Management of chronic fatigue syndrome/myalgic encephalomyelitis in a pediatric population: A scoping review. J Child Health Care 2020; 24:411-431. [PMID: 31379194 PMCID: PMC7863118 DOI: 10.1177/1367493519864747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) negatively impacts the quality of life for children with the condition. Although up to 2% of children have CFS/ME, the bulk of research investigates adults with CFS/ME. Using the PRISMA extension for a scoping review and the work of Arksey and O'Malley (2005), a scoping review was conducted of all relevant peer-reviewed research investigating nutrition, exercise, and psychosocial factors within a pediatric population diagnosed with CFS/ME. Key themes found were nutrition and dietary components, exercise therapy, psychosocial factors, and multifaceted treatment. Nutrition was explored on its own as a tool to decrease symptoms; however, there were very few studies found to examine nutritional deficiency or treatment with those under the age of 18. Graded exercise and resistance training improved fatigue severity and symptoms of depression in adolescents with CFS/ME. Research exploring psychosocial factors of CFS/ME presented attributes that could lead to being diagnosed as well as barriers to treatment. The multifaceted treatment undertaken typically consists of graded activities/exercise, cognitive behavioral therapy, nutritional advice, and family sessions. This has shown to increase school attendance and decrease the severity of the fatigue for adolescents. Minimal literature exploring CFS/ME within a prepubescent population presents the need for further research.
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Affiliation(s)
- Sarah S Collard
- Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Bournemouth, UK
| | - Jane Murphy
- Faculty of Health and Social Sciences, Bournemouth University, Royal London House, Bournemouth, UK
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Ali S, Adamczyk L, Burgess M, Chalder T. Psychological and demographic factors associated with fatigue and social adjustment in young people with severe chronic fatigue syndrome/myalgic encephalomyelitis: a preliminary mixed-methods study. J Behav Med 2019; 42:898-910. [PMID: 30684123 DOI: 10.1007/s10865-019-00010-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 01/05/2019] [Indexed: 10/27/2022]
Abstract
This mixed-methods study investigated factors associated with fatigue, disability and school attendance in young people with severe CFS/ME. Participants' illness experiences were also explored. Questionnaires were completed at baseline (T1) and approximately 5 months later (T2). There were 51 participants aged between 12 and 25, with a mean age of 18.8 years (SD 3.4). At T1, participants reported severe fatigue and poor social adjustment. Stronger fear avoidance beliefs at T1 were associated with higher fatigue at T2, and with worse social adjustment at T1 and T2. Female gender was associated with lower work/school attendance at T1 and T2 but not with higher fatigue or worse social adjustment. Having accessed treatment was associated with reporting lower levels of work/school attendance at T1 and T2. Multivariate analyses of key outcomes identified significant associations between stronger fear avoidance beliefs and worse social adjustment at T2, and between female gender and lower work/school attendance at T2. It was clear from the qualitative data that severe CFS/ME negatively impacted on many aspects of young people's lives. Fearful beliefs about activity could be targeted using cognitive-behavioural interventions.
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Affiliation(s)
- Sheila Ali
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lucy Adamczyk
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mary Burgess
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Crawley E. Pediatric chronic fatigue syndrome: current perspectives. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2018; 9:27-33. [PMID: 29722371 PMCID: PMC5919160 DOI: 10.2147/phmt.s126253] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Pediatric chronic fatigue syndrome is an important illness as it is relatively common and also very disabling with a wide range of impacts on the child, the family, and health care systems. It is a complicated illness but the majority of children get better with specialist treatment. This literature review provides an update on the epidemiology of chronic fatigue syndrome / myalgic encephalomyelitis, including factors associated with it, and discusses the current evidence for treatment.
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Affiliation(s)
- Esther Crawley
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
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Baos S, Brigden A, Anderson E, Hollingworth W, Price S, Mills N, Beasant L, Gaunt D, Garfield K, Metcalfe C, Parslow R, Downing H, Kessler D, Macleod J, Stallard P, Knoop H, Van de Putte E, Nijhof S, Bleijenberg G, Crawley E. Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to Activity Management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): protocol for a randomised controlled trial. Trials 2018; 19:136. [PMID: 29471861 PMCID: PMC5824604 DOI: 10.1186/s13063-018-2500-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 12/07/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. METHODS Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. DISCUSSION If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. TRIAL REGISTRATION ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.
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Affiliation(s)
- Sarah Baos
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Amberly Brigden
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Emma Anderson
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - William Hollingworth
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Simon Price
- Computer Science, University of Bristol, Merchant Venturers Building, Woodland Road, Bristol, BS8 1UB UK
| | - Nicola Mills
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Lucy Beasant
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Daisy Gaunt
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Kirsty Garfield
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Roxanne Parslow
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Harriet Downing
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David Kessler
- Bristol Medical School: Population Health Sciences, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - John Macleod
- Bristol Medical School: Population Health Sciences, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Paul Stallard
- Department for Health, University of Bath, Bath, BA2 7AD UK
| | - Hans Knoop
- Department for Medical Psychology, Academic Medical Centre (AMC) University of Amsterdam, Postbox 22660, 1100 DD Amsterdam, The Netherlands
| | - Elise Van de Putte
- Department of Paediatrics, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Sanne Nijhof
- Department of Paediatrics, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands
| | | | - Esther Crawley
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
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Brigden A, Loades M, Abbott A, Bond-Kendall J, Crawley E. Practical management of chronic fatigue syndrome or myalgic encephalomyelitis in childhood. Arch Dis Child 2017; 102:981-986. [PMID: 28659269 PMCID: PMC5947766 DOI: 10.1136/archdischild-2016-310622] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/04/2022]
Abstract
Paediatric chronic fatigue syndrome or myalgic encephalomyelitis affects at least 1% of secondary school children in the UK and is very disabling. Treatment is effective but few children get a diagnosis or access treatment. This paper summarises what we currently know about diagnosing and treating this important illness in childhood.
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Affiliation(s)
- Amberly Brigden
- Centre for Child and Adolescent Heath, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Maria Loades
- Centre for Child and Adolescent Heath, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Department of Psychology, University of Bath, Bath, UK
- Paediatric CFS/ME Service, Children's Centre, Royal United Hospital, Bath, UK
| | - Anna Abbott
- Paediatric CFS/ME Service, Children's Centre, Royal United Hospital, Bath, UK
| | - Joanne Bond-Kendall
- Paediatric CFS/ME Service, Children's Centre, Royal United Hospital, Bath, UK
| | - Esther Crawley
- Centre for Child and Adolescent Heath, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Paediatric CFS/ME Service, Children's Centre, Royal United Hospital, Bath, UK
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Collin SM, Bakken IJ, Nazareth I, Crawley E, White PD. Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001-2013: a Clinical Practice Research Datalink study. J R Soc Med 2017; 110:231-244. [PMID: 28358988 PMCID: PMC5499564 DOI: 10.1177/0141076817702530] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective Trends in recorded diagnoses of chronic fatigue syndrome (CFS, also known as ‘myalgic encephalomyelitis’ (ME)) and fibromyalgia (FM) in the UK were last reported more than ten years ago, for the period 1990–2001. Our aim was to analyse trends in incident diagnoses of CFS/ME and FM for the period 2001–2013, and to investigate whether incidence might vary by index of multiple deprivation (IMD) score. Design Electronic health records cohort study. Setting NHS primary care practices in the UK. Participants Participants: Patients registered with general practices linked to the Clinical Practice Research Datalink (CPRD) primary care database from January 2001 to December 2013. Main outcome measure Incidence of CFS/ME, FM, post-viral fatigue syndrome (PVFS), and asthenia/debility. Results The overall annual incidence of recorded cases of CFS/ME was 14.8 (95% CI 14.5, 15.1) per 100,000 people. Overall annual incidence per 100,000 people for FM was 33.3 (32.8–33.8), for PVFS 12.2 (11.9, 12.5), and for asthenia/debility 7.0 (6.8, 7.2). Annual incidence rates for CFS/ME diagnoses decreased from 17.5 (16.1, 18.9) in 2001 to 12.6 (11.5, 13.8) in 2013 (annual percent change −2.8% (−3.6%, −2.0%)). Annual incidence rates for FM diagnoses decreased from 32.3 (30.4, 34.3) to 27.1 (25.5, 28.6) in 2007, then increased to 38.2 (36.3, 40.1) per 100,000 people in 2013. Overall annual incidence of recorded fatigue symptoms was 2246 (2242, 2250) per 100,000 people. Compared with the least deprived IMD quintile, incidence of CFS/ME in the most deprived quintile was 39% lower (incidence rate ratio (IRR) 0.61 (0.50, 0.75)), whereas rates of FM were 40% higher (IRR 1.40 (0.95, 2.06)). Conclusion These analyses suggest a gradual decline in recorded diagnoses of CFS/ME since 2001, and an increase in diagnoses of fibromyalgia, with opposing socioeconomic patterns of lower rates of CFS/ME diagnoses in the poorest areas compared with higher rates of FM diagnoses.
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Affiliation(s)
- Simon M Collin
- 1 School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Inger J Bakken
- 2 Norwegian Institute of Public Health, 0403 Oslo, Norway
| | - Irwin Nazareth
- 3 UCL Department of Primary Care and Population Health, UCL Royal Free Campus, London NW3 2PF, UK
| | - Esther Crawley
- 1 School of Social and Community Medicine, University of Bristol, Bristol BS8 2BN, UK
| | - Peter D White
- 4 Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
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Harris S, Gilbert M, Beasant L, Linney C, Broughton J, Crawley E. A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis. Clin Child Psychol Psychiatry 2017; 22:128-139. [PMID: 27215228 PMCID: PMC5207298 DOI: 10.1177/1359104516646813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND An estimated 10% of children and adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience eating difficulties; however, little is known about why these difficulties develop, what the impact is or how to manage them. METHODS Semi-structured interviews were conducted with adolescents (aged 12-17 years) attending a specialist service who have a primary diagnosis of CFS/ME and experience nausea, abdominal pain and/or eating difficulties. A total of 11 adolescents were interviewed (eight female, mean age: 15 years). Transcripts were analysed thematically using techniques of constant comparison which commenced soon after data collection and informed further interview protocols. RESULTS Adolescents perceived their eating difficulties were caused by abdominal symptoms, being too fatigued to eat and changes to their senses of taste and smell. Some of the adolescents recognised how their eating difficulties were exacerbated and maintained by psychological factors of low mood and anxiety. The adolescents eating difficulties had a negative impact on their weight, fatigue, socialising and family life. They perceived helpful interventions to include modifying their diets, families adjusting and also medical interventions (e.g. medication). Adolescents identified that early education and support about diet and eating habits would have been helpful. CONCLUSIONS If adolescents diagnosed with CFS/ME develop eating difficulties, this has a significant impact on their quality of life, illness and on their families. Not eating increases fatigue, low mood and anxiety which further exacerbates the eating difficulties. Clinicians should screen for eating difficulties in those with symptoms of nausea and abdominal pain, warn adolescents and their families of the risk of developing eating difficulties and provide interventions and support as early as possible.
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Affiliation(s)
- Sarah Harris
- 1 South Wales Doctoral Programme in Clinical Psychology, Cardiff University, UK
| | - Matthew Gilbert
- 2 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| | - Lucy Beasant
- 2 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| | | | - Jessica Broughton
- 2 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| | - Esther Crawley
- 2 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
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Collin SM, Norris T, Nuevo R, Tilling K, Joinson C, Sterne JAC, Crawley E. Chronic Fatigue Syndrome at Age 16 Years. Pediatrics 2016; 137:e20153434. [PMID: 26810786 DOI: 10.1542/peds.2015-3434] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, chronic disabling fatigue lasting ≥6 months affected 1.3% of 13-year-olds, was equally common in boys and girls, and became more prevalent with increasing family adversity. METHODS ALSPAC data were used to estimate the prevalence of chronic fatigue syndrome (CFS) at age 16 years, defined by parental report of unexplained disabling fatigue lasting ≥6 months. We investigated gender and a composite 14-item family adversity index as risk factors. School absence data were obtained from the National Pupil Database. Multiple imputation was used to address bias caused by missing data. RESULTS The prevalence of CFS was 1.86% (95% confidence interval [CI]: 1.47 to 2.24). After excluding children with high levels of depressive symptoms, the prevalence was 0.60% (95% CI: 0.37 to 0.84). Authorized school absences were much higher (mean difference: 35.6 [95% CI: 26.4 to 44.9] half-day sessions per academic year) and reported depressive symptoms were much more likely (odds ratio [OR]: 11.0 [95% CI: 5.92 to 20.4]) in children with CFS than in those without CFS. Female gender (OR: 1.95 [95% CI: 1.33 to 2.86]) and family adversity (OR: 1.20 [95% CI: 1.01 to 1.42] per unit family adversity index) were also associated with CFS. CONCLUSIONS CFS affected 1.9% of 16-year-olds in a UK birth cohort and was positively associated with higher family adversity. Gender was a risk factor at age 16 years but not at age 13 years or in 16-year-olds without high levels of depressive symptoms.
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Affiliation(s)
- Simon M Collin
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Tom Norris
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Roberto Nuevo
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | | | - Carol Joinson
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | | | - Esther Crawley
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
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Hinton D, Kirk S. Families' and healthcare professionals' perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:12-26. [PMID: 25684117 DOI: 10.1111/hsc.12184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 06/04/2023]
Abstract
Children and young people frequently report physical complaints that have no observable physical pathology known as medically unexplained symptoms (MUS). Research suggests that MUS are associated with substantial physical and psychological impairments and may have a negative impact on children's and young people's functional status and well-being in the long term. Due to the potentially complex needs of this group, children and young people with MUS may require timely access to suitable health and social care services to effectively manage symptoms and achieve their academic, social and personal potential. Families and professionals can offer important insights into the availability and appropriateness of current community and specialist health and social care services. This review is the first critical evaluation and synthesis of research that has examined families' and healthcare professionals' (HCP) perceptions of healthcare services for children and young people with MUS. A systematic search of electronic databases and manual searches of key journals and reference lists identified 17 papers from 15 studies for inclusion in the review. The review highlights the paucity of rigorously conducted research on this topic. Studies have been narrowly focused on the views of a homogeneous group of mothers and young people attending single centres. There has been some attempt to examine doctors' views, but the perceptions of children, fathers and health and social care professionals are absent or under-represented, and multi-site and longitudinal studies are lacking. Thematic analysis of the results from the included studies suggests that knowledge, communication, health beliefs and healthcare settings are factors that influence families' and HCPs' perceptions of services. Families report dissatisfaction with some HCPs' approach to managing MUS. The findings suggest that children and young people with MUS are at risk of receiving suboptimal care and support because there is insufficient research to inform high-quality, evidence-based practice.
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Affiliation(s)
- Denise Hinton
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Susan Kirk
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Marks MR, Huws JC, Whitehead L. Working with uncertainty: A grounded theory study of health-care professionals' experiences of working with children and adolescents with chronic fatigue syndrome. J Health Psychol 2015; 21:2658-2667. [PMID: 25957226 DOI: 10.1177/1359105315583367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This grounded theory study explores conceptualisations of chronic fatigue syndrome/myalgic encephalomyelitis from semi-structured interviews with 10 health-care professionals working with children and adolescents. The findings suggest that a lack of a clear empirical understanding of chronic fatigue syndrome/myalgic encephalomyelitis leads to 'working with uncertainty', whereby health-care professionals utilise previous experiences to make sense of the condition and inform their clinical practice. How health-care professionals make sense of chronic fatigue syndrome/myalgic encephalomyelitis may influence the labels given to young people and the interventions they receive. The findings provide insight into a currently understudied area, and highlight potential avenues for further research and clinical practice.
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Picariello F, Ali S, Moss-Morris R, Chalder T. The most popular terms for medically unexplained symptoms: the views of CFS patients. J Psychosom Res 2015; 78:420-426. [PMID: 25791667 DOI: 10.1016/j.jpsychores.2015.02.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Medically unexplained symptoms/syndromes are common, highly distressing and are often associated with profound disability. One of the controversies surrounding this area relates to which umbrella term should be used to group such symptoms. The purpose of this research was to establish the preferences of patients with chronic fatigue syndrome (CFS) for an umbrella term for medically unexplained symptoms. METHODS A cross-sectional mixed methods survey design was used. Participants were asked to indicate their three most preferred terms out of a list of commonly used terms and to provide any extra comments. Frequency analysis was employed to look at the preferences of terms for each rank. Comments were analysed using principles of inductive thematic analysis. RESULTS Eighty-seven patients with CFS completed a self-report survey. The term "Persistent Physical Symptoms" was the most popular first choice term chosen by 20.7% of patients. Terms containing the word "physical" were consistently more likely to be chosen. Three main themes emerged from the thematic analysis: 1) Physical nature of the illness, 2) Stigma, and 3) Evaluation of the terms, giving a more in-depth understanding of the findings. CONCLUSION According to CFS patients, an umbrella term has to reflect the physical experience of MUS.
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Affiliation(s)
- Federica Picariello
- King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Sheila Ali
- South London and Maudsley NHS Foundation Trust, United Kingdom
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Abstract
Most paediatricians regularly see children with chronic fatigue syndrome or myalgic encephalitis (CFS/ME) in their clinics and yet we know little about how common it is, who is affected, whether there are risk factors and how likely a child is to recover (or what might predict recovery). Recent research suggests that this illness is more complicated than previously thought and that rather than being an illness found in middle class families, it is more common in those who are socially deprived. This article reviews what is currently known about this important but little understood condition.
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Winger A, Ekstedt M, Wyller VB, Helseth S. 'Sometimes it feels as if the world goes on without me': adolescents' experiences of living with chronic fatigue syndrome. J Clin Nurs 2013; 23:2649-57. [PMID: 24354631 DOI: 10.1111/jocn.12522] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2013] [Indexed: 02/06/2023]
Abstract
AIMS AND OBJECTIVES To explore the experience of being an adolescent with chronic fatigue syndrome. BACKGROUND Despite ample research, chronic fatigue syndrome is still poorly understood, and there are still controversies related to the illness. Adolescents with chronic fatigue syndrome are often unable to attend school and lose social relations with friends. The challenges they face will affect their quality of life. DESIGN A qualitative, phenomenological hermeneutical design. METHOD Six boys and twelve girls, aged 12-18, were interviewed, emphasising their own experiences living with chronic fatigue syndrome. Analyses were performed using a phenomenological hermeneutical method. RESULTS The core theme, 'Sometimes it feels as if the world goes on without me', encompasses the feelings an adolescent living with chronic fatigue syndrome might have about life. The core theme was supported by four subthemes: 'On the side of life--locked in and shut out'; 'the body, the illness and me'; 'if the illness is not visible to others, does it exist?'; and 'handling life while hoping for a better future'. The subthemes reflect the experience of social isolation, their own and others' understanding of the illness and hope for the future. CONCLUSIONS Not being able to be with friends, or attend school, made the adolescents feel different and forgotten. They felt alienated in their own bodies and were struggling to be visible to themselves and to their surroundings. Spending less time with friends and more time with their parents constituted a threat to independence and development. Yet they managed to envision a better future despite all the difficulties. RELEVANCE FOR CLINICAL PRACTICE To provide effective support and constructive relations to adolescents with chronic fatigue syndrome, all health professions involved need insight from the persons who are themselves ill. Health centres could function as resource centres for patients and healthcare professionals.
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Affiliation(s)
- Anette Winger
- Faculty of Nursing, Oslo and Akershus University College of Applied Sciences, Oslo, Norway; Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Knight S, Harvey A, Lubitz L, Rowe K, Reveley C, Veit F, Hennel S, Scheinberg A. Paediatric chronic fatigue syndrome: complex presentations and protracted time to diagnosis. J Paediatr Child Health 2013; 49:919-924. [PMID: 24251657 DOI: 10.1111/jpc.12425] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2013] [Indexed: 11/28/2022]
Abstract
AIM The diagnosis and management of paediatric chronic fatigue syndrome (CFS) remain ongoing challenges for paediatric clinicians, particularly given its unknown aetiology and the little research on effective treatments for this condition. The aim of this study was to describe the presenting features of new patients attending a specialist chronic fatigue clinic at a tertiary-level Australian children's hospital. METHOD The medical records of all patients with an initial consultation at the chronic fatigue clinic over a 12-month period were reviewed using a standardised data collection template. Functional impact was based on school attendance and classified according to the National Institute of Health and Clinical Excellence guidelines (2007). RESULTS A total of 99 patients attending the clinic were identified. Of these, 59 were diagnosed with CFS. Median age was 15.4 years with almost two-thirds of patients of female sex. Median time between symptom onset and diagnosis was 15.5 months. There was a high occurrence of fatigue, sleep disturbance, pain, postexertional malaise, and autonomic and cognitive symptoms in the group. The functional impact of CFS was classified as mild for 20%, moderate for 66% and severe for 14% of patients. CONCLUSIONS Most young people diagnosed with CFS experience symptoms for a protracted period, with considerable functional impact prior to initial tertiary service consultation. This audit has identified important areas for research, practice development and education in relation to the management of patients with CFS.
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Affiliation(s)
- Sarah Knight
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Paediatric Rehabilitation Service, Monash Children's, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Adrienne Harvey
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Paediatric Rehabilitation Service, Monash Children's, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lionel Lubitz
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kathy Rowe
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Colette Reveley
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Frederike Veit
- Department of Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sabine Hennel
- Victorian Paediatric Rehabilitation Service, Monash Children's, Melbourne, Victoria, Australia
| | - Adam Scheinberg
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Victorian Paediatric Rehabilitation Service, Monash Children's, Melbourne, Victoria, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
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Albright K, Gechter K, Kempe A. Importance of mixed methods in pragmatic trials and dissemination and implementation research. Acad Pediatr 2013; 13:400-7. [PMID: 24011744 DOI: 10.1016/j.acap.2013.06.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/21/2013] [Accepted: 06/29/2013] [Indexed: 12/19/2022]
Abstract
With increased attention to the importance of translating research to clinical practice and policy, recent years have seen a proliferation of particular types of research, including pragmatic trials and dissemination and implementation research. Such research seeks to understand how and why interventions function in real-world settings, as opposed to highly controlled settings involving conditions not likely to be repeated outside the research study. Because understanding the context in which interventions are implemented is imperative for effective pragmatic trials and dissemination and implementation research, the use of mixed methods is critical to understanding trial results and the success or failure of implementation efforts. This article discusses a number of dimensions of mixed methods research, utilizing at least one qualitative method and at least one quantitative method, that may be helpful when designing projects or preparing grant proposals. Although the strengths and emphases of qualitative and quantitative approaches differ substantially, methods may be combined in a variety of ways to achieve a deeper level of understanding than can be achieved by one method alone. However, researchers must understand when and how to integrate the data as well as the appropriate order, priority, and purpose of each method. The ability to demonstrate an understanding of the rationale for and benefits of mixed methods research is increasingly important in today's competitive funding environment, and many funding agencies now expect applicants to include mixed methods in proposals. The increasing demand for mixed methods research necessitates broader methodological training and deepened collaboration between medical, clinical, and social scientists. Although a number of challenges to conducting and disseminating mixed methods research remain, the potential for insight generated by such work is substantial.
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Affiliation(s)
- Karen Albright
- Department of Community and Behavioral Health, Colorado School of Public Health; Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus; Center for Research in Implementation Science and Prevention.
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Nijhof SL, Priesterbach LP, Uiterwaal CSPM, Bleijenberg G, Kimpen JLL, van de Putte EM. Internet-based therapy for adolescents with chronic fatigue syndrome: long-term follow-up. Pediatrics 2013; 131:e1788-95. [PMID: 23669515 DOI: 10.1542/peds.2012-2007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Cognitive behavioral therapy (CBT) is known to be an effective treatment of adolescents with chronic fatigue syndrome (CFS), but its availability is limited. Fatigue in Teenagers on the Internet (FITNET), an Internet-based CBT program for adolescents with CFS, has been developed as an alternative to face-to-face CBT. Recently, its short-term effectiveness has been proven in a randomized clinical trial. Here we aimed to assess the long-term outcome of CFS in adolescents after FITNET treatment and after usual care. In addition, factors related to recovery at long-term follow-up (LTFU) for adolescents treated with the FITNET program were investigated. METHODS The study was an LTFU of participants of the FITNET trial. Data were completed for 112 (88.2%) of 127 approached FITNET study participants. Primary outcomes were fatigue severity (Checklist Individual Strength-20), physical functioning (87-item Child Health Questionnaire), and school/work attendance. RESULTS After a mean follow-up of 2.7 years, 66 (58.9%) adolescents had recovered from CFS. Most adolescents who recovered directly after treatment with FITNET were still recovered at LTFU. At LTFU there was no difference between the recovery rates for the different treatment strategies (original randomization: FITNET [64%] versus any form of usual care [52.8%]). Per additional month of "pretreatment disease duration," the odds for recovery were 4% lower (odds ratio: 0.96; 95% confidence interval: 0.93-0.99; P = .016), and per added point on "focus on bodily symptoms" (Body Consciousness Scale) of the mother (0-20 points) the odds for recovery were 11% lower (odds ratio: 0.89; 95% confidence interval: 0.80-0.99; P = .029). CONCLUSIONS The short-term effectiveness of Internet-based CBT on adolescent CFS is maintained at LTFU. At LTFU, usual care led to similar recovery rates, although these rates were achieved at a slower pace.
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Affiliation(s)
- Sanne L Nijhof
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, Netherlands.
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Adolescents and mothers value referral to a specialist service for chronic fatigue syndrome or myalgic encephalopathy (CFS/ME). Prim Health Care Res Dev 2013; 15:134-42. [PMID: 23731646 DOI: 10.1017/s1463423613000121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Paediatric chronic fatigue syndrome or myalgic encephalopathy (CFS/ME) is relatively common and disabling. Current guidance recommends referral to specialist services, although some general practitioners believe the label of CFS/ME is harmful and many are not confident about diagnosing CFS/ME. Aim Explore whether or not adolescents and their mothers value referral to a specialist service for young people with CFS/ME. METHODS A qualitative study nested within a feasibility study of interventions for CFS/ME [Specialist Medical Intervention and Lightning Evaluation (SMILE)]. In-depth interviews were undertaken with 13 mothers and 12 adolescents participating in the SMILE study. Transcripts were systematically assigned codes using the qualitative data organisation package NVivo and analysed thematically using techniques of constant comparison. RESULTS Gaining access to the specialist service was difficult and took a long time. Mothers felt that they needed to be proactive and persistent, partly because of a lack of knowledge in primary and secondary care. Having gained access, mothers felt the CFS/ME service was useful because it recognised and acknowledged their child's condition and opened channels of dialogue between health-care professionals and education providers. Adolescents reported that specialist medical care resulted in better symptom management, although some adolescents did not like the fact that the treatment approach limited activity. CONCLUSIONS Adolescents and their mothers value receiving a diagnosis from a specialist service and making progress in managing CFS/ME. General practitioners should support adolescents with CFS/ME in accessing CFS/ME specialist services, consistent with current guidance.
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