Derek Pheby
Bucks New University, Health and Society, Department Member
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The prevalence of long-term catheterization in the adult population is of the order of 0.03–0.07%, rising to 0.5% in those over 75 years and 2% in those over 85 years old. Studies have shown that the prevalence of urinary incontinence... more
The prevalence of long-term catheterization in the adult population is of the order of 0.03–0.07%, rising to 0.5% in those over 75 years and 2% in those over 85 years old. Studies have shown that the prevalence of urinary incontinence increases with age and is higher in females. Little is known about the costs of long-term catheterization, which have consequences for care decisions. A pilot study was conducted to test (a) the applicability in the UK of a methodology developed in the USA for measuring the cost of long-term catheterization in community based patients, and (b) the feasibility of using it in larger-scale community-based studies. The study made use of the method developed in the USA by Wagner and Hu (1998) to assess the true costs in the population. Patients were selected in order to represent as broad as possible a range of underlying disease processes and social circumstances. Eight patients were selected, drawn from 3 distinct groups of patients. The pilot study demon...
Research Interests: Nursing, Long Term Care, Medicine, England, Humans, and 12 moreFemale, Community health nursing, Feasibility Studies, Male, Questionnaires, Cost of Illness, Health Care Costs, Pilot Projects, Time and Motion Studies, Econometric models - Eviews SPSS, personnel staffing and scheduling, and Urinary catheterization
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Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)... more
Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST) (https://www.cost.eu/cost-actions/what-are-costactions/ ) COST action 15111 from 2016 to 2020. The main goal of the Cost Action was to assess the existing fragmented knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report on the recommendations for clinical diagnosis, heath services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS (https://www.cost.eu/actions/CA15111/#tabs|Name:overview).
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Guiding legislation and associated bureaucracy for the ethical review of clinical trials observational studies and food related research play an important role in the competitiveness of a nation in the face of tough global competition to... more
Guiding legislation and associated bureaucracy for the ethical review of clinical trials observational studies and food related research play an important role in the competitiveness of a nation in the face of tough global competition to attract sponsors and investigators. This is of particular relevance in the case of multicentre trials and multidisciplinary research. Accordingly, in this report we tried to gather in-depth knowledge of the current role and practices of ethics committees nationwide in both clinical and research settings. This mini-review aims to describe the formulation and organization of ethical committees in Italy in order to provide a focus for deliberations on ethical issues in medical and scientific research in line with human rights, as set out in the European Union charter. Furthermore, we evaluated the impact of an institution’s ethical committee intervention on reducing the time required to obtain an opinion from Research Ethics Committees by guiding inves...
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BACKGROUND: Case History Research on ME (CHROME) was established in 1994 to undertake research on severely affected patients. Since 1995 CHROME has collected data on volunteers with severe ME/CFS. All are medically diagnosed, conform to... more
BACKGROUND: Case History Research on ME (CHROME) was established in 1994 to undertake research on severely affected patients. Since 1995 CHROME has collected data on volunteers with severe ME/CFS. All are medically diagnosed, conform to Fukuda criteria, are or were house-bound, and ill for at least two years. Participants complete initial and annual follow-up questionnaires, and report their condition at onset of illness, a year previously, on recruitment, and annually thereafter. METHOD: We report symptom severity and ability to undertake activities of daily living in 324 participants recruited between 1995 and 1998, their evolution through time, and, for later onset (age 17+) subjects, changes occurring between recruitment and the latest questionnaire. Significance was assessed using the McNemar test or its binomial equivalent. RESULTS: For most features, subjects deteriorated between onset and recruitment, with subsequent improvement, often slow and uneven, among later onset case...
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There is no consistent or standardized practice for the collection of treatment data in UK cancer registries. This limits the usefulness and effectiveness of undertaking multiregional or national studies of treatment outcomes and... more
There is no consistent or standardized practice for the collection of treatment data in UK cancer registries. This limits the usefulness and effectiveness of undertaking multiregional or national studies of treatment outcomes and survival. A working group was established to examine the practices for recording the type and the amount of treatment data held in the cancer records at different registries. A common set of anonymized case notes for breast and colorectal cancer patients, drawn from each registry, was employed to eliminate any selection bias. Each registry coded these case notes according to their own criteria, and the comparability of such data between registries was determined from their returns. Of the 11 registries in England, seven participated in the full study, with a total of 84 records being submitted by five registries. A flow diagram was constructed to show how specific data items in the cancer record structure could be linked between registries. Errors or inconsistencies in recording treatment details were identified, and the constraints in data comparability were defined from the case note returns. Variations in coding practice between registries were such as to vitiate interregional or national comparisons of current data. The working group recommended an extended minimum dataset, which included a date for the start of each treatment modality, that most registries should be able to implement with some system changes.
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Much attention has been focused on the apparent risk to long-haul air travelers of venous thromboembolism [deep vein thrombosis (DVT) and pulmonary embolism (PE)], following a number of well-publicized cases. However, there is little... more
Much attention has been focused on the apparent risk to long-haul air travelers of venous thromboembolism [deep vein thrombosis (DVT) and pulmonary embolism (PE)], following a number of well-publicized cases. However, there is little epidemiological data to elucidate the problem. PE tends to be under-diagnosed as a cause of death in the general population. This study sets out to establish the level of risk of fatal PE among long-haul passengers arriving in the UK, on the basis of a reappraisal of the role of PE in mortality in the general population. Autopsies carried out at Gloucester in 1996-2000 were reviewed to determine age-specific mortality rates for PE for West Gloucestershire. These rates were applied to long-haul air travelers arriving in the UK, for whom the number of passenger-years at risk were calculated, to estimate the expected numbers of deaths in this group. In 3764 autopsies, PE was the primary cause of death in 221 cases (5.9%), while in 304 (8.1%) it was present...
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The particular logistical problems of collecting cancer registration data in the South-Western region of England are discussed. The Regional Cancer Registry has endeavoured to overcome these through developing electronic links to... more
The particular logistical problems of collecting cancer registration data in the South-Western region of England are discussed. The Regional Cancer Registry has endeavoured to overcome these through developing electronic links to hospital-based patient-information systems. Some of these involve data transfer on magnetic media, but there are also interrogation facilities which operate on a realtime, interactive basis, and complement these other facilities. A PC-based program (SNODEV5), which can accept data from histopathology computer systems, translate SNOMED codes to ICD-9, and produce files suitable for processing by the registry's Batch Data Entry system is described. Its contribution to the achievement and monitoring of equity in health care provision is discussed.
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Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is a disease, or group of diseases, which for years has divided the clinical professions*. There has been no clear consensus about either the nature or aetiology of the... more
Chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) is a disease, or group of diseases, which for years has divided the clinical professions*. There has been no clear consensus about either the nature or aetiology of the disease, or possible approaches to the treatment and care of those suffering from it. However, no one who has experienced this illness, or who has had the responsibility of caring for a family member who has had the misfortune to suffer from it, can have any doubt not only about the extent of the real pain, suffering and distress that it can cause, but also as to the disastrous effect it can have on social relationships and life in the community. This is particularly the case among child sufferers, for whom the effect upon their educational development and social well-being may be catastrophic, particularly when child and family encounter unsympathetic professionals. The consequences may last for years. CFS/ME is a spectrum of disease which causes substantial suffering and disability, and which has significant cost implications, both in terms of demands on health services, loss of time from work, and social security and insurance claims (National Task Force, 1994, page 7). Commonly triggered by viral infections, it appears from current research that dysfunction of the immune system, the central nervous system and the neuroendocrine system (particularly the hypo
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ABSTRACT
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As part of the development of integrated, patient-based hospital information technology (IT) systems in the South-Western Region of England, a module has been developed which will hold core data pertaining to the functional status and... more
As part of the development of integrated, patient-based hospital information technology (IT) systems in the South-Western Region of England, a module has been developed which will hold core data pertaining to the functional status and current resources of elderly or disabled patients. Its purpose is to assist early identification of unmet needs and facilitate prompt transfer to community care. The module provides a shared database, which is completed or updated as necessary on admission and is then available to all appropriate users of the hospital system, avoiding duplication of data collection. In addition to details of home circumstances and support, it includes brief, standardized assessment scales for activities of daily living and mental state, which will identify the need for specialist referral. A summary is provided for easy communication with other care agencies.
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... School of Health and Social Sciences, Middlesex University and CHROME Research Group 7 Wilderton Road, London, N16 5QY, UK e-mail : Peter.Sneddon@btinternet.com ... Rachel Barker, Catherine Manley, Ken Manley, Colin Parratt and Emma... more
... School of Health and Social Sciences, Middlesex University and CHROME Research Group 7 Wilderton Road, London, N16 5QY, UK e-mail : Peter.Sneddon@btinternet.com ... Rachel Barker, Catherine Manley, Ken Manley, Colin Parratt and Emma Toy, to Victor ...
This study represents a comparison of the functional interrelation of fatigue and cognitive, cardiovascular and autonomic nervous systems in a group of Chronic Fatigue Syndrome (CFS) patients compared with those in healthy individuals at... more
This study represents a comparison of the functional interrelation of fatigue and cognitive, cardiovascular and autonomic nervous systems in a group of Chronic Fatigue Syndrome (CFS) patients compared with those in healthy individuals at different stages of analysis: at baseline and after changes induced by whole-body cryotherapy (WBC) combined with a static-stretching (SS) program. The study included 32 patients (Fukuda criteria) and 18 healthy controls. Fatigue, cognitive, cardiovascular and autonomic function and arterial stiffness were measured before and after 10 sessions of WBC with SS. In the patients, a disturbance in homeostasis was observed. The network relationship based on differences before and after intervention showed comparatively higher stress and eccentricity in the CFS group: 50.9 ± 56.1 vs. 6.35 ± 8.72, p = 0.002, r = 0.28; and 4.8 ± 0.7 vs. 2.4 ± 1, p < 0.001, r = 0.46, respectively. Before and after intervention, in the CFS group increased fatigue was relate...
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Background and objectives: Current studies show an important role of affective temperament in sport performance. The aim of this study was to assess the feasibility of the use of the TEMPS-A scale, by using it to examine five dimensions... more
Background and objectives: Current studies show an important role of affective temperament in sport performance. The aim of this study was to assess the feasibility of the use of the TEMPS-A scale, by using it to examine five dimensions of affective temperament in three groups of athletes. We hypothesized that temperament may be a predisposing factor to the level of commitment and type of training. Materials and methods: The study group (N:71, 33 female) consisted of professional canoeists (N:25, aged 18–30), sports pilots (N:21, aged 19–57) and non-professionals regularly performing aerobic exercises (N:25, aged 23–33). The Affective Temperament of Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) was used to evaluate affective temperament dimensions. Statistical analysis was performed using non-parametric tests. Results: The TEMPS_A scale shows good internal consistency; a hyperthymic temperament was associated with different factors compared to other temperament traits. The m...
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© 2009 Drachler et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License
Metabolic-associated fatty liver disease (MAFLD), previously called non-alcoholic fatty liver disease (NAFLD), is the most common chronic liver disease worldwide. It is characterised by excessive fat accumulation in hepatocytes.... more
Metabolic-associated fatty liver disease (MAFLD), previously called non-alcoholic fatty liver disease (NAFLD), is the most common chronic liver disease worldwide. It is characterised by excessive fat accumulation in hepatocytes. Currently, no pharmacological therapy is effective for this disease, so non-pharmacological alternatives such as diet, supplementation or physical activity are being sought. For this reason, we reviewed the available databases to analyse the studies conducted to date using different modifications of intermittent fasting among patients with MAFLD. Eight studies using this dietary strategy were included in this review. The results obtained in the different trials are varied and do not allow a clear determination of the effect of the different types of intermittent fasting on anthropometric and biochemical parameters among patients with MAFLD. However, this type of diet seems to show some therapeutic potential, but further studies are needed.
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Luis Nacul (luis.nacul@lshtm.ac.uk) Eliana M Lacerda (eliana.lacerda@lshtm.ac.uk) Peter D Campion (p.d.campion@hull.ac.uk) Derek F Pheby (derekpheby@btinternet.com) Maria L Drachler (jcdc.leite@googlemail.com) Jose C Leite... more
Luis Nacul (luis.nacul@lshtm.ac.uk) Eliana M Lacerda (eliana.lacerda@lshtm.ac.uk) Peter D Campion (p.d.campion@hull.ac.uk) Derek F Pheby (derekpheby@btinternet.com) Maria L Drachler (jcdc.leite@googlemail.com) Jose C Leite (jcdc.leite@googlemail.com) Fiona Poland (F.Poland@uea.ac.uk) Amanda Howe (Amanda.Howe@uea.ac.uk) Shagufta Fayyaz (Shagufta.Fayyaz@lshtm.ac.uk) Mariam Molokhia (Mariam.Molokhia@kcl.ac.uk)
Post-exertional malaise (PEM) is regarded as the hallmark symptom in chronic fatigue syndrome (CFS). The aim of the current study is to explore differences in CFS patients with and without PEM in indicators of aortic stiffness, autonomic... more
Post-exertional malaise (PEM) is regarded as the hallmark symptom in chronic fatigue syndrome (CFS). The aim of the current study is to explore differences in CFS patients with and without PEM in indicators of aortic stiffness, autonomic nervous system function, and severity of fatigue. One-hundred and one patients met the Fukuda criteria. A Chronic Fatigue Questionnaire (CFQ) and Fatigue Impact Scale (FIS) were used to assess the level of mental and physical fatigue. Aortic systolic blood pressure (sBPaortic) and the autonomic nervous system were measured with the arteriograph and Task Force Monitor, respectively. Eighty-two patients suffered prolonged PEM according to the Fukuda criteria, while 19 did not. Patients with PEM had higher FIS scores (p = 0.02), lower central systolic blood pressure (p = 0.02) and higher mental fatigue (p = 0.03). For a one-point increase in the mental fatigue component of the CFQ scale, the risk of PEM increases by 34%. For an sBPaortic increase of 1 ...
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Background and Objectives: We have conducted a survey of academic and clinical experts who are participants in the European ME/CFS Research Network (EUROMENE) to elicit perceptions of general practitioner (GP) knowledge and understanding... more
Background and Objectives: We have conducted a survey of academic and clinical experts who are participants in the European ME/CFS Research Network (EUROMENE) to elicit perceptions of general practitioner (GP) knowledge and understanding of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and suggestions as to how this could be improved. Materials and Methods: A questionnaire was sent to all national representatives and members of the EUROMENE Core Group and Management Committee. Survey responses were collated and then summarized based on the numbers and percentages of respondents selecting each response option, while weighted average responses were calculated for questions with numerical value response options. Free text responses were analysed using thematic analysis. Results: Overall there were 23 responses to the survey from participants across 19 different European countries, with a 95% country-level response rate. Serious concerns were expressed about GPs’ knowledge...
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This report addresses the extent to which there may be scope for preventive programmes for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and, if so, what economic benefits may accrue from the implementation of such... more
This report addresses the extent to which there may be scope for preventive programmes for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and, if so, what economic benefits may accrue from the implementation of such programmes. We consider the economic case for prevention programmes, whether there is scope for preventive programmes for ME/CFS, and what are the health and economic benefits to be derived from the implementation of such programmes. We conclude that there is little scope for primary prevention programmes, given that ME/CFS is attributable to a combination of host and environmental risk factors, with host factors appearing to be most prominent, and that there are few identified modifiable risk factors that could be the focus of such programmes. The exception is in the use of agricultural chemicals, particularly organophosphates, where there is scope for intervention, and where Europe-wide programmes of health education to encourage safe use would be benefic...
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The potential benefits of the scientific insights gleaned from years of treating ME/CFS for the emerging symptoms of COVID-19, and in particular Longhaul- or Longhauler-COVID-19 are discussed in this opinion article. Longhaul COVID-19 is... more
The potential benefits of the scientific insights gleaned from years of treating ME/CFS for the emerging symptoms of COVID-19, and in particular Longhaul- or Longhauler-COVID-19 are discussed in this opinion article. Longhaul COVID-19 is the current name being given to the long-term sequelae (symptoms lasting beyond 6 weeks) of SARS-CoV-2 infection. Multiple case definitions for ME/CFS exist, but post-exertional malaise (PEM) is currently emerging as the ‘hallmark’ symptom. The inability to identify a unique trigger of ME/CFS, as well as the inability to identify a specific, diagnostic laboratory test, led many physicians to conclude that the illness was psychosomatic or non-existent. However, recent research in the US and the UK, championed by patient organizations and their use of the internet and social media, suggest underlying pathophysiologies, e.g., oxidative stress and mitochondrial dysfunction. The similarity and overlap of ME/CFS and Longhaul COVID-19 symptoms suggest to u...
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Background and Objectives: There is some evidence that knowledge and understanding of ME among doctors is limited. Consequently, an audit study was carried out on a group of hospital doctors attending a training event to establish how... more
Background and Objectives: There is some evidence that knowledge and understanding of ME among doctors is limited. Consequently, an audit study was carried out on a group of hospital doctors attending a training event to establish how much they knew about ME and their attitudes towards it. Materials and Methods: Participants at the training event were asked to complete a questionnaire, enquiring about prior knowledge and experience of ME and their approaches to diagnosis and treatment. A total of 44 completed questionnaires were returned. Responses were tabulated, proportions selecting available options determined, 95% confidence limits calculated, and the significance of associations determined by Fisher’s exact test. Results: Few respondents had any formal teaching on ME, though most had some experience of it. Few knew how to diagnose it and most lacked confidence in managing it. None of the respondents who had had teaching or prior experience of ME considered it a purely physical...
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This collection of research papers addresses fundamental questions concerning the nature of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), the problem of disbelief and lack of knowledge and understanding of the condition... more
This collection of research papers addresses fundamental questions concerning the nature of myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS), the problem of disbelief and lack of knowledge and understanding of the condition among many doctors and the origins of this problem, and its impact on patients and their families. We report briefly the growing knowledge of the underlying pathological processes in ME/CFS, and the development of new organizations, including Doctors with ME, the US ME/CFS Clinical Coalition and EUROMENE, to address aspects of the challenges posed by the illness. We discuss the implications of COVID-19, which has much in common with ME/CFS, with much overlap of symptoms, and propose a new taxonomic category, which we are terming post-active phase of infection syndromes (PAPIS) to include both. This collection of papers includes a number of papers reporting similar serious impacts on the quality of life of patients and their families in various Europea...
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We have developed a Europe-wide approach to investigating the economic impact of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), facilitating acquisition of information on the economic burden of ME/CFS, and international... more
We have developed a Europe-wide approach to investigating the economic impact of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), facilitating acquisition of information on the economic burden of ME/CFS, and international comparisons of economic costs between countries. The economic burden of ME/CFS in Europe appears large, with productivity losses most significant, giving scope for substantial savings through effective prevention and treatment. However, economic studies of ME/CFS, including cost-of-illness analyses and economic evaluations of interventions, are problematic due to different, arbitrary case definitions, and unwillingness of doctors to diagnose it. We therefore lack accurate incidence and prevalence data, with no obvious way to estimate costs incurred by undiagnosed patients. Other problems include, as for other conditions, difficulties estimating direct and indirect costs incurred by healthcare systems, patients and families, and heterogeneous healthcare ...
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Background and Objectives: A comparative survey of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients was carried out in three countries, with the aim of identifying appropriate policy measures designed to alleviate the... more
Background and Objectives: A comparative survey of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients was carried out in three countries, with the aim of identifying appropriate policy measures designed to alleviate the burden of disease both on patients and their families, and also on public institutions. The survey addressed demographic features, the economic impact of the disease on household incomes, patterns of medical and social care, specific therapies, social relationships, and the impact of the illness on quality of life. Materials and Methods: Parallel surveys were undertaken in Italy, Latvia, and the UK. There were 88 completed responses from Italy, 75 from Latvia, and 448 from the UK. To facilitate comparisons, 95% confidence intervals were calculated in respect of responses to questions from all three countries. To explore to what extent general practitioners (GPs) manage ME/CFS disease, a separate questionnaire for GPs, with questions about the criter...
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Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology... more
Designed by a group of ME/CFS researchers and health professionals, the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) has received funding from the European Cooperation in Science and Technology (COST)—COST action 15111—from 2016 to 2020. The main goal of the Cost Action was to assess the existing knowledge and experience on health care delivery for people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in European countries, and to enhance coordinated research and health care provision in this field. We report our findings and make recommendations for clinical diagnosis, health services and care for people with ME/CFS in Europe, as prepared by the group of clinicians and researchers from 22 countries and 55 European health professionals and researchers, who have been informed by people with ME/CFS.
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Background and Objectives The socioeconomics working group of the European ME/CFS Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs’ knowledge and understanding of ME/CFS. Materials and Methods A... more
Background and Objectives The socioeconomics working group of the European ME/CFS Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs’ knowledge and understanding of ME/CFS. Materials and Methods A MEDLINE search was carried out. The papers identified were reviewed following the Synthesis Without Meta-analysis (SWiM) methodology, and were classified according to the focus of the enquiry (patients, GPs, database and medical record studies, evaluation of a training programme, and overview papers), and whether they were quantitative or qualitative in nature. Results 33 papers were identified in the MEDLINE search. The quantitative surveys of GPs demonstrated that a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it. Patient surveys indicated that a similar proportion of patients was dissatisfied with the primary medical care they had received. These...
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This review aimed at determining the prevalence and incidence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Europe. We conducted a primary search in Scopus, PubMed and Web of Science for publications between 1994 and... more
This review aimed at determining the prevalence and incidence of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in Europe. We conducted a primary search in Scopus, PubMed and Web of Science for publications between 1994 and 15 June 2019 (PROSPERO: CRD42017078688). Additionally, we performed a backward-(reference lists) and forward-(citations) search of the works included in this review. Grey literature was addressed by contacting all members of the European Network on ME/CFS (EUROMENE). Independent reviewers searched, screened and selected studies, extracted data and evaluated the methodological and reporting quality. For prevalence, two studies in adults and one study in adolescents were included. Prevalence ranged from 0.1% to 2.2%. Two studies also included incidence estimates. In conclusion, studies on the prevalence and incidence of ME/CFS in Europe were scarce. Our findings point to the pressing need for well-designed and statistically powered epidemiological stud...
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A literature review was carried out of the health impacts of incineration, landfill, composting, landspreading sewage sludge and sewage discharges. A protocol for making judgements about the strength and reliability of the evidence was... more
A literature review was carried out of the health impacts of incineration, landfill, composting, landspreading sewage sludge and sewage discharges. A protocol for making judgements about the strength and reliability of the evidence was applied using an algorithm with defined criteria. Possible judgements were “convincing”, “probable”, “possible” or “insufficient”. The review found that the evidence linking any adverse health outcomes with incineration, landfill or landspreading sewage sludge was “insufficient” to claim a causal association. The evidence is “insufficient” to link residence near a centralised composting facility with adverse health outcomes but it is “possible” that working at a centralised composting facility causes health problems. Working in sewage treatment plants “probably” causes gastrointestinal tract problems, headache, fatigue and airways symptoms. The only “convincing” evidence is that gastrointestinal symptoms result from bathing in sewage contaminated recr...
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Research Interests: Applied Ethics, Civil Rights, Medical Ethics, Medicine, Medical and Research ethics, and 12 moreInformation Services, Humans, Child, Confidentiality, Great Britain, Moral Obligations, Patient Rights, Interdisciplinary Communication, Minors, Medical Records, Government Regulation, and Physician-Patient Relations
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Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a condition, the aetiology of which remains controversial, and there is still no consensus on its nature and determination. It has rarely been studied in post-mortem... more
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a condition, the aetiology of which remains controversial, and there is still no consensus on its nature and determination. It has rarely been studied in post-mortem examinations, despite increasing evidence of abnormalities from neuroimaging studies. To ascertain the feasibility of developing a national post-mortem ME/CFS tissue bank in the UK, to enhance studies on aetiology and pathogenesis, including cell and tissue abnormalities associated with the condition. The case study was carried out combining qualitative methods, ie, key informant interviews, focus group discussions with people with ME/CFS, and a workshop with experts in ME/CFS or in tissue banking. The study results suggest that the establishment of the post-mortem ME/CFS tissue bank is both desirable and feasible, and would be acceptable to the possible tissue donors, provided that some issues were explicitly addressed.