Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) or chronic fatigue syndrome (CFS) has been used to name a range of chronic conditions characterized by extreme fatigue and other disabling symptoms. Attempts to estimate the burden of disease have been limited by selection bias, and by lack of diagnostic biomarkers and of agreed reproducible case definitions. We estimated the prevalence and incidence of ME/CFS in three regions in England, and discussed the implications of frequency statistics and the use of different case definitions for health and social care planning and for research.

Background: We aimed to review systematically the needs for support in managing illness and maintaining social inclusion expressed by people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) Methods: We carried out a systematic review of primary research and personal ('own') stories expressing the needs of people with CFS/ME. Structured searches were carried out on Medline, AMED, CINAHL, EMBASE, ASSIA, CENTRAL, and other health, social and legal databases from inception to November 2007. Study inclusion, data extraction and risk of bias were assessed independently in duplicate. Expressed needs were tabulated and a conceptual framework developed through an iterative process. Results: Thirty two quantitative and qualitative studies, including the views of over 2500 people with CFS/ME with mainly moderate or severe illness severity, met the inclusion criteria. The following major support needs emerged: 1) The need to make sense of symptoms and gain diagnosis, 2) for respect and empathy from service providers, 3) for positive attitudes and support from family and friends, 4) for information on CFS/ME, 5) to adjust views and priorities, 6) to develop strategies to manage impairments and activity limitations, and 7) to develop strategies to maintain/regain social participation. Conclusions: Although the studies were heterogeneous, there was consistent evidence that substantial support is needed to rebuild lives. Gaining support depends - most importantly - on the ability of providers of health and social care, colleagues, friends and relatives, and those providing educational and leisure services, to understand and respond to those needs.

Background: Needs-based resource allocation is fundamental to equitable care provision, which can meet the often-complex, fluctuating needs of people with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This has posed challenges both for those providing and those seeking support providers, in building shared understanding of the condition and of actions to address it. This qualitative study reports on needs for equity in health and social care expressed by adults living with CFS/ME. Methods: The participants were 35 adults with CFS/ME in England, purposively selected to provide variation in clinical presentations, social backgrounds and illness experiences. Accounts of experienced needs and needs-related encounters with health and social services were obtained through a focus group (n = 6) and semi-structured interviews (n = 35). These were transcribed and needs related topics identified through data-led thematic analysis. Findings: Participants emphasised needs for personalised, timely and sustained support to alleviate CFS/ME impacts and regain life control, in three thematic areas: (1) Illness symptoms, functional limitations and illness management; (2) practical support and social care; (3) financial support. Access of people with CFS/ME to support from health and social services was seen to be constrained by barriers stemming from social, cultural, organisational and professional norms and practices, further heightened for disadvantaged groups including some ethnic minorities. These reduced opportunities for their illness to be explained or associated functional limitations and social disadvantages to be addressed through social support. Participants sought more understanding of bio-psycho-social aspects of CFS/ME, of felt needs of people with CFS/ME and of human rights and disability rights, for providing person-centred, equitable care. Conclusions: Changes in attitudes of health practitioners, policy makers and general public and more flexibly organised health and social care provision are needed to address equity issues in support needs expressed by people with CFS/ME, to be underpinned by research-based knowledge and communication, for public and professional education. Policy development should include shared decision-making and coordinated action across organizations working for people with CFS/ME, human rights and disadvantaged groups. Experiences of people with CFS/ME can usefully inform an understanding of equity in their health and social care.

Promover a saúde com eqüidade é um grande desafio para os gestores públicos. A magnitude das desigualdades sociais em saúde e os recursos escassos impõem que as prioridades para a gestão pública se fundamentem no conhecimento da situação de saúde e do impacto de políticas, programas, projetos e ações sobre a saúde e seus determinantes. Este artigo apresenta a proposta metodológica de construção e seleção de indicadores de desigualdades em saúde utilizada pela Pesquisa Avaliativa de Desigualdades em Saúde no Rio Grande do Sul (PADS-RS) para auxiliar a definição de prioridades para a gestão pública. Os indicadores foram construídos visando avaliar desigualdades em saúde como diferenças na qualidade de vida e capacidades humanas socialmente determinadas. A metodologia baseia-se em princípios de promoção ativa da eqüidade que orientam (1) o Sistema Único de Saúde Brasileiro, (2) as pesquisas avaliativas de desigualdades em saúde realizadas no Reino Unido e (3) o método RAWP (Resources Allocation Working Party) de alocação de recursos financeiros públicos em saúde entre regiões e considera as peculiaridades dos sistemas oficiais de informação no Estado e no Brasil.

Estudo transversal de base populacional investigou determinantes de sobrepeso em crianças de 12 a 59 meses em Porto Alegre (n = 2.660). Razões de chance (RC) de sobrepeso, definido por peso/altura > 2 escores-z do padrão NCHS, foram estimadas para condições sócio-econômicas e demográficas, ambiente social imediato e eventos de saúde da criança. A prevalência de sobrepeso foi 6,5%. No modelo multivariado, a chance de sobrepeso na criança associou-se positivamente à escolaridade materna (escolaridade > 12 anos, RC = 2,36; IC95%: 1,21-4,60; 9-11 anos, RC = 2,07; IC95%: 1,16-3,70) e à renda familiar per capita > 2 salários mínimos (RC = 1,86; IC95%: 1,13-3,08) e negativamente ao trabalho materno remunerado (RC = 0,72; IC95%: 0,52-0,99). A chance foi maior para os nascidos grandes para idade gestacional (RC = 2,29; IC95%: 1,36-3,85) e menor para os nascidos pequenos (RC = 0,57; IC95%: 0,33-0,99), comparados aos nascidos com peso adequado. Escolaridade paterna, qualificação profissional dos pais e idade materna ao nascimento da criança evidenciaram efeito somente no modelo bruto. São necessários programas para prevenir sobrepeso em crianças, com especial atenção às famílias e crianças em maior risco.

Uma escala de expectativa de auto-eficácia para seguir prescrição anti-retroviral em situações difíceis (21 itens) foi desenvolvida pela análise do conteúdo de entrevistas com pacientes que estavam em tratamento ou que o abandonaram. A consistência interna e a validade de construto foram examinadas em 60 sujeitos que freqüentaram ambulatório para pacientes em estágios avançados da doença (hospital-dia). Um escore de expectativa de auto-eficácia para adesão ao tratamento foi derivado do primeiro componente da análise de componentes principais. A média do escore foi 0,25 para os sujeitos aderentes e -0,33 para os não-aderentes ao tratamento (teste t, p = 0,046). A chance de adesão duplicou quando o escore de expectativa de auto-eficácia era maior em uma unidade (OR = 2,07; IC95% = 1,002 a 4,26). A consistência interna foi alta (alfa de Cronbach = 0.96). A escala demonstrou validade de construto e confiabilidade para medir auto-eficácia para tratamento anti-retroviral nesses pacientes. A 21-item scale of efficacy-expectation for adhesion to antiretroviral therapy in high-risk situations was developed by content analysis of interviews with HIV/AIDS patients undergoing and dropouts from therapy. Internal consistency and construct validity were examined in 60 patients attending at an ambulatory for patients in advanced stages of the disease (day-hospital). A score of self-efficacy for treatment adhesion was derived from the first component of the principal component analysis. The mean score was 0.25 among adherent patients and -0.33 among those who were non-adherent (t test, p < 0.046). The odds of treatment adhesion increased 2,07 times when the efficacy-expectation score increased by one unit (OR = 2,07; IC95% = 1,002 a 4,26). The internal consistency was high (Cronbach-alpha = 0.96). The scale demonstrated construct validity and reliability as a measure of self-efficacy for antiretroviral therapy in these patients