Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) is a major cause of school absence: surveillance outcomes from school-based clinics.
Unidentified Chronic Fatigue Syndrome/myalgic encephalomyelitis (CFS/ME) is a major cause of school absence: surveillance outcomes from school-based clinics.
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DOI：
10.1136/bmjopen-2011-000252
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发表时间：
2011
期刊：
影响因子：
2.9
通讯作者：
Sterne JA
中科院分区：
文献类型：
--
作者：
Crawley EM;Emond AM;Sterne JA
探讨在学校开展慢性疲劳综合征/肌痛性脑脊髓炎（CFS/ME）门诊的可行性。以学校为基础的临床项目。11-16岁的儿童在英格兰的三所公立中学就读。 新诊断为CFS/ME的儿童人数。出勤官员确定了在6周内没有已知原因而缺课≥20%的儿童，不包括那些有一次缺课，一种已知的医学疾病解释缺课或已知逃学的儿童。有疲劳的儿童被转介到一个专门的CFS/ME服务作进一步评估。作者将通过学校诊所确定的CFS/ME儿童与通过卫生服务转介的儿童进行了比较。在6周和6个月时评价CFS/ME的结局。 2855名入学儿童中有461名在6周内缺课率≥20%。在315例中，其中3例患有CFS/ME，缺席原因已知。146名无故缺席的儿童中有112名在学校参加了临床审查;其中两人曾被诊断为慢性疲劳综合症/肌肉无力，42人被转介往专科诊所，而23人则是新诊断为慢性疲劳综合症/肌肉无力。因此，2855中的28个（1.0%）儿童患有CFS/ME。通过监测发现的ME患病时间与通过卫生服务转介的ME相当，但疲劳程度较低（平均差异4.4，95% CI 2.2至6.6），残疾程度较轻（平均差异-5.7，95% CI-7.9至3.5），症状较少（平均差异1.86，95% CI 0.8至2.93）。在19名随访儿童中，6名在6周时完全康复，另外6名在6个月时完全康复。 慢性疲劳是导致无故缺课的一个重要原因。通过学校诊所诊断的儿童受到的影响不如转介到专家服务的儿童严重，而且在获得治疗时似乎进展迅速。假设：尽管有证据表明治疗对儿童有效，但许多CFS/ME儿童仍然未被诊断和治疗。研究问题：以学校为基础的诊所是识别CFS/ME儿童并提供治疗的可行方法吗？1.0%的入学儿童因CFS/ME缺课≥20%。不到五分之一的CFS/ME儿童接受了诊断并接受了治疗。通过学校诊所检测到的CFS/ME儿童受到的影响比通过卫生服务转介的儿童要轻，并且一旦接受治疗似乎效果良好。无论缺勤如何分类，都对儿童进行评估。所有被诊断为CFS/ME的儿童都进行了其他疲劳的医学和情感原因的筛查，并进行了前瞻性的特征描述和随访。在西南部的三所学校进行了学校诊所，这三所学校拥有完善的CFS/ME专家服务。结果可能无法推广到没有爱幼学校/教育部服务的地区，也无法推广到影响入学率的社会经济因素不同的地区。
To investigate the feasibility of conducting clinics for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in schools. School-based clinical project. Children aged 11–16 years were enrolled in three state secondary schools in England. Number of children newly diagnosed as having CFS/ME. Attendance officers identified children missing ≥20% of school in a 6-week term without a known cause, excluding those with a single episode off school, a known medical illness explaining the absence or known to be truanting. Children with fatigue were referred to a specialist CFS/ME service for further assessment. The authors compared children with CFS/ME identified through school-based clinics with those referred via health services. Outcomes of CFS/ME were evaluated at 6 weeks and 6 months. 461 of the 2855 enrolled children had missed ≥20% school over a 6-week period. In 315, of whom three had CFS/ME, the reason for absence was known. 112 of the 146 children with unexplained absence attended clinical review at school; two had been previously diagnosed as having CFS/ME and 42 were referred on to a specialist clinic, where 23 were newly diagnosed as having CFS/ME. Therefore, 28 of the 2855 (1.0%) children had CFS/ME. Children with CFS/ME identified through surveillance had been ill for an amount of time comparable to those referred via health services but had less fatigue (mean difference 4.4, 95% CI 2.2 to 6.6), less disability (mean difference −5.7, 95% CI −7.9 to −3.5) and fewer symptoms (mean difference 1.86, 95% CI 0.8 to 2.93). Of 19 children followed up, six had fully recovered at 6 weeks and a further six at 6 months. Chronic fatigue is an important cause of unexplained absence from school. Children diagnosed through school-based clinics are less severely affected than those referred to specialist services and appear to make rapid progress when they access treatment. Hypothesis: many children with CFS/ME remain undiagnosed and untreated, despite evidence that treatment is effective in children. Research question: are school-based clinics a feasible way to identify children with CFS/ME and offer treatment? 1.0% of enrolled children missed ≥20% of school because of CFS/ME. Fewer than one in five children with CFS/ME had received a diagnosis and been offered treatment. Children with CFS/ME who were detected through school-based clinics were less severely affected than children referred via health services and appeared to do well once treated. Children were offered assessment regardless of how their absence had been classified. All children given a diagnosis of CFS/ME were screened for other medical and emotional causes of fatigue and were prospectively characterised and followed up. School clinics were conducted in three schools in the south west, which has a well-established specialist CFS/ME service. Results may not be generalisable to regions without a CFS/ME service or to regions with different socioeconomic factors that impact on school attendance.
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影响因子：
7.6
作者：
Jones, JF;Nisenbaum, R;Reeves, WC
通讯作者：
Reeves, WC
影响因子：
6.9
作者：
Chalder, T.;Deary, V.;Walwyn, R.
通讯作者：
Walwyn, R.
影响因子：
5.2
作者：
Chalder, T;Tong, J;Deary, V
通讯作者：
Deary, V
影响因子：
--
作者：
Chalder, T;Goodman, R;Meltzer, H
通讯作者：
Meltzer, H
DOI：
10.1093/qjmed/90.3.223
发表时间：
1997-03-01
期刊：
QJM-MONTHLY JOURNAL OF THE ASSOCIATION OF PHYSICIANS
影响因子：
--
作者：
Joyce, J;Hotopf, M;Wessely, S
通讯作者：
Wessely, S