[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET
The results of the guided graded exercise self-help trial (GETSET) by Lucy Clark and colleagues1 reaffirm that graded exercise therapy (GET) is not a rehabilitative treatment for chronic fatigue syndrome.2 Although fatigue (measured by Chalder Fatigue Questionnaire [CFQ]) and physical functioning (assessed using the Short Form-36 physical function [SF-36 PF] subscale) improved in the guided graded exercise self-help (GES) group (and the non-intervention group), these effects were by far insufficient to come close to the normal levels defined previously3 by one of the GETSET authors (CFQ ≤6 and SF-36 PF ≥85). (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Frank Twisk Tags: Correspondence Source Type: research
[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET
I was surprised to read that the GETSET trial by Lucy Clark and colleagues1 excluded participants who had physical contraindications to exercise, as such a criterion would appear to exclude anyone suffering from post-exertional malaise (PEM). In its 2015 report,2 the US Institute of Medicine concluded: “There is sufficient evidence that PEM is a primary feature that helps distinguish ME/CFS [myalgic encephalomyelitis/chronic fatigue syndrome] from other conditions”. Indeed, post-exertional neuroimmune exhaustion is a compulsory requirement for a diagnosis of myalgic encephalomyelitis under the International Consensus C...
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Robert H Saunders Tags: Correspondence Source Type: research
[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET
The mean score for physical functioning (measured by the Short Form-36 [SF-36] subscale)1 for people aged 35 –44 years is 93·3 (SD 13·4).2 Participants in the GETSET trial by Lucy Clark and colleagues3 had a mean age of 38·1 years in the active treatment arm (guided graded exercise self-help [GES] group) and 38·7 years in the control group. After the short 12-week intervention, participants' mean sel f-reported physical functioning score using the SF-36 scale was 55·7 (23·3) in the GES group, an increase from 47·3 (22·2) before the intervention, compared with a slight increase in physical functioning in the contr...
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Joan S Crawford Tags: Correspondence Source Type: research
[Correspondence] Graded exercise self-help for chronic fatigue syndrome in GETSET
Lucy Clark and colleagues1 (July 22, 2017, p 363) reported that guided graded exercise self-help (GES) for chronic fatigue syndrome was “more useful in those with worse physical functioning”, defined as a Short Form-36 physical function (SF-36 PF) score of 40 or less. As follow-up GES sessions were done by Skype and telephone, this result might suggest to some clinicians the possibility of modifying and extending this interventi on to patients with severe and very severe chronic fatigue syndrome, all of whom are housebound and some of whom are bedbound. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Karen D Kirke Tags: Correspondence Source Type: research
[Correspondence] Systems modelling tools to support policy and planning
In their Viewpoint, Harry Rutter and colleagues (Dec 9, 2017, p 2602)1 make another welcomed call for increased uptake and investment in systems modelling tools to provide evidence better suited to addressing complex public health problems. We note the authors' assessment that systems modelling tools and approaches are “rarely operationalised in ways that generate relevant evidence” to support public health policy and practice. We disagree with this assessment and provide a broader perspective to show the efforts and progress in using systems modelling tools to support complex public health problems. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Jo-An Atkinson, Andrew Page, Ante Prodan, Geoff McDonnell, Nathaniel Osgood Tags: Correspondence Source Type: research
[Correspondence] Planetary health: a new sociopolitical framework is urgently needed
We welcome the Lecture by Samuel S Myers (Dec 23, 2017, p 2860)1 on planetary health. Paul J Crutzen assigned the term Anthropocene to “the present, in many ways human-dominated, geological epoch”.2 The capacity of mankind to shape its own habitat is a major environmental force. More than 15 000 scientists proclaimed that urgent changes are needed to avoid the consequences of humanity's impact on the environment and reverse t he trend of collapsing the delicate planetary health.3 (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Ivan Landires, Virginia Nu ñez-Samudio, Giovanni Apraez-Ippolito, Guillermo Castro Tags: Correspondence Source Type: research
[Correspondence] Action on minimum unit pricing of alcohol: a broader need
The impending minimum unit pricing (MUP) of alcohol in Scotland, commented on by Richard Horton in The Lancet (Jan 13, p 106),1 focuses attention on this public health strategy again. However, this strategy is a live issue well beyond the UK. An MUP has existed in Canadian provinces since the 1990s and in several eastern European countries since 2008.2 Nevertheless, the Scottish MUP of £0·50 per unit of alcohol is likely to have only a moderate effect because the amount was based on 2010 prices. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Heng Jiang, Robin Room Tags: Correspondence Source Type: research
[Perspectives] The vanishing act
One of the most poignant representations of the devastating impact of morphine addiction on a family comes from Eugene O'Neill's play Long Day's Journey Into Night, written in 1941 –42 but published only in 1956. In this work, rightly considered one of the best American plays of the 20th century, O'Neill drew inspiration for the characters from his own family who had to face his mother's morphine addiction. Time has not dented the intensity of this seminal work now on stage in a superb production directed by Richard Eyre at the Wyndham's Theatre in London, UK. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Marco De Ambrogi Tags: Perspectives Source Type: research
[World Report] Commitments to an end to tuberculosis renewed in India
At a summit in Delhi on March 13, Prime Minister Narendra Modi launched a campaign to end tuberculosis by 2025. Dinesh C Sharma reports. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Dinesh Sharma Tags: World Report Source Type: research
[World Report] New York Challenge sets high bar for HPV vaccination
A joint campaign from the CUGH, Perlmutter Cancer Center, and the Department of Population Health at NYU Langone Health sets new targets for HPV vaccination rate. Geoff Watts reports. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Geoff Watts Tags: World Report Source Type: research
[World Report] Trump Administration's new direction for Medicaid
Medicaid work requirements would make the health insurance programme a pathway out of poverty, say top US health officials. Susan Jaffe, The Lancet's Washington correspondent, reports. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Susan Jaffe Tags: World Report Source Type: research
[Comment] Offline: Liberty vs equity in global health
Is equity the defining objective of global health in the 21st century? Equity is hardwired into every definition of global health. It would be insane to argue otherwise. But global health is too important to allow this assumption to go unchallenged. Global health is about who we are, who we want to be, and how we want to live together on this wounded world of ours. Global health is about everything we hold dear in life. So if we ask what is wrong with our societies today, is the answer really that we have too little equity? (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Richard Horton Tags: Comment Source Type: research
[Comment] The Lancet Commission on tuberculosis: building a tuberculosis-free world
The Sustainable Development Goals have prioritised ending the epidemic of tuberculosis by 2030. We are therefore at a critical juncture in implementing efforts to control and eliminate tuberculosis. Current efforts have averted 56 million deaths since 2000.1 We also have better diagnostic tools and the promise of a few new, potent agents in the pipeline.2 Yet tuberculosis remains the leading source of infectious disease deaths globally, responsible for 1 ·7 million deaths in 2016.1 The UN's High-Level Meeting on Tuberculosis, due to take place in New York, USA, later in 2018, represents a unique opportunity to secure a co...
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Eric Goosby, Dean Jamison, Soumya Swaminathan, Michael Reid, Elizabeth Zuccala Tags: Comment Source Type: research
[Comment] Addressing social determinants to end tuberculosis
Leave no one behind. This is the overarching pledge of the Sustainable Development Goals; a pledge that is far from being realised. In 2016, more than 4 million people with tuberculosis were estimated to be undiagnosed or their care and treatment were unknown.1 In the same year, nearly a fifth of the people who were diagnosed and known to be treated for tuberculosis had adverse outcomes, including 1 ·3 million deaths.1 One reason that millions of people affected by tuberculosis are left behind is an absence of coordinated, international action to combat poverty and inequality. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: Tom Wingfield, Marco A Tovar, Sumona Datta, Matthew J Saunders, Carlton A Evans Tags: Comment Source Type: research
[Editorial] Diagnosis of heavy menstrual bleeding: a change in direction
Menorrhagia is a debilitating condition that negatively affects quality of life, with accompanying symptoms sometimes including severe abdominal pain and persistent and irregular bleeding outside the menstrual cycle. The UK's National Institute for Health and Care Excellence (NICE) estimates that menorrhagia affects up to 25% of women of reproductive age, accounting for 12% of all UK gynaecological specialist referrals. (Source: LANCET)
Source: LANCET - March 23, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research
