Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disease that affects children and adolescents as well as adults. The etiology has not been established. While many pediatricians and other health-care providers are aware of ME/CFS, they often lack essential knowledge that is necessary for diagnosis and treatment. Many young patients experience symptoms for years before receiving a diagnosis. This primer, written by the International Writing Group for Pediatric ME/CFS, provides information necessary to understand, diagnose, and manage the symptoms of ME/CFS in children and adolescents. ME/CFS is characterized by overwhelming fatigue with a substantial loss of physical and mental stamina. Cardinal features are malaise and a worsening of symptoms following minimal physical or mental exertion. These post-exertional symptoms can persist for hours, days, or weeks and are not relieved by rest or sleep. Other symptoms include cognitive problems, unrefreshing or disturbed sleep, generalized or localized pain, lightheadedness, and additional symptoms in multiple organ systems. While some young patients can attend school, on a full or part-time basis, many others are wheelchair dependent, housebound, or bedbound. Prevalence estimates for pediatric ME/CFS vary from 0.1 to 0.5%. Because there is no diagnostic test for ME/CFS, diagnosis is purely clinical, based on the history and the exclusion of other fatiguing illnesses by physical examination and medical testing. Co-existing medical conditions including orthostatic intolerance (OI) are common. Successful management is based on determining the optimum balance of rest and activity to help prevent post-exertional symptom worsening. Medications are helpful to treat pain, insomnia, OI and other symptoms. The published literature on ME/CFS and specifically that describing the diagnosis and management of pediatric ME/CFS is very limited. Where published studies are lacking, recommendations are based on the clinical observations and practices of the authors

Equity and justice in climate change adaptation : Policy and practical implication in Nigeria

Over the past decade, justice and equity have become a quasi-universal answer to problems of environmental governance. The principles of justice and equity emerged as a useful entry point in global governance to explore the responsibilities, distribution, and procedures required for just climate change adaptation. These principles are designed primarily through the establishment of funding mechanisms, top-down guides, and frameworks for adaptation, and other adaptation instruments from the UNFCCC process, to ensure effective adaptation for vulnerable countries like Nigeria that have contributed least to the issue of climate change but lack adaptive capacity. Global adaptation instruments have been acknowledged for adaptation in Nigeria. Climate change has a detrimental impact on Nigeria as a nation, with the burden falling disproportionately on the local government areas. As Nigeria develop national plans and policies to adapt to the consequences of climate change, these plans will have significant consequences for local government areas where adaptation practices occur. Although the local government’s adaptation burden raises the prospects for justice and equity, its policy and practical implication remains less explored. This chapter explores the principles of justice and equity in national adaptation policy and adaptation practices in eight local government areas in southeast Nigeria. The chapter argues that some factors make it challenging to achieve equity and justice in local adaptation practices. With the use of a qualitative approach (interview (n = 52), observation, and document analysis), this chapter identified some of the factors that constraints equity and justice in local government adaptation in southeast Nigeria.publishedVersio

ME/CFS: A Primer for Clinical Practitioners

https://scholarlycommons.pacific.edu/phs-facbooks/1009/thumbnail.jp

ME/CFS: A Primer for Clinical Practitioners

https://scholarlycommons.pacific.edu/phs-facbooks/1009/thumbnail.jp