Graded exercise therapy compared to activity management for paediatric chronic fatigue syndrome/myalgic encephalomyelitis: pragmatic randomized controlled trial.

The MAGENTA pragmatic parallel groups randomized controlled trial compared graded exercise therapy (GET) with activity management (AM) in treating paediatric myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). Children aged 8-17 years with mild/moderate ME/CFS and presenting to NHS specialist paediatric services were allocated at random to either individualised flexible treatment focussing on physical activity (GET, 123 participants) or on managing cognitive, school and social activity (AM, 118 participants) delivered by NHS therapists. The primary outcome was the self-reported short-form 36 physical function subscale (SF-36-PFS) after 6 months, with higher scores indicating better functioning. After 6 months, data were available for 201 (83%) participants who received a mean of 3.9 (GET) or 4.6 (AM) treatment sessions. Comparing participants with measured outcomes in their allocated groups, the mean SF-36-PFS score changed from 54.8 (standard deviation 23.7) to 55.7 (23.3) for GET and from 55.5 (23.1) to 57.7 (26.0) for AM giving an adjusted difference in means of -2.02 (95% confidence interval -7.75, 2.70). One hundred thirty-five participants completed the mean SF-36-PFS at 12 months, and whilst further improvement was observed, the difference between the study groups remained consistent with chance. The two study groups showed similar changes on most of the secondary outcome measures: Chalder Fatigue, Hospital Anxiety and Depression Scale: Depression, proportion of full-time school attended, a visual analogue pain scale, participant-rated change and accelerometer measured physical activity, whether at the 6-month or 12-month assessment. There was an isolated finding of some evidence of an improvement in anxiety in those allocated to GET, as measured by the Hospital Anxiety and Depression Scale at 6 months, with the 12-month assessment, and the Spence Children's Anxiety scale being aligned with that finding. There was weak evidence of a greater risk of deterioration with GET (27%) than with AM (17%; p = 0.069). At conventional UK cost per QALY thresholds, the probability that GET is more cost-effective than AM ranged from 18 to 21%. Whilst completion of the SF-36-PFS, Chalder Fatigue Scale and EQ-5D-Y was good at the 6-month assessment point, it was less satisfactory for other measures, and for all measures at the 12-month assessment.  Conclusion: There was no evidence that GET was more effective or cost-effective than AM in this setting, with very limited improvement in either study group evident by the 6-month or 12-month assessment points.  Trial registration: The study protocol was registered at www.isrctn.com (3rd September 2015; ISRCTN 23962803) before the start of enrolment to the initial feasibility phase.

The development of an informative leaflet for children and adolescents suffering from Osgood-Schlatter disease.

The mainstay in the treatment of Osgood-Schlatter Disease (OSD) is guidance on activity modification alongside exercises. The purpose of this study was to create an informative leaflet for patients with OSD, based on evidence and stakeholders perspectives. A synthesis of the literature, including national reference work, clinical research, and systematic reviews informed the initial leaflet. Twelve children with OSD and four clinical experts provided feedback through semi-structured interviews. After incorporating stakeholder input, the leaflet 'Osgood-Schlatter-Information and guidance' was developed. This provides a resource to assist the provision of information and translation of the current evidence.

Evaluation of an Education Program on Community Orientation among Community Health Nurses in Fiji.

AIM: The study objective was to evaluate the effectiveness of an education program to improve community orientation among community health nurses in Fiji. A 1.5-day education program was developed that enabled participants to learn a concept through discussion, as they reviewed their experiences. DESIGN: This study used mixed methods research. METHODS: The education program involving 78 community health nurses and supervisors was conducted. The 30-item Community Orientation among Community Health Nurses scale, six-item program evaluation questionnaire, and participant reflection sheets were analyzed using both quantitative and qualitative methods. RESULTS: Program evaluations demonstrated high satisfaction among participants. The content analysis of participant views on community orientation revealed three categories; utilizing community intelligence in community activities, relationships with community members as a community health nurses, and human resource development tool. Our findings suggest that this education program should be held regularly, in conjunction with on-the-job and off-site training.

Frequency and Pattern of Rheumatoid Arthritis in a Tertiary Hospital in Maiduguri, North-Eastern Nigeria.

BACKGROUND: Rheumatoid arthritis (RA) is considered rare and mild in Africa, its exact burden is unknown. OBJECTIVES: To determine the pattern of RA and medications used in its management at University of Maiduguri Teaching Hospital (UMTH), Nigeria. METHODS: A retrospective cross-sectional study of RA patients, aged >18 years, satisfying the American college of rheumatology (ACR)/European alliance of associations for rheumatology (EULAR) 2010 and/or ACR 1987 classification criteria seen over six years (January 2015 to December 2020) at UMTH. Ethical approval was granted by the hospital's Ethics committee. Excluded, were other Rheumatic and musculoskeletal diseases (RMDs) and those with incomplete data. Sociodemographic, clinical features, laboratory results, medications used, and clinical disease activity index (CDAI) were recorded. Data were analyzed using SPSS version 23.0. A p-value of < 0.05 was considered significant. RESULTS: Of the 1,315 RMDs seen, 162 (12.3%) had RA of which 32 were excluded due to incomplete data. Their median [IQR] age was 40.9 [29.6-54.0] years and 78.5% were females. The median [IQR] disease duration before presentation was 3 [2-5] years. The wrist joint was the most affected (88.5%), while the hip was the least (15.4%). Sicca symptoms was reported by 42.3% while, 41.1% had subcutaneous nodules. The median [IQR] erythrocyte sedimentation rate (ESR) was 66.2 [45-72.3] mm in the 1st hour, 65.7% had positive Rheumatoid factor (RF). The mean(±SD) CDAI score was 33.0(±9.5) and 86.2% of patients had high disease activity. All patients were treated with steroids, 70.0% had methotrexate (MTX) while none received biologics. CONCLUSION: In Maiduguri, RA patients present late with high disease activity and poor access to biologics. There is a need to improve early diagnosis and prompt referral to a rheumatologist.

BACKGROUND: La polyarthrite rhumatoïde (PR) est considérée comme rare et bénigne en Afrique, son poids exact est inconnu. OBJECTIFS: Déterminer le profil de la PR et les médicaments utilisés pour sa prise en charge à l'hôpital universitaire de Maiduguri (UMTH), au Nigeria. MÉTHODES: Étude rétrospective transversale des patients atteints de PR, âgés de plus de 18 ans, répondant aux critères de classification 2010 de l'American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) et/ou ACR 1987, examinés sur une période de six ans (de janvier 2015 à décembre 2020) à l'UMTH. L'approbation éthique a été accordée par le comité d'éthique de l'hôpital. Ont été exclues, les autres maladies rhumatismales et musculosquelettiques (RMD) et celles dont les données étaient incomplètes. Les caractéristiques sociodémographiques et cliniques, les résultats de laboratoire, les médicaments utilisés et l'indice d'activité clinique de la maladie (CDAI) ont été enregistrés. Les données ont été analysées à l'aide de SPSS version 23.0. Une valeur p de < 0,05 a été considérée comme significative. RÉSULTATS: Sur les 1 315 DMR examinés, 162 (12,3 %) étaient atteints de PR, dont 32 ont été exclus en raison de données incomplètes. Leur âge médian [IQR] était de 40,9 [29,6-54,0] ans et 78,5% étaient des femmes. La durée médiane [IQR] de la maladie avant la présentation était de 3 [2-5] ans. L'articulation du poignet était la plus touchée (88,5 %), tandis que la hanche était la moins touchée (15,4 %). Des symptômes de siccité ont été signalés par 42,3 % des patients, tandis que 41,1 % présentaient des nodules sous-cutanés. Le taux de sédimentation érythrocytaire médian [IQR] était de 66,5 %. La vitesse de sédimentation des érythrocytes (VS) médiane [IQR] était de 66,2 [45-72,3] mm au cours de la première heure, 65,7 % avaient un facteur rhumatoïde (FR) positif. Le score CDAI moyen (±SD) était de 33,0 (±9,5) et 86,2% des patients présentaient une forte activité de la maladie. Tous les patients ont été traités par stéroïdes, 70,0 % par méthotrexate (MTX) et aucun n'a reçu de produits biologiques. CONCLUSION: A Maiduguri, les patients atteints de PR se présentent tardivement avec une forte activité de la maladie et un faible accès aux produits biologiques. Il est nécessaire d'améliorer le diagnostic précoce et l'orientation rapide vers un rhumatologue. Mots clés: Polyarthrite rhumatoïde, Nord-Est du Nigeria, Investigations, Disease Activity Management.

Effect of an evidence-based activity management program on delivery outcomes in pregnant women after intraspinal labor analgesia.

OBJECTIVE: To investigate the effect of an evidence-based activity management program for pregnant women after intraspinal labor analgesia based on their delivery outcomes. METHODS: A prospective study was conducted in 96 pregnant women who received intraspinal labor analgesia in our hospital. The control group (48 cases) received routine nursing care after analgesia, and the intervention group (48 cases) received evidence-based activity management program after analgesia. The labor time, sense of birth control, physiological and psychological stress reactions, analgesic effect, delivery outcome and early postpartum pelvic floor function were compared between the two groups. RESULTS: Compared with the control group, the first, second and third stages of labor time and the total labor time of the intervention group were significantly shorter, while the Labor Agentry Scale (LAS) score was significantly higher (P<0.05). Compared with the control group, the diastolic blood pressure, systolic blood pressure, heart rate, Visual Analogue Scale (VAS) score, Self-Rating Anxiety Scale (SAS) score and Self-Rating Depression Scale (SDS) score of the intervention group were significantly lower (P<0.05). The total analgesic rate of the intervention group was significantly higher than that of the control group (95.83% vs. 79.17%, P<0.05). The overall incidence of postpartum hemorrhage, perineal laceration, lateral episiotomy, fetal distress and neonatal asphyxia in the intervention group was significantly lower than that of the control group (16.67% vs. 35.42%, P<0.05). The incidence of pelvic organ prolapse (POP) and pelvic floor dysfunction in the intervention group were significantly lower than those in the control group (P<0.05). CONCLUSION: An evidence-based activity management program for pregnant women after intraspinal labor analgesia can effectively shorten the labor time, strengthen the analgesic effect, reduce the physiological and psychological stress reactions, increase the sense of control during birth and improve the delivery outcome as well as early pelvic floor function.

Pain-Related Activity Management Patterns as Predictors of Treatment Outcomes in Patients with Fibromyalgia Syndrome.

OBJECTIVES: This study sought to determine if pre- to post-treatment changes in pain-related activity patterns (i.e., overdoing, avoidance, and pacing) were associated with pre- to post-treatment changes in function (i.e., pain interference, psychological function, and physical function) in patients with fibromyalgia syndrome who participated in either an operant learning- or an energy conservation-based training in activity management. METHODS: Sixty-nine patients with fibromyalgia syndrome participated in an activity management treatment (32 in an operant learning group and 37 in an energy conservation group). Outcomes were assessed at pre- and post-treatment, and patients provided demographic information and completed measures assessing pain intensity, pain interference, psychological function, physical function, and pain management activity patterns. Three linear hierarchical regression analyses predicting changes in pain outcomes from changes in pacing, overdoing, and avoidant activity patterns were performed. RESULTS: Changes in pain-related activity patterns made significant contributions to the prediction of changes in patients' function. Specifically: (a) increases in overdoing predicted reductions in pain interference; (b) decreases in avoidance predicted improvements in psychological function; and (c) increases in pacing predicted improvements in physical function. CONCLUSIONS: This study provides support for a role of activity management treatments in improved adjustment to chronic pain. Research is needed to replicate and extend these findings in order to build an empirical basis for developing more effective chronic pain treatments for facilitating improved physical and psychological function in individuals with chronic pain.

Results of the feasibility phase of the managed activity graded exercise in teenagers and pre-adolescents (MAGENTA) randomised controlled trial of treatments for chronic fatigue syndrome/myalgic encephalomyelitis.

BACKGROUND: Chronic fatigue syndrome (CFS) also known as myalgic encephalomyelitis (ME) is relatively common in young people and causes significant disability. Graded exercise therapy (GET) and activity management are recommended by the National Institute for Health and Care Excellence (NICE) despite a limited evidence-base for either treatment in paediatric CFS/ME. This paper reports on feasibility and acceptability measures from the feasibility phase of the ongoing MAGENTA randomised controlled trial (RCT) investigating GET versus activity management for young people with CFS/ME. METHODS: Setting: Three specialist secondary care National Health Service (NHS) Paediatric CFS/ME services (Bath, Cambridge and Newcastle).Participants: Young people aged 8-17 years with a diagnosis of mild to moderate CFS/ME. Young people were excluded if they were severely affected, referred to cognitive behavioural therapy (CBT) at initial assessment or unable to attend clinical sessions.Interventions: GET and activity management delivered by physiotherapists, occupational therapists, nurses and psychologists. Families and clinicians decided the number (typically 8-12) and frequency of appointments (typically every 2-6 weeks).Outcome Measures: Recruitment and follow-up statistics. We used integrated qualitative methodology to explore the feasibility and acceptability of the trial processes and the interventions. RESULTS: 80/161 (49.7%) of eligible young people were recruited at two sites between September 2015 and August 2016, indicating recruitment to the trial was feasible. Most recruitment (78/80; 97.5%) took place at one centre. Recruitment consultations, online consent and interventions were acceptable, with less than 10% in each arm discontinuing trial treatment. Response rate to the primary outcome (the SF36-PFS at 6 months) was 91.4%. Recruitment, treatment and data collection were not feasible at one centre. The site was withdrawn from the study.In response to data collected, we optimised trial processes including using Skype for recruitment discussions; adapting recruiter training to improve recruitment discussions; amending the accelerometer information leaflets; shortening the resource use questionnaires; and offering interventions via Skype. These amendments have been incorporated into the full trial protocol. CONCLUSIONS: Conducting an RCT investigating GET versus activity management is feasible and acceptable for young people with CFS/ME. TRIAL REGISTRATION: ISRCTN23962803 10.1186/ISRCTN23962803, date of registration: 03 September 2015.

Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to Activity Management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): protocol for a randomised controlled trial.

BACKGROUND: Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. METHODS: Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. DISCUSSION: If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. TRIAL REGISTRATION: ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.

Relationship between patterns of daily physical activity and fatigue in cancer survivors.

PURPOSE: This study investigated: (1) physical activity behaviour of cancer survivors throughout the day, (2) the relationship between objective and subjective measures of physical activity, and (3) the relationship between daily physical activity and fatigue. METHOD: Physical activity was measured objectively using 3D-accelerometry (expressed in counts per minute (cpm)), and subjectively using a Visual Analogue Scale (VAS; 0-10) implemented on a smartphone in 18 cancer survivors (6 male; age 55.7 ± 10.2 yrs; free from cancer, last treatment ≥three months previously), and matched controls. Fatigue was scored thrice daily on a smartphone (0-10 VAS). RESULTS: Mean daily physical activity of cancer survivors did not deviate from controls (1108 ± 287 cpm versus 1223 ± 371 cpm, p = .305). However, in cancer survivors physical activity significantly decreased from morning to evening (p < .01) and increased levels of fatigue throughout the day were reported (p < .01). Furthermore, a positive correlation was found between levels of fatigue and the magnitude of the decline in physical activity from afternoon to evening (p < .05). Objective and subjective measured physical activity showed low correlations. CONCLUSIONS: This study demonstrated imbalanced activity patterns in cancer survivors. Also, the more a survivor felt fatigued, the greater the decline in activity behaviour throughout the day. The low correlation between objective and subjective physical activity suggests low awareness in cancer survivors about their daily physical activity performed. Ambulatory monitoring provides new insights in both patterns of physical activity and fatigue, which might be a valuable tool to provide activity management more efficiently during treatment of fatigue.

Consideraciones teóricas para el estudio de la dimensión institucional del desarrollo de la ciencia en Cuba / Theoretical considerations for studying institutional dimension of science development in Cuba

El presente artículo tiene como objetivo fundamentar un marco teórico que permita estudiar el proceso de institucionalización de la ciencia en Cuba. Al enfocar la ciencia como actividad, su dinámica e integración dentro del sistema de las actividades sociales; se le debe prestar especial atención al proceso de institucionalización. Se justifica el abordaje de los procesos de institucionalización de la ciencia cubana como procesos específicos condicionados por lo económico, lo político y lo cultural. El trabajo consta de los siguientes momentos: primero se trata de develar el papel que juega la política científico- tecnológica en el desarrollo del proceso institucional; segundo, se caracteriza el lugar de la gestión de la actividad científica, y por último, se utiliza el enfoque de la red de actores para desentrañar los nexos y relaciones que se producen en el proceso de institucionalización.

This paper is aimed at supporting a theoretical framework to study the institutionalization process of science in Cuba. When focusing on science as an activity, on its dynamics and integration within social activities, a special attention must be given to institutionalization. Dealing with the institutionalization process of Cuban science is conditioned by specifically economical, political and cultural factors. This paper firstly exposes the role of the scientific technological policy in the development of the institutionalization process. Later on, the place of scientific activity management is characterized. Finally, the approach of those involved is used to clear up the links and relations produced along the institutionalization process.