The effectiveness of home-based therapeutic exercises on adults with fibromyalgia: a systematic review and meta-analysis.

The objective of this systematic review and meta-analysis is to evaluate the effectiveness of home-based exercises (HBE) in alleviating pain, fatigue, depression, and anxiety and enhancing the quality of life (QOL) among adults with fibromyalgia. A comprehensive search was conducted across four databases PubMed, Cochrane, CINAHL (EBSCO), and PEDro to identify eligible randomized controlled trials (RCTs). Standardized mean differences (SMDs) at a 95% confidence interval (CI) were computed. Ten RCTs met the inclusion criteria, involving 601 participants, with a good-to-fair quality according to the PEDro scale. Of the 10 included studies, 3 compared HBE to no exercise, while 7 compared HBE to center-based exercises (CBE). HBE showed significant pain reduction (SMD = 0.775, P = 0.003) and improved QOL as measured by the fibromyalgia impact questionnaire (FIQ) (SMD = 0.621, P = 0.001) compared with no exercise, but there were no significant differences in depression and QOL as measured by SF-36 compared with CBE. In contrast, CBE demonstrated greater pain reduction (SMD = -1.325, P < 0.001) and improved FIQ scores (SMD = -0.843, P = 0.017) compared with HBE. In conclusion, HBE exhibit effectiveness in alleviating pain, and depression and enhancing QOL among fibromyalgia patients in comparison to no exercise. However, CBE are more effective in reducing pain and enhancing QOL than HBE, although HBE can be valuable for maintaining activity levels in fibromyalgia patients between treatment cycles.

Cholera outbreak in Funpur, Winland.

Vibrio Cholerae is a category B agent which has moderate to high potential to be used in bioterrorist events. This fictitious case study is based on man-made outbreak investigation and response carried out by disease surveillance and response unit of country Winland. The numbers of acute watery diarrhoea cases (AWDs) were concentrated in city Funpur of country Winland which share international border with Robiland, another country with poor health infrastructure. Regular movement of nomadic population between two countries has additional risk of international spread. This case study is designed for the training of public health students and workers on steps of outbreak investigation, packaging of biological samples, understanding IHR reporting algorithm, understanding difference between biosafety and biosecurity, different categories of bioterrorism organisms and PPE & its zones. This case study can be used as supporting training tool for application of learned concepts to a real situation and can be carried out in 2-3 hours.