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BACKGROUND: The disease ME/CFS is unknown to many doctors in Germany. Within the healthcare system, significant deficits in dealing with ME/CFS patients have been repeatedly revealed. Hence, the aim of the present study was to identify the specialties of the doctors consulted by ME/CFS patients and to find out whether information on the medical procedure in the context of the diagnosis process can be derived from this. METHOD: As part of the APAV-ME/CFS survey, the quantitative responses of 674 adult ME/CFS sufferers (>20 y.; 554 â, 120 â) who already had a medical ME/CFS diagnosis were statistically examined. The sampling was done by self-activation and via the snowball principle. The data were primarily evaluated descriptively. An analysis of variance was carried out to consider possible relationships. RESULTS: Almost a quarter of the patients said they had suffered from ME/CFS for 6 to 10 years. Diagnosis was made within 10 years of disease onset in 62%. For 6.4% it took 21-40 years. 75% of the participants consulted 6 to 15 different doctors from a wide range of disciplines in the course of the disease, in particular from general medicine, neurology, internal medicine and psychosomatics/psychiatry. Diagnosis was made in particular by GPs and immunologists. On average, the test persons named 11 mostly neuroregulatory symptoms. CONCLUSIONS: The results suggest that in the context of finding a diagnosis in Germany for ME/CFS, referral behaviour to specialists based on single ME/CFS symptoms or rather arbitrary contacting of doctors from a wide variety of disciplines has prevailed so far. Therefore, training and further education measures on the subject of ME/CFS are urgently needed in all specialist disciplines in the resident, inpatient and rehabilitation sectors.
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Many people with intellectual and developmental disabilities (IDD) were much more affected by COVID-19 than the average population. The morbidity in this population group was significantly higher due to the form of their housing and care as well as disability-associated health factors (such as Down's syndrome). This led, among other things, to a higher incidence of inpatient settings, a higher mortality rate among hospitalized patients, and a higher case fatality rate among certain subgroups. Risk factors were co-diseases such as dysphagia, epilepsy, or mental disorders. In addition, there were health consequences from restrictive exposure prophylaxis measures at the beginning of the COVID-19 pandemic.This overview article describes the main developments in the care of people with IDD since the beginning of the pandemic. New mental problems or an increase in existing mental problems occurred more frequently in people with IDD who were cared for on an outpatient basis or by relatives. People with IDD in inpatient residential facilities were less frequently affected. The main reasons for psychological problems were lack of social contacts, lost work and employment opportunities, the frightening pandemic situation, and the major structural and personnel changes in the facilities at the beginning of the pandemic. During the pandemic, there were also problems with the implementation of therapeutic and preventive measures. On the other hand, especially in the inpatient area, the "slowing down of life" associated with the restrictions at the beginning of the pandemic also had a stress-reducing effect on some of the people with IDD and was perceived by them as something positive. Caregivers had more time for the genuine (i.e., pedagogical) work. Overall, it was shown that health-promoting measures must also take into account the great heterogeneity of the people with IDD and their living conditions during the pandemic.
Assuntos
COVID-19 , Deficiência Intelectual , Criança , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Pandemias/prevenção & controle , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/terapia , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/terapia , Deficiência Intelectual/complicações , Alemanha/epidemiologia , Fatores de RiscoRESUMO
BACKGROUND: ME/CFS (Myalgic encephalomyelitis/chronic fatigue syndrome) is an illness that is predominantly viewed as a neuroimmunological multisystem disease, which is still unknown to many doctors in Germany or which they classify as a psychosomatic disease. From their perspective, ME/CFS patients report significant deficits in terms of medical treatment and a doctor-patient relationship (DP relationship) that is perceived as problematic. The aim of the present study is to more precisely analyse the process of finding a diagnosis as an influencing factor on the DP relationship in ME/CFS from the point of view of those affected. METHOD: As part of an explorative qualitative survey, 544 ME/CFS patients (> 20 years; 455 â, 89 â) with a medical diagnosis of ME/CFS were asked in writing about their experiences with regard to the process of finding a diagnosis. The sampling was previously done by self-activation and via the snowball principle. The questionnaire to be answered was structured analogously to a focused, standardized guideline interview. The evaluation was carried out as part of a qualitative content analysis according to Mayring. Some of the results were subsequently quantified. RESULTS: The participants described what they saw as the inadequate process of making a diagnosis as a central factor in a problematic DP relationship in ME/CFS. From their point of view, many doctors deny the existence of ME/CFS or classify it as a solely psychosomatic illness, insist on their level of knowledge, ignore patient knowledge and disregard scientific information provided. They follow the standard program, think in "pigeonholes" and are incapable of systemic thinking. This has a significant impact on the DP relationship. DISCUSSION: From the point of view of ME/CFS patients, the process of making a diagnosis and the recognition of ME/CFS as a neuroimmunological multisystem disease are the central aspects of a DP relationship that they experience as problematic. In the past, findings classified as "subjective" and thus ignored, the pigeonholing that is characteristic of biomedically oriented medicine and a healthcare system that opposes systemic thinking when making a diagnosis have all been identified as factors that may have a significant impact on the DP relationship.
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Síndrome de Fadiga Crônica , Humanos , Síndrome de Fadiga Crônica/diagnóstico , Síndrome de Fadiga Crônica/psicologia , Síndrome de Fadiga Crônica/terapia , Relações Médico-Paciente , Saúde Pública , Pesquisa Qualitativa , Transtornos Psicofisiológicos , Análise de SistemasRESUMO
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe, chronic multisystemic disease which, depending on its severity, can lead to considerable physical and cognitive impairment, loss of ability to work and the need for nursing care including artificial nutrition and, in very severe cases, even death.The aim of this D-A-CH (Germany, Austria, Switzerland) consensus statement is 1) to summarize the current state of knowledge on ME/CFS, 2) to highlight the Canadian Consensus Criteria (CCC) as clinical criteria for diagnostics with a focus on the leading symptom post-exertional malaise (PEM) and 3) to provide an overview of current options and possible future developments, particularly with regard to diagnostics and therapy. The D-A-CH consensus statement is intended to support physicians, therapists and valuer in diagnosing patients with suspected ME/CFS by means of adequate anamnesis and clinical-physical examinations as well as the recommended clinical CCC, using the questionnaires and other examination methods presented. The overview of the two pillars of therapy for ME/CFS, pacing and symptom-relieving therapy options, is intended not only to provide orientation for physicians and therapists, but also to support decision-makers from healthcare policy and insurance companies in determining which therapy options should already be reimbursable by them at this point in time for the indication ME/CFS.
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Síndrome de Fadiga Crônica , Síndrome de Fadiga Crônica/terapia , Síndrome de Fadiga Crônica/diagnóstico , Humanos , Áustria , Alemanha , Suíça , Colaboração Intersetorial , Guias de Prática Clínica como Assunto , Equipe de Assistência ao PacienteRESUMO
BACKGROUND: Most patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are dissatisfied with medical care. They complain about e. g. the lack of medical recognition of ME/CFS as a neuroimmunological disease and the medical perception of those affected as "difficult patients". METHOD: As part of an exploratory qualitative survey, 544 medically diagnosed ME/CFS patients (> 20 years; 455 â, 89 â) were asked about their subjective experiences with regard to the doctor-patient relationships (DP relationship) to their treating physicians. The questionnaire was structured analogously to a focused, standardized guideline interview. The written answers were evaluated using a qualitative content analysis according to Mayring. RESULTS: The participants reported a significant deterioration in their health situation and their quality of life as a result of misdiagnoses and incorrect treatments, the strained DP relationship and the lack of support from the physicians. All of this leads to fear of visiting the doctor, a general loss of trust in physicians, a feeling of helplessness up to bitterness and resignation - with suicide as the last mental option for some patients to escape from this precarious situation. During medical consultations, other participants only addressed health problems that were not related to ME/CFS, or only went to the doctor in an emergency, or refrained from contacting doctors entirely. CONCLUSIONS: The DP relationship described by the participants as problematic in their opinion has significant negative health consequences for them. It is therefore of great urgency to develop a patient-centred treatment concept that focuses on ME/CFS patients as experts on their own illness.