102-532: Myalgic encephalomyelitis/chronic fatigue syndrome ( ME/CFS ) is a disabling chronic illness . People with ME/CFS experience profound fatigue that does not go away with rest, sleep issues, and problems with memory or concentration. The hallmark symptom of ME/CFS is post-exertional malaise , a worsening of the illness which starts hours to days after minor physical or mental activity. This "crash" can last from hours or days to several months. Further common symptoms include dizziness , nausea and pain. The cause of
204-499: A neurological disease by the World Health Organization (WHO) since 1969, initially under the name benign myalgic encephalomyelitis . The classification of ME/CFS as a neurological disease is based on symptoms which indicate a central role of the nervous system. Alternatively, based on abnormalities in immune cells , ME/CFS is sometimes labelled a neuroimmune condition. The disease can further be regarded as
306-473: A post-acute infection syndrome (PAIS) or an infection-associated chronic illness. PAISes such as long COVID and post-treatment Lyme disease syndrome share many symptoms with ME/CFS and are suspected to have a similar cause. Many names have been proposed for the illness. The most commonly used are chronic fatigue syndrome , myalgic encephalomyelitis , and the umbrella term myalgic encephalomyelitis/chronic fatigue syndrome ( ME/CFS ). Reaching consensus on
408-534: A clearly defined onset. Symptoms must be present at least half of the time, and be of moderate severity or worse; previous criteria just required symptoms to be present. In 2021, NICE revised its criteria based on the IOM criteria. The updated criteria require fatigue, PEM, non-restorative sleep, and cognitive difficulties persisting for at least three months. Separate diagnostic criteria have been developed for children and young people. A diagnosis for children often requires
510-785: A diagnosis, and diagnoses may be missed altogether. Specialists in ME/CFS may be asked to confirm the diagnosis, as primary care physicians often lack a good understanding of the illness. Multiple research and clinical criteria exist to diagnose ME/CFS. These include the NICE guidelines, Institute of Medicine (IOM) criteria, the International Consensus Criteria (ICC), the Canadian Consensus Criteria (CCC), and CDC criteria. The criteria sets were all developed based on expert consensus and differ in
612-496: A factor in ME/CFS. There is a subset of people with ME/CFS with increased levels of autoantibodies , possibly as a result of viral mimicry . Some may have higher levels of autoantibodies to muscarinic acetylcholine receptors as well as to β2 adrenergic receptors . Problems with these receptors can lead to impaired blood flow. Objective signs of PEM have been found with the 2-day cardiopulmonary exercise test . People with ME/CFS have lower performance compared to healthy controls on
714-461: A full-time job. The cause of ME/CFS is not yet known. Between 60% and 80% of cases start after an infection, usually a viral infection. A genetic factor is believed to contribute, but there is no single gene responsible for increased risk. Instead, many gene variants probably have a small individual effect, but their combined effect can be strong. Other factors may include problems with the nervous and immune systems, as well as energy metabolism. ME/CFS
816-571: A genetic factor. In the United States, white Americans are diagnosed more frequently than other groups, but the illness is probably at least as prevalent among African Americans and Hispanics. It used to be thought that ME/CFS was more common among those with higher incomes. Instead, people in minority groups or lower income groups may have increased risks due to poorer nutrition, lower healthcare access, and increased work stress. Viral infections have long been suspected to cause ME/CFS, based on
918-549: A large set of symptoms. Several studies suggest neuroinflammation in the cortical and limbic regions of the brain. Individuals with ME/CFS, for instance, have higher brain lactate and choline levels, which are signs of neuroinflammation. More direct evidence from two small Positron emission tomography studies of microglia , a type of immune cell in the brain, were contradictory, however. ME/CFS affects sleep. Individuals experience decreased sleep efficiency , take longer to fall asleep , and take longer to achieve REM sleep ,
1020-528: A large social and economic impact, and the disease can be socially isolating. About a quarter of those affected are unable to leave their bed or home. People with ME/CFS often face stigma in healthcare settings, and care is complicated by controversies around the cause and treatments of the illness. Doctors may be unfamiliar with ME/CFS, as it is often not fully covered in medical school. Historically, research funding for ME/CFS has been far below that of diseases with comparable impact. ME/CFS has been classified as
1122-741: A major cause for the disparities observed in the care of chronic disease. Lack of access and delay in receiving care result in worse outcomes for patients from minorities and underserved populations. Those barriers to medical care complicate patients monitoring and continuity in treatment. In the US, minorities and low-income populations are less likely to seek, access and receive preventive services necessary to detect conditions at an early stage. The majority of US health care and economic costs associated with medical conditions are incurred by chronic diseases and conditions and associated health risk behaviors. Eighty-four percent of all health care spending in 2006
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#17327761052691224-451: A means of improving the number of people with chronic conditions that miss medical appointments, however there is no strong evidence that these approaches make a difference. Nursing can play an important role in assisting patients with chronic diseases achieve longevity and experience wellness. Scholars point out that the current neoliberal era emphasizes self-care, in both affluent and low-income communities. This self-care focus extends to
1326-679: A much larger scale in these areas. In Europe, the European Chronic Disease Alliance was formed in 2011, which represents over 100,000 healthcare workers. In the United States, there are a number of nonprofits focused on chronic conditions, including entities focused on specific diseases such as the American Diabetes Association , Alzheimer's Association , or Crohn's and Colitis Foundation . There are also broader groups focused on advocacy or research into chronic illness in general, such as
1428-506: A name has been challenging because the cause and pathology remain unknown. In the WHO's most recent classification, the ICD-11 , chronic fatigue syndrome and myalgic encephalomyelitis are named under post-viral fatigue syndrome. The term post-infectious fatigue syndrome was initially proposed as a subset of "chronic fatigue syndrome" with a documented triggering infection, but might also be used as
1530-440: A nursing-heavy approach to the management of chronic disease. Foregrounding the problem of distance from healthcare facility, the study recommends patients increase their request for care. It uses nurses and health officers to fill, in a cost-efficient way, the large unmet need for chronic disease treatment. They led their health centers staffed by nurses and health officers; so, there are specific training required for involvement in
1632-504: A phase of sleep characterised by rapid eye movement. Changes to non-REM sleep have also been found, together suggesting a role of the autonomic nervous system. Individuals often have a blunted heart rate response to exercise , but a higher heart rate during a tilt table test when the body is rotated from lying flat to an upright position. This again suggests dysfunction in the autonomic nervous system. People with ME/CFS often have immune system abnormalities. A consistent finding in studies
1734-431: A psychosocial approach to chronic illness to aid the increasing number of individuals diagnosed with these conditions. Despite this movement, there is still criticism that chronic conditions are not being treated appropriately, and there is not enough emphasis on the behavioral aspects of chronic conditions or psychological types of support for patients. The mental health intersectionality on those with chronic conditions
1836-631: A report that estimated investing $ 10 per person annually in community-based programs of proven effectiveness and promoting healthy lifestyle (increase in physical activity, healthier diet and preventing tobacco use) could save more than $ 16 billion annually within a period of just five years. A 2017 review (updated in 2022) found that it is uncertain whether school-based policies on targeting risk factors on chronic diseases such as healthy eating policies, physical activity policies, and tobacco policies can improve student health behaviours or knowledge of staffs and students. The updated review in 2022 did determine
1938-485: A role in AIDS prevalence, only exposure is truly needed to contract this chronic disease. Communicable chronic diseases are also typically only treatable with medication intervention, rather than lifestyle change as some non-communicable chronic diseases can be treated. As of 2003, there are a few programs which aim to gain more knowledge on the epidemiology of chronic disease using data collection. The hope of these programs
2040-428: A school event, food shopping, or even taking a shower. For some, being in a stimulating environment can be sufficient to trigger PEM. PEM usually starts 12 to 48 hours after the activity, but can also follow immediately after. PEM can last hours, days, weeks, or months. Extended periods of PEM, commonly referred to as "crashes" or "flare-ups" by people with the illness, can lead to a prolonged relapse. Unrefreshing sleep
2142-493: A shorter symptom duration. For example, the CCC definition only requires three months of persistent symptoms in children compared to six months for adults. NICE requires only four weeks of symptoms to suspect ME/CFS in children, compared to six weeks in adults. Exclusionary diagnoses also differ; for instance, children and teenagers may have anxiety related to school attendance , which could explain symptoms. Screening can be done using
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#17327761052692244-592: A slight improvement in measures of obesity and physical activity as the use of improved strategies lead to increased implementation interventions but continued to call for additional research to address questions related to alcohol use and risk. Encouraging those with chronic conditions to continue with their outpatient ( ambulatory ) medical care and attend scheduled medical appointments may help improve outcomes and reduce medical costs due to missed appointments. Finding patient-centered alternatives to doctors or consultants scheduling medical appointments has been suggested as
2346-665: A slowdown in information processing. Individuals may have difficulty speaking, struggling to find words and names. They may have trouble concentrating or multitasking , or may have difficulties with short-term memory. Tests often show problems with short-term visual memory, reaction time and reading speed . There may also be problems with attention and verbal memory . People with ME/CFS often experience orthostatic intolerance , symptoms that start or worsen with standing or sitting. Symptoms, which include nausea, lightheadedness, and cognitive impairment, often improve again after lying down. Weakness and vision changes may also be triggered by
2448-439: A sore throat. People may also develop allergies or become sensitive to foods, lights, noise, smells or chemicals. ME/CFS often leads to serious disability, but the degree varies considerably. ME/CFS is generally classified into four categories of illness severity: Roughly a quarter of those living with ME/CFS fall into the mild category, and half fall into the moderate or moderate-to-severe categories. The final quarter falls into
2550-436: A straightforward cause and effect relationship with chronic disease diagnosis. While typically higher socioeconomic status is correlated with lower occurrence of chronic disease, it is not known is there is a direct cause and effect relationship between these two variables. The epidemiology of communicable chronic diseases such as AIDS is also different from that of noncommunicable chronic disease. While Social factors do play
2652-458: A synonym of ME/CFS or as a broader set of fatigue conditions after infection. Many individuals with ME/CFS object to the term chronic fatigue syndrome . They consider the term simplistic and trivialising, which in turn prevents the illness from being taken seriously. At the same time, there are also issues with the use of myalgic encephalomyelitis (myalgia means muscle pain and encephalomyelitis means brain and spinal cord inflammation), as there
2754-501: A tilt table test. If that is unavailable, it can also be assessed with the simpler NASA 10-minute lean test , which tests the response to prolonged standing. Standard laboratory findings are usually normal. Standard tests when suspecting ME/CFS include an HIV test, and blood tests to determine full blood count , red blood cell sedimentation rate (ESR), C-reactive protein , blood glucose and thyroid-stimulating hormone . Tests for antinuclear antibodies may come back positive, but below
2856-407: A trigger. ME/CFS can also begin with multiple minor triggering events, followed by a final trigger that leads to a clear onset of symptoms. ME/CFS can affect people of all ages, ethnicities, and income levels, but it is more common in women than men. People with a history of frequent infections are more likely to develop it. Those with family members who have ME/CFS are also at higher risk, suggesting
2958-532: A twofold increase in psychiatric disorders. Higher parental depression and other family stressors predicted more problems among patients. In addition, sibling problems along with the burden of illness on the family as a whole led to more psychological strain on the patients and their families. A growing body of evidence supports that prevention is effective in reducing the effect of chronic conditions; in particular, early detection results in less severe outcomes. Clinical preventive services include screening for
3060-571: A worsening of existing symptoms, patients may experience some symptoms exclusively during PEM. Patients often describe PEM as a "crash", "relapse", or "setback". PEM is triggered by "minimal" physical or mental activities that were previously tolerated, and that healthy people tolerate, like attending a social event, grocery shopping, or even taking a shower. Sensory overload, emotional distress, injury, sleep deprivation , infections, and spending too long standing or sitting up are other potential triggers. The resulting symptoms are disproportionate to
3162-452: A year to non-communicable diseases. In the United States approximately 40% of adults have at least two chronic conditions. Living with two or more chronic conditions is referred to as multimorbidity . Chronic conditions have often been used to describe the various health related states of the human body such as syndromes, physical impairments, disabilities as well as diseases. Epidemiologists have found interest in chronic conditions due to
Myalgic encephalomyelitis/chronic fatigue syndrome - Misplaced Pages Continue
3264-504: Is 77% higher among non-Hispanic blacks, and American Indians and Alaska Natives are 60% more likely to be obese than non-Hispanic whites. Some of this prevalence has been suggested to be in part from environmental racism . Flint, Michigan, for example, had high levels of lead poisoning in their drinkable water after waste was dumped into low-value housing areas. There are also higher rates of asthma in children who live in lower income areas due to an abundance of pollutants being released on
3366-425: Is a biological disease, not a psychological condition, and is not due to deconditioning . Besides viruses, other reported triggers include stress, traumatic events, and environmental exposures such as to mould . Bacterial infections such as Q-fever are other potential triggers. ME/CFS may further occur after physical trauma, such as an accident or surgery. Pregnancy has been reported in around 3% to 10% of cases as
3468-417: Is a common feature of ME/CFS, but is more closely associated with fibromyalgia . Modern definitions of fibromyalgia not only include widespread pain but also fatigue, sleep disturbances, and cognitive issues. This makes it difficult to distinguish ME/CFS from fibromyalgia and the two are often co-diagnosed. Chronic condition A chronic condition (also known as chronic disease or chronic illness )
3570-408: Is a decreased function of natural killer cells, a type of immune cell that targets virus-infected and tumour cells. They are also more likely to have active viral infections, correlating with cognitive issues and fatigue. T cells show less metabolic activity. This may reflect they have reached an exhausted state and cannot respond effectively against pathogens . Autoimmunity has been proposed to be
3672-610: Is a further core symptom. People wake up exhausted and stiff rather than restored after a night's sleep. This can be caused by a pattern of sleeping during the day and being awake at night , shallow sleep, or broken sleep. However, even a full night's sleep is typically non-restorative. Some individuals experience insomnia, hypersomnia (excessive sleepiness), or vivid nightmares. Cognitive dysfunction in ME/CFS can be as disabling as physical symptoms, leading to difficulties at work or school, as well as in social interactions. People with ME/CFS sometimes describe it as "brain fog", and report
3774-542: Is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months. Common chronic diseases include diabetes , functional gastrointestinal disorder , eczema , arthritis , asthma , chronic obstructive pulmonary disease , autoimmune diseases , genetic disorders and some viral diseases such as hepatitis C and acquired immunodeficiency syndrome . An illness which
3876-437: Is a large aspect often overlooked by doctors. And chronic illness therapists are available for support to help with the mental toll of chronic illness a it is often underestimated in society. Adults with chronic illness that restrict their daily life present with more depression and lower self-esteem than healthy adults and adults with non-restricting chronic illness. The emotional influence of chronic illness also has an effect on
3978-416: Is a worsening of symptoms that occurs after minimal exertion. It is the hallmark symptom of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and common in long COVID and fibromyalgia . PEM is often severe enough to be disabling, and is triggered by ordinary activities that healthy people tolerate. Typically, it begins 12–48 hours after the activity that triggers it, and lasts for days, but this
4080-416: Is based on symptoms and involves taking a medical history and a mental and physical examination. No specific lab tests are approved for diagnosis; while physical abnormalities can be found, no single finding is considered sufficient for diagnosis. Blood and urine tests are used to rule out other conditions that could be responsible for the symptoms. People with ME/CFS often face significant delays in obtaining
4182-622: Is diverse and the epidemiology of some chronic diseases can change in response to new treatments. In the treatment of HIV, the success of anti-retroviral therapies means that many patients will experience this infection as a chronic disease that for many will span several decades of their chronic life. Some epidemiology of chronic disease can apply to multiple diagnosis. Obesity and body fat distribution for example contribute and are risk factors for many chronic diseases such as diabetes, heart, and kidney disease. Other epidemiological factors, such as social, socioeconomic, and environment do not have
Myalgic encephalomyelitis/chronic fatigue syndrome - Misplaced Pages Continue
4284-476: Is highly variable and may persist much longer. Management of PEM is symptom-based, and patients are recommended to pace their activities to avoid triggering PEM. One of the first definitions of ME/CFS, the Holmes Criteria published in 1988, does not use the term post-exertional malaise but describes prolonged fatigue after exercise as a symptom. The term was later used in a 1991 review summarizing
4386-542: Is lifelong because it ends in death is a terminal illness . It is possible and not unexpected for an illness to change in definition from terminal to chronic. Diabetes and HIV for example were once terminal yet are now considered chronic due to the availability of insulin for diabetics and daily drug treatment for individuals with HIV which allow these individuals to live while managing symptoms. In medicine , chronic conditions are distinguished from those that are acute . An acute condition typically affects one portion of
4488-568: Is of a longer duration and greater severity than in other conditions characterized by fatigue. The hallmark feature of ME/CFS is a worsening of symptoms after exertion, known as post-exertional malaise or post-exertional symptom exacerbation . PEM involves increased fatigue and is disabling. It can also include flu-like symptoms, pain, cognitive difficulties, gastrointestinal issues, nausea , and sleep problems. All types of activities that require energy, whether physical, cognitive, social, or emotional, can trigger PEM. Examples include attending
4590-498: Is only limited evidence of brain inflammation implied by the name. The umbrella term ME/CFS would retain the better-known phrase CFS without trivialising the disease, but some people object to this name too, as they see CFS and ME as distinct illnesses. A 2015 report from the US Institute of Medicine recommended the illness be renamed systemic exertion intolerance disease ( SEID ) and suggested new diagnostic criteria. While
4692-462: Is present in about 90% of people, usually in a latent state. The levels of antibodies to EBV are commonly higher in people with ME/CFS, indicating possible viral reactivation. ME/CFS is associated with changes in several areas, including the nervous and immune systems, as well as disturbances in energy metabolism. Neurological differences include autonomic nervous system dysfunction and a change in brain structure and metabolism . Observed changes in
4794-434: Is the development of combined antiviral therapies that led to remarkable improvement in survival rates and quality of life of HIV -infected patients. In addition to direct costs in health care, chronic diseases are a significant burden to the economy, through limitations in daily activities, loss in productivity and loss of days of work. A particular concern is the rising rates of overweight and obesity in all segments of
4896-438: Is the more familiar term. Post-exertional malaise involves an exacerbation of symptoms, or the appearance of new symptoms, which are often severe enough to impact a person's functioning. While fatigue is often prominent, it is "more than fatigue following a stressor ". Other symptoms that may occur during PEM include cognitive impairment , flu-like symptoms, pain, weakness, and trouble sleeping . Though typically cast as
4998-1006: Is to gather epidemiological data on various chronic diseases across the United States and demonstrate how this knowledge can be valuable in addressing chronic disease. In the United States, as of 2004 nearly one in two Americans (133 million) has at least one chronic medical condition, with most subjects (58%) between the ages of 18 and 64. The number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million. The most common chronic conditions are high blood pressure , arthritis , respiratory diseases like emphysema , and high cholesterol . Based on data from 2014 Medical Expenditure Panel Survey (MEPS), about 60% of adult Americans were estimated to have one chronic illness, with about 40% having more than one; this rate appears to be mostly unchanged from 2008. MEPS data from 1998 showed 45% of adult Americans had at least one chronic illness, and 21% had more than one. According to research by
5100-654: Is uncommon. No therapies or medications are approved to treat the condition, and management is aimed at relieving symptoms. Pacing of activities can help avoid worsening symptoms, and counselling may help in coping with the illness. Before the COVID-19 pandemic , ME/CFS affected two to nine out of every 1000 people, depending on the definition. However, many people fit ME/CFS diagnostic criteria after contracting long COVID . ME/CFS occurs more often in women than in men. It most commonly affects adults between ages 40 and 60 but can occur at other ages, including childhood. ME/CFS has
5202-402: Is viewed and treated in society. Women's chronic health issues are often considered to be most worthy of treatment or most severe when the chronic condition interferes with a woman's fertility. Historically, there is less of a focus on a woman's chronic conditions when it interferes with other aspects of her life or well-being. Many women report feeling less than or even "half of a woman" due to
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#17327761052695304-629: The CDC , chronic disease is also especially a concern in the elderly population in America. Chronic diseases like stroke, heart disease, and cancer were among the leading causes of death among Americans aged 65 or older in 2002, accounting for 61% of all deaths among this subset of the population. It is estimated that at least 80% of older Americans are currently living with some form of a chronic condition, with 50% of this population having two or more chronic conditions. The two most common chronic conditions in
5406-504: The DePaul Symptom Questionnaire , which assesses the frequency and severity of ME/CFS symptoms. Individuals may struggle to answer questions related to PEM, if they are unfamiliar with the symptom. To find patterns in symptoms, they may be asked to keep a diary. A physical exam may appear completely normal, particularly if the individual has rested substantially before a doctor's visit. There may be tenderness in
5508-638: The International Consensus Criteria , the National Academy of Medicine criteria , and NICE's definition of ME/CFS all require it. The Canadian Consensus Criteria require "post exertional malaise and/or [post exertional] fatigue" instead. On the other hand, the older Oxford Criteria lack any mention of PEM, and the Fukuda Criteria consider it optional. Depending on the definition of ME/CFS used, PEM
5610-608: The immune system include decreased natural killer cell function and, in some cases, autoimmunity . A range of structural, biochemical, and functional abnormalities are found in brain imaging studies of people with ME/CFS. Common findings are changes in the brainstem and the use of additional brain areas for cognitive tasks. Other consistent findings, based on a smaller number of studies, are low metabolism in some areas, reduced serotonin transporters , and problems with neurovascular coupling . Neuroinflammation has been proposed as an underlying mechanism of ME/CFS that could explain
5712-684: The Fukuda criteria. The 2011 International Consensus Criteria defines ME using symptom clusters and has no minimum duration of symptoms. Similarly to the CCC criteria, ICC is stricter than the Fukuda criteria and selects more severely ill people. The 2015 IOM criteria share significant similarities with the CCC but were developed to be easy to use for clinicians. Diagnosis requires fatigue, PEM, non-restorative sleep, and either cognitive issues (such as memory impairment) or orthostatic intolerance. Additionally, fatigue must persist for at least six months, substantially impair activities in all areas of life, and have
5814-883: The National Association of Chronic Disease Directors, Partnership to Fight Chronic Disease, the Chronic Disease Coalition which arose in Oregon in 2015, and the Chronic Policy Care Alliance. Signs and symptoms Syndrome Disease Medical diagnosis Differential diagnosis Prognosis Acute Chronic Cure Eponymous disease Acronym or abbreviation Remission Post-exertional malaise Post-exertional malaise ( PEM ), sometimes referred to as post-exertional symptom exacerbation ( PESE ) or post-exertional neuroimmune exhaustion (PENE) ,
5916-1086: The U.S. population. Obesity itself is a medical condition and not a disease, but it constitutes a major risk factor for developing chronic illnesses, such as diabetes, stroke, cardiovascular disease and cancers. Obesity results in significant health care spending and indirect costs, as illustrated by a recent study from the Texas comptroller reporting that obesity alone cost Texas businesses an extra $ 9.5 billion in 2009, including more than $ 4 billion for health care, $ 5 billion for lost productivity and absenteeism, and $ 321 million for disability. There have been recent links between social factors and prevalence as well as outcome of chronic conditions. The connection between loneliness, overall health, and chronic conditions has recently been highlighted. Some studies have shown that loneliness has detrimental health effects similar to that of smoking and obesity. One study found that feelings of isolation are associated with higher self reporting of health as poor, and feelings of loneliness increased
6018-402: The WHO recommends that clinicians explicitly ask long COVID patients whether symptoms worsen with activity. The 2-day Cardiopulmonary Exercise Test (CPET) may aid in documenting PEM, showing apparent abnormalities in the body's response to exercise. Still, more research on developing a diagnostic test is needed. PEM is considered a cardinal symptom of ME/CFS by modern diagnostic criteria:
6120-451: The ability to function and typically last for three to six months before a diagnosis can be confirmed. ME/CFS usually starts after an infection. Onset can be sudden or more gradual over weeks to months. People with ME/CFS experience persistent debilitating fatigue . It is made worse by normal physical, mental, emotional, and social activity, and is not a result of ongoing overexertion. Rest provides limited relief from fatigue. Particularly in
6222-786: The ability to speak, swallow, or communicate completely due to cognitive issues. They can further experience severe pain and hypersensitivities to touch, light, sound, and smells. Minor day-to-day activities can be sufficient to trigger PEM. Individuals with ME/CFS have decreased quality of life when evaluated by the SF-36 questionnaire, especially in the domains of physical and social functioning, general health, and vitality. However, their emotional functioning and mental health are not much lower than those of healthy individuals. Functional impairment in ME/CFS can be greater than multiple sclerosis , heart disease , or lung cancer . Fewer than half of people with ME/CFS are employed, and roughly one in five have
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#17327761052696324-471: The body and responds to treatment. A chronic condition, on the other hand, usually affects multiple areas of the body, is not fully responsive to treatment, and persists for an extended period of time. Chronic conditions may have periods of remission or relapse where the disease temporarily goes away, or subsequently reappears. Periods of remission and relapse are commonly discussed when referring to substance abuse disorders which some consider to fall under
6426-417: The brain under orthostatic stress (as found in a tilt table test), small-fibre neuropathy , and an increase in the amount of gut microbes entering the blood. The diversity of gut microbes is reduced compared to healthy controls. Women with ME/CFS are more likely to experience endometriosis , early menopause , and other menstrual irregularities compared to women without the condition. Diagnosis of ME/CFS
6528-449: The category of chronic condition. Chronic conditions are often associated with non-communicable diseases which are distinguished by their non-infectious causes. Some chronic conditions though, are caused by transmissible infections such as HIV/AIDS. 63% of all deaths worldwide are from chronic conditions. Chronic diseases constitute a major cause of mortality , and the World Health Organization (WHO) attributes 38 million deaths
6630-604: The chronic illness being a source of stress for the individual. A study of loneliness in adults over age 65 found that low levels of loneliness as well as high levels of familial support were associated with better outcomes of multiple chronic conditions such as hypertension and diabetes. There are some recent movements in the medical sphere to address these connections when treating patients with chronic illness. The biopsychosocial approach for example, developed in 2006 focuses on patients "patient's personality, family, culture, and health dynamics." Physicians are leaning more towards
6732-590: The diagnostic criteria for ME/CFS. Of people who get infectious mononucleosis , which is caused by the Epstein–Barr virus (EBV), around 8% to 15% develop ME/CFS, depending on criteria. Other viral infections that can trigger ME/CFS are the H1N1 influenza virus , varicella zoster (the virus that causes chickenpox and shingles ), and SARS-CoV-1 . Reactivation of latent viruses, in particular EBV and human herpesvirus 6 , has also been hypothesised to drive symptoms. EBV
6834-444: The disease is unknown. ME/CFS often starts after an infection, such as mononucleosis . It can run in families, but no genes that contribute to ME/CFS have been confirmed. ME/CFS is associated with changes in the nervous and immune systems, as well as in energy production. Diagnosis is based on symptoms and a differential diagnosis because no diagnostic test is available. The illness can improve or worsen over time, but full recovery
6936-566: The elderly are high blood pressure and arthritis, with diabetes, coronary heart disease, and cancer also being reported among the elder population. In examining the statistics of chronic disease among the living elderly, it is also important to make note of the statistics pertaining to fatalities as a result of chronic disease. Heart disease is the leading cause of death from chronic disease for adults older than 65, followed by cancer, stroke, diabetes, chronic lower respiratory diseases, influenza and pneumonia, and, finally, Alzheimer's disease. Though
7038-404: The existence of the disease or predisposition to its development, counseling and immunizations against infectious agents. Despite their effectiveness, the utilization of preventive services is typically lower than for regular medical services. In contrast to their apparent cost in time and money, the benefits of preventive services are not directly perceived by patient because their effects are on
7140-474: The eyes and in the neck, as well as neuropathic pain (related to disorders of the nervous system). Headaches and migraines that were not present before the illness can occur as well. However, chronic daily headaches may indicate an alternative diagnosis. Additional common symptoms include irritable bowel syndrome or other problems with digestion, chills and night sweats , shortness of breath or an irregular heartbeat . Some experience sore lymph nodes and
7242-449: The fact they contribute to disease, disability, and diminished physical and/or mental capacity. For example, high blood pressure or hypertension is considered to be not only a chronic condition itself but also correlated with diseases such as heart attack or stroke . Additionally, some socioeconomic factors may be considered as a chronic condition as they lead to disability in daily life. An important one that public health officials in
7344-592: The first test. On the second test, healthy people's scores stay roughly the same or increase slightly, while those with ME/CFS have a clinically significant decrease in work rate at the anaerobic threshold . Potential causes include mitochondrial dysfunction, and issues with the transport and use of oxygen. Some of the usual recovery processes following exercise may be lacking, providing an alternative explanation for PEM. Studies have observed mitochondrial abnormalities in cellular energy production, but differences between studies make it hard to draw clear conclusions. ATP ,
7446-564: The four major types as: Other examples of chronic diseases and health conditions include: While risk factors vary with age and gender, many of the common chronic diseases in the US are caused by dietary, lifestyle and metabolic risk factors. Therefore, these conditions might be prevented by behavioral changes , such as quitting smoking, adopting a healthy diet, and increasing physical activity. Social determinants are important risk factors for chronic diseases. Social factors , e.g., socioeconomic status, education level, and race/ethnicity, are
7548-607: The general public. Within the medical-industrial complex , chronic illnesses can impact the relationship between pharmaceutical companies and people with chronic conditions. Life-saving drugs, or life-extending drugs, can be inflated for a profit . There is little regulation on the cost of chronic illness drugs, which suggests that abusing the lack of a drug cap can create a large market for drug revenue. Likewise, certain chronic conditions can last throughout one's lifetime and create pathways for pharmaceutical companies to take advantage of this. Gender influences how chronic disease
7650-510: The impact of risk factors on the individual's development and functioning. People with chronic conditions pay more out-of-pocket; a study found that Americans spent $ 2,243 more on average. The financial burden can increase medication non-adherence. In some countries, laws protect patients with chronic conditions from excessive financial responsibility; for example, as of 2008 France limited copayments for those with chronic conditions, and Germany limits cost sharing to 1% of income versus 2% for
7752-483: The initial period of illness, this fatigue is described as "flu-like". Individuals may feel "physically drained" and unable to start or finish activities. They may also feel restless while fatigued, describing their experience as "wired but tired". When starting an activity, muscle strength may drop rapidly, which can lead to difficulty with coordination, clumsiness or sudden weakness . Mental fatigue may also make cognitive efforts difficult. The fatigue experienced in ME/CFS
7854-535: The intellectual and educational development of the individual. For example, people living with type 1 diabetes endure a lifetime of monotonous and rigorous health care management usually involving daily blood glucose monitoring, insulin injections, and constant self-care. This type of constant attention that is required by type 1 diabetes and other chronic illness can result in psychological maladjustment. There have been several theories, namely one called diabetes resilience theory, that posit that protective processes buffer
7956-408: The levels that suggest the individual may have lupus . C-reactive protein levels are often at the high end of normal. Serum ferritin levels may be useful to test, as borderline anaemia can make some ME/CFS symptoms worse. Some medical conditions have symptoms similar to ME/CFS. Diagnosis often involves clinical evaluation, testing, and specialist referrals to identify the correct condition. During
8058-399: The likelihood of mental health disorders in individuals. The connection between chronic illness and loneliness is established, yet oftentimes ignored in treatment. One study for example found that a greater number of chronic illnesses per individual were associated with feelings of loneliness. Some of the possible reasons for this listed are an inability to maintain independence as well as
8160-580: The long term or might be greater for society as a whole than at the individual level. Therefore, public health programs are important in educating the public, and promoting healthy lifestyles and awareness about chronic diseases. While those programs can benefit from funding at different levels (state, federal, private) their implementation is mostly in charge of local agencies and community-based organizations. Studies have shown that public health programs are effective in reducing mortality rates associated to cardiovascular disease, diabetes and cancer, but
8262-425: The lymph nodes and abdomen or signs of hypermobility. Answers to questions may show a temporary difficulty with finding words or other cognitive problems. Cognitive tests and a two-day cardiopulmonary exercise test (CPET) can be helpful to document aspects of the illness, but they may be risky as they can cause severe PEM. They may be warranted to support a disability claim. Orthostatic intolerance can be measured with
8364-603: The new name was not widely adopted, the diagnostic criteria were taken over by the CDC. Like CFS , the name SEID only focuses on a single symptom, and opinion from those affected was generally negative. ME/CFS causes debilitating fatigue, sleep problems, and post-exertional malaise (PEM, overall symptoms getting worse after mild activity). In addition, cognitive issues, orthostatic intolerance (dizziness or nausea when upright) or other physical symptoms may be present (see also § Diagnostic criteria ). Symptoms significantly reduce
8466-459: The nursing of patients with chronic diseases, replacing a more holistic role for nursing with an emphasis on patients managing their own health conditions. Critics note that this is challenging if not impossible for patients with chronic disease in low-income communities where health care systems, and economic and social structures do not fully support this practice. A study in Ethiopia showcases
8568-519: The observation that ME/CFS sometimes occurs in outbreaks and is possibly connected to autoimmune diseases . How viral infections cause ME/CFS is unclear; it could be via viral persistence or via a "hit and run" mechanism, in which infections dysregulate the immune system or cause autoimmunity. Different types of viral infection have been implicated in ME/CFS, including airway infections, bronchitis , gastroenteritis , or an acute "flu-like illness". Between 15% and 50% of people with long COVID also meet
8670-580: The pressures that society puts on the importance of fertility and health when it comes to typically feminine ideals. These kinds of social barriers interfere with women's ability to perform various other activities in life and fully work toward their aspirations. Race is also implicated in chronic illness, although there may be many other factors involved. Racial minorities are 1.5-2 times more likely to have most chronic diseases than white individuals. Non-Hispanic blacks are 40% more likely to have high blood pressure that non-Hispanic whites, diagnosed diabetes
8772-426: The primary energy carrier in cells, is likely more frequently produced from lipids and amino acids than from carbohydrates . Some people with ME/CFS have abnormalities in their hypothalamic–pituitary–adrenal axis hormones. This can include lower cortisol levels , less change in cortisol levels throughout the day, and a weaker reaction to stress and stimuli. Other proposed abnormalities are reduced blood flow to
8874-477: The programmed must be carried out regularly, to ensure that new staff is educated in administering chronic disease care. The program shows that community-based care and education, primarily driven by nurses and health officers, works. It highlights the importance of nurses following up with individuals in the community, and allowing nurses flexibility in meeting their patients' needs and educating them for self-care in their homes. The epidemiology of chronic disease
8976-419: The rates of chronic disease differ by race for those living with chronic illness, the statistics for leading causes of death among elderly are nearly identical across racial/ethnic groups. Chronic illnesses cause about 70% of deaths in the US and in 2002 chronic conditions (heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer's disease, mental illness and kidney diseases) were six of
9078-426: The required symptoms and which conditions preclude a diagnosis of ME/CFS. The definitions differ in their conceptualisation of the cause and mechanisms of ME/CFS. As there is no biomarker for ME/CFS, it is not possible to determine which set of criteria is the most accurate. A trade-off must be made between overdiagnosis and missing more diagnoses. The broad Fukuda criteria have a higher risk of overdiagnosis, whereas
9180-473: The results are somewhat heterogeneous depending on the type of condition and the type of programs involved. For example, results from different approaches in cancer prevention and screening depended highly on the type of cancer. The rising number of patient with chronic diseases has renewed the interest in prevention and its potential role in helping control costs. In 2008, the Trust for America's Health produced
9282-451: The severe or very severe category. Severity may change over time. Symptoms might get worse, improve, or the illness may go into remission for a period of time. People who feel better for a period of time may overextend their activities, triggering PEM and a worsening of symptoms. Those with severe and very severe ME/CFS experience more extreme and diverse symptoms. They may face severe weakness and greatly limited ability to move. They can lose
9384-559: The social science setting have begun highlighting is chronic poverty . Researchers, particularly those studying the United States, utilize the Chronic Condition Indicator (CCI) which maps ICD codes as "chronic" or "non-chronic". The list below includes these chronic conditions and diseases: In 2015 the World Health Organization produced a report on non-communicable diseases, citing
9486-605: The strict ICC criteria have a higher risk of missing people. The IOM and NICE criteria fall in the middle. The 1994 CDC criteria, sometimes called the Fukuda criteria, require six months of persistent or relapsing fatigue for diagnosis, as well as the persistent presence of four out of eight other symptoms. While used frequently, the Fukuda criteria have limitations: PEM and cognitive issues are not mandatory. The large variety of optional symptoms can lead to diagnosis of individuals who differ significantly from each other. The Canadian Consensus Criteria, another commonly used criteria set,
9588-540: The symptoms of ME/CFS. Afterwards, the Canadian Consensus Criteria from 2003 and the International Consensus Criteria from 2011 used the term, as well as later definitions . The 2021 NICE committee stated they consider the term PEM outdated, as it may give the impression of just a "vague discomfort", and argued that the term post-exertional symptom exacerbation better captures the symptom. Nonetheless, they decided to continue using PEM as it
9690-462: The symptoms, vary from person to person, and within individuals over time. Due to this variability, affected people may be unable to predict what will trigger it. This variable, relapsing-remitting pattern can cause one's abilities to fluctuate from one day to the next. PEM is a hallmark symptom of ME/CFS and is common in long COVID . However, its presence can be difficult to assess because patients and doctors may be unfamiliar with it. Hence,
9792-1181: The time other possible diagnoses are explored, advice can be given on symptom management to help prevent the condition from getting worse. Before a diagnosis of ME/CFS is confirmed, a waiting period is used to exclude acute medical conditions or symptoms which may resolve within that time frame. Possible differential diagnoses span a large set of specialties and depend on the medical history. Examples are infectious diseases , such as Epstein–Barr virus and Lyme disease , and neuroendocrine disorders, including diabetes and hypothyroidism . Blood disorders , such as anaemia , and some cancers may also present similar symptoms. Various rheumatological and autoimmune diseases, such as Sjögren's syndrome , lupus, and arthritis , may have overlapping symptoms with ME/CFS. Furthermore, it may be necessary to evaluate psychiatric diseases , such as depression or substance use disorder , as well as neurological disorders, such as narcolepsy , multiple sclerosis , and craniocervical instability . Finally, sleep disorders, coeliac disease , and side effects of medications may also explain symptoms. Joint and muscle pain without swelling or inflammation
9894-564: The top ten causes of mortality in the general US population. Chronic diseases are a major factor in the continuous growth of medical care spending. In 2002, the U.S. Department of Health and Human Services stated that the health care for chronic diseases cost the most among all health problems in the U.S. Healthy People 2010 reported that more than 75% of the $ 2 trillion spent annually in U.S. medical care are due to chronic conditions; spending are even higher in proportion for Medicare beneficiaries (aged 65 years and older). Furthermore, in 2017 it
9996-424: The triggering activity and are often debilitating, potentially rendering someone housebound or bedbound until they recover. The course of a crash is highly variable. Symptoms typically begin 12–48 hours after the triggering activity, but may be immediate, or delayed up to 7 days. PEM lasts "usually a day or longer", but can span hours, days, weeks, or months. The level of activity that triggers PEM, as well as
10098-540: The upright posture. Some have postural orthostatic tachycardia syndrome (POTS), an excessive increase in heart rate after standing up, which can result in fainting . Additionally, individuals may experience orthostatic hypotension , a drop in blood pressure after standing. Pain and hyperalgesia (an abnormally increased sensitivity to pain) are common in ME/CFS. The pain is not accompanied by swelling or redness. The pain can be present in muscles ( myalgia ) and joints . Individuals with ME/CFS may have chronic pain behind
10200-409: Was developed in 2003. In addition to PEM, fatigue and sleep problems, pain and neurological or cognitive issues are required for diagnosis. Furthermore, three categories of symptoms are defined (orthostatic, thermal instability, and immunological). At least one symptom in two of these categories needs to be present. People diagnosed under the CCC have more severe symptoms compared to those diagnosed under
10302-461: Was estimated that 90% of the $ 3.3 billion spent on healthcare in the United States was due to the treatment of chronic diseases and conditions. Spending growth is driven in part by the greater prevalence of chronic illnesses and the longer life expectancy of the population. Also, improvement in treatments has significantly extended the lifespans of patients with chronic diseases but results in additional costs over long period of time. A striking success
10404-425: Was for the 50% of the population who have one or more common chronic medical conditions (CDC, 2014). There are several psychosocial risk and resistance factors among children with chronic illness and their family members. Adults with chronic illness were significantly more likely to report life dissatisfaction than those without chronic illness. Compared to their healthy peers, children with chronic illness have about
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