Chronic fatigue syndrome and occupational health

Chronic fatigue syndrome (CFS) is a controversial conditionthat many occupational physicians find difficult to advise on.In this article we review the nature and definition of CFS,the principal aetiologic hypotheses and the evidence concerningprognosis. We also outline a practical approach to patient assessment,diagnosis and management. The conclusions of this review arethen applied to the disability discrimination field. The implicationsof the new UK occupational health legislation are also examined.Despite continuing controversy about the status, aetiology andoptimum management of CFS, we argue that much can be done toimprove the outcome for patients with this condition. The mosturgent needs are for improved education and rehabilitation,especially in regard to employment. Occupational physiciansare well placed to play an important and unique role in meetingthese needs.     

Parents' Reasons for Bringing Young Children to Hospital Emergency for Non-Urgent Reasons

The use of hospital emergency departments (EDs) has increased in recent years. Within children's hospitals, use for non-emergency reasons is dominated by young children, especially infants. A research team at the Hospital for Sick Children in Toronto, Canada sought to understand its ED use better with a view to determining the best strategic policy for dealing with its non-emergency patients. It undertook a 2-phase analysis of the use of its ED: the first phase (Brown & Shaw, 2000) analyzed patterns of use from the ED's database; the second phase, reported here, asked 158 parents and caregivers of patients age 0-7 their reasons for coming to the ED. Interview questions directly addressed 11 research questions. Users of ED for non-urgent reasons were mostly parents, fairly well educated, lived in various parts in a large urban area, and were likely to have very young and/or only children. About two-thirds had been to the ED previously, most had taken their children to more than one health care setting, 89.9% had family physicians, most had visited their own physicians recently, most made their own decisions to come to the ED, and half knew of another place they could have gone. A wide variety of health reasons were provided for coming to this ED and for not going elsewhere, but the most common were: this hospital provides the best care, and an emergency situation was perceived. Information from this study suggests that there are no simple solutions to providing information, alternate settings, or disincentives to non-urgent ED users for three reasons: (1) people come to EDs for a wide variety of reasons, (2) it is difficult to identify a subgroup that can be targeted for intervention, and (3) parents and caregivers may not use alternate settings or physicians. Two groups that might be targeted for intervention are parents of infants (especially first time parents), and parents of only children. Intervention should be at various levels of sophistication. High numbers of non-urgent ED users may be ongoing, and the price some children's hospitals pay for their high profile and prestige.     

Culture results via the internet: a novel way for communication after an emergency department visit

OBJECTIVE: To determine whether the Internet could be used to facilitate personal delivery of culture results to care givers after patient discharge from the pediatric emergency department. STUDY DESIGN: We recruited families of children who had cultures taken and were discharged home from our tertiary pediatric emergency department. Parents were given a unique ID and password to retrieve information on culture results from the study web-site. Results were posted and an e-mail was sent to the family. Access pattern to the web-site was recorded, and follow-up calls at 5 and 10 days after posting were made. RESULTS: A total of 527 families were approached; 224 were excluded. Of 303 cultures available, 24 (8%) were positive and 5 (2%) were considered to be contaminants. 186 (61%) parents accessed the Internet-system after mean 94 hours (range 1 minute to 611 hours) after posting. Of the 243 (80%) families reached for follow-up, 66 (27%) "had no time" to enter the website. CONCLUSIONS: This web-based follow-up system is valuable for negative cultures but access by parents is delayed for positive cultures. Future effort to increase awareness regarding importance of obtaining culture results is needed.