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ME exercise therapy guidance scrapped by Health watchdog Nice


ME exercise therapy guidance scrapped by Health watchdog Nice

A disputed therapy that encourages people with ME to gradually increase physical activity will no longer be officially recommended, a health watchdog said, marking a victory for campaigners.

The controversial treatment, called graded exercise therapy, has been removed from guidance given by the National Institute for Health and Care Excellence (Nice) for diagnosing and managing myalgic encephalomyelitis, which is also known as chronic fatigue syndrome.

The long-awaited landmark guidance had been due in August but was put on hold following concerns from some groups over its contents. It is thought some health professionals had been unhappy with some of the recommendations made by Nice.

The campaign group ME Action UK had urged Nice to publish the guideline – which said graded exercise should not be recommended – without delay, saying evidence demonstrated that graded exercise “harms most people with ME” and that any evidence supporting its use “was deemed to be of low or very low quality by the independent Nice guideline committee”.

Charities and patient groups had been fighting for greater recognition of the condition as a medical illness rather than psychological problem. Graded exercise therapy (GET) involves incremental increases in physical activity to gradually build up tolerance. Patient groups have argued that its use suggests those with ME have symptoms due to inactivity.

ME is thought to affect about 250,000 people in the UK and has been estimated to cost the economy billions of pounds annually. The condition includes sufferers experiencing mental fogginess, pain and a debilitating loss of energy.

It can affect anyone, including children, but is more common in women, and tends to develop when people are in the mid-20s to mid-40s age bracket. Treatments have included, besides graded exercise therapy, medication to control pain, nausea and sleeping problems, as well as cognitive behavioural therapy.

Sian Leary, from ME Action UK, said not publishing the guideline in August had been “devastating to thousands of people with ME” whom she said had been “seriously harmed by graded exercise therapy”.

Nice held a roundtable meeting in London in October with professional organisations and representatives from interested patient groups to discuss key issues around the guideline.

The new guideline says that ME/CFS is a complex condition where there is no “one size fits all” approach to managing symptoms, and adds that any therapy would depend on patient preferences and should not represent a fixed increase in activity.

The guideline says people should be given a personalised plan that is reviewed regularly. Nice said this was designed to help people understand their energy limits so they could reduce the risk of over-exertion worsening their symptoms.

The guideline also recommends a route to earlier diagnosis for those with ME/CFS, reducing the time-span for persistent symptoms from four months to three before a diagnosis is made.

Lady Finlay, consultant in palliative medicine and vice-chair of the guideline committee, said: “ME/CFS is a complex long-term condition that causes disordered energy metabolism and can be profoundly disabling. Those with ME/CFS need to be listened to, understood and supported to adapt their lives.

“The committee members involved in this guideline have worked particularly hard to ensure care becomes more empathetic and focused on the individual’s needs.”

Prof Chris Ponting, at the Institute of Genetics and Molecular Medicine, University of Edinburgh, said: “The new Nice guidelines will improve the lives of people with ME worldwide, well beyond England and Wales. They will improve awareness that graded exercise often makes ME symptoms worse.

“Nice took due care and attention developing these guidelines, applying their rigorous methods and listening to highly regarded professionals and lay people. Low and very low-quality scientific evidence was rightly discarded.

“Graded exercise therapy and cognitive behavioural therapy cannot now be offered as cures. The new guidelines vindicate the longstanding views of many people with ME, their carers and families.”

Prof Peter White, emeritus professor of psychological medicine, at Queen Mary University of London, said: “Having looked after many patients with this illness I worry that this guideline seems to suggest that patients need to learn to live with CFS/ME, rather than be helped to recover from it.

“Nice have banned graded exercise therapy, in spite of it being found to be helpful in a major Cochrane systematic review, while recommending an energy management programme which involves ‘staying within your energy limits’, for which there is little evidence for it helping, and some evidence that it doesn’t.”

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AIDS Agency Chief Says 1 Out Of 100 Persons Positive In Kaduna

The Executive Secretary of Kaduna State Aids Control Agency (KADSACA), Dr Isa Baka has said a survey had revealed that one out of 100 people is positive to the AIDS disease in the state.

Baka disclosed this speaking shortly after a walk in commemoration of the World AIDS Day, on Thursday in Kaduna.

The theme of the year’s’ World AIDS Day is “Equalise to End AIDS: Equal Access to Treatment and Prevention Services’’.

He said the present statistics was a remarkable development against previous survey which gave 11 of every 100 people in the state.

Baka added that the AIDS prevalence in Kaduna, which is at 1.1, being a survey carried out by the state government itself, was later done at the national level, where that of Kaduna was confirmed as very accurate.

“At the national level, the prevalence of the virus (AIDS) was at 1.4 (four people out of 100 test positive), while that of Kaduna is confirmed to be 1.1, was in determination of the state government and KADSACA’s efforts to ensure minimal prevalence of the virus,” he said.

He said as part of efforts to continue reducing the prevalence of AIDS in the state, government initiated programmes across the 23 LGAs.

He said one of the UNICEF anchored programmes, which is the ‘Adolescent and Youths Living With HIV and AIDS’ programme, was present and effective in at least, 18 LGAs and 24 sites in the state.

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Malawi Commences Large Scale Malaria Vaccination- First In The World

Malawi has commenced large-scale vaccination of children against malaria.

This is the first large-scale malaria vaccination campaign since the World Health Organisation (WHO) endorsed the widespread use of the RTS,S/AS01 (RTS,S) malaria vaccine in October 2021.

The endorsement followed a two-year vaccination programme, which involved more than 800,000 children in Ghana, Kenya and Malawi.

Recommended for children from five months of age to around 18 months, the vaccine  has an efficacy of 39 percent.

The first phase of the vaccination in Malawi is expected to cover 11 of the country’s 28 districts.

In a tweet on Tuesday, the WHO in Malawi said the expansion of access to the malaria vaccine will enable more children at risk of malaria to benefit from an additional prevention tool.

“Malawi has expanded access to the first malaria vaccine! The expansion of the RTS,S Malaria vaccine, into the 11 districts that participated in the malaria vaccine implementation program (MVIP) has been launched today. The vaccine offers a glimmer hope for Malawi,” WHO wrote.

Michael Kayange, Malawi’s national malaria control programme manager, told the BBC’s Focus on Africa that although the vaccine has low efficacy, “in malaria control, there is no single intervention that does it all”.

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Nigeria Yet To Attain 70% Covid-19 Vaccination Coverage- NPHCDA

The National Primary Health Care Development Agency (NPHCDA) has disclosed that Nigeria is yet to achieve 70 percent coverage for COVID-19 vaccination.

Faisal Shuaib, executive director of NPHCDA, said on Tuesday that as of November 25, a total of 56,790,371 eligible persons targeted for COVID-19 vaccination are fully vaccinated while 12,492,646 are partially vaccinated in 36 states and the FCT.

“We are 21.6 million eligible persons away from reaching its target of fully vaccinating 70 percent of its eligible population by December 2022,” he said.

“But 62 percent of the country’s eligible population is at least partially vaccinated against COVID-19.

“The country has fully vaccinated half of the total population eligible for COVID-19 vaccination.

“We have also fully vaccinated an additional over 25 percent of its eligible population, in the last 110 days of SCALES 3.0 implementation.”

The executive director said 13.2 percent of fully vaccinated persons in the country have received the COVID-19 booster dose for additional protection against the virus.

He commended the COVID-19 strategy group for achieving 50 percent vaccination coverage in the country and promised that the momentum would be sustained.

Shuaib said he has also directed the team to intensify efforts toward the attainment of herd immunity.

“Until this is achieved, the strategy group will continue to develop strategies that will help the country achieve health security,” he said.

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