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Table 1. Socio-economic information for women in Ireland.
Pseudonym
Age
Education
Individual
Yearly
Incomea
Income Sourceb
Profession or
Employment
Tenure
Household
Membersc
Aisling
26
Teacher
Training
€6,760
State Disability
Teacher
parents
Parents
Alana
40
Leaving Certs
€6,760
State Disability
Service
rent
Ann
54
Leaving Certs
€6,760
State Disability
Service
own
Corina
41
Nurse Training
€6,760
Nurse
rent
Dorothy
56
Nurse Training
€7,800
State Disability
Employment
Pension
Husband and
children
Husband and
children
Alone
Nurse, Retired
own
Husband
Elizabeth
29
University
€35,000
Job
Communications
pays no
rent
Partner
Heidi
52
Teacher
Training
€15,600
Employment
Pension
Teacher, Retired
own
Alone
Inga
40
Secondary
€6,760
State Disability
Service
own
Kathleen
[45]
Leaving Certs
€6,760
State Disability
Industry
own
Maighread
50
Postgraduate
Job
Counsellor
own
Martha
45
University
Mary
42
Niamh
Jobs
Professional,
own
Leaving Certs
Not
reported
Not
reported
€6,448
State Disability
Labourer
parents
33
University
None
Awaiting Disabiilty
Professional
own
Pat
59
Leaving Certs
€6,760
Employment
Pension
Service, retired
own
Rhona
42
Leaving Certs
€6,760
State Disability
Not Employed
own
Roisin
Siobhan
Twyla
Una
31
23
38
30
University
University
Nurse Training
Secondary
€6,760
€6,760
€8,840
€6,760
State Disability
State Disability
State Allowance
State Disability
Service
Professional
Nurse
Service
parents
rent
own
rent
Husband and
children
Husband and
children
Husband and
children
Husband and
children
Parents
Husband and
children
Husband
Husband and
children
Parents
Alone
Children
Partner
a Incomes were self-reported. There may be discrepancies in amounts reported.
b In order to maintain confidentiality, some income sources were not reported, such as trusts, real estate, and support payments are not listed.
c “Own” implies there is a mortgage. We note the status of the mortgage only in the cases where the mortgage is paid off. Additional fees are also noted.
d Description of household members are self-reported. We use the terms the woman used. “Partner” does not indicate sexuality.
Table 2. Socio-economic information for women in British Columbia, Canada. (Source: Adapted from
Moss Y Dyck (20020, pp. 72-73.)
Pseudony
m
Age
Education
Individual
Yearly
Incomea
Agnes
71
Trade school, BSW,
MSW
$26,500
Alex
44
College
$21,500
Brie
57
BA
$8,220
State Disability Pension
Caron
51
BA, MSW
$26,400
Connie
60
Trade school
Debby
37
Dolores
44
Elise
44
BA, BSW
College Degree in
Nursing
BSW, MSW
Erin
38
Gina
Income Sourceb
State Disability
Pension; Old Age
Pension
State Disability
Pension, Long-Term
Disability
Profession or
Employment
Tenure
Household
Membersc
Retired
own; no
mortgage
Husband
Banking
own
Alone
rent
Alone
Long-Term Disability
Psychological
Testing
Social Worker
own
$19,920
Long-Term Disability
Secretary
own
None
Mother
Student
n/a
Husband
Husband;
children
Mother
$24,000
Long-Term Disability
Nurse
own
Alone
$60,000
Employed as Counselor
Counselor
Partner
Grade 12
$8,220
Social Assistance
Retail
own
own; no
mortgage;
maintenance
fees
47
MSW
$6,200
State Disability
Pension, Life Insurance
Disability Benefits
Social Worker
own
Husband;
children
Janice
33
BA
$14,400
Employed as Teacher
Teacher
own
Husband;
children
Jayne
53
BEd
$37,680
Teacher
own; no
mortgage
Alone
Julia
40
Trade School
$40,000
Retail
rent
Alone
Leeza
Pauline
54
55
None
$25,000
Husband
Alone
54
$33,600
Long-Term Disability
Homemaker
Social Worker
Project
Manager
own
own
Raquel
Business College
BA
College Degree in
Interior Design
State Disability
Pension, Long-Term
Disability
Employed in several
retail positions
Husband
Long-Term Disability
own
Alone
Reann
33
BSc, MSc
$22,560
Technician
own
Husband
Sandra
late 30s
College Degree in
Dental Hygiene
$14,950
Healthcare
Provider
own
Husband;
children
Shelagh
43
College
None
Sophie
Stella
61
57
Trade school
High School
Teresa
49
Verna
Alone
Homemaker
own
Husband
$36,780
$24,000
State Disability
Pension, Long-Term
Disability
Employed as
Healthcare Provider
Note: State Disability
Pension denied
Long-Term Disability
Ex-husband
Technologist
Homemaker
Alone
Alone
Trade school
$8,220
Social Assistancee
Nurse’s Aide
own
own
own; no
mortgage
late
40's
BA
Not
reported
Alone
40
BA
Fluctuating
Community
Organizer
Banking/Stude
nt
own
Vivienne
Employed as
Community Organizer
Student Research
Contract Work
own
Partner
Yvonne
33
BA
Not
reported
Father
Student
rent
Alone
a Incomes were self-reported. There may be discrepancies in amounts reported.
b In order to maintain confidentiality, some income sources were not reported, such as trusts, real estate, and support payments are not listed.
c “Own” implies there is a mortgage. We note the status of the mortgage only in the cases where the mortgage is paid off. Additional fees are also noted.
d Description of household members are self-reported. We use the terms the woman used. “Partner” does not indicate sexuality.
e At the time of the interview, Teresa’s state disability claim was under review. Her application has since been granted, increasing her income to about $12,000 per year.
Alone
Table 3. Four sets of defining criteria for ME.
Definig Criteria
Ramsay
(Ramsay 1988)
London Criteria
(Dowset, E et al.
1994)
Primary Manifestations
Exercise-induced fatigue
after trivially small
exertion, Memory
impairment and loss of
concentration with other
neurological and
psychological
disturbances, and
Fluctuation of symptoms
Usually follows an infection
Severe fatigue for six
months or longer
Four of the following: short term
memory or concentration impairment,
sore throat, tender lymph nodes,
muscle pain, multi-joint pain without
redness or swelling, headaches of new
type, pattern or severity, unrefreshing
sleep, and post-exertional malaise
lasting more than 24 hours
Fatigue, Post-exertional
malaise and/or fatigue,
Sleep dysfunction, and
Pain
Two symptoms of
Neurological/cognitive manifestations;
One symptom from two of three
categories: Autonomic, manifestations
Neuroendocrine, manifestations,
Immune manifestations
(Published in 1994
as an update to
Homes et al. 1988)
Canadian Criteria
(Carruthers, BM et
al. 2003)
Other defining criteria
Using the wrong words,
Alteration to sleep rhythm or
vivid dreams, Frequency of
micturition, Hyperacuisis,
Episodic sweating,
Orthostatic tachycardia
Muscular Phenomena,
Circulatory Impairment,
and Cerebral
Dysfunction
CDC
http://www.cdc.gov/
ncidod/diseases/cfs/a
bout/what.htm
Other manifestations used as part of
diagnosis
Onset usually sudden, but can
be gradual; Six months for
adults and three months for
children
Table 4. The “Canadian Criteria”.
A patient with ME/CFS will meet the criteria for fatigue, post-exertional malaise and/or fatigue, sleep dysfunction, and pain; have two
or more neurological/cognitive manifestations and one or more symptoms from two of the categories of autonomic, neuroendocrine
and immune manifestations; and adhere to item 7.
1. Fatigue: The patient must have a significant degree of new onset, unexplained, persistent, or recurrent physical and mental fatigue
that substantially reduces activity level.
2. Post-Exertional Malaise and/or Fatigue: There is an inappropriate loss of physical and mental stamina, rapid muscular and
cognitive fatigability, post exertional malaise and/or fatigue and/or pain and a tendency for other associated symptoms within the
patient's cluster of symptoms to worsen. There is a pathologically slow recovery period–usually 24 hours or longer.
3. Sleep Dysfunction:* There is unrefreshed sleep or sleep quantity or rhythm disturbances such as reversed or chaotic diurnal sleep
rhythms.
4. Pain:* There is a significant degree of myalgia. Pain can be experienced in the muscles and/or joints, and is often widespread and
migratory in nature. Often there are significant headaches of new type, pattern or severity.
5. Neurological/Cognitive Manifestations: Two or more of the following difficulties should be present: confusion, impairment of
concentration and short-term memory consolidation, disorientation, difficulty with information processing, categorizing and word
retrieval, and perceptual and sensory disturbances–e.g., spatial instability and disorientation and inability to focus vision. Ataxia,
muscle weakness and fasciculations are common. There may be overload 1 phenomena: cognitive, sensory–e.g., photophobia and
hypersensitivity to noise–and/or emotional overload, which may lead to “crash”2 periods and/or anxiety.
6. At Least One Symptom from Two of the Following Categories:
a. Autonomic Manifestations: orthostatic intolerance–neurally mediated hypotenstion (NMH), postural orthostatic tachycardia
syndrome (POTS), delayed postural hypotension; light-headedness; extreme pallor; nausea and irritable bowel syndrome; urinary
frequency and bladder dysfunction; palpitations with or without cardiac arrhythmias; exertional dyspnea.
b. Neuroendocrine Manifestations: loss of thermostatic stability– subnormal body temperature and marked diurnal fluctuation,
sweating episodes, recurrent feelings of feverishness and cold extremities; intolerance of extremes of heat and cold; marked weight
change–anorexia or abnormal appetite; loss of adaptability and worsening of symptoms with stress.
c. Immune Manifestations: tender lymph nodes, recurrent sore throat, recurrent flu-like symptoms, general malaise, new sensitivities to
food, medications and/or chemicals.
7. The illness persists for at least six months. It usually has a distinct onset,** although it may be gradual. Preliminary diagnosis may
be possible earlier. Three months is appropriate for children.
To be included, the symptoms must have begun or have been significantly altered after the onset of this illness. It is unlikely that a
patient will suffer from all symptoms in criteria 5 and 6. The disturbances tend to form symptom clusters that may fluctuate and
change over time. Children often have numerous prominent symptoms but their order of severity tends to vary from day to day.
*There is a small number of patients who have no pain or sleep dysfunction, but no other diagnosis fits except ME/CFS. A diagnosis
of ME/CFS can be entertained when this group has an infectious illness type onset. **Some patients have been unhealthy for other
reasons prior to the onset of ME/CFS and lack detectable triggers at onset and/or have more gradual or insidious onset.
Exclusions: Exclude active disease processes that explain most of the major symptoms of fatigue, sleep disturbance, pain, and
cognitive dysfunction. It is essential to exclude certain diseases, which would be tragic to miss: Addison’s disease, Cushing’s
Syndrome, hypothyroidism, hyperthyroidism, iron deficiency, other treatable forms of anemia, iron overload syndrome, diabetes
mellitus, and cancer. It is also essential to exclude treatable sleep disorders such as upper airway resistance syndrome and obstructive
or central sleep apnea; rheumatological disorders such as rheumatoid arthritis, lupus, polymyositis and polymyalgia rheumatica;
immune disorders such as AIDS; neurological disorders such as multiple sclerosis (MS), Parkinsonism, myasthenia gravis and B12
deficiency; infectious diseases such as tuberculosis, chronic hepatitis, Lyme disease, etc.; primary psychiatric disorders and substance
abuse. Exclusion of other diagnoses, which cannot be reasonably excluded by the patient’s history and physical examination, is
achieved by laboratory testing and imaging. If a potentially confounding medical condition is under control, then the diagnosis of
ME/CFS can be entertained if patients meet the criteria otherwise.
Co-Morbid Entities: Fibromyalgia Syndrome (FMS), Myofascial Pain Syndrome (MPS), Temporomandibular Joint Syndrome (TMJ),
Irritable Bowel Syndrome (IBS), Interstitial Cystitis, Irritable Bladder Syndrome, Raynaud’s Phenomenon, Prolapsed Mitral Valve,
Depression, Migraine, Allergies, Multiple Chemical Sensitivities (MCS), Hashimoto’s thyroiditis, Sicca Syndrome, etc. Such comorbid entities may occur in the setting of ME/CFS. Others such as IBS may precede the development of ME/CFS by many years, but
then become associated with it. The same holds true for migraines and depression. Their association is thus looser than between the
symptoms within the syndrome. ME/CFS and FMS often closely connect and should be considered to be “overlap syndromes.”
Idiopathic Chronic Fatigue: If the patient has unexplained prolonged fatigue (6 months or more) but has insufficient symptoms to
meet the criteria for ME/CFS, it should be classified as idiopathic chronic fatigue.
“Overload” refers to hypersensitivities to various types of stimuli that has changed from pre-illness status.
“Crash” refers to a temporary period of immobilizing physical and/or mental fatigue.
From: Caruuthers et al. 2003.
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