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The article listed below is another creative way to "examine" CFS and FM patients.

First, they discuss the reporting of CFS is related to higher income countries. Any one who has any experience with this problem knows this is in part because the poor do not have good medical care and medicine in Brazil is hardly the envy of anyone. Further, high-income patients tend to be aggressive in seeking cures and seeking out answers, and are willing to use the same intensity that helped them economically in their medical care. Further, in a pending book we are working on, WHEN YOU ARE FED UP WITH YOUR PHYSICIAN: REAL SOLUTIONS TO CHRONIC FATIGUE AND FIBROMYALGIA, we will show non-viral search for medical relief. This includes finding NON-VIRAL infectious causes and other causes that are not the same in all locations around the world.

This article is useful in telling Brazil family practitioners not to miss CFS when it is right under their noses. Of course, I am not aware of anyone in Brazil who is really up on all the many emerging and diverse causes of crippling fatigue. I hope I am wrong.

Comparative epidemiology of chronic fatigue syndrome in Brazilian and British primary care: prevalence and recognition.

Department of Preventive Medicine, University of So Paulo Medical School, University Hospital, University of So Paulo, Brazil. h.cho@iop.kcl.ac.uk

BACKGROUND: Although fatigue is a ubiquitous symptom across countries, clinical descriptions of chronic fatigue syndrome have arisen from a limited number of high-income countries. This might reflect differences in true prevalence or clinical recognition influenced by sociocultural factors. AIMS: To compare the prevalence, physician recognition and diagnosis of chronic fatigue syndrome in London and So Paulo. METHOD: Primary care patients in London (n=2459) and So Paulo (n=3914) were surveyed for the prevalence of chronic fatigue syndrome. Medical records were reviewed for the physician recognition and diagnosis. RESULTS: The prevalence of chronic fatigue syndrome according to Centers for Disease Control 1994 criteria was comparable in Britain and Brazil: 2.1% v. 1.6% (P=0.20). Medical records review identified 11 diagnosed cases of chronic fatigue syndrome in Britain, but none in Brazil (P<0.001). CONCLUSIONS: The primary care prevalence of chronic fatigue syndrome was similar in two culturally and economically distinct nations. However, doctors are unlikely to recognise and label chronic fatigue syndrome as a discrete disorder in Brazil. The recognition of this illness rather than the illness itself may be culturally induced.

Cho HJ, Menezes PR, Hotopf M, Bhugra D, Wessely S. Br J Psychiatry. 2009 Feb;194(2):117-22.

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