title: Comparative epidemiology of chronic fatigue syndrome in Brazilian and British primary care: prevalence and recognition.
abstract: 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.
  
  
  OBJECTIVE
  To compare the prevalence, physician recognition and diagnosis of chronic fatigue syndrome in London and São Paulo.
  
  
  METHODS
  Primary care patients in London (n=2459) and São 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.
authors.affiliation: Department of Preventive Medicine, University of São Paulo Medical School, University Hospital, University of São Paulo, Brazil. h.cho@iop.kcl.ac.uk
authors.forename: Hyong Jin
authors.initials: HJ
authors.lastname: Cho
authors.forename: Paulo Rossi
authors.initials: PR
authors.lastname: Menezes
authors.forename: Matthew
authors.initials: M
authors.lastname: Hotopf
authors.forename: Dinesh
authors.initials: D
authors.lastname: Bhugra
authors.forename: Simon
authors.initials: S
authors.lastname: Wessely
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002908:Chronic Disease; D003431:Cross-Cultural Comparison; D004812:Epidemiologic Methods; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult