[Investigation of subjective symptoms among visual display terminal users and their affecting factors--analysis using log-linear models]

In order to evaluate factors affecting visual and musculoskeletal symptoms by visual display terminal (VDT) operation, a questionnaire survey was conducted among clerical workers in Chiba university. The results were as follows: 1) Of these workers, 81.9% engaged in VDT operation. For most of the subjective symptoms, the prevalence rates tended to increase with the degree of VDT use. 2) These complaints were combined to give visual and musculoskeletal symptom scores. Both of the scores were higher among females than males, and the musculoskeletal symptom score was significantly higher. No difference was found in regard to age. 3) Analysis using log-linear models was performed to evaluate the effects of sex and age. The results showed that the visual and musculoskeletal symptom scores were significantly higher among the workers operating VDTs for one or more hours per day than among those who did not operate them at all. Analysis of the effects of VDT workloads revealed that VDT use for five or more days per week significantly increased the prevalence rates of both symptoms. Their use for less than four days per week affected neither of the symptoms. With regard to operating time per day or length of VDT use, no differences were found. 4) This investigation suggested that the VDT workloads were not so heavy and that the effects on each symptom were minor among the subjects of the present survey. However, it is important that consideration be given to ensure that the workloads for workers who operate VDTs every day not be too heavy.

A protocol for initiation of nasal positive pressure ventilation

BACKGROUND

Respiratory failure related to neuromuscular weakness has commonly been managed with long-term ventilation by tracheostomy. Currently, nasal positive pressure ventilation is being used with success in this patient population. It has been suggested that initiation of nasal positive pressure ventilation is best done in an intensive care setting.

METHOD

Nine patients were placed on nasal ventilation during a brief admission to a medical floor staffed by nurses trained in respiratory care. This process was facilitated by use of a standardized protocol for nursing staff that identified treatment objectives.

RESULTS

Following the initiation of nasal positive pressure ventilation, this group of patients experienced near normalization of daytime measurements of partial pressure of arterial carbon dioxide, reported increases in daytime energy levels, and relief of nighttime signs and symptoms. These objectives were accomplished with no significant complications. Use of this protocol may also decrease length and cost of hospitalization and improve patient acceptance of noninvasive ventilatory assistance.

Community exposure to a paraquat drift

A mixture of paraquat and water was applied, by helicopter, to agricultural fields near a residential community and near an associated commercial complex. Drift from the application passed directly over the community, which resulted in resident complaints to the local county agricultural department. A community survey was undertaken to determine what health consequences, if any, resulted from the drift. A comparison of 2-wk self-reported symptom rates between the exposed community and three historical control communities indicated that 10 symptoms were elevated significantly at p < .05: cough, diarrhea, eye irritation, headache, nausea, rhinitis, throat irritation, trouble breathing, unusual tiredness, and wheezing. An internal comparison, which predicted symptom rates by an index of paraquat exposure (smelling an unusual odor in the prior 2-wk period), indicated fever (relative risk [RR] = 11.97) and nausea (RR = 3.75) to have elevated relative risks. Odor perception also predicted the report of a greater than the average number of symptoms. Based upon these findings, it was concluded that these residents probably did experience an increase in health symptoms from the drift. It is recommended that paraquat not be sprayed near residential communities.

Evaluation of symptomatology in planning palliative care

Cross-sectional surveys are a useful tool in planning health care, both in the community and in hospitals. We found that a review of routine case records did not yield sufficient information for planning palliative care services in the hospital environment, and therefore decided to conduct a cross-sectional survey involving random patients attending the outpatient division of the Regional Cancer Centre, Trivandrum, India. Three hundred and twelve patients were interviewed, and pain and weight loss were found to be the most prominent symptoms (> 90%). This study indicates that symptomatology has to be addressed in detail while planning palliative care services in a hospital setting. Even with its selection bias, the study provides valuable clues for the adequate organization and continuation of palliative care services.

Sleep disturbances, vitality, and fatigue among a select group of employed childbearing women

Self-reported sleep disturbances and levels of vitality and fatigue were studied in a secondary analysis of 25 pregnant and 29 postpartum employed women. Results indicate that pregnant women have problems initiating and maintaining sleep, and postpartum women have problems maintaining sleep, but not falling asleep. The primary reason for midsleep awakenings was urinary frequency among the pregnant women, and child care responsibilities among the postpartum women. Chronic sleep disturbance was indicated by a greater percentage of postpartum women who fell asleep easily, very few who felt highly energetic at work, and most who perceived a high level of fatigue during the past week. Even with these sleep disruptions, no differences occurred in the mean scores for perception of fatigue and vitality between the two groups. Clinicians can use these findings to educate women about some changes they may anticipate and how they might manage them during pregnancy and postpartum.

Patterns of self-care needs and interventions related to biologic response modifier therapy: fatigue as a model

Many patients receiving biologic response modifier (BRM) therapy experience fatigue as a significant and, at times, dose-limiting side effect. For this reason, a multiinstitutional pilot study was designed to collect data about the needs and self-care interventions of patients who had undergone at least one prior treatment with a BRM and had experienced fatigue as a symptom. Information was also obtained on the extent to which the needs and self-care interventions identified by patients compared with those perceived by their family members and nurses. Of the 16 patients who participated in the study, seven were being treated with interleukin-2 (IL-2), eight with interferon alfa (IFN-alpha), and one with tumor necrosis factor (TNF). The study found no significant correlation between the degree or duration of fatigue and the BRM or dosage administered. Not surprisingly, patient and family member responses correlated fairly well. However, in several parameters, including the degree and duration of fatigue, nurses' perceptions did not correlate at all with those of the patient. While 46% of nurse responses matched those of the patient as to useful self-care interventions, only 17% of nurses accurately identified factors or events that patients perceived as worsening fatigue. Further, there was no correlation among patient, family member, and nurse responses on interventions that could be used by others to help the patient cope with fatigue. The overall results of this pilot study indicate that nurses need to be more attuned to assessing fatigue as a side effect of BRM therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Daytime sleepiness: a risk factor in community life

The prevalence of daytime sleepiness and background factors associated with it were investigated in a study carried out at the UKK Institute. The inquiry took the form of a questionnaire mailed to 1600 people of middle age. Daytime sleepiness was found to be associated with disturbed night sleep. Women were more tired than men, but men slept more frequently during the day. Those suffering from tiredness complained of poor health more than other respondents. Traffic accidents and other mishaps attributable to tiredness had occurred in 1.3% of cases, and almost 5% of male respondents had dozed off while driving at least five times in their lives. The findings indicate a need for increased attention to disturbance of sleep and daytime sleepiness in routine health screening.

Symptom distress in cardiac transplant candidates

OBJECTIVE

To examine symptom frequency and distress in heart transplant candidates.

DESIGN

Prospective, two-site study with a correlational design.

SETTING

Large Midwestern and large Southern medical center.

SAMPLE

Convenience sample of 175 adult patients (mean age 52 years, 85% men) awaiting heart transplantation. Fifty percent of the patients had ischemic cardiomyopathy and 47% had dilated cardiomyopathy.

INSTRUMENTS

The Heart Transplant Symptom Checklist (Grady, Jalowiec, & Grusk, 1988), a 92-item self-administered instrument that measures how much patients are bothered by symptoms on a four-point rating scale, was developed by the research team for the study. Cronbach alpha reliability for the total scale was 0.95.

RESULTS

The most frequent and distressing symptoms for patients awaiting heart transplantation were tiredness, difficulty breathing when walking or doing something, difficulty sleeping, and weakness in the whole body. Patients who had more symptom distress were unable to work. Higher symptom distress correlated significantly with higher stress, less life satisfaction, lower quality of life, and more functional disability.

SUMMARY

Heart transplant candidates experience symptoms that may affect their ability to work and are associated with more functional disability and lower quality of life.

IMPLICATIONS

Identification of the most frequent and distressing symptoms helps nurses and other health care providers to better assess and intervene with patients who are heart transplant candidates.

Iron state in female adolescents

OBJECTIVE

To document a subjective response to iron therapy in female adolescents.

DESIGN

Double-blind, placebo-controlled prospective study.

SETTING

High school classes in an urban community in Israel.

PARTICIPANTS

Twenty-nine girls, aged 16 and 17 years, who ingested syrup containing iron (daily for 2 months) and 30 girls who received a placebo.

MAIN RESULTS

By the end of the study, a statistically significant improvement in three subjective parameters, ie, lassitude, the ability to concentrate in school, and mood was reported by the girls who ingested iron compared with the controls. Sixty-five percent, 100%, and 65% of the girls, respectively, who reported improvement in the above-mentioned parameters were hypoferremic initially and became normoferremic by the end of the study.

CONCLUSION

Iron supplementation may be of benefit to female adolescents, as evidenced by their responses to subjective parameters.

Patients' perceptions of pulmonary problems and nursing interventions during hospitalization for Pneumocystis carinii pneumonia

BACKGROUND AND METHODS

The descriptive, correlational study examined patients' perceptions of pulmonary problems and nursing interventions in a sample (n = 201) of persons living with AIDS hospitalized for Pneumocystis carinii. Additionally, the study assessed differences in physiological variables, patient symptoms, and functional status based on the type of problems identified: dyspnea, pulmonary problems without dyspnea, and nonpulmonary problems.

RESULTS

A total of 601 problems was identified including 61 instances of dyspnea and 83 reports of other pulmonary problems. The remainder of the problems was nonpulmonary. Nursing interventions associated with dyspnea and pulmonary problems other than dyspnea were mainly broadly defined interventions such as oxygen and medication administration. When patients were placed into three groups based on identification of dyspnea, pulmonary problems without dyspnea, or only nonpulmonary problems, there were no differences between groups in functional status or patient symptoms of pain, nausea, or fatigue as measured by the Quality Audit Marker.

CONCLUSIONS

This study demonstrated that hospitalized patients with Pneumocystis carinii present with a broad array of problems. Contrary to expectations, dyspnea was not ubiquitous but was reported by less than one-third of this sample. When dyspnea was present there were few independent nursing interventions that patients identified. Studies are needed to test effective strategies for the nursing management of dyspnea and a large variety of other patient problems associated with HIV infection.

Dyspnea on exercise. Pathophysiologic mechanisms

To evaluate the frequency of the causes of exercise limitation in patients with chronic pulmonary disease and to assess the relationship between the resting pulmonary functional parameters and the degree of exercise dyspnea, we reviewed the data from 88 consecutive stable patients with chronic lung disease (62 COPD, 16 interstitial lung disease [ILD]). In each patient, the intensity of dyspnea was measured by a Borg scale (BS) during an incremental symptom-limited exercise test. COPD patients stopped exercise due to fatigue (46%), dyspnea (36%), cardiac limitation (12%), and peripheral circulatory limitation (6%). ILD patients stopped exercise due to dyspnea (62%), fatigue (25%), and cardiac limitation (12%). In all patients, dyspnea severity increased linearly with exercise intensity as measured as VO2, VE, and VE/MVV. The severity of dyspnea expressed as the slope of the relationship between BS and VE/MVV (DBS/D[VE/MVV]) showed in COPD a significant inverse correlation with VC, FEV1, MIP, and a positive correlation with PaCO2 and VE/MVV at rest. In ILD, DBS/D(VE/MVV) showed a significant inverse correlation with VC, FEV1, TLC, and PaO2 and a positive correlation with VE/MVV at rest. The predicting power of all equations was very low.

Fatigue in primary care: prevalence, psychiatric comorbidity, illness behavior, and outcome

OBJECTIVES

To identify the prevalence, psychiatric comorbidity, illness behavior, and outcome of patients with a presenting complaint of fatigue in a primary care setting.

METHODS

686 patients attending two family medicine clinics on a self-initiated visit completed structured interviews for presenting complaints, self-report measures of symptoms and hypochondriasis, and the Diagnostic Interview Schedule (DIS). Fatigue was identified as a primary or secondary complaint from patient reports and questionnaires completed by physicians.

RESULTS

Of the 686 patients, 93 (13.6%) presented with a complaint of fatigue. Fatigue was the major reason for consultation of 46 patients (6.7%). Patients with fatigue were more likely to be working full or part time and to be French Canadian, but did not differ from the other clinic patients on any other sociodemographic characteristic or in health care utilization. Patients with fatigue received a lifetime diagnosis of depression or anxiety disorder more frequently than did other clinic patients (45.2% vs. 28.2%). Current psychiatric diagnoses, as indicted by the DIS, were limited to major depression, diagnosed for 16 (17.2%) fatigue patients. Patients with fatigue reported more medically unexplained physical symptoms, greater perceived stress, more pathologic symptom attributions, and greater worries about having emotional problems than did other patients. However, only those fatigue patients with coexisting depressive symptoms differed significantly from nonfatigue patients. Patients with fatigue lasting six months or longer compared with patients with more recent fatigue had lower family incomes and greater hypochondriacal worry. Duration of fatigue was not related to rate of current or lifetime psychiatric disorder. One half to two thirds of fatigue patients were still fatigued one year later.

CONCLUSIONS

In a primary care setting, only those fatigue patients who have coexisting psychological distress exhibit patterns of abnormal illness cognition and behavior. Regardless of the physical illnesses associated with fatigue, psychiatric disorders and somatic amplification may contribute to complaints of fatigue in less than 50% of cases presented to primary care.

Effect of combined prednisolone, epidural analgesia, and indomethacin on the systemic response after colonic surgery

Twenty patients undergoing colonic resection were randomized to either conventional postoperative pain treatment with morphine chloride and acetaminophen (group 1, n = 9) or methylprednisolone sodium succinate 90 minutes before surgery plus intraoperative neural blockade, with a postoperative analgesic regimen with combined bupivacaine hydrochloride-morphine and indomethacin sodium for systemic effect (group 2, n = 11). Assessments of pain, pulmonary function, convalescence, and various injury factors were done several times until 8 days after surgery. Postoperative pain and hyperthermic response were eliminated in group 2. Conventional reduction in pulmonary function measures was improved in group 2, and fatigue and mobility were less pronounced. Prostaglandin E2, interleukin 6, and C-reactive protein levels increased in both groups, but significantly less in group 2. These results suggest that a combined neural and humoral blockade may more effectively inhibit the global stress response to elective surgery than previously observed with neural blockade with or without indomethacin.

A study of persons undergoing outpatient gastrointestinal radiography

A large proportion of the illnesses for which adults seek health care are disorders of the gastrointestinal tract. X-ray studies of the upper gastrointestinal tract and the barium enema are commonly ordered gastrointestinal diagnostic procedures. The purpose of this research was to examine the effects of upper gastrointestinal tract and barium enema x-ray studies on a person's sleep pattern, fatigue, anxiety, blood pressure, pulse, and perceived energy expenditure. Outpatients were assigned to established groups by their ordered x-ray procedure (i.e. barium enema [n = 36], upper gastrointestinal tract x-ray procedure [n = 31], or nonpreparation procedure [n = 36]). Persons who were undergoing a barium enema rated sleep significantly poorer, awakened a greater number of times during the night, and perceived greater energy expenditure during the procedure. This study has implications for the teaching and safety of patients who are undergoing gastrointestinal radiography. The study needs to be expanded to include hospitalized patients, persons with stomas, and persons who are undergoing other gastrointestinal diagnostic procedures such as endoscopic examinations.

Fatigue syndrome due to localized radiation

For cancer patients, fatigue is a disturbing symptom caused by many factors. Since fatigue is the most common side effect of localized radiation to the breast, this treatment provides a unique opportunity to follow patients prospectively as they develop one type of fatigue. We evaluated the effect of radiation treatment in 15 women with Stage I or II node-negative breast cancer who were otherwise healthy. Fatigue, contrary to our hypothesis, did not increase linearly with cumulative radiation dose over time. It dropped from the first to second week and rose in the third week. The cumulative effects reached a plateau in the fourth week (after an average of 17 fractions), which was maintained during the remaining weeks of treatment. Within 3 wk after treatment, fatigue had diminished. No patient had sustained depressive symptoms. Cardiopulmonary exercise capacity in 5 patients at 6 and 12 wk did not change from just before radiation. Other markers, including reverse triiodothyronine and pulse change with orthostatic stress, did not correlate with subjective fatigue nor cumulative radiation in 15 patients. The curve of the fatigue syndrome during treatment conforms to the adaptation of the organism to a continuing stress and begins to describe a mild fatigue syndrome associated with radiation.

The Norwegian meningococcal group B outer membrane vesicle vaccine: side effects in phase II trials

In order to establish the safety of the Norwegian meningococcus B vaccine we have focused on detailed reporting of side effects in several phase II trials. We report here the results of the largest single phase II study, (step II-6) including 877 school children. The incidence of local side effects was significantly higher in the vaccine than in the placebo group, but most of them were mild and short-lasting. Mild systemic side effects were commonly reported in both groups, but more severe side effects were rare and almost equally distributed between the groups.

Effects of methanol vapor on human neurobehavioral measures

Methanol could become an important motor fuel. The objective of this exploratory study was to provide preliminary information about whether or not acute exposure to methanol at 250 mg/m3 for 75 minutes would have adverse effects on human neurobehavioral functions important in everyday life. This concentration level was selected because it is at the upper limit of the traffic scenario estimates provided by the U.S. Environmental Protection Agency (EPA)2 (86 to 240 mg/m3), but is below the maximum concentrations for eight-hour average exposures currently recommended by the National Institute of Occupational Safety and Health (NIOSH) and the American Conference of Government and Industrial Hygienists (ACGIH) (260 mg/m3). Although traffic scenario exposure estimates suggest that such high levels of exposure last less than 15 minutes, we used a 75-minute exposure to increase the probability of identifying dependent measures that should be studied in more detail in a future confirmatory study. Twelve healthy young men, each serving as his own control, participated in two sham exposures and two methanol exposures under counterbalanced, double-blind control conditions. Because methanol is present in many foods, and because high preexposure levels of methanol or formate might obscure exposure effects, subjects were required to strictly limit their diets for 12 hours before each experimental session. The following endpoints were examined before, during, and after exposure to methanol and sham vapors: blood and urinary methanol; plasma formate; oral temperature; blood pressure; subjective mood, alertness, fatigue, workload, and symptom scales; spectral analysis of the electroencephalogram; visual- and auditory-event-related potentials; contingent negative variation; respiration; cardiac interbeat interval; Symbol Digit substitution task; three-choice reaction time; Stroop color-word test; simple reaction time; visual function; critical flicker fusion frequency; hand steadiness; visual search task; Gamberale reaction time task; visual tracking task; Sternberg memory task; interval production task; and speeded addition task. Two dual tasks were also included in the task batteries. These endpoints were selected from those indicated in the literature to be sensitive to solvents, and from those that are widely used in other neurobehavioral test batteries to identify the effects of environmental pollutants. Because the number of endpoints examined was large and the number of subjects was small, procedures designed to reduce the number of statistical tests performed were used. Mean methanol concentration in the exposure room during methanol exposures was 249 mg/m3 (SD +/- 7 mg/m3). Exposure produced significant increases in blood and urine methanol concentration. As expected, no changes in plasma formate were observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Factors which contribute to fatigue associated with rheumatoid arthritis

The purpose of this research was to identify the factors which people with rheumatoid arthritis (RA) believed contributed to their fatigue. A second purpose was to examine the relationships among identified factors and the sensation of fatigue. One hundred people with RA were asked to identify verbally factors which they believed contributed to their fatigue. The three most frequently identified factors included RA disease activity, disturbed sleep and increased physical effort. These factors were operationalized and measured as joint pain using the Modified McGill Pain Inventory, fragmented sleep through overnight electroencephalographic (EEG) sleep studies, and reduced physical ability using walking time and grip strength measures. Fifteen of the original subjects with RA and 12 age and gender matched control subjects completed the second phase of the research. Five of the RA subjects were experiencing a disease flare while the remaining 10 were either in remission or their disease was midly active. Those subjects in flare had significantly (P less than 0.01) more joint pain, significantly (P less than 0.05) more fragmented sleep, and significantly reduced functional capacity as measured through walking time (P less than 0.05) and grip strength (P less than 0.05) when compared to non-flare and control subjects. Fatigue levels of the subjects in flare were positively correlated with joint pain (r = 0.62), fragmented sleep (r = 0.42) and grip strength of the right hand (r = 0.52) and left hand (r = 0.88). Fatigue levels of non-flare and control subjects were negatively correlated with the majority of measured variables.(ABSTRACT TRUNCATED AT 250 WORDS)

A critical appraisal of the research literature investigating fatigue in the individual with cancer

Fatigue is a commonly experienced symptom, which may be a component of virtually any disease and can have a psychological, physical, or mixed origin. Nurses need to understand the onset, duration, and progression of fatigue to intervene successfully with the cancer patient adapting to diagnosis and treatment. While the literature is an important source of information, results of research studies must be critically interpreted before proceeding with practice guidelines based on research findings. A critical appraisal of the research literature investigating the problem of fatigue in individuals with cancer was conducted. There is strong evidence to suggest that fatigue is a prevalent problem among cancer patients receiving chemotherapy and radiation therapy. However past research has been limited by methodological problems. Typically, studies fail to include a control group, do not control for possible confounding variables, and have restricted measurement to unidimensional scales with limited reliability and validity. While several correlates of fatigue have been postulated, research to date has found no consistent relationships among such correlates as weight loss, anemia, or psychological distress. This article reviews what is currently known about fatigue in the cancer patient and how future research could be designed to improve on past measurement and sampling problems.

Fatigue affecting family caregivers of cancer patients

Fatigue, a universally reported symptom, may be one of the most prevalent feelings of people suffering physical or mental diseases. An understanding of the factors leading to fatigue in the caregiving population can contribute to better care and support of both the cancer patient and caregiver. The purpose of this article is to investigate and describe the experience of fatigue among caregivers of cancer patients, in relation to caregiver age, employment status, number of hours of care provided daily, duration of caregiving, and the impact upon the caregiver's schedule. A sample of 248 caregivers of cancer patients, participating in the Family Homecare Cancer Study, were surveyed regarding fatigue related to their caregiving roles. No relationship was found between severity of fatigue experienced by the caregiver of the cancer patient and caregiver age, employment status, the number of hours of daily caregiving, or the duration of caregiving. However, a significant relationship was found between fatigue and the impact of care on the daily schedule. This finding has strong implications for the oncology nurse, because the more the caregiver's schedule is a burden, the greater will be the fatigue experienced.

Use and perceived efficacy of self-care activities in patients receiving chemotherapy

Information about chemotherapy side effects and the efficacy of self-care activities used to deal with these side effects is needed to direct nursing interventions for patients receiving chemotherapy. Using the self-care diary (SCD) developed for this study, a sample of 49 adult patients with cancer recorded their side effects, rated the severity of each side effect, and reported on the use and efficacy of self-care activities two days after treatment. Data were collected again five days after treatment to examine the test-retest reliability of the side effect severity component of the SCD. The most common side effect, experienced by 81% of the subjects, was fatigue. Other side effects reported by more than one-third of the subjects were sleeping difficulty, nausea, decreased appetite, and changes in taste or smell. The most frequently reported side effects received mean severity scores indicative of moderate severity. The most commonly used self-care activities were rated as providing some relief to moderate relief of individual side effects. None of the reported self-care activities received mean efficacy ratings that indicated complete side effect relief.

Rooming-in at night in the postpartum ward

Since the early 1970s it has been common practice for 'rooming-in' to take place during the day in Swedish maternity wards. At night newborn babies are usually looked after by nursing staff in special nurseries. One reason for this is to avoid disturbing the mothers' sleep at night. To promote mother-infant adaptation, we undertook a programme intended to encourage night-time rooming-in. Evaluation of the programme was carried out as a quasi-experiment, divided into a pretest period (I), a 6-month implementation period, and a post-test period (II). Breast feeding and maternal sleep were studied during the first 3 postpartum days by means of self-report by 104 mothers in Period I and 111 mothers in Period II. The number of hours that the babies spent in the nursery decreased from Period I to Period II, a difference that was most obvious during the second and third postpartum nights. No difference was found in the number of breast feeds in Periods I and II, except during the third night, when Period II mothers breast fed more often. In spite of increased rooming-in in Period II, these mothers slept the same number of hours and felt equally alert as Period I mothers.

Fatigue in postpartum women

Childbirth and the responsibilities of parenting after birth require a great deal of energy. Fatigue in postpartum women is a concern for maternal-child nurses because of the impact on the health and parenting ability of the mother. To determine fatigue levels and types, 35 women who vaginally delivered were surveyed at 2 days, 2 weeks, and 6 weeks postpartum. This sample was found to be mildly fatigued, with situational and/or psychological fatigue. Nurses can intervene by assessing postpartum fatigue and using teaching/counseling methods for knowledge preparation and for clients at risk.

Fatigue in cancer patients. A descriptive study

The purpose of this study was to examine relationships between fatigue and various physical and psychological factors in women undergoing chemotherapy for ovarian cancer. The Rhoten Fatigue Scale (RFS) and the Beck Depression Inventory (BDI) were used to evaluate levels of fatigue and depression in the patient sample. The sample was composed of 12 adult ovarian cancer patients who were receiving chemotherapy and 12 apparently healthy adult women. The patients' responses to the instruments used in this study indicated no significant relationship between fatigue and age, stage of disease, course of treatment, or depression. Weak-to-moderate relationships were found between levels of fatigue and CA 125 levels. A moderately strong (r = 0.68, p less than 0.01) relationship was found between ratings on the RFS and fatigue items on the BDI. A fatigue trajectory was found to peak at day 7 and to slowly decline during the remainder of the 28-day treatment course.

Background factors in craniomandibular disorders: reported symptoms in adolescents with special reference to joint hypermobility and oral parafunctions

Correlations between craniomandibular disorders (CMD) symptoms and an inherited factor (general joint hypermobility) were studied in 193 adolescents (96 girls and 97 boys). They answered a questionnaire concerning CMD symptoms, oral parafunctions, head and jaw trauma and symptoms from other joints. Joint mobility was assessed by determining the Beighton score (0-9). Twenty-eight percent of the girls and 21% of the boys could perform four or more of the manoeuvres. Twenty-two percent of the girls and 3% of the boys were extremely hypermobile (score greater than or equal to 5). Eighty-nine percent were aware of some oral parafunction and the prevalences of oral habits were about the same in the two groups. Girls reported significantly more dysfunction symptoms than boys. No indication was found that oral parafunctions generally produced CMD but a systemic factor (joint hypermobility) seemed to play an important role when the masticatory system was exposed to local forces as in oral parafunction. This may be one explanation for the predominance of females among CMD patients.

True incidence of pacemaker syndrome

Although the purported incidence of pacemaker syndrome according to the literature is only 5%-15%, this is based on a series of patients with VVI pacing. Increasing numbers of studies are being reported in which patients prefer the dual chamber mode despite little benefit being demonstrated on objective testing, suggesting that pacemaker syndrome may be more common than is generally reported. This study was designed to evaluate the reported symptoms in a series of patients programmed to both the VVI and one or more dual chamber modes. Forty unselected patients with dual chamber pacemakers were entered into a blind, randomized trial comparing the symptoms associated with VVI pacing to those associated with dual chamber pacing. Patients were randomized to either VVI or dual chamber pacing. At the end of 1 week, questionnaires rating 16 different symptoms were completed. Blood pressure, LV function, presence of ventriculoatrial conduction, and ability to override the pacemaker were evaluated. The pacemaker was then programmed to the other mode. Overall, 12 of 16 symptoms were significantly worse in the VVI as compared to dual chamber mode. The most highly significant (P less than 0.005) were shortness of breath, dizziness, fatigue, pulsations in the neck or abdomen, cough, and apprehension. Pacemaker syndrome was clinically recognized in 83% of patients paced in the VVI mode with 65% of patients experiencing moderate to severe symptoms. There were no readily identified clinical, hemodynamic, or electrophysiological parameters that predicted which patients would develop pacemaker syndrome. Thus, when patients have an opportunity to experience both pacing modes in close proximity to one another, there is a high incidence of pacemaker syndrome in the VVI mode.

Tired, weak, or in need of rest: fatigue among general practice attenders

OBJECTIVES

To determine the prevalence and associations of symptoms of fatigue.

DESIGN

Questionnaire survey.

SETTING

London general practice.

PARTICIPANTS

611 General practice attenders.

MAIN OUTCOME MEASURES

Scores on a fatigue questionnaire and reasons given for fatigue.

RESULTS

10.2% Of men (17/167) and 10.6% of women (47/444) had substantial fatigue for one month or more. Age, occupation, and marital status exerted minor effects. Subjects attributed fatigue equally to physical and non-physical causes. Physical ill health, including viral infection, was associated with more severe fatigue. Women rather than men blamed family responsibilities for their fatigue. The profile of persistent fatigue did not differ from that of short duration. Only one person met criteria for the chronic fatigue syndrome.

CONCLUSIONS

Fatigue is a common complaint among general practice attenders and can be severe. Patients may attribute this to physical, psychological, and social stress.

[Analyses of neurotic symptoms and subjective symptoms of fatigue in seamen during a long voyage]

The variations of neurotic symptoms and subjective symptoms of fatigue were studied in relation to circumstances aboard ship in subsamples of the crew (N = 24) and students and researchers (N = 24) of a training ship belonging to a university during a summer voyage of the North Pacific route in 1987. The data were obtained by a self-administered questionnaire administered seven times before and during the voyage. The present study analysed the data collected during the 40 d voyage (the first four questionnaires including that before departure). Complaints of neurotic symptoms and fatigue were reported to be much greater in the present sample than those in a general occupational setting. Although the complaints reported by students and researchers decreased at landing, complaints of physical fatigue reported by the crew increased at landing but those of mental fatigue hardly changed. With regard to correlation between the values of the responses to circumstances aboard ship and the values of neurotic symptoms and fatigue, "quality of sleep" was significantly correlated with these symptoms for the crew. For the students and researchers, significant correlations were demonstrated between such items as "boredom toward work" and "quality of sleep", and physical fatigue, between the "anxiety over disease" and mental fatigue and "anxiety over disease", "risk of injury" and "fear of death" and neurotic symptoms in the first survey after departure (13th day).

Interpleural catheter for analgesia after cholecystectomy: the surgical perspective

Sixteen otherwise healthy women undergoing cholecystectomy were randomized to receive postoperative analgesia either by continuous infusion of papaveretum (n = 8), or by continuous interpleural infusion of bupivacaine (n = 8). Postoperative pain was assessed by linear analogue and ventilatory capacity. Changes in body protein were measured by in vivo neutron activation analysis. Clinical course was also noted. Pain scores were significantly lower in the interpleural group over the first 48 h (P less than 0.02). Ventilatory capacity was also significantly better for the first 24 h (P less than 0.025). There was no evidence of shortened postoperative ileus; hospital stay and postoperative fatigue were similar for the two groups. Weight and protein losses over a 2 week period were similar in the two groups. It is concluded that the apparent advantages in patient comfort and mobility offered by interpleural infusion are most marked in the first 48 h postoperatively, with an advantage in ventilatory capacity over the first 24 h.

Fatigue in rheumatoid arthritis. Conditions, strategies, and consequences

Fatigue is a frequent and debilitating problem for people with rheumatoid arthritis (RA). In this descriptive study a Fatigue Interview Schedule was administered to 20 patients with RA to elicit symptom-specific information. Qualitative analyses resulted in the identification of descriptors of fatigue, conditions under which fatigue occurs, an intricate repertoire of strategies used to prevent and manage fatigue, and the consequences of chronic fatigue.

Feelings of fatigue and psychopathology: a conceptual history

Since the 19th century, fatigue has received far more attention in the medical literature than feeling of fatigue. The latter is defined as a primary, sui generis feeling, which can be studied (and is experienced) independently of physical phenomena such as tiredness, and cognitive concomitants such as "not wanting to continue or initiate a task." The unexplained feeling of fatigue is a common medical complaint, and accompanies various medical and psychiatric conditions. Several meaning systems can be identified in relation to feeling of fatigue and provide material for construction of a measuring instrument. Such a scale will allow us to answer four questions: Is the feeling of fatigue a unitary and primary experience or sensation? Is it the same regardless of the clinical or social context in which it occurs? Are the somatic and cognitive accompaniments of feeling of fatigue an essential part of its definition? Does feeling of fatigue have a neurobiological basis?

Stress at work and mental health status among female hospital workers

Relations between working conditions and mental health status of female hospital workers were studied in a sample of 1505 women: 43% were nurses, 32% auxiliaries, and 7% ancillary staff; 13% were other qualified health care staff, mainly head nurses; 5% had occupations other than direct health care; 63% worked on the morning, 20% on the afternoon, and 17% on the night shift. Data were collected at the annual routine medical visit by the occupational health practitioner, using self administered questionnaires and clinical assessments. Five health indicators were considered: a high score to the general health questionnaire (GHQ); fatigue; sleep impairment; use of antidepressants, sleeping pills, or sedatives; and diagnosis of psychiatric morbidity at clinical assessment. Four indices of stress at work were defined: job stress, mental load, insufficiency in internal training and discussion, and strain caused by schedule. The analysis was conducted by multiple logistic regression, controlling for type of occupation, shift, number of years of work in hospital, daily travel time to work, age, marital status, number of children, and wish to move house. Sleep impairment was mostly linked to shift and strain due to schedule. For all other indicators of mental health impairment and especially high GHQ scores, the adjusted odds ratios increased significantly with the levels of job stress, mental load, and strain due to schedule. This evidence of association between work involving an excessive cumulation of stress factors and mental wellbeing should be considered in interventions aimed at improving the working conditions of hospital workers.

The effects of fatigue, distractibility, and absenteeism on school achievement in children with rheumatic diseases

Children with chronic health impairments have a variety of psychosocial, physical, and medical complications affecting daily life. This study investigated the relationship between the effects of a rheumatic disease (RD) and school functioning. Factors investigated were fatigue, distractibility, and absenteeism. In addition, disease severity and mobility were assessed. Forty-six children with RD and their parents participated in the study. Results indicated that inattention and distractibility were highly related to school achievement. A minimal relationship between fatigue and absenteeism and school performance was noted. In addition, ratings of mobility used by physicians were unrelated to success on math and reading achievement testing.

The epidemiology of post viral fatigue syndrome

The epidemiology of the post viral fatigue syndrome was studied for the years 1985-86. With a strict definition of the syndrome, it was found that there were many misconceptions about this illness. The sex incidence was nearly equal with a similar pattern of twin peaks at 25-29 years and 40-45 years. At diagnosis, 56% were ill for three to six months and only 9% for more than two years. It is estimated that this syndrome is more common than infectious mononucleosis.

The frequency of the chronic fatigue syndrome in patients with symptoms of persistent fatigue

STUDY OBJECTIVE

To determine the frequency of the chronic fatigue syndrome among patients with symptoms of fatigue.

DESIGN

Prospective, cohort study.

SETTING

Referral clinic, based in a primary care general internal medicine faculty practice of a university medical center.

PATIENTS

Consecutive sample of 135 patients (53 men, 82 women) with 6 months or more of debilitating fatigue.

INTERVENTIONS

All patients had a complete history taken, had a physical examination and a comprehensive battery of blood tests, and were given the Diagnostic Interview Schedule of the National Institute of Mental Health, a highly-structured 260-item instrument designed to enable accurate psychiatric diagnoses. Other diagnostic studies (for example, sleep studies and electroencephalography) were ordered if necessary for individual patients.

MEASUREMENTS AND MAIN RESULTS

Six of the one hundred thirty-five patients met criteria for chronic fatigue syndrome (95% CI, 0 to 10). Ninety-one (67%) patients (CI, 56 to 78) had clinically active psychiatric disorders and 4 (3%) patients (CI, 0 to 8) had medical disorders that were considered a major cause of their fatigue. Thirty-four (25%) patients (CI, 14 to 36) had insufficient symptoms or objective findings of the chronic fatigue syndrome.

CONCLUSION

The chronic fatigue syndrome is rare among patients with symptoms of persistent fatigue. Most of these patients have psychiatric disorders.

Chronic fatigue in primary care. Prevalence, patient characteristics, and outcome

Although fatigue is one of the most common complaints in ambulatory care, research has been minimal. Of the 1159 consecutive patients surveyed in two adult primary-care clinics, 276 (24%) indicated that fatigue was a major problem. Fatigue was more prevalent in women than in men (28% vs 19%). Extensive clinical, laboratory, psychometric, and functional data were gathered for 102 fatigued patients and 26 controls. Laboratory testing was not useful in detecting unsuspected medical conditions or in determining the cause of fatigue. Depression or somatic anxiety or both were suggested by screening psychometric instruments in 82 fatigued patients (80%) compared with three controls (12%). Global dysfunction was marked, as reported by patients on the Sickness Impact Profile. The mean score on the Sickness Impact Profile of 11.3 for fatigued patients is similar to that reported for patients with major medical illnesses. After one year of follow-up, only 29 fatigued patients (28%) had improved. The high prevalence, persistence, and functional consequences of fatigue mandate a search for effective therapy.

Simulator induced syndrome in Coast Guard aviators

The incidence of adverse symptoms in Coast Guard aviators undergoing flight simulator training was determined. A voluntary, multi-part questionnaire was completed by 238 pilots. During the first simulator flight 64.3% of pilots reported at least one adverse symptom, 39.4% during the last flight. Simulator induced syndrome (SIS) was present in 47.1% of subjects during the first simulator flight, 23.5% during their last flight. Most subjects reported their symptoms as mild, with some symptoms rated as moderate or severe in nature. There was no statistically significant association (p greater than 0.05) between the development of SIS and flight experience, simulator experience, length of simulator session, or self-determined motion sickness susceptibility. There was a significant association (p less than 0.05) between SIS development and the use of simulators with computer-generated imagery (CGI). Nine pilots experienced adverse symptoms at least 2 d after their last simulator flight. In conclusion, this study revealed that SIS occurs frequently, is more common when CGI is present, may recur, suggests an adaptative process, and may not be associated with some factors previously claimed.

A cluster of patients with a chronic mononucleosis-like syndrome. Is Epstein-Barr virus the cause?

A cluster of 134 patients who had undergone Epstein-Barr virus (EBV) serological testing because of suspected chronic EBV syndrome was investigated in Nevada. Fifteen case-patients were identified who had severe, persistent fatigue of undetermined etiology for more than two months. When compared with the remaining 119 patients who had less severe illnesses and with 30 age-, sex-, and race-matched control-persons, these 15 patients had significantly higher antibody titers against various components of EBV and against cytomegalovirus and herpes simplex and measles viruses. Epstein-Barr virus serology could not reliably differentiate individual case-patients from the others, and the reproducibility of the tests within and among laboratories was poor. As a group, the case-patients appear to have had a syndrome that is characterized by chronic fatigue, fever, sore throat, and lymphadenopathy. The relationship of this fatigue syndrome to EBV is unclear; further studies are needed to determine its etiology.

Frequency of 'chronic active Epstein-Barr virus infection' in a general medical practice

Twenty-one percent of 500 unselected patients, aged 17 to 50 years, seeking primary care for any reason were found to be suffering from a chronic fatigue syndrome consistent with "chronic active Epstein-Barr virus (EBV) infection," They had been experiencing "severe" fatigue, usually cyclic, for a median of 16 months (range, six to 458 months), associated with sore throat, myalgias, or headaches; 45% of the patients were periodically bedridden; and 25% to 73% reported recurrent cervical adenopathy, paresthesias, arthralgias, and difficulty in concentrating or sleeping. The patients had no recognized chronic "physical" illness and were not receiving psychiatric care. While antibody titers to several EBV-specific antigens were higher in patients than in age- and sex-matched controls subjects, the differences generally were not statistically significant. A chronic fatigue syndrome consistent with the chronic active EBV infection syndrome was prevalent in our primary care practice. However, our data offer no evidence that EBV is causally related to the syndrome. Indeed, we feel that among unselected patients seen in a general medical practice currently available EBV serologic test results must be interpreted with great caution.

[Factors affecting subjective symptoms of VDT workers]

In 1983, 285 (male: 129, female: 156) VDT workers and 60 (male: 30, female: 30) control subjects were examined in order to detect the factors affecting the subjective symptoms of VDT workers. Biological information (for example: sex, age), life histories, information about VDT work, tests (for example: visual acuity), symptoms and interferences to daily life of VDT workers and control subjects were collected. The following results were obtained. Female VDT workers experienced more fatigue from commuting to work, stiffness in shoulders, distant blurred vision complaints of visual acuity and sum of the scores of ocular complaints than female control subjects. Only among female VDT workers, the longer the daily working hours, the greater were their ocular symptoms. A remarkable relationships were observed between psychological burden factors (for example: self-control of VDT work, sensation of excessive VDT work) and subjective symptoms of the VDT workers (both sexes). In particular, VDT workers who considered VDT work to be excessive had marked by greater subjective symptoms than those who did not.

Health, disorders, and drug consumption in an elderly population in northern Sweden

A population study of health state, care, and drug consumption among 187 70-, 75-, and 79-year-old persons in Umeå, Sweden, was performed. It was shown subsequently that women felt less healthy and had a higher drug consumption than men, while concerning definable diseases there was no sex difference. Only 13% of the subjects were considered medically healthy, i.e., without definable diseases. 69% had been hospitalized over the age of 60 years.

Prevalence of depressive and other symptoms in elderly Finnish men

The prevalence of depressive and other symptoms were studied in Finnish men aged 65 to 84 years and living either in eastern (n = 310) or in southwestern (n = 378) Finland. The Zung self-rating depression scale showed depressed affect, fatigue and suicidal thoughts to be more common in the east, but indecisiveness to be more prevalent in the south-west. The mean of the sum scores in the Zung scale was 37.8 (+/- 8.4) for the eastern and 37.2 (+/- 8.3) for the south-western population, and no differences were found between the areas in this respect. However, many of the other symptoms, including somatic and psychosomatic (such as pains, dyspnea, nausea, impaired memory, apathy, itching skin and sight disturbances) were more common among men living in eastern Finland. The former findings support the idea that there are differences in the affects between men living in the east and men living in the south-west, but, as a whole, depressive symptoms are equally prevalent in both elderly male populations. The latter finding may reflect the well-known differences in the prevalences of somatic diseases between these two areas.