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Rahnama'i MS, Van Koeveringe GA, Van Kerrebroeck PE. Overactive bladder syndrome and the potential role of prostaglandins and phosphodiesterases: an introduction. Nephrourol Mon 2013; 5:934-45. [PMID: 24350100 PMCID: PMC3842572 DOI: 10.5812/numonthly.14087] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/15/2013] [Indexed: 12/14/2022] Open
Abstract
In this paper, a general introduction is given, presenting the overactive bladder syndrome (OAB) and its impact on the quality of life and economical burden in patients affected. Moreover, the anatomy, physiology and histology of the lower urinary tract are discussed, followed by a brief overview on the possible role of prostaglandin (PG) and phosphodiesterase type 5 (PDE5) in the urinary bladder. The current literature on the role and distribution of PGE2 and its receptors in the urinary bladder is discussed. In both animal models and in human studies, high levels of signaling molecules such as PG and cGMP have been implicated, in decreased functional bladder capacity and micturition volume, as well as in increased voiding contraction amplitude. As a consequence, inhibition of prostanoid production, the use of prostanoid receptor antagonists, or PDE inhibitors might be a rational way to treat patients with detrusor overactivity. Similarly, prostanoid receptor agonists, or agents that stimulate their production, might have a function in treating bladder underactivity.
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Affiliation(s)
- Mohammad Sajjad Rahnama'i
- Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
- Corresponding author: Mohammad Sajjad Rahnama'i, Department of Urology, Maastricht University Medical Centre (MUMC+), PO Box 5800, 6202 AZ Maastricht, The Netherlands. Tel: +31-433875255, Fax: +31-433875259, E-mail:
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Flores S, Brown A, Adeoye S, Jason LA, Evans M. Examining the Impact of Obesity on Individuals with Chronic Fatigue Syndrome. Workplace Health Saf 2013; 61:299-307. [DOI: 10.1177/216507991306100705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 05/06/2013] [Indexed: 11/17/2022]
Abstract
Chronic fatigue syndrome (CFS) is a complex disorder affecting multiple body systems. The most commonly used definition of CFS is 6 or more months of fatigue and the presence of at least four of eight minor symptoms. In addition, many health and psychological conditions, including severe obesity–body mass index (BMI) of 40 kg/m2 or greater–exclude individuals from a diagnosis of CFS. Obesity has been correlated with fatigue, sleep problems, and less satisfaction with general health, functioning, and vitality. The current study investigated weight trends over time in a community-based sample of individuals with CFS and healthy controls. The study further investigated the impact of comorbid weight issues on several health and disability outcomes in a subset of overweight individuals. Overweight and obese individuals with CFS demonstrated poorer functioning than controls who were similarly weighted One participant was excluded because she had gained weight at a monitoring visit and her BMI was greater than 40 kg/m2. The implications of these findings for health care workers are discussed.
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Flores S, Brown A, Adeoye S, Jason LA, Evans M. Examining the impact of obesity on individuals with chronic fatigue syndrome. Workplace Health Saf 2013. [PMID: 23799656 DOI: 10.3928/21650799-20130617-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Chronic fatigue syndrome (CFS) is a complex disorder affecting multiple body systems. The most commonly used definition of CFS is 6 or more months of fatigue and the presence of at least four of eight minor symptoms. In addition, many health and psychological conditions, including severe obesity-body mass index (BMI) of 40 kg/m(2) or greater-exclude individuals from a diagnosis of CFS. Obesity has been correlated with fatigue, sleep problems, and less satisfaction with general health, functioning, and vitality. The current study investigated weight trends over time in a community-based sample of individuals with CFS and healthy controls. The study further investigated the impact of comorbid weight issues on several health and disability outcomes in a subset of overweight individuals. Overweight and obese individuals with CFS demonstrated poorer functioning than controls who were similarly weighted. One participant was excluded because she had gained weight at a monitoring visit and her BMI was greater than 40 kg/m(2). The implications of these findings for health care workers are discussed.
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Staud R. Peripheral and central mechanisms of fatigue in inflammatory and noninflammatory rheumatic diseases. Curr Rheumatol Rep 2013; 14:539-48. [PMID: 22802155 DOI: 10.1007/s11926-012-0277-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fatigue is a common symptom in a large number of medical and psychological disorders, including many rheumatologic illnesses. A frequent question for health care providers is related to whether reported fatigue is "in the mind" or "in the body"-that is, central or peripheral. If fatigue occurs at rest without any exertion, this suggests psychological or central origins. If patients relate their fatigue mostly to physical activities, including exercise, their symptoms can be considered peripheral. However, most syndromes of fatigue seem to depend on both peripheral and central mechanisms. Sometimes, muscle biopsy with histochemistry may be necessary for the appropriate tissue diagnosis, whereas serological tests generally provide little reliable information about the origin of muscle fatigue. Muscle function and peripheral fatigue can be quantified by contractile force and action potential measurements, whereas validated questionnaires are frequently used for assessment of mental fatigue. Fatigue is a hallmark of many rheumatologic conditions, including fibromyalgia, myalgic encephalitis/chronic fatigue syndrome, rheumatoid arthritis, systemic lupus, Sjogren's syndrome, and ankylosing spondylitis. Whereas many studies have focused on disease activity as a correlate to these patients' fatigue, it has become apparent that other factors, including negative affect and pain, are some of the most powerful predictors for fatigue. Conversely, sleep problems, including insomnia, seem to be less important for fatigue. There are several effective treatment strategies available for fatigued patients with rheumatologic disorders, including pharmacological and nonpharmacological therapies.
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Affiliation(s)
- Roland Staud
- Division of Rheumatology and Clinical Immunology, University of Florida, PO Box 100221, Gainesville, FL 32610-0221, USA.
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Rowe PC, Fontaine KR, Violand RL. Neuromuscular strain as a contributor to cognitive and other symptoms in chronic fatigue syndrome: hypothesis and conceptual model. Front Physiol 2013; 4:115. [PMID: 23720638 PMCID: PMC3655286 DOI: 10.3389/fphys.2013.00115] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 05/01/2013] [Indexed: 11/23/2022] Open
Abstract
Individuals with chronic fatigue syndrome (CFS) have heightened sensitivity and increased symptoms following various physiologic challenges, such as orthostatic stress, physical exercise, and cognitive challenges. Similar heightened sensitivity to the same stressors in fibromyalgia (FM) has led investigators to propose that these findings reflect a state of central sensitivity. A large body of evidence supports the concept of central sensitivity in FM. A more modest literature provides partial support for this model in CFS, particularly with regard to pain. Nonetheless, fatigue and cognitive dysfunction have not been explained by the central sensitivity data thus far. Peripheral factors have attracted attention recently as contributors to central sensitivity. Work by Brieg, Sunderland, and others has emphasized the ability of the nervous system to undergo accommodative changes in length in response to the range of limb and trunk movements carried out during daily activity. If that ability to elongate is impaired—due to movement restrictions in tissues adjacent to nerves, or due to swelling or adhesions within the nerve itself—the result is an increase in mechanical tension within the nerve. This adverse neural tension, also termed neurodynamic dysfunction, is thought to contribute to pain and other symptoms through a variety of mechanisms. These include mechanical sensitization and altered nociceptive signaling, altered proprioception, adverse patterns of muscle recruitment and force of muscle contraction, reduced intra-neural blood flow, and release of inflammatory neuropeptides. Because it is not possible to differentiate completely between adverse neural tension and strain in muscles, fascia, and other soft tissues, we use the more general term “neuromuscular strain.” In our clinical work, we have found that neuromuscular restrictions are common in CFS, and that many symptoms of CFS can be reproduced by selectively adding neuromuscular strain during the examination. In this paper we submit that neuromuscular strain is a previously unappreciated peripheral source of sensitizing input to the nervous system, and that it contributes to the pathogenesis of CFS symptoms, including cognitive dysfunction.
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Affiliation(s)
- Peter C Rowe
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine Baltimore, MD, USA
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Morris G, Anderson G, Galecki P, Berk M, Maes M. A narrative review on the similarities and dissimilarities between myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and sickness behavior. BMC Med 2013; 11:64. [PMID: 23497361 PMCID: PMC3751187 DOI: 10.1186/1741-7015-11-64] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 03/08/2013] [Indexed: 12/14/2022] Open
Abstract
It is of importance whether myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a variant of sickness behavior. The latter is induced by acute infections/injury being principally mediated through proinflammatory cytokines. Sickness is a beneficial behavioral response that serves to enhance recovery, conserves energy and plays a role in the resolution of inflammation. There are behavioral/symptomatic similarities (for example, fatigue, malaise, hyperalgesia) and dissimilarities (gastrointestinal symptoms, anorexia and weight loss) between sickness and ME/CFS. While sickness is an adaptive response induced by proinflammatory cytokines, ME/CFS is a chronic, disabling disorder, where the pathophysiology is related to activation of immunoinflammatory and oxidative pathways and autoimmune responses. While sickness behavior is a state of energy conservation, which plays a role in combating pathogens, ME/CFS is a chronic disease underpinned by a state of energy depletion. While sickness is an acute response to infection/injury, the trigger factors in ME/CFS are less well defined and encompass acute and chronic infections, as well as inflammatory or autoimmune diseases. It is concluded that sickness behavior and ME/CFS are two different conditions.
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Affiliation(s)
- Gerwyn Morris
- Tir Na Nog, Bryn Road Seaside 87, Llanelli, SA152LW, UK
| | - George Anderson
- CRC Clinical Research Centre/Communications, Laurel Street 57, Glasgow, G11 7QT,UK
| | - Piotr Galecki
- Department of Adult Psychiatry, Medical University of Lodz, Aleksandrowska 159, Lodz, 91229, Poland
| | - Michael Berk
- Barwon Health, School of Medicine, Deakin University, PO Box 291, Geelong, 3220, Australia
- Orygen Youth Health Research Centre, Poplar Road 35, Parkville, 3052, Australia
- Centre of Youth Mental Health, University of Melbourne, Poplar Road 35, Parkville, 3052, Australia
- The Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, Royal Parade 30, Parkville, 3052, Australia
- Department of Psychiatry, University of Melbourne, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia
| | - Michael Maes
- Barwon Health, School of Medicine, Deakin University, PO Box 291, Geelong, 3220, Australia
- Department of Psychiatry, Chulalongkorn University, Rama 4 Road 1873, Pathumwan, Bangkok, 10330, Thailand
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Richardson G, Epstein D, Chew-Graham C, Dowrick C, Bentall RP, Morriss RK, Peters S, Riste L, Lovell K, Dunn G, Wearden AJ. Cost-effectiveness of supported self-management for CFS/ME patients in primary care. BMC FAMILY PRACTICE 2013; 14:12. [PMID: 23327355 PMCID: PMC3556109 DOI: 10.1186/1471-2296-14-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 01/07/2013] [Indexed: 12/03/2022]
Abstract
BACKGROUND Nurse led self-help treatments for people with chronic fatigue syndrome/myalgic encephalitis (CFS/ME) have been shown to be effective in reducing fatigue but their cost-effectiveness is unknown. METHODS Cost-effectiveness analysis conducted alongside a single blind randomised controlled trial comparing pragmatic rehabilitation (PR) and supportive listening (SL) delivered by primary care nurses, and treatment as usual (TAU) delivered by the general practitioner (GP) in North West England. A within trial analysis was conducted comparing the costs and quality adjusted life years (QALYs) measured within the time frame of the trial. 296 patients aged 18 and over with CFS/ME diagnosed using the Oxford criteria were included in the cost-effectiveness analysis. RESULTS Treatment as usual is less expensive and leads to better patient outcomes compared with Supportive Listening. Treatment as usual is also less expensive than Pragmatic Rehabilitation. PR was effective at reducing fatigue in the short term, but the impact of the intervention on QALYs was uncertain. However, based on the results of this trial, PR is unlikely to be cost-effective in this patient population. CONCLUSIONS This analysis does not support the introduction of SL. Any benefits generated by PR are unlikely to be of sufficient magnitude to warrant recommending PR for this patient group on cost-effectiveness grounds alone. However, dissatisfaction with current treatment options means simply continuing with 'treatment as usual' in primary care is unlikely to be acceptable to patients and practitioners. TRIAL REGISTRATION The trial registration number is IRCTN74156610.
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Affiliation(s)
- Gerry Richardson
- Centre for Health Economics, University of York, Hull/York Medical School, York, YO10 5DD, United Kingdom
| | - David Epstein
- Centre for Health Economics, University of York, Hull/York Medical School, York, YO10 5DD, United Kingdom
| | - Carolyn Chew-Graham
- School of Community Based Medicine, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Christopher Dowrick
- School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, L69 3GB, United Kingdom
| | - Richard P Bentall
- School of Psychology, University of Bangor, Adeilad Brigantia, Penrallt Road, Bangor, Gwynedd, LL57 2AS, United Kingdom
| | - Richard K Morriss
- School of Community Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, NG7 2TU, United Kingdom
| | - Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Lisa Riste
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Graham Dunn
- School of Community Based Medicine, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Alison J Wearden
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
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YANO M, SUZUKI H, KAMIYA N, KATO T, NOMURA K, KURAMOCHI H, OHTA S, MIKAMI K, NAKATSU H, OKANO T, ONISHI T, ICHIKAWA T. Clinical Impact of Solifenacin on Generic and Symptom-Specific Quality of Life for Females with Overactive Bladder: Using the Overactive Bladder Symptom Score and Rand Medical Outcomes Study 36-Item Health Survey. Low Urin Tract Symptoms 2013; 5:5-10. [DOI: 10.1111/j.1757-5672.2012.00155.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fuller-Thomson E, Mehta R, Sulman J. Long-term parental unemployment in childhood and subsequent chronic fatigue syndrome. ISRN FAMILY MEDICINE 2013; 2013:978250. [PMID: 24959579 PMCID: PMC4041243 DOI: 10.5402/2013/978250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 12/24/2012] [Indexed: 11/23/2022]
Abstract
Objective. The association between long-term parental unemployment in childhood and chronic fatigue syndrome was examined in a population-based sample of women. Methods. A secondary analysis of data from a regionally representative sample of women (n = 7, 288) from the Canadian Community Health Survey (2005) was conducted using logistic regression. Age and race as well as the following clusters of factors were controlled for: (1) other childhood adversities, (2) adult health behaviors and hypertension, (3) adult stressors and socioeconomic status, and (4) adult mental health. Results. When adjusting for age and race only, the odds ratio of chronic fatigue syndrome among those reporting parental unemployment was 4.12 (95% CI: 2.60, 6.52) compared to those not reporting parental unemployment. When controlling for age and race plus all four clusters of factors the odds ratio for chronic fatigue syndrome dropped slightly to 3.05 (95% CI: 1.81, 5.14), but remained statistically significant. Conclusions. This study provides evidence for a significant association between long-term parental unemployment in childhood and chronic fatigue syndrome even after controlling for a wide range of potential risk factors.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1A1 ; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada M5G 1V7
| | - Rukshan Mehta
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1A1
| | - Joanne Sulman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1A1 ; Theodore J. Freedman Department of Social Work, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5
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VanNess JM, Stevens SR, Bateman L, Stiles TL, Snell CR. Postexertional malaise in women with chronic fatigue syndrome. J Womens Health (Larchmt) 2012; 19:239-44. [PMID: 20095909 DOI: 10.1089/jwh.2009.1507] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Postexertional malaise (PEM) is a defining characteristic of chronic fatigue syndrome (CFS) that remains a source of some controversy. The purpose of this study was to explore the effects of an exercise challenge on CFS symptoms from a patient perspective. METHODS This study included 25 female CFS patients and 23 age-matched sedentary controls. All participants underwent a maximal cardiopulmonary exercise test. Subjects completed a health and well-being survey (SF-36) 7 days postexercise. Subjects also provided, approximately 7 days after testing, written answers to open-ended questions pertaining to physical and cognitive responses to the test and length of recovery. SF-36 data were compared using multivariate analyses. Written questionnaire responses were used to determine recovery time as well as number and type of symptoms experienced. RESULTS Written questionnaires revealed that within 24 hours of the test, 85% of controls indicated full recovery, in contrast to 0 CFS patients. The remaining 15% of controls recovered within 48 hours of the test. In contrast, only 1 CFS patient recovered within 48 hours. Symptoms reported after the exercise test included fatigue, light-headedness, muscular/joint pain, cognitive dysfunction, headache, nausea, physical weakness, trembling/instability, insomnia, and sore throat/glands. A significant multivariate effect for the SF-36 responses (p < 0.001) indicated lower functioning among the CFS patients, which was most pronounced for items measuring physiological function. CONCLUSIONS The results of this study suggest that PEM is both a real and an incapacitating condition for women with CFS and that their responses to exercise are distinctively different from those of sedentary controls.
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Affiliation(s)
- J Mark VanNess
- Pacific Fatigue Laboratory, University of the Pacific, Stockton, California 95211, USA.
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Goudsmit EM, Nijs J, Jason LA, Wallman KE. Pacing as a strategy to improve energy management in myalgic encephalomyelitis/chronic fatigue syndrome: a consensus document. Disabil Rehabil 2011; 34:1140-7. [PMID: 22181560 DOI: 10.3109/09638288.2011.635746] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterized by a number of symptoms which typically worsen following minimal exertion. Various strategies to manage the limited energy levels have been proposed. Of these, pacing has been consistently rated as one of the most helpful in surveys conducted by patient groups. This review is a response to the paucity of the information on pacing in the scientific literature. METHOD We describe the principle of pacing and how this can be adapted to meet individual abilities and preferences. A critical evaluation of the research was conducted to ascertain the benefits and limitations of this strategy. RESULTS Based on various studies, it is proposed that pacing can help to stabilize the condition and avoid post-exertional malaise. CONCLUSION Pacing offers practitioners an additional therapeutic option which is acceptable to the majority of patients and can reduce the severity of the exertion-related symptoms of ME/CFS.
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Affiliation(s)
- Ellen M Goudsmit
- School of Psychology, University of East London, Stratford, London, E15 4LZ, UK.
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Activity Limitations and Participation Restrictions in Patients with Chronic Fatigue Syndrom—Construction of a Disease Specific Questionnaire. ACTA ACUST UNITED AC 2011. [DOI: 10.1300/j092v10n03_02] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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69
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Clinical and Biochemical Characteristics Differentiating Chronic Fatigue Syndrome from Major Depression and Healthy Control Populations. ACTA ACUST UNITED AC 2011. [DOI: 10.1300/j092v12n01_02] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Prospective Study of Body Mass Index, Weight Change, and Fatigue in Acute Infectious Mononucleosis. ACTA ACUST UNITED AC 2011. [DOI: 10.1300/j092v14n03_03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kim HW, Lee JZ, Shin DG. Predictors of response to fesoterodine in patients with an overactive bladder. J INCL PHENOM MACRO 2011. [DOI: 10.1007/s10847-011-0013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVES To propose a new method for comparing and integrating original qualitative data with systematic reviews of quantitative and qualitative studies, demonstrated by a study of the psychosocial needs of chronic fatigue syndrome (CFS) sufferers in Québec. METHODS A systematic literature review was performed across various databases for English and French language studies, on the psychosocial aspects of CFS. Qualitative, quantitative, and mixed method studies published between January 1994 and July 2008 were included. Unpublished literature and reference lists of included studies were also searched. Themes identified in the literature were used to guide semi-structured interviews with seventeen CFS-sufferers, mostly recruited from a large specialist practice in Montreal. Interviews were transcribed verbatim and validated by a research assistant. Transcripts were coded using the identified themes. New codes were created when new issues arose. All themes were subsequently synthesized into overall categories using a constant comparative method. RESULTS The literature search yielded thirty-one papers: twenty-eight primary studies and three systematic reviews. Twelve themes were identified and synthesized into four overall problem categories, such as "Lack of professional recognition." Interviews confirmed findings from the literature, but also revealed unidentified needs specific to CFS-sufferers in Québec. Policy recommendations were provided to address these needs. CONCLUSIONS Multi-Source Synthesis provides a systematic method for synthesizing data from original studies with literature findings, thereby broadening the knowledge base and the local relevance of decisions concerning specific patient populations.
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Han YK, Lee WK, Lee SH, Yang DY, Kim H. Effect of desmopressin with anticholinergics in female patients with overactive bladder. Korean J Urol 2011; 52:396-400. [PMID: 21750750 PMCID: PMC3123815 DOI: 10.4111/kju.2011.52.6.396] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 05/23/2011] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the effect of desmopressin combined with anticholinergics on daytime frequency and urgency in female patients with overactive bladder (OAB). MATERIALS AND METHODS We included 68 female patients with OAB. Patients were randomly assigned to receive 5 mg of solifenacin (group I) or 5 mg of solifenacin and 0.2 mg of desmopressin (group II) for 2 weeks. A pre/post-treatment 3-day voiding diary and the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to assess changes in voiding symptoms and quality of life (QoL); results were compared between the two groups. RESULTS Groups I and II included 31 and 37 patients, respectively. Time to first void was 12 min later in group II (105 min vs. 117 min), but this difference was not statistically significant. However, time to the second and third voids (203 min vs. 255 min, 312 min vs. 368 min) and the first urgency episode (212 min vs. 255 min) were significantly longer in group II. Compared with group I, patients in group II showed significant improvement in QoL scores. When improvement after treatment was defined as increase in time to first void of greater than 10% after 2 weeks of treatment, desmopressin with anticholinergics was more effective in patients over the age of 65 years and with more than 150 ml of voided volume. CONCLUSIONS Desmopressin combined with anticholinergics was more effective than anticholinergics only in the treatment of female patients with OAB.
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Affiliation(s)
- Young Kook Han
- Department of Urology, School of Medicine, Hallym University, Seoul, Korea
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Steele SS. Botulinum toxin A: First-line therapy for idiopathic detrusor overactivity. Can Urol Assoc J 2011; 5:207-9. [PMID: 21672486 DOI: 10.5489/cuaj.11045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Stephen S Steele
- Assistant Professor, Departments of Urology and Pediatrics, Queen's University, Kingston, ON
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Overactive Bladder Syndrome: The Social and Economic Perspective. Urologia 2011; 78:241-56. [DOI: 10.5301/ru.2011.8886] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2011] [Indexed: 11/20/2022]
Abstract
Overactive bladder syndrome (OAB) is a highly prevalent condition associated with a significant impairment of patients’ Quality of Life (QoL) because of its adverse effects on social, sexual, interpersonal, and professional functions. Cost-of-illness analyses showed the huge economic burden related to OAB for patients, public healthcare systems, and society, secondary to both direct and indirect costs. These types of cost analyses, however, exclude intangible costs related to QoL impairment. Recently, many novel therapies have been introduced, arising the need to apply the modern methodology of Health Technology Assessment (HTA) to new therapies in order to evaluate objectively their value in terms of both improvement in length/Quality of Life and costs. By producing information on the clinical, economic, organizational, social and ethical impact of health technologies, HTA has been used worldwide to inform decision makers at different levels in health systems. The HTA approach demonstrated, worldwide, to be a useful approach to increase the level of appropriateness in the use of medical technology and, as a consequence of that, of resources. Health utilities are instruments that allow a measurement of QoL and its integration in the economic evaluation using the Quality-of-life-Adjusted-Life-Years (QALYs) model and cost-utility analysis. The development of suitable instruments for quantifying utility in the specific group of OAB patients is vitally important to extend the application of cost-utility analysis in OAB and to guide healthcare resources allocation for this disorder. Studies are required to define the cost-effectiveness of available pharmacological and non-pharmacological therapy options.
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Nacul LC, Lacerda EM, Campion P, Pheby D, Drachler MDL, Leite JC, Poland F, Howe A, Fayyaz S, Molokhia M. The functional status and well being of people with myalgic encephalomyelitis/chronic fatigue syndrome and their carers. BMC Public Health 2011; 11:402. [PMID: 21619607 PMCID: PMC3123211 DOI: 10.1186/1471-2458-11-402] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 05/27/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome or ME/CFS is largely based on clinical history, and exclusion of identifiable causes of chronic fatigue. Characterization of cases and the impact of interventions have been limited due to clinical heterogeneity and a lack of reliable biomarkers for diagnosis and outcome measures. People with ME/CFS (PWME) often report high levels of disability, which are difficult to measure objectively. The well being of family members and those who care for PWME are also likely to be affected. This study aimed to investigate the functional status and well being of PWME and their lay carers, and to compare them with people with other chronic conditions. METHODS We used a cross sectional design to study 170 people aged between 18 and 64 years with well characterized ME/CFS, and 44 carers, using SF-36 v2™. Mean physical and mental domains scores (scales and component summaries) were calculated and compared internally and externally with reference standards for the general population and for population groups with 10 chronic diseases. RESULTS SF-36 scores in PWME were significantly reduced, especially within the physical domain (mean norm-based Physical Component Summary (PCS) score = 26.8), but also within the mental domain (mean norm-based score for Mental Component Summary (MCS) = 34.1). The lowest and highest scale scores were for "Role-Physical" (mean = 25.4) and "Mental Health" (mean = 36.7) respectively. All scores were in general lower than those for the general population and diseased-specific norms for other diseases. Carers of those with ME/CFS tended to have low scores in relation to population norms, particularly within the mental domain (mean = 45.4). CONCLUSIONS ME/CFS is disabling and has a greater impact on functional status and well being than other chronic diseases such as cancer. The emotional burden of ME/CFS is felt by lay carers as well as by people with ME/CFS. We suggest the use of generic instruments such as SF-36, in combination of other objective outcome measurements, to describe patients and assess treatments.
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Affiliation(s)
- Luis C Nacul
- Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Foundation for Genomics and Population Health (PHGF), Cambridge, CB1 8RN, UK
| | - Eliana M Lacerda
- Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Peter Campion
- Hull-York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Derek Pheby
- National ME Observatory Project Coordinator, and Buckinghamshire New University, Society and Health, Uxbridge Campus, 106, Oxford Road, Middlesex, UB8 1NA, UK
| | | | | | | | | | - Shagufta Fayyaz
- Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Mariam Molokhia
- Department of Primary Care & Public Health Sciences, Division of Health and Social Care Research. Kings College, London, SE1 3QD, UK
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77
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Haywood KL, Staniszewska S, Chapman S. Quality and acceptability of patient-reported outcome measures used in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. Qual Life Res 2011; 21:35-52. [DOI: 10.1007/s11136-011-9921-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2011] [Indexed: 12/26/2022]
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78
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Quality of life among testicular cancer survivors: a case-control study in the United States. Qual Life Res 2011; 20:1629-37. [PMID: 21499930 DOI: 10.1007/s11136-011-9907-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2011] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Evidence from previous studies has suggested there may be physical and mental changes in health among testicular cancer survivors. No studies have been conducted in the United States, however. METHODS Study participants were initially enrolled in the US Servicemen's Testicular Tumor Environmental and Endocrine Determinants (STEED) study between 2002 and 2005. A total of 246 TGCT (testicular germ cell tumor) cases and 236 non-testicular cancer controls participated in the current study, and completed a self-administered questionnaire. Mean time since diagnosis for cases was 14 years, and no less than five for all cases. Component scores determined from responses to questions about physical and mental health on SF36 were tabulated to yield two summary measures, physical component scores (PCS), and mental component scores (MCS). Component and summary scores were normalized to a score of 50 with a standard deviation of 10 by a linear T-score transformation. RESULTS Overall, cases may not suffer greatly in different quality of life than controls. When all cases and controls are compared, TGCT cases had lower PCS (mean: 51.9 95% CI: 50.6-53.2, P value: 0.037) than controls (mean: 53.6 95% CI: 52.7-54.6). MCS were not significantly different (P value: 0.091). In multivariate analyses, several physical health components were worse for TGCT cases such as role-physical (OR 1.19, 95% CI: 1.01-1.39) and general health (OR 1.26, 95% CI: 1.07-1.49) compared to controls. However, TGCT cases treated with chemotherapy had lower PCS (cases: 50.2, 95% CI: 47.6-52.8; controls: 53.6, 95% CI: 52.7-54.6, P value: 0.0032) and MCS (cases: 49.3, 95% CI: 46.5-52.1; controls: 52.0, 95% CI: 50.9-53.2, P value: 0.039). TGCT cases who received treatments other than chemotherapy did not differ from controls in either PCS or MCS. DISCUSSION Physical and general health limitations may affect testicular cancer survivors. Men treated with chemotherapy, however, may be most likely to suffer adverse health outcomes due to a combination of body-wide effects on physical and mental factors which affect various aspects of physical health, mental health, and overall quality of life. And in particular, physical functioning, role-physical, and general health are strongly affected.
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79
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Conservative Management and Behavioral Modifications for Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2011. [DOI: 10.1007/s11884-010-0076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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80
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Yao K, Crawford JR, Komaroff AL, Ablashi DV, Jacobson S. Review part 2: Human herpesvirus-6 in central nervous system diseases. J Med Virol 2010; 82:1669-78. [PMID: 20827763 DOI: 10.1002/jmv.21861] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Karen Yao
- Viral Immunology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
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81
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Prevalence of chronic fatigue among Chinese adults in Hong Kong: a population-based study. J Affect Disord 2010; 127:248-56. [PMID: 20580826 DOI: 10.1016/j.jad.2010.04.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 04/28/2010] [Accepted: 04/28/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Epidemiologic data is available on chronic fatigue for Western, but not for Chinese populations. The aims of the present study were to determine the prevalence of chronic fatigue in the general population of Hong Kong, compare health and lifestyle characteristics of non-chronic fatigue and chronic fatigue cases, and identify risk factors for chronic fatigue. METHODS We performed telephone interviews on 5001 randomly selected Chinese adults aged ≥18 years administering the Chinese version of Chronic Fatigue Scale (ChCFS), the Hospital Anxiety and Depression Scale (HADS), and quality of life (QoL) indexed by Medical Outcomes Study 12-item Short-Form Health Survey (SF12). Lifestyle, and sociodemographic data were also collected. Chronic fatigue was defined according to Fukuda et al.'s (1994) criteria and case criterion was a ChCFS total scores ≥4. RESULTS The weighted prevalence of chronic fatigue was 10.7%, which was equivalent to 0.6 million adults in Hong Kong. Higher prevalence rates were found in females, older age groups, and low socioeconomic status. Fully adjusted stepwise regression analyses identified older age, retirees, housewife, existing long-term health problems, higher HADS scores, poor QoL, and low self-perceived health to be significantly associated with increased risk of chronic fatigue, whereas regular exercise was associated with decreased risk of chronic fatigue (all p<0.05). LIMITATIONS The cross-sectional design did not allow determination of the time course and causal relationship between chronic fatigue and associated factors. CONCLUSIONS Our data evidenced that chronic fatigue is common in the general population of Hong Kong, and the prevalence increased with age and was higher in the women and lower socioeconomic population.
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82
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Jason LA, Evans M, Brown M, Porter N. What is fatigue? Pathological and nonpathological fatigue. PM R 2010; 2:327-31. [PMID: 20656613 DOI: 10.1016/j.pmrj.2010.03.028] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 03/23/2010] [Indexed: 12/17/2022]
Abstract
Aid in understanding issues surrounding the construct validity of fatigue including the distinction between pathological versus nonpathological fatigue. Fatigue is a universal symptom reported by individuals in the general population as well as by those suffering from different medical and psychological illnesses, including cancer, multiple sclerosis, chronic fatigue syndrome, depression, and anxiety. Chronic fatigue is a significant problem in many primary care settings, and the debilitating and prolonged nature of fatigue can pose significant economic consequences for society. Researchers have struggled to better assess and understand the etiology and classification of fatigue within different illness groups.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614, USA.
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83
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SHIN DG, KIM HW, LEE JZ. Effect of the Amount of Hours Spent Studying on the Prevalence of Overactive Bladder in College Women. Low Urin Tract Symptoms 2010; 2:113-8. [DOI: 10.1111/j.1757-5672.2010.00069.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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84
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Costigan A, Elliott C, McDonald C, Newton JL. Orthostatic symptoms predict functional capacity in chronic fatigue syndrome: implications for management. QJM 2010; 103:589-95. [PMID: 20534655 DOI: 10.1093/qjmed/hcq094] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To establish the relationship between the functional impairment experienced by Chronic fatigue syndrome (CFS) patients and the symptoms frequently experienced by those with CFS; specifically cognitive impairment, fatigue and orthostatic symptoms. DESIGN Cross sectional questionnaire survey. SETTING Specialist CFS Clinical Service. SUBJECTS Ninety-nine Fukuda diagnosed CFS and 64-matched controls. MAIN OUTCOME MEASURES Symptom and functional assessment tools completed and returned by post included; PROMIS HAQ (Patient-Reported Outcomes Measurement Information System, Health Assessment Questionnaire), CFQ (Cognitive Failures Questionnaire), FIS (Fatigue Impact Scale) and OGS (Orthostatic Grading Scale) assessment tools. RESULTS CFS patients experience greater functional impairment than controls [mean (95% CI) PROMIS HAQ scores CFS 36 (31-42) vs. controls 6 (2-10); P < 0.0001], especially in the functional domains of activities and reach. Poorer functional ability impairment is significantly associated with greater cognitive impairment (P = 0.0002, r = 0.4), fatigue (P < 0.0001, r = 0.5) and orthostatic symptoms (P < 0.0001, r = 0.6). However, only orthostatic symptoms (OGS) independently associated with functional impairment (beta = 0.4, P = 0.01). CONCLUSION Treatment of orthostatic symptoms in CFS has the potential to improve functional capacity and so improve quality of life.
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Affiliation(s)
- A Costigan
- NIHR Biomedical Research Centre in Ageing-Cardiovascular Theme, Newcastle University, Newcastle, UK
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85
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Jason L, Brown M, Evans M, Anderson V, Lerch A, Brown A, Hunnell J, Porter N. Measuring substantial reductions in functioning in patients with chronic fatigue syndrome. Disabil Rehabil 2010; 33:589-98. [PMID: 20617920 DOI: 10.3109/09638288.2010.503256] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE All the major current case definitions for chronic fatigue syndrome (CFS) specify substantial reductions in previous levels of occupational, educational, social, or personal activities to meet criteria. Difficulties have been encountered in operationalizing 'substantial reductions.' For example, the Medical Outcomes Study Short Form-36 Health Survey (SF-36) has been used to determine whether individuals met the CFS disability criterion. However, previous methods of using the SF-36 have been prone to including people without substantial reductions in key areas of physical functioning when diagnosing CFS. This study sought to empirically identify the most appropriate SF-36 subscales for measuring substantial reductions in patients with CFS. METHOD The SF-36 was administered to two samples of patients with CFS: one recruited from tertiary care and the other a community-based sample; as well as a non-fatigued control group. Receiver operating characteristics were used to determine the optimal cutoff scores for identifying patients with CFS. RESULTS The SF-36 Role-Emotional subscale had the worst sensitivity and specificity, whereas the Vitality, Role-Physical, and Social Functioning subscales had the best sensitivity and specificity. CONCLUSION Based on the evidence from this study, the potential criteria for defining substantial reductions in functioning and diagnosing CFS is provided.
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Affiliation(s)
- Leonard Jason
- Center for Community Research, DePaul University, Chicago, IL 60614, USA.
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86
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Gordon BA, Knapman LM, Lubitz L. Graduated exercise training and progressive resistance training in adolescents with chronic fatigue syndrome: a randomized controlled pilot study. Clin Rehabil 2010; 24:1072-9. [DOI: 10.1177/0269215510371429] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To investigate the differential effects of aerobic graded exercise and progressive resistance training on exercise tolerance, fatigue and quality of life in adolescent patients with chronic fatigue syndrome (CFS). Design: Single-blind, randomized controlled pilot trial. Setting: A major metropolitan hospital in Melbourne, Australia. Subjects: Twenty-two adolescents aged 13—18 years diagnosed with CFS and admitted to the inpatient chronic fatigue rehabilitation programme. Intervention: Patients were randomized to either graded aerobic exercise training or a progressive resistance training programme, for five days/week for four weeks. The graded aerobic training consisted of 20—40 minutes of stationary cycling and treadmill exercise. The progressive resistance training involved 16 exercises performed with single set, moderate load and high repetitions. Main measures: Exercise tolerance (time to fatigue) measured on a graded sub-maximal treadmill test, metabolic equivalents and quality of life, along with muscular strength (maximium push-ups) and endurance (sit-to-stand) and questionnaires evaluating depressive symptoms and fatigue severity. Results: No intervention was significantly better than the other for any outcome. However, physical capacity and quality of life significantly improved in both groups, while fatigue severity and symptoms of depression improved only with aerobic training. Conclusions: Resistance and aerobic training resulted in similar changes to physical capacity, quality of life and fatigue severity. Generally, patients who completed resistance training or aerobic training experienced significant improvements in outcomes from baseline when they entered the programme. Whether these improvements can be attributed to the treatment is unknown.
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Affiliation(s)
- Brett A Gordon
- Physiotherapy Department, Austin Health and Discipline of Exercise Science, RMIT University,
| | | | - Lionel Lubitz
- Department of Paediatrics, Austin Health and Royal Children's Hospital, Melbourne, Australia
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87
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Illness trajectories in the chronic fatigue syndrome: a longitudinal study of improvers versus non-improvers. J Nerv Ment Dis 2010; 198:486-93. [PMID: 20611051 DOI: 10.1097/nmd.0b013e3181e4ce0b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The natural progression of chronic fatigue syndrome (CFS) in adults is not well established. The aims of this longitudinal study were to (a) compare CFS Improvers and Non-Improvers; (b) determine whether an initial diagnosis of fibromyalgia (FM) was associated with CFS nonimprovement; and (c) determine whether this effect could be explained by the presence of nonspecific physical symptoms. Consecutive referrals to a tertiary clinic that satisfied case criteria for CFS were invited to enroll in a longitudinal study. After an initial on-site physical examination and psychiatric interview, a total of 94 female care-seekers completed biannual telephone surveys, including the Short Form-36 physical functioning (PF) scale, over a period of 2(1/2) years. There were very few differences between Improvers and Non-Improvers at baseline but at final assessment Improvers had less disability, less fatigue, lower levels of pain, fewer symptoms of depressed mood, and fewer nonspecific physical complaints. Participants with FM at baseline were 3.23 times (p < 0.05) more likely to become Non-Improvers than those without FM. Participants identified initially as Somatizers were 3.33 times (p < 0.05) more likely to become Non-Improvers. Patients with CFS who bear the added burden of FM are at greater risk of a negative outcome than patients with CFS alone. This effect could not be explained by the presence of multiple, nonspecific symptoms.
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88
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Ho CH, Tai HC, Yu HJ. Urodynamic findings in female diabetic patients with and without overactive bladder symptoms. Neurourol Urodyn 2010; 29:424-7. [PMID: 19283863 DOI: 10.1002/nau.20727] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS The purpose was to analyze urodynamic findings in female diabetic patients with OAB symptoms. METHODS Data from 94 female diabetic patients who underwent urodynamic studies in evaluation of various LUTS were retrospectively reviewed. Urodynamic findings, demographic data, and clinical symptoms were compared between patients with and without OAB. RESULTS Among the 94 subjects analyzed, 34 (36.2%) were diagnosed as OAB. Demographic data were similar between the patients with and without OAB. In the OAB group, patients had significantly higher storage symptom scores and marginally higher voiding symptom scores. On cystometry, the OAB group had a higher percentage of increased bladder sensation (41.2% vs 11.7%, P = 0.001) and detrusor overactivity (29.4% vs 10.0%, P = 0.023). The OAB group had lower peak flow rate (16.2 +/- 5.9 vs 19.3 +/- 6.3 ml/s, P = 0.023), greater PVR volume (60.3 +/- 29.4 vs 45.0 +/- 25.1 ml, P = 0.009), and lower bladder voiding efficiency (BVE, 75.2 +/- 2.8 vs 81.5 +/- 2.9%, P < 0.001). On pressure-flow studies, the OAB group had a higher percentage of BOO (26.5% vs 6.7%, P = 0.008). CONCLUSIONS Our study shows that the most frequent urodynamic finding of OAB in female diabetic patients is increased bladder sensation, followed by detrusor overactivity. Compared to those without OAB, female diabetic patients with OAB are more likely to have impaired voiding function, characterized by lower peak flow rate, greater PVR volume, lower BVE, and a higher percentage of BOO. In these patients, BOO not only causes voiding difficulty but may also contribute to the development of OAB.
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Affiliation(s)
- Chen-Hsun Ho
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
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89
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Wearden AJ, Dowrick C, Chew-Graham C, Bentall RP, Morriss RK, Peters S, Riste L, Richardson G, Lovell K, Dunn G. Nurse led, home based self help treatment for patients in primary care with chronic fatigue syndrome: randomised controlled trial. BMJ 2010; 340:c1777. [PMID: 20418251 PMCID: PMC2859122 DOI: 10.1136/bmj.c1777] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of home delivered pragmatic rehabilitation-a programme of gradually increasing activity designed collaboratively by the patient and the therapist-and supportive listening-an approach based on non-directive counselling-for patients in primary care with chronic fatigue syndrome/myalgic encephalomyelitis or encephalitis (CFS/ME). DESIGN Single blind, randomised, controlled trial. SETTING 186 general practices across the north west of England between February 2005 and May 2007. PARTICIPANTS 296 patients aged 18 or over with CFS/ME (median illness duration seven years) diagnosed using the Oxford criteria. INTERVENTIONS Participants were randomly allocated to pragmatic rehabilitation, supportive listening, or general practitioner treatment as usual. Both therapies were delivered at home in 10 sessions over 18 weeks by one of three adult specialty general nurses who had received four months' training, including supervised practice, in each of the interventions. GP treatment as usual was unconstrained except that patients were not to be referred for systematic psychological therapies during the treatment period. Main outcome measures The primary clinical outcomes were fatigue and physical functioning at the end of treatment (20 weeks) and 70 weeks from recruitment compared with GP treatment as usual. Lower fatigue scores and higher physical functioning scores denote better outcomes. RESULTS A total of 257 (87%) of the 296 patients who entered the trial were assessed at 70 weeks, the primary outcome point. Analysis was on an intention to treat basis, with robust treatment effects estimated after adjustment for missing data using probability weights. Immediately after treatment (at 20 weeks), patients allocated to pragmatic rehabilitation (n=95) had significantly improved fatigue (effect estimate -1.18, 95% confidence interval -2.18 to -0.18; P=0.021) but not physical functioning (-0.18, 95% CI -5.88 to +5.52; P=0.950) compared with patients allocated to treatment as usual (n=100). At one year after finishing treatment (70 weeks), there were no statistically significant differences in fatigue or physical functioning between patients allocated to pragmatic rehabilitation and those on treatment as usual (-1.00, 95% CI -2.10 to +0.11; P=0.076 and +2.57, 95% CI 3.90 to +9.03; P=0.435). At 20 weeks, patients allocated to supportive listening (n=101) had poorer physical functioning than those allocated to treatment as usual (-7.54, 95% CI -12.76 to -2.33; P=0.005) and no difference in fatigue. At 70 weeks, patients allocated to supportive listening did not differ significantly from those allocated to treatment as usual on either primary outcome. CONCLUSIONS For patients with CFS/ME in primary care, pragmatic rehabilitation delivered by trained nurse therapists improves fatigue in the short term compared with unconstrained GP treatment as usual, but the effect is small and not statistically significant at one year follow-up. Supportive listening delivered by trained nurse therapists is not an effective treatment for CFS/ME. Trial registration International Standard Randomised Controlled Trial Number IRCTN74156610.
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Affiliation(s)
- Alison J Wearden
- School of Psychological Sciences, University of Manchester, Manchester.
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90
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Johnson SK, Schmaling KB, Dmochowski J, Bernstein D. An investigation of victimization and the clinical course of chronic fatigue syndrome. J Health Psychol 2010; 15:351-61. [DOI: 10.1177/1359105309349453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Medically unexplained syndromes, including chronic fatigue syndrome (CFS), have been associated with victimization in childhood and adulthood. The purpose of this study was to examine the associations of victimization experiences in childhood and adulthood with functional status and illness severity in a sample of patients with CFS using longitudinal data. In the sample of 93 patients with CFS, childhood abuse and neglect had greater impact than adulthood victimization. Overall, victimization experiences in childhood demonstrated modest associations with clinical outcomes in CFS, although several victimization experiences were in the opposite direction of expectations. Victimization predicted worse outcomes, but not worsening outcomes over time.
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91
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Sacco E, Tienforti D, D'Addessi A, Pinto F, Racioppi M, Totaro A, D'Agostino D, Marangi F, Bassi P. Social, economic, and health utility considerations in the treatment of overactive bladder. Open Access J Urol 2010. [PMID: 24198609 DOI: 10.2147/oaju.s4166] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Overactive bladder (OAB) is a highly prevalent urinary syndrome with a profound impact on quality of life (QoL) of affected patients and their family because of its adverse effects on social, sexual, interpersonal, and professional function. Cost-of-illness analyses showed the huge economic burden related to OAB for patients, public healthcare systems, and society, secondary to both direct and indirect costs; however, intangible costs related to QoL impact are usually omitted from these analyses. Recently many novel treatment modalities have been introduced and the need to apply the modern methodology of health technology assessment to these treatment strategies was immediately clear in order to evaluate objectively their value in term of both improvement in length/quality of life and costs. Health utilities are instruments that allow a measurement of QoL and its integration in the economic evaluation using the quality-adjusted life-years model and cost-utility analysis. The development of suitable instruments for quantifying utility in the specific group of OAB patients is vitally important to extend the application of cost-utility analysis in OAB and to guide healthcare resources allocation for this disorder. Studies are required to define the cost-effectiveness of available pharmacological and nonpharmacological therapy options for this disorder.
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Affiliation(s)
- Emilio Sacco
- Urologic Clinic, Department of Surgery, "Agostino Gemelli" Hospital, Catholic University Medical School, Rome, Italy
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92
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Sacco E, Tienforti D, D'Addessi A, Pinto F, Racioppi M, Totaro A, D'Agostino D, Marangi F, Bassi P. Social, economic, and health utility considerations in the treatment of overactive bladder. Res Rep Urol 2010; 2:11-24. [PMID: 24198609 PMCID: PMC3818873 DOI: 10.2147/rru.s4166] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Overactive bladder (OAB) is a highly prevalent urinary syndrome with a profound impact on quality of life (QoL) of affected patients and their family because of its adverse effects on social, sexual, interpersonal, and professional function. Cost-of-illness analyses showed the huge economic burden related to OAB for patients, public healthcare systems, and society, secondary to both direct and indirect costs; however, intangible costs related to QoL impact are usually omitted from these analyses. Recently many novel treatment modalities have been introduced and the need to apply the modern methodology of health technology assessment to these treatment strategies was immediately clear in order to evaluate objectively their value in term of both improvement in length/quality of life and costs. Health utilities are instruments that allow a measurement of QoL and its integration in the economic evaluation using the quality-adjusted life-years model and cost-utility analysis. The development of suitable instruments for quantifying utility in the specific group of OAB patients is vitally important to extend the application of cost-utility analysis in OAB and to guide healthcare resources allocation for this disorder. Studies are required to define the cost-effectiveness of available pharmacological and nonpharmacological therapy options for this disorder.
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Affiliation(s)
- Emilio Sacco
- Urologic Clinic, Department of Surgery, "Agostino Gemelli" Hospital, Catholic University Medical School, Rome, Italy
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93
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Tiersky LA, Natelson BH, Ottenweller J, Lange G, Fiedler N, DeLuca J. Functional Status and Mood in Persian Gulf Veterans With Unexplained Fatiguing Illness. MILITARY PSYCHOLOGY 2009. [DOI: 10.1207/s15327876mp1204_01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Lana A. Tiersky
- Center for Environmental Hazards Research, DVAMC, East Orange, New Jersey; School of Psychology, Fairleigh Dickinson University; and Kessler Medical Rehabilitation Research and Education Cooperation, West Orange, New Jersey
| | - Benjamin H. Natelson
- Center for Environmental Hazards Research, DVAMC, East Orange, New Jersey, and Department of Neurosciences, UMDNJ–New Jersey Medical School
| | - John Ottenweller
- Center for Environmental Hazards Research, DVAMC, East Orange, New Jersey, and Department of Neurosciences, UMDNJ–New Jersey Medical School
| | - Gudrun Lange
- Center for Environmental Hazards Research, DVAMC, East Orange, New Jersey, and Department of Radiology and Department of Psychiatry, UMDNJ–New Jersey Medical School
| | - Nancy Fiedler
- Center for Environmental Hazards Research, DVAMC, East Orange, New Jersey, and Department of Environmental and Community Medicine, Rutgers University
| | - John DeLuca
- Center for Environmental Hazards Research, DVAMC, East Orange, New Jersey; Kessler Medical Rehabilitation Research and Education Cooperation, West Orange, New Jersey; and Department of Neurosciences and Department of Physical Medicine and Rehabilitation, UMDNJ–New Jersey Medical School
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94
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Romano JM, Jensen MP, Schmaling KB, Hops H, Buchwald DS. Illness behaviors in patients with unexplained chronic fatigue are associated with significant other responses. J Behav Med 2009; 32:558-69. [PMID: 19915971 DOI: 10.1007/s10865-009-9234-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 08/25/2009] [Indexed: 12/19/2022]
Abstract
Chronic fatigue syndrome (CFS) and unexplained chronic fatigue (CF) are characterized by compromised functional status and physical disability. Prior research on chronic pain has suggested that social factors may contribute to disability. This study examined the relationship between significant other responses and patient outcomes in patients with unexplained CF. Questionnaire data were collected from 117 patients on physical function, fatigue, pain, illness behaviors and responses of significant others to them, and depression. Ninety-four SOs reported their perceptions of patient illness behavior and their responses. Thirty-seven of these dyads also completed a series of household activities while being videotaped. Dyadic interactions were coded and analyzed. Both reported and observed solicitous responses by the significant other were associated with reported and observed patient illness behavior. Negative responses to patient illness behavior by significant others were associated with higher levels of patient depressive symptoms. The findings provide support for the role of operant behavioral factors in the context of chronic fatigue. They also suggest that further research on the relationship between dysfunction and significant other responses in patients with CFS or CF appears warranted and may have implications for treatment development.
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Affiliation(s)
- Joan M Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA 98195, USA.
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95
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96
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Baune BT, McAfoose J, Leach G, Quirk F, Mitchell D. Impact of psychiatric and medical comorbidity on cognitive function in depression. Psychiatry Clin Neurosci 2009; 63:392-400. [PMID: 19566772 DOI: 10.1111/j.1440-1819.2009.01971.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM The aim of the present study was to investigate the association between cognitive performance and psychiatric and medical comorbidity in major depression. METHODS The present study evaluated the cognitive performance of patients (n = 96) diagnosed with a major depressive episode in relation to the presence of medical and/or psychiatric comorbidity. Participants were assessed clinically and cognitively using the Mini International Neuropsychiatric Interview and Repeatable Battery for the Assessment of Neuropsychological Status. Four groups of comorbidity were categorized: (i) no comorbidity, (ii) medical comorbidity; (iii) psychiatric comorbidity; and (iv) both medical and psychiatric comorbidity, and subsequently analyzed for differences across six cognitive domains: immediate memory, visuospatial, language, attention, delayed memory, and total score. RESULTS Only 20.8% of the participants did not have a comorbidity of any kind, while psychiatric comorbidities (67.7%) were more frequent than medical comorbidities (39.6%). Education and severity of depressive symptoms negatively influenced cognitive performance. Psychiatric comorbidity alone significantly decreased cognitive performance in the visuospatial/constructional and the language domains and the total score. In addition, increasing numbers of psychiatric comorbidities were related to worse cognitive performance. In contrast, medical illnesses alone had no negative impact on any of the domains of cognitive performance. Evidence was found for additive effects of medical and psychiatric comorbidities in depression on visuospatial/constructional cognitive abilities. CONCLUSION The strongest predictor of poor cognitive performance in depression was psychiatric comorbidity. The assessment and treatment of cognitive dysfunction in depression should consider the relative impact of psychiatric comorbidity.
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Affiliation(s)
- Bernhard T Baune
- Psychiatry and Psychiatric Neuroscience, School of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
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97
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van den Berg B, Yzermans CJ, van der Velden PG, Stellato RK, Brunekreef B, Lebret E, Grievink L. Risk factors for unexplained symptoms after a disaster: a five-year longitudinal study in general practice. PSYCHOSOMATICS 2009; 50:69-77. [PMID: 19213975 DOI: 10.1176/appi.psy.50.1.69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medically unexplained symptoms (MUS) are a common reason to seek medical care. When presented to the general practitioner (GP), more than three-quarters of symptoms such as stomach ache, headache, and pain in bones and muscles cannot be explained by a medical disorder. OBJECTIVE The authors examined the course of MUS presented to the GP in the 1 year before the disaster and in the 4 years after a disaster in order to study the risk factors for MUS. METHOD Data were extracted from the electronic medical records of survivors and from a questionnaire (N=1,216). RESULTS Although the mean number of MUS was significantly increased statistically in the first 2 years post-disaster, the increase was not clinically significant. CONCLUSION The authors identified several important risk factors, such as immigrant status and psychological problems, that are easy for GPs to recognize. Despite this, the sensitivity of the regression model was relatively low.
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Affiliation(s)
- Bellis van den Berg
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
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98
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Assefi N, Bogart A, Goldberg J, Buchwald D. Reiki for the treatment of fibromyalgia: a randomized controlled trial. J Altern Complement Med 2009; 14:1115-22. [PMID: 18991519 DOI: 10.1089/acm.2008.0068] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Fibromyalgia is a common, chronic pain condition for which patients frequently use complementary and alternative medicine, including Reiki. Our objective was to determine whether Reiki is beneficial as an adjunctive fibromyalgia treatment. DESIGN This was a factorial designed, randomized, sham-controlled trial in which participants, data collection staff, and data analysts were blinded to treatment group. SETTING/LOCATION The study setting was private medical offices in the Seattle, Washington metropolitan area. SUBJECTS The subjects were comprised 100 adults with fibromyalgia. INTERVENTION Four (4) groups received twice-weekly treatment for 8 weeks by either a Reiki master or actor randomized to use direct touch or no touch (distant therapy). OUTCOME MEASURES The primary outcome was subjective pain as measured by visual analog scale at weeks 4, 8, and 20 (3 months following end of treatment). Secondary outcomes were physical and mental functioning, medication use, and health provider visits. Participant blinding and adverse effects were ascertained by self-report. Improvement between groups was examined in an intention-to-treat analysis. RESULTS Neither Reiki nor touch had any effect on pain or any of the secondary outcomes. All outcome measures were nearly identical among the 4 treatment groups during the course of the trial. CONCLUSION Neither Reiki nor touch improved the symptoms of fibromyalgia. Energy medicine modalities such as Reiki should be rigorously studied before being recommended to patients with chronic pain symptoms.
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Affiliation(s)
- Nassim Assefi
- Department of Medicine, University of Washington, Seattle, WA, USA
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99
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Raison CL, Lin JMS, Reeves WC. Association of peripheral inflammatory markers with chronic fatigue in a population-based sample. Brain Behav Immun 2009; 23:327-37. [PMID: 19111923 DOI: 10.1016/j.bbi.2008.11.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 11/25/2008] [Accepted: 11/26/2008] [Indexed: 12/19/2022] Open
Abstract
Alterations in the innate immune response may contribute to the pathogenesis of chronic fatigue syndrome (CFS). However, studies have been limited by small sample sizes, use of patients from tertiary care settings, inappropriate selection of controls, and failure to control for confounding demographic, medical and behavioral factors independently associated with immune activity. It is also not known whether specific symptoms account for observed associations between CFS and the innate immune response. To address these limitations, the current study examined plasma concentrations of high-sensitivity c-reactive protein (hs-CRP), white blood cell count (WBC) and a combined inflammation factor in a large population-based sample. Log-transformed mean plasma concentrations of hs-CRP were increased in subjects with CFS (n=102) and in subjects with unwellness symptoms that did not meet diagnostic criteria for CFS (defined as "insufficient fatigue" [ISF]) (n=240) when compared to subjects who were well (n=115). Log transformed WBC was increased in ISF and was increased at a trend level in CFS. The combined inflammation factor was increased in both CFS and ISF. Subjects with CFS and ISF did not differ on any of the inflammation measures. In the entire subject population, the physical component summary score (PCS), but not the mental component summary score (MCS), from the Medical Outcomes Study Short Form-36 (SF-36) was negatively associated with each of the inflammation measures. Depressive symptoms were also associated with increased log hs-CRP. After adjustment for age, sex, race, location of residence, BMI, depressive status and immune-modulating medications, subjects classified as ISF continued to demonstrate increased log hs-CRP, WBC and elevations on the inflammation factor when compared to well controls; however, associations between CFS and log hs-CRP and the inflammation factor were no longer statistically significant. After adjustment, PCS score also remained independently associated with each of the inflammation measures. These findings support a role for innate immune activation in unexplained fatigue and unwellness, but do not suggest that immune activation is specific to CFS.
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Affiliation(s)
- Charles L Raison
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365C Clifton Road, Room 5004, Atlanta, GA 30322, USA.
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100
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Goudsmit E, Stouten B, Howes S. Illness Intrusiveness in Myalgic Encephalomyelitis. J Health Psychol 2009; 14:215-21. [DOI: 10.1177/1359105308100205] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study assessed the relationship between illness intrusiveness, symptoms, disability and depression in patients with myalgic encephalomyelitis (ME). Participants were 16 patients with ME and eight patients with ME plus co-morbid disorders. The patients with co-morbid disorders reported greater illness intrusiveness than the patients with ME alone, but there were no differences between the groups on the other variables. Significant correlations were found between illness intrusiveness on the one hand, and fatigue, cognitive dysfunction, disability and depression, on the other. We conclude that ME is a disabling illness, which has a major impact on various life domains.
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