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Swain MG, Jones DEJ. Fatigue in chronic liver disease: New insights and therapeutic approaches. Liver Int 2019; 39:6-19. [PMID: 29935104 DOI: 10.1111/liv.13919] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023]
Abstract
The management of fatigue associated with chronic liver disease is a complex and major clinical challenge. Although fatigue can complicate many chronic diseases, it is particularly common in diseases with an inflammatory component. Fatigue can have both peripheral (i.e., neuromuscular) and central (i.e., resulting from changes in neurotransmission within the brain) causes. However, fatigue in chronic liver disease has strong social/contextual components and is often associated with behavioural alterations including depression and anxiety. Given the increasing awareness of patient-reported outcomes as important components of treatment outcomes and clinical research, there is a growing need to better understand and manage this poorly understood yet debilitating symptom. Although several pathophysiological mechanisms for explaining the development of fatigue have been generated, our understanding of fatigue in patients with chronic liver disease remains incomplete. A better understanding of the pathways and neurotransmitter systems involved may provide specific directed therapies. Currently, the management of fatigue in chronic liver disease can involve a combined use of methods to beneficially alter behavioural components and pharmacological interventions, of which several treatments have potential for the improved management of fatigue in chronic liver disease. However, evidence and consensus are lacking on the best approach and the most appropriate biochemical target(s) whilst clinical trials to address this issue have been few and limited by small sample size. In this review, we outline current understanding of the impact of fatigue and related symptoms in chronic liver disease, discuss theories of pathogenesis, and examine current and emerging approaches to its treatment.
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Affiliation(s)
- Mark G Swain
- Calgary Liver Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David E J Jones
- Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne, UK
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Pickard AS, Jalundhwala YJ, Bewsher H, Sharp LK, Walton SM, Schumock GT, Caskey RN. Lifestyle-related attitudes: do they explain self-rated health and life-satisfaction? Qual Life Res 2018; 27:1227-1235. [PMID: 29302851 DOI: 10.1007/s11136-017-1774-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Strategies to improve public health may benefit from targeting specific lifestyles associated with poor health behaviors and outcomes. The aim of this study was to characterize and examine the relationship between health and lifestyle-related attitudes (HLAs) and self-rated health and life-satisfaction. METHODS Secondary analyses were conducted on data from a 2012 community wellness survey in Kirklees, UK. Using a validated HLA tool, respondents (n = 9130) were categorized into five segments: health conscious realists (33%), balanced compensators (14%), live-for-todays (18%), hedonistic immortals (10%), and unconfident fatalists (25%). Multivariate regression was used to examine whether HLAs could explain self-rated health using the EQ-5D visual analog scale (EQ-VAS) and life-satisfaction. Health conscious realists served as the reference group. RESULTS Self-rated health differed by HLA, with adjusted mean EQ-VAS scores being significantly higher (better) among balanced compensators (1.15, 95% CI 0.27, 2.03) and lower scores among unconfident fatalists (- 9.02, 95% CI - 9.85, - 8.21) and live-for-todays (- 1.96, 95% CI - 2.80, - 1.14). Balanced compensators were less likely to report low life-satisfaction (OR 0.75, 95% CI 0.62, 0.90), while unconfident fatalists were most likely to have low life-satisfaction (OR 3.51, 95% CI 2.92, 4.23). SIGNIFICANCE Segmentation by HLA explained differences in self-rated health and life-satisfaction, with unconfident fatalists being a distinct segment with significantly worse health perceptions and life-satisfaction. Health promotion efforts may benefit from considering the HLA segment that predominates a patient group, especially unconfident fatalists.
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Affiliation(s)
- A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA. .,Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA.
| | - Yash J Jalundhwala
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Helen Bewsher
- Kirklees Council, The University of Manchester, Huddersfield, West Yorkshire, United Kingdom
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Surrey M Walton
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Rachel N Caskey
- Internal Medicine and Pediatrics, College of Medicine, University of Illinois at Chicago, 840 S Wood St, Chicago, IL, 60612, USA
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Hartog I, Scherer-Rath M, Kruizinga R, Netjes J, Henriques J, Nieuwkerk P, Sprangers M, van Laarhoven H. Narrative meaning making and integration: Toward a better understanding of the way falling ill influences quality of life. J Health Psychol 2017; 25:738-754. [PMID: 28948830 PMCID: PMC7221864 DOI: 10.1177/1359105317731823] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Falling seriously ill is often experienced as a life event that causes conflict
with people’s personal goals and expectations in life and evokes existential
questions. This article presents a new humanities approach to the way people
make meaning of such events and how this influences their quality of life.
Incorporating theories on contingency, narrative identity, and quality of life,
we developed a theoretical model entailing the concepts life event, worldview,
ultimate life goals, experience of contingency, narrative meaning making,
narrative integration, and quality of life. We formulate testable hypotheses and
describe the self-report questionnaire that was developed based on the
model.
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Affiliation(s)
- Iris Hartog
- University of Amsterdam, The Netherlands.,Radboud University Nijmegen, The Netherlands
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