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Orji NC, Cox IA, Jason LA, Chen G, Zhao T, Rogerson MJ, Kelly RM, Wills K, Hensher M, Palmer AJ, de Graaff B, Campbell JA. Assessing health state utilities for people with myalgic encephalomyelitis/chronic fatigue syndrome in Australia using the EQ-5D-5L, AQoL-8D and EQ-5D-5L-psychosocial instruments. Qual Life Res 2024; 33:45-57. [PMID: 37561337 PMCID: PMC10784392 DOI: 10.1007/s11136-023-03498-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic condition with a constellation of symptoms presenting as severe and profound fatigue of ≥ 6 months not relieved by rest. ME/CFS affects health-related quality of life (HRQoL), which can be measured using multi-attribute health state utility (HSU) instruments. The aims of this study were to quantify HSUs for people living with ME/CFS, and to identify an instrument that is preferentially sensitive for ME/CFS. METHODS Cross-sectional national survey of people with ME/CFS using the AQoL-8D and EQ-5D-5L. Additional questions from the AQoL-8D were used as 'bolt-ons' to the EQ-5D-5L (i.e., EQ-5D-5L-Psychosocial). Disability and fatigue severity were assessed using the De Paul Symptom Questionnaire-Short Form (DSQ-SF). HSUs were generated using Australian tariffs. Mean HSUs were stratified for sociodemographic and clinical factors. Bland-Altman plots were used to compare the three HSU instruments. RESULTS For the 198 participants, mean HSUs (95% confidence intervals) were EQ-5D-5L: 0.46 (0.42-0.50); AQoL-8D: 0.43 (0.41-0.45); EQ-5D-5L-Psychosocial: 0.44 (0.42-0.46). HSUs were substantially lower than population norms: EQ-5D-5L: 0.89; AQoL-8D: 0.77. As disability and fatigue severity increased, HSUs decreased in all three instruments. Bland-Altman plots revealed interchangeability between the AQoL-8D and EQ-5D-5LPsychosocial. Floor and ceiling effects of 13.5% and 2.5% respectively were observed for the EQ-5D-5L instrument only. CONCLUSIONS ME/CFS has a profound impact on HRQoL. The AQoL-8D and EQ-5D-5L-Psychosocial can be used interchangeably: the latter represents a reduced participant burden.
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Affiliation(s)
- Nneka C Orji
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Ingrid A Cox
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Leonard A Jason
- DePaul University Center for Community Research, Chicago, IL, USA
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Ting Zhao
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Melissa J Rogerson
- School of Computing & Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Ryan M Kelly
- School of Computing & Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Karen Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Martin Hensher
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
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Requier F, Demnitz-King H, Whitfield T, Klimecki O, Marchant NL, Collette F. The Effect of Meditation-Based Interventions on Patients with Fatigue Symptoms: A Systematic Review and Meta-Analysis. Psychol Belg 2023; 63:64-81. [PMID: 37358949 PMCID: PMC10289041 DOI: 10.5334/pb.1182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Persistent fatigue constitutes a prevalent and debilitating symptom in several diseases. The symptom is not effectively alleviated by pharmaceutical treatments, and meditation has been proposed as a non-pharmacological intervention. Indeed, meditation has been shown to reduce inflammatory/immune problems, pain, stress, anxiety and depression which are associated with pathological fatigue. This review synthesizes data from randomized control trials (RCTs) that explored the effect of meditation-based interventions (MeBIs) on fatigue in pathological conditions. Eight databases were searched from inception to April 2020. Thirty-four RCTs met eligibility criteria and covered six conditions (68% cancer), 32 of which were included in the meta-analysis. The main analysis showed an effect in favor of MeBIs compared to control groups (g = 0.62). Separate moderator analyses assessing control group, pathological condition, and MeBI type, highlighted a significantly moderating role of the control group. Indeed, compared to actively controlled studies, studies using a passive control group were associated with a statistically significantly more beneficial impact of the MeBIs (g = 0.83). These results indicate that MeBIs alleviate pathological fatigue and it seems that the studies with a passive control group showed a greater effect of MeBI on the reduction of fatigue compared to studies using active control groups. However, the specific effect of meditation type and pathological condition should be analyzed with more studies, and there remains a need to assess meditation effects on different types of fatigue (i.e., physical and mental) and in additional conditions (e.g., post-COVID-19).
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Affiliation(s)
- Florence Requier
- GIGA-CRC In Vivo Imaging, Université de Liège, Bâtiment B30, Allée du Six Août, 8, Sart Tilman, 4000 Liège, Belgium
- Department of Psychology, Cognition and Behavior, University of Liège, Liège, Belgium
| | | | - Tim Whitfield
- Division of Psychiatry, University College London, London, UK
| | - Olga Klimecki
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | | | - Fabienne Collette
- GIGA-CRC In Vivo Imaging, Université de Liège, Bâtiment B30, Allée du Six Août, 8, Sart Tilman, 4000 Liège, Belgium
- Department of Psychology, Cognition and Behavior, University of Liège, Liège, Belgium
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Li Y, Wu K, Hu X, Xu T, Li Z, Zhang Y, Li K. Altered Effective Connectivity of Resting-State Networks by Tai Chi Chuan in Chronic Fatigue Syndrome Patients: A Multivariate Granger Causality Study. Front Neurol 2022; 13:858833. [PMID: 35720086 PMCID: PMC9203735 DOI: 10.3389/fneur.2022.858833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/05/2022] [Indexed: 12/05/2022] Open
Abstract
Numerous evidence has shown that patients with chronic fatigue syndrome (CFS) have changes in resting brain functional connectivity, but there is no study on the brain network effect of Tai Chi Chuan intervention in CFS. To explore the influence of Tai Chi Chuan exercise on the causal relationship between brain functional networks in patients with CFS, 21 patients with CFS and 19 healthy controls were recruited for resting-state functional magnetic resonance imaging (rs-fMRI) scanning and 36-item Short-Form Health Survey (SF-36) scale assessment before and after 1month-long training in Tai Chi Chuan. We extracted the resting brain networks using the independent component analysis (ICA) method, analyzed the changes of FC in these networks, conducted Granger causality analysis (GCA) on it, and analyzed the correlation between the difference causality value and the SF-36 scale. Compared to the healthy control group, the SF-36 scale scores of patients with CFS were lower at baseline. Meanwhile, the causal relationship between sensorimotor network (SMN) and default mode network (DMN) was weakened. The above abnormalities could be improved by Tai Chi Chuan training for 1 month. In addition, the correlation analyses showed that the causal relationship between SMN and DMN was positively correlated with the scores of Role Physical (RP) and Bodily Pain (BP) in CFS patients, and the change of causal relationship between SMN and DMN before and after training was positively correlated with the change of BP score. The findings suggest that Tai Chi Chuan is helpful to improve the quality of life for patients with CFS. The change of Granger causality between SMN and DMN may be a readout parameter of CFS. Tai Chi Chuan may promote the functional plasticity of brain networks in patients with CFS by regulating the information transmission between them.
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Affiliation(s)
- Yuanyuan Li
- Department of Neurology and Stroke Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kang Wu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaojie Hu
- Department of Rehabilitation, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianjiao Xu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zongheng Li
- Department of Rehabilitation, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yong Zhang
- Department of Rehabilitation, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Yong Zhang
| | - Kuangshi Li
- Department of Rehabilitation, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Kuangshi Li
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Koga M, Shigetoh H, Tanaka Y, Morioka S. Characteristics of clusters with contrasting relationships between central sensitization-related symptoms and pain. Sci Rep 2022; 12:2626. [PMID: 35173213 PMCID: PMC8850439 DOI: 10.1038/s41598-022-06453-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/31/2022] [Indexed: 12/12/2022] Open
Abstract
The central sensitization inventory (CSI) evaluates the central sensitization (CS)-related symptoms associated with increased pain sensitivity. However, the CSI includes items that are not directly related to pain. In this study, 146 patients with pain were classified into subgroups by k-means cluster analysis based on the short form of the central sensitization inventory (CSI9) and pain scores. In addition, inter-group and multiple comparisons were performed to examine the characteristics of each group. As a result of this study, there were three subgroups (clusters 1, 2, and 3) in which the CSI9 and pain intensity were both low, moderate, and high, and one subgroup (cluster 4) in which only CSI9 was high and pain intensity was low. Two subgroups with high CSI9 scores but contrasting pain intensities (clusters 3 and 4) were extracted; the pattern of CS-related symptoms in these two groups was very similar, with no differences in most of the non-pain factors. It is necessary to consider these points when interpreting the clinical condition of a patient with pain when using the assessment of CS-related symptoms.
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Affiliation(s)
- Masayuki Koga
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2, Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan. .,Department of Rehabilitation, Kyowakai Hospital, Osaka, Japan.
| | - Hayato Shigetoh
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2, Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Yoichi Tanaka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2, Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2, Umaminaka, Koryo-cho, Kitakatsuragi-gun, Nara, 635-0832, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
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Brownlie H, Speight N. Back to the Future? Immunoglobulin Therapy for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Healthcare (Basel) 2021; 9:1546. [PMID: 34828592 PMCID: PMC8623195 DOI: 10.3390/healthcare9111546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 11/20/2022] Open
Abstract
The findings of controlled trials on use of intravenous immunoglobulin G (IV IgG) to treat myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) are generally viewed as representing mixed results. On detailed review, a clearer picture emerges, which suggests that the potential therapeutic value of this intervention has been underestimated. Our analysis is consistent with the propositions that: (1) IgG is highly effective for a proportion of patients with severe and well-characterised ME/CFS; (2) responders can be predicted with a high degree of accuracy based on markers of immune dysfunction. Rigorous steps were taken in the research trials to record adverse events, with transient symptom exacerbation commonly experienced in both intervention and placebo control groups, suggesting that this reflected the impact of participation on people with an illness characterised by post-exertional symptom exacerbation. Worsening of certain specific symptoms, notably headache, did occur more commonly with IgG and may have been concomitant to effective treatment, being associated with clinical improvement. The findings emerging from this review are supported by clinical observations relating to treatment of patients with severe and very severe ME/CFS, for whom intramuscular and subcutaneous administration provide alternative options. We conclude that: (1) there is a strong case for this area of research to be revived; (2) pending further research, clinicians would be justified in offering a course of IgG to selected ME/CFS patients at the more severe end of the spectrum. As the majority of trial participants had experienced an acute viral or viral-like onset, we further suggest that IgG treatment may be pertinent to the care of some patients who remain ill following infection with SARS-CoV-2 virus.
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Affiliation(s)
- Helen Brownlie
- Independent Researcher and Former Local Government Officer, Social Policy and Research, Glasgow G2 4P, UK;
| | - Nigel Speight
- Paediatrician and Independent Researcher, Durham DH1 1QN, UK
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Zvolensky MJ, Kauffman BY, Bogiaizian D, Viana AG, Bakhshaie J, Peraza N. Worry among Latinx college students: relations to anxious arousal, social anxiety, general depression, and insomnia. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:529-536. [PMID: 31702977 PMCID: PMC7205584 DOI: 10.1080/07448481.2019.1686004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/21/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Latinx young adults in college (ages 18-25 years) are at a heightened risk for health disparities and there is a need to understand individual-based characteristics that are related to such health inequalities including anxiety, depression, and sleep disturbances. The cross-sectional current study investigated the role of worry in relation to anxious arousal, social anxiety, general depression, and insomnia among Latinx college students. Participants/Method: Participants included 401 (Mage = 21 years; SD =2.01; 83% female) Latinx students at a large, southwestern university. Results: Results indicated that greater levels of worry were related to increased levels of anxious arousal, social anxiety, general depression, and insomnia. These findings were evident above and beyond variance accounted for by age, sex, and subjective social status. Conclusions: The current investigation suggests that elevated levels of worry among Latinx young adults may be associated with greater levels of anxiety, depression, and insomnia.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | | | - Daniel Bogiaizian
- Psychotherapeutic Area of “Asociación Ayuda”, Anxiety Disorders Clinic (Buenos Aires, Argentina)
| | - Andres G. Viana
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Natalia Peraza
- Department of Psychology, University of Houston, Houston, TX, USA
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Boulazreg S, Rokach A. The Lonely, Isolating, and Alienating Implications of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Healthcare (Basel) 2020; 8:E413. [PMID: 33092097 PMCID: PMC7711762 DOI: 10.3390/healthcare8040413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/27/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022] Open
Abstract
This article provides a narrative review on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) through a psychosocial lens and examines how this impairment affects its sufferers during adolescence and adulthood, as well as how it impacts family caregivers and healthcare professionals' mental health. Since there has been a lack of investigation in the literature, the primary psychosocial stressor that this review focuses on is loneliness. As such, and in an attempt to help establish a theoretical framework regarding how loneliness may impact ME/CFS, loneliness is comprehensively reviewed, and its relation to chronic illness is described. We conclude by discussing a variety of coping strategies that may be employed by ME/CFS individuals to address their loneliness. Future directions and ways with which the literature may investigate loneliness and ME/CFS are discussed.
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Affiliation(s)
- Samir Boulazreg
- Faculty of Education, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Ami Rokach
- Department of Psychology, York University, Toronto, ON M3J 1P3, Canada;
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Vink M, Vink-Niese F. Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies. Diagnostics (Basel) 2019; 9:diagnostics9040124. [PMID: 31547009 PMCID: PMC6963831 DOI: 10.3390/diagnostics9040124] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 01/31/2023] Open
Abstract
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome leads to severe functional impairment and work disability in a considerable number of patients. The majority of patients who manage to continue or return to work, work part-time instead of full time in a physically less demanding job. The prognosis in terms of returning to work is poor if patients have been on long-term sick leave for more than two to three years. Being older and more ill when falling ill are associated with a worse employment outcome. Cognitive behavioural therapy and graded exercise therapy do not restore the ability to work. Consequently, many patients will eventually be medically retired depending on the requirements of the retirement policy, the progress that has been made since they have fallen ill in combination with the severity of their impairments compared to the sort of work they do or are offered to do. However, there is one thing that occupational health physicians and other doctors can do to try and prevent chronic and severe incapacity in the absence of effective treatments. Patients who are given a period of enforced rest from the onset, have the best prognosis. Moreover, those who work or go back to work should not be forced to do more than they can to try and prevent relapses, long-term sick leave and medical retirement.
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Affiliation(s)
- Mark Vink
- Family and Insurance Physician, 1096 HZ Amsterdam, The Netherlands.
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Manning K, Garey L, Mayorga NA, Shepherd JM, Zvolensky MJ. The relation between fatigue severity and anxious arousal, negative affect, and emotion dysregulation among adult e-cigarette users. FATIGUE: BIOMEDICINE, HEALTH & BEHAVIOR 2019. [DOI: 10.1080/21641846.2019.1626059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Kara Manning
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | | | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Sciences, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
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Kanchanatawan B, Sriswasdi S, Maes M. Supervised machine learning to decipher the complex associations between neuro-immune biomarkers and quality of life in schizophrenia. Metab Brain Dis 2019; 34:267-282. [PMID: 30467771 DOI: 10.1007/s11011-018-0339-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/04/2018] [Indexed: 12/17/2022]
Abstract
Stable phase schizophrenia is characterized by altered patterning in tryptophan catabolites (TRYCATs) and memory impairments, which are associated with PHEMN (psychosis, hostility, excitation, mannerism and negative) and DAPS (depression, anxiety and physio-somatic) symptoms. This study was carried out to examine the association between TRYCAT patterning, memory impairments, psychopathological features and health-related quality of life (HR-QoL) in schizophrenia. The World Health Organization (WHO) QoL instrument-Abbreviated version (WHO-QoL-BREF), IgA/IgM responses to TRYCATs, cognitive tests, Scale for the Assessment of Negative Symptoms (SANS), Hamilton and Depression (HAMD) and Anxiety (HAMA) Rating Scales and the Fibromyalgia and Chronic Fatigue Syndrome Rating Scale (FF) were measured in 80 schizophrenia patients and 40 controls. Neural Network analysis shows that the total HR-Qol score is best predicted by (in descending order) HAMA, FF, HAMD, and psychosis. Partial least Squares (PLS) analysis shows that 56.7% of the variance in the WHO-QoL scores is explained by PHEMN / DAPS symptoms, while 64.3% of the variance in those symptoms is explained by TRYCAT patterning and episodic/semantic memory impairments. IgA responses to picolinic acid, xanthurenic acid and 3-hydroxy-kynurenine (all negatively) and anthranilic acid (positively) have highly significant indirect effects on WHO-QoL scores, which are completely mediated by cognitive impairments and PHEMN / DAPS symptoms. The results show that lowered HR-Qol in schizophrenia is strongly associated with noxious TRYCATs and that these effects are mediated by impairments in episodic / semantic memory and schizophrenia phenomenology, especially physio-somatic and anxiety symptoms. Mucosal activation of the TRYCAT pathway combined with a deficit in natural IgM isotype antibodies to TRYCATs determine cognitive impairments and DAPS/PHEMN symptoms, which together determine to a large extent lowered HR-QoL in schizophrenia.
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Affiliation(s)
- Buranee Kanchanatawan
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, 10330, Thailand
| | - Sira Sriswasdi
- Computational Molecular Biology Group, Chulalongkorn University, Pathum Wan, Bangkok, 10330, Thailand
- Research Affairs, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, 10330, Thailand
| | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Pathum Wan, Bangkok, 10330, Thailand.
- Department of Psychiatry, Medical University of Plovdiv, 4000, Plovdiv, Bulgaria.
- IMPACT Strategic Research Center, Barwon Health, Deakin University, PO Box 281, Geelong, Vic, 3220, Australia.
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McManimen SL, McClellan D, Stoothoff J, Jason LA. Effects of unsupportive social interactions, stigma, and symptoms on patients with myalgic encephalomyelitis and chronic fatigue syndrome. JOURNAL OF COMMUNITY PSYCHOLOGY 2018; 46:959-971. [PMID: 30311972 PMCID: PMC7944645 DOI: 10.1002/jcop.21984] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/26/2018] [Accepted: 03/26/2018] [Indexed: 05/29/2023]
Abstract
Prior research has found a heightened risk of suicide in patients with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). It is possible that a number of factors including stigma, unsupportive social interactions, and severe symptoms could lead to the development of depression, suicidal ideation, and heightened risk of suicide in this patient population. Prior studies have indicated that patients often report the legitimacy of their illness being questioned by family, friends, and even their physicians. This study aimed to determine whether stigma experienced, social support, symptomology, and functioning may be associated with depression and endorsement of suicidal ideation (SI) in patients with a self-reported diagnosis of ME or CFS. Findings indicated that participants that endorsed both SI and depression, in contrast to those that did not, experienced more frequent unsupportive social interactions in the form of blame for their illness, minimization of its severity, and social distancing from others. In addition, 7.1% of patients with ME and CFS endorsed SI but do not meet the criteria for clinical depression These findings highlight the importance of stigma and unsupportive social interactions as risk factors for suicidal thoughts or actions among patients with ME and CFS. Community psychologists have an important role to play in helping educate health care professionals and the public to these types of risk factors for patients marginalized by ME and CFS.
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Geraghty KJ, Blease C. Myalgic encephalomyelitis/chronic fatigue syndrome and the biopsychosocial model: a review of patient harm and distress in the medical encounter. Disabil Rehabil 2018; 41:3092-3102. [PMID: 29929450 DOI: 10.1080/09638288.2018.1481149] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective: Despite the growing evidence of physiological and cellular abnormalities in myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS), there has been a strong impetus to tackle the illness utilizing a biopsychosocial model. However, many sufferers of this disabling condition report distress and dissatisfaction following medical encounters. This review seeks to account for this discord.Methods: A narrative review methodology is employed to synthesize the evidence for potential iatrogenesis.Results: We identify seven potential modalities of iatrogenesis or harm reported by patients:difficulties in reaching an acceptable diagnosis;misdiagnosis, including of other medical and psychological conditions;difficulties in accessing the sick role, medical care and social support;high levels of patient dissatisfaction with the quality of medical care;negative responses to controversial therapies (cognitive behavioral therapy and graded exercise therapy);challenges to the patient narrative and experience;psychological harm (individual and collective distress).Conclusion: The biopsychosocial framework currently applied to ME/CFS is too narrow in focus and fails to adequately incorporate the patient narrative. Misdiagnosis, conflict, and harm are observable outcomes where doctors' and patients' perspectives remain incongruent. Biopsychosocial practices should be scrutinized for potential harms. Clinicians should consider adopting alternative patient-centred approaches.Implications for rehabilitationPatients with ME/CFS may report or experience one or more of the modalities of harms and distress identified in this review.It is important health and rehabilitation professionals seek to avoid and minimize harms when treating or assisting ME/CFS patients.There are conflicting models of ME/CFS; we highlight two divergent models, a biopsychosocial model and a biomedical model that is preferred by patients.The 'biopsychosocial framework' applied in clinical practice promotes treatments such as cognitive behavioral therapy and exercise therapy, however, the evidence for their success is contested and many patients reject the notion their illness is perpetuated by dysfunctional beliefs, personality traits, or behaviors.Health professionals may avoid conflict and harm causation in ME/CFS by adopting more concordant 'patient-centred' approaches that give greater prominence to the patient narrative and experience of illness.
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Affiliation(s)
- Keith J Geraghty
- Division of Health Services Research and Population Health, University of Manchester, Centre for Primary Care, Manchester, UK
| | - Charlotte Blease
- Department of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Stormorken E, Jason LA, Kirkevold M. Factors impacting the illness trajectory of post-infectious fatigue syndrome: a qualitative study of adults' experiences. BMC Public Health 2017; 17:952. [PMID: 29237442 PMCID: PMC5729235 DOI: 10.1186/s12889-017-4968-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/29/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Post-infectious fatigue syndrome (PIFS), also known as post-viral fatigue syndrome, is a complex condition resulting in physical, cognitive, emotional, neurological, vocational and/or role performance disabilities in varying degrees that changes over time. The needs for health care resources are high, and costly, as is the economic burden on the affected individuals. Many factors may impact the trajectory, and frequently PIFS develops into a chronic condition. Health professionals lack understanding and knowledge, which results in delayed diagnosis, lack of recognition, appropriate treatment, support and practical help. The aim of our study was to explore, from the perspective of persons who had lived with PIFS for four years following an outbreak of Giardia l. induced enteritis, factors that may have impacted their illness trajectory and how these factors had played a role during different phases. METHODS In this retrospective exploratory qualitative study a group of 26 affected adults between 26 and 59 years old were selected for in-depth interviews. A maximum variation sample was recruited from a physician-diagnosed cohort of persons with PIFS enrolled at a tertiary outpatient fatigue clinic. The interviews were audio-recorded, transcribed verbatim and subjected to qualitative content analysis. RESULTS Unhelpful and helpful factors were associated with the healthcare system, health professionals and the affected persons were experienced as having an impact on the trajectory. External impacting factors which are related to the health care system, providers and the social security system are misdiagnosis, trivialization of symptoms, unhelpful advice, delayed diagnosis and lack of appropriate help. Internal impacting factors related to the affected individuals were lack of knowledge, overestimating functional capacity, assuming the condition will pass, ignoring body signals and denial. A model of impacting factors in each phase of the trajectory is presented. CONCLUSION Unmet needs may result in unnecessary disability and high societal and personal costs. Enhanced knowledge of impacting factors in each phase of the trajectory may contribute to more timely and tailored health care services and less use of health services. Increased functional capacity, improved health and ability to work or study may reduce the societal costs and the economic burden for the affected individuals.
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Affiliation(s)
- Eva Stormorken
- Department of Nursing Science, Institute of Health and Society, University of Oslo, P.O.B. 1130 Blindern, 0318 Oslo, Norway
| | - Leonard A. Jason
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Suite 3100, Chicago, IL 60614 USA
| | - Marit Kirkevold
- Department of Nursing Science, Institute of Health and Society, University of Oslo, P.O.B. 1130 Blindern, 0318 Oslo, Norway
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McManimen SL, Devendorf AR, Brown AA, Moore BC, Moore JH, Jason LA. Mortality in Patients with Myalgic Encephalomyelitis and Chronic Fatigue Syndrome. FATIGUE : BIOMEDICINE, HEALTH & BEHAVIOR 2016; 4:195-207. [PMID: 28070451 PMCID: PMC5218818 DOI: 10.1080/21641846.2016.1236588] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/12/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a dearth of research examining mortality in individuals with myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Some studies suggest there is an elevated risk of suicide and earlier mortality compared to national norms. However, findings are inconsistent as other researchers have not found significant increases in all-cause mortality for patients. OBJECTIVE This study sought to determine if patients with ME or CFS are reportedly dying earlier than the overall population from the same cause. METHODS Family, friends, and caregivers of deceased individuals with ME or CFS were recruited through social media, patient newsletters, emails, and advocate websites. This study analyzed data including cause and age of death for 56 individuals identified as having ME or CFS. RESULTS The findings suggest patients in this sample are at a significantly increased risk of earlier all-cause (M = 55.9 years) and cardiovascular-related (M = 58.8 years) mortality, and they had a directionally lower mean age of death for suicide (M = 41.3 years) and cancer (M =66.3 years) compared to the overall U.S. population [M = 73.5 (all-cause), 77.7 (cardiovascular), 47.4 (suicide), and 71.1 (cancer) years of age]. CONCLUSIONS The results suggest there is an increase in risk for earlier mortality in patients with ME and CFS. Due to the small sample size and over-representation of severely ill patients, the findings should be replicated to determine if the directional differences for suicide and cancer mortality are significantly different from the overall U.S. population.
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McManimen SL, Sunnquist ML, Jason LA. Deconstructing post-exertional malaise: An exploratory factor analysis. J Health Psychol 2016; 24:188-198. [PMID: 27557649 DOI: 10.1177/1359105316664139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Post-exertional malaise is a cardinal symptom of myalgic encephalomyelitis and chronic fatigue syndrome. There are two differing focuses when defining post-exertional malaise: a generalized, full-body fatigue and a muscle-specific fatigue. This study aimed to discern whether post-exertional malaise is a unified construct or whether it is composed of two smaller constructs, muscle fatigue and generalized fatigue. An exploratory factor analysis was conducted on several symptoms that assess post-exertional malaise. The results suggest that post-exertional malaise is composed of two empirically different experiences, one for generalized fatigue and one for muscle-specific fatigue.
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Parslow R, Patel A, Beasant L, Haywood K, Johnson D, Crawley E. What matters to children with CFS/ME? A conceptual model as the first stage in developing a PROM. Arch Dis Child 2015; 100:1141-7. [PMID: 26453575 PMCID: PMC4680202 DOI: 10.1136/archdischild-2015-308831] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/14/2015] [Accepted: 08/04/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) is relatively common and disabling. Research is hampered because current patient-reported outcome measures (PROMs) do not capture outcomes that are important to children with CFS/ME. AIM The aim of this study was to explore the aspects of life and health outcomes that matter to children with CFS/ME. METHODS Twenty-five children with CFS/ME were interviewed (11 males, 14 females; mean age 12.9 years (SD 2.2), range 8-17). Twelve were trial participants interviewed during the trial and 13 were recruited as part of a follow-up qualitative study. Parents were present in 19 interviews with their children. Three mothers participated in a focus group. All the interviews and the focus group were audio-recorded and transcribed. Data were analysed thematically using techniques of constant comparison. NVivo was used to structure and categorise data in a systematic way. RESULTS Children identified four key themes (health outcome domains): 'symptoms' that fluctuated, which caused an unpredictable reduction in both 'physical activity' and 'social participation' all of which impacted on 'emotional well-being'. These domains were influenced by both 'management' and 'contextual factors', which could be positive and negative. The relationship between healthcare and school was considered pivotal. CONCLUSIONS Children's descriptions helped to inform a conceptual model that is necessary to develop a new paediatric CFS/ME PROM. Doctors need to be aware of how children conceptualise CFS/ME; the relationship between healthcare and school is fundamental to ameliorate the impact of CFS/ME. TRIAL REGISTRATION NUMBER ISRCTN81456207.
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Affiliation(s)
- Roxanne Parslow
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Aarti Patel
- Psychology Department, University of Bath, Bath, UK
| | - Lucy Beasant
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Kirstie Haywood
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Debbie Johnson
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
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Wise S, Ross A, Brown A, Evans M, Jason L. An assessment of fatigue in patients with postural orthostatic tachycardia syndrome. J Health Psychol 2015; 22:733-742. [DOI: 10.1177/1359105315613624] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Individuals with postural orthostatic tachycardia syndrome share many symptoms with those who have chronic fatigue syndrome; one of which is severe fatigue. Previous literature found that those with chronic fatigue syndrome experience many forms of fatigue. The goal of this study was to investigate whether individuals with postural orthostatic tachycardia syndrome also experience multidimensional fatigue and whether these individuals can be clustered into subgroups based on the types of fatigue they endorse. A convenience sample of 138 participants (aged 14–29) with postural orthostatic tachycardia syndrome completed questionnaires that assessed fatigue, brain fog symptom severity, activities that improve brain fog, and brain fog-related disability. An exploratory factor analysis was conducted on the Fatigue Types Questionnaire, and a three-factor solution was produced. Factor scores were then used to cluster the patients into groups using a TwoStep cluster analysis. This resulted in two clusters, a high severity group and a low severity group. The clusters were then compared on a number of items related to symptom expression. Individuals within the more severe cluster had significantly more brain fog at the beginning and end of the survey when compared to cluster two. Those in the more severe cluster also described more activity impairment as well as more frequent, more severe, and more debilitation from postural orthostatic tachycardia syndrome and brain fog. The findings of the factor analysis suggest that patients with postural orthostatic tachycardia syndrome experience fatigue as a multidimensional construct and they also can be subgrouped based on symptom severity.
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Nyland H, Næss H, Nyland M. Kartlegging av funksjon ved kronisk utmattelsessyndrom. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:1540-1. [DOI: 10.4045/tidsskr.15.0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Krishnan V, Sood M, Chadda RK. Caregiver burden and disability in somatization disorder. J Psychosom Res 2013; 75:376-80. [PMID: 24119946 DOI: 10.1016/j.jpsychores.2013.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Revised: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Authors assessed disability and caregiver burden in patients with somatization disorder (SOM-D), and compared it with that in patients with schizophrenia and chronic depression. METHODS The sample consisted of 30 patients diagnosed as SOM-D as per ICD 10 Diagnostic Criteria for Research (ICD-10-DCR), and 30 age- and gender-matched patients each of schizophrenia and depression, who served as comparison groups. Disability and caregiver burden were assessed using WHO's Disability Assessment Schedule (WHO-DAS) and the Family Burden Assessment Schedule (FBAS) respectively. Functioning and severity of illness were assessed on the Global Assessment of Functioning scale (GAF) and Clinical Global Impression scale (CGI) respectively. RESULTS Severity of illness in patients with SOM-D was comparable to that in the comparison groups. Patients with SOM-D scored higher on total disability on WHO-DAS than the patients with schizophrenia and depression, though scores on family burden were comparable. Disability in patients with SOM-D was more in females, less educated, older and those working at home, compared to the other demographic groups. CONCLUSION Patients with SOM-D suffer considerable disability due to illness and impose significant burden on their caregivers, comparable to that seen in severe mental illnesses like schizophrenia and chronic depression.
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Affiliation(s)
- Vijay Krishnan
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
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Taylor RR, Kielhofner GW, Abelenda J, Colantuono K, Fong T, Heredia R, Kulkarni S, Vazquez E. An approach to persons with chronic fatigue syndrome based on the model of human occupation: part one, impact on occupational performance and participation. Occup Ther Health Care 2013; 17:47-61. [PMID: 23944637 DOI: 10.1080/j003v17n02_04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Chronic fatigue syndrome (CFS) is a prevalent and disabling condition that involves six or more months of unexplained fatigue severe enough to interfere with previous levels of occupational, educational, and/or social performance. The fatigue is accompanied by at least four of eight additional physical and cognitive symptoms (Fukuda et al., 1994). This paper conceptualizes the multiple factors that affect occupational adaptation in persons with CFS. The Model of Human Occupation (MOHO) if used as a framework for understanding the synergistic and evolving relationships between motivation, roles, habits, performance capacities, and the environment as they influence individuals with CFS. Examples from the literature, autobiographical accounts, and from practice experience are used to illustrate the experience and impact of CFS on everyday life.
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Affiliation(s)
- Renee R Taylor
- Department of Occupational Therapy (M/C 811), University of Illinois at Chicago, 1919 W. Taylor Street, Chicago, IL, 60612
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Son CG. A case of chronic fatigue syndrome improved by traditional Korean medicine. Integr Med Res 2013; 2:32-35. [PMID: 28664051 PMCID: PMC5481679 DOI: 10.1016/j.imr.2013.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 01/18/2013] [Accepted: 01/21/2013] [Indexed: 11/04/2022] Open
Abstract
The etiology of chronic fatigue syndrome (CFS) is unknown and no conventional medicine therapies are available. This report presents a clinical case of a patient suffering from CFS who was cured by traditional Korean medicine. A 33-year-old female patient had to take time off work because of terrible fatigue symptoms that did not respond to conventional treatments. Her disorder was significantly reduced by herbal medicine, acupuncture, and moxibustion. Changes in fatigue severity were evaluated using a visual analog scale (VAS) and a numerical rating scale (NRS). NRS and VAS scores decreased from 70 and 8.1 to 37 and 3.7, respectively, during 3 months. This case reveals the therapeutic potential of traditional Korean medicine for CFS and fatigue-associated disorders.
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Affiliation(s)
- Chang-Gue Son
- Liver and Immunology Research Center, Daejeon Oriental Hospital of Daejeon University Daejeon, Korea
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Arroll MA, Howard A. 'The letting go, the building up, [and] the gradual process of rebuilding': identity change and post-traumatic growth in myalgic encephalomyelitis/chronic fatigue syndrome. Psychol Health 2012; 28:302-18. [PMID: 22963543 DOI: 10.1080/08870446.2012.721882] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim of this study was to explore the phenomenon of identity change and subsequent post-traumatic growth (PTG) in individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Ten participants (average illness duration 7.4 years) were interviewed (average length, 79 minutes) via a semi-structured interview schedule and verbatim transcriptions were analysed with interpretative phenomenological analysis. The four superordinate themes revealed were 'comparisons of past to present self: "you have to be someone else, and you have to live with that''', 'the effect of social isolation on identity and subsequent insights into others' behaviours', 'contemplation of future and identity: ''where do I go from here?"', and 'PTG: "the letting go, the building up, [and] the gradual process of rebuilding"'. These themes outlined the experiences of those with ME/CFS as they underwent changes in identity due to the limitations the condition imposed on activities and roles, understanding others' behaviours after a period of isolation, the comparison of the past self with the present self and finally, the positive growth that was noted by two of the interviewees with regards to a new 'true' self. Despite the distressing and unpredictable nature of ME/CFS, it appears that individuals with this disorder can experience personal growth.
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Dansie E, Heppner P, Furberg H, Goldberg J, Buchwald D, Afari N. The comorbidity of self-reported chronic fatigue syndrome, post-traumatic stress disorder, and traumatic symptoms. PSYCHOSOMATICS 2012; 53:250-7. [PMID: 22296866 PMCID: PMC3343192 DOI: 10.1016/j.psym.2011.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND Data from primary care and community samples suggest higher rates of post-traumatic stress disorder (PTSD) among individuals with chronic fatigue syndrome (CFS). OBJECTIVE This study investigated the co-occurrence of CFS, PTSD, and trauma symptoms and assessed the contribution of familial factors to the association of CFS with lifetime PTSD and current traumatic symptoms. METHOD Data on lifetime CFS and PTSD, as measured by self-report of a doctor's diagnosis of the disorder, and standardized questionnaire data on traumatic symptoms, using the Impact of Events Scale (IES), were obtained from 8544 female and male twins from the community-based University of Washington Twin Registry. RESULTS Lifetime prevalence of CFS was 2% and lifetime prevalence of PTSD was 4%. Participants who reported a history of PTSD were over eight times more likely to report a history of CFS. Participants with scores ≥ 26 on the IES were over four times more likely to report CFS than those who had scores ≤ 25. These associations were attenuated but remained significant after adjusting for familial factors through within-twin pair analyses. CONCLUSION These results support similar findings that a lifetime diagnosis of CFS is strongly associated with both lifetime PTSD and current traumatic symptoms, although familial factors, such as shared genetic and environmental contributions, played a limited role in the relationship between CFS, PTSD, and traumatic symptoms. These findings suggest that future research should investigate both the familial and the unique environmental factors that may give rise to both CFS and PTSD.
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Affiliation(s)
- Elizabeth Dansie
- Center for Clinical and Epidemiological Research, University of Washington, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Pia Heppner
- Department of Psychiatry, University of California, San Diego, CA; San Diego VA Healthcare System, San Diego, CA
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, NY
| | - Jack Goldberg
- Department of Epidemiology, University of Washington & Vietnam Era Twin Registry, Seattle, WA
| | - Dedra Buchwald
- Department of Medicine, University of Washington, Seattle, WA
| | - Niloofar Afari
- Department of Psychiatry, University of California, San Diego, CA; San Diego VA Healthcare System, San Diego, CA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA
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25
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Castell BD, Kazantzis N, Moss-Morris RE. Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: A meta‐analysis. ACTA ACUST UNITED AC 2011. [DOI: 10.1111/j.1468-2850.2011.01262.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Double-blind, randomized study of the effects of influenza vaccination on the specific antibody response and clinical course of patients with chronic fatigue syndrome. Can J Infect Dis 2011; 11:267-73. [PMID: 18159300 DOI: 10.1155/2000/602862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/1999] [Accepted: 11/26/1999] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine whether influenza immunization is associated with early side effects, a deleterious impact on the illness course and depressed antibody response in patients with chronic fatigue syndrome (CFS). DESIGN Prospective, randomized, double-blind, placebo controlled trial. CFS patients and healthy volunteers filled out a questionnaire on immunization side effects and had hemagglutination-inhibiting (HI) antibody titres measured pre- and three weeks after immunization. CFS patients completed symptom and function questionnaires before and during the six-week, postimmunization period. SETTING Ambulatory care. POPULATION STUDIED Convenience sample of 40 CFS patients fulfilling the Centers for Disease Control and Prevention criteria and 21 demographically matched healthy volunteers. INTERVENTIONS CFS patients were randomly selected to receive commercially available whole virus influenza vaccine (n=19) or an injection of saline placebo (n=21). Healthy volunteers received vaccine only. MAIN RESULTS As a group, immunized CFS patients had lower geometric mean HI antibody rises than healthy volunteers (P<0.001). However, there was no difference in the rates of fourfold titre rises, and immunization did achieve a probably protective titre (1:32 or greater) in most CFS patients. No difference could be detected between immunized and placebo CFS patients in immunization side effects, although CFS patients as a group reported four times as many side effects as healthy volunteers. Further, in the six weeks following immunization, placebo and immunized CFS patients did not demonstrate any differences in terms of functioning, symptom severity and sleep disturbance. CONCLUSIONS In patients with CFS, influenza immunization is safe, not associated with any excess early reactions, and stimulates an immunizing response comparable with that of healthy volunteers.
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Poppe C, Crombez G, Hanoulle I, Vogelaers D, Petrovic M. Mental quality of life in chronic fatigue is associated with an accommodative coping style and neuroticism: a path analysis. Qual Life Res 2011; 21:1337-45. [DOI: 10.1007/s11136-011-0048-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2011] [Indexed: 10/15/2022]
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Association between generic and disease-specific quality of life questionnaires and mobility and balance among women with osteoporosis and vertebral fractures. Aging Clin Exp Res 2011; 23:296-303. [PMID: 22067372 DOI: 10.1007/bf03324967] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND AIMS The aims of this study were to assess correlations between two health-related quality of life (HRQOL) measurements, the Quality of Life Questionnaire issued by the European Foundation for Osteoporosis (QUALEFFO- 41) and the total score of The General Health Questionnaire (GHQ-20) in a population of women living at home with well-established osteoporosis and at least one vertebral fracture, as well as the internal consistency and floor and ceiling effects of these measurements. Also examined were the mean values of these measurements, to ascertain whether they were significantly different for the group consisting of 75% of the women with the best performance on mobility and balance, compared with the other participants. METHODS Across-sectional study of 89 women aged 60 years or more, evaluated by QUALEFFO-41 (consisting of one total score and five section scores), GHQ-20 (one total score), maximum speed and Functional Reach (FR). RESULTS Cronbach's alpha coefficient for measurements of HRQOL ranged from 0.61 to 0.92. Significant correlations between 'QUALEFFO- 41: total score' and 'GHQ-20: total score' were 0.49, and between 'GHQ-20: total score' and section scores of 'QUALEFFO-41' 0.28-0.63. Those in the 75% group with the highest maximum walking speed or longest distance on FR reported significantly better disease-specific HRQOL than the others, with poorer results on these tests. CONCLUSIONS Disease-specific and generic HRQOL instruments are not redundant when applied together, and the disease-specific 'QUALEFFO-41' and generic GHQ-20 measure different aspects of HRQOL.
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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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Drachler MDL, Leite JCDC, Hooper L, Hong CS, Pheby D, Nacul L, Lacerda E, Campion P, Killett A, McArthur M, Poland F. The expressed needs of people with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. BMC Public Health 2009; 9:458. [PMID: 20003363 PMCID: PMC2799412 DOI: 10.1186/1471-2458-9-458] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 12/11/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to review systematically the needs for support in managing illness and maintaining social inclusion expressed by people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) METHODS: We carried out a systematic review of primary research and personal ('own') stories expressing the needs of people with CFS/ME. Structured searches were carried out on Medline, AMED, CINAHL, EMBASE, ASSIA, CENTRAL, and other health, social and legal databases from inception to November 2007. Study inclusion, data extraction and risk of bias were assessed independently in duplicate. Expressed needs were tabulated and a conceptual framework developed through an iterative process. RESULTS Thirty two quantitative and qualitative studies, including the views of over 2500 people with CFS/ME with mainly moderate or severe illness severity, met the inclusion criteria. The following major support needs emerged: 1) The need to make sense of symptoms and gain diagnosis, 2) for respect and empathy from service providers, 3) for positive attitudes and support from family and friends, 4) for information on CFS/ME, 5) to adjust views and priorities, 6) to develop strategies to manage impairments and activity limitations, and 7) to develop strategies to maintain/regain social participation. CONCLUSIONS Although the studies were heterogeneous, there was consistent evidence that substantial support is needed to rebuild lives. Gaining support depends - most importantly - on the ability of providers of health and social care, colleagues, friends and relatives, and those providing educational and leisure services, to understand and respond to those needs.
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Affiliation(s)
| | | | - Lee Hooper
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Chia Swee Hong
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Derek Pheby
- Plaishetts House, Hadspen, Castle Carey, BA7 7LR, UK
| | - Luis Nacul
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Eliana Lacerda
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Peter Campion
- Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
| | - Anne Killett
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Maggie McArthur
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Fiona Poland
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
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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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Dickson A, Toft A, O'Carroll RE. Neuropsychological functioning, illness perception, mood and quality of life in chronic fatigue syndrome, autoimmune thyroid disease and healthy participants. Psychol Med 2009; 39:1567-1576. [PMID: 19144216 DOI: 10.1017/s0033291708004960] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This study attempted to longitudinally investigate neuropsychological function, illness representations, self-esteem, mood and quality of life (QoL) in individuals with chronic fatigue syndrome (CFS) and compared them with both healthy participants and a clinical comparison group of individuals with autoimmune thyroid disease (AITD). METHOD Neuropsychological evaluation was administered at two time points, five weeks apart. Twenty-one individuals with CFS, 20 individuals with AITD and 21 healthy participants were matched for age, pre-morbid intelligence, education level and socio-economic status (SES). All groups also completed measures of illness perceptions, mood, self-esteem and QoL at both time points. RESULTS The CFS group showed significantly greater impairment on measures of immediate and delayed memory, attention and visuo-constructional ability, and reported significantly higher levels of anxiety and depression. After controlling for the effects of mood, the CFS group still demonstrated significant impairment in attention. The CFS group also reported significantly lower self-reported QoL than the AITD and healthy participants. In terms of illness perceptions, the AITD group believed that their condition would last longer, that they had more treatment control over their condition, and reported less concern than the CFS group. CONCLUSIONS These results suggest that the primary cognitive impairment in CFS is attention and that this is not secondary to affective status. The lower treatment control perceptions and greater illness concerns that CFS patients report may be causally related to their affective status.
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Affiliation(s)
- A Dickson
- School of Health and Social Sciences, Napier University, Edinburgh, UK.
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Reynolds F, Vivat B, Prior S. Women's experiences of increasing subjective well-being in CFS/ME through leisure-based arts and crafts activities: A qualitative study. Disabil Rehabil 2009; 30:1279-88. [DOI: 10.1080/09638280701654518] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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34
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Taylor RR, Kielhofner GW. Work-related impairment and employment-focused rehabilitation options for individuals with chronic fatigue syndrome: A review. J Ment Health 2009. [DOI: 10.1080/09638230500136571] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Creavin ST, Dunn KM, Mallen CD, Nijrolder I, van der Windt DAWM. Co-occurrence and associations of pain and fatigue in a community sample of Dutch adults. Eur J Pain 2009; 14:327-34. [PMID: 19540139 DOI: 10.1016/j.ejpain.2009.05.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 04/30/2009] [Accepted: 05/16/2009] [Indexed: 12/27/2022]
Abstract
Widespread pain and chronic fatigue are common in the general population. Previous research has demonstrated co-occurrence of syndromes that are associated with pain and fatigue (fibromyalgia and chronic fatigue syndrome), but there is limited existing data on the co-occurrence of these symptoms in general. This study investigates the co-occurrence of pain and fatigue, and characterises people with these symptoms individually, and in combination. A postal questionnaire was sent to a random sample of 4741 community dwelling Dutch adults registered with five general practices. There were 2447 participants (adjusted response=53.5%). Persistent fatigue was reported by 60% of the 451 subjects with chronic widespread pain. Chronic widespread pain was reported by 33% of the 809 responders with persistent fatigue. Anxiety and depression were more common in subjects who reported both symptoms than those who reported either one or neither. Participants who had chronic disease, high body mass index, low activity levels or did not perceive ability to influence health had higher adjusted odds of reporting both symptoms (but not one alone) than subjects not having these characteristics. Pain and fatigue occur more often than would be expected by chance and there are a number of reasons for this. Clinicians should be aware that co-occurrence of the symptoms is common, especially in people who have high BMI or chronic disease, and that people with both symptoms are often anxious or depressed. Further work should address longitudinal associations of pain and fatigue.
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Affiliation(s)
- Samuel T Creavin
- Arthritis Research Campaign National Primary Care Centre, Keele University, Staffordshire ST5 5BG, United Kingdom.
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Gibson PR, Vogel VM. Sickness-related dysfunction in persons with self-reported multiple chemical sensitivity at four levels of severity. J Clin Nurs 2009; 18:72-81. [PMID: 19120734 DOI: 10.1111/j.1365-2702.2008.02439.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine quality of life outcome for persons who self-report chemical sensitivity, often referred to as multiple chemical sensitivity. BACKGROUND Multiple chemical sensitivity is poorly understood with few providers specialising in its treatment. This lack of treatment and the ubiquity of chemicals engender severe life impacts such as job loss, financial loss, social isolation and even homelessness for persons who experience these sensitivities. DESIGN Survey. METHOD We examined chemical incitants, symptoms and sickness-related behavioural dysfunction as measured by the Sickness Impact Profile in 254 persons self-identified with multiple chemical sensitivity. RESULTS Chemicals rated as causing the most symptomatology in respondents were pesticide, formaldehyde, fresh paint, new carpet, diesel exhaust, perfume and air fresheners. The five highest rated symptoms in this sample were tiredness/lethargy, difficulty concentrating, muscle aches, memory difficulties and long-term fatigue. Overall mean Sickness Impact Profile score was 25.25%, showing serious impairment, with the most serious dysfunction in the categories of work (55.36%), alertness behaviour (53.45%) and recreation and pastimes (45.20%). CONCLUSION Multiple chemical sensitivity is an important health care issue because it often includes serious dysfunction, is poorly understood by providers and poses extensive financial and treatment obstacles for those who experience it. RELEVANCE TO CLINICAL PRACTICE Persons with multiple chemical sensitivity seek medical treatment in a variety of contexts and informed providers can both avoid iatrogenic harm due to medical exposures and provide any possible treatment for the chemical sensitivities. Understanding the impact of the health condition is crucial to communicate with and treat persons who experience the sensitivities.
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Affiliation(s)
- Pamela Reed Gibson
- Department of Psychology, James Madison University, Harrisonburg, VA 28807, USA.
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The association between early outcome, health-related quality of life, and survival following elective open-heart surgery. J Cardiovasc Nurs 2008; 23:432-42. [PMID: 18728516 DOI: 10.1097/01.jcn.0000317453.10521.5b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We investigated the impact of perioperative complications on patients' health-related quality of life (HRQL) and intermediate-term survival after cardiac surgery. Improved results for cardiac surgery are well demonstrated in low rates of operative mortality and morbidity. However, the association between perioperative morbid events, HRQL at 1 year, and survival is unclear. We performed a prospective study among 836 elective cardiac surgery patients to assess the impact of perioperative outcomes on survival and HRQL at 1 year. Health-related quality of life was generated using the 20-item short-form questionnaire. Kaplan-Meier and life-table estimates were used to examine the relationship of HRQL at 1-year and intermediate-term survival. All HRQL domains were statistically improved at 1 year, with the highest gains in general health perception (+19.4%) and the least gains in social (+5.1%) and mental (+5.1%) domains. Patients experiencing 1 or more perioperative complication or increased length of stay reported similar HRQL scores as patients with no complications. Patients with negative changes in social (94.5% vs 99.2%, P < .001) and general health perception (99.4% vs 95.5%, P < .001) domains showed a reduced survival compared with patients with positive HRQL gains at 2 to 5 years after surgery. Perioperative complications had minimal or no effect on HRQL at 1 year after cardiac surgery.
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Dancey CP, Friend J. Symptoms, impairment and illness intrusiveness–their relationship with depression in women with CFS/ME. Psychol Health 2008; 23:983-99. [DOI: 10.1080/08870440701619957] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Christine. P. Dancey
- a School of Psychology, University of East London , Romford Road, London, E15 4LZ
| | - Julie Friend
- a School of Psychology, University of East London , Romford Road, London, E15 4LZ
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Dickson A, Knussen C, Flowers P. ‘That was my old life; it's almost like a past-life now’: Identity crisis, loss and adjustment amongst people living with Chronic Fatigue Syndrome. Psychol Health 2008; 23:459-76. [DOI: 10.1080/08870440701757393] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Donner-Banzhoff N, Schrappe M, Lelgemann M. [A guide to the critical reflection of health services research studies]. ACTA ACUST UNITED AC 2008; 101:463-71. [PMID: 18183867 DOI: 10.1016/j.zgesun.2007.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Proponents of evidence-based medicine have developed a framework for the critical appraisal of clinical studies. Though this framework is generally accepted, a universal standard for health services research is not yet available. While clinical research evaluates the efficacy and effectiveness of medical interventions, the remit of health services research is to investigate the actual delivery of care in a given health care system. Here, we propose six criteria for the critical appraisal of work published in the field of health services research: the research question, the validity of the study design, the indicators used, the data source, the audience being addressed and the interests behind a study should all be considered when discussing health services research studies. Ideally, health services research should be an integral part of research efforts including basic as well as clinical research.
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Affiliation(s)
- Norbert Donner-Banzhoff
- Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität, Marburg.
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Bondini S, Kallman J, Dan A, Younoszai Z, Ramsey L, Nader F, Younossi ZM. Health-related quality of life in patients with chronic hepatitis B. Liver Int 2007; 27:1119-25. [PMID: 17845541 DOI: 10.1111/j.1478-3231.2007.01558.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED Although chronic hepatitis C (CH-C) has consistently been shown to impair patients' health-related quality of life (HRQL), the impact of chronic hepatitis B (CH-B) on HRQL has not been fully explored. AIM Compare HRQL between patients with CH-B, CH-C, primary biliary cirrhosis (PBC) and healthy controls. DESIGN Three HRQL questionnaires [Chronic Liver Disease Questionnaire (CLDQ), Short Form 36 (SF-36) and the Health Utility Index (HUI Mark-2 and Mark-3)] were administered prospectively. Additional clinical and laboratory data and normative data for healthy individuals, were available. ANALYSIS Scores were compared using analysis of variance and multiple regression. RESULTS One hundred and forty-six patients with CH-B, CH-C and PBC were included [mean age 47.1 years (+/-11.6), 41% female, 33% cirrhosis]. CH-C and PBC patients scored the lowest on all CLDQ, SF-36 and HUI domains compared with CH-B patients and healthy controls. CH-B patients had scores similar to the healthy population, measured by most CLDQ and SF-36 scales. However, the HUI scores for CH-B patients showed more impairment than population norms. Having CH-B and not having cirrhosis were predictive of utility and HRQL scores in multivariate models. CONCLUSIONS CH-B patients have better HRQL than CH-C, PBC and population norms. CH-B patients' overall utility scores are lower than population norms.
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Affiliation(s)
- Silvia Bondini
- Center for Liver Diseases, Inova Fairfax Hospital, Fairfax, VA, USA
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42
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Dan AA, Kallman JB, Wheeler A, Younoszai Z, Collantes R, Bondini S, Gerber L, Younossi ZM. Health-related quality of life in patients with non-alcoholic fatty liver disease. Aliment Pharmacol Ther 2007; 26:815-20. [PMID: 17767465 DOI: 10.1111/j.1365-2036.2007.03426.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The relative impact of non-alcoholic fatty liver disease (NAFLD) on health-related quality of life (HRQL) compared to other chronic liver diseases has not been fully explored. AIM To compare the domain scores of the 29-item Chronic Liver Disease Questionnaire (CLDQ) for patients with NAFLD to those with chronic hepatitis B and chronic hepatitis C. METHODS A HRQL questionnaire, CLDQ, was routinely administered to patients attending a liver clinic. Additional clinical and laboratory data were obtained on patients with NAFLD, chronic hepatitis B, and chronic hepatitis C from our quality of life database. Scores for each of the six CLDQ domains were compared using one-way anova and multiple regression. RESULTS Complete data were available for 237 patients. NAFLD patients scored lowest on multiple CLDQ domains. Based on the bivariate data, NAFLD patients have the poorest HRQL, followed by chronic hepatitis C and chronic hepatitis B patients. Multivariate analysis showed that some specific domain score correlations remained significant for NAFLD diagnosis, cirrhosis, gender, and body mass index. CONCLUSION NAFLD patients had significantly lower quality of life scores compared with patients with hepatitis B or hepatitis C on multiple CLDQ domains, suggesting that HRQL was severely impaired in patients with NAFLD.
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Affiliation(s)
- A A Dan
- Center for Liver Diseases, INOVA Fairfax Hospital, and INOVA Outcomes Research Program, INOVA Health System, Falls Church, VA, USA
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Logie H, Crombez G, Evers AWM. De Ziekte Cognitie Lijst bij chronische onverklaarde lichamelijke klachten. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/bf03071769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Taylor RR, Thanawala SG, Shiraishi Y, Schoeny ME. Long-term outcomes of an integrative rehabilitation program on quality of life: a follow-up study. J Psychosom Res 2006; 61:835-9. [PMID: 17141674 DOI: 10.1016/j.jpsychores.2005.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2004] [Accepted: 08/24/2005] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the long-term effects of an integrative rehabilitation program on the overall quality of life of individuals with chronic fatigue syndrome (CFS). METHODS This study utilized a within-subjects, repeated measures cohort design. Twenty-three subjects diagnosed with CFS attended eight sessions of an illness-management group followed by 7 months of goal-oriented, individualized counseling that occurred once weekly for 30 min per session. Quality of life was assessed at five time points (baseline, following the group phase, following the one-on-one phase, and 4 and 12 months following program completion). RESULTS A within-subjects repeated measures ANOVA revealed significant increases in overall quality of life for up to 1 year following program completion [F(4, 21)=23.5, P<.001]. CONCLUSIONS Definitive conclusions about program efficacy are limited by design issues. However, findings suggest that the program may have led to improvement in quality of life for up to 1 year following program completion.
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Affiliation(s)
- Renee R Taylor
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Van Damme S, Crombez G, Van Houdenhove B, Mariman A, Michielsen W. Well-being in patients with chronic fatigue syndrome: the role of acceptance. J Psychosom Res 2006; 61:595-9. [PMID: 17084136 DOI: 10.1016/j.jpsychores.2006.04.015] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 04/06/2006] [Accepted: 04/25/2006] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Research in chronic pain patients has shown that accepting the chronic nature of their illness is positively related to quality of life. The aim of this study was to investigate whether acceptance is also associated with better well-being in patients suffering from chronic fatigue syndrome (CFS). METHODS Ninety-seven patients completed a battery of questionnaires measuring fatigue, functional impairment, psychological distress, and acceptance. RESULTS Results indicated that acceptance has a positive effect upon fatigue and psychological aspects of well-being. More specifically, acceptance was related to more emotional stability and less psychological distress, beyond the effects of demographic variables, and fatigue severity. CONCLUSION We suggest that promoting acceptance in patients with CFS may often be more beneficial than trying to control largely uncontrollable symptoms.
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Affiliation(s)
- Stefaan Van Damme
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
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Michielsen HJ, Drent M, Peros-Golubicic T, De Vries J. Fatigue Is Associated With Quality of Life in Sarcoidosis Patients. Chest 2006; 130:989-94. [PMID: 17035429 DOI: 10.1378/chest.130.4.989] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Fatigue is one of the core symptoms of sarcoidosis patients. Although it is known that fatigue affects quality of life (QOL) in other patient groups, this relationship has never been studied in sarcoidosis patients using a reliable and valid fatigue scale and a multidimensional QOL instrument. The present cross-sectional study among sarcoidosis patients attempts to gain more insight into this relationship. METHODS One hundred forty-five sarcoidosis patients of an outpatient pulmonary clinic in Zagreb, Croatia, completed the Fatigue Assessment Scale (FAS) and QOL scale (World Health Organization Quality of Life Assessment Instrument-100) between January 2002 and May 2004. Clinical parameters were derived from the patients' medical files. RESULTS Tired patients reported a worse QOL in all domains and fatigue negatively predicted all QOL domains by means of multivariate regression analyses (beta values ranging from - 0.31 to - 0.64, all p < 0.001). Corticosteroid use was not a predictor of QOL. Diffusion capacity of the lung for carbon monoxide was the only clinical parameter associated with a QOL domain, namely level of independence. CONCLUSIONS Fatigue was related to all QOL domains. Furthermore, standard clinical parameters were not associated with fatigue or QOL, except for level of independence. If these results were to be replicated in a prospective study, fatigue as measured by the FAS could be a good indicator of QOL in sarcoidosis patients.
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Affiliation(s)
- Helen J Michielsen
- Department of Psychology and Health, Medical Psychology, Tilburg University, Room P507a, PO Box 90153, 5000 LE Tilburg, the Netherlands.
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47
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Query M, Taylor RR. Linkages between goal attainment and quality of life for individuals with chronic fatigue syndrome. Occup Ther Health Care 2006; 19:3-22. [PMID: 23927776 DOI: 10.1080/j003v19n04_02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Goal setting was the cornerstone of a rehabilitation program for people with chronic fatigue syndrome. This study examines the relationship between goal attainment and quality of life. Participants (N = 47) set goals over eight supportive and educational group sessions. Group members reported goal progress and confidence level for goal attainment. Using a forward, stepwise linear regression analysis, goal attainment emerged as the only significant predictor of quality of life improvement (B = 0.234, 95% CI for B: 0.050 to 0.419, SE = 0.091, β = 0.372, p <. 05) independently of fatigue severity, symptom severity, and comorbid psychiatric diagnosis.
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Taylor RR, Jason LA, Shiraishi Y, Schoeny ME, Keller J. Conservation of resources theory, perceived stress, and chronic fatigue syndrome: Outcomes of a consumer-driven rehabilitation program. Rehabil Psychol 2006. [DOI: 10.1037/0090-5550.51.2.157] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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49
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Martin LM, Dan AA, Younossi ZM. Measurement of health-related quality of life in patients with chronic liver disease. Liver Transpl 2006; 12:22-3. [PMID: 16382455 DOI: 10.1002/lt.20575] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Rakib A, White PD, Pinching AJ, Hedge B, Newbery N, Fakhoury WK, Priebe S. Subjective quality of life in patients with chronic fatigue syndrome. Qual Life Res 2005; 14:11-9. [PMID: 15789937 DOI: 10.1007/s11136-004-1693-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to (1) assess Subjective Quality of Life (SQOL) of patients with Chronic Fatigue Syndrome (CFS) using a generic concept and to compare the findings with those in groups with mental disorders and healthy subjects, and (2) investigate whether and, if so, to what extent socio-demographic and clinical variables predict SQOL in CFS patients. Seventy-three patients diagnosed with CFS were randomly selected and interviewed from two specialised clinics. CFS was diagnosed using the Oxford Criteria. SQOL was assessed on the Manchester Short Assessment of Quality of Life (MANSA) and Health-Related Quality of Life (HRQOL) on the Medical Outcome Study Short-Form 36 (MOS) SF-36. A battery of mood and symptom questionnaires, including the Symptom Checklist Questionnaire (SCL-90-R), was administered to assess various aspects of symptomatology as potential predictor variables. Multiple regression analyses were conducted to identify predictors of SQOL. Overall, SQOL was low in CFS patients and less favourable than in groups with mental disorders and healthy subjects. Satisfaction was particularly low with life as a whole, leisure activities and financial situation. Whilst SQOL was only moderately correlated with HRQOL, the SCL-90-R score, especially SCL-90-R Depression scale score, was the best predictor of SQOL explaining 35% of the variance. HRQOL and generic SQOL appear distinct despite some overlap. The findings underline that SQOL is significantly disrupted in CFS patients. Depressive symptoms are statistically the strongest 'predictor' of SQOL, although the direction of the relationship is not established. These data suggest that treatment of depression associated with CFS, regardless of causation, could help to improve SQOL in CFS patients.
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Affiliation(s)
- A Rakib
- Queen Mary's School of Medicine and Dentistry, Newham Centre for Mental Health, London, UK
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