Prevalence of chronic fatigue among Chinese adults in Hong Kong: a population-based study

Stilbenes-enriched peanut sprouts alleviated physical fatigue via regulating interactions of nutrients-microbiota-metabolites revealed by multi-omics analysis

In this study, the antifatigue effect and mechanism of peanut sprouts were explored. BALB/c mice divided into three groups (control, dark and UV-C) were respectively supplemented with a normal diet, peanut sprouts (dark germination) added diet and stilbenes-enriched peanut sprouts (UV-C radiated germination) added diet. Results showed that swimming time and levels of blood glucose and antioxidant enzymes significantly increased, while contents of triglyceride and malondialdehyde notably decreased by peanut sprout supplementation. Besides, combined analysis of gut microbiota gene sequencing and targeted metabolomics of fecal metabolites revealed that peanut sprout supplementation up-regulated abundances and metabolic transformations of Catenibacillus, Odoribacter, Prevotellaceae-UCG-001 and Butyricicoccus while it down-regulated the abundance of Parabacteroides. Consequently, contents of sebacic acid, azelaic acid, suberic acid, heptanoic acid, pimelic acid, aminoadipic acid and mono-phenolics notably increased, which were markedly correlated with the antifatigue effect. Compared with the dark group, the swimming time, glutathione peroxidase activity, methylmalonylcarnitine content and abundances of Butyricicoccus, Catenibacillus and Lachnospiraceae NK4A136 were higher in the UV-C group, while opposite results were obtained for the levels of triglyceride, malondialdehyde, alpha-linolenic acid, gamma-linolenic acid, 10Z-heptadecenoic acid and palmitelaidic acid. Overall, peanut sprout supplementation could alleviate fatigue by modulating gut microbiota composition to promote fatty acid oxidation and lysine and stilbene catabolism to increase energy supply and regulate redox balance. UV-C-radiated peanut sprout supplementation could alleviate fatigue more effectively by up-regulating abundances of Butyricicoccus, Catenibacillus and Lachnospiraceae NK4A136 to promote long-chain fatty acid oxidation and catabolism of flavonoids and stilbenes efficiently.

Cross-sectional and prospective association between internet addiction and risk of fatigue among Chinese college students

Severe internet addiction (IA) is associated with a higher risk of musculoskeletal pain, but whether there is a significant prospective association between IA and fatigue is unclear. This study aimed to examine the association between IA and fatigue level among Chinese college students. A cross-sectional (n = 1011) and prospective study (n = 653) was conducted to examine the association between IA and risk of fatigue. IA was measured using Young internet addiction test. Fatigue level was evaluated using the Chalder fatigue scale. Multivariate logistic regression analyses showed a cross-sectional association between IA and the risk of fatigue. The odds ratios (95% CIs) of fatigue for normal, mild, and moderate to severe groups were 1.00 (reference), 1.88 (1.20, 2.95), and 5.60 (3.33, 9.42), respectively (P for trend: <0.001). Similarly, multivariate logistic regression analyses also revealed a significant prospective relationship between IA and the risk of fatigue during the 1-year follow-up period. The odds ratios (95% CIs) of fatigue for normal, mild, and moderate to severe groups were 1.00 (reference), 1.56 (0.67, 3.67), and 3.29 (1.08, 10.04), respectively (P for trend: 0.046). Our findings indicate that IA is positively related to risk of fatigue among Chinese college students. Further interventional studies are needed to explore the causality underlying the effects of IA on fatigue.

Stressful Life Events and Chronic Fatigue Among Chinese Government Employees: A Population-Based Cohort Study

Background

Currently, evidence on the role of stressful life events in fatigue among the Chinese working adults is lacking. This study aimed at exploring the prospective associations between stressful life events and chronic fatigue among Chinese government employees.

Methods

From January 2018 to December 2019, a total of 16206 government employees were included at baseline and they were followed-up until May 2021. A digital self-reported questionnaire platform was established to collect information on participants' health and covariates. Life events were assessed by the Life Events Scale (LES), fatigue was assessed by using a single item, measuring the frequency of its occurrence. Binary logistic regression analysis was used for the data analysis.

Results

Of the included 16206 Chinese government employees at baseline, 60.45% reported that they experienced negative stressful life events and 43.87% reported that they experienced positive stressful life events over the past year. Fatigue was reported by 7.74% of the sample at baseline and 8.19% at follow-up. Cumulative number of life events at baseline, and cumulative life events severity score at baseline were positively associated with self-reported fatigue at follow up, respectively. After adjusting sociodemographic factors, occupational factors and health behavior related factors, negative life events at baseline (OR: 2.06, 95% CI: 1.69–2.51) were significantly associated with self-reported fatigue at follow-up. Some specific life events including events related to work and events related to economic problems were significantly associated with self-reported fatigue. Specifically, work stress (OR = 1.76, 95%CI: 1.45–2.13), as well as not satisfied with the current job (OR = 1.95, 95%CI: 1.58–2.40), in debt (OR = 1.75, 95%CI: 1.40–2.17) were significantly associated with self-reported fatigue. The economic situation has improved significantly (OR = 0.62, 95%CI: 0.46–0.85) at baseline was significantly associated with lower incidence of self-reported fatigue.

Conclusion

Negative stressful life events were associated with fatigue among Chinese government employees. Effective interventions should be provided to employees who have experienced negative stressful life events.

Validation of the Traditional Chinese Version of the Pittsburgh Fatigability Scale for Older Adults

OBJECTIVES

The Pittsburgh Fatigability Scale (PFS) is a self-administered 10-item tool to measure physical and mental fatigability in older adults. The aim of the current study was to validate the psychometric properties of the traditional Chinese version of PFS (TC-PFS).

METHODS

We recruited 114 community-dwellingolder adults, where 35 were diagnosed with late-life depression (LLD), 26 with mild cognitive impairment (MCI), and 53 were cognitively normal (CN) from a larger community study of older adults. Statistical analyses were done separately for TC-PFS Physical and Mental subscales. Factor analysis was used for reliability, Cronbach's alpha for internal consistency, Pearson's correlation for construct validity, and group comparison for discriminative validity.

RESULTS

Factor analysis revealed a two-factor structure for both the TC-PFS Physical and Mental subscales with high reliability (α = 0.89 and 0.89, respectively). Patients with LLD had the highest PFS scores, with 80.0% and 82.9% classified as having greater physical and mental fatigability. For concurrent validity, we found moderate associations with the vitality and physical functioning subscales of the 36-Item Short Form Health Survey. For convergent validity, TC-PFS showed moderate association with emotional-related psychometrics, particularly for the Physical subscale in those with LLD. In contrast, TC-PFS Mental subscale showed correlations with cognitive function, particularly in the MCI group.

CONCLUSIONS

Our results indicate that the TC-PFS is a valid instrument to measure perceived physical and mental fatigability in older Taiwanese adults.Clinical implications: Perceived fatigability reflects the underlying physical, mental or cognitive function in older adults with or without depression.

Nationwide epidemiological characteristics of chronic fatigue syndrome in South Korea

Background

Chronic fatigue syndrome (CFS) is a long-term disabling illness accompanied by medically unexplained fatigue. This study aimed to explore the epidemiological characteristics of CFS in South Korea.

Methods

Using the nationwide medical records provided by the Korean Health Insurance Review & Assessment Service (HIRA), we analyzed the entire dataset for CFS patients diagnosed by physicians in South Korea from January 2010 to December 2020.

Results

The annual mean incidence of CFS was estimated to be 44.71 ± 6.10 cases per 100,000 individuals [95% CI: 40.57, 48.76], and the prevalence rate was 57.70 ± 12.20 cases per 100,000 individuals [95% CI: 49.40, 65.79]. These two rates increased by 1.53- and 1.94-fold from 2010 to 2020, respectively, and showed an increasing trend with aging and an approximately 1.5-fold female predominance.

Conclusions

This study is the first to report the nationwide epidemiological features of CFS, which reflects the clinical reality of CFS diagnosis and care in South Korea. This study will be a valuable reference for studies of CFS in the future.

A Botanical Product Containing Cistanche and Ginkgo Extracts Potentially Improves Chronic Fatigue Syndrome Symptoms in Adults: A Randomized, Double-Blind, and Placebo-Controlled Study

Dietary therapy may be beneficial in alleviating symptoms of chronic fatigue syndrome (CFS), a disorder that is characterized by extreme fatigue and other symptoms, but the cause of which remains unclear. The aim of this study was to evaluate the protective effect of a botanical product containing cistanche (Cistanche tubulosa [Schenk] Wight) and ginkgo (Ginkgo biloba L.) extracts on adults with CFS in a randomized, double-blind, placebo-controlled clinical trial. A total of 190 subjects (35-60 years old, non-obese) with CFS were randomized to receive one tablet of a low dose (120-mg ginkgo and 300-mg cistanche), a high dose (180-mg ginkgo and 450-mg cistanche) or a placebo once daily for 60 days. Blood samples and responses on the Chalder fatigue scale (CFQ 11), the World Health Organization's quality of life questionnaire (WHOQOL), and the sexual life quality questionnaire (SLQQ) were collected at baseline and post-intervention. CFS symptoms of impaired memory or concentration, physical fatigue, unrefreshing sleep, and post-exertional malaise were significantly improved (p < 0.001) in both of the treatment groups. The botanical intervention significantly decreased physical and mental fatigue scores of CFQ 11 and improved WHOQOL and SLQQ scores of the subjects (p < 0.01). Levels of blood ammonia and lactic acid in the treatment groups were significantly lower than those of the placebo group (low-dose: p < 0.05; high-dose: p < 0.01). In addition, the change in lactic acid concentration was negatively associated with the severity of CFS symptoms (p = 0.0108) and was correlated with the change in total physical fatigue score of the CFQ (p = 0.0302). Considering the trivial effect size, the results may lack clinical significance. In conclusion, this botanical product showed promising effects in ameliorating the symptoms of CFS. Clinical trials with improved assessment tools, an expanded sample size, and an extended follow-up period are warranted to further validate the findings. Clinical Trial Registration: https://clinicaltrials.gov/, identifier: NCT02807649.

Prevalence of fatigue and associated factors among clinically stable patients with chronic obstructive pulmonary disease in Guizhou, China: A cross-sectional study

INTRODUCTION

Fatigue is important, but ignored symptom among COPD patients. At present, there is very limited data are available for the prevalence of fatigue and its risk factors among COPD patients in China.

OBJECTIVE

The purpose of this study is to determine the prevalence of fatigue and to investigate the factors associated with fatigue among clinically stable patients with COPD in China.

METHODS

This is a cross-sectional study using a questionnaire to collect data on sociodemographic, related to COPD disease, and exercise habits. Multidimensional fatigue inventory (MFI-20) was used to assess the prevalence of fatigue. Independent samples t test, bivariate correlation, one-way ANOVA test, and test for several independent samples were used to compare the sociodemographic factors with MFI-20 scores of COPD patients. Multiple stepwise linear regression was performed to estimate influencing factors related to the MFI-20 of COPD patients.

RESULTS

Among the participants, the prevalence of fatigue was 88.62%. Negative correlations were found between FEV_1% and multidimensional fatigue (r = -0.40, p < 0.01), general fatigue (r = -0.20, p < 0.05), reduced activity (r = -0.20, p < 0.01), and physical fatigue (r = -0.10, p < 0.01). A multiple linear regression models revealed that age (p < 0.05), BMI (p < 0.05), FEV₁ % (p < 0.01), exercise times (p < 0.01), and the times of hospitalization in the past 12 months (p < 0.05) were associated with multidimensional fatigue scores.

CONCLUSIONS

The prevalence of fatigue is high among clinically stable patients with COPD. Keeping exercise, prevention obesity, and exacerbation should be an effective intervention strategy to reduce COPD-related fatigue.

The Role of Prevention in Reducing the Economic Impact of ME/CFS in Europe: A Report from the Socioeconomics Working Group of the European Network on ME/CFS (EUROMENE)

This report addresses the extent to which there may be scope for preventive programmes for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and, if so, what economic benefits may accrue from the implementation of such programmes. We consider the economic case for prevention programmes, whether there is scope for preventive programmes for ME/CFS, and what are the health and economic benefits to be derived from the implementation of such programmes. We conclude that there is little scope for primary prevention programmes, given that ME/CFS is attributable to a combination of host and environmental risk factors, with host factors appearing to be most prominent, and that there are few identified modifiable risk factors that could be the focus of such programmes. The exception is in the use of agricultural chemicals, particularly organophosphates, where there is scope for intervention, and where Europe-wide programmes of health education to encourage safe use would be beneficial. There is a need for more research on risk factors for ME/CFS to establish a basis for the development of primary prevention programmes, particularly in respect of occupational risk factors. Secondary prevention offers the greatest scope for intervention, to minimise diagnostic delays associated with prolonged illness, increased severity, and increased costs.

Physical activity in periods of social distancing due to COVID-19: a cross-sectional survey

Physical inactivity and sedentary behavior are associated with poor physical and mental health. The article aims to assess the changes in the habits of the Brazilian participants engaged in physical activities in relation to their practices, due the measures of social distancing during the COVID-19 epidemic in 2020. The secondary objective was to describe their levels of anxiety and depression. The questionnaire used in this online survey included demographic information, questions about self-perceptions of the impact of the COVID-19 in the life routines and the 14-item Hospital Anxiety Depression Scale. A total of 1,613 adults completed the questionnaire between May 11 and 15, 2020. Of those, 79.4% reported that the measures to contain the epidemic had any impact on their physical activities, and many had to interrupt or decrease the frequency of their practices. Participants who felt a higher impact of quarantine on their physical activities tend to have higher prevalence of anxiety and depression symptoms. Individuals who practiced physical activities reported that social distance had a high influence on their practices. Furthermore, changes in these habits are associated with high levels of poor mental health.

The mediation role of work-life balance stress and chronic fatigue in the relationship between workaholism and depression among Chinese male workers in Hong Kong

BACKGROUND AND AIMS

Few studies have tested the underlying mechanisms in the association between workaholism and depression. This study aims to investigate the potential mediation effects of work-life balance stress and chronic fatigue and depression among Chinese male workers in Hong Kong.

METHODS

A population-based study among male workers in Hong Kong (n = 1,352) was conducted. The self-reported scales of assessing workaholism, work-life balance stress, chronic fatigue and depressive symptoms were included in the questionnaire. Path analysis was conducted to test the proposed mediation model.

RESULTS

Workaholism was directly and indirectly associated with depression through work-life balance stress and chronic fatigue, respectively. The association between work-life balance stress and chronic fatigue was statistically significant in the correlation analysis but not in the path analysis. As high as 30.5% of the participants were classified as having probable chronic fatigue, while 8.4% of the participants were classified as having probable depression.

DISCUSSION

Workaholism is a stressor that may induce negative consequences on well-being and health among male workers in Hong Kong. Interventions to help workers with time and stress management and fatigue reduction may be beneficial for their mental health. Theoretical and practical implications are discussed.

Effects of job conditions, occupational stress, and emotional intelligence on chronic fatigue among Chinese nurses: a cross-sectional study

Purpose: Nurses are undertaking considerable emotional and physical work, which may lead to unrecoverable fatigue. This study aimed to evaluate the level of chronic fatigue and explore its associated factors among Chinese nurses in the hope of providing scientific evidence for fatigue-reduction strategies.

Methods: This cross-sectional study was carried out in Liaoning Province, China in 2018. The study recruited 700 nurses and collected 566 effective respondents. Chronic fatigue, demographic factors, job conditions, and emotional intelligence were assessed through questionnaires. Chronic fatigue was assessed with the Fatigue Scale 11, occupational stress with the Effort–Reward Imbalance Questionnaire, and emotional intelligence with the Wong and Law Emotional Intelligence Scale. Hierarchical multiple regression was used to explore factors related to chronic fatigue and to test the moderating effect of emotional intelligence on the association between occupational stress and chronic fatigue. Simple slope analysis was conducted to visualize the interaction.

Results: The mean score of chronic fatigue among the Chinese nurses was 17.14±6.16. Being married, having long weekly work time, working night shifts, and discontent with the nurse–patient relationship were positively associated with chronic fatigue. Effort:reward ratio, overcommitment, and emotional intelligence were important factors related to chronic fatigue. Emotional intelligence played a moderating role in the relationship between the effort:reward ratio and chronic fatigue. When emotional intelligence was higher, the effect of the effort:reward ratio on chronic fatigue became weaker.

Conclusion: Most nurses surveyed in China might have relatively high levels of chronic fatigue. Our results highlight the importance of interventions on these factors for the reduction of fatigue among nurses in China. Providing more opportunities and support and developing emotional intelligence are crucial strategies to reduce chronic fatigue among nurses in China.

Biotransformation profiles from a cohort of chronic fatigue women in response to a hepatic detoxification challenge

Chronic fatigue, in its various manifestations, frequently co-occur with pain, sleep disturbances and depression and is a non-communicable condition which is rapidly becoming endemic worldwide. However, it is handicapped by a lack of objective definitions and diagnostic measures. This has prompted the World Health Organization to develop an international instrument whose intended purpose is to improve quality of life (QOL), with energy and fatigue as one domain of focus. To complement this objective, the interface between detoxification, the exposome, and xenobiotic-sensing by nuclear receptors that mediate induction of biotransformation-linked genes, is stimulating renewed attention to a rational development of strategies to identify the metabolic profiles in complex multifactorial conditions like fatigue. Here we present results from a seven-year study of a cohort of 576 female patients suffering from low to high levels of chronic fatigue, in which phase I and phase II biotransformation was assessed. The biotransformation profiles used were based on hepatic detoxification challenge tests through oral caffeine, acetaminophen and acetylsalicylic acid ingestion coupled with oxidative stress analyses. The interventions indicated normal phase I but increased phase II glucuronidation and glycination conjugation. Complementarity was indicated between a fatigue scale, medical symptoms and associated energy-related parameters by application of Chi-square Automatic Interaction Detector (CHAID) analysis. The presented study provides a cluster of data from which we propose that multidisciplinary inputs from the combination of a fatigue scale, medical symptoms and biotransformation profiles provide the rationale for the development of a comprehensive laboratory instrument for improved diagnostics and personalized interventions in patients with chronic fatigue with a view to improving their QOL.

Jin's three-needle acupuncture technique for chronic fatigue syndrome: a study protocol for a multicentre, randomized, controlled trial

Background

With an unclear pathomechanism, no confirmed treatment regimen has been established for chronic fatigue syndrome (CFS). Acupuncture is applied as an alternative therapy for CFS. As a kind of acupuncture therapy, Jin’s three-needle acupuncture (JTN) has been applied to treat CFS. However, few large-sample randomised controlled trials on JTN treatment for CFS have been reported. We designed this study to evaluate the efficacy and safety of JTN treatment for CFS.

Method/design

This study is a multicentre, single-blind, randomised controlled trial. Patients who meet the inclusion criteria will be recruited and randomly assigned to either the JTN treatment group or the basic acupuncture group. Both interventions will be conducted for five consecutive days per week and last for 2 weeks. The primary outcome is the effective rate based on the 14-item Fatigue Scale (FS-14) score. Other outcome measures include the Fatigue Assessment Scale (FAI), the Depression Status Inventory (DSI), and the Self-rating Anxiety Scale (SAS). Plasma adrenocorticotropic hormone (ACTH), plasma cortisol, and serum levels of IL-2 and IFN-γ will also be measured in this study. Adverse events will be observed and recorded for the safety evaluation.

Discussion

This study may help to identify the efficacy and safety of JTN acupuncture treatment for CFS.

Trial registration

Chinese Clinical Trial Registry, ID: ChiCTR-IOR-17011009. Registered on 29 March 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3243-5) contains supplementary material, which is available to authorized users.

Qigong exercise for chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is often overlooked, has unclear etiology and no effective cure except some symptomatic treatments. Additionally, most people with CFS do not seek medical attention. Qigong exercise, an ancient Eastern body-mind-spirit practice, has been long practiced in Chinese communities and may powerfully trigger the self-healing process. Using full baseline data (n=1409), the average Hong Kong CFS respondent was found to be female, married, 42.5yo, highly educated and employed full-time, experiencing sleep disturbance (~95%), anxiety (>80%), and depressive symptoms (68%). Here, we summarized our previous studies to evaluate the potential of Qigong as a complementary and alternative therapy for CFS. Two randomized controlled trials were conducted (RCT1 n₁=137, RCT2 n₂=150). In both trials, extensive online questionnaires allowed individuals with CFS-like illness (i.e., symptoms match CFS, yet without clinical confirmation) to be identified. RCT1 included a 5-week intervention. The intervention in RCT2 was 8weeks. In RCT1 Qigong group had reduced fatigue (P<0.001) and depressive symptoms (P=0.002), and improved telomerase activity (P=0.029). An effective practice regimen was identified (≥3 days/week, at ≥30min/session). Methods were slightly adjusted for RCT2, which replicated RCT1 findings, and further documented improved subjective sleep quality (P=0.008) and adiponectin levels (P<0.05). A significant dose-response relationship was founded. Thus, Qigong exercise should be recognized as a possible standalone therapy and self-management skill in CFS. Strategies are needed to increase motivation for regular practice and to explore its possibility of self-management skill in brain health. Further clarity would come from studies comparing Qigong with other physical exercises.

Oxidative Stress is a Convincing Contributor to Idiopathic Chronic Fatigue

The linkage between oxidative stress and idiopathic chronic fatigue (ICF) has not been explored in detail. This study thoroughly compared the serum levels of biomarkers for oxidative stress and antioxidants from 103 subjects with ICF (20 men and 83 women) to those of 82 healthy volunteers (27 men and 55 women). Oxidative parameters, which included reactive oxygen species (ROS), malondialdehyde (MDA) and F2-isoprotan, and tumor necrosis factor-alpha (TNF-α) were significantly elevated, while antioxidant parameters, which included total antioxidant activity (TAC), catalase, superoxide dismutase, SOD and GSH activity, were decreased compared to those of healthy subjects (by approximately 1.2- to 2.3-fold, p < 0.05 or 0.01). Our results confirmed that oxidative stress is a key contributor in the pathophysiology of ICF, and firstly explored the features of oxidative stress parameters in ICF subjects compared to a healthy population.

Fatigue among South African adolescents living with HIV: Is the Chalder Fatigue Questionnaire a suitable measure and how common is fatigue?

Evidence suggests that HIV-infected adolescents experience elevated levels of fatigue that impacts their functioning at school and other important aspects of their lives. Yet, fatigue has not been measured amongst this population group. In this cross-sectional, mixed-methods study we explored the psychometric properties of the 11-item Chalder Fatigue Questionnaire (CFQ) amongst 134 South African adolescents (11-18 years old) receiving antiretroviral therapy (ART) in the Western Cape. Using the Likert scoring method for the CFQ, the mean total score was 14.89 (SD=3.83) and about a quarter (n=33, 24.63%) of adolescents scored ≥ 18, indicating problematic levels of fatigue. The CFQ demonstrated good internal consistency with a Cronbach's alpha of 0.83 (0.84, with item 11 deleted), which is comparable to other validation studies. On the first iteration of the principal component analysis (PCA) with a Varimax rotation, three factors accounted for 59.15% of the variance. However, the third factor consisted of one item only which we chose to remove from the analysis. On the second iteration of the PCA, a two factor solution was retained that accounted for 54.24% of the variance. The first factor, 'Physical fatigue', represented the first eight items on the scale. The second factor 'Mental fatigue' represented items nine and ten. The CFQ also demonstrated modest content and construct validity. The CFQ is a short, easy-to-use and cost-effective measure of fatigue, and demonstrates reliability and validity amongst a South African sample of adolescents. Given the high rate of fatigue amongst our participants, we recommend that future interventions be developed to reduce fatigue among HIV-infected adolescents, which may ultimately lead to improvements in school performance and social functioning. Future research may include test-retest reliability of the CFQ in order to show stability over time.

Validity and reliability of the Traditional Chinese version of the Multidimensional Fatigue Inventory in general population

Background

Fatigue is a common symptom in the general population and has a substantial effect on individuals’ quality of life. The Multidimensional Fatigue Inventory (MFI) has been widely used to quantify the impact of fatigue, but no Traditional Chinese translation has yet been validated. The goal of this study was to translate the MFI from English into Traditional Chinese (‘the MFI-TC’) and subsequently to examine its validity and reliability.

Methods

The study recruited a convenience sample of 123 people from various age groups in Taiwan. The MFI was examined using a two-step process: (1) translation and back-translation of the instrument; and (2) examination of construct validity, convergent validity, internal consistency, test-retest reliability, and measurement error. The validity and reliability of the MFI-TC were assessed by factor analysis, Spearman rho correlation coefficient, Cronbach’s alpha coefficient, intraclass correlation coefficient (ICC), minimal detectable change (MDC), and Bland-Altman analysis. All participants completed the Short-Form-36 Health Survey Taiwan Form (SF-36-T) and the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) concurrently to test the convergent validity of the MFI-TC. Test-retest reliability was assessed by readministration of the MFI-TC after a 1-week interval.

Results

Factor analysis confirmed the four dimensions of fatigue: general/physical fatigue, reduced activity, reduced motivation, and mental fatigue. A four-factor model was extracted, combining general fatigue and physical fatigue as one factor. The results demonstrated moderate convergent validity when correlating fatigue (MFI-TC) with quality of life (SF-36-T) and sleep disturbances (PSQI) (Spearman's rho = 0.68 and 0.47, respectively). Cronbach’s alpha for the MFI-TC total scale and subscales ranged from 0.73 (mental fatigue subscale) to 0.92 (MFI-TC total scale). ICCs ranged from 0.85 (reduced motivation) to 0.94 (MFI-TC total scale), and the MDC ranged from 2.33 points (mental fatigue) to 9.5 points (MFI-TC total scale). The Bland-Altman analyses showed no significant systematic bias between the repeated assessments.

Conclusions

The results support the use of the Traditional Chinese version of the MFI as a comprehensive instrument for measuring specific aspects of fatigue. Clinicians and researchers should consider interpreting general fatigue and physical fatigue as one subscale when measuring fatigue in Traditional Chinese-speaking populations.

Rheumatism and chronic fatigue, the two facets of post-chikungunya disease: the TELECHIK cohort study on Reunion island

Prolonged fatigue is increasingly reported among chikungunya virus (CHIKV)-infected populations. We investigated the relationships between CHIKV exposure, long-lasting rheumatic musculoskeletal pain (LRMSP) and chronic fatigue. 1094 participants (512 CHIKV seropositive and 582 seronegative) of the TELECHIK population-based cohort were analysed considering the duration of the manifestations throughout an average 2-year follow-up. Weighted prevalence rates and prevalence ratios for LRMSP, idiopathic chronic fatigue (ICF), and chronic fatigue syndrome (CFS)-like illness, both latter syndromes adapted from Centers for Disease Control (CDC)-1994/Fukuda criteria, were compared. Population attributable fractions (PAF) were estimated to assess the contribution of CHIKV infection to each of the three phenotypes. Among 362 adult subjects who had reported either rheumatic pain or fatigue at the onset of the infection, weighted prevalence rates of LRMSP, ICF and CFS-like illness were respectively of 32.9%, 38.7% and 23.9%, and of 8.7%, 8.5% and 7.4% among initially asymptomatic peers (P < 0.01, respectively). Each of the three outcomes was highly attributable to chikungunya (PAF of 43.2%, 36.2% and 41.0%, respectively). In the sub-cohort of CHIKV-infected subjects, LRMSP, ICF and CFS-like illness, which overlapped in 70%, accounted for 53% of the chronic manifestations. In addition to rheumatic disease, chronic fatigue could be considered in caring for patients with chronic chikungunya disease.

A correlation between sickness or injury within two weeks, chronic diseases and fatigue among adults aged 18-45 years

To investigate the prevalence of fatigue, the relationship between sickness or injury within two weeks, chronic diseases and fatigue among adults aged 18-45 years. Thousand five hundred and seventy nine individuals were included in this cross-sectional study. The Chalder Fatigue Scale (CFS) was used to assess fatigue defined as CFS score ≥4. The prevalence of fatigue was 25% in this study. Our results showed that only sickness or injury within two weeks (odds ratio [OR]: 2.440) and chronic diseases (OR: 1.727) were significantly related to fatigue. Moreover, their ORs for fatigue remained the same in all models (binary logistic regression models with adjusting for demographic and health-related characteristics one by one). In conclusion, fatigue was prevalent among adults aged 18-45 years. Sickness or injury within two weeks and chronic diseases were the risk factors for fatigue independent of demographic and health-related characteristics.

High fatigue and its associations with health and work related factors among female medical personnel at 54 hospitals in Zhuhai, China

The present study aimed to investigate the prevalence of fatigue and determine factors associated with fatigue in female medical personnel. Based on a cross-sectional study, a total of 1608 female medical personnel at 54 hospitals in Zhuhai, China were recruited by a multistage stratified cluster sampling method. The Symptoms Checklist-90-Revised and Chalder Fatigue Scale were used to assess psychiatric symptoms and fatigue, respectively. Data regarding demographic, health, and work related variables were also collected. Multivariate logistic regression model was constructed to determine the influencing factors of fatigue. Approximately 83% of participants had experienced fatigue in the past week. The risk of fatigue was higher in aged 30-39 years old than older or younger participants; Longer sleeping time predicted a lower prevalence of fatigue (OR = .35), while tense physician-patient relationship predicted a higher prevalence of fatigue (OR = 1.77). Depression (OR = 1.76) and anxiety (OR = 1.96) were found related to fatigue. Additionally, fatigue was associated with marital status, occupation, health related factors (exercise, regular diet, and health status), and work related factors (hospital rank and turnover intention). These study findings might facilitate development and implementation of targeted interventions and preventive measures.

Familiality and Heritability of Fatigue in an Australian Twin Sample

Familial factors have previously been implicated in the etiology of fatigue, of which a significant proportion is likely attributable to genetic influences. However, family studies have primarily focused on chronic fatigue syndrome, while univariate twin studies have investigated broader fatigue phenotypes. The results for similar fatigue phenotypes vary between studies, particularly with regard to sex-specific contributions to the heritability of the traits. Therefore, the current study aims to investigate the familiality and sex-specific effects of fatigue experienced over the past few weeks in an older Australian population of 660 monozygotic (MZ) twin pairs, 190 MZ singleton twins, 593 dizygotic (DZ) twin pairs, and 365 DZ singleton twins. Higher risks for fatigue were observed in MZ compared to DZ co-twins of probands with fatigue. Univariate heritability analyses indicated fatigue has a significant genetic component, with a heritability (h2) estimate of 40%. Sex-specific effects did not significantly contribute to the heritability of fatigue, with similar estimates for males (h2= 41%, 95% CI [18, 62]) and females (h2= 40%, 95% CI [27, 52]). These results indicate that fatigue experienced over the past few weeks has a familial contribution, with additive genetic factors playing an important role in its etiology.

Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Fatigue is not only a familiar symptom in our daily lives, but also a common ailment that affects all of our bodily systems. Several randomized controlled trials (RCTs) have proven Tai Chi to be beneficial for patients suffering from fatigue, however conclusive evidence is still lacking. A systematic review and meta-analysis was performed on all RCTs reporting the effects of Tai Chi for fatigue.

METHODS

In the end of April 2016, seven electronic databases were searched for RCTs involving Tai Chi for fatigue. The search terms mainly included Tai Chi, Tai-ji, Taiji, fatigue, tiredness, weary, weak, and the search was conducted without language restrictions. Methodological quality was assessed using the Cochrane Risk of Bias tool. RevMan 5.3 software was used for meta-analysis. Publication bias was estimated with a funnel plot and Egger's test. We also assessed the quality of evidence with the GRADE system.

RESULTS

Ten trials (n = 689) were included, and there was a high risk of bias in the blinding. Two trials were determined to have had low methodological quality. Tai Chi was found to have improved fatigue more than conventional therapy (standardized mean difference (SMD): -0.45, 95% confidence interval (CI): -0.70, -0.20) overall, and have positive effects in cancer-related fatigue (SMD:-0.38, 95% CI: -0.65, -0.11). Tai Chi was also more effective on vitality (SMD: 0.63, 95% CI: 0.20, 1.07), sleep (SMD: -0.32, 95% CI: -0.61, -0.04) and depression (SMD: -0.58, 95% CI: -1.04, -0.11). However, no significant difference was found in multiple sclerosis-related fatigue (SMD: -0.77, 95% CI: -1.76, 0.22) and age-related fatigue (SMD: -0.77, 95% CI: -1.78, 0.24). No adverse events were reported among the included studies. The quality of evidence was moderate in the GRADE system.

CONCLUSIONS

The results suggest that Tai Chi could be an effective alternative and /or complementary approach to existing therapies for people with fatigue. However, the quality of the evidence was only moderate and may have the potential for bias. There is still absence of adverse events data to evaluate the safety of Tai Chi. Further multi-center RCTs with large sample sizes and high methodological quality, especially carefully blinded design, should be conducted in future research.

REGISTRATION NUMBER

PROSPERO CRD42016033066.

The severity and associated factors of participation restriction among community-dwelling frail older people: an application of the International Classification of Functioning, Disability and Health (WHO-ICF)

Background

The International Classification of Functioning, Disability, and Health (WHO-ICF) describes participation restriction as one aspect of disability. Participation restriction refers to health problems that can hinder people’s involvement in different life events. It is rational to believe that the prevalence of participation restriction increases among a frail population. However, information about the level of participation restriction among older people, particularly the pre-frail or frail, remains scant. The aim of this study was to identify the prevalence and underlying risk factors associated with participation restriction among community-dwelling frail and pre-frail older people.

Methods

A cross-section of 299 community-dwelling frail older people with a mean age of 79.5 participated in this study. They had to have been identified as being either pre-frail or frail based on the five common characteristics of the frailty phenotype. Their level of participation restriction was assessed based on the Chinese Reintegration to Nursing Living Index (C-RNLI). All other independent variables were identified and systematically linked to different components in the WHO-ICF framework.

Results

Among all participants, 207 (69.2%) were identified as encountering participation restrictions in at least one aspect of their life, with a mean C-RNLI score of 68.3 (SD 19.43). A multivariate regression analysis showed that the participants’ status of frailty, self-perceived social status, level of exhibited depressive mood, sleep quality, mobility, level of fear of falling, and physical activity levels had a significant association with participation restriction. When all of the variables, regardless of significance, were included, the factors together explained 67.1% of the variance in the participants’ participation restriction.

Conclusion

Participation restriction was prevalent among community-dwelling frail older people and was associated with factors across different components in the WHO-ICF. This finding supports the view that participation restriction is multifactorial in nature.

Validation of the qi blood yin yang deficiency questionnaire on chronic fatigue

Background

Chronic fatigue (CF) reflects an imbalance of inter-organ functions or of the four essential physiological components qi, blood (xue), yin, and yang. CF can be subdivided into different patterns. However, there are no diagnostic methods for CF. This study aimed to clinically validate a pattern identification method by identifying correlations between CF and responses to the qi blood yin yang deficiency questionnaire (QBYY-Q).

Methods

Participants were recruited between May and June 2014 through the Kyung Hee University Korean Medicine hospital website and via posters and comprised 129 CF patients diagnosed with the United States Centers for Disease Control and Prevention (1994) criteria. Participants who had organic diseases that explained the CF were excluded. A total of 159 participants were asked to complete the QBYY-Q, the fatigue severity scale, and the Chalder fatigue scale. The latter two questionnaires were used to assess convergent validity with the QBYY-Q. Among the 129 CF participants, 70 and 59 had chronic fatigue syndrome and idiopathic chronic fatigue, respectively. Two Korean medical doctors independently assessed participants’ qi, blood, yin, and yang deficiency patterns using QBYY deficiency pattern identification guidelines. Based on the results of a preliminary study of the QBYY-Q, we selected 32 reliable items for symptoms corresponding to each deficiency pattern. The items were used to estimate internal consistency and construct validity. Multinomial logistic regression analysis was performed for scores on each deficiency pattern.

Results

The data were means and standard deviations or numbers of participants and proportions for continuous and categorical variables, respectively. A statistical significance level of P < 0.05 was assumed. The QBYY-Q showed satisfactory internal consistency. Explanatory factor analysis extracted two factors for each deficiency pattern. The percentages of explained variance for qi, blood, yin, and yang deficiency were 45.1, 58.0, 52.2, and 63.4 %, respectively. Each QBYY-Q deficiency score was positively associated with each corresponding deficiency pattern. Qi deficiency was used as a reference category. Odds ratios of blood, yin, and yang deficiency were 10.97, 10.69, and 14.64, respectively.

Conclusion

The QBYY-Q was suitable for estimating the influences of qi, blood, yin, and yang deficiencies in CF.

Trial registration This trial was registered with the Korean Clinical Trial Register (KCT0001199)

Electronic supplementary material

The online version of this article (doi:10.1186/s13020-016-0092-y) contains supplementary material, which is available to authorized users.

The Association between Job-Related Psychosocial Factors and Prolonged Fatigue among Industrial Employees in Taiwan

Background and Objectives

Prolonged fatigue is common among employees, but the relationship between prolonged fatigue and job-related psychosocial factors is seldom studied. This study aimed (1) to assess the individual relations of physical condition, psychological condition, and job-related psychosocial factors to prolonged fatigue among employees, and (2) to clarify the associations between job-related psychosocial factors and prolonged fatigue using hierarchical regression when demographic characteristics, physical condition, and psychological condition were controlled.

Methods

A cross-sectional study was employed. A questionnaire was used to obtain information pertaining to demographic characteristics, physical condition (perceived physical health and exercise routine), psychological condition (perceived mental health and psychological distress), job-related psychosocial factors (job demand, job control, and workplace social support), and prolonged fatigue.

Results

A total of 3,109 employees were recruited. Using multiple regression with controlled demographic characteristics, psychological condition explained 52.0% of the variance in prolonged fatigue. Physical condition and job-related psychosocial factors had an adjusted R² of 0.370 and 0.251, respectively. Hierarchical multiple regression revealed that, among job-related psychosocial factors, job demand and job control showed significant associations with fatigue.

Conclusion

Our findings highlight the role of job demand and job control, in addition to the role of perceived physical health, perceived mental health, and psychological distress, in workers’ prolonged fatigue. However, more research is required to verify the causation among all the variables.

From Body to Mind and Spirit: Qigong Exercise for Bereaved Persons with Chronic Fatigue Syndrome-Like Illness

Bereavement may bring negative impacts on the mind, body, and spiritual well-being of grieving persons. Some bereaved persons with chronic fatigue syndrome- (CFS-) illness experience a dual burden of distress. This study investigated the effects of bereavement on CFS-like illness by comparing bereaved and nonbereaved participants. It also adopted a random group design to investigate the effectiveness of Qigong on improving the well-being of bereaved participants. The Qigong intervention comprised 10 group sessions delivered twice a week for 5 weeks and home-practice for at least three times a week lasting 15–30 minutes each. The participants' fatigue, anxiety, and depression, quality of life (QoL), and spiritual well-being were measured at baseline and 3 months after treatment. The bereaved participants experienced significantly greater mental fatigue (16.09 versus 14.44, p = 0.017) and lower physical QoL (34.02 versus 37.17, p = 0.011) than their nonbereaved counterparts. After 3 months, the mental fatigue (−8 versus −4, p = 0.010) and physical fatigue (−10 versus −5, p = 0.007) experienced by intervention group had declined significantly, and improvements on their spirituality (14 versus −2, p = 0.013) and psychological QoL (8.91 versus 0.69, p = 0.002) scores exceeded those of the control group.

A community-based cross-sectional study of fatigue in middle-aged and elderly women

BACKGROUND

Fatigue has been widely studied in the general population; however, limited studies have investigated it in the female population. The objectives of this community-based study were to (1) investigate the prevalence of fatigue, (2) explore the relationship between gynecological history and experiences of fatigue, and (3) identify risk factors for fatigue in middle-aged and elderly women.

METHODS

Based on a cross-sectional health study that employed a multi-instrument questionnaire, 1272 women aged 45years or older dwelling in the community were included. The Chinese version of Chalder Fatigue Scale (CFS) was used to assess fatigue, and socio-demographic, health-related, and gynecological data were also collected. Fatigue was defined as a total CFS score≥4.

RESULTS

The prevalence of fatigue among women aged over 45years was 33.9%. Multivariate logistic regression analysis identified that older age, single marital status, lower education level, the presence of chronic diseases, underweight, hospitalization in the last year, postmenopause, and a higher number of live births were associated with an increased risk of fatigue (P<0.05).

CONCLUSIONS

Our results indicated that fatigue was common in middle-aged and elderly females. Being postmenopausal and having more than three live births were the particular gynecological factors contributing to fatigue in the general population.

Factors Associated with Fatigue among Men Aged 45 and Older: A Cross-Sectional Study

Background and Purpose: Fatigue is one of the most common symptoms reported in several studies; but few studies have concentrated on the male population, especially for the middle-aged and older men who are exposed to greater fatigue risk. The purpose of this study was to explore the prevalence of fatigue and identify the risk factors of fatigue among men aged 45 and older in China. Methods: This study was part of a cross-sectional study on community health in Shunde (Guangdong Province, China). A total sample of 1158 men aged 45 and older were included. Sociodemographic characteristics, health and lifestyle factors and the Chalder Fatigue Scale (CFS) were measured by structured questionnaires through face-to-face interviews. Multivariate logistic regression was applied to determine the risk factors of fatigue. Results: Approximately 30% of participants experienced fatigue. Older age (≥75 years: adjusted OR 3.88, 95% CI 2.09–7.18), single marital status (1.94, 1.04–3.62), unemployed status (1.68, 1.16–2.43), number of self-reported chronic diseases (≥2 chronic diseases: 2.83, 1.86–4.31), number of individuals’ children (≥4 children: 2.35, 1.33–4.15), hospitalization in the last year (1.61, 1.03–2.52) were all significantly associated with increased risk of fatigue, while regular exercise (0.46, 0.32–0.65) was a protective factor against fatigue. Conclusions: Fatigue was usual in males and several factors were associated with the fatigue. These findings may have implication in risk assessment of fatigue and help in developing and implementing targeted interventions in middle-aged and elderly males.

Association among measures of mobility-related disability and self-perceived fatigue among older people: a population-based study

Objective:

To investigate the relationship between self-perceived fatigue with different physical functioning tests and functional performance scales used for evaluating mobility-related disability among community-dwelling older persons.

Method:

This is a cross-sectional, population-based study. The sample was composed of older persons with 65 years of age or more living in Cuiabá, MT, and Barueri, SP, Brazil. The data for this study is from the FIBRA Network Study. The presence of self-perceived fatigue was assessed using self-reports based on the Center for Epidemiologic Studies-Depression Scale. The Lawton instrumental activities of daily living scale (IADL) and the advanced activities of daily living scale (AADL) were used to assess performance and participation restriction. The following physical functioning tests were used: five-step test (FST), the Short Physical Performance Battery (SPPB), and usual gait speed (UGS). Three models of logistic regression analysis were conducted, and a significance level of α<0.05 was adopted.

Results:

The sample was composed of 776 older adults with a mean age (SD) of 71.9 (5.9) years, of whom the majority were women (74%). The prevalence of self-perceived fatigue within the participants was 20%. After adjusting for covariates, SPPB, UGS, IADL, and AADL remained associated with self-perceived fatigue in the final multivariate regression model.

Conclusion:

Our results suggest that there is an association between self-perceived fatigue and lower extremity function, usual gait speed and activity limitation and participation restriction in older adults. Further cohort studies are needed to investigate which physical performance measure may be able to predict the negative impact of fatigue in older adults.

Psychometric properties of the Chalder Fatigue Scale revisited: an exploratory structural equation modeling approach

Objective

Previous validation studies of the Chalder Fatigue Scale (CFS) suffer methodological shortcomings. The present study aimed to re-evaluate its psychometric properties using exploratory structural equation modeling (ESEM).

Methods

A Chinese sample of 1259 community-dwelling residents completed the 11-item Chinese CFS and a variety of health measures (anxiety, depression, exhaustion, sleep disturbance, and quality of life). In addition to traditional confirmatory factor analysis, ESEM was performed to assess the fit of two- and three-factor models using robust maximum likelihood estimation and oblique geomin rotation. Convergent validity of the CFS was examined via associations with five covariates (gender, age, exercise, perceived health, and life event) and the health measures in the ESEM model.

Results

The ESEM models displayed a superior fit to confirmatory factor models. The three-factor ESEM model showed a satisfactory model fit to the data but not for the two-factor model. The three factors were physical fatigue (three items, α = .800), low energy (four items, α = .821), and mental fatigue (four items, α = .861). The factors exhibited convergent validity with the model covariates and health measures.

Conclusion

The results demonstrate the satisfactory reliability and convergent validity for the three-factor structure of the CFS as a valid measure of fatigue symptoms in the general population. Future psychometric studies could adopt the ESEM approach as a practical alternative to traditional confirmatory factor analysis.

Dimensions of pure chronic fatigue: psychophysical, cognitive and biological correlates in the chronic fatigue syndrome

OBJECTIVES

To investigate associated dimensions of fatigue regarding cognitive impairment, psychomotor performances, muscular effort power and circulating cytokine levels and their relations to symptom intensity in a sample of pure chronic fatigue syndrome (CFS) patients without overlapping objective sleepiness or sleep disorders.

METHODS

16 CFS patients were compared to 14 matched controls. We assessed structured symptom-scales, polysomnography, multiple sleep latency tests, attention (Zazzo-Cancellation ZCT, digit-symbol-substitution DSST), psychomotor vigilance and speed (PVT, finger tapping test, FTT), dynamometer handgrip force (tonic and phasic trials) and circulating cytokines (IFN-γ, IL-1b, IL-6, IL-8, IL-10, TNF-α).

RESULTS

In addition to fatigue, CFS patients presented with higher affective symptom intensity and worse perceived sleep quality. Polysomnography showed more slow-wave sleep and microarousals in CFS but similar sleep time, efficiency and light-sleep durations than controls. Patients presented with impaired attention (DSST, ZCT), slower reaction times (PVT) but not with lower hit rates (FTT). Notwithstanding lower grip strength during tonic and phasic trials, CFS also presented with higher fatigability during phasic trials. Cytokine levels were increased for IL-1b, IL-8, IL-10 and TNF-α and fatigue intensity was correlated to grip strength and IL-8.

CONCLUSIONS

In contrast to sleepiness, chronic fatigue is a more complex phenomenon that cannot be reduced to one single measured dimension (i.e., sleep propensity). Showing its relations to different measurements, our study reflects this multidimensionality, in a psychosomatic disorder such as CFS. To obtain objective information, routine assessments of fatigue should rule out sleepiness, combine aspects of mental and physical fatigue and focus on fatigability.

Anxiety and depression in the general population in Colombia: reference values of the Hospital Anxiety and Depression Scale (HADS)

PURPOSE

The objective of this study was to generate normative values and to test psychometric properties of the Hospital Anxiety and Depression Scale (HADS) for the general population of Colombia. While there are several normative studies in Europe, Latin American normative values are missing. The identification of people with mental distress requires norms obtained for the specific country.

METHODS

A representative face-to-face household study (n = 1,500) was conducted in 2012. The survey questionnaire contained the HADS, several other questionnaires, and sociodemographic variables.

RESULTS

HADS mean values (anxiety: M = 4.61 ± 3.64, depression: M = 4.30 ± 3.91) were similar to those reported from European studies. Females were more anxious and depressed than males. The depression scale showed a nearly linear age dependency with increasing scores for old people. Mean scores and percentiles (75 and 90%) are presented for each age decade for both genders. Both anxiety and depression correlated significantly with the total score of the multidimensional fatigue inventory and with the mental component summary score of the quality of life questionnaire SF-8. Internal consistency coefficients of both scales were satisfying, but confirmatory factorial analysis results only partially supported the two-dimensional structure of the questionnaire.

CONCLUSION

This study supports the reliability of the HADS in one Latin American country. The normative scores can be used to compare a patient's score with those derived from a reference group. However, the generalizability to other Latin American regions requires further research.

The psychological impact of breast and ovarian cancer preventive options in BRCA1 and BRCA2 mutation carriers

This study was performed to describe the impact of preventive options on the psychological condition of BRCA1/BRCA2 carriers. A sample of 52 cancer-affected (C-A) and 27 cancer-unaffected (C-UN) women were enrolled after gene test disclosure (T0). Psychological evaluations were performed at T0 and 15 months later (T1). The surgical options were more likely to be chosen in C-A women (62%), although a consistent proportion of C-UN women (30%) also opt for these preventive measures. At the baseline, both samples had average anxiety and depression scores below the cut-off value, restrained average cancer worry scores and a risk perception consistent with the risk percentage provided during genetic counselling. The longitudinal results indicated no clinically meaningful variations in the anxiety and depression scores in either of the two samples. Statistically significant reductions in cancer-risk perception emerged in women who chose surgery in both C-A and C-UN women. In BRCA1/BRCA2 mutation carriers, surveillance does not influence their initial psychological condition, whereas prophylactic surgery has a significant impact in reducing the perceived risk and worry about getting sick. C-A and C-UN women have to be considered as two separate populations of BRCA mutation carriers requiring personalized approaches to risk management.

Factors associated with fatigue in acquired immunodeficiency syndrome patients with antiretroviral drug adverse reactions: a retrospective study

OBJECTIVE

To retrospectively study the prevalence of fatigue and factors associated with fatigue among acquired immunodeficiency syndrome (AIDS) patients with antiretroviral drug adverse reactions.

METHODS

Data were collected from case report forms (CRFs) for a project funded by the 11th National 5-year Special Science and Technology Program on Major Infectious Diseases. Fatigue was defined by patient self-report. The outcomes were the prevalence of fatigue and the potential risk factors of fatigue. Univariate and multivariate logistic regression analyses were conducted to identify the factors associated with fatigue.

RESULTS

Among the 228 subjects, the prevalence of fatigue was 86.8%. In univariate analysis, the significant differences in demographic characteristics between patients with and without fatigue were: gender [OR = 2.29; 95% CI (1.05-4.98)], education level [OR = 0.40; 95% CI (0.18-0.85)], anemia [OR = 3.80; 95% CI (1.27-11.31)], time of HIV diagnosis [OR = 0.29; 95% CI (0.13-0.65)], and route of infection [OR = 0.14; 95% CI (0.06-0.32)]. Abnormal taste and rapid pulse were more commonly seen in patients with fatigue (P < 0.05), while abdominal distension and lumbar soreness were encountered less often in patients with fatigue (P < 0.05). Multivariate analysis showed that the four main factors associated with fatigue were anemia [OR = 3.50; 95% CI (1.01-12.15)], route of infection [OR = 3.40; 95% CI (1.21-9.58); P = 0.02 < 0.05], lumbar soreness [OR = 0.06; 95% CI (0.02-0.18); P = 0.000 < 0.05], and rapid pulse [OR = 10.58; 95% CI (2.16-51.75); P = 0.004 < 0.05].

CONCLUSION

This study demonstrated that fatigue is common (86.8% prevalence) in AIDS patients with antiretroviral drug adverse reactions, and that anemia, route of infection (i.e., non-commercial blood donation) and rapid pulse were risk factors, while lumbar soreness was a protective factor related to fatigue. More attention should be paid to fatigue and more efforts should be made to find ways to prevent, control and eliminate this symptom in AIDS patients with antiretroviral drug adverse reactions.

Effects of qigong exercise on fatigue, anxiety, and depressive symptoms of patients with chronic fatigue syndrome-like illness: a randomized controlled trial

Background. Anxiety/depressive symptoms are common in patients with chronic fatigue syndrome- (CFS-) like illness. Qigong as a modality of complementary and alternative therapy has been increasingly applied by patients with chronic illnesses, but little is known about the effect of Qigong on anxiety/depressive symptoms of the patients with CFS-like illness. Purpose. To investigate the effects of Qigong on fatigue, anxiety, and depressive symptoms in patients with CFS-illness. Methods. One hundred and thirty-seven participants who met the diagnostic criteria for CFS-like illness were randomly assigned to either an intervention group or a waitlist control group. Participants in the intervention group received 10 sessions of Qigong training twice a week for 5 consecutive weeks, followed by home-based practice for 12 weeks. Fatigue, anxiety, and depressive symptoms were assessed at baseline and postintervention. Results. Total fatigue score [F(1,135) = 13.888, P < 0.001], physical fatigue score [F(1,135) = 20.852, P < 0.001] and depression score [F(1,135) = 9.918, P = 0.002] were significantly improved and mental fatigue score [F(1,135) = 3.902, P = 0.050] was marginally significantly improved in the Qigong group compared to controls. The anxiety score was not significantly improved in the Qigong group. Conclusion. Qigong may not only reduce the fatigue symptoms, but also has antidepressive effect for patients with CFS-like illness. Trial registration HKCTR-1200.

Diagnosing Chronic Fatigue Syndrome in South Asians: Lessons from a Secondary Analysis of a UK Qualitative Study

BACKGROUND

Chronic fatigue syndrome/myalgic encephalitis (CFS/ME) is rarely diagnosed in South Asia (SA), although the symptoms of this condition are seen in the population. Lessons from UK based South Asian, Black and Minority Ethnic (BME) communities may be of value in identifying barriers to diagnosis of CFS/ME in SA.

OBJECTIVES

To explore why CFS/ME may not be commonly diagnosed in SA.

SETTINGS AND DESIGN

A secondary analysis of qualitative data on the diagnosis and management of CFS/ME in BME people of predominantly South Asian origin in the UK using 27 semi-structured qualitative interviews with people with CFE/ME, carers, general practitioners (GPs), and community leaders.

RESULTS

CFS/ME is seen among the BME communities in the UK. People from BME communities in the UK can present to healthcare practitioners with vague physical complaints and they can hold a biomedical model of illness. Patients found it useful to have a label of CFS/ME although some GPs felt it to be a negative label. Access to healthcare can be limited by GPs reluctance to diagnose CFS/ME, their lack of knowledge and patients negative experiences. Cultural aspects among BME patients in the UK also act as a barrier to the diagnosis of CFS/ME.

CONCLUSION

Cultural values and practices influence the diagnosis of CFS/ME in BME communities. The variations in the perceptions around CFS/ME among patients, carers, and health professionals may pose challenges in diagnosing CFS/ME in SA as well. Raising awareness of CFS/ME would improve the diagnosis and management of patients with CFS/ME in SA.

A randomized controlled trial of qigong exercise on fatigue symptoms, functioning, and telomerase activity in persons with chronic fatigue or chronic fatigue syndrome

Background

Chronic fatigue is common in the general population. Complementary therapies are often used by patients with chronic fatigue or chronic fatigue syndrome to manage their symptoms.

Purpose

This study aimed to assess the effect of a 4-month qigong intervention program among patients with chronic fatigue or chronic fatigue syndrome.

Methods

Sixty-four participants were randomly assigned to either an intervention group or a wait list control group. Outcome measures included fatigue symptoms, physical functioning, mental functioning, and telomerase activity.

Results

Fatigue symptoms and mental functioning were significantly improved in the qigong group compared to controls. Telomerase activity increased in the qigong group from 0.102 to 0.178 arbitrary units (p < 0.05). The change was statistically significant when compared to the control group (p < 0.05).

Conclusion

Qigong exercise may be used as an alternative and complementary therapy or rehabilitative program for chronic fatigue and chronic fatigue syndrome.

The co-morbidity of chronic pain, insomnia, and fatigue in the general adult population of Hong Kong: Prevalence and associated factors

OBJECTIVES

Although research suggests there is considerable overlap among chronic pain, fatigue, and sleep disturbances, no research to date has concurrently examined their interrelationships. This study estimates the co-occurrence of these three conditions in terms of prevalence and associated factors in the general adult population.

METHODS

In a population-based, cross-sectional telephone survey, 5001 adults aged ≥18 years drawn from the Hong Kong general population completed the Chronic Pain Grade (CPG) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Chronic Fatigue Scale (CFS), Hospital Anxiety and Depression Scale (HADS), and socio-demographic questions.

RESULTS

The overall prevalence of reporting all three chronic conditions was 5.6% (95% CI: 4.9-6.4) and increased with age, being higher in women, and those in lower income and education level groups. Individuals with multiple symptoms also reported poorer mental health, and self-perceived health. Results of multi-ordinal regression analyses identified female, divorced/separated, having part time employment, retirees, unemployment, housewives, existing long-term health problems, higher HADS scores, and low self-perceived health to be significantly associated with reporting all three symptoms.

CONCLUSION

This study has shown that the co-occurrence of chronic pain, fatigue, and sleep disturbances was common in the general adult population. Multiple symptoms are comorbid of psychological distress.