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Toccaceli Blasi M, Alfano AR, Salzillo M, Buscarnera S, Raparelli V, Cesari M, Bruno G, Canevelli M. Sex-specific clinical and neurobiological correlates of fatigue in older adults. GeroScience 2024:10.1007/s11357-024-01259-0. [PMID: 39129050 DOI: 10.1007/s11357-024-01259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/14/2024] [Indexed: 08/13/2024] Open
Abstract
Fatigue is a common and distressful symptom in older people and has been associated with adverse health outcomes. Nevertheless, its sex-specific pathophysiological underpinnings and clinical correlates have been scarcely investigated. We aimed to comprehensively explore the clinical and neurobiological determinants of fatigue in cognitively unimpaired older adults. A sex-stratified analysis was conducted to look for differences in the clinical expression of fatigue among women and men. Data on cognitively normal individuals were gathered from the Alzheimer's Disease Neuroimaging Initiative (ADNI) 2 study. Fatigue was defined based on self-report at baseline. For each participant, information on sociodemographics, comorbidities, mood, cognitive performance, frailty, and biomarkers of brain pathology was collected. Logistic regression models, stratified by sex, were conducted to explore the factors associated with fatigue. Among the 291 participants selected, 44 subjects (15.1% of the total sample) self-reported fatigue at baseline. Subjects reporting fatigue were more likely women, had higher frailty degrees, and more severe depressive symptoms than those without fatigue. Moreover, they tended to have lower MRI hippocampus volumes. Among women, those reporting fatigue exhibited higher frailty levels, worse depression, and lower MRI hippocampus volumes relative to those without fatigue. Higher frailty degrees were also observed in men reporting vs. non-reporting fatigue. In the adjusted logistic regression model, more severe depression (OR 1.64, 95% CI 1.18-2.28; p < 0.01) and lower MRI hippocampus volumes (OR 0.41, 95% CI 0.19-0.90; p = 0.03) resulted independently associated with fatigue in women, while higher frailty degrees (OR 3.10, 95% CI 1.27-7.54 per 0.1 increase in a 39-item Frailty index; p = 0.01) in men. Fatigue is a complex symptom with a sex-specific pattern of clinical and neurobiological correlates. A better understanding of the underlying mechanisms of these associations is warranted to develop sex-informed approaches for personalized treatments.
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Affiliation(s)
| | - Alba Rosa Alfano
- Department of Internal Medicine and Medical Specialties, UOC Geriatrics, "Sapienza" University, Rome, Italy
| | - Martina Salzillo
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Simona Buscarnera
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
| | - Valeria Raparelli
- Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Matteo Cesari
- Ageing and Health Unit, Department of Maternal, Newborn, Child, Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Giuseppe Bruno
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
- Santa Lucia Foundation IRCCS, Rome, Italy
| | - Marco Canevelli
- Department of Human Neuroscience, "Sapienza" University, Rome, Italy
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, Rome, Italy
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Hsiao CK, Tsai YJ, Lu CW, Hsiung JC, Hsiao HY, Chen YC, Tu YK. Effects of Kinesio taping on forearm supination/pronation performance fatigability. BMC Musculoskelet Disord 2022; 23:131. [PMID: 35139848 PMCID: PMC8826704 DOI: 10.1186/s12891-022-05068-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Repetitive exertion in supination/pronation could increase the risk of forearm diseases due to fatigue. Kinesio taping (KT) is a physical therapy technique that decreases muscle tone and musculoskeletal disorders (MSDs) risk. Many assumptions about taping have been made and several studies have considered the taping applications; however, the effect of KT on strength and fatigue of the forearm supination/pronation remains unclear. The purpose of this study was to evaluate the effect of KT on forearm performance fatigability. Methods A screwing test was constructed to measure the forearm force loss and screwing efficiency during repetitive supination/pronation. Data from 18 healthy adults who underwent both KT and no taping (NT) sessions were used to investigate the forearm strength change in terms of grip force (GF), driving torque (DT), and push force (PF). The maximal isometric forces before and after the screwing test and force decreasing rate (efficiency) during screwing were evaluated to assess the performance fatigability in KT and NT conditions. Results A statistically significant force loss (FL) in maximal isometric GF (p = 0.039) and maximal isometric DT (p = 0.044); however, no significant difference was observed in maximal isometric PF (p = 0.426) between NT and KT. KT provides greater screwing efficiency than NT. Conclusions KT could not improve FL in the maximal muscle strength of the forearm in healthy subjects. KT on the forearm was associated with a lesser decline in DT efficiency than NT, implying that KT could decrease the loss rate of muscle strength and delay the development of fatigue; however, the KT did not yield improvements in PF while performing screwing tasks.
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Affiliation(s)
- Chih-Kun Hsiao
- Department of Orthopedics, E-Da Hospital, No. 1 E-Da Rd, Yuan-Chau District, Kaohsiung, Taiwan
| | - Yi-Jung Tsai
- Department of Orthopedics, E-Da Hospital, No. 1 E-Da Rd, Yuan-Chau District, Kaohsiung, Taiwan
| | - Chih-Wei Lu
- Department of Industrial and Systems Engineering, Chung Yuan Christian University, Chung Li, Taiwan
| | - Jen-Chou Hsiung
- Department of Mechanical Engineering, Cheng Shiu University, No.840, Chengcing Rd., Niaosong Dist, Kaohsiung City, Taiwan
| | - Hao-Yuan Hsiao
- Department of Orthopedics, E-Da Hospital, No. 1 E-Da Rd, Yuan-Chau District, Kaohsiung, Taiwan
| | - Yung-Chuan Chen
- Department of Vehicle Engineering, National Pingtung University of Science and Technology, No. 1, Shuefu Road, Neipu, Pingtung, 91201, Taiwan.
| | - Yuan-Kun Tu
- Department of Orthopedics, E-Da Hospital, No. 1 E-Da Rd, Yuan-Chau District, Kaohsiung, Taiwan.
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Chemical Characterization and Preliminary Evaluation of the Efficacy and Tolerability of a Food Supplement Based on Pomegranate Extract, B Vitamins, and Vitamin C against Prolonged Fatigue in Healthy Consumers. Processes (Basel) 2022. [DOI: 10.3390/pr10020208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Fatigue, characterized by periods of exhaustion that interfere with normal activities and negatively affect quality of life, can be classified as prolonged fatigue (or short-term fatigue, SF) or chronic fatigue. Vitamin deficiency and chronic inflammation seem to be possible causes of fatigue. Due to the unavailability of effective remedies that attenuate fatigue and provide consumer satisfaction, the aim of this investigation is to assess whether a commercial food supplement consisting of pomegranate extract with known anti-inflammatory activity, B vitamins, and vitamin C can help fight SF. To this end, the chemical composition of whole fruit pomegranate dry extract was determined through a RP-UHPLC–HRMS method, which indicated the presence of ellagitannins, gallotannins, and organic and phenolic acids. In a survey of consumers of food supplements aimed at reducing fatigue, 78 subjects (21 men and 57 women) were recruited for one month to evaluate the efficacy and tolerability of this food supplement through validated questionnaires for assessing fatigue level and quality of life. The consumers reported a significant improvement in their conditions without adverse effects over this time period. Although further studies are needed, these preliminary data suggest the capacity of a combination of pomegranate extract and hydrosoluble vitamins to alleviate SF.
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4
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Lim EJ, Ahn YC, Jang ES, Lee SW, Lee SH, Son CG. Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). J Transl Med 2020; 18:100. [PMID: 32093722 PMCID: PMC7038594 DOI: 10.1186/s12967-020-02269-0] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 02/14/2020] [Indexed: 01/31/2023] Open
Abstract
Background Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has been emerging as a significant health issue worldwide. This study aimed to systemically assess the prevalence of CFS/ME in various aspects of analyses for precise assessment. Methods We systematically searched prevalence of CFS/ME from public databases from 1980 to December 2018. Data were extracted according to 7 categories for analysis: study participants, gender and age of the participants, case definition, diagnostic method, publication year, and country of the study conducted. Prevalence data were collected and counted individually for studies adopted various case definitions. We analyzed and estimated prevalence rates in various angles: average prevalence, pooled prevalence and meta-analysis of all studies. Results A total of 1291 articles were initially identified, and 45 articles (46 studies, 56 prevalence data) were selected for this study. Total 1085,976 participants were enrolled from community-based survey (540,901) and primary care sites (545,075). The total average prevalence was 1.40 ± 1.57%, pooled prevalence 0.39%, and meta-analysis 0.68% [95% CI 0.48–0.97]. The prevalence rates were varied by enrolled participants (gender, study participants, and population group), case definitions and diagnostic methods. For example, in the meta-analysis; women (1.36% [95% CI 0.48–0.97]) vs. men (0.86% [95% CI 0.48–0.97]), community-based samples (0.76% [95% CI 0.53–1.10]) vs. primary care sites (0.63% [95% CI 0.37–1.10]), adults ≥ 18 years (0.65% [95% CI 0.43–0.99]) vs. children and adolescents < 18 years (0.55% [95% CI 0.22–1.35]), CDC-1994 (0.89% [95% CI 0.60–1.33]) vs. Holmes (0.17% [95% CI 0.06–0.49]), and interviews (1.14% [95% CI 0.76–1.72]) vs. physician diagnosis (0.09% [95% CI 0.05–0.13]), respectively. Conclusions This study comprehensively estimated the prevalence of CFS/ME; 0.89% according to the most commonly used case definition CDC-1994, with women approximately 1.5 to 2 folds higher than men in all categories. However, we observed the prevalence rates are widely varied particularly by case definitions and diagnostic methods. An objective diagnostic tool is urgently required for rigorous assessment of the prevalence of CFS/ME.
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Affiliation(s)
- Eun-Jin Lim
- Institute of Bioscience and Integrative Medicine, Department of Korean Medicine, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon, Republic of Korea
| | - Yo-Chan Ahn
- Department of Health Service Management, Daejeon University, 96-3 Yongun-dong, Dong-gu, Daejeon, 300-716, Republic of Korea
| | - Eun-Su Jang
- Institute of Bioscience and Integrative Medicine, Department of Korean Medicine, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon, Republic of Korea
| | - Si-Woo Lee
- Division of Future Medicine, Korean Institute of Oriental Medicine, Yuseong-daero, 1672, Daejeon, Republic of Korea
| | - Su-Hwa Lee
- The Catholic University of Korea, Daejeon St. Mary Hospital, 64, Daeheung-ro, Jung-gu, Daejeon, Republic of Korea
| | - Chang-Gue Son
- Institute of Bioscience and Integrative Medicine, Department of Korean Medicine, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon, Republic of Korea.
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5
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Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, Fitzcharles MA, Paiva ES, Staud R, Sarzi-Puttini P, Buskila D, Macfarlane GJ. AAPT Diagnostic Criteria for Fibromyalgia. THE JOURNAL OF PAIN 2019; 20:611-628. [DOI: 10.1016/j.jpain.2018.10.008] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/28/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023]
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7
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Abdel-Khalek A. Prevalence rates of chronic fatigue complaints in a probability sample of Arab college students. HEART AND MIND 2019. [DOI: 10.4103/hm.hm_49_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Chen CS, Cheng HM, Chen HJ, Tsai SY, Kao CH, Lin HJ, Wan L, Yang TY. Dry eye syndrome and the subsequent risk of chronic fatigue syndrome-a prospective population-based study in Taiwan. Oncotarget 2018; 9:30694-30703. [PMID: 30093979 PMCID: PMC6078132 DOI: 10.18632/oncotarget.25544] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 05/19/2018] [Indexed: 12/13/2022] Open
Abstract
Background and Aim The clinical association between dry eye syndrome (DES) and chronic fatigue syndrome (CFS) remain unclear with less evidences. We aimed to investigate the relationship between CFS and DES using a national insurance and prospective cohort study. Methods Data from the Longitudinal Health Insurance Database 2000 was applied to estimate the incidence of CFS among patients with DES, and their age- and sex-matched controls without DES over a long-term follow-up period. All participants were CFS free at baseline, before the interval (2005-2007), but were later diagnosed with CFS. DES patients and its relative matched controls were excluded prevalent CFS before the same interval. Results We identified 884 patients with DES and 3,536 matched controls in baseline and estimated the hazard ratios for incident CFS in the follow-up period. Patients with DES had a 2.08-fold considerably increasing risk of developing CFS, compared to non-DES group. An elevated risk of developing CFS remained (1.61-fold risk) even after adjusting for age, sex, and comorbidities. There was a presence of increasing risk in DES-related CFS when CFS-related comorbidities existing (adjusted hazard ratio, 1.98, 95% confidence interval, 1.19-3.29; p < 0.01). The subsequent risk for CFS between DES and non-DES patients was significant increased with three or more annual medical visits, the adjusted risk for CFS was 4.88-fold risk (95% CI, 2.26-10.58, p < 0.001). Conclusion We recommended that physicians should be aware of the increased risk of CFS among DES patients and adequately assess the health impacts among these patients.
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Affiliation(s)
- Chih-Sheng Chen
- Department of Chinese Traumatology, Division of Chinese Traumatology Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Traditional Chinese Medicine, Asia University Hospital, Taichung, Taiwan.,Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hui-Man Cheng
- Department of Integration of Traditional Chinese and Western Medicine, China Medical University Hospital, Taichung, Taiwan.,School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan.,Asia University, Taichung, Taiwan
| | - Shin-Yi Tsai
- Department of Laboratory Medicine, Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan.,Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Hui-Ju Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
| | - Lei Wan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.,Department of Biotechnology, Asia University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan.,Research Center for Chinese Medicine and Acupuncture, China Medical University, Taichung, Taiwan
| | - Tse-Yen Yang
- Molecular and Genomic Epidemiology Center, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan
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9
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Affiliation(s)
- Steven E. Harte
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Richard E. Harris
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Daniel J. Clauw
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
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10
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Loy BD, O'Connor PJ, Dishman RK. Effect of Acute Exercise on Fatigue in People with ME/CFS/SEID: A Meta-analysis. Med Sci Sports Exerc 2017; 48:2003-12. [PMID: 27187093 DOI: 10.1249/mss.0000000000000990] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE A prominent symptom of myalgic encephalomyelitis, chronic fatigue syndrome, or systemic exertion intolerance disease (ME/CFS/SEID) is persistent fatigue that is worsened by physical exertion. Here the population effect of a single bout of exercise on fatigue symptoms in people with ME/CFS/SEID was estimated and effect moderators were identified. METHODS Google Scholar was systematically searched for peer-reviewed articles published between February 1991 and May 2015. Studies were included where people diagnosed with ME/CFS/SEID and matched control participants completed a single bout of exercise and fatigue self-reports were obtained before and after exercise. Fatigue means, standard deviations, and sample sizes were extracted to calculate effect sizes and the 95% confidence interval. Effects were pooled using a random-effects model and corrected for small sample bias to generate mean Δ. Multilevel regression modeling adjusted for nesting of effects within studies. Moderators identified a priori were diagnostic criteria, fibromyalgia comorbidity, exercise factors (intensity, duration, and type), and measurement factors. RESULTS Seven studies examining 159 people with ME/CFS/SEID met inclusion criteria, and 47 fatigue effects were derived. The mean fatigue effect was Δ = 0.73 (95% confidence interval = 0.24-1.23). Fatigue increases were larger for people with ME/CFS/SEID when fatigue was measured 4 h or more after exercise ended rather than during or immediately after exercise ceased. CONCLUSIONS This preliminary evidence indicates that acute exercise increases fatigue in people with ME/CFS/SEID more than that in control groups, but effects were heterogeneous between studies. Future studies with no-exercise control groups of people with ME/CFS/SEID are needed to obtain a more precise estimate of the effect of exercise on fatigue in this population.
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Affiliation(s)
- Bryan D Loy
- 1Department of Neurology, Oregon Health and Science University, Portland, OR; 2Department of Kinesiology, University of Georgia, Athens, GA
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Ko LW, Komarov O, Hairston WD, Jung TP, Lin CT. Sustained Attention in Real Classroom Settings: An EEG Study. Front Hum Neurosci 2017; 11:388. [PMID: 28824396 PMCID: PMC5534477 DOI: 10.3389/fnhum.2017.00388] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/12/2017] [Indexed: 11/17/2022] Open
Abstract
Sustained attention is a process that enables the maintenance of response persistence and continuous effort over extended periods of time. Performing attention-related tasks in real life involves the need to ignore a variety of distractions and inhibit attention shifts to irrelevant activities. This study investigates electroencephalography (EEG) spectral changes during a sustained attention task within a real classroom environment. Eighteen healthy students were instructed to recognize as fast as possible special visual targets that were displayed during regular university lectures. Sorting their EEG spectra with respect to response times, which indicated the level of visual alertness to randomly introduced visual stimuli, revealed significant changes in the brain oscillation patterns. The results of power-frequency analysis demonstrated a relationship between variations in the EEG spectral dynamics and impaired performance in the sustained attention task. Across subjects and sessions, prolongation of the response time was preceded by an increase in the delta and theta EEG powers over the occipital region, and decrease in the beta power over the occipital and temporal regions. Meanwhile, implementation of the complex attention task paradigm into a real-world classroom setting makes it possible to investigate specific mutual links between brain activities and factors that cause impaired behavioral performance, such as development and manifestation of classroom mental fatigue. The findings of the study set a basis for developing a system capable of estimating the level of visual attention during real classroom activities by monitoring changes in the EEG spectra.
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Affiliation(s)
- Li-Wei Ko
- Institute of Bioinformatics and Systems Biology, National Chiao Tung UniversityHsinchu, Taiwan.,Institute of Molecular Medicine and Bioengineeing, National Chiao Tung UniversityHsinchu, Taiwan.,Brain Research Center, National Chiao Tung UniversityHsinchu, Taiwan.,Swartz Center for Computational Neuroscience, University of California, San Diego, San DiegoCA, United States
| | - Oleksii Komarov
- Institute of Molecular Medicine and Bioengineeing, National Chiao Tung UniversityHsinchu, Taiwan.,Brain Research Center, National Chiao Tung UniversityHsinchu, Taiwan
| | - W David Hairston
- Human Research and Engineering Directorate, Army Research Lab, AberdeenWA, United States
| | - Tzyy-Ping Jung
- Brain Research Center, National Chiao Tung UniversityHsinchu, Taiwan.,Swartz Center for Computational Neuroscience, University of California, San Diego, San DiegoCA, United States
| | - Chin-Teng Lin
- Brain Research Center, National Chiao Tung UniversityHsinchu, Taiwan.,Centre for Artificial Intelligence, Faculty of Engineering and Information Technology, University of Technology Sydney, SydneyNSW, Australia
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Smith EML, Pang H, Ye C, Cirrincione C, Fleishman S, Paskett ED, Ahles T, Bressler LR, Le-Lindqwister N, Fadul CE, Loprinzi C, Shapiro CL. Predictors of duloxetine response in patients with oxaliplatin-induced painful chemotherapy-induced peripheral neuropathy (CIPN): a secondary analysis of randomised controlled trial - CALGB/alliance 170601. Eur J Cancer Care (Engl) 2015; 26. [PMID: 26603828 DOI: 10.1111/ecc.12421] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 01/22/2023]
Abstract
Duloxetine is an effective treatment for oxaliplatin-induced painful chemotherapy-induced peripheral neuropathy (CIPN). However, predictors of duloxetine response have not been adequately explored. The objective of this secondary and exploratory analysis was to identify predictors of duloxetine response in patients with painful oxaliplatin-induced CIPN. Patients (N = 106) with oxaliplatin-induced painful CIPN were randomised to receive duloxetine or placebo. Eligible patients had chronic CIPN pain and an average neuropathic pain score ≥4/10. Duloxetine/placebo dose was 30 mg/day for 7 days, then 60 mg/day for 4 weeks. The Brief Pain Inventory-Short Form and the EORTC QLQ-C30 were used to assess pain and quality of life, respectively. Univariate and multiple logistic regression analyses were performed to identify demographic, physiologic and psychological predictors of duloxetine response. Higher baseline emotional functioning predicted duloxetine response (≥30% reduction in pain; OR 4.036; 95% CI 0.999-16.308; p = 0.050). Based on the results from a multiple logistic regression using patient data from both the duloxetine and placebo treatment arms, duloxetine-treated patients with high emotional functioning are more likely to experience pain reduction (p = 0.026). In patients with painful, oxaliplatin-induced CIPN, emotional functioning may also predict duloxetine response. ClinicalTrials.gov, Identifier NCT00489411.
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Affiliation(s)
- E M L Smith
- PhD program, University of Michigan School of Nursing, Ann Arbor, MI
| | - H Pang
- Alliance Statistics and Data Center, Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.,School of Public Health, Li Ka Shing Faculty of Medicine, Hong Kong SAR, China
| | - C Ye
- Alliance Statistics and Data Center, Duke University, Durham, NC
| | - C Cirrincione
- Alliance Statistics and Data Center, Duke University, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - S Fleishman
- Cancer Supportive Services program, Continuum Cancer Centers of New York: Beth Israel and St. Luke's-Roosevelt, New York, NY, USA
| | - E D Paskett
- The Ohio State University Comprehensive Cancer Center, College of Medicine, Department of Internal Medicine, Columbus, OH, USA
| | - T Ahles
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - L R Bressler
- University of Illinois College of Pharmacy (Emeritus Faculty), Chicago, IL, USA
| | | | - C E Fadul
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - C Loprinzi
- Mayo Clinic, Rochester, Rochester, MN, USA
| | - C L Shapiro
- Mount Sinai Medical Center, Division of Hematology/Medical Oncology: Tisch Cancer Institute, New York, NY, USA
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Egerton T, Hokstad A, Askim T, Bernhardt J, Indredavik B. Prevalence of fatigue in patients 3 months after stroke and association with early motor activity: a prospective study comparing stroke patients with a matched general population cohort. BMC Neurol 2015; 15:181. [PMID: 26444541 PMCID: PMC4596493 DOI: 10.1186/s12883-015-0438-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/24/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Fatigue is a common complaint after stroke. Reasons for higher prevalence are still unclear. This study aimed to determine if fatigue prevalence in stroke patients is different to that of age and gender matched general population controls, and to explore whether early motor activity was associated with reduced likelihood of fatigue three months after stroke. METHODS This was a prospective multicenter cohort study of stroke patients admitted to eleven regional Norwegian hospitals, within 14 days after stroke. Stroke patients (n = 257) were age and gender matched to participants in a general population health survey (HUNT3-survey) carried out in a regional county of central Norway. The single-item fatigue questionnaire from the HUNT3-survey was administered to both groups to compare prevalence. The association between early motor activity (time in bed, time sitting out of bed, and time upright) and fatigue at three months after stroke (Fatigue Severity Scale) was tested with logistic regression. Simple models including each activity outcome, with adjustment for stroke severity and pre-stroke function, were tested, as well as a comprehensive model that included additional independent variables of depression, pain, pre-stroke fatigue, age and gender. RESULTS Prevalence was higher after stroke compared with the general population: 31.1% versus 10.9%. In the simple regression models, none of the early motor activity categories were associated with fatigue three months after stroke. In the comprehensive model, depression, pain and pre-stroke fatigue were significantly associated with post-stroke fatigue. Time in bed through the daytime during hospital stay approached statistical significance (p = 0.058) with an odds ratio for experiencing fatigue of 1.02 (95% CI 1.00-1.04) for each additional 5.4 minutes in bed. CONCLUSIONS Stroke patients had higher prevalence of fatigue three months after stroke than the age and gender matched general population sample, which may be partly explained by the stroke population being in poorer health overall. The relationship between early motor activity (and inactivity) and fatigue remains unclear. Further research, which may help drive development of new treatments to target this challenging condition, is needed.
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Affiliation(s)
- Thorlene Egerton
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science & Technology, Trondheim, Norway.
| | - Anne Hokstad
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science & Technology, Trondheim, Norway. .,The Stroke Unit, Department of Medicine, St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway.
| | - Torunn Askim
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science & Technology, Trondheim, Norway. .,Department of Physiotherapy, Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway.
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
| | - Bent Indredavik
- Department of Neuroscience, Faculty of Medicine, Norwegian University of Science & Technology, Trondheim, Norway. .,The Stroke Unit, Department of Medicine, St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway.
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Lin WQ, Jing MJ, Tang J, Wang JJ, Zhang HS, Yuan LX, Wang PX. Factors Associated with Fatigue among Men Aged 45 and Older: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10897-909. [PMID: 26404346 PMCID: PMC4586650 DOI: 10.3390/ijerph120910897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/23/2015] [Accepted: 08/25/2015] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Wei-Quan Lin
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
| | - Meng-Juan Jing
- Institute of Public Health, School of Nursing, Henan University, Kaifeng, 475004, China; E-Mail:
| | - Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
| | - Jia-Ji Wang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
| | - Hui-Shan Zhang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
| | - Le-Xin Yuan
- Department of Nursing, School of Nursing, Guangzhou Medical University, Guangzhou, 510182, China; E-Mail:
| | - Pei-Xi Wang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
- Institute of Public Health, School of Nursing, Henan University, Kaifeng, 475004, China; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +86-20-8134-0186; Fax: +86-20-8134-0196
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Jason LA, Sunnquist M, Brown A, Reed J. Defining Essential Features of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2015; 25:657-674. [PMID: 27047234 PMCID: PMC4817848 DOI: 10.1080/10911359.2015.1011256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Considerable debate surrounds the search for the defining features of patients with Myalgic Encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Current case definitions were created through clinical consensus. Failure to operationalize these case definitions has led to considerable variability in the identification of patients. In addition, some case definitions (e.g., Fukuda et al., 1994) do not require cardinal symptoms of this illness, where as other case definitions do require core symptoms of this illness (Carruthers et al., 2003, 2011), and these latter case criteria appear to identify a more impaired group of patients. Criterion variance is most likely to occur when operationally explicit criteria do not exist for diagnostic categories (Spitzer, Endicott, & Robins, 1978), or when there are varying criteria for contrasting case definitions, which is an impediment to the research in this field. To deal with this problem, it is possible to differentiate those that meet more loosely defined criteria from those that are more narrowly and defined, thus differentiating CFS from ME. In order to progress the search for biological markers and effective treatments, essential features need to be operationalized and broadly used in order to increase the probability that individuals included in samples have the same underlying illness.
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16
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Gray matter volumes in patients with chronic fatigue syndrome. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:380615. [PMID: 25792998 PMCID: PMC4352504 DOI: 10.1155/2015/380615] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/26/2014] [Indexed: 11/17/2022]
Abstract
Chronic fatigue syndrome (CFS) is a debilitating and complex disorder characterized by profound fatigue with uncertain pathologic mechanism. Neuroimage may be an important key to unveil the central nervous system (CNS) mechanism in CFS. Although most of the studies found gray matter (GM) volumes reduced in some brain regions in CFS, there are many factors that could affect GM volumes in CFS, including chronic pain, stress, psychiatric disorder, physical activity, and insomnia, which may bias the results. In this paper, through reviewing recent literatures, we discussed these interferential factors, which overlap with the symptoms of CFS.
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Kluger BM, Krupp LB, Enoka RM. Fatigue and fatigability in neurologic illnesses: proposal for a unified taxonomy. Neurology 2013; 80:409-16. [PMID: 23339207 DOI: 10.1212/wnl.0b013e31827f07be] [Citation(s) in RCA: 652] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fatigue is commonly reported in many neurologic illnesses, including multiple sclerosis, Parkinson disease, myasthenia gravis, traumatic brain injury, and stroke. Fatigue contributes substantially to decrements in quality of life and disability in these illnesses. Despite the clear impact of fatigue as a disabling symptom, our understanding of fatigue pathophysiology is limited and current treatment options rarely lead to meaningful improvements in fatigue. Progress continues to be hampered by issues related to terminology and assessment. In this article, we propose a unified taxonomy and a novel assessment approach to addressing distinct aspects of fatigue and fatigability in clinical and research settings. This taxonomy is based on our current knowledge of the pathophysiology and phenomenology of fatigue and fatigability. Application of our approach indicates that the assessment and reporting of fatigue can be clarified and improved by utilizing this taxonomy and creating measures to address distinct aspects of fatigue and fatigability. We review the strengths and weaknesses of several common measures of fatigue and suggest, based on our model, that many research questions may be better addressed by using multiple measures. We also provide examples of how to apply and validate the taxonomy and suggest directions for future research.
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Affiliation(s)
- Benzi M Kluger
- Department of Neurology, University of Colorado Denver, Aurora, USA.
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18
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Phillips K, Clauw DJ. Central pain mechanisms in the rheumatic diseases: future directions. ARTHRITIS AND RHEUMATISM 2013; 65:291-302. [PMID: 23045168 PMCID: PMC3610409 DOI: 10.1002/art.37739] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/02/2012] [Indexed: 01/08/2023]
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19
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Murphy SL, Lyden AK, Phillips K, Clauw DJ, Williams DA. Association between pain, radiographic severity, and centrally-mediated symptoms in women with knee osteoarthritis. Arthritis Care Res (Hoboken) 2011; 63:1543-9. [PMID: 22034116 DOI: 10.1002/acr.20583] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To examine the relationship between pain, radiographic severity, and a common set of co-occurring centrally-mediated symptoms (fatigue, sleep quality, and depression) in women with knee osteoarthritis. METHODS Participants underwent knee radiographs, and had repeated assessments of pain severity and other centrally-mediated symptoms during a 5-day home monitoring period. To examine associations between pain severity (the average of pain over the home monitoring period), measures of osteoarthritis radiographic severity (Kellgren/Lawrence grade, minimum joint space width), centrally-mediated symptoms, and demographics (age) were used. Symptoms of fatigue, sleep efficiency, and depression were used in a composite measure representing centrally-mediated symptoms. RESULTS Using a series of linear regression models in which each variable was entered hierarchically (n = 54), the final model showed that 27% of the variance in pain severity was explained by age, radiographic severity, and centrally-mediated symptoms. Centrally-mediated symptoms explained an additional 10% of the variance in pain severity after the other 2 variables were entered. CONCLUSION Both radiographic severity and centrally-mediated symptoms were independently and significantly associated with pain severity in women with knee osteoarthritis. In addition to more severe radiographic features, women with higher centrally-mediated symptoms had greater pain severity. Treatments for women with symptomatic knee osteoarthritis may be optimized by addressing both peripheral and central sources of pain.
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Affiliation(s)
- Susan L Murphy
- VA Ann Arbor Health Care System and University of Michigan, USA.
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20
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Abstract
Fibromyalgia syndrome is a common chronic pain disorder of unknown etiology. The lack of understanding of the pathophysiology of fibromyalgia has made this condition frustrating for patients and clinicians alike. The most common symptoms of this disorder are chronic widespread pain, fatigue, sleep disturbances, difficulty with memory, and morning stiffness. Emerging evidence points towards augmented pain processing within the central nervous system (CNS) as having a primary role in the pathophysiology of this disorder. Currently the two drugs that are approved by the United States Food and Drug Administration (FDA) for the management of fibromyalgia are pregabalin and duloxetine. Newer data suggests that milnacipran, a dual norepinephrine and serotonin reuptake inhibitor, may be promising for the treatment of fibromyalgia. A double-blind, placebo-controlled trial of milnacipran in 125 fibromyalgia patients showed significant improvements relative to placebo. Milnacipran given either once or twice daily at doses up to 200 mg/day was generally well tolerated and yielded significant improvements relative to placebo on measures of pain, patient's global impression of change in their disease state, physical function, and fatigue. Future studies are needed to validate the efficacy of milnacipran in fibromyalgia.
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Affiliation(s)
- Richard E Harris
- Department of Anesthesiology, The University of Michigan, Ann, Arbor, MI, USA.
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21
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Subgroups of older adults with osteoarthritis based upon differing comorbid symptom presentations and potential underlying pain mechanisms. Arthritis Res Ther 2011; 13:R135. [PMID: 21864381 PMCID: PMC3239378 DOI: 10.1186/ar3449] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/08/2011] [Accepted: 08/24/2011] [Indexed: 01/26/2023] Open
Abstract
Introduction Although people with knee and hip osteoarthritis (OA) seek treatment because of pain, many of these individuals have commonly co-occurring symptoms (for example, fatigue, sleep problems, mood disorders). The purpose of this study was to characterize adults with OA by identifying subgroups with the above comorbid symptoms along with illness burden (a composite measure of somatic symptoms) to begin to examine whether subsets may have differing underlying pain mechanisms. Methods Community-living older adults with symptomatic knee and hip OA (n = 129) participated (68% with knee OA, 38% with hip OA). Hierarchical agglomerative cluster analysis was used. To determine the relative contribution of each variable in a cluster, multivariate analysis of variance was used. Results We found three clusters. Cluster 1 (n = 45) had high levels of pain, fatigue, sleep problems, and mood disturbances. Cluster 2 (n = 38) had intermediate degrees of depression and fatigue, but low pain and good sleep. Cluster 3 (n = 42) had the lowest levels of pain, fatigue, and depression, but worse sleep quality than Cluster 2. Conclusions In adults with symptomatic OA, three distinct subgroups were identified. Although replication is needed, many individuals with OA had symptoms other than joint pain and some (such as those in Cluster 1) may have relatively stronger central nervous system (CNS) contributions to their symptoms. For such individuals, therapies may need to include centrally-acting components in addition to traditional peripheral approaches.
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22
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ter Wolbeek M, van Doornen LJP, Kavelaars A, Tersteeg-Kamperman MDJ, Heijnen CJ. Fatigue, depressive symptoms, and anxiety from adolescence up to young adulthood: a longitudinal study. Brain Behav Immun 2011; 25:1249-55. [PMID: 21549830 DOI: 10.1016/j.bbi.2011.04.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 04/21/2011] [Accepted: 04/22/2011] [Indexed: 11/24/2022] Open
Abstract
Fatigue is a common complaint among adolescents. We investigated the course of fatigue in females during the transition from adolescence to young adulthood and examined psychological, immunological, and life style risk factors for development of fatigue and chronic fatigue syndrome (CFS)-related symptoms. Six hundred and thirty-three healthy females (age 14.63±1.37 years) filled out questionnaires measuring fatigue severity, depressive symptoms, anxiety, chronic fatigue syndrome (CFS)-related symptoms, sleep features, and life style characteristics at baseline and 4½ years thereafter. Of 64 participants LPS- and CD2CD28-induced cytokine data at baseline were available. The best predictor of fatigue in young adulthood was previous fatigue severity. In participants who were non-fatigued during adolescence and who experienced a notable increase in fatigue, fatigue development was preceded by emotional problems and CFS-related complaints during adolescence. Increases as well as decreases in fatigue severity were accompanied by respectively increase and decrease in depressive symptoms and anxiety, suggesting that these symptoms cluster and co-vary over time. Higher interferon (IFN)-γ, higher IFN-γ/interleukin (IL)-4 ratio, lower tumor necrosis factor-α and lower IL-10 at baseline were related to fatigue severity at follow up. The rise in total number of CFS-related symptoms at follow up was predicted by anxiety and decreased physical activity during adolescence. Sleep and substance use were associated with fatigue severity and anxiety and depression. In conclusion, vulnerability to develop fatigue and associated symptoms in young adulthood can to a certain extent be identified already years before the manifestation of complaints.
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Affiliation(s)
- Maike ter Wolbeek
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, Office KC 03.068.0, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
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24
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Jason LA, Evans M, Brown M, Porter N. What is fatigue? Pathological and nonpathological fatigue. PM R 2010; 2:327-31. [PMID: 20656613 DOI: 10.1016/j.pmrj.2010.03.028] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 03/23/2010] [Indexed: 12/17/2022]
Abstract
Aid in understanding issues surrounding the construct validity of fatigue including the distinction between pathological versus nonpathological fatigue. Fatigue is a universal symptom reported by individuals in the general population as well as by those suffering from different medical and psychological illnesses, including cancer, multiple sclerosis, chronic fatigue syndrome, depression, and anxiety. Chronic fatigue is a significant problem in many primary care settings, and the debilitating and prolonged nature of fatigue can pose significant economic consequences for society. Researchers have struggled to better assess and understand the etiology and classification of fatigue within different illness groups.
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Affiliation(s)
- Leonard A Jason
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614, USA.
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25
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Tanaka M, Watanabe Y. A new hypothesis of chronic fatigue syndrome: Co-conditioning theory. Med Hypotheses 2010; 75:244-9. [DOI: 10.1016/j.mehy.2010.02.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 02/24/2010] [Accepted: 02/25/2010] [Indexed: 02/08/2023]
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Glucocorticoid sensitivity of immune cells in severely fatigued adolescent girls: a longitudinal study. Psychoneuroendocrinology 2008; 33:375-85. [PMID: 18242001 DOI: 10.1016/j.psyneuen.2007.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Revised: 12/10/2007] [Accepted: 12/18/2007] [Indexed: 11/21/2022]
Abstract
Fatigue during adolescence is associated with somatic and psychological complaints that resemble the pattern of symptoms described for chronic fatigue syndrome (CFS). Studies in CFS and other stress-related syndromes suggested a dysfunction of the interactions between the hypothalamic-pituitary-adrenal axis (HPA-axis) and the immune system, i.e. a changed glucocorticoid (GC) receptor sensitivity of immune cells, to exist. Here we investigated whether severely fatigued girls from a healthy population have altered cortisol production and immune cell sensitivity for the synthetic GC, dexamethasone (DEX). In a longitudinal design, we examined ex vivo DEX sensitivity of monocytes and of T-cell mitogen-induced responses of severely fatigued (N=65) and non-fatigued girls (N=60). Fatigued girls reported more severe comorbid complaints than non-fatigued participants across three measurements during 1 year (T1: spring, T2: autumn, T3: spring) and had higher plasma cortisol levels throughout the study. DEX sensitivity of T-cell mitogen-induced responses showed seasonal variation with increased sensitivity in autumn compared to spring. No systematic variation of monocyte glucocorticoid receptor (GR) sensitivity was observed. Significant rank correlations of DEX sensitivity of T-cell mitogen-induced responses between the three assessments during the year suggest a stable trait of immune function. Groups did not differ in DEX sensitivity on any of the read outs. However, in a persistently fatigued subgroup, sensitivity to DEX was significantly reduced on the level of interferon (IFN)-gamma production. These results show that although fatigued participants had severe (comorbid) complaints, only in the case when symptoms persisted, altered GC sensitivity of immune cells was observed.
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ter Wolbeek M, van Doornen LJP, Kavelaars A, Heijnen CJ. Predictors of persistent and new-onset fatigue in adolescent girls. Pediatrics 2008; 121:e449-57. [PMID: 18310166 DOI: 10.1542/peds.2007-1093] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the stability of fatigue in adolescents and to explore whether psychological, somatic, and lifestyle factors are involved in the onset and persistence of fatigue during adolescence. METHODS In this longitudinal study, a total of 653 adolescent girls (aged 14.40 +/- 1.45 years) who previously participated in an epidemiological study filled out questionnaires 6 (T2) and 12 (T3) months after the initial assessment (T1). Fatigue severity, depression, anxiety, and chronic fatigue syndrome-related symptoms were assessed. We determined the prevalence of severely fatigued cases at T2 and T3 and evaluated whether persistently fatigued participants initially differed from nonfatigued participants and participants with transient fatigue. We examined which factors predicted the development of new-onset fatigue and investigated whether changes in fatigue covaried with changes in other complaints and changes in lifestyle. RESULTS Of all participants who were severely fatigued at T1, 25.7% were persistently fatigued throughout the study. Persistently fatigued participants had higher levels of depression and anxiety at the beginning of the study, were less physically active, and slept shorter. New-onset fatigue was predicted by depression, less physical activity, and more nightlife activities. Interestingly, new onset was not predicted by initial levels of fatigue. Persistently fatigued participants did not differ in initial fatigue severity from short-term fatigued patients. A decrease in fatigue severity was associated with a decrease in depression, anxiety, and chronic fatigue syndrome-related symptoms and, to a lesser extent, with an increase in physical activity and sleep duration. CONCLUSIONS The stability of severe fatigue among adolescents is substantial. The involvement in the onset and persistence of fatigue suggests that both preventive and therapeutic strategies with respect to fatigue treatment in adolescents should concentrate on emotional well-being. Moreover, adolescents at risk should be stimulated to spend more time on physical activities and to sleep longer.
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Affiliation(s)
- Maike ter Wolbeek
- Laboratory of Psychoneuroimmunology, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
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28
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ter Wolbeek M, van Doornen LJP, Kavelaars A, van de Putte EM, Schedlowski M, Heijnen CJ. Longitudinal analysis of pro- and anti-inflammatory cytokine production in severely fatigued adolescents. Brain Behav Immun 2007; 21:1063-74. [PMID: 17544255 DOI: 10.1016/j.bbi.2007.04.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 04/10/2007] [Accepted: 04/20/2007] [Indexed: 11/25/2022] Open
Abstract
In the adolescent population, fatigue is associated with somatic complaints, unrefreshing sleep, cognitive disturbances and symptoms of depression and anxiety. This pattern of symptoms resembles the one described in chronic fatigue syndrome (CFS). Since immunological alterations have been reported in CFS patients, we wondered whether also severely fatigued girls from a healthy population would show comparable alterations in psychological and immunological parameters. We tested this hypothesis in a longitudinal design, allowing a reliable assessment of the participants' characteristic immune status. Groups of severely fatigued (N=67) and non-fatigued (N=61) participants were selected. Severely fatigued girls reported more depressive symptoms, anxiety, reduced sleep quality, and somatic and CFS-related symptoms than non-fatigued participants across three measurements during one year (T1: spring, T2: autumn, T3: spring). In contrast, no group differences in mitogen-induced cytokine production or T-cell proliferation in vitro or in leukocyte subset counts were observed. Although absolute cytokine production and cell counts were affected by seasonal variation, the within-subject values, relatively to the rest of the participants, were fairly stable. Data from a small group of CFS patients (N=11) showed similarities in self-reported complaints between CFS patients and fatigued participants. Interestingly, CFS patients showed a distinct immune profile when compared to the severely fatigued or non-fatigued participants, i.e. increased levels of anti-inflammatory cytokines (IL-10, decreased IFN-gamma/IL-10 ratio) and reduced levels of pro-inflammatory cytokines (IL-6, TNF-alpha) over all three time points analyzed. These results show that, although overlap in symptomatology between the general population and patients with CFS was observed, only CFS patients show a skewing of the cytokine balance towards an anti-inflammatory profile.
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Affiliation(s)
- Maike ter Wolbeek
- Laboratory of Psychoneuroimmunology, University Medical Center Utrecht, 3508 AB Utrecht, The Netherlands
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Abstract
Syndromes characterized by pain, fatigue, mood disorder, cognitive dysfunction, and sleep disturbance have been referred to as stress-related somatic disorders by virtue of the observation that onset and exacerbation of symptoms occur with stress. These syndromes include but are not limited to fibromyalgia, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. As with most chronic illnesses, genetic susceptibility and lifetime environmental exposures play a role in creating vulnerability to disease. Cumulative lifetime stress has been associated with a number of physiologic changes in the brain and body that reflect dysregulated hormonal and autonomic activity. Exposure to the stressor of violence is likely to create a state of vulnerability for the stress-related somatic syndromes and also to contribute to symptom expression and severity. Understanding the relationship between violence, stress, and somatic syndromes will help in clarifying the consequences of violence exposure to long-term health and health-related quality of life.
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Affiliation(s)
- Leslie J Crofford
- Center for the Advancement of Women's Health, University of Kentucky, USA.
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30
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ter Wolbeek M, van Doornen LJP, Kavelaars A, Heijnen CJ. Severe fatigue in adolescents: a common phenomenon? Pediatrics 2006; 117:e1078-86. [PMID: 16740810 DOI: 10.1542/peds.2005-2575] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of severe fatigue in adolescent boys and girls, to explore the role of lifestyle factors in fatigue, and to investigate whether severe fatigue in a healthy population is associated with depression, anxiety, and comorbid factors also observed in chronic fatigue syndrome patients. METHODS In a sample of 1718 boys and 1749 girls, fatigue severity and duration were measured using a multidimensional questionnaire (Checklist Individual Strength). In addition, self-reports of depressive symptoms, anxiety, chronic fatigue syndrome-related symptoms, and lifestyle characteristics were assessed by means of questionnaires. Prevalence rates of severe fatigue and severe fatigue for > or =1 month, based on a clinical cutoff score of the Checklist Individual Strength, were determined for boys and girls separately, and gender-specific predictors of fatigue were identified by multiple regression analysis. RESULTS The data showed high prevalence rates of severe fatigue in adolescents. Remarkable differences between boys and girls were observed: 20.5% of girls and 6.5% of the boys scored above the clinical cutoff score on the Checklist Individual Strength. Of these subjects 80.0% of the girls and 61.5% of the boys reported severe fatigue for > or =1 month. Of the examined lifestyle characteristics, only sleep characteristics and the participation in sports played a role in predicting fatigue in both genders. Moreover, in girls, fatigue was associated with higher age, an early menarche, medication use, and the absence of an additional job. Overall, girls scored higher on depression, anxiety, and chronic fatigue syndrome-related symptoms. However, the relation between fatigue and these comorbid symptoms did not differ between genders. In both girls and boys, the duration of fatigue was positively related to fatigue severity, severity of depression and anxiety, and the number of chronic fatigue syndrome-related symptoms. CONCLUSIONS Fatigue prevalence among adolescents is high, especially in girls. Adolescent girls seem to be more vulnerable to symptoms of fatigue and comorbidity than boys. Interestingly, despite a female predominance in complaints, the relation between fatigue and depression, anxiety, and chronic fatigue syndrome-related symptoms was not gender specific and emerged as a cluster. In both genders, fatigue duration was associated with the severity of fatigue and the level of psychological comorbidity and chronic fatigue syndrome-related symptoms, and we, therefore, hypothesize that enduring severe fatigue may form a risk factor for the development of chronic fatigue syndrome.
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Affiliation(s)
- Maike ter Wolbeek
- Laboratory of Psychoneuroimmunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Furberg H, Olarte M, Afari N, Goldberg J, Buchwald D, Sullivan PF. The prevalence of self-reported chronic fatigue in a U.S. twin registry. J Psychosom Res 2005; 59:283-90. [PMID: 16253618 PMCID: PMC2949064 DOI: 10.1016/j.jpsychores.2005.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the prevalence and correlates of various definitions of self-reported lifetime fatiguing illness in a U.S. twin registry. METHODS Data from 4591 female and male twins from the population-based Mid-Atlantic Twin Registry were available for this study. Variables representing different definitions of lifetime fatiguing illness and personal characteristics were obtained through questionnaires. Odds ratios and 95% confidence intervals were calculated as measures of association between fatigue and gender. Kaplan-Meier curves were produced to examine the age at onset for lifetime fatiguing illnesses. RESULTS Prevalences for different definitions of self-reported lifetime fatigue ranged from 36.7% for any fatigue to 2.7% for chronic fatigue syndrome-like illness. Females were two to three times more likely to report fatigue than males. Gender differences increased as fatigue definitions grew more restrictive. Ages at onset of chronic fatiguing illness were significantly earlier and the number of ancillary symptoms was greater for females than males. People with lifetime fatigue had significantly more compromised functional status than people without lifetime fatigue. CONCLUSION The prevalence of self-reported lifetime fatiguing illness varied widely depending upon how it was defined. Given the debilitating consequences of fatiguing illnesses, the reasons for the female predominance and the earlier onset in women should receive increased research priority.
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Affiliation(s)
- Helena Furberg
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Megan Olarte
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Niloo Afari
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Jack Goldberg
- Department of Epidemiology, University of Washington & Vietnam Era Twin Registry, Seattle, WA, USA
| | - Dedra Buchwald
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Patrick F. Sullivan
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
- Corresponding author. Tel.: +1 919 966 3358; fax: +1 919 966 3630.
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Ogawa Y, Sugiura K, Watanabe A, Kunimatsu M, Mishima M, Tomita Y, Muro Y. Autoantigenicity of DFS70 is restricted to the conformational epitope of C-terminal alpha-helical domain. J Autoimmun 2005; 23:221-31. [PMID: 15501393 DOI: 10.1016/j.jaut.2004.07.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2004] [Revised: 06/29/2004] [Accepted: 07/13/2004] [Indexed: 11/26/2022]
Abstract
Autoantibodies against DFS70 (Dense Fine Speckles 70) are found in 30% of Japanese atopic dermatitis patients, and less frequently in patients with other diseases. We have recently reported that they are also seen in 11% of hospital workers, but in only approximately 2% of patients with systemic rheumatic disease. In this study, in order to investigate the possible pathological role of anti-DFS70 antibodies, fine epitope mapping was carried out using 93 anti-DFS70 autoantibody-positive sera. Immunoblotting using overlapping peptides failed to reveal major linear epitopes. Western blotting using various truncated proteins showed a strikingly uniform epitope distribution on a suspected tertiary structure expressed by DFS70(349-435). Some sera showed reactivity only in an immunoprecipitation assay using an in vitro translated DFS70. Circular dichroism analysis revealed that DFS(349-435) contains an approximately 40% alpha-helical conformation, while an overlapping, non-antigenic peptide is composed of random coiled structures. The skewed single major epitope enabled us to establish a highly quantitative ELISA for the epitope region. Antibody titers showed no significant differences between the diseased group and healthy individuals. We propose that anti-DFS70 antibody may be a natural autoantibody, which might modify or reflect the inflammatory process of various disorders.
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Affiliation(s)
- Yasushi Ogawa
- Division of Connective Tissue Disease & Autoimmunity, Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya 466-8550, Japan
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Singal A, Kaur S, Tirkey N, Chopra K. Green Tea Extract and Catechin Ameliorate Chronic Fatigue-Induced Oxidative Stress in Mice. J Med Food 2005; 8:47-52. [PMID: 15857209 DOI: 10.1089/jmf.2005.8.47] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Chronic fatigue syndrome (CFS) is an illness characterized by persistent and relapsing fatigue, often accompanied by numerous symptoms involving various body systems. The etiology of CFS remains unclear, but a number of studies have shown that oxidative stress may be involved in its pathogenesis. The present study was designed to investigate the protective effect of green tea extract (GTE) and catechin in the mouse model of CFS. Animals were subjected to a forced swimming test session of 6 minutes every day for 7 days; a significant increase in immobility time on successive days represented the CFS in mice. Biochemical analysis revealed that the chronic swim test significantly increased lipid peroxidation levels and decreased glutathione levels in mouse whole-brain homogenate. Treatment with GTE (25 or 50 mg/kg, i.p.) and catechin (50 or 100 mg/kg, i.p.) for 7 days reversed the increase in immobility time. Protection was correlated with the lowered levels of lipid peroxidation and restoration of reduced glutathione levels in the brains of fatigued mice. These findings strongly suggest the pivotal role of oxidative stress in the pathophysiology of CFS and that GTE and catechin could be used as potential agents in the management of CFS and warrant the inclusion of GTE and catechin in the treatment regimen of CFS patients.
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Affiliation(s)
- Anjali Singal
- Pharmacology Division, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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Abstract
The aetiologies of both chronic fatigue syndrome (CFS) and its predecessor neurasthenia, have been linked to technological advances in 'developed' countries. This paper discusses how this has led to a form of race thinking within discussions about fatigue which has persisted for more than a century. We review the historical development of this race thinking from neurasthenia to CFS and describe how it is manifested in both the lay- and medical literature. We also review the epidemiological literature on CFS and ethnicity to better understand the relatively low percentage of non-white patients seen in tertiary referral clinics for CFS. The aim of this paper is to act as a starting point for a debate on race and CFS.
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Affiliation(s)
- A Luthra
- King's College School of Medicine, Institute of Psychiatry, 103 Denmark Hill, London SE5 8AZ, UK
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Evengård B, Jonzon E, Sandberg A, Theorell T, Lindh G. Differences between patients with chronic fatigue syndrome and with chronic fatigue at an infectious disease clinic in Stockholm, Sweden. Psychiatry Clin Neurosci 2003; 57:361-8. [PMID: 12839515 DOI: 10.1046/j.1440-1819.2003.01132.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background data were collected from patients presenting with fatigue at the clinic of infectious diseases at Huddinge University Hospital, Stockholm. The main purpose was to look for differences as to demographic and functional status for patients fulfilling criteria for chronic fatigue syndrome (CFS) and chronic fatigue (CF). A cross-sectional questionnaire survey was performed using a variety of instruments. A thorough medical investigation was performed. No difference was found as to social situation, occupation and illness attributions for patients in the two categories. Patients with CFS reported in general a higher degree of 'sickness' with more self-reported somatic symptoms, more self-reported functional impairment and more absence from work. A higher degree of psychiatric comorbidity was observed in CF than in CFS patients. A majority of CFS patients (80%) had an acute infectious onset compared to 43% in the CF group. Presently used criteria might, according to findings presented here, define two different patient categories in a population characterized by severe, prolonged fatigue. Because CFS patients (compared to patients with CF) have more somatic symptoms, more often report an infectious, sudden onset and have less psychiatric comorbidity, and CF patients seem to have more of an emotional, burn-out-like component one could speculate about the existence of different pathogenetic backgrounds behind the two diagnoses.
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Affiliation(s)
- Birgitta Evengård
- Department of Laboratory Medicine, Karolinska Institute at Huddinge University Hospital, Stockholm, Sweden.
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Abstract
The chronic fatigue syndrome is characterised by a fatigue that is disproportionate to the intensity of effort that is undertaken, has persisted for 6 months or longer, and has no obvious cause. Unless there has been a long period of patient- or physician-imposed inactivity, objective data may show little reduction in muscle strength or peak aerobic power, but the affected individual avoids heavy activity. The study of aetiology and treatment has been hampered by the low disease prevalence (probably <0.1% of the general population), and (until recently) by a lack of clear and standardised diagnostic criteria. It is unclear how far the aetiology is similar for athletes and nonathletes. It appears that in top competitors, overtraining and/or a negative energy balance can be precipitating factors. A wide variety of other possible causes and/or precipitating factors have been cited in the general population, including psychological stress, disorders of personality and affect, dysfunction of the hypothalamic-pituitary-adrenal axis, hormonal imbalance, nutritional deficits, immune suppression or activation and chronic infection. However, none of these factors have been observed consistently. The prognosis is poor; often disability and impairment of athletic performance are prolonged. Prevention of overtraining by careful monitoring seems the most effective approach in athletes. In those where the condition is established, treatment should aim at breaking the vicious cycle of effort avoidance, deterioration in physical condition and an increase in fatigue through a combination of encouragement and a progressive exercise programme.
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Affiliation(s)
- R J Shephard
- Defence & Civil Institute of Environmental Medicine, and Faculty of Physical Education & Health, University of Toronto, Ontario, Canada.
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Bouwer C, Claassen J, Dinan TG, Nemeroff CB. Prednisone augmentation in treatment-resistant depression with fatigue and hypocortisolaemia: a case series. Depress Anxiety 2001; 12:44-50. [PMID: 10999245 DOI: 10.1002/1520-6394(2000)12:1<44::aid-da6>3.0.co;2-c] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abnormalities of the hypothalamic-pituitary-adrenal (HPA) axis have long been implicated in major depression with hypercortisolaemia reported in typical depression and hypocortisolaemia in some studies of atypical depression. We report on the use of prednisone in treatment-resistant depressed patients with reduced plasma cortisol concentrations. Six patients with treatment-resistant major depression were found to complain of severe fatigue, consistent with major depression, atypical subtype, and to demonstrate low plasma cortisol levels. Prednisone 7.5 mg daily was added to the antidepressant regime. Five of six patients demonstrated significant improvement in depression on prednisone augmentation of antidepressant therapy. Although hypercortisolaemia has been implicated in some patients with depression, our findings suggest that hypocortisolaemia may also play a role in some subtypes of this disorder. In treatment-resistant depressed patients with fatigue and hypocortisolaemia, prednisone augmentation may be useful.
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Affiliation(s)
- C Bouwer
- Department of Psychological Medicine, University of Otago University, Dunedin, New Zealand.
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Butera ST, Brown J, Callahan ME, Owen SM, Matthews AL, Weigner DD, Chapman LE, Sandstrom PA. Survey of veterinary conference attendees for evidence of zoonotic infection by feline retroviruses. J Am Vet Med Assoc 2000; 217:1475-9. [PMID: 11128537 DOI: 10.2460/javma.2000.217.1475] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine exposure risks, possibility of zoonosis, and potential disease associations for feline retroviruses among a group of occupationally exposed individuals. DESIGN Unlinked voluntary cross-sectional epidemiologic survey. SAMPLE POPULATION 204 veterinarians, laboratory scientists, and other occupationally exposed individuals who attended a veterinary conference on feline geriatric medicine. PROCEDURE Blood was collected from participants who also completed a 13-question survey requesting demographic, occupational, exposure, and health information. Blood specimens were fractionated into plasma and mononuclear cell components. Plasma was tested for antibodies against feline immunodeficiency virus (FIV) and feline foamy virus (FeFV), as well as p27 antigen of FeLV. Mononuclear cell lysates were tested for FeLV provirus. RESULTS Subjects reported extensive duration of work with cats (mean, 17.3 years) and multiple high-risk exposures (eg, cat bites, scratches, and injuries with sharp instruments) per year. However, neither serologic nor molecular evidence of zoonosis with any of the 3 feline retroviruses was detected. CONCLUSIONS AND CLINICAL RELEVANCE Veterinarians encounter occupational exposures to animal material that place them at high risk for zoonoses. For feline retroviruses, the risk of zoonosis among healthy adult humans appears to be extremely small. However, potential for retroviral zoonosis, especially for viruses such as FeLV and FeFV that can replicate in human cells, cannot be eliminated, and universal precautions to reduce potential exposures should be used when handling sick cats.
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Affiliation(s)
- S T Butera
- HIV and Retrovirology Branch, Division of AIDS, STD, and TB Laboratory Research, National Center for Infectious Diseases, Centers for Disease Control and Prevnetion, Atlanta, GA 30333, USA
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Marshall GS. Report of a workshop on the epidemiology, natural history, and pathogenesis of chronic fatigue syndrome in adolescents. J Pediatr 1999; 134:395-405. [PMID: 10190912 DOI: 10.1016/s0022-3476(99)70195-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- G S Marshall
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Wessely S. The epidemiology of chronic fatigue syndrome. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 1998; 7:10-24. [PMID: 9658678 DOI: 10.1017/s1121189x00007089] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Shefer A, Dobbins JG, Fukuda K, Steele L, Koo D, Nisenbaum R, Rutherford GW. Fatiguing illness among employees in three large state office buildings, California, 1993: was there an outbreak? J Psychiatr Res 1997; 31:31-43. [PMID: 9201645 DOI: 10.1016/s0022-3956(96)00049-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED The objective was to determine if a cluster of chronic fatigue syndrome (CFS)-like illness had occurred among employees in two large state office buildings in northern California, and to identify risk factors for and features of fatiguing illness in this population. DESIGN case-control study. POPULATION AND SETTING Over 3300 current employees in two state office buildings and employees in a comparable "control" building. Information was collected on demographic and occupational variables, the occurrence of fatiguing illness for at least one month in the previous year, and the presence of 36 symptoms. A total of 3312 (82%) of 4035 employees returned questionnaires. Overall, 618 (18.7%) persons reported fatigue lasting at least one month; including 382 (11.5%) with fatigue of at least six months' duration and 75 (2.3%) with symptoms compatible with a CFS-like illness. Independent risk factors for fatigue lasting one month or longer were found to be Native American ethnicity (OR 2.4, CI 1.1,5.3), Hispanic ethnicity (OR 1.7, CI 1.3,2.3), female sex (OR 1.5, CI 1.2,1.9), gross household incomes of less than $50,000 (OR 1.3, CI 1.1,1.6), and less than a college education (OR 1.3, CI 1.1,1.6). Similar risks were observed for persons who reported fatigue lasting six months or longer. Female sex (OR 3.2, CI 1.7, 6.4) was the only independent risk factor found for those persons classified as having a CFS-like illness. Case prevalence rates for all three categories of fatigue, as determined by multivariate analysis, were not significantly different among buildings. Despite finding a substantial number of employees with fatiguing illness in the two state office buildings, the prevalence was not significantly different than that for a comparable control building. Previously unidentified risk factors for fatigue of at least one month and at least six months identified in this population included Hispanic ethnicity, not having completed college, and income below $50,000.
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Affiliation(s)
- A Shefer
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Abstract
Epidemiologic studies of chronic fatigue syndrome (CFS) have been hampered by the absence of a specific diagnostic test, but with increasing interest in this disorder there has been a greater understanding of the risk factors, illness patterns, and other aspects of this multisystem disorder. Working case definitions have been developed for research purposes but they have continued to change over time and have not always been utilized precisely by various investigators. This has been a major factor in the widely varying estimates of prevalence rates, but two different studies using the same working definition and including a medical work-up have estimated the prevalence to be approximately 200/100,000. Clusters of CFS cases, which appear to be related to earlier reports of "epidemic neuromyasthenia", have attracted considerable attention and appear to be well documented, although investigated with varying methodology and often with dissimilar case definitions. Risk factors for cases occurring in clusters and sporadically appear to be similar, the most consistent ones being female gender and the co-existence of some form of stress, either physical or psychological. The prognosis of CFS is difficult to predict, although cases occurring as part of clusters appear to have a better prognosis as a group than sporadic cases, and those with an acute onset have a better prognosis than those with gradual onset. It is highly unlikely that there is a single agent, infectious or noninfectious, that is responsible for more than a small proportion of CFS cases and, at the present time, the risk factors for developing CFS appear to lie more prominently in the host rather than the environment.
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Affiliation(s)
- P H Levine
- Department of Medicine, George Washington University Medical Center, Washington, D.C. 20037, USA
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