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Gaunt DM, Brigden A, Harris SRS, Hollingworth W, Jago R, Solomon-Moore E, Beasant L, Mills N, Sinai P, Crawley E, Metcalfe C. Graded exercise therapy compared to activity management for paediatric chronic fatigue syndrome/myalgic encephalomyelitis: pragmatic randomized controlled trial. Eur J Pediatr 2024; 183:2343-2351. [PMID: 38429546 PMCID: PMC11035451 DOI: 10.1007/s00431-024-05458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 03/03/2024]
Abstract
The MAGENTA pragmatic parallel groups randomized controlled trial compared graded exercise therapy (GET) with activity management (AM) in treating paediatric myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS). Children aged 8-17 years with mild/moderate ME/CFS and presenting to NHS specialist paediatric services were allocated at random to either individualised flexible treatment focussing on physical activity (GET, 123 participants) or on managing cognitive, school and social activity (AM, 118 participants) delivered by NHS therapists. The primary outcome was the self-reported short-form 36 physical function subscale (SF-36-PFS) after 6 months, with higher scores indicating better functioning. After 6 months, data were available for 201 (83%) participants who received a mean of 3.9 (GET) or 4.6 (AM) treatment sessions. Comparing participants with measured outcomes in their allocated groups, the mean SF-36-PFS score changed from 54.8 (standard deviation 23.7) to 55.7 (23.3) for GET and from 55.5 (23.1) to 57.7 (26.0) for AM giving an adjusted difference in means of -2.02 (95% confidence interval -7.75, 2.70). One hundred thirty-five participants completed the mean SF-36-PFS at 12 months, and whilst further improvement was observed, the difference between the study groups remained consistent with chance. The two study groups showed similar changes on most of the secondary outcome measures: Chalder Fatigue, Hospital Anxiety and Depression Scale: Depression, proportion of full-time school attended, a visual analogue pain scale, participant-rated change and accelerometer measured physical activity, whether at the 6-month or 12-month assessment. There was an isolated finding of some evidence of an improvement in anxiety in those allocated to GET, as measured by the Hospital Anxiety and Depression Scale at 6 months, with the 12-month assessment, and the Spence Children's Anxiety scale being aligned with that finding. There was weak evidence of a greater risk of deterioration with GET (27%) than with AM (17%; p = 0.069). At conventional UK cost per QALY thresholds, the probability that GET is more cost-effective than AM ranged from 18 to 21%. Whilst completion of the SF-36-PFS, Chalder Fatigue Scale and EQ-5D-Y was good at the 6-month assessment point, it was less satisfactory for other measures, and for all measures at the 12-month assessment. Conclusion: There was no evidence that GET was more effective or cost-effective than AM in this setting, with very limited improvement in either study group evident by the 6-month or 12-month assessment points. Trial registration: The study protocol was registered at www.isrctn.com (3rd September 2015; ISRCTN 23962803) before the start of enrolment to the initial feasibility phase.
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Affiliation(s)
- Daisy M Gaunt
- Bristol Medical School, Centre for Academic Child Health, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Bristol Medical School, Bristol Trials Centre, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Amberly Brigden
- Digital Health, School of Computer Science, Electrical and Electronic Engineering, University of Bristol, Bristol, BS1 5DD, UK
| | - Shaun R S Harris
- Swansea Centre for Health Economics, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - William Hollingworth
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Russell Jago
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Emma Solomon-Moore
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Lucy Beasant
- Bristol Medical School, Centre for Academic Child Health, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Nicola Mills
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Parisa Sinai
- Bristol Medical School, Centre for Academic Child Health, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Esther Crawley
- Bristol Medical School, Centre for Academic Child Health, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
- Bristol Medical School, Bristol Trials Centre, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
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Baken DM, Ross KJ, Hodges LD, Batten L. Experiences of carers of youth, adult children and spouses with ME/CFS. Chronic Illn 2023; 19:719-729. [PMID: 36259126 DOI: 10.1177/17423953221121696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The debilitating nature of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) means that family members often take on a caring role. This study compared the experiences of people caring for three groups: youth, young adults, spouses. METHODS An opportunistic sample of 36 carers completed an online survey of open-ended questions asking about their experiences. Thematic analysis was used to consider the three sets of responses separately and Thematic Comparison was used to identify points of connection and disconnection across the sets. RESULTS The themes identified were very similar to those identified in past studies. Two super-ordinate themes were identified: "Lack of knowledge and understanding" and "Holistic Impact". Though most sub-ordinate themes were evident across all three groups, important differences were found. The sub-ordinate themes "Caring Blindly", "Emotional and physical health cost", and "Impact on the whole family" were more evident amongst carers of youth while the theme "Worry for the future" was more evident from carers of young adults and spouses. DISCUSSION Differences seemed to be related to both the time since diagnosis and the life stage. A longitudinal study would help to understand how carer experiences change over the life course of caring for someone with ME/CFS.
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Affiliation(s)
- Don M Baken
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Kirsty J Ross
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Lynette D Hodges
- School of Sport, Exercise and Nutrition, Massey University, Palmerston North, New Zealand
| | - Lesley Batten
- Palmerston North Hospital, Palmerston North, New Zealand
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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Josev EK, Chen J, Seal M, Scheinberg A, Cole RC, Rowe K, Lubitz L, Knight SJ. What lies beneath: White matter microstructure in pediatric myalgic encephalomyelitis/chronic fatigue syndrome using diffusion MRI. J Neurosci Res 2023; 101:1572-1585. [PMID: 37331007 DOI: 10.1002/jnr.25223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 04/28/2023] [Accepted: 05/27/2023] [Indexed: 06/20/2023]
Abstract
Recent studies in adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) suggest that changes in brain white matter microstructural organization may correlate with core ME/CFS symptoms, and represent a potential biomarker of disease. However, this has yet to be investigated in the pediatric ME/CFS population. We examined group differences in macrostructural and microstructural white matter properties, and their relationship with clinical measures, between adolescents recently diagnosed with ME/CFS and healthy controls. Forty-eight adolescents (25 ME/CFS, 23 controls, mean age 16 years) underwent brain diffusion MRI, and a robust multi-analytic approach was used to evaluate white and gray matter volume, regional brain volume, cortical thickness, fractional anisotropy, mean/axial/radial diffusivity, neurite dispersion and density, fiber density, and fiber cross section. From a clinical perspective, adolescents with ME/CFS showed greater fatigue and pain, poorer sleep quality, and poorer performance on cognitive measures of processing speed and sustained attention compared with controls. However, no significant group differences in white matter properties were observed, with the exception of greater white matter fiber cross section of the left inferior longitudinal fasciculus in the ME/CFS group compared with controls, which did not survive correction for intracranial volume. Overall, our findings suggest that white matter abnormalities may not be predominant in pediatric ME/CFS in the early stages following diagnosis. The discrepancy between our null findings and white matter abnormalities identified in the adult ME/CFS literature could suggest that older age and/or longer illness duration influence changes in brain structure and brain-behavior relationships that are not yet established in adolescence.
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Affiliation(s)
- Elisha K Josev
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jian Chen
- Developmental Imaging, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Marc Seal
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Developmental Imaging, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Adam Scheinberg
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rebecca C Cole
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Katherine Rowe
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Lionel Lubitz
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Sarah J Knight
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Paediatric Rehabilitation Service, Royal Children's Hospital, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Vyas J, Muirhead N, Singh R, Ephgrave R, Finlay AY. Impact of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) on the quality of life of people with ME/CFS and their partners and family members: an online cross-sectional survey. BMJ Open 2022; 12:e058128. [PMID: 35501074 PMCID: PMC9062824 DOI: 10.1136/bmjopen-2021-058128] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/11/2022] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the impact of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) on the quality of life (QoL) of people with ME/CFS and their relative or partner (family member). DESIGN A patient-partner, multinational, subject-initiated, cross-sectional online survey. SETTING International survey using ME/CFS charities, support groups and social media. PARTICIPANTS Participants were self-selected with recruitment via social media. Inclusion criteria were aged 18 years or over and reported diagnosis of ME/CFS by health professional. 1418 people with ME/CFS and their 1418 family members from 30 countries participated in the survey. Participants with ME/CFS had a mean age of 45.8 years (range 18-81) and were predominantly women (1214 (85.6%) of 1418). Family members had a mean age of 51.9 years (range 18-87) and were predominantly men (women: 504 (35.5%) of 1418). 991 (70%) family members were partners of the people with ME/CFS. INTERVENTIONS EuroQoL-5 Dimension (EQ-5D-3L), completed by people with ME/CFS, and Family Reported Outcome Measure (FROM-16) questionnaire, completed by family members. RESULTS The mean overall health status on a Visual Analogue Scale for people with ME/CFS was 33.8 (0=worst, 100=best). People with ME/CFS were most affected by ability to perform usual activities, pain, mobility, self-care and least impacted by anxiety. For family members, the overall mean FROM-16 score was 17.9 (0=no impact, 32=worst impact), demonstrating a major impact on QoL. Impact on QoL was significantly correlated between the person with ME/CFS and their family member (p<0.0001). Family members were most impacted emotionally by worry, frustration and sadness and personally by family activities, holidays, sex life and finances. CONCLUSIONS To the best of our knowledge, this is the largest study on the impact of the QoL of persons with ME/CFS and their family members. While open participation surveys are limited by selection bias, this research has revealed a significant worldwide burden of ME/CFS on the QoL of people with ME/CFS and their family members.
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Affiliation(s)
- Jui Vyas
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - Nina Muirhead
- Dermatology, Buckinghamshire Healthcare NHS Trust, Amersham, UK
| | - Ravinder Singh
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Cochrane M, Mitchell E, Hollingworth W, Crawley E, Trépel D. Cost-effectiveness of Interventions for Chronic Fatigue Syndrome or Myalgic Encephalomyelitis: A Systematic Review of Economic Evaluations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:473-486. [PMID: 33646528 PMCID: PMC7917957 DOI: 10.1007/s40258-021-00635-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) has profound quality of life and economic consequences for individuals, their family, formal services and wider society. Little is known about which therapeutic interventions are more cost-effective. OBJECTIVE A systematic review was carried out to identify and critically appraise the evidence on the cost-effectiveness of CFS/ME interventions. METHODS The review protocol was prespecified (PROSPERO: CRD42018118731). Searches were carried out across two databases-MEDLINE (1946-2020) and EMBASE (1974-2020). Additional studies were identified by searching reference lists. Only peer-reviewed journal articles of full economic evaluations examining CFS/ME interventions were included. Trial- and/or model-based economic evaluations were eligible. Data extraction and screening were carried out independently by two reviewers. The methodological quality of the economic evaluation and trial were assessed using the Consensus Health Economic Criteria checklist (CHEC-list) and Risk of Bias-2 (RoB-2) tool, respectively. A narrative synthesis was used to summarise the economic evidence for interventions for adults and children in primary and secondary care settings. RESULTS Ten economic evaluations, all based on data derived from randomised controlled trials, met our eligibility criteria. Cognitive behavioural therapy (CBT) was evaluated across five studies, making it the most commonly evaluated intervention. There was evidence from three trials to support CBT as a cost-effective treatment option for adults; however, findings on CBT were not uniform, suggesting that cost-effectiveness may be context-specific. A wide array of other interventions were evaluated in adults, including limited evidence from two trials supporting the cost effectiveness of graded exercise therapy (GET). Just one study assessed intervention options for children. Our review highlighted the importance of informal care costs and productivity losses in the evaluation of CFS/ME interventions. CONCLUSIONS We identified a limited patchwork of evidence on the cost-effectiveness of interventions for CFS/ME. Evidence supports CBT as a cost-effective treatment option for adults; however, cost-effectiveness may depend on the duration and frequency of sessions. Limited evidence supports the cost effectiveness of GET. Key weaknesses in the literature included small sample sizes and short duration of follow-up. Further research is needed on pharmacological interventions and therapies for children.
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Affiliation(s)
- M Cochrane
- Bristol Medical School, University of Bristol, Bristol, UK.
| | - E Mitchell
- Global Brain Health Institute, Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland
- School of Biological Sciences, IGFS, Gibson Institute, Queen's University Belfast, Belfast, UK
| | - W Hollingworth
- Bristol Medical School, University of Bristol, Bristol, UK
| | - E Crawley
- Bristol Medical School, University of Bristol, Bristol, UK
| | - D Trépel
- School of Biological Sciences, IGFS, Gibson Institute, Queen's University Belfast, Belfast, UK
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Asprusten TT, Sletner L, Wyller VBB. Are there subgroups of chronic fatigue syndrome? An exploratory cluster analysis of biological markers. J Transl Med 2021; 19:48. [PMID: 33516248 PMCID: PMC7847574 DOI: 10.1186/s12967-021-02713-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is defined according to subjective symptoms only, and several conflicting case definition exist. Previous research has discovered certain biological alterations. The aim of the present study was to explore possible subgroups based on biological markers within a widely defined cohort of adolescent CFS patients and investigate to what extent eventual subgroups are associated with other variables. METHODS The Norwegian Study of Chronic Fatigue Syndrome in Adolescents: Pathophysiology and Intervention Trial (NorCAPITAL) has previously performed detailed investigation of immunological, autonomic, neuroendocrine, cognitive and sensory processing functions in an adolescent group of CFS patients recruited according to wide diagnostic criteria. In the present study, hierarchical cluster analyses (Ward's method) were performed using representative variables from all these domains. Associations between clusters and constitutional factors (including candidate genetic markers), diagnostic criteria, subjective symptoms and prognosis were explored by standard statistical methods. RESULTS A total of 116 patients (26.7% males, mean age 15.4 years) were included. The final cluster analyses revealed six clusters labelled pain tolerant & good cognitions, restored HPA dynamics, orthostatic intolerance, low-grade inflammation, pain intolerant & poor cognitions, and high vagal (parasympathetic) activity, respectively. There was substantial overlap between clusters. The pain intolerant & poor cognitions-cluster was associated with low functional abilities and quality of life, and adherence to the Canada 2003 diagnostic criteria for CFS. No other statistically significant cluster associations were discovered. CONCLUSION Within a widely defined cohort of adolescent CFS patients, clusters could be delineated, but no distinct subgroups could be identified. Associations between clusters and constitutional factors, subjective symptoms and prognosis were scarce. These results question the clinical usefulness of searching for CFS subgroups, as well as the validity of the most "narrow" CFS diagnostic criteria. TRIAL REGISTRATION Clinical Trials NCT01040429.
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Affiliation(s)
- Tarjei Tørre Asprusten
- Department of Paediatric and Adolescent Health, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Line Sletner
- Department of Paediatric and Adolescent Health, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Vegard Bruun Bratholm Wyller
- Department of Paediatric and Adolescent Health, Akershus University Hospital, 1478 Lørenskog, Norway
- Division of Medicine and Laboratory Sciences, University of Oslo, Oslo, Norway
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Brittain E, Muirhead N, Finlay AY, Vyas J. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Major Impact on Lives of Both Patients and Family Members. ACTA ACUST UNITED AC 2021; 57:medicina57010043. [PMID: 33430175 PMCID: PMC7825605 DOI: 10.3390/medicina57010043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: To explore the impacts that Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) has on the patient and their family members using the WHOQOL-BREF (Abbreviated World Health Organisation Quality of Life questionnaire) and FROM-16 (Family Reported Outcome Measure-16) quality of life assessments. Materials and Methods: A quantitative research study using postal questionnaires was conducted. A total of 39 adult volunteers expressed an interest in participating in the study: 24 returned appropriately completed questionnaires. Patients with ME/CFS completed the WHOQOL-BREF and up to four of their family members completed the FROM-16 questionnaire. Results: ME/CFS negatively affects the quality of life of the patient (median scores WHOQOL-BREF: Physical health = 19, Psychological = 44, Social relationships = 37.5, Environment = 56, n = 24) and their family members' quality of life (FROM-16: Emotional = 9.5, Personal and social = 11.5, Overall = 20.5, n = 42). There was a significant correlation between the patient's reported quality of life scores and their family members' mean FROM-16 total scores. Conclusions: This study identifies the major impact that having an adult family member with ME/CFS has on the lives of partners and of other family members. Quality of life of ME/CFS patients was reduced most by physical health compared to the other domains. Quality of life of family members was particularly impacted by worry, family activities, frustration and sadness. This highlights the importance of measuring the impact on the lives of family members using tools such as the FROM-16 in the ME/CFS clinical encounter and ensuring appropriate support is widely available to family members.
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Affiliation(s)
- Esme Brittain
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK; (E.B.); (A.Y.F.)
| | - Nina Muirhead
- Buckinghamshire Healthcare NHS Trust, Amersham Hospital, Amersham HP7 0JD, UK;
| | - Andrew Y. Finlay
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK; (E.B.); (A.Y.F.)
| | - Jui Vyas
- School of Medicine, Cardiff University, Cardiff CF14 4XN, UK; (E.B.); (A.Y.F.)
- Correspondence:
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Brigden A, Shaw A, Anderson E, Crawley E. Chronic fatigue syndrome/myalgic encephalomyelitis in children aged 5 to 11 years: A qualitative study. Clin Child Psychol Psychiatry 2021; 26:18-32. [PMID: 33092395 PMCID: PMC7802053 DOI: 10.1177/1359104520964528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Treatments for paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) have not been designed or evaluated for younger children (5-11-years). The development of a complex intervention for this population requires an in-depth understanding of the perspectives and psychosocial context of children and families. Children with CFS/ME (5-11-years) and their families were recruited from a specialist CFS/ME service, and interviewed using semi-structured topic guides. Data were analysed thematically. Twenty-two participants were interviewed; eight parents, two children (aged nine and ten) and six parent-child dyads (aged 5-11-years). Theme 1: CFS/ME in younger children is complex and disabling. Theme 2: Children aged eight and over (in comparison to those under eight) were more able to describe their illness, engage in clinical consultation, understand diagnosis and self-manage. Theme 3: Parents of children under eight took full responsibility for their child's treatment. As children got older, this increasingly became a joint effort between the parent and child. Parents felt unsupported in their caring role. Clinicians should consider different treatment approaches for children under eight, focusing on: parent-only clinical sessions, training parents to deliver treatment, and increasing support for parents. Children over eight may benefit from tools to help them understand diagnosis, treatment and aids for self-management.
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Affiliation(s)
- Amberly Brigden
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Shaw
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma Anderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Crawley
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Boulazreg S, Rokach A. The Lonely, Isolating, and Alienating Implications of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Healthcare (Basel) 2020; 8:E413. [PMID: 33092097 PMCID: PMC7711762 DOI: 10.3390/healthcare8040413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/27/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022] Open
Abstract
This article provides a narrative review on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) through a psychosocial lens and examines how this impairment affects its sufferers during adolescence and adulthood, as well as how it impacts family caregivers and healthcare professionals' mental health. Since there has been a lack of investigation in the literature, the primary psychosocial stressor that this review focuses on is loneliness. As such, and in an attempt to help establish a theoretical framework regarding how loneliness may impact ME/CFS, loneliness is comprehensively reviewed, and its relation to chronic illness is described. We conclude by discussing a variety of coping strategies that may be employed by ME/CFS individuals to address their loneliness. Future directions and ways with which the literature may investigate loneliness and ME/CFS are discussed.
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Affiliation(s)
- Samir Boulazreg
- Faculty of Education, University of Western Ontario, London, ON N6A 3K7, Canada
| | - Ami Rokach
- Department of Psychology, York University, Toronto, ON M3J 1P3, Canada;
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Abrams EM, Simons E, Roos L, Hurst K, Protudjer JLP. Qualitative analysis of perceived impacts on childhood food allergy on caregiver mental health and lifestyle. Ann Allergy Asthma Immunol 2020; 124:594-599. [PMID: 32145318 DOI: 10.1016/j.anai.2020.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/09/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Approximately 8% of children have food allergy. Yet, little is known about how parents cope with the burden of this disease. OBJECTIVE This study aimed to describe the perceptions of food allergy-related mental health issues of parents of children with food allergy. METHODS Parents of children with pediatric allergist-diagnosed food allergy were recruited through allergy clinics and education centers in a large Canadian city. We used content analysis to identify overarching themes. RESULTS We interviewed 21 parents with children (boys [13/21; 62.9%]) aged younger than 12 months to 16 years. Interviews averaged 47 (range 33-82) minutes. Most children were diagnosed as infants, and few (7/21; 33.3%) were monoallergic. About one-half (7/16; 43.8%) had a history of anaphylaxis. Parents of children with a single food allergy spoke of "accommodation and adaptation." In contrast, parents of children with multiple food allergies described "anxiety and isolation" and spoke of being "depressed" and "terrified" about leaving their children in the care of others who may not be equipped to handle food allergy. Many parents felt "overwhelmed and alone," especially if they lacked support from extended family and/or their social circle. "Fear for today, fear for the future" was commonly described by parents, although a tenuous symbiotic coexistence was developed, with parents stating "Food allergy management has become our normal." Finally, a small group of parents reported that "Bullying happens, but we are alone to cope with it." CONCLUSION Multiple food allergies negatively affect the mental health of parents, in a variety of well-being domains.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Meadowood Medical Centre, Winnipeg, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of British Columbia, Vancouver, Canada
| | - Elinor Simons
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Leslie Roos
- Deparment of Psychology, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Kim Hurst
- Faculty of Arts and Sciences (Life Sciences), Queen's University, Kingston, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
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Kristiansen MS, Stabursvik J, O'Leary EC, Pedersen M, Asprusten TT, Leegaard T, Osnes LT, Tjade T, Skovlund E, Godang K, Wyller VBB. Clinical symptoms and markers of disease mechanisms in adolescent chronic fatigue following Epstein-Barr virus infection: An exploratory cross-sectional study. Brain Behav Immun 2019; 80:551-563. [PMID: 31039432 DOI: 10.1016/j.bbi.2019.04.040] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/24/2019] [Accepted: 04/26/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Acute Epstein-Barr virus (EBV) infection is a trigger of chronic fatigue (CF) and Chronic Fatigue Syndrome (CFS). The aim of this cross-sectional study was to explore clinical symptoms as well as markers of disease mechanisms in fatigued and non-fatigued adolescents 6 months after EBV-infection, and in healthy controls. MATERIALS AND METHODS A total of 200 adolescents (12-20 years old) with acute EBV infection were assessed 6 months after the initial infectious event and divided into fatigued (EBV CF+) and non-fatigued (EBV CF-) cases based on questionnaire score. The EBV CF+ cases were further sub-divided according to case definitions of CFS. In addition, a group of 70 healthy controls with similar distribution of sex and age was included. Symptoms were mapped with a questionnaire. Laboratory assays included EBV PCR and serology; detailed blood leukocyte phenotyping and serum high-sensitive C-reactive protein; and plasma and urine cortisol and catecholamines. Assessment of autonomic activity was performed with continuous, non-invasive monitoring of cardiovascular variables during supine rest, controlled breathing and upright standing. Differences between EBV CF+ and EBV CF- were assessed by simple and multiple linear regression adjusting for sex as well as symptoms of depression and anxiety. A p-value ≤ 0.05 was considered statistically significant. This study is part of the CEBA-project (Chronic fatigue following acute Epstein-Barr virus infection in adolescents). RESULTS The EBV CF+ group had significantly higher scores for all clinical symptoms. All markers of infection and most immune, neuroendocrine and autonomic markers were similar across the EBV CF+ and EBV CF- group. However, the EBV CF+ group had slightly higher serum C-reactive protein (0.48 vs 0.43 mg/L, p = 0.031, high-sensitive assay), total T cell (CD3+) count (median 1573 vs 1481 × 106 cells/L, p = 0.012), plasma norepinephrine (1420 vs 1113 pmol/L, p = 0.01) and plasma epinephrine (363 vs 237 nmol/L, p = 0.032); lower low-frequency:high frequency (LF/HF) ratio of heart rate variability at supine rest (0.63 vs 0.76, p = 0.008); and an attenuated decline in LF/HF ratio during controlled breathing (-0.11 vs -0.25, p = 0.002). Subgrouping according to different CFS diagnostic criteria did not significantly alter the results. Within the EBV CF+ group, there were no strong correlations between clinical symptoms and markers of disease mechanisms. In a multiple regression analysis, serum CRP levels were independently associated with serum cortisol (B = 4.5 × 10-4, p < 0.001), urine norepinephrine (B = 9.6 × 10-2, p = 0.044) and high-frequency power of heart rate variability (B = -3.7 × 10-2, p = 0.024). CONCLUSIONS In adolescents, CF and CFS 6 months after acute EBV infection are associated with high symptom burden, but no signs of increased viral load and only subtle alterations of immune, autonomic, and neuroendocrine markers of which no one is strongly correlated with symptom scores. A slight sympathetic over parasympathetic predominance is evident in CF and might explain slightly increased CRP levels.
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Affiliation(s)
- Miriam Skjerven Kristiansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Pediatrics, Akershus University Hospital, Lørenskog, Norway
| | - Julie Stabursvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Pediatrics, Akershus University Hospital, Lørenskog, Norway
| | - Elise Catriona O'Leary
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Pediatrics, Akershus University Hospital, Lørenskog, Norway
| | - Maria Pedersen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Pediatrics, Akershus University Hospital, Lørenskog, Norway
| | - Tarjei Tørre Asprusten
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Pediatrics, Akershus University Hospital, Lørenskog, Norway
| | - Truls Leegaard
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway
| | | | | | - Eva Skovlund
- Dept. of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; Norwegian Institute of Public Health, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Dept. of Endocrinology, Oslo University Hospital, Norway
| | - Vegard Bruun Bratholm Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Dept. of Pediatrics, Akershus University Hospital, Lørenskog, Norway.
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Abstract
PURPOSE OF REVIEW The current review aims to determine the recent evidence regarding cause, impact, effective treatment and prognosis of children and young people (CYP) affected by chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) at a time when the National Institute for Clinical Excellence guidelines in the United Kingdom are being reviewed and more research is called for worldwide. RECENT FINDINGS CFS/ME is a debilitating illness with no clear cause. This review describes the heterogeneous clinical picture and the effects on the young person and family. Comorbidities such as mood disorders and pain are discussed including evidence for treatment. The various aetiological hypotheses are discussed and the precipitating factors identified. The evidence base is limited regarding effective treatment for CYP with CFS/ME, particularly the severely affected group. A large trial of online cognitive behavioural therapy with teenagers is being explored in the United Kingdom. The Lightning Process has been shown to be effective when added to medical care. SUMMARY Current evidence is hampered by different diagnostic criteria, the heterogeneous nature of the condition, and limited number of small studies. There is a clear need for more research and larger studies exploring the cause of and most effective treatment for CYP with CFS/ME.
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Loades ME, Rimes KA, Ali S, Lievesley K, Chalder T. Does fatigue and distress in a clinical cohort of adolescents with chronic fatigue syndrome correlate with fatigue and distress in their parents? Child Care Health Dev 2019; 45:129-137. [PMID: 30342433 DOI: 10.1111/cch.12626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/12/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Previous studies have found that parents of children with chronic fatigue syndrome (CFS) are more fatigued, and mothers are more distressed than healthy controls. Managing the disabling symptoms of CFS can result in disruption and burden for the family. Most research has focused on mothers. This study sought to further explore the associations between adolescent fatigue and distress and parental fatigue and distress, as well as family functioning, including both mothers and fathers. DESIGN Cross-sectional study of a clinical cohort of consecutive attenders at a specialist chronic fatigue unit. METHODS Questionnaires were completed by adolescents (N = 115, age 11-18) with a confirmed diagnosis of CFS and their mothers (N = 100) and fathers (N = 65). RESULTS Maternal fatigue was significantly correlated with maternal distress, but not with adolescent fatigue, depression, anxiety, or functioning. This pattern held true for paternal fatigue. Maternal and paternal anxiety and depression were significantly correlated with family functioning. Paternal and maternal distress were correlated with each other. Mothers and fathers tended to have a consistent view of family functioning. Family functioning, specifically being overwhelmed by difficulties and scoring lower on strengths and adaptability, was positively associated with adolescent depression. Unexpectedly, higher levels of adolescent fatigue and poorer physical functioning were associated with better family functioning as rated by the mother. CONCLUSIONS Parents of adolescents with fatigue scored near to or within normative range for non-clinical samples on distress, fatigue, and family functioning. Parental distress may contribute to or result from poorer family functioning. Family functioning, particularly building strengths and adaptability, may be clinically important in CFS, as well as attending to parental (particularly paternal) distress in families where adolescents are low in mood.
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Affiliation(s)
- Maria E Loades
- Department of Psychology, University of Bath, Bath, United Kingdom.,School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom.,South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX
| | - Sheila Ali
- South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX
| | - Kate Lievesley
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - Trudie Chalder
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom.,South London and Maudsley NHS Trust, Monks Orchard Road, Beckenham, Kent, BR3 3BX
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Harland MR, Parslow RM, Anderson N, Byrne D, Crawley E. Paediatric chronic fatigue syndrome patients' and parents' perceptions of recovery. BMJ Paediatr Open 2019; 3:e000525. [PMID: 32500105 PMCID: PMC7245384 DOI: 10.1136/bmjpo-2019-000525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is common in children and adolescents; however, little is known about how we should define recovery. This study aims to explore perceptions of recovery held by paediatric patients with CFS/ME and their parents. METHODS Children with CFS/ME and their parents were recruited through a single specialist paediatric CFS/ME service. Data were collected through semistructured interviews with children and parents. The interview questions explored how participants would know if they/their child had recovered from CFS/ME. Thematic analysis was used to identify patterns within the data. RESULTS Twenty-one children with CFS/ME, twenty mothers and two fathers were interviewed. Some children found it hard to define recovery as the illness had become a 'new normal'. Others thought recovery would indicate returning to pre-morbid levels of activity or achieving the same activity level as peers (socialising, education and leisure activities). Increased flexibility in routines and the absence of payback after activities were important. The interviews highlighted the concept of recovery as highly individual with wide variation in symptoms experienced, type and level of activity that would signify recovery. Parents describe how changes in mood and motivation would signify their child's recovery, but children did not reflect on this. CONCLUSION Some parents and children struggle to define what would constitute complete recovery. However, signs of recovery were more easily identifiable. Definitions of recovery went far beyond symptom reduction and were focused towards rebuilding lives.
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Affiliation(s)
| | | | - Nina Anderson
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Danielle Byrne
- Centre for Academic Child Health, University of Bristol, Bristol, UK
| | - Esther Crawley
- Centre for Academic Child Health, University of Bristol, Bristol, UK
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Coetzee B, Loades M, Du Toit S, Read R, Kagee A. Fatigue among South African adolescents living with HIV: Is the Chalder Fatigue Questionnaire a suitable measure and how common is fatigue? VULNERABLE CHILDREN AND YOUTH STUDIES 2018; 13:305-316. [PMID: 32587628 PMCID: PMC7316568 DOI: 10.1080/17450128.2018.1510147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- B Coetzee
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - M.E Loades
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, United Kingdom
| | - S Du Toit
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - R Read
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, United Kingdom
| | - A Kagee
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
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Crawley E. Pediatric chronic fatigue syndrome: current perspectives. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2018; 9:27-33. [PMID: 29722371 PMCID: PMC5919160 DOI: 10.2147/phmt.s126253] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Pediatric chronic fatigue syndrome is an important illness as it is relatively common and also very disabling with a wide range of impacts on the child, the family, and health care systems. It is a complicated illness but the majority of children get better with specialist treatment. This literature review provides an update on the epidemiology of chronic fatigue syndrome / myalgic encephalomyelitis, including factors associated with it, and discusses the current evidence for treatment.
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Affiliation(s)
- Esther Crawley
- Centre for Child and Adolescent Health, Bristol Medical School, University of Bristol, Bristol, UK
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Baos S, Brigden A, Anderson E, Hollingworth W, Price S, Mills N, Beasant L, Gaunt D, Garfield K, Metcalfe C, Parslow R, Downing H, Kessler D, Macleod J, Stallard P, Knoop H, Van de Putte E, Nijhof S, Bleijenberg G, Crawley E. Investigating the effectiveness and cost-effectiveness of FITNET-NHS (Fatigue In Teenagers on the interNET in the NHS) compared to Activity Management to treat paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME): protocol for a randomised controlled trial. Trials 2018; 19:136. [PMID: 29471861 PMCID: PMC5824604 DOI: 10.1186/s13063-018-2500-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 12/07/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a relatively common and disabling condition. The National Institute for Health and Clinical Excellence (NICE) recommends Cognitive Behavioural Therapy (CBT) as a treatment option for paediatric CFS/ME because there is good evidence that it is effective. Despite this, most young people in the UK are unable to access local specialist CBT for CFS/ME. A randomised controlled trial (RCT) showed FITNET was effective in the Netherlands but we do not know if it is effective in the National Health Service (NHS) or if it is cost-effective. This trial will investigate whether FITNET-NHS is clinically effective and cost-effective in the NHS. METHODS Seven hundred and thirty-four paediatric patients (aged 11-17 years) with CFS/ ME will be randomised (1:1) to receive either FITNET-NHS (online CBT) or Activity Management (delivered via video call). The internal pilot study will use integrated qualitative methods to examine the feasibility of recruitment and the acceptability of treatment. The full trial will assess whether FITNET-NHS is clinically effective and cost-effective. The primary outcome is disability at 6 months, measured using the SF-36-PFS (Physical Function Scale) questionnaire. Cost-effectiveness is measured via cost-utility analysis from an NHS perspective. Secondary subgroup analysis will investigate the effectiveness of FITNET-NHS in those with co-morbid mood disorders. DISCUSSION If FITNET-NHS is found to be feasible and acceptable (internal pilot) and effective and cost-effective (full trial), its provision by the NHS has the potential to deliver substantial health gains for the large number of young people suffering from CFS/ME but unable to access treatment because there is no local specialist service. This trial will provide further evidence evaluating the delivery of online CBT to young people with chronic conditions. TRIAL REGISTRATION ISRCTN registry, registration number: ISRCTN18020851 . Registered on 4 August 2016.
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Affiliation(s)
- Sarah Baos
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Amberly Brigden
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Emma Anderson
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - William Hollingworth
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Simon Price
- Computer Science, University of Bristol, Merchant Venturers Building, Woodland Road, Bristol, BS8 1UB UK
| | - Nicola Mills
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Lucy Beasant
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Daisy Gaunt
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Kirsty Garfield
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Roxanne Parslow
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
| | - Harriet Downing
- Bristol Medical School: Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David Kessler
- Bristol Medical School: Population Health Sciences, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - John Macleod
- Bristol Medical School: Population Health Sciences, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - Paul Stallard
- Department for Health, University of Bath, Bath, BA2 7AD UK
| | - Hans Knoop
- Department for Medical Psychology, Academic Medical Centre (AMC) University of Amsterdam, Postbox 22660, 1100 DD Amsterdam, The Netherlands
| | - Elise Van de Putte
- Department of Paediatrics, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Sanne Nijhof
- Department of Paediatrics, Wilhelmina Children’s Hospital, University Medical Centre, Utrecht, The Netherlands
| | | | - Esther Crawley
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Oakfield House, Oakfield, Grove, Bristol, BS8 2BN UK
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Crawley EM, Gaunt DM, Garfield K, Hollingworth W, Sterne JAC, Beasant L, Collin SM, Mills N, Montgomery AA. Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial. Arch Dis Child 2018; 103:155-164. [PMID: 28931531 PMCID: PMC5865512 DOI: 10.1136/archdischild-2017-313375] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Investigate the effectiveness and cost-effectiveness of the Lightning Process (LP) in addition to specialist medical care (SMC) compared with SMC alone, for children with chronic fatigue syndrome (CFS)/myalgic encephalitis (ME). DESIGN Pragmatic randomised controlled open trial. Participants were randomly assigned to SMC or SMC+LP. Randomisation was minimised by age and gender. SETTING Specialist paediatric CFS/ME service. PATIENTS 12-18 year olds with mild/moderate CFS/ME. MAIN OUTCOME MEASURES The primary outcome was the the 36-Item Short-Form Health Survey Physical Function Subscale (SF-36-PFS) at 6 months. Secondary outcomes included pain, anxiety, depression, school attendance and cost-effectiveness from a health service perspective at 3, 6 and 12 months. RESULTS We recruited 100 participants, of whom 51 were randomised to SMC+LP. Data from 81 participants were analysed at 6 months. Physical function (SF-36-PFS) was better in those allocated SMC+LP (adjusted difference in means 12.5(95% CI 4.5 to 20.5), p=0.003) and this improved further at 12 months (15.1 (5.8 to 24.4), p=0.002). At 6 months, fatigue and anxiety were reduced, and at 12 months, fatigue, anxiety, depression and school attendance had improved in the SMC+LP arm. Results were similar following multiple imputation. SMC+LP was probably more cost-effective in the multiple imputation dataset (difference in means in net monetary benefit at 12 months £1474(95% CI £111 to £2836), p=0.034) but not for complete cases. CONCLUSION The LP is effective and is probably cost-effective when provided in addition to SMC for mild/moderately affected adolescents with CFS/ME. TRIAL REGISTRATION NUMBER ISRCTN81456207.
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Affiliation(s)
- Esther M Crawley
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol
| | - Daisy M Gaunt
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol,Bristol Randomised Trials Collaboration, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol
| | - Kirsty Garfield
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol,Bristol Randomised Trials Collaboration, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol
| | - William Hollingworth
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol
| | - Jonathan A C Sterne
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol
| | - Lucy Beasant
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol
| | - Simon M Collin
- Centre for Child and Adolescent Health, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol
| | - Nicola Mills
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol
| | - Alan A Montgomery
- Bristol Randomised Trials Collaboration, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol,Nottingham Clinical Trials Unit, School of Medicine, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
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20
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Collin SM, Norris T, Gringras P, Blair PS, Tilling K, Crawley E. Childhood sleep and adolescent chronic fatigue syndrome (CFS/ME): evidence of associations in a UK birth cohort. Sleep Med 2018; 46:26-36. [PMID: 29773208 PMCID: PMC5974860 DOI: 10.1016/j.sleep.2018.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 01/06/2018] [Accepted: 01/08/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVE/BACKGROUND Sleep abnormalities are characteristic of chronic fatigue syndrome (CFS, also known as 'ME'), however it is unknown whether sleep might be a causal risk factor for CFS/ME. PATIENTS/METHODS We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. We describe sleep patterns of children aged 6 months to 11 years, who were subsequently classified as having (or not having) 'chronic disabling fatigue' (CDF, a proxy for CFS/ME) between the ages 13 and 18 years, and we investigated the associations of sleep duration at age nine years with CDF at age 13 years, as well as sleep duration at age 11 years with CDF at age 16 years. RESULTS Children who had CDF during adolescence had shorter night-time sleep duration from 6 months to 11 years of age, and there was strong evidence that difficulties in going to sleep were more common in children who subsequently developed CDF. The odds of CDF at age 13 years were 39% lower (odds ratio (OR) = 0.61, 95% CI = 0.43, 0.88) for each additional hour of night-time sleep at age nine years, and the odds of CDF at age 16 years were 51% lower (OR = 0.49, 95% CI = 0.34, 0.70) for each additional hour of night-time sleep at age 11 years. Mean night-time sleep duration at age nine years was 13.9 (95% CI = 3.75, 24.0) minutes shorter among children who developed CDF at age 13 years, and sleep duration at age 11 years was 18.7 (95% CI = 9.08, 28.4) minutes shorter among children who developed CDF at age 16 (compared with children who did not develop CDF at 13 and 16 years, respectively). CONCLUSIONS Children who develop chronic disabling fatigue in adolescence have shorter night-time sleep duration throughout early childhood, suggesting that sleep abnormalities may have a causal role in CFS/ME or that sleep abnormalities and CFS/ME are associated with a common pathophysiological cause.
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Affiliation(s)
- Simon M Collin
- Centre for Child and Adolescent Health, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK; Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Tom Norris
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK
| | - Paul Gringras
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Peter S Blair
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Kate Tilling
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK; Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
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21
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Asprusten TT, Sulheim D, Fagermoen E, Winger A, Skovlund E, Wyller VB. Systemic exertion intolerance disease diagnostic criteria applied on an adolescent chronic fatigue syndrome cohort: evaluation of subgroup differences and prognostic utility. BMJ Paediatr Open 2018; 2:e000233. [PMID: 29637195 PMCID: PMC5887832 DOI: 10.1136/bmjpo-2017-000233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/02/2018] [Accepted: 01/02/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Existing case definitions for chronic fatigue syndrome (CFS) all have disputed validity. The present study investigates differences between adolescent patients with CFS who satisfy the systemic exertion intolerance disease (SEID) diagnostic criteria (SEID-positive) and those who do not satisfy the criteria (SEID-negative). METHODS 120 adolescent patients with CFS with a mean age of 15.4 years (range 12-18 years) included in the NorCAPITAL project (ClinicalTrials ID: NCT01040429) were post-hoc subgrouped according to the SEID criteria based on a comprehensive questionnaire. The two subgroups were compared across baseline characteristics, as well as a wide range of cardiovascular, inflammatory, infectious, neuroendocrine and cognitive variables. Data from 30-week follow-up were used to investigate prognostic differences between SEID-positive and SEID-negative patients. RESULTS A total of 45 patients with CFS were SEID-positive, 69 were SEID-negative and 6 could not be classified. Despite the fact that clinically depressed patients were excluded in the NorCAPITAL project, the SEID-positive group had significantly higher score on symptoms suggesting a mood disorder (Mood and Feelings Questionnaire): 23.2 vs 13.4, difference 9.19 (95% CI 5.78 to 12.6). No other baseline characteristics showed any group differences. When accounting for multiple comparisons, there were no statistically significant differences between the groups regarding cardiovascular, inflammatory, infectious, neuroendocrine and cognitive variables. Steps per day and Chalder Fatigue Questionnaire at week 30 showed no differences between the groups. CONCLUSION The findings question the discriminant and prognostic validity of the SEID diagnostic criteria in adolescent CFS, and suggest that the criteria tend to select patients with depressive symptoms.
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Affiliation(s)
| | - Dag Sulheim
- Department of Pediatrics and Adolescent Medicine, Innlandet Hospital Trust, Lillehammer, Norway
| | - Even Fagermoen
- Department of Anesthesiology and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Anette Winger
- Department of Nursing and Health Promotion, Oslo University College of Applied Sciences, Oslo, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pharmacoepidemiology, Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Vegard Bruun Wyller
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Pediatrics and Adolescent Medicine, Akershus University Hospital, Akershus, Norway
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22
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Wyller VB, Nguyen CB, Ludviksen JA, Mollnes TE. Transforming growth factor beta (TGF-β) in adolescent chronic fatigue syndrome. J Transl Med 2017; 15:245. [PMID: 29202780 PMCID: PMC5716371 DOI: 10.1186/s12967-017-1350-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/25/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is a prevalent and disabling condition among adolescent. The disease mechanisms are unknown. Previous studies have suggested elevated plasma levels of several cytokines, but a recent meta-analysis of 38 articles found that of 77 different cytokines measured in plasma, transforming growth factor beta (TGF-β) was the only one that was elevated in patients compared to controls in a sufficient number of articles. In the present study we therefore compared the plasma levels of the three TGF-β isoforms in adolescent CFS patients and healthy controls. In addition, the study explored associations between TGF-β levels, neuroendocrine markers, clinical markers and differentially expressed genes within the CFS group. METHODS CFS patients aged 12-18 years (n = 120) were recruited nation-wide to a single referral center as part of the NorCAPITAL project (ClinicalTrials ID: NCT01040429). A broad case definition of CFS was applied, requiring 3 months of unexplained, disabling chronic/relapsing fatigue of new onset, whereas no accompanying symptoms were necessary. Healthy controls (n = 68) were recruited from local schools. The three isoforms of TGF-β (TGF-β1, TGF-β2, TGF-β3) were assayed using multiplex technology. Neuroendocrine markers encompassed plasma and urine levels of catecholamines and cortisol, as well as heart rate variability indices. Clinical markers consisted of questionnaire scores for symptoms of post-exertional malaise, inflammation, fatigue, depression and trait anxiety, as well as activity recordings. Whole blood gene expression was assessed by RNA sequencing in a subgroup of patients (n = 29) and controls (n = 18). RESULTS Plasma levels of all three isoforms of TGF-β were equal in the CFS patients and the healthy controls. Subgrouping according to the Fukuda and Canada 2003 criteria of CFS did not reveal differential results. Within the CFS group, all isoforms of TGF-β were associated with plasma cortisol, urine norepinephrine and urine epinephrine, and this association pattern was related to fatigue score. Also, TGF-β3 was related to expression of the B cell annotated genes TNFRSF13C and CXCR5. CONCLUSIONS Plasma levels of all TGF-β isoforms were not altered in adolescent CFS. However, the TGF-β isoforms were associated with neuroendocrine markers, an association related to fatigue score. Furthermore, TGF-β3 might partly mediate an association between plasma cortisol and B cell gene expression. Trial registration Clinical Trials NCT01040429.
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Affiliation(s)
- Vegard Bruun Wyller
- Department of Pediatrics and Adolescent Health, Akershus University Hospital, 1478 Lørenskog, Norway
- Division of Medicine and Laboratory Sciences, University of Oslo, Oslo, Norway
| | - Chinh Bkrong Nguyen
- Department of Pediatrics and Adolescent Health, Akershus University Hospital, 1478 Lørenskog, Norway
| | - Judith Anita Ludviksen
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
| | - Tom Eirik Mollnes
- Research Laboratory, Nordland Hospital, Bodø, Norway
- Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway
- Department of Immunology, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen IRC, University of Oslo, Oslo, Norway
- Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
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23
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Norris T, Collin SM, Tilling K, Nuevo R, Stansfeld SA, Sterne JAC, Heron J, Crawley E. Natural course of chronic fatigue syndrome/myalgic encephalomyelitis in adolescents. Arch Dis Child 2017; 102:522-528. [PMID: 28104625 PMCID: PMC5466925 DOI: 10.1136/archdischild-2016-311198] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 12/08/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Little is known about persistence of or recovery from chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in adolescents. Previous studies have small sample sizes, short follow-up or have focused on fatigue rather than CFS/ME or, equivalently, chronic fatigue, which is disabling. This work aimed to describe the epidemiology and natural course of CFS/ME in adolescents aged 13-18 years. DESIGN Longitudinal follow-up of adolescents enrolled in the Avon Longitudinal Study of Parents and Children. SETTING Avon, UK. PARTICIPANTS We identified adolescents who had disabling fatigue of >6 months duration without a known cause at ages 13, 16 and 18 years. We use the term 'chronic disabling fatigue' (CDF) because CFS/ME was not verified by clinical diagnosis. We used multiple imputation to obtain unbiased estimates of prevalence and persistence. RESULTS The estimated prevalence of CDF was 1.47% (95% CI 1.05% to 1.89%) at age 13, 2.22% (1.67% to 2.78%) at age 16 and 2.99% (2.24% to 3.75%) at age 18. Among adolescents with CDF of 6 months duration at 13 years 75.3% (64.0% to 86.6%) were not classified as such at age 16. Similar change was observed between 16 and 18 years (75.0% (62.8% to 87.2%)). Of those with CDF at age 13, 8.02% (0.61% to 15.4%) presented with CDF throughout the duration of adolescence. CONCLUSIONS The prevalence of CDF lasting 6 months or longer (a proxy for clinically diagnosed CFS/ME) increases from 13 to 18 years. However, persistent CDF is rare in adolescents, with approximately 75% recovering after 2-3 years.
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Affiliation(s)
- Tom Norris
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Simon M Collin
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Kate Tilling
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Roberto Nuevo
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Stephen A Stansfeld
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK
| | - Jonathan AC Sterne
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Jon Heron
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, University of Bristol, Bristol, UK
- School of Social & Community Medicine, University of Bristol, Bristol, UK
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24
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Nguyen CB, Alsøe L, Lindvall JM, Sulheim D, Fagermoen E, Winger A, Kaarbø M, Nilsen H, Wyller VB. Whole blood gene expression in adolescent chronic fatigue syndrome: an exploratory cross-sectional study suggesting altered B cell differentiation and survival. J Transl Med 2017; 15:102. [PMID: 28494812 PMCID: PMC5426002 DOI: 10.1186/s12967-017-1201-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/02/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is a prevalent and disabling condition affecting adolescents. The pathophysiology is poorly understood, but immune alterations might be an important component. This study compared whole blood gene expression in adolescent CFS patients and healthy controls, and explored associations between gene expression and neuroendocrine markers, immune markers and clinical markers within the CFS group. METHODS CFS patients (12-18 years old) were recruited nation-wide to a single referral center as part of the NorCAPITAL project. A broad case definition of CFS was applied, requiring 3 months of unexplained, disabling chronic/relapsing fatigue of new onset, whereas no accompanying symptoms were necessary. Healthy controls having comparable distribution of gender and age were recruited from local schools. Whole blood samples were subjected to RNA sequencing. Immune markers were blood leukocyte counts, plasma cytokines, serum C-reactive protein and immunoglobulins. Neuroendocrine markers encompassed plasma and urine levels of catecholamines and cortisol, as well as heart rate variability indices. Clinical markers consisted of questionnaire scores for symptoms of post-exertional malaise, inflammation, fatigue, depression and trait anxiety, as well as activity recordings. RESULTS A total of 29 CFS patients and 18 healthy controls were included. We identified 176 genes as differentially expressed in patients compared to controls, adjusting for age and gender factors. Gene set enrichment analyses suggested impairment of B cell differentiation and survival, as well as enhancement of innate antiviral responses and inflammation in the CFS group. A pattern of co-expression could be identified, and this pattern, as well as single gene transcripts, was significantly associated with indices of autonomic nervous activity, plasma cortisol, and blood monocyte and eosinophil counts. Also, an association with symptoms of post-exertional malaise was demonstrated. CONCLUSION Adolescent CFS is characterized by differential gene expression pattern in whole blood suggestive of impaired B cell differentiation and survival, and enhanced innate antiviral responses and inflammation. This expression pattern is associated with neuroendocrine markers of altered HPA axis and autonomic nervous activity, and with symptoms of post-exertional malaise. Trial registration Clinical Trials NCT01040429.
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Affiliation(s)
- Chinh Bkrong Nguyen
- Department of Paediatrics and Adolescent Health, Akershus University Hospital, 1478 Lørenskog, Norway
- Division of Medicine and Laboratory Sciences, Medical Faculty, University of Oslo, Oslo, Norway
| | - Lene Alsøe
- Institute of Clinical Medicine, Department of Clinical Molecular Biology, University of Oslo, and Akershus University Hospital, Lørenskog, Norway
| | - Jessica M. Lindvall
- National Bioinformatics Infrastructure Sweden (NBIS), Science for Life Laboratory, Department of Biochemistry and Biophysics, Stockholm University, Stockholm, Sweden
| | - Dag Sulheim
- Department of Paediatrics, Lillehammer County Hospital, Lillehammer, Norway
| | - Even Fagermoen
- Department of Anesthesiology and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Anette Winger
- Institute of Nursing Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Mari Kaarbø
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
| | - Hilde Nilsen
- Institute of Clinical Medicine, Department of Clinical Molecular Biology, University of Oslo, and Akershus University Hospital, Lørenskog, Norway
| | - Vegard Bruun Wyller
- Department of Paediatrics and Adolescent Health, Akershus University Hospital, 1478 Lørenskog, Norway
- Division of Medicine and Laboratory Sciences, Medical Faculty, University of Oslo, Oslo, Norway
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25
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Kluck BN, Junghans-Rutelonis AN, Jones AE, Fischer PR, Weiss KE. Adolescent Chronic Fatigue and Orthostatic Intolerance: Relationships Between Parental Attributes and Child Functioning. Clin Pediatr (Phila) 2017; 56:85-89. [PMID: 27421749 DOI: 10.1177/0009922816644730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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26
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Harris S, Gilbert M, Beasant L, Linney C, Broughton J, Crawley E. A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis. Clin Child Psychol Psychiatry 2017; 22:128-139. [PMID: 27215228 PMCID: PMC5207298 DOI: 10.1177/1359104516646813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND An estimated 10% of children and adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience eating difficulties; however, little is known about why these difficulties develop, what the impact is or how to manage them. METHODS Semi-structured interviews were conducted with adolescents (aged 12-17 years) attending a specialist service who have a primary diagnosis of CFS/ME and experience nausea, abdominal pain and/or eating difficulties. A total of 11 adolescents were interviewed (eight female, mean age: 15 years). Transcripts were analysed thematically using techniques of constant comparison which commenced soon after data collection and informed further interview protocols. RESULTS Adolescents perceived their eating difficulties were caused by abdominal symptoms, being too fatigued to eat and changes to their senses of taste and smell. Some of the adolescents recognised how their eating difficulties were exacerbated and maintained by psychological factors of low mood and anxiety. The adolescents eating difficulties had a negative impact on their weight, fatigue, socialising and family life. They perceived helpful interventions to include modifying their diets, families adjusting and also medical interventions (e.g. medication). Adolescents identified that early education and support about diet and eating habits would have been helpful. CONCLUSIONS If adolescents diagnosed with CFS/ME develop eating difficulties, this has a significant impact on their quality of life, illness and on their families. Not eating increases fatigue, low mood and anxiety which further exacerbates the eating difficulties. Clinicians should screen for eating difficulties in those with symptoms of nausea and abdominal pain, warn adolescents and their families of the risk of developing eating difficulties and provide interventions and support as early as possible.
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Affiliation(s)
- Sarah Harris
- 1 South Wales Doctoral Programme in Clinical Psychology, Cardiff University, UK
| | - Matthew Gilbert
- 2 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| | - Lucy Beasant
- 2 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| | | | - Jessica Broughton
- 2 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
| | - Esther Crawley
- 2 Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, UK
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27
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De Baets S, Vanhalst M, Coussens M, Rombaut L, Malfait F, Van Hove G, Calders P, Vanderstraeten G, van de Velde D. The influence of Ehlers-Danlos syndrome - hypermobility type, on motherhood: A phenomenological, hermeneutical study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 60:135-144. [PMID: 27931013 DOI: 10.1016/j.ridd.2016.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 11/22/2016] [Accepted: 11/24/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND The consequences of the Ehlers-Danlos Syndrome hypermobility type (EDS-HT) affect many aspects of daily life. "Living with limitations" is a central theme in the life of patients affected by this heritable disorder of connective tissue. The aim of the present study was to explore the lived experiences of women with EDS-HT concerning diagnosis, influence on daily life and becoming and being a mother. METHOD A phenomenological-hermeneutical study, using in-depth interviews. Patients were selected by a purposive sampling strategy. RESULTS This study shows that the EDS-HT syndrome affects daily life. Ten woman between 31 and 65 years were interviewed. They have between 2 and 5 children. The data analysis results in six themes. (1) Getting a diagnosis is a relief and supports the choice to become a mother; (2) EDS-HT causes emotional distress, imposes a physical burden and has a major impact on social behavior; (3) EDS-HT demands a restructuring of everyday activities; (4) Children's and mothers' expectations do not correspond; (5) Having a supportive social and physical environment is of major importance; (6) The presence of the child reduces the feeling of illness of the mother. CONCLUSION The diagnosis of EDS-HT is a catalysing factor in the choice of whether or not to become a mother. EDS-HT has a huge impact on bodily functions, which in turn influences activities and participation. IMPLICATIONS This study gives insight in the activities of daily life of persons with EDS-HT. Health care professionals can be of great importance to help patients in (re)organizing their lives according to the available energy and in supporting their choices. They can help defining goals and setting priorities in daily life.
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Affiliation(s)
- Stijn De Baets
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy Program. Ghent University, De Pintelaan 185, 9000 Ghent Belgium.
| | - Marieke Vanhalst
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy Program. Ghent University, De Pintelaan 185, 9000 Ghent Belgium
| | - Marieke Coussens
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy Program. Ghent University, De Pintelaan 185, 9000 Ghent Belgium
| | - Lies Rombaut
- Centre for Medical Genetics, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - Fransiska Malfait
- Centre for Medical Genetics, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - Geert Van Hove
- Faculty of Psychology and Educational Sciences, Department of Special Needs Education, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Patrick Calders
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy Program. Ghent University, De Pintelaan 185, 9000 Ghent Belgium
| | - Guy Vanderstraeten
- Department of Physical and Rehabilitation Medicine, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium
| | - Dominique van de Velde
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Occupational Therapy Program. Ghent University, De Pintelaan 185, 9000 Ghent Belgium
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28
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McGarrigle R, Dawes P, Stewart AJ, Kuchinsky SE, Munro KJ. Pupillometry reveals changes in physiological arousal during a sustained listening task. Psychophysiology 2016; 54:193-203. [DOI: 10.1111/psyp.12772] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 09/13/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ronan McGarrigle
- Manchester Centre for Audiology and Deafness, School of Health Sciences; University of Manchester; Manchester UK
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, School of Health Sciences; University of Manchester; Manchester UK
| | - Andrew J. Stewart
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences; University of Manchester; Manchester UK
| | - Stefanie E. Kuchinsky
- Center for Advanced Study of Language, University of Maryland; College Park Maryland USA
- Maryland Neuroimaging Center, University of Maryland; College Park Maryland USA
| | - Kevin J. Munro
- Manchester Centre for Audiology and Deafness, School of Health Sciences; University of Manchester; Manchester UK
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre; Manchester UK
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29
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Velleman S, Collin SM, Beasant L, Crawley E. Psychological wellbeing and quality-of-life among siblings of paediatric CFS/ME patients: A mixed-methods study. Clin Child Psychol Psychiatry 2016; 21:618-633. [PMID: 26395764 PMCID: PMC5094299 DOI: 10.1177/1359104515602373] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) is a disabling condition known to have a negative impact on all aspects of a child's life. However, little is understood about the impact of CFS/ME on siblings. A total of 34 siblings completed questionnaires measuring depression (Hospital Anxiety and Depression Scale (HADS)), anxiety (HADS and Spence Children's Anxiety Scale (SCAS)) and European Quality-of-life-Youth (EQ-5D-Y). These scores were compared with scores from normative samples. Siblings had higher levels of anxiety on the SCAS than adolescents of the same age recruited from a normative sample; however, depression and quality-of-life were similar. Interviews were undertaken with nine siblings of children with CFS/ME who returned questionnaires. Interview data were analysed using a framework approach to thematic analysis. Siblings identified restrictions on family life, 'not knowing' and lack of communication as negative impacts on their family, and change of role/focus, emotional reactions and social stigma as negative impacts on themselves. They also described positive communication, social support and extra activities as protective factors. Paediatric services should be aware of the impact of CFS/ME on the siblings of children with CFS/ME, understand the importance of assessing paediatric CFS/ME patients within the context of their family and consider providing information for siblings about CFS/ME.
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Affiliation(s)
- Sophie Velleman
- Paediatric CFS/ME Service, Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, UK
| | - Simon M Collin
- Centre for Child and Adolescent Health, University of Bristol, UK
| | - Lucy Beasant
- Centre for Child and Adolescent Health, University of Bristol, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, University of Bristol, UK
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30
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Bansal AS. Investigating unexplained fatigue in general practice with a particular focus on CFS/ME. BMC FAMILY PRACTICE 2016; 17:81. [PMID: 27436349 PMCID: PMC4950776 DOI: 10.1186/s12875-016-0493-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/13/2016] [Indexed: 01/23/2023]
Abstract
Unexplained fatigue is not infrequent in the community. It presents a number of challenges to the primary care physician and particularly if the clinical examination and routine investigations are normal. However, while fatigue is a feature of many common illnesses, it is the main problem in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This is a poorly understood condition that is accompanied by several additional symptoms which suggest a subtle multisystem dysfunction. Not infrequently it is complicated by sleep disturbance and alterations in attention, memory and mood. Specialised services for the diagnosis and management of CFS/ME are markedly deficient in the UK and indeed in virtually all countries around the world. However, unexplained fatigue and CFS/ME may be confidently diagnosed on the basis of specific clinical criteria combined with the normality of routine blood tests. The latter include those that assess inflammation, autoimmunity, endocrine dysfunction and gluten sensitivity. Early diagnosis and intervention in general practice will do much to reduce patient anxiety, encourage improvement and prevent expensive unnecessary investigations. There is presently an on-going debate as to the precise criteria that best confirms CFS/ME to the exclusion of other medical and psychiatric/psychological causes of chronic fatigue. There is also some disagreement as to best means of investigating and managing this very challenging condition. Uncertainty here can contribute to patient stress which in some individuals can perpetuate and aggravate symptoms. A simple clinical scoring system and a short list of routine investigations should help discriminate CFS/ME from other causes of continued fatigue.
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Affiliation(s)
- Amolak S Bansal
- Department of Immunology and Allergy, St. Helier Hospital, Carshalton, Surrey, SM5 1AA, UK. .,The Sutton CFS Service, Sutton Hospital, Cotswold Rd, Sutton, SM2 5NF, UK.
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Wortinger LA, Endestad T, Melinder AMD, Øie MG, Sevenius A, Bruun Wyller V. Aberrant Resting-State Functional Connectivity in the Salience Network of Adolescent Chronic Fatigue Syndrome. PLoS One 2016; 11:e0159351. [PMID: 27414048 PMCID: PMC4944916 DOI: 10.1371/journal.pone.0159351] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/29/2016] [Indexed: 01/31/2023] Open
Abstract
Neural network investigations are currently absent in adolescent chronic fatigue syndrome (CFS). In this study, we examine whether the core intrinsic connectivity networks (ICNs) are altered in adolescent CFS patients. Eighteen adolescent patients with CFS and 18 aged matched healthy adolescent control subjects underwent resting-state functional magnetic resonance imaging (rfMRI). Data was analyzed using dual-regression independent components analysis, which is a data-driven approach for the identification of independent brain networks. Intrinsic connectivity was evaluated in the default mode network (DMN), salience network (SN), and central executive network (CEN). Associations between network characteristics and symptoms of CFS were also explored. Adolescent CFS patients displayed a significant decrease in SN functional connectivity to the right posterior insula compared to healthy comparison participants, which was related to fatigue symptoms. Additionally, there was an association between pain intensity and SN functional connectivity to the left middle insula and caudate that differed between adolescent patients and healthy comparison participants. Our findings of insula dysfunction and its association with fatigue severity and pain intensity in adolescent CFS demonstrate an aberration of the salience network which might play a role in CFS pathophysiology.
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Affiliation(s)
- Laura Anne Wortinger
- Department of Pediatrics, Akershus University Hospital, Nordbyhagen, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- * E-mail:
| | - Tor Endestad
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Annika Maria D. Melinder
- Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Oslo, Norway
| | - Merete Glenne Øie
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Department, Innlandet Hospital Trust, Lillehammer, Norway
| | - Andre Sevenius
- Department of Psychology, University of Oslo, Oslo, Norway
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Wyller VB, Vitelli V, Sulheim D, Fagermoen E, Winger A, Godang K, Bollerslev J. Altered neuroendocrine control and association to clinical symptoms in adolescent chronic fatigue syndrome: a cross-sectional study. J Transl Med 2016; 14:121. [PMID: 27149955 PMCID: PMC4858924 DOI: 10.1186/s12967-016-0873-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is a common and disabling disorder, and a major threat against adolescent health. The pathophysiology is unknown, but alteration of neuroendocrine control systems might be a central element, resulting in attenuation of the hypothalamus-pituitary-adrenalin (HPA) axis and enhancement of the sympathetic/adrenal medulla (SAM) system. This study explored differences in neuroendocrine control mechanisms between adolescent CFS patients and healthy controls, and whether characteristics of the control mechanisms are associated with important clinical variables within the CFS group. METHODS CFS patients 12-18 years of age were recruited nation-wide to a single referral center as part of the NorCAPITAL project. A broad case definition of CFS was applied. A comparable group of healthy controls were recruited from local schools. A total of nine hormones were assayed and subjected to network analyses using the ARACNE algorithm. Symptoms were charted by a questionnaire, and daily physical activity was recorded by an accelerometer. RESULTS A total of 120 CFS patients and 68 healthy controls were included. CFS patients had significantly higher levels of plasma norepinephrine, plasma epinephrine and plasma FT4, and significantly lower levels of urine cortisol/creatinine ratio. Subgrouping according to other case definitions as well as adjusting for confounding factors did not alter the results. Multivariate linear regression models as well as network analyses revealed different interrelations between hormones of the HPA axis, the SAM system, and the thyroid system in CFS patients and healthy controls. Also, single hormone degree centrality was associated with clinical markers within the CFS group. CONCLUSION This study reveals different interrelation between hormones of the HPA axis, the SAM system, and the thyroid system in CFS patients and healthy controls, and an association between hormone control characteristics and important clinical variables in the CFS group. These results add to the growing insight of CFS disease mechanisms. Trial registration Clinical Trials NCT01040429.
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Affiliation(s)
- Vegard Bruun Wyller
- />Division of Medicine and Laboratory Sciences, Medical Faculty, University of Oslo, Oslo, Norway
- />Department of Paediatrics, Akershus University Hospital, Nordbyhagen, 1478 Lørenskog, Norway
| | - Valieria Vitelli
- />Department of Biostatistics, Institute of Basic Medical Sciences, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway
| | - Dag Sulheim
- />Department of Paediatrics, Oslo University Hospital, Oslo, Norway
- />Department of Paediatrics, Lillehammer County Hospital, Lillehammer, Norway
| | - Even Fagermoen
- />Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- />Department of Anesthesiology and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Anette Winger
- />Institute of Nursing Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Kristin Godang
- />Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jens Bollerslev
- />Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
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Westendorp T, Verbunt J, Remerie S, de Blécourt A, van Baalen B, Smeets R. Social functioning in adulthood: Understanding long-term outcomes of adolescents with chronic pain/fatigue treated at inpatient rehabilitation programs. Eur J Pain 2016; 20:1121-30. [DOI: 10.1002/ejp.836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/10/2022]
Affiliation(s)
- T. Westendorp
- Rijndam Rehabilitation Center; Rotterdam The Netherlands
- Department of Rehabilitation Medicine; CAPHRI; Maastricht University; Maastricht The Netherlands
| | - J.A. Verbunt
- Department of Rehabilitation Medicine; CAPHRI; Maastricht University; Maastricht The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- Department of Rehabilitation Medicine; Maastricht University Medical Center (MUMC+); Maastricht The Netherlands
| | - S.C. Remerie
- Rijndam Rehabilitation Center; Rotterdam The Netherlands
| | - A.C.E. de Blécourt
- Center for Rehabilitation; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - B. van Baalen
- Rijndam Rehabilitation Center; Rotterdam The Netherlands
| | - R.J.E.M. Smeets
- Department of Rehabilitation Medicine; CAPHRI; Maastricht University; Maastricht The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- Department of Rehabilitation Medicine; Maastricht University Medical Center (MUMC+); Maastricht The Netherlands
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Collin SM, Norris T, Nuevo R, Tilling K, Joinson C, Sterne JAC, Crawley E. Chronic Fatigue Syndrome at Age 16 Years. Pediatrics 2016; 137:e20153434. [PMID: 26810786 DOI: 10.1542/peds.2015-3434] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, chronic disabling fatigue lasting ≥6 months affected 1.3% of 13-year-olds, was equally common in boys and girls, and became more prevalent with increasing family adversity. METHODS ALSPAC data were used to estimate the prevalence of chronic fatigue syndrome (CFS) at age 16 years, defined by parental report of unexplained disabling fatigue lasting ≥6 months. We investigated gender and a composite 14-item family adversity index as risk factors. School absence data were obtained from the National Pupil Database. Multiple imputation was used to address bias caused by missing data. RESULTS The prevalence of CFS was 1.86% (95% confidence interval [CI]: 1.47 to 2.24). After excluding children with high levels of depressive symptoms, the prevalence was 0.60% (95% CI: 0.37 to 0.84). Authorized school absences were much higher (mean difference: 35.6 [95% CI: 26.4 to 44.9] half-day sessions per academic year) and reported depressive symptoms were much more likely (odds ratio [OR]: 11.0 [95% CI: 5.92 to 20.4]) in children with CFS than in those without CFS. Female gender (OR: 1.95 [95% CI: 1.33 to 2.86]) and family adversity (OR: 1.20 [95% CI: 1.01 to 1.42] per unit family adversity index) were also associated with CFS. CONCLUSIONS CFS affected 1.9% of 16-year-olds in a UK birth cohort and was positively associated with higher family adversity. Gender was a risk factor at age 16 years but not at age 13 years or in 16-year-olds without high levels of depressive symptoms.
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Affiliation(s)
- Simon M Collin
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Tom Norris
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Roberto Nuevo
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | | | - Carol Joinson
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
| | | | - Esther Crawley
- School of Social & Community Medicine and Centre for Child & Adolescent Health, University of Bristol, Bristol, United Kingdom
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Hinton D, Kirk S. Families' and healthcare professionals' perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:12-26. [PMID: 25684117 DOI: 10.1111/hsc.12184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2014] [Indexed: 06/04/2023]
Abstract
Children and young people frequently report physical complaints that have no observable physical pathology known as medically unexplained symptoms (MUS). Research suggests that MUS are associated with substantial physical and psychological impairments and may have a negative impact on children's and young people's functional status and well-being in the long term. Due to the potentially complex needs of this group, children and young people with MUS may require timely access to suitable health and social care services to effectively manage symptoms and achieve their academic, social and personal potential. Families and professionals can offer important insights into the availability and appropriateness of current community and specialist health and social care services. This review is the first critical evaluation and synthesis of research that has examined families' and healthcare professionals' (HCP) perceptions of healthcare services for children and young people with MUS. A systematic search of electronic databases and manual searches of key journals and reference lists identified 17 papers from 15 studies for inclusion in the review. The review highlights the paucity of rigorously conducted research on this topic. Studies have been narrowly focused on the views of a homogeneous group of mothers and young people attending single centres. There has been some attempt to examine doctors' views, but the perceptions of children, fathers and health and social care professionals are absent or under-represented, and multi-site and longitudinal studies are lacking. Thematic analysis of the results from the included studies suggests that knowledge, communication, health beliefs and healthcare settings are factors that influence families' and HCPs' perceptions of services. Families report dissatisfaction with some HCPs' approach to managing MUS. The findings suggest that children and young people with MUS are at risk of receiving suboptimal care and support because there is insufficient research to inform high-quality, evidence-based practice.
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Affiliation(s)
- Denise Hinton
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Susan Kirk
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Parslow R, Patel A, Beasant L, Haywood K, Johnson D, Crawley E. What matters to children with CFS/ME? A conceptual model as the first stage in developing a PROM. Arch Dis Child 2015; 100:1141-7. [PMID: 26453575 PMCID: PMC4680202 DOI: 10.1136/archdischild-2015-308831] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/14/2015] [Accepted: 08/04/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Paediatric chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) is relatively common and disabling. Research is hampered because current patient-reported outcome measures (PROMs) do not capture outcomes that are important to children with CFS/ME. AIM The aim of this study was to explore the aspects of life and health outcomes that matter to children with CFS/ME. METHODS Twenty-five children with CFS/ME were interviewed (11 males, 14 females; mean age 12.9 years (SD 2.2), range 8-17). Twelve were trial participants interviewed during the trial and 13 were recruited as part of a follow-up qualitative study. Parents were present in 19 interviews with their children. Three mothers participated in a focus group. All the interviews and the focus group were audio-recorded and transcribed. Data were analysed thematically using techniques of constant comparison. NVivo was used to structure and categorise data in a systematic way. RESULTS Children identified four key themes (health outcome domains): 'symptoms' that fluctuated, which caused an unpredictable reduction in both 'physical activity' and 'social participation' all of which impacted on 'emotional well-being'. These domains were influenced by both 'management' and 'contextual factors', which could be positive and negative. The relationship between healthcare and school was considered pivotal. CONCLUSIONS Children's descriptions helped to inform a conceptual model that is necessary to develop a new paediatric CFS/ME PROM. Doctors need to be aware of how children conceptualise CFS/ME; the relationship between healthcare and school is fundamental to ameliorate the impact of CFS/ME. TRIAL REGISTRATION NUMBER ISRCTN81456207.
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Affiliation(s)
- Roxanne Parslow
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Aarti Patel
- Psychology Department, University of Bath, Bath, UK
| | - Lucy Beasant
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Kirstie Haywood
- Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick, Coventry, UK
| | - Debbie Johnson
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Esther Crawley
- Centre for Child and Adolescent Health, School of Social & Community Medicine, University of Bristol, Bristol, UK
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Twisk FNM. Accurate diagnosis of myalgic encephalomyelitis and chronic fatigue syndrome based upon objective test methods for characteristic symptoms. World J Methodol 2015; 5:68-87. [PMID: 26140274 PMCID: PMC4482824 DOI: 10.5662/wjm.v5.i2.68] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/10/2015] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
Although myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are considered to be synonymous, the definitional criteria for ME and CFS define two distinct, partially overlapping, clinical entities. ME, whether defined by the original criteria or by the recently proposed criteria, is not equivalent to CFS, let alone a severe variant of incapacitating chronic fatigue. Distinctive features of ME are: muscle weakness and easy muscle fatigability, cognitive impairment, circulatory deficits, a marked variability of the symptoms in presence and severity, but above all, post-exertional “malaise”: a (delayed) prolonged aggravation of symptoms after a minor exertion. In contrast, CFS is primarily defined by (unexplained) chronic fatigue, which should be accompanied by four out of a list of 8 symptoms, e.g., headaches. Due to the subjective nature of several symptoms of ME and CFS, researchers and clinicians have questioned the physiological origin of these symptoms and qualified ME and CFS as functional somatic syndromes. However, various characteristic symptoms, e.g., post-exertional “malaise” and muscle weakness, can be assessed objectively using well-accepted methods, e.g., cardiopulmonary exercise tests and cognitive tests. The objective measures acquired by these methods should be used to accurately diagnose patients, to evaluate the severity and impact of the illness objectively and to assess the positive and negative effects of proposed therapies impartially.
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Asprusten TT, Fagermoen E, Sulheim D, Skovlund E, Sørensen Ø, Mollnes TE, Wyller VB. Study findings challenge the content validity of the Canadian Consensus Criteria for adolescent chronic fatigue syndrome. Acta Paediatr 2015; 104:498-503. [PMID: 25640602 DOI: 10.1111/apa.12950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 11/23/2014] [Accepted: 01/26/2015] [Indexed: 01/24/2023]
Abstract
AIM The 2003 Canadian Consensus Criteria for chronic fatigue syndrome (CFS) are often assumed to suggest low-grade systemic inflammation, but have never been formally validated. This study explored the content validity of the Criteria in a sample of adolescents with CFS selected according to a wide case definition. METHODS A total of 120 patients with CFS with a mean age of 15.4 years (range 12-18 years) included in the NorCAPITAL project were post hoc subgrouped according to the Canadian Consensus Criteria. Those who satisfied the criteria (Criteria positive) and those who did not (Criteria negative) were compared across a wide range of disease markers and markers of prognosis. RESULTS A total of 46 patients were classified as Criteria positive, 69 were classified as Criteria negative, and five could not be classified. All disease markers were equal across the two groups, except the digit span backward test of cognitive function, which showed poorer performance in the Criteria-positive group. Also, the prognosis over a 30-week period was equal between the groups. CONCLUSION This study questions the content validity of the Canadian Consensus Criteria, as few differences were found between adolescent patients with CFS who did and did not satisfy the Criteria.
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Affiliation(s)
- Tarjei Tørre Asprusten
- Division of Medicine and Laboratory Sciences; Medical Faculty; University of Oslo; Oslo Norway
| | - Even Fagermoen
- Institute of Clinical Medicine; Medical Faculty; University of Oslo; Oslo Norway
- Department of Anesthesiology and Critical Care; Oslo University Hospital; Oslo Norway
| | - Dag Sulheim
- Department of Paediatrics; Oslo University Hospital; Oslo Norway
- Department of Paediatrics; Innlandet Hospital Trust; Lillehammer Norway
| | - Eva Skovlund
- School of Pharmacy; University of Oslo; Oslo Norway
| | - Øystein Sørensen
- Oslo Centre for Biostatistics and Epidemiology; Department of Biostatistics; University of Oslo; Oslo Norway
| | - Tom Eirik Mollnes
- Department of Immunology; Oslo University Hospital; Oslo Norway
- K.G. Jebsen IRC; University of Oslo; Oslo Norway
- Research Laboratory; Nordland Hospital; Bodø Norway
- Faculty of Health Sciences; K.G. Jebsen TREC; University of Tromsø; Tromsø Norway
- Centre of Molecular Inflammation Research; Norwegian University of Science and Technology; Trondheim Norway
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Plasma cytokine expression in adolescent chronic fatigue syndrome. Brain Behav Immun 2015; 46:80-6. [PMID: 25555530 DOI: 10.1016/j.bbi.2014.12.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 12/18/2014] [Accepted: 12/23/2014] [Indexed: 12/11/2022] Open
Abstract
Chronic fatigue syndrome (CFS) is a prevalent and disabling condition among adolescents. The pathophysiology is poorly understood, but low-grade systemic inflammation has been suggested as an important component. This study compared circulating levels of individual cytokines and parameters of cytokine networks in a large set of adolescent CFS patients and healthy controls, and explored associations between cytokines and symptoms in the CFS group. CFS patients (12-18years old) were recruited nation-wide to a single referral center as part of the NorCAPITAL project (ClinicalTrials ID: NCT01040429). A broad case definition of CFS was applied, requiring three months of unexplained, disabling chronic/relapsing fatigue of new onset, whereas no accompanying symptoms were necessary. Thus, the case definition was broader than the Fukuda-criteria of CFS. Healthy controls having comparable distribution of gender and age were recruited from local schools. Twenty-seven plasma cytokines, including interleukins, chemokines and growth factors were assayed using multiplex technology. The results were subjected to network analyses using the ARACNE algorithm. Symptoms were charted by a questionnaire, and patients were subgrouped according to the Fukuda-criteria. A total of 120 CFS patients and 68 healthy controls were included. CFS patients had higher scores for fatigue (p<0.001) and inflammatory symptoms (p<0.001) than healthy controls. All cytokine levels and cytokine network parameters were similar, and none of the differences were statistically different across the two groups, also when adjusting for adherence to the Fukuda criteria of CFS. Within the CFS group, there were no associations between aggregate cytokine network parameters and symptom scores. Adolescent CFS patients are burdened by symptoms that might suggest low-grade systemic inflammation, but plasma levels of individual cytokines as well as cytokine network measures were not different from healthy controls, and there were no associations between symptoms and cytokine expression in the CFS group. Low-grade systemic inflammation does not appear to be a central part of adolescent CFS pathophysiology.
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40
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Collin SM, Tilling K, Joinson C, Rimes KA, Pearson RM, Hughes RA, Sterne JAC, Crawley E. Maternal and childhood psychological factors predict chronic disabling fatigue at age 13 years. J Adolesc Health 2015; 56:181-7. [PMID: 25448612 DOI: 10.1016/j.jadohealth.2014.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/05/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate whether premorbid maternal and childhood psychological problems are risk factors for chronic disabling fatigue at age 13 years among children in the Avon Longitudinal Study of Parents and Children birth cohort. METHODS Chronic disabling fatigue was defined as fatigue of at least 3-month, and up to 5-year, duration that prevented school attendance or hobbies/sport/leisure activities, and for which other causes were not identified. Maternal psychological factors were symptoms of anxiety and depression assessed up to eight times between pregnancy and age 6 years. We investigated critical periods for maternal effects and effects of paternal depression at three time points. Child psychological factors included internalizing and externalizing problems and upsetting life events occurring at age 7-8 years. RESULTS Of 5,657 children, 110 (1.9%) had chronic disabling fatigue at age 13 years. Maternal anxiety (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI], 1.09-1.31 per episode), maternal depression (AOR, 1.24; CI, 1.11-1.39 per episode), child psychological problems (AOR, 1.19; CI, 1.00-1.41 per problem), and upsetting events (AOR, 1.22; CI, .99-1.58 per event) were associated with chronic disabling fatigue. Associations of child psychological problems and upsetting events were attenuated (AOR, 1.12; CI, .93-1.33 per problem; AOR, 1.19; CI, .94-1.52 per event) after further adjusting for maternal anxiety and depression. CONCLUSIONS Pediatricians need to be aware that children whose mothers experience anxiety and/or depression between pregnancy and child's age 6 years have an increased risk of developing chronic disabling fatigue in early adolescence. Conversely, clinicians need to be alert to fatigue in children whose mothers have longstanding anxiety and depression. These findings suggest the importance of family-based approaches to treatment.
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Affiliation(s)
- Simon M Collin
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom.
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Carol Joinson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rebecca M Pearson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Rachael A Hughes
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Esther Crawley
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; Centre for Child and Adolescent Health, University of Bristol, Bristol, United Kingdom
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Wyller VB, Fagermoen E, Sulheim D, Winger A, Skovlund E, Saul JP. Orthostatic responses in adolescent chronic fatigue syndrome: contributions from expectancies as well as gravity. Biopsychosoc Med 2014; 8:22. [PMID: 25237387 PMCID: PMC4166398 DOI: 10.1186/1751-0759-8-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 09/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orthostatic intolerance is common in chronic fatigue syndrome (CFS), and several studies have documented an abnormal sympathetic predominance in the autonomic cardiovascular response to gravitational stimuli. The aim of this study was to explore whether the expectancies towards standing are contributors to autonomic responses in addition to the gravitational stimulus itself. METHODS A total of 30 CFS patients (12-18 years of age) and 39 healthy controls underwent 20° head-up tilt test and a motor imagery protocol of standing upright. Beat-to-beat cardiovascular variables were recorded. RESULTS At supine rest, CFS patients had significantly higher heart rate, diastolic blood pressure, and mean arterial blood pressure, and lower stroke index and heart rate variability (HRV) indices. The response to 20° head-up tilt was identical in the two groups. The response to imaginary upright position was characterized by a stronger increase of HRV indices of sympathetic predominance (power in the low-frequency range as well as the ratio low-frequency: high-frequency power) among CFS patients. CONCLUSIONS These results suggest that in CFS patients expectancies towards orthostatic challenge might be additional determinants of autonomic cardiovascular modulation along with the gravitational stimulus per se.
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Affiliation(s)
- Vegard Bruun Wyller
- Department of Pediatrics, Oslo University Hospital, N-1478 Oslo, Norway ; Division of Medicine and Laboratory Sciences, Medical Faculty, University of Oslo, Oslo, Norway ; Department of Pediatrics, Akershus University Hospital, Nordbyhagen, Norway
| | - Even Fagermoen
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway ; Department of Anesthesiology and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Dag Sulheim
- Department of Pediatrics, Oslo University Hospital, N-1478 Oslo, Norway ; Department of Pediatrics, Lillehammer County Hospital, Lillehammer, Norway
| | - Anette Winger
- Institute of Nursing Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway ; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Eva Skovlund
- School of Pharmacy, University of Oslo, Oslo, Norway ; Norwegian Institute of Public Health, Oslo, Norway
| | - Jerome Philip Saul
- Department of Pediatrics, Medical University of South Carolina, Charleston, USA
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A review of the predisposing, precipitating and perpetuating factors in Chronic Fatigue Syndrome in children and adolescents. Clin Psychol Rev 2014; 34:233-48. [DOI: 10.1016/j.cpr.2014.02.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 01/01/2023]
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Abstract
Most paediatricians regularly see children with chronic fatigue syndrome or myalgic encephalitis (CFS/ME) in their clinics and yet we know little about how common it is, who is affected, whether there are risk factors and how likely a child is to recover (or what might predict recovery). Recent research suggests that this illness is more complicated than previously thought and that rather than being an illness found in middle class families, it is more common in those who are socially deprived. This article reviews what is currently known about this important but little understood condition.
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