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Das D, Singh AK. Interactions between work-related factors, perceived fatigue and musculoskeletal disorders among handicraft artisans: structural equation model analysis. ERGONOMICS 2024:1-17. [PMID: 38192115 DOI: 10.1080/00140139.2023.2300952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024]
Abstract
The cross-sectional study aimed to investigate the relationship between work-related factors, perceived work fatigue (PWF) and musculoskeletal disorders (MSDs) among handicraft artisans. 364 artisans participated in a questionnaire survey, and a structural equation model (SEM) was developed to explore the direct and indirect relationships between these factors using partial least squares analysis. The SEM explained 98.2% of the variance in MSDs and revealed that exposure to biomechanical factors had a direct impact on PWF and MSDs, with PWF mediating the effect of biomechanical factors on MSDs. Additionally, job demand was found to be positively associated with MSDs, while job control and social support reduced the risk of MSDs. The findings underscore the importance of strategic initiatives to mitigate the risk of developing MSDs among artisans. The study also highlights the potential of SEM as a novel framework for understanding the complex pathogenesis of MSDs in occupational health research.Practitioner summary: The study sought to comprehensively examine the intricate relationships among work-related factors, PWF, and MSDs. To achieve this, an SEM approach was employed to capture both direct and indirect relationships between these factors, employing partial least squares analysis. Findings revealed SEM as an innovative framework for understanding the intricate development of MSDs.
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Affiliation(s)
- Dipayan Das
- Department of Mechanical Engineering, National Institute of Technology Sikkim, Sikkim, India
| | - Ashish Kumar Singh
- Department of Fashion and Lifestyle Accessories, National Institute of Fashion Technology (NIFT), Bhopal, India
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Franklin J. How to be sociable in a pandemic. Med Confl Surviv 2022; 38:233-241. [PMID: 36065081 DOI: 10.1080/13623699.2022.2118104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Campbell LM, Sun-Suslow N, Heaton A, Heaton RK, Ellis RJ, Moore DJ, Moore RC. Fatigue is associated with worse cognitive and everyday functioning in older persons with HIV. AIDS 2022; 36:763-772. [PMID: 34999606 PMCID: PMC9081180 DOI: 10.1097/qad.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether there are relationships between fatigue, cognition, and everyday functioning in older persons with and without HIV and to examine if associations remain after accounting for depression, anxiety, and sleep quality. METHODS Sixty-nine persons with HIV (PWH) and 36 persons without HIV, aged 50-74 years, were recruited from ongoing studies at UC San Diego's HIV Neurobehavioral Research Program and from the community. Participants completed neuropsychological testing, a performance-based measure of everyday functioning, and self-report questionnaires of fatigue, depression, anxiety, sleep quality, and everyday functioning. Multivariable linear regressions and logistic regressions stratified by HIV serostatus were used to examine relationships between fatigue, cognition, and everyday functioning. Psychiatric symptoms and sleep quality were examined as covariates. RESULTS In this cross-sectional study, PWH had significantly greater fatigue than the HIV-negative group (g = 0.83; P < 0.01). When stratifying by HIV serostatus, greater fatigue was significantly associated with worse global cognition (β = -0.56;P < 0.01) in PWH even when controlling for covariates;however, fatigue was not significantly associated with global cognition in persons without HIV. In PWH and when accounting for covariates, fatigue was also associated with greater risk of self-reported everyday functioning impairment [odds ratio (OR) = 1.66 for 10-point increase in fatigue, P = 0.04] but not performance-based everyday functioning (P = 0.95). CONCLUSION Fatigue is associated with cognition, particularly measures with a speeded component, and self-reported everyday functioning in older PWH. Findings suggest that fatigue is important to assess and consider in the context of aging with HIV.
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Affiliation(s)
- Laura M Campbell
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ni Sun-Suslow
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Anne Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ronald J Ellis
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Raeanne C Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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The Impact of a Peer Social Support Network from the Perspective of Women with Fibromyalgia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312801. [PMID: 34886527 PMCID: PMC8657284 DOI: 10.3390/ijerph182312801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022]
Abstract
Background: Fibromyalgia is a chronic and complex disease whose management by patients requires a high level of commitment. Patient empowerment therefore represents an important milestone in chronic disease treatment and control. We explored the impact of a peer social support network from the perspective of women with fibromyalgia. Methods: A generic qualitative design was proposed for the study, for which women who had been diagnosed with fibromyalgia were purposefully selected. Six semi-structured interviews were conducted, and the collected data were thematically analysed. Results: Three key themes emerged regarding the peer social support network: (1) empowerment (facilitating acceptance of the diagnosis and acting as a source of information); (2) effects on well-being and quality of life (attenuated the stigma, improved physical well-being, provided emotional support and was a socialization medium); and (3), valuable aspects (transmitted feelings of being understood and listened to and increased personal feelings of satisfaction). Conclusions: A peer social support network for women with fibromyalgia exerts positive effects on their physical, mental, and social well-being and empowers them to better manage their disease. Healthcare for women with fibromyalgia should include strategies that connect them through peer social support networks.
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Chartogne M, Leclercq A, Beaune B, Boyas S, Forestier C, Martin T, Thomas-Ollivier V, Landry S, Bourgeois H, Cojocarasu O, Pialoux V, Zanna O, Messonnier LA, Rahmani A, Morel B. Building a biopsychosocial model of cancer-related fatigue: the BIOCARE FActory cohort study protocol. BMC Cancer 2021; 21:1140. [PMID: 34688272 PMCID: PMC8542307 DOI: 10.1186/s12885-021-08831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Cancer-related fatigue (CRF) is the most common side effect of cancer and cancer treatment. CRF prevalence is up to 50% in breast cancer patients and can continue several years after cancer remission. This persistent subjective sense of exhaustion is multifactorial. Numerous parameters have been evidenced to be related to CRF across biological, physical, psychological, social and/or behavioral dimensions. Although CRF has been studied for many years, the majority of previous studies focused on only one dimension, i.e., physical function. Moreover, few studies investigated CRF longitudinally with repeated measures. These are the two main obstacles that limit the understanding of CRF mechanisms. The purpose of this study is to create a biopsychosocial model of CRF with simultaneous and longitudinal anthropometric, clinical, biological, physical, psychological and sociological parameters. Methods BIOCARE FActory is a multicentric prospective study that will consist of an 18-month follow-up of 200 women diagnosed with breast cancer. Four visits will be scheduled at diagnosis, after treatments, and 12 and 18 months after diagnosis. The same procedure will be followed for each visit. Each session will be composed of anthropometric data collection, a semi-structured interview, cognitive tests, postural control tests, neuromuscular fatigability tests and a cardiorespiratory fitness test. Clinical and biological data will be collected during medical follow-ups. Participants will also complete questionnaires to assess psychological aspects and quality of life and wear an actigraphy device. Using a structural equation modeling analysis (SEM), collected data will build a biopsychosocial model of CRF, including the physiological, biological, psychological, behavioral and social dimensions of CRF. Discussion This study aims to highlight the dynamics of CRF and its correlates from diagnosis to post treatment. SEM analysis could examine some relations between potential mechanisms and CRF. Thus, the biopsychosocial model will contribute to a better understanding of CRF and its underlying mechanisms from diagnosis to the aftermaths of cancer and its treatments. Trial registration This study is registered at ClinicalTrials.gov (NCT04391543), May 2020.
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Affiliation(s)
- M Chartogne
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France.
| | - A Leclercq
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - B Beaune
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - S Boyas
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - C Forestier
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - T Martin
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - V Thomas-Ollivier
- Nantes Université, Movement - Interactions - Performance, MIP, 4334, Nantes, EA, France
| | - S Landry
- Elsan-Clinique Victor Hugo, Centre Jean Bernard, Le Mans, France
| | - H Bourgeois
- Elsan-Clinique Victor Hugo, Centre Jean Bernard, Le Mans, France
| | - O Cojocarasu
- Centre Hospitalier Le Mans (CHM), Le Mans, France
| | - V Pialoux
- Univ Lyon, University Claude Bernard Lyon 1, Inter-University Laboratory of Human Movement Biology, Team Atherosclerosis Thrombosis & Physical Activity, EA7424, Lyon, France
| | - O Zanna
- Le Mans Université, VIPS2, EA4636, Le Mans, France
| | - L A Messonnier
- Laboratoire Interuniversitaire de Biologie de la Motricité, Univ. Savoie Mont Blanc, 7424, F-73000, Chambéry, EA, France
| | - A Rahmani
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France
| | - B Morel
- Le Mans Université, Movement - Interactions - Performance, MIP, 4334, F-72000, Le Mans, EA, France.,Laboratoire Interuniversitaire de Biologie de la Motricité, Univ. Savoie Mont Blanc, 7424, F-73000, Chambéry, EA, France
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Worm-Smeitink M, Monden R, Groen RN, van Gils A, Bekhuis E, Rosmalen J, Knoop H. Towards personalized assessment of fatigue perpetuating factors in patients with chronic fatigue syndrome using ecological momentary assessment: A pilot study. J Psychosom Res 2021; 140:110296. [PMID: 33264751 DOI: 10.1016/j.jpsychores.2020.110296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 10/26/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to explore the associations between cognitions, behaviours and affects and fatigue in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and their relation to reduction of fatigue after cognitive behaviour therapy (CBT). METHODS In CFS/ME patients, 22 behaviours, cognitions and affects, potentially perpetuating fatigue were registered 5 times a day using ecological momentary assessment (EMA) and an actigraphy. Simultaneous Components Analysis (SCA) was used to identify components of perpetuation, that were tested for their associations with fatigue in multilevel vector autoregressive (VAR) modelling. Fatigue severity was measured pre- and posttreatment with the Checklist Individual Strength. The relationship between perpetuation (the strength and direction of the possible associations between fatigue and the components) and therapy outcome was investigated. RESULTS 58 patients met inclusion criteria (m age = 36.5; 65.5% female) and data of 50 patients were analysed in the multilevel analysis. Two perpetuating components were found: "psychological discomfort" and "activity". For the total group, both perpetuating components did not predict fatigue on a following time-point. For individual patients the strength and direction of the associations varied. None of the associations between perpetuating components and fatigue significantly predicted treatment outcome. CONCLUSION Results suggest that there is heterogeneity in perpetuation of fatigue in CFS/ME. Investigating fatigue and perpetuators on an individual rather than group level could lead to new insights.
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Affiliation(s)
- Margreet Worm-Smeitink
- Expert Center for Chronic Fatigue, Department of Medical Psychology, University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Rei Monden
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Robin Nikita Groen
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Anne van Gils
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Ella Bekhuis
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Judith Rosmalen
- University of Groningen, University Medical Center of Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Netherlands
| | - Hans Knoop
- Expert Center for Chronic Fatigue, Department of Medical Psychology, University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands.
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Brewer G, Stratton K. Living with Chronic Fatigue Syndrome during lockdown and a global pandemic. FATIGUE: BIOMEDICINE, HEALTH & BEHAVIOR 2020. [DOI: 10.1080/21641846.2020.1827503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- G. Brewer
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - K. Stratton
- Department of Psychology, University of Liverpool, Liverpool, UK
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Li M, Shu Q, Huang H, Bo W, Wang L, Wu H. Associations of occupational stress, workplace violence, and organizational support on chronic fatigue syndrome among nurses. J Adv Nurs 2020; 76:1151-1161. [DOI: 10.1111/jan.14312] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/29/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Mengyao Li
- Department of Social Medicine School of Public Health China Medical University Shenyang China
| | - Qianyi Shu
- Party Committee Office Shengjing Hospital of China Medical University Shenyang China
| | - Hao Huang
- Department of Social Medicine School of Public Health China Medical University Shenyang China
| | - Wen Bo
- Department of Social Medicine School of Public Health China Medical University Shenyang China
| | - Lulu Wang
- Department of Social Medicine School of Public Health China Medical University Shenyang China
| | - Hui Wu
- Department of Social Medicine School of Public Health China Medical University Shenyang China
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Milrad SF, Hall DL, Jutagir DR, Lattie EG, Czaja SJ, Perdomo DM, Ironson G, Doss BD, Mendez A, Fletcher MA, Klimas N, Antoni MH. Relationship satisfaction, communication self-efficacy, and chronic fatigue syndrome-related fatigue. Soc Sci Med 2019; 237:112392. [PMID: 31377502 DOI: 10.1016/j.socscimed.2019.112392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 05/21/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
RATIONALE Relationship dissatisfaction has been linked with worse health outcomes in many patient populations, though the mechanism(s) underlying this effect are unclear. Among patients with chronic fatigue syndrome (CFS) and their partners, there is evidence for a bi-directional association between poorer relationship satisfaction and the severity of CFS-related fatigue. OBJECTIVE Here, we hypothesized that relationship dissatisfaction negatively impacts fatigue severity through greater depression and less patient satisfaction about communication about symptoms to partners. METHOD Baseline data were drawn from diagnosed CFS patients (N = 150) participating in a trial testing the efficacy of a stress management intervention. Data derived from fatigue severity (Fatigue Symptom Index, FSI), depression (Center for Epidemiologic Survey-Depression, CES-D), relationship quality (Dyadic Adjustment Scale, DAS) and communication satisfaction (Patient Symptom Disclosure Satisfaction, PSDS) questionnaires were used for bootstrapped indirect effect analyses using parallel mediation structural equation modeling in Mplus (v8). Age and BMI were entered as covariates. RESULTS Greater relationship satisfaction predicted greater communication satisfaction (p < 0.01) and lower CES-D scores (p < 0.01), which in turn were each significantly related to greater fatigue severity (p < 0.05). Tests of the indirect paths indicated that relationship satisfaction had a significant effect on fatigue severity through both constructs, but primarily via depression. There was no direct association between relationship satisfaction and fatigue severity after the intermediate variables (depression, communication satisfaction) were included in the model. CONCLUSION Results highlight the importance of considering depression and communication-related factors when examining the effects of relationship satisfaction on CFS symptoms such as fatigue. Further mechanism-based, longitudinal research might identify relationship-related mediating variables that can be targeted therapeutically.
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Affiliation(s)
| | - Daniel L Hall
- Department of Psychiatry, Massachusetts General Hospital/ Harvard Medical School, USA
| | - Devika R Jutagir
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, USA
| | - Emily G Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago IL, USA
| | - Sara J Czaja
- Department of Psychiatry and Behavioral Sciences, University of Miami, USA
| | - Dolores M Perdomo
- Department of Psychiatry and Behavioral Sciences, University of Miami, USA
| | - Gail Ironson
- Department of Psychology, University of Miami, USA
| | - Brian D Doss
- Department of Psychology, University of Miami, USA
| | | | - Mary Ann Fletcher
- Institute for Neuro Immune Medicine, Nova Southeastern University, USA
| | - Nancy Klimas
- Institute for Neuro Immune Medicine, Nova Southeastern University, USA
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Pearson C, Swindale R, Keighley P, McKinlay AR, Ridsdale L. Not Just a Headache: Qualitative Study About Web-Based Self-Presentation and Social Media Use by People With Migraine. J Med Internet Res 2019; 21:e10479. [PMID: 31219049 PMCID: PMC6607770 DOI: 10.2196/10479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/15/2018] [Accepted: 04/18/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To help with a long-term but invisible medical condition such as migraine, many people seek information and support on social media. The effect of using social media for people with migraine is not fully understood and remains to be investigated. OBJECTIVE The aim of this study was to describe how people with migraine use social media and how social media use affects their identity and sense of self. METHODS A total of 20 participants who experienced migraine were recruited via migraine-specific charities. Semistructured interviews were conducted with questions based on a topic guide. Interviews were transcribed verbatim, and transcripts were analyzed using thematic analysis. RESULTS People with migraine are using social media to obtain information to better understand their condition and treatment options. Social media offers instant access to continuous information and social support. This exchange of social support and information was viewed as mutually beneficial. Participants viewed social media as an outlet to vent frustrations and validate the migraine experience. Several participants pointed out that the invisible and episodic nature of migraine can lead to societal misunderstanding of the impact and or severity of their condition. Some participants masked their online migraine-related behavior using different sites or closed online groups to control who saw their migraine-related content. Participating in closed social media groups sometimes changed Web-based behavior in other areas of the platform. This illustrates the complex relationship between migraine, social media, and identity. CONCLUSIONS How migraine is part of an individual's identity and how this is represented online can vary. Social media can provide people who experience migraine with instant and continuous access to support and information, from a group of empathic others with similar lived experiences. Social media is used to validate the illness experience, as well as provide reassurance and help reduce feelings of isolation.
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Affiliation(s)
- Carly Pearson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Rosanna Swindale
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Peter Keighley
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Alison Ruth McKinlay
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Leone Ridsdale
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Noble S, Bonner C, Hersch J, Jansen J, McGeechan K, McCaffery K. Could disease labelling have positive effects? An experimental study exploring the effect of the chronic fatigue syndrome label on intended social support. PATIENT EDUCATION AND COUNSELING 2019; 102:486-493. [PMID: 30514660 DOI: 10.1016/j.pec.2018.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 10/04/2018] [Accepted: 10/13/2018] [Indexed: 06/09/2023]
Abstract
Objective Chronic fatigue syndrome (CFS) patients report limited social support, which can affect symptom severity. Friends are a key source of social support for young adults with CFS, but there is limited research on friends' responses to the CFS label. We explored the potential benefits or harms of the CFS label for shaping the potential for social support from a friend's perspective. Method 207 university students responded to hypothetical scenarios about a close friend experiencing CFS. Participants were randomly allocated to either the CFS-label or no-label conditions. The potential for social support was operationalised as attitude (sympathetic or hostile), intended treatment support and intended behavioural support. Results The CFS label elicited a greater potential for social support, with significantly higher sympathetic responses, lower rejecting responses and greater support for active treatment. These effects were significantly greater in men compared to women. There was no effect on intended behavioural support. Conclusion This study suggests the CFS label may increase the potential for social support. Young adults, particularly men, held more supportive attitudes towards their friend when the CFS label was used. Practical Implications The effects of labels on the potential for social support need to be considered when evaluating the usefulness of a disease label.
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Affiliation(s)
- Samara Noble
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia; Wiser Healthcare, Australia; The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia.
| | - Carissa Bonner
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia; Wiser Healthcare, Australia; The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Jolyn Hersch
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia; Wiser Healthcare, Australia; The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Jesse Jansen
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia; Wiser Healthcare, Australia; The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Kevin McGeechan
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia; Wiser Healthcare, Australia; The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
| | - Kirsten McCaffery
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, Sydney, Australia; Wiser Healthcare, Australia; The University of Sydney, Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Sydney, Australia
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Milic V, Grujic M, Barisic J, Marinkovic-Eric J, Duisin D, Cirkovic A, Damjanov N. Personality, depression and anxiety in primary Sjogren's syndrome - Association with sociodemographic factors and comorbidity. PLoS One 2019; 14:e0210466. [PMID: 30653543 PMCID: PMC6336324 DOI: 10.1371/journal.pone.0210466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/25/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Patients with primary Sjögren’s Syndrome (pSS) have diminished health quality and fatigue, arthralgia along with dryness of the mouth and eyes have major impact on their psychological and social aspects of life. The purpose of this study was to determine psychological features of patients with pSS. We analyzed personality, depression and anxiety of patients with primary Sjögren’s Syndrome (pSS) in comparison with patients with rheumatoid arthritis (RA) and healthy controls (HC) and assessed their association with sociodemographic factors and comorbidity. Methods In 105 pSS patients (mean age 51.34 years, mean disease duration 5.98 years), 52 RA patients (mean age 51.37 years, mean disease duration 8.10 years) and 54 HC (mean age 51.35 years) clinical and sociodemographic characteristics were determined and results analyzed. At enrollment patients and controls completed the Revisited NEO Personality Inventory Five-Factor model (NEO-PI-R), the Zung Self-Rating Depression Scale and the Zung Self-Rating Anxiety Scale. Statistical analyses were performed using SPSS [Version 16.0]. The relative size of the effect was assessed based on standardized estimates of effect size (d). Results Patients with pSS, similarly to RA patients had higher scores of Neuroticism (d = 0.46, p = 0.007) and lower scores of Extraversion (d = 0.51, p = 0.001) and Openness for experience (d = 0.65, p = 0.013) compared to HC. There was no significant differences between pSS group and HC in the depression (d = 0.171, p>0.05). However, patients with pSS had higher anxiety in comparison to HC (p<0.0001). In multivariate models, education and satisfaction with family relationships were significant predictors for psychological characteristics of patients, independently of clinical diagnosis. Conclusions Our study is the first to show that patients with pSS scored high on neuroticism and anxiety and low on sociability. Education and satisfaction with family relationships predisposed to their psychological profile. Psychological assessment of patients with pSS may improve understanding and treatment of this clinical condition.
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Affiliation(s)
- Vera Milic
- Department of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- * E-mail:
| | - Milica Grujic
- Department of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasmina Barisic
- Department of Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Marinkovic-Eric
- Department of Medical Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Duisin
- Department of Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Andja Cirkovic
- Department of Medical Statistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nemanja Damjanov
- Department of Rheumatology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Raijmakers RPH, Keijmel SP, Breukers EMC, Bleijenberg G, van der Meer JWM, Bleeker-Rovers CP, Knoop H. Long-term effect of cognitive behavioural therapy and doxycycline treatment for patients with Q fever fatigue syndrome: One-year follow-up of the Qure study. J Psychosom Res 2019; 116:62-67. [PMID: 30654996 DOI: 10.1016/j.jpsychores.2018.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/09/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Previously, we reported a randomized placebo-controlled trial, the Qure study, showing that cognitive behavioural therapy (CBT), and not doxycycline, was significantly more effective than placebo in reducing fatigue severity in Q fever fatigue syndrome (QFS) patients. This follow-up study evaluates the long-term effect of these treatment regimens, 1 year after completion of the original trial. METHODS All patients who completed the Qure study, CBT (n = 50), doxycycline (n = 52), and placebo (n = 52), were included in this follow-up study. Between twelve and fifteen months after end of treatment (EOT), patients filled out web-based questionnaires including the main outcome measure fatigue severity, assessed with the Checklist Individual Strength (CIS), subscale fatigue severity. RESULTS Fatigue severity in the CBT, but not doxycycline or placebo, group was significantly increased at follow-up compared to EOT (respective means 39.5 [95% CI, 36.2-42.9] and 31.3 [95% CI, 27.5-35.1], mean difference 8.2 [95% CI, 4.9-11.6]; P < .001). Fatigue severity scores of CBT (adjusted mean 39.8 [95% CI, 36.1-43.4]) and doxycycline (adjusted mean 41.0 [95% CI, 37.5-44.6]) groups did not significantly differ from the placebo group (adjusted mean 37.1 [95% CI, 33.6-40.7]; P = .92 and P = .38, respectively). CONCLUSION The beneficial effect of CBT on fatigue severity at EOT was not maintained 1 year thereafter. Due to its initial beneficial effect and side effects of long-term doxycycline use, we still recommend CBT as treatment for QFS. We suggest further investigation on tailoring CBT more to QFS, possibly followed by booster sessions.
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Affiliation(s)
- Ruud P H Raijmakers
- Radboud Expert Center for Q Fever, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Stephan P Keijmel
- Radboud Expert Center for Q Fever, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Evi M C Breukers
- Radboud Expert Center for Q Fever, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Gijs Bleijenberg
- Expert Center for Chronic Fatigue, Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Jos W M van der Meer
- Radboud Expert Center for Q Fever, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Chantal P Bleeker-Rovers
- Radboud Expert Center for Q Fever, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Hans Knoop
- Expert Center for Chronic Fatigue, Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands; Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Campbell R, Tobback E, Delesie L, Vogelaers D, Mariman A, Vansteenkiste M. Basic psychological need experiences, fatigue, and sleep in individuals with unexplained chronic fatigue. Stress Health 2017; 33:645-655. [PMID: 28371225 DOI: 10.1002/smi.2751] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 02/15/2017] [Accepted: 02/16/2017] [Indexed: 11/08/2022]
Abstract
Grounded in self-determination theory, this study tested the hypothesis that the satisfaction and frustration of the psychological needs for autonomy, competence, and relatedness would relate to fatigue and subjective and objective sleep parameters, with stress and negative sleep cognitions playing an explanatory role in these associations. During a stay at a sleep laboratory in Belgium, individuals with unexplained chronic fatigue (N = 160; 78% female) underwent polysomnography and completed a questionnaire at 3 different points in time (i.e., after arrival in the sleep lab, before bedtime, and the following morning) that assessed their need-based experiences and stress during the previous week, fatigue during the preceding day, and sleep-related cognitions and sleep during the previous night. Results indicated that need frustration related to higher stress, which in turn, related to higher evening fatigue. Need frustration also related to poorer subjective sleep quality and shorter sleep duration, as indicated by both subjective and objective shorter total sleep time and subjective (but not objective) longer sleep latency. These associations were accounted for by stress and negative sleep cognitions. These findings suggest that health care professionals working with individuals with unexplained chronic fatigue may consider focusing on basic psychological needs within their therapeutic approach.
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Affiliation(s)
- Rachel Campbell
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Els Tobback
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Delesie
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - An Mariman
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Maarten Vansteenkiste
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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Crane PB, Efird JT, Abel WM. Fatigue in Older Adults Postmyocardial Infarction. Front Public Health 2016; 4:55. [PMID: 27148509 PMCID: PMC4826886 DOI: 10.3389/fpubh.2016.00055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/14/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to comprehensively examine putative factors that may independently contribute to fatigue and subsequent persistence of fatigue in elderly adults 6-8 months post-myocardial infarction (MI). Studies suggest cardiac function, comorbidities, daytime sleepiness, depression, anemia, interleukins, and social support are correlates of fatigue; however, no studies have systematically examined these factors 6 months post-MI in an aging population. METHODS Study participants included 49 women and men (N = 98) ages 65-91 who were 6-8 months post-MI. Data collection included the demographic health status questionnaire (heart rate, blood pressure, body mass index, and medications), fatigue-related comorbidity scale, revised Piper fatigue scale, Epworth sleepiness scale, geriatric depression scale, social provisions scale, and venous blood tests (B-natriuretic peptide, hemoglobin, and interleukin-6). RESULTS Fatigue persisted after MI in 76% of older men and women with no difference by sex. Only depression scores (P trend = 0.0004) and mean arterial pressure (P trend = 0.015) were found to be linearly independent predictors for fatigue, controlling for age, Il-6 levels, and body mass index. CONCLUSION Post-MI depression and mean arterial blood pressure are important to assess when examining fatigue post-MI in older populations.
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Affiliation(s)
| | - Jimmy T. Efird
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Willie Mae Abel
- Department of Nursing, University of North Carolina at Charlotte, Charlotte, NC, USA
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16
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Fatigue and its associated psychosocial factors in cancer patients on active palliative treatment measured over time. Support Care Cancer 2015; 24:1349-55. [PMID: 26335403 PMCID: PMC4729797 DOI: 10.1007/s00520-015-2909-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/16/2015] [Indexed: 11/16/2022]
Abstract
Purpose Fatigue is a frequently reported symptom by patients with advanced cancer, but hardly any prospective information is available about fatigue while on treatment in the palliative setting. In a previous cross-sectional study, we found several factors contributing to fatigue in these patients. In this study, we investigated the course of fatigue over time and if psychosocial factors were associated with fatigue over time. Methods Patients on cancer treatment for incurable solid tumors were observed over 6 months. Patients filled in the Checklist Individual Strength monthly to measure the course of fatigue. Baseline questionnaires were used to measure disease acceptance, anxiety, depressive mood, fatigue catastrophizing, sleeping problems, discrepancies in social support, and self-reported physical activity for their relation with fatigue over time. Results At baseline 137 patients and after 6 months 89 patients participated. The mean duration of participation was 4.9 months. At most time points, fatigue scores were significantly higher in the group dropouts in comparison with the group participating 6 months (completers). Overall fatigue levels remained stable over time for the majority of participants. In the completers, 42 % never experienced severe fatigue, 29 % persisted being severely fatigued, and others had either an increasing or decreasing level. Of the investigated factors, low reported physical activity and non-acceptance of cancer were associated significantly to fatigue. Conclusion A substantial number of participants never experienced severe fatigue and fatigue levels remained stable over time. For those who do experience severe fatigue, non-acceptance of having incurable cancer and low self-reported physical activity may be fatigue-perpetuating factors.
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Verspaandonk J, Coenders M, Bleijenberg G, Lobbestael J, Knoop H. The role of the partner and relationship satisfaction on treatment outcome in patients with chronic fatigue syndrome. Psychol Med 2015; 45:2345-2352. [PMID: 25732090 DOI: 10.1017/s0033291715000288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) leads to a significant decrease in CFS-related symptoms and disability. The primary objective of this study was to explore whether partners' solicitous responses and patients' and partners' perceived relationship satisfaction had an effect on treatment outcome. METHOD The treatment outcome of a cohort of 204 consecutively referred patients treated with CBT was analysed. At baseline, CFS patients completed the Maudsley Marital Questionnaire. The Checklist Individual Strength subscale Fatigue and the Sickness Impact Profile total scores completed by CFS patients post-treatment were used as measures of clinically significant improvement. Partners completed the Family Response Questionnaire, the Maudsley Marital Questionnaire, the Brief Illness Perception Questionnaire, and the Causal Attribution List. Logistic regression analyses were performed with clinically significant improvement in fatigue and disability as dependent variables and scores on questionnaires at baseline as predictors. RESULTS Solicitous responses of the partner were associated with less clinically significant improvement in fatigue and disability. Partners more often reported solicitous responses when they perceived CFS as a severe condition. Patients' relationship dissatisfaction was negatively associated with clinically significant improvement in fatigue. CONCLUSIONS Partners' solicitous responses and illness perceptions at the start of the therapy can negatively affect the outcome of CBT for CFS. We emphasize the importance of addressing this in therapy.
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Affiliation(s)
- J Verspaandonk
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre,Nijmegen,The Netherlands
| | - M Coenders
- Faculty of Social and Behavioural Sciences,Utrecht University,The Netherlands
| | - G Bleijenberg
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre,Nijmegen,The Netherlands
| | - J Lobbestael
- Faculty of Clinical Psychological Science,Maastricht University,The Netherlands and RINO Zuid,Postdoctoral Education Institute,Eindhoven,The Netherlands
| | - H Knoop
- Expert Centre for Chronic Fatigue, Radboud University Medical Centre,Nijmegen,The Netherlands
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18
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Aylaz R, Karadağ E, Işik K, Yildirim M. Relationship between social support and fatigue in patients with type 2 diabetes mellitus in the east of turkey. Jpn J Nurs Sci 2015; 12:367-76. [DOI: 10.1111/jjns.12076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 01/28/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Rukuye Aylaz
- Department of Public Health Nursing, School of Health; Inonu University; Malatya Turkey
| | - Ezgi Karadağ
- Department of Internal Medicine Nursing; Tunceli University Health High School; Tunceli Turkey
| | - Kevser Işik
- Department of Public Health Nursing, School of Health; Inonu University; Malatya Turkey
| | - Melek Yildirim
- Department of Internal Medicine Nursing; Malatya State Hospital; Malatya Turkey
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19
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McInnis OA, McQuaid RJ, Bombay A, Matheson K, Anisman H. Finding benefit in stressful uncertain circumstances: relations to social support and stigma among women with unexplained illnesses. Stress 2015; 18:169-77. [PMID: 25544022 DOI: 10.3109/10253890.2014.1001975] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Living with a chronic illness can be challenging, but the ability to derive benefits and grow from this experience may enhance well-being. However, the possibility of obtaining such benefits may be dependent on the levels of stigmatization and lack of social support experienced by an individual as a result of the illness. Chronic fatigue syndrome (CFS) and fibromyalgia are chronic conditions that remain largely unexplained and those with these conditions must often contend with stigma and skepticism from others. Individuals with CFS/fibromyalgia often display stress-related biological alterations and the experience of stressful life events has been associated with illness development. The present study demonstrated that women with CFS/fibromyalgia (n = 40) as well as community participants who were depressed/anxious (n = 37), reported higher stigma levels than healthy women (n = 33). Moreover, women with CFS/fibromyalgia and those with depression/anxiety also reported greater levels of stigma than women with a chronic yet more widely accepted condition (n = 35; rheumatoid arthritis, osteoarthritis and multiple sclerosis). Secrecy related to stigma among those with CFS/fibromyalgia declined with increased social support, but this was not apparent among those with other chronic conditions. In addition, posttraumatic growth was lower among women with CFS/fibromyalgia compared to those with other chronic conditions. Qualitative analysis examining both negative impacts and positive changes stemming from illness experience revealed many similarities between women with CFS/fibromyalgia and those with other chronic conditions, including elevated appreciation for life, personal growth and compassion for others. However, women with CFS/fibromyalgia tended to report less positive change regarding interpersonal relationships compared to women with other chronic conditions. In general, unexplained illnesses were also accompanied by stigmatization which might ultimately contribute to women's lower ability to derive positive growth from their illness experience.
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Affiliation(s)
- Opal A McInnis
- Department of Neuroscience, Carleton University , Ottawa, ON , Canada
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20
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van Leeuwen N, Bossema ER, Knoop H, Kruize AA, Bootsma H, Bijlsma JWJ, Geenen R. Psychological profiles in patients with Sjogren's syndrome related to fatigue: a cluster analysis. Rheumatology (Oxford) 2014; 54:776-83. [DOI: 10.1093/rheumatology/keu387] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Indexed: 11/13/2022] Open
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21
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Gaab J. Go West or Rest! Die Behandlung chronischer Erschöpfungssyndrome im Wandel der Zeiten. VERHALTENSTHERAPIE 2014. [DOI: 10.1159/000362914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Peters MEWJ, Goedendorp MM, Verhagen SAHHVM, van der Graaf WTA, Bleijenberg G. Exploring the contribution of psychosocial factors to fatigue in patients with advanced incurable cancer. Psychooncology 2014; 23:773-9. [DOI: 10.1002/pon.3481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Marlies E. W. J. Peters
- Department of Medical Oncology; Radboud University, Medical Center; Nijmegen The Netherlands
| | - Martine M. Goedendorp
- Expert Center Chronic Fatigue; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Health Sciences; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | | | | | - Gijs Bleijenberg
- Expert Center Chronic Fatigue; Radboud University Medical Center; Nijmegen The Netherlands
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Effects of pre-experience of social exclusion on hypothalamus-pituitary-adrenal axis and catecholaminergic responsiveness to public speaking stress. PLoS One 2013; 8:e60433. [PMID: 23573255 PMCID: PMC3616100 DOI: 10.1371/journal.pone.0060433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/27/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Being socially excluded is associated with a variety of psychological changes and with an increased risk of disease. Today, the immediate physiological consequences of being socially excluded are not well understood. In two recent studies employing a standardized exclusion paradigm (Cyberball) we found social exclusion in this virtual game did not alter cortisol secretion directly. However, exclusion pre-experience suppresses the normal cortisol response to public speaking stress in women. The present study aims to replicate our previous finding and further elucidate it by analyzing for the first time whether this alteration of cortisol-responsiveness is associated to ACTH and whether the catecholaminergic system is affected as well. METHODS Women were randomly assigned to Cyberball-induced exclusion (SE, n = 22) or inclusion (SI, n = 21), respectively. Immediately afterwards they were subjected to public speaking stress. Salivary cortisol, plasma ACTH, catecholamines and estradiol were assessed as were psychological distress and mood. RESULTS Cyberball exclusion led to a highly significant immediate increase in negative affect in excluded women. After public speaking negative affect in included women increased as well and groups no longer differed. We replicate our previous finding of cortisol non-responsiveness to public speaking stress after exclusion pre-experience and find this effect to be significantly correlated with ACTH alterations. No such effects are observed for catecholamines. CONCLUSIONS We replicated our previous study result of a suppressed cortisol stress response after a short exclusion experience via Cyberball, thereby underlining the profound effects of social exclusion on a subsequent cortisol stress response. This further demonstrates that these alterations are associated with ACTH. Lack of effects on catecholamines is discussed in view of the tend-and-befriend hypothesis but also from a methodological perspective.
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Karadag E, Kilic SP, Metin O. Relationship between fatigue and social support in hemodialysis patients. Nurs Health Sci 2013; 15:164-71. [DOI: 10.1111/nhs.12008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 09/14/2012] [Accepted: 09/21/2012] [Indexed: 12/11/2022]
Affiliation(s)
- Ezgi Karadag
- Department of Internal Medicine Nursing; Tunceli University Health High School; Tunceli
| | - Serap Parlar Kilic
- Department of Internal Medicine Nursing; Gaziantep University Faculty of Health Sciences; Gaziantep
| | - Ozgur Metin
- Turgut Özal Tıp Merkezi; Malatya Inonu University; Malatya; Turkey
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Abstract
Chronic fatigue syndrome (CFS) is an illness characterized by disabling fatigue of at least 6 months. The aetiology of the condition has been hotly debated. In this chapter the evidence for CFS as a post viral condition and/or a neurological condition is reviewed. Although there is evidence that CFS is triggered by certain viruses in some patients and that neurobiological changes such as hypocortisolism are associated with the syndrome, neither mechanism is sufficient to explain the extent of the symptoms or disability experienced by patients. It is unlikely that CFS can be understood through one aetiological mechanisms. Rather it is a complex illness which is best explained in terms of a multifactorial cognitive behavioural model. This model proposes that CFS is precipitated by life events and/or viral illness in vulnerable individuals, such as those who are genetically predisposed, prone to distress, high achievement, and over or under activity. A self perpetuating cycle where physiological changes, illness beliefs, reduced and inconsistent activity, sleep disturbance, medical uncertainty and lack of guidance interact to maintain symptoms. Treatments based on this model including cognitive behavioural therapy and graded exercise therapy are effective at significantly reducing fatigue and disability in CFS. This chapter provides a description of these approaches and details of the trials conducted in the area.
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Fuller-Thomson E, Mehta R, Sulman J. Long-term parental unemployment in childhood and subsequent chronic fatigue syndrome. ISRN FAMILY MEDICINE 2013; 2013:978250. [PMID: 24959579 PMCID: PMC4041243 DOI: 10.5402/2013/978250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 12/24/2012] [Indexed: 11/23/2022]
Abstract
Objective. The association between long-term parental unemployment in childhood and chronic fatigue syndrome was examined in a population-based sample of women. Methods. A secondary analysis of data from a regionally representative sample of women (n = 7, 288) from the Canadian Community Health Survey (2005) was conducted using logistic regression. Age and race as well as the following clusters of factors were controlled for: (1) other childhood adversities, (2) adult health behaviors and hypertension, (3) adult stressors and socioeconomic status, and (4) adult mental health. Results. When adjusting for age and race only, the odds ratio of chronic fatigue syndrome among those reporting parental unemployment was 4.12 (95% CI: 2.60, 6.52) compared to those not reporting parental unemployment. When controlling for age and race plus all four clusters of factors the odds ratio for chronic fatigue syndrome dropped slightly to 3.05 (95% CI: 1.81, 5.14), but remained statistically significant. Conclusions. This study provides evidence for a significant association between long-term parental unemployment in childhood and chronic fatigue syndrome even after controlling for a wide range of potential risk factors.
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Affiliation(s)
- Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1A1 ; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada M5G 1V7
| | - Rukshan Mehta
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1A1
| | - Joanne Sulman
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, Canada M5S 1A1 ; Theodore J. Freedman Department of Social Work, Mount Sinai Hospital, Toronto, ON, Canada M5G 1X5
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Ekmann A, Avlund K, Osler M, Lund R. Do negative aspects of social relations influence fatigue? A cross-sectional study on a non-clinical sample of middle-aged Danish men. J Psychosom Res 2012; 73:277-82. [PMID: 22980533 DOI: 10.1016/j.jpsychores.2012.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/24/2012] [Accepted: 08/07/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Fatigue is a common complaint among young and old adults and may be associated with negative aspects of social relations. Hence, the purpose of this study was to explore the association between demands from and conflicts with different sources of social relations and fatigue. METHODS The study was based on sub-populations of the 6292 members of the Danish Metropolit Cohort. The cohort comprises men born in 1953 in the Copenhagen Metropolitan area who participated in a questionnaire survey in 2004. Data were analysed using χ(2)-tests and multivariable logistic regression. RESULTS The results showed that demands from and conflicts with children were independently associated with fatigue in a dose-response pattern. The adjusted odds ratio for fatigue was 1.48 (95% CI: 1.01-2.17) when the men experienced frequent demands from children and 1.89 (95% CI: 1.17-3.06) when they had frequent conflicts with their children. Crude analyses of demands from or conflicts with spouse, relatives or friends, respectively showed associations with fatigue compared to no demands or no conflicts. However, adjustment for depression and physical chronic disease cancelled out these associations. CONCLUSION We concluded that middle-aged Danish men, who had frequent negative social interactions with their children, more frequently experienced fatigue. However, negative social interactions with spouse, relatives or friends were not associated with fatigue.
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Affiliation(s)
- Anette Ekmann
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Denmark.
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Vos-Vromans DCWM, Smeets RJEM, Rijnders LJM, Gorrissen RRM, Pont M, Köke AJA, Hitters MWMGC, Evers SMAA, Knottnerus AJ. Cognitive behavioural therapy versus multidisciplinary rehabilitation treatment for patients with chronic fatigue syndrome: study protocol for a randomised controlled trial (FatiGo). Trials 2012; 13:71. [PMID: 22647321 PMCID: PMC3781576 DOI: 10.1186/1745-6215-13-71] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 04/16/2012] [Indexed: 01/04/2023] Open
Abstract
Background Patients with chronic fatigue syndrome experience extreme fatigue, which
often leads to substantial limitations of occupational, educational, social
and personal activities. Currently, there is no consensus regarding the
treatment. Patients try many different therapies to overcome their fatigue.
Although there is no consensus, cognitive behavioural therapy is seen as one
of the most effective treatments. Little is known about multidisciplinary
rehabilitation treatment, a combination of cognitive behavioural therapy
with principles of mindfulness, gradual increase of activities, body
awareness therapy and pacing. The difference in effectiveness and
cost-effectiveness between multidisciplinary rehabilitation treatment and
cognitive behavioural therapy is as yet unknown. The FatiGo (Fatigue-Go)
trial aims to compare the effects of both treatment approaches in outpatient
rehabilitation on fatigue severity and quality of life in patients with
chronic fatigue syndrome. Methods One hundred twenty patients who meet the criteria of chronic fatigue
syndrome, fulfil the inclusion criteria and sign the informed consent form
will be recruited. Both treatments take 6 months to complete. The outcome
will be assessed at 6 and 12 months after the start of treatment. Two weeks
after the start of treatment, expectancy and credibility will be measured,
and patients will be asked to write down their personal goals and score
their current performance on these goals on a visual analogue scale. At 6
and 14 weeks after the start of treatment, the primary outcome and three
potential mediators—self-efficacy, causal attributions and
present-centred attention-awareness—will be measured. Primary outcomes
are fatigue severity and quality of life. Secondary outcomes are physical
activity, psychological symptoms, self-efficacy, causal attributions, impact
of disease on emotional and physical functioning, present-centred
attention-awareness, life satisfaction, patient personal goals, self-rated
improvement and economic costs. The primary analysis will be based on
intention to treat, and longitudinal analysis of covariance will be used to
compare treatments. Discussion The results of the trial will provide information on the effects of cognitive
behavioural therapy and multidisciplinary rehabilitation treatment at 6 and
12 months follow-up, mediators of the outcome, cost-effectiveness,
cost-utility, and the influence of treatment expectancy and credibility on
the effectiveness of both treatments in patients with chronic fatigue
syndrome. Trial registration Current Controlled Trials ISRCTN77567702.
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Wiborg JF, Knoop H, Frank LE, Bleijenberg G. Towards an evidence-based treatment model for cognitive behavioral interventions focusing on chronic fatigue syndrome. J Psychosom Res 2012; 72:399-404. [PMID: 22469284 DOI: 10.1016/j.jpsychores.2012.01.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 01/02/2012] [Accepted: 01/31/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of the present study was to develop a treatment model for cognitive behavioral interventions focusing on chronic fatigue syndrome (CFS) based on the model of perpetuating factors introduced by Vercoulen et al. [Journal of Psychosomatic Research 1998;45:507-17]. METHODS For this purpose, we reanalyzed the data of a previously conducted randomized controlled trial in which a low intensity cognitive behavioral intervention was compared to a waiting list control group. Structural equation modeling was used to test a treatment model in which changes in focusing on symptoms, perceived problems with activity, and sense of control over fatigue were hypothesized to mediate the effect of our intervention on fatigue severity and disability. RESULTS In the final model, which had a good fit to the data, the effect of treatment was mediated by a decrease in perceived problems with activity and an increase in sense of control over fatigue. CONCLUSION Our findings suggest that cognitive behavioral interventions for CFS need to change the illness perception and beliefs of their patients in order to be effective.
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Affiliation(s)
- Jan F Wiborg
- Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands.
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Joosen MCW, Frings-Dresen MHW, Sluiter JK. Long-term outcomes following vocational rehabilitation treatments in patients with prolonged fatigue. Int J Behav Med 2011; 20:42-51. [PMID: 22135188 PMCID: PMC3576556 DOI: 10.1007/s12529-011-9208-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Multi-component vocational rehabilitation (VR) provides positive short-term outcomes in patients with prolonged fatigue. Purpose The purpose of this study is to evaluate the long-term outcomes of Dutch multi-component VR up to 18 months after treatment. Method In a pre–post-study, measurements were taken before treatment (t0), after treatment (t1) and in long-term follow-ups at 6 (t2), 12 (t3) and 18 months (t4) after treatment. Primary outcomes (fatigue, work participation and workability) and secondary outcomes [physical and social functioning, mental health and heart rate variability (HRV)] were assessed over time using linear mixed models analyses. Post hoc long-term outcomes were compared with t0 and t1. Results Sixty patients with severe fatigue complaints participated. The primary outcomes significantly (p < 0.001) improved at follow-ups compared with t0 and showed no relapse compared with t1. Moreover, fatigue decreased (p < 0.002) whereas workability (p < 0.001) and work participation (p < 0.001) increased further after treatment (t1). The secondary outcomes, physical functioning, mental health, social functioning and HRV, improved significantly (p < 0.001, p < 0.001, p < 0.001 and p = 0.049, respectively) over the long term compared with t0. At 6-month follow-up (t2), mental health (p < 0.003) and social functioning (p = 0.003) further increased after the treatment was stopped. Conclusion Multi-component VR treatments seem to significantly and in a clinically relevant way decrease fatigue symptoms and improve individual functioning and work participation in patients with severe prolonged fatigue over the long term and without showing relapse.
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Affiliation(s)
- Margot C. W. Joosen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
- Present Address: School of Social and Behavioral Sciences, Tilburg University, Tranzo, Tilburg The Netherlands
| | - Monique H. W. Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Judith K. Sluiter
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
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Oldershaw A, Hambrook D, Rimes K, Tchanturia K, Treasure J, Richards S, Schmidt U, Chalder T. Emotion recognition and emotional theory of mind in chronic fatigue syndrome. Psychol Health 2011; 26:989-1005. [DOI: 10.1080/08870446.2010.519769] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bhui KS, Dinos S, Ashby D, Nazroo J, Wessely S, White PD. Chronic fatigue syndrome in an ethnically diverse population: the influence of psychosocial adversity and physical inactivity. BMC Med 2011; 9:26. [PMID: 21418640 PMCID: PMC3072345 DOI: 10.1186/1741-7015-9-26] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 03/21/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is a complex multifactorial disorder. This paper reports the prevalence of chronic fatigue (CF) and CFS in an ethnically diverse population sample and tests whether prevalence varies by social adversity, social support, physical inactivity, anxiety and depression. METHODS Analysis of survey data linking the Health Survey for England (1998 and 1999) and the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) study undertaken in 2000. The study population comprised a national population sample of 4,281 people ages 16 to 74 years. CF and CFS were operationally defined on the basis of an interview in the EMPIRIC study, alongside questions about psychosocial risk factors. Previous illnesses were reported in the Health Survey for England during 1998 and 1999, as was physical inactivity. RESULTS All ethnic minority groups had a higher prevalence of CFS than the White group. The lowest prevalence was 0.8% in the White group, and it was highest at 3.5% in the Pakistani group (odds ratio (OR), 4.1; 95% confidence interval (95% CI), 1.6 to 10.4). Anxiety (OR, 1.8; 95% CI, 1.4 to 2.2), depression (OR, 1.4; 95% CI, 1.1 to 1.8), physical inactivity (OR, 2.0; 95% CI, 1.1 to 3.8), social strain (OR, 1.24; 95% CI, 1.04 to 1.48) and negative aspects of social support (OR, 2.12; 95% CI, 1.4 to 3.3) were independent risk factors for CFS in the overall sample. Together these risk factors explained ethnic differences in the prevalence of CFS, but no single risk factor could explain a higher prevalence in all ethnic groups. CONCLUSIONS The prevalence of CFS, but not CF, varies by ethnic group. Anxiety, depression, physical inactivity, social strain and negative aspects of social support together accounted for prevalence differences of CFS in the overall sample.
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Affiliation(s)
- Kamaldeep S Bhui
- Centre for Psychiatry, Wolson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood 2011; 117:2604-13. [DOI: 10.1182/blood-2010-09-306308] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Before, during, and after allogeneic hematopoietic stem cell transplantation (allo-HSCT), patients experience considerable physical and psychologic distress. Besides graft-versus-host disease and infections, reduced physical performance and high levels of fatigue affect patients' quality of life. This multicenter randomized controlled trial examined the effects of a partly self-administered exercise intervention before, during, and after allo-HSCT on these side effects. After randomization to an exercise and a social contact control group 105 patients trained in a home-based setting before hospital admission, during inpatient treatment and a 6- to 8-week period after discharge. Fatigue, physical performance, quality of life, and physical/psychologic distress were measured by standardized instruments at baseline, admission to, and discharge from hospital and 6 to 8 weeks after discharge. The exercise group showed significantly improvement in fatigue scores (up to 15% improvement in exercise group vs up to 28% deterioration in control; P < .01-.03), physical fitness/functioning (P = .02-.03) and global distress (P = .03). All effects were at least detectable at one assessment time point after hospitalization or repeatedly. Physical fitness correlated significantly with all reported symptoms/variables. In conclusion, this partly supervised exercise intervention is beneficial for patients undergoing allo-HSCT. Because of low personnel requirements, it might be valuable to integrate such a program into standard medical care.
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Skovbjerg S, Rasmussen A, Zachariae R, Schmidt L, Lund R, Elberling J. The association between idiopathic environmental intolerance and psychological distress, and the influence of social support and recent major life events. Environ Health Prev Med 2011; 17:2-9. [PMID: 21431806 DOI: 10.1007/s12199-011-0210-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 02/09/2011] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Idiopathic environmental intolerance (IEI) is a disorder characterized by non-specific symptoms attributed to common airborne chemicals. Increasing evidence points to an association between IEI and symptoms of psychological distress. However, whether other risk factors influence this association has not been clarified. The objective of this study was to examine the association between psychological distress and IEI and to determine whether the association is confounded by social support and major life events. METHODS Data were collected by postal questionnaires; other results from the study have been published previously in this journal. The study included participants from a general population-based study who had reported symptoms of chemical sensitivities (n = 787) and two patient groups. The first patient group (n = 101) included individuals who had contacted the Danish Research Centre for Chemical Sensitivities, and the second included individuals who had been diagnosed with environmental intolerance (n = 136). Multiple, hierarchical linear regression analyses were conducted with four IEI-related domains, i.e., mucosal and CNS symptoms, chemical intolerances and social consequences, as the dependent variables, and psychological distress, social support and major life events as the independent variables. RESULTS Our study confirmed positive and statistically significant associations between psychological distress and IEI. The associations remained statistically significant after adjusting for major life events and social support. CONCLUSIONS The results suggest that the association between IEI and psychological distress cannot be explained by known risk factors. More studies, including longitudinal studies, are needed to determine the role of psychological distress in the development and course of IEI.
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Affiliation(s)
- Sine Skovbjerg
- Department of Dermato-Allergology, The Danish Research Centre for Chemical Sensitivities, Copenhagen University Hospital Gentofte, Ledreborg Alle 40, 2, 2820, Gentofte, Denmark.
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Voermans NC, Knoop H, van de Kamp N, Hamel BC, Bleijenberg G, van Engelen BG. Fatigue Is a Frequent and Clinically Relevant Problem in Ehlers-Danlos Syndrome. Semin Arthritis Rheum 2010; 40:267-74. [DOI: 10.1016/j.semarthrit.2009.08.003] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Revised: 08/16/2009] [Accepted: 08/24/2009] [Indexed: 12/01/2022]
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Weik U, Maroof P, Zöller C, Deinzer R. Pre-experience of social exclusion suppresses cortisol response to psychosocial stress in women but not in men. Horm Behav 2010; 58:891-7. [PMID: 20816966 DOI: 10.1016/j.yhbeh.2010.08.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 08/23/2010] [Accepted: 08/26/2010] [Indexed: 11/28/2022]
Abstract
Lack of social support and social exclusion is associated with adverse effects for mental and physical health. Additionally, women appear to be more vulnerable to social triggers of health disturbances. The hypothalamus-pituitary-adrenocortical-axis (HPA axis) might play a key role in this context as it has been shown both to relate to psychosocial conditions and health outcomes and to respond differentially depending on gender. In a previous experiment we found no effects of exclusion alone (operationalized via Cyberball) on cortisol secretion. Here we examine the effects of a social exclusion pre-experience on psychological and cortisol responses to a public speaking stressor. Subjects (33 m, 34 f) were randomly assigned to social exclusion (SE) or one of two control conditions (exclusion attributed to technical default (TD) and social inclusion (SI)). Afterwards salivary cortisol and psychological responses to a public speaking paradigm were assessed. Exclusion pre-treatment does not affect psychological responses to public speaking stress though with respect to cortisol significant. Cyberball by gender and Cyberball by gender by time interactions are found. SE-women show a blunted cortisol stress response to public speaking while cortisol responses of SE-men fall between SI-men and TD-men. Pre-experience of social exclusion leads to a blunted cortisol response to stress in women but not in men. This factor might contribute to the higher vulnerability to social triggers of health disturbances observed in women.
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Affiliation(s)
- Ulrike Weik
- Institute of Medical Psychology, University of Giessen, Friedrichstr. 36, Giessen, Germany
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Friedberg F. Chronic fatigue syndrome, fibromyalgia, and related illnesses: a clinical model of assessment and intervention. J Clin Psychol 2010; 66:641-65. [PMID: 20186721 DOI: 10.1002/jclp.20676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A clinically informative behavioral literature on chronic fatigue syndrome (CFS) and fibromyalgia (FM) has emerged over the past decade. The purpose of this article is to (a) define these conditions and their less severe counterparts, i.e., unexplained chronic fatigue (UCF) and chronic widespread pain; (b) briefly review the behavioral theory and intervention literature on CFS and FM; and (c) describe a user-friendly clinical model of assessment and intervention for these illnesses. The assessments described will facilitate understanding of the somewhat unusual and puzzling somatic presentations that characterize these patients. Using an individualized cognitive-behavioral approach the mental health clinician can offer significant help to these often stigmatized and medically underserved patients.
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Affiliation(s)
- Fred Friedberg
- Putnam Hall/South Campus, Stony Brook University, Stony Brook, NY 11794-8790, USA.
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Tanaka M, Watanabe Y. A new hypothesis of chronic fatigue syndrome: Co-conditioning theory. Med Hypotheses 2010; 75:244-9. [DOI: 10.1016/j.mehy.2010.02.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 02/24/2010] [Accepted: 02/25/2010] [Indexed: 02/08/2023]
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Drachler MDL, Leite JCDC, Hooper L, Hong CS, Pheby D, Nacul L, Lacerda E, Campion P, Killett A, McArthur M, Poland F. The expressed needs of people with chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. BMC Public Health 2009; 9:458. [PMID: 20003363 PMCID: PMC2799412 DOI: 10.1186/1471-2458-9-458] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 12/11/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We aimed to review systematically the needs for support in managing illness and maintaining social inclusion expressed by people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) METHODS: We carried out a systematic review of primary research and personal ('own') stories expressing the needs of people with CFS/ME. Structured searches were carried out on Medline, AMED, CINAHL, EMBASE, ASSIA, CENTRAL, and other health, social and legal databases from inception to November 2007. Study inclusion, data extraction and risk of bias were assessed independently in duplicate. Expressed needs were tabulated and a conceptual framework developed through an iterative process. RESULTS Thirty two quantitative and qualitative studies, including the views of over 2500 people with CFS/ME with mainly moderate or severe illness severity, met the inclusion criteria. The following major support needs emerged: 1) The need to make sense of symptoms and gain diagnosis, 2) for respect and empathy from service providers, 3) for positive attitudes and support from family and friends, 4) for information on CFS/ME, 5) to adjust views and priorities, 6) to develop strategies to manage impairments and activity limitations, and 7) to develop strategies to maintain/regain social participation. CONCLUSIONS Although the studies were heterogeneous, there was consistent evidence that substantial support is needed to rebuild lives. Gaining support depends - most importantly - on the ability of providers of health and social care, colleagues, friends and relatives, and those providing educational and leisure services, to understand and respond to those needs.
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Affiliation(s)
| | | | - Lee Hooper
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Chia Swee Hong
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Derek Pheby
- Plaishetts House, Hadspen, Castle Carey, BA7 7LR, UK
| | - Luis Nacul
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Eliana Lacerda
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Peter Campion
- Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Castle Road, Cottingham, HU16 5JQ, UK
| | - Anne Killett
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Maggie McArthur
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Fiona Poland
- School of Allied Health Professions, University of East Anglia, Norwich, NR4 7TJ, UK
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Van Houdenhove B, Luyten P, Tiber Egle U. Stress as a Key Concept in Chronic Widespread Pain and Fatigue Disorders. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/10582450903284745] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
BACKGROUND Although fatigue is a common problem presenting to primary care, few prospective studies have examined the contribution of a wide range of prognostic factors. AIM To determine the combination of factors most strongly associated with a favourable or unfavourable course of fatigue, when fatigue is presented as a main symptom in primary care. DESIGN OF STUDY Prospective, observational cohort study with a 1-year follow-up. SETTING A total of 147 primary care practices in the Netherlands. METHOD Patients presenting with fatigue as a main symptom completed questionnaires at baseline, and 1, 4, 8, and 12 months later. The prognostic value of potential predictors was assessed by applying multivariable logistic regression analysis. The outcome was severity of fatigue, defined as a combination of dichotomised scores on several repeated measurements with the Checklist Individual Strength. Separate models were used to predict either a favourable or an unfavourable course of fatigue. RESULTS Baseline severity of fatigue and patient expectations of chronicity consistently predicted a poor outcome. Additional factors predicting a chronic course were baseline pain intensity and less social support. Baseline characteristics predicting a fast recovery were: male sex, not providing care for others (for example, for older people), better perceived health, and fewer (serious) prolonged difficulties. Both models had good reliability and discriminative validity (area under the receiver operating characteristic curve after internal validation: 0.78 and 0.79). CONCLUSION The identified combination of predictors reflects the multidimensionality of fatigue, with a significant contribution of patient expectations of chronicity in the prediction of a poor prognosis. These negative perceptions are modifiable, and should receive more attention in the initial assessment of patients presenting with fatigue.
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Van Houdenhove B, Luyten P. Customizing treatment of chronic fatigue syndrome and fibromyalgia: the role of perpetuating factors. PSYCHOSOMATICS 2009; 49:470-7. [PMID: 19122123 DOI: 10.1176/appi.psy.49.6.470] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Syndromes characterized by chronic, medically unexplained fatigue, effort- and stress-intolerance, and widespread pain are highly prevalent in medicine. RESULTS In chronic fatigue syndrome (CFS) and fibromyalgia (FM), various perpetuating factors may impair patients' quality of life and functioning and impede recovery. Although cognitive-behavioral and graded-exercise therapy are evidence-based treatments, the effectiveness and acceptability of therapeutic interventions in CFS/FM may largely depend on a customized approach taking the heterogeneity of perpetuating factors into account. CONCLUSION Further research should clarify the aim and outcome of different treatment strategies in CFS/FM, as well as the underlying mechanisms of change, including those facilitating neurobiological recovery.
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Price JR, Mitchell E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev 2008; 2008:CD001027. [PMID: 18646067 PMCID: PMC7028002 DOI: 10.1002/14651858.cd001027.pub2] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is a common, debilitating and serious health problem. Cognitive behaviour therapy (CBT) may help to alleviate the symptoms of CFS. OBJECTIVES To examine the effectiveness and acceptability of CBT for CFS, alone and in combination with other interventions, compared with usual care and other interventions. SEARCH STRATEGY CCDANCTR-Studies and CCDANCTR-References were searched on 28/3/2008. We conducted supplementary searches of other bibliographic databases. We searched reference lists of retrieved articles and contacted trial authors and experts in the field for information on ongoing/completed trials. SELECTION CRITERIA Randomised controlled trials involving adults with a primary diagnosis of CFS, assigned to a CBT condition compared with usual care or another intervention, alone or in combination. DATA COLLECTION AND ANALYSIS Data on patients, interventions and outcomes were extracted by two review authors independently, and risk of bias was assessed for each study. The primary outcome was reduction in fatigue severity, based on a continuous measure of symptom reduction, using the standardised mean difference (SMD), or a dichotomous measure of clinical response, using odds ratios (OR), with 95% confidence intervals (CI). MAIN RESULTS Fifteen studies (1043 CFS participants) were included in the review. When comparing CBT with usual care (six studies, 373 participants), the difference in fatigue mean scores at post-treatment was highly significant in favour of CBT (SMD -0.39, 95% CI -0.60 to -0.19), with 40% of CBT participants (four studies, 371 participants) showing clinical response in contrast with 26% in usual care (OR 0.47, 95% CI 0.29 to 0.76). Findings at follow-up were inconsistent. For CBT versus other psychological therapies, comprising relaxation, counselling and education/support (four studies, 313 participants), the difference in fatigue mean scores at post-treatment favoured CBT (SMD -0.43, 95% CI -0.65 to -0.20). Findings at follow-up were heterogeneous and inconsistent. Only two studies compared CBT against other interventions and one study compared CBT in combination with other interventions against usual care. AUTHORS' CONCLUSIONS CBT is effective in reducing the symptoms of fatigue at post-treatment compared with usual care, and may be more effective in reducing fatigue symptoms compared with other psychological therapies. The evidence base at follow-up is limited to a small group of studies with inconsistent findings. There is a lack of evidence on the comparative effectiveness of CBT alone or in combination with other treatments, and further studies are required to inform the development of effective treatment programmes for people with CFS.
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Affiliation(s)
- Jonathan R Price
- Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford, UK, OX3 7JX.
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Knoop H, Bleijenberg G, Gielissen MFM, van der Meer JWM, White PD. Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome? PSYCHOTHERAPY AND PSYCHOSOMATICS 2007; 76:171-6. [PMID: 17426416 DOI: 10.1159/000099844] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) for chronic fatigue syndrome (CFS) leads to a decrease in symptoms and disabilities. There is controversy about the nature of the change following treatment; some suggest that patients improve by learning to adapt to a chronic condition, others think that recovery is possible. The objective of this study was to find out whether recovery from CFS is possible after CBT. METHODS The outcome of a cohort of 96 patients treated for CFS with CBT was studied. The definition of recovery was based on the absence of the criteria for CFS set up by the Center for Disease Control (CDC), but also took into account the perception of the patients' fatigue and their own health. Data from healthy population norms were used in calculating conservative thresholds for recovery. RESULTS After treatment, 69% of the patients no longer met the CDC criteria for CFS. The percentage of recovered patients depended on the criteria used for recovery. Using the most comprehensive definition of recovery, 23% of the patients fully recovered. Fewer patients with a co-morbid medical condition recovered. CONCLUSION Significant improvement following CBT is probable and a full recovery is possible. Sharing this information with patients can raise the expectations of the treatment, which may enhance outcomes without raising false hopes.
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Affiliation(s)
- Hans Knoop
- Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Abstract
BACKGROUND In this article, current scientific knowledge on the chronic fatigue syndrome (CFS) is reviewed. The US case definition of CFS (the CDC-definition) is most widespread in research and clinical practice. Estimates of prevalence vary from 0.2% to above 2%. The female-male ratio is approximately 3:1. CLINICAL FEATURES Severe fatigue is the dominating complaint; it is worsened from exertions and not substantially relieved by rest. In addition, the patients might have a varying combination of accompanying symptoms. Clinical evaluation should be based upon standardized guidelines, including an assessment of functional impairments. PATHOPHYSIOLOGY The pathophysiology should be interpreted within a biopsychosocial framework. Present knowledge suggests that certain genetic polymorphisms and personality traits might be regarded as predisposing factors, some infections and severe psychosocial stress constitute precipitating factors, whereas disturbances of immunity, skeletal muscle, cognitive abilities, endocrine control and cardiovascular homeostasis are possible perpetuating factors. TREATMENT Cognitive behavioural therapy and graded exercise therapy are of proven value in randomized controlled trials. Several pharmaceutical measures have been explored and found to have no beneficial effect. Most patients might expect long-term improvement, but full recovery is rare; however, the prognosis is better among adolescents.
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Affiliation(s)
- Vegard Bruun Wyller
- Department of Pediatrics, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway.
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Dirkzwager AJE, Verhaak PFM. Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care. BMC FAMILY PRACTICE 2007; 8:33. [PMID: 17540013 PMCID: PMC1894968 DOI: 10.1186/1471-2296-8-33] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Accepted: 05/31/2007] [Indexed: 11/16/2022]
Abstract
Background Medically unexplained physical symptoms (MUPS) are common in general practice (GP), and are even more problematic as they become persistent. The present study examines the relationship between persistent MUPS in general practice on the one hand and quality of life, social conditions, and coping on the other hand. Additionally, it is examined how patients with persistent MUPS evaluate the quality of GP-care. Methods Data were used from a representative survey of morbidity in Dutch general practice, in which data from the electronic medical records were extracted. A random sample of patients participated in an extensive health interview and completed self-reported measures on social isolation, coping and the quality of GP-care. Patients with persistent MUPS (N = 192) were compared with general practice patients not meeting the criteria for persistent MUPS (N = 7.314), and with a group of patients that visited the GP in comparable rates for medical diagnoses (N = 2.265). Multiple logistic regression analyses were used to control for relevant socio-demographic variables and chronic diseases. Results After adjustment for demographics and chronic diseases, patients with persistent MUPS reported more psychological distress, more functional impairment, more social isolation, and they evaluated the quality of GP-care less positive than the other two patient groups. Although the majority of MUPS patients were positive about the quality of GP-care, they more often felt that they were not taken seriously or not involved in treatment decisions, and more often reported that the GP did not take sufficient time. The three groups did not differ with respect to the statement that the GP unnecessarily explains physical problems as psychological ones. Conclusion Strengthening MUPS patients' social network and encouraging social activities may be a meaningful intervention in which the GP may play a stimulating role. To further improve MUPS patients' satisfaction with GP-care, GPs may pay extra attention to taking sufficient time when treating MUPS patients, taking the problems seriously, and involving them in treatment decisions.
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Affiliation(s)
- Anja JE Dirkzwager
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
| | - Peter FM Verhaak
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands
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Knoop H, Stulemeijer M, Prins JB, van der Meer JWM, Bleijenberg G. Is cognitive behaviour therapy for chronic fatigue syndrome also effective for pain symptoms? Behav Res Ther 2007; 45:2034-43. [PMID: 17451642 DOI: 10.1016/j.brat.2007.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 03/07/2007] [Accepted: 03/08/2007] [Indexed: 11/30/2022]
Abstract
Patients with chronic fatigue syndrome (CFS) frequently report chronic pain symptoms. Cognitive behavioural therapy (CBT) for CFS results in a reduction of fatigue, but is not aimed at pain symptoms. In this study, we tested the hypothesis that a successful treatment of CFS can also lead to a reduction of pain. The second objective was to explore possible mechanisms of changes in pain. The third objective was to assess the predictive value of pain for treatment outcome. Data from two previous CBT studies were used, one of adult CFS patients (n=96) and one of adolescent CFS patients (n=32). Pain severity was assessed with a daily self-observation list at baseline and post-treatment. The location of pain in adults was assessed with the McGill Pain Questionnaire (MPQ). Patients were divided into recovered and non-recovered groups. Recovery was defined as reaching a post-treatment level of fatigue within normal range. Recovered adult and adolescent CFS patients reported a significant reduction of pain severity compared to non-recovered patients. Recovered adult patients also had fewer pain locations following treatment. The decrease in fatigue predicted the change in pain severity. In adult patients, a higher pain severity at baseline was associated with a negative treatment outcome.
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Affiliation(s)
- Hans Knoop
- Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Post Box 9011, 6525 EC Nijmegen, The Netherlands.
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48
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Zhang AY, Strauss GJ, Siminoff LA. Intervention of urinary incontinence and quality of life outcome in prostate cancer patients. J Psychosoc Oncol 2007; 24:17-30. [PMID: 17046804 DOI: 10.1300/j077v24n02_02] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined the effect of combined Pelvic Floor Muscle Exercises (PFME) and support group on quality of life of postprostatectomy patients. Twenty-nine participants learned PFME through biofeedback and were randomized to the control group (n = 15) and support group (n = 14). Assessment of quality of life was conducted at baseline and 3-month follow-up. The findings indicated a trend of increased functioning and reduced perception of illness intrusiveness in the support group, compared with the control group. Improved urinary continence was significantly associated with reduced depression and symptom distress over time. The findings suggest that an intervention focusing on urinary continence improves quality of life in these patients.
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Affiliation(s)
- Amy Y Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-4904, USA.
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Brown RF, Schutte NS. Direct and indirect relationships between emotional intelligence and subjective fatigue in university students. J Psychosom Res 2006; 60:585-93. [PMID: 16731233 DOI: 10.1016/j.jpsychores.2006.05.001] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to examine the direct and indirect relationships between emotional intelligence and subjective fatigue. METHODS One hundred sixty seven university students completed questionnaires assessing subjective fatigue, emotional intelligence, and a range of other psychosocial factors. A series of regression analyses were used to examine the direct and indirect relationships between subjective fatigue and psychosocial factors. RESULTS Higher emotional intelligence was associated with less fatigue. The psychosocial variables depression, anxiety, optimism, internal health locus of control, amount of social support, and satisfaction with social support each partially mediated between emotional intelligence and fatigue. Additionally, sleep quality partially mediated between emotional intelligence and fatigue. CONCLUSION These findings regarding the association between subjective fatigue, emotional intelligence, and other psychosocial factors may facilitate an understanding of the aetiology of fatigue and contribute to future research examining interventions aimed at helping individuals cope with fatigue.
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Affiliation(s)
- Rhonda F Brown
- Department of Psychology, University of New England, ARMIDALE NSW 2351, Australia.
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Wearden AJ, Riste L, Dowrick C, Chew-Graham C, Bentall RP, Morriss RK, Peters S, Dunn G, Richardson G, Lovell K, Powell P. Fatigue Intervention by Nurses Evaluation--the FINE Trial. A randomised controlled trial of nurse led self-help treatment for patients in primary care with chronic fatigue syndrome: study protocol. [ISRCTN74156610]. BMC Med 2006; 4:9. [PMID: 16603058 PMCID: PMC1456982 DOI: 10.1186/1741-7015-4-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Accepted: 04/07/2006] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome, also known as ME (CFS/ME), is a condition characterised primarily by severe, disabling fatigue, of unknown origin, which has a poor prognosis and serious personal and economic consequences. Evidence for the effectiveness of any treatment for CFS/ME in primary care, where most patients are seen, is sparse. Recently, a brief, pragmatic treatment for CFS/ME, based on a physiological dysregulation model of the condition, was shown to be successful in improving fatigue and physical functioning in patients in secondary care. The treatment involves providing patients with a readily understandable explanation of their symptoms, from which flows the rationale for a graded rehabilitative plan, developed collaboratively with the therapist. The present trial will test the effectiveness and cost-effectiveness of pragmatic rehabilitation when delivered by specially trained general nurses in primary care. We selected a client-centred counselling intervention, called supportive listening, as a comparison treatment. Counselling has been shown to be as effective as cognitive behaviour therapy for treating fatigue in primary care, is more readily available, and controls for supportive therapist contact time. Our control condition is treatment as usual by the general practitioner (GP). METHODS AND DESIGN This study protocol describes the design of an ongoing, single-blind, pragmatic randomized controlled trial of a brief (18 week) self-help treatment, pragmatic rehabilitation, delivered by specially trained nurse-therapists in patients' homes, compared with nurse-therapist delivered supportive listening and treatment as usual by the GP. An economic evaluation, taking a societal viewpoint, is being carried out alongside the clinical trial. Three adult general nurses were trained over a six month period to deliver the two interventions. Patients aged over 18 and fulfilling the Oxford criteria for CFS are assessed at baseline, after the intervention, and again one year later. Primary outcomes are self-reported physical functioning and fatigue at one year, and will be analysed on an intention-to-treat basis. A qualitative study will examine the interventions' mechanisms of change, and also GPs' drivers and barriers towards referral.
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Affiliation(s)
- AJ Wearden
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - L Riste
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - C Dowrick
- School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, L69 3GB, UK
| | - C Chew-Graham
- Division of Primary Care, Rusholme Academic Unit, University of Manchester, Manchester, M14 5NP, UK
| | - RP Bentall
- School of Psychological Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - RK Morriss
- Department of Psychiatry, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK
| | - S Peters
- Division of Psychiatry, University of Liverpool, Liverpool, L69 3GA, UK
| | - G Dunn
- Division of Epidemiology and Health Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - G Richardson
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - K Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL, UK
| | - P Powell
- Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, L7 8XP UK
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