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Iyizoba-Ebozue Z, Nicklin E, Price J, Prestwich R, Brown S, Hall E, Lilley J, Lowe M, Thomson DJ, Slevin F, Murray L, Boele F. "Why am I still suffering?": Experience of long-term fatigue and neurocognitive changes in oropharyngeal cancer survivors following (chemo)radiotherapy. Tech Innov Patient Support Radiat Oncol 2024; 30:100241. [PMID: 38510557 PMCID: PMC10951087 DOI: 10.1016/j.tipsro.2024.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/02/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
Background Late effects of cancer treatment, such as neurocognitive deficits and fatigue, can be debilitating. Other than head and neck-specific functional deficits such as impairments in swallowing and speech, little is known about survivorship after oropharyngeal cancer. This study examines the lived experience of fatigue and neurocognitive deficits in survivors of oropharyngeal squamous cell cancer and impact on their daily lives. Methods This work is part of the multicentre mixed method ROC-oN study (Radiotherapy for Oropharyngeal Cancer and impact on Neurocognition), evaluating fatigue and neurocognitive function in patients following radiotherapy +/- chemotherapy for oropharyngeal cancer and impact on quality of life. Semi-structured interviews were conducted in adults treated with radiotherapy (+/-chemotherapy) for oropharyngeal squamous cell carcinoma >/=24 months from completing treatment. Reflexive thematic analysis performed. Results 21 interviews (11 men and 10 women; median age 58 years and median time post-treatment 5 years) were conducted and analysed, yielding six themes: (1) unexpected burden of fatigue, (2) noticing changes in neurocognitive function, (3) the new normal, (4) navigating changes, (5)insufficient awareness and (6)required support. Participants described fatigue that persisted beyond the acute post-treatment period and changes in neurocognitive abilities across several domains. Paid and unpaid work, emotions and mood were impacted. Participants described navigating the new normal by adopting self-management strategies and accepting external support. They reported lack of recognition of these late effects, being poorly informed and being unprepared. Follow-up services were thought to be inadequate. Conclusions Fatigue and neurocognitive impairment were frequently experienced by survivors of oropharyngeal cancer, at least two years after treatment. Patients felt ill-prepared for these late sequelae, highlighting opportunities for improvement of patient information and support services.
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Affiliation(s)
| | - Emma Nicklin
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - James Price
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Robin Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Sarah Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research
| | - Emma Hall
- The Institute of Cancer Research, London, UK
| | - John Lilley
- Department of Radiotherapy Physics, Leeds Cancer Centre, Leeds, UK
| | - Matthew Lowe
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Finbar Slevin
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Louise Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Florien Boele
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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White PD. A perspective on causation of the chronic fatigue syndrome by considering its nosology. J Eval Clin Pract 2019; 25:991-996. [PMID: 31373106 DOI: 10.1111/jep.13240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022]
Abstract
The causes of chronic fatigue syndrome (CFS) remain unknown, with many failures to replicate new findings. This may be because the condition is hard to diagnose, difficult to classify, or because of its heterogeneous nature. Authors have problems in differentiating CFS from myalgic encephalomyelitis (ME), which leads many to label it as a hybrid CFS/ME or ME/CFS. Attempts to validate the many published criterion-based definitions have ended in failure. The International Classification of Diseases provide several different descriptions to choose from, although the latest 11th edition has narrowed this down. This paper describes conventional attempts to define and classify the illness, suggesting that this may be what leads to a failure to replicate putative causes. The approach to CFS/ME may require a shift in the assumption that the illness is homogeneous. An alternative approach is provided by studies suggesting that the condition is heterogeneous. CONCLUSION: The way forward may be to be over-inclusive regarding the diagnosis as a first step, while subdividing the condition into likely subgroups as a means of finding valid and reliable associations with potential causes. Studies of aetiology must involve prospective designs since cross-sectional studies cannot inform either aetiology or pathophysiology.
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Affiliation(s)
- Peter Denton White
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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Liu H, Yu Z, Chen C, Hong R, Jin K, Yang C. Visualization and Bibliometric Analysis of Research Trends on Human Fatigue Assessment. J Med Syst 2018; 42:179. [PMID: 30116894 DOI: 10.1007/s10916-018-1033-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/09/2018] [Indexed: 12/28/2022]
Abstract
This study aims to analyze the scientific research progress on human fatigue assessment (HFA) by using a bibliometric method, which was conducted a systematic analyses of 28,028 scientific papers about HFA from the Web of Science database, and the results were discussed from the following perspectives: temporal distribution, geographical distribution, discipline distribution, and key words distribution. In addition, this analysis also provides the network of author co-citation and key words. The results are summarized as follows: 1) the number of papers about HFA increased rapidly since 1990s; 2) The United States is a high-yield, high-cited country with 36.70% of the world's total literatures, and whose average citation index on HFA research is 47.89 per paper; China is the developing country with the largest number of publications, but its total citations and average citations are backward, only with an average of 21 citations per article; 3) The assessment of human fatigue shows the development trend of multidisciplinary intersecting; 4) There is a relative lack of cooperation among the world's leading scholars; the Dutch Gijs Bleijenberg is the most published scholar in the world, who have 108 articles on HFA research; the American scholar David Cella has the most influential article, with an h-index of 36; the distribution of Chinese scholars is relatively scattered, and no one has written more than five articles; 5) All of countries in the world had the same research topics, "muscle fatigue" is an important part of the HFA; China needs to pay more attention to the fatigue assessment associated with cancer. The results of the analysis can be used to enhance our understanding of HFA research and support further research in this area.
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Affiliation(s)
- Hui Liu
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China.
| | - Zhihong Yu
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| | - Chan Chen
- Department of Internal Medicine, Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Rui Hong
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| | - Kan Jin
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
| | - Chun Yang
- College of Quality and Safety Engineering, China Jiliang University, Hangzhou, China
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Baken DM, Harvey ST, Bimler DL, Ross KJ. Stigma in Myalgic Encephalomyelitis and its association with functioning. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2018. [DOI: 10.1080/21641846.2018.1419553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Don M. Baken
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - Shane T. Harvey
- School of Psychology, Massey University, Palmerston North, New Zealand
| | - David L. Bimler
- School of Psychology, Massey University Wellington, Wellington, New Zealand
| | - Kirsty J. Ross
- School of Psychology, Massey University, Palmerston North, New Zealand
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De Gucht V, Garcia FK, den Engelsman M, Maes S. Differences in Physical and Psychosocial Characteristics Between CFS and Fatigued Non-CFS Patients, a Case-Control Study. Int J Behav Med 2017; 23:589-94. [PMID: 26895839 PMCID: PMC5031722 DOI: 10.1007/s12529-016-9544-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Purpose The main research question is: “Do CFS patients differ from fatigued non-CFS patients with respect to physical, cognitive, behavioral, social, and emotional determinants?” In addition, group differences in relevant outcomes were explored. Method Patients who met the Centers for Disease Control (CDC) criteria for CFS were categorized as CFS; these patients were mainly recruited via a large Dutch patient organization. Primary care patients who were fatigued for at least 1 month and up to 2 years but did not meet the CDC criteria were classified as fatigued non-CFS patients. Both groups were matched by age and gender (N = 192 for each group). Results CFS patients attributed their fatigue more frequently to external causes, reported a worse physical functioning, more medical visits, and a lower employment rate. The results of a multiple logistic regression analysis showed that patients who believe that their fatigue is associated with more severe consequences, that their fatigue will last longer and is responsible for more additional symptoms are more likely to be classified as CFS, while patients who are more physically active and have higher levels of “all or nothing behavior” are less likely to be classified as having CFS. Conclusion A longitudinal study should explore the predictive value of the above factors for the transition from medically unexplained fatigue to CFS in order to develop targeted interventions for primary care patients with short-term fatigue complaints.
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Affiliation(s)
- Veronique De Gucht
- Health, Medical, and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, P.O. BOX 955, 2300 RB, Leiden, Netherlands.
| | - Franshelis Katerinee Garcia
- Health, Medical, and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, P.O. BOX 955, 2300 RB, Leiden, Netherlands
| | - Marielle den Engelsman
- Health, Medical, and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, P.O. BOX 955, 2300 RB, Leiden, Netherlands
| | - Stan Maes
- Health, Medical, and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, P.O. BOX 955, 2300 RB, Leiden, Netherlands
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Doerr JM, Jopp DS, Chajewski M, Nater UM. Patterns of control beliefs in chronic fatigue syndrome: results of a population-based survey. BMC Psychol 2017; 5:6. [PMID: 28264716 PMCID: PMC5340015 DOI: 10.1186/s40359-017-0174-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background Chronic fatigue syndrome (CFS) represents a unique clinical challenge for patients and health care providers due to unclear etiology and lack of specific treatment. Characteristic patterns of behavior and cognitions might be related to how CFS patients respond to management strategies. Methods This study investigates control beliefs in a population-based sample of 113 CFS patients, 264 individuals with insufficient symptoms or fatigue for CFS diagnosis (ISF), and 124 well individuals. Results Controlling for personality and coping, individuals with low confidence in their problem-solving capacity were almost 8 times more likely to be classified as ISF and 5 times more likely to be classified as CFS compared to being classified as well. However there was a wide distribution within groups and individuals with “low confidence” scores were found in 31.7% of Well individuals. Individuals with low levels of anxiety and who were more outgoing were less likely to be classified as ISF or CFS. Conclusions These findings suggest that fostering control beliefs could be an important focus for developing behavioral management strategies in CFS and other chronic conditions.
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Affiliation(s)
- Johanna M Doerr
- Clinical Biopsychology, Dept. of Psychology, University of Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany
| | - Daniela S Jopp
- Dept. of Psychology, Fordham University, Dealy 318, 441 East Fordham Road, Bronx, NY, 10458-9993, USA
| | - Michael Chajewski
- Dept. of Psychology, Fordham University, Dealy 318, 441 East Fordham Road, Bronx, NY, 10458-9993, USA
| | - Urs M Nater
- Clinical Biopsychology, Dept. of Psychology, University of Marburg, Gutenbergstrasse 18, 35032, Marburg, Germany.
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Changes in Gut and Plasma Microbiome following Exercise Challenge in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). PLoS One 2015; 10:e0145453. [PMID: 26683192 PMCID: PMC4684203 DOI: 10.1371/journal.pone.0145453] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/03/2015] [Indexed: 12/11/2022] Open
Abstract
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disease characterized by intense and debilitating fatigue not due to physical activity that has persisted for at least 6 months, post-exertional malaise, unrefreshing sleep, and accompanied by a number of secondary symptoms, including sore throat, memory and concentration impairment, headache, and muscle/joint pain. In patients with post-exertional malaise, significant worsening of symptoms occurs following physical exertion and exercise challenge serves as a useful method for identifying biomarkers for exertion intolerance. Evidence suggests that intestinal dysbiosis and systemic responses to gut microorganisms may play a role in the symptomology of ME/CFS. As such, we hypothesized that post-exertion worsening of ME/CFS symptoms could be due to increased bacterial translocation from the intestine into the systemic circulation. To test this hypothesis, we collected symptom reports and blood and stool samples from ten clinically characterized ME/CFS patients and ten matched healthy controls before and 15 minutes, 48 hours, and 72 hours after a maximal exercise challenge. Microbiomes of blood and stool samples were examined. Stool sample microbiomes differed between ME/CFS patients and healthy controls in the abundance of several major bacterial phyla. Following maximal exercise challenge, there was an increase in relative abundance of 6 of the 9 major bacterial phyla/genera in ME/CFS patients from baseline to 72 hours post-exercise compared to only 2 of the 9 phyla/genera in controls (p = 0.005). There was also a significant difference in clearance of specific bacterial phyla from blood following exercise with high levels of bacterial sequences maintained at 72 hours post-exercise in ME/CFS patients versus clearance in the controls. These results provide evidence for a systemic effect of an altered gut microbiome in ME/CFS patients compared to controls. Upon exercise challenge, there were significant changes in the abundance of major bacterial phyla in the gut in ME/CFS patients not observed in healthy controls. In addition, compared to controls clearance of bacteria from the blood was delayed in ME/CFS patients following exercise. These findings suggest a role for an altered gut microbiome and increased bacterial translocation following exercise in ME/CFS patients that may account for the profound post-exertional malaise experienced by ME/CFS patients.
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Lin WQ, Jing MJ, Tang J, Wang JJ, Zhang HS, Yuan LX, Wang PX. Factors Associated with Fatigue among Men Aged 45 and Older: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:10897-909. [PMID: 26404346 PMCID: PMC4586650 DOI: 10.3390/ijerph120910897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/23/2015] [Accepted: 08/25/2015] [Indexed: 12/17/2022]
Abstract
Background and Purpose: Fatigue is one of the most common symptoms reported in several studies; but few studies have concentrated on the male population, especially for the middle-aged and older men who are exposed to greater fatigue risk. The purpose of this study was to explore the prevalence of fatigue and identify the risk factors of fatigue among men aged 45 and older in China. Methods: This study was part of a cross-sectional study on community health in Shunde (Guangdong Province, China). A total sample of 1158 men aged 45 and older were included. Sociodemographic characteristics, health and lifestyle factors and the Chalder Fatigue Scale (CFS) were measured by structured questionnaires through face-to-face interviews. Multivariate logistic regression was applied to determine the risk factors of fatigue. Results: Approximately 30% of participants experienced fatigue. Older age (≥75 years: adjusted OR 3.88, 95% CI 2.09–7.18), single marital status (1.94, 1.04–3.62), unemployed status (1.68, 1.16–2.43), number of self-reported chronic diseases (≥2 chronic diseases: 2.83, 1.86–4.31), number of individuals’ children (≥4 children: 2.35, 1.33–4.15), hospitalization in the last year (1.61, 1.03–2.52) were all significantly associated with increased risk of fatigue, while regular exercise (0.46, 0.32–0.65) was a protective factor against fatigue. Conclusions: Fatigue was usual in males and several factors were associated with the fatigue. These findings may have implication in risk assessment of fatigue and help in developing and implementing targeted interventions in middle-aged and elderly males.
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Affiliation(s)
- Wei-Quan Lin
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
| | - Meng-Juan Jing
- Institute of Public Health, School of Nursing, Henan University, Kaifeng, 475004, China; E-Mail:
| | - Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
| | - Jia-Ji Wang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
| | - Hui-Shan Zhang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
| | - Le-Xin Yuan
- Department of Nursing, School of Nursing, Guangzhou Medical University, Guangzhou, 510182, China; E-Mail:
| | - Pei-Xi Wang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, 510182, China; E-Mails: (W.-Q.L.); (J.T.); (J.-J.W.); (H.-S.Z.)
- Institute of Public Health, School of Nursing, Henan University, Kaifeng, 475004, China; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +86-20-8134-0186; Fax: +86-20-8134-0196
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Wright F, D'Eramo Melkus G, Hammer M, Schmidt BL, Knobf MT, Paul SM, Cartwright F, Mastick J, Cooper BA, Chen LM, Melisko M, Levine JD, Kober K, Aouizerat BE, Miaskowski C. Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue. J Pain Symptom Manage 2015; 50:176-89. [PMID: 25828559 PMCID: PMC4526314 DOI: 10.1016/j.jpainsymman.2015.02.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/06/2015] [Accepted: 02/18/2015] [Indexed: 11/25/2022]
Abstract
CONTEXT Fatigue is the most common symptom in oncology patients during chemotherapy. Little is known about the predictors of interindividual variability in initial levels and trajectories of morning fatigue severity in these patients. OBJECTIVES An evaluation was done to determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of morning fatigue and to compare findings with our companion paper on evening fatigue. METHODS A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (n = 586) completed demographic and symptom questionnaires a total of six times over two cycles of chemotherapy. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling was used to answer the study objectives. RESULTS A large amount of interindividual variability was found in the morning fatigue trajectories. A piecewise model fit the data best. Patients with higher body mass index, who did not exercise regularly, with a lower functional status, and who had higher levels of state anxiety, sleep disturbance, and depressive symptoms reported higher levels of morning fatigue at enrollment. Variations in the trajectories of morning fatigue were predicted by the patients' ethnicity and younger age. CONCLUSION The modifiable risk factors that were associated with only morning fatigue were body mass index, exercise, and state anxiety. Modifiable risk factors that were associated with both morning and evening fatigue included functional status, depressive symptoms, and sleep disturbance. Using this information, clinicians can identify patients at higher risk for more severe morning fatigue and evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.
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Affiliation(s)
- Fay Wright
- Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA
| | - Gail D'Eramo Melkus
- Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA
| | - Marilyn Hammer
- Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA
| | - Brian L Schmidt
- Department of Oral and Maxillofacial Surgery, School of Dentistry, New York University, New York, New York, USA
| | - M Tish Knobf
- Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, Connecticut, USA
| | - Steven M Paul
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | | | - Judy Mastick
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Lee-May Chen
- Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California, USA
| | - Michelle Melisko
- Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Jon D Levine
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California at San Francisco, San Francisco, California, USA
| | - Kord Kober
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Bradley E Aouizerat
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA; The Institute for Human Genetics, University of California at San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA.
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Patrick DM, Miller RR, Gardy JL, Parker SM, Morshed MG, Steiner TS, Singer J, Shojania K, Tang P. Lyme Disease Diagnosed by Alternative Methods: A Phenotype Similar to That of Chronic Fatigue Syndrome. Clin Infect Dis 2015; 61:1084-91. [DOI: 10.1093/cid/civ470] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/08/2015] [Indexed: 11/15/2022] Open
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Miller RR, Reid WD, Mattman A, Yamabayashi C, Steiner T, Parker S, Gardy J, Tang P, Patrick DM. Submaximal exercise testing with near-infrared spectroscopy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome patients compared to healthy controls: a case-control study. J Transl Med 2015; 13:159. [PMID: 25990639 PMCID: PMC4438583 DOI: 10.1186/s12967-015-0527-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a debilitating illness. Symptoms include profound fatigue and distinctive post-exertional malaise (PEM). We asked whether a submaximal exercise test would prove useful for identifying different patterns of tissue oxygen utilization in individuals with ME/CFS versus healthy subjects. Such a test has potential to aid with ME/CFS diagnosis, or to characterize patients' illness. METHODS A case-control study of 16 patients with ME/CFS compared to 16 healthy controls completing a 3-min handgrip protocol was performed. Response was measured using near-infrared spectroscopy, resulting in measurements of oxygenated (O2Hb) and deoxygenated hemoglobin (HHb) over wrist extensors and flexors. Changes in O2Hb (delta (d)O2Hb) and HHb (dHHb) absorbance between the first and last contraction were calculated, as were the force-time product of all contractions, measured as tension-time index (TTI), and ratings of perceived exertion (RPE). RESULTS Individuals with ME/CFS demonstrated smaller dO2Hb and dHHb than controls. However, after adjusting for TTI and change in total hemoglobin (delta (d)tHb), differences in dO2Hb and dHHb were reduced, with large overlapping variances. RPE was significantly higher for cases than controls, particularly at rest. CONCLUSIONS Relative to controls, participants with ME/CFS demonstrated higher RPE, lower TTI, and reduced dO2Hb and dHHb during repetitive handgrip exercise, although considerable variance was observed. With further study, submaximal exercise testing may prove useful for stratifying patients with a lower propensity for inducing PEM, and have the ability to establish baseline intensities for exercise prescription.
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Affiliation(s)
- Ruth R Miller
- School of Population and Public Health, British Columbia Centre for Disease Control, University of British Columbia, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Andre Mattman
- Adult Metabolic Disease Clinic, Vancouver General Hospital, Level 4, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Cristiane Yamabayashi
- Muscle Biophysics Laboratory, Department of Physical Therapy, University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 3P1, Canada.
| | - Theodore Steiner
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, V5Z 3J5, Canada.
| | - Shoshana Parker
- Centre for Health Evaluation and Outcome Sciences, 588-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Jennifer Gardy
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Patrick Tang
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - David M Patrick
- School of Population and Public Health, British Columbia Centre for Disease Control, University of British Columbia, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. .,British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
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Vergauwen K, Huijnen IPJ, Kos D, Van de Velde D, van Eupen I, Meeus M. Assessment of activity limitations and participation restrictions with persons with chronic fatigue syndrome: a systematic review. Disabil Rehabil 2014; 37:1706-16. [DOI: 10.3109/09638288.2014.978507] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Affiliation(s)
| | - E Baltaretsou
- Cardiology Department St Nicolas General Hospital, Greece
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15
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Borsini A, Hepgul N, Mondelli V, Chalder T, Pariante CM. Childhood stressors in the development of fatigue syndromes: a review of the past 20 years of research. Psychol Med 2014; 44:1809-1823. [PMID: 24093427 DOI: 10.1017/s0033291713002468] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) and fibromyalgia (FM) are both highly prevalent conditions associated with extreme disability and with the development of co-morbid psychiatric disorders, such as depression and anxiety. Childhood stressors have been shown to induce persistent changes in the function of biological systems potentially relevant to the pathogenesis of both CFS and FM, such as the inflammatory system and the hypothalamic-pituitary-adrenal (HPA) axis. In this review, we examined whether multiple forms of childhood stressors are contributing factors to the development of these disorders, and of the associated psychiatric symptoms. METHOD Using PubMed, we identified 31 papers relevant to this narrative review. We included cohort studies and case-control studies, without any exclusion in terms of age and gender. No study characteristics or publication date restrictions were imposed. RESULTS Most studies across the literature consistently show that there is a strong association between experiences of childhood stressors and the presence of CFS and FM, with rates of CFS/FM being two- to three-fold higher in exposed than in unexposed subjects. We also found evidence for an increased risk for the development of additional symptoms, such as depression, anxiety and pain, in individuals with CFS and FM with a previous history of childhood stressors, compared with individuals with CFS/FM and no such history. CONCLUSIONS Our review confirms that exposure to childhood stressors is associated with the subsequent development of fatigue syndromes such as CFS and FM, and related symptoms. Further studies are needed to identify the mechanisms underlying these associations.
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Affiliation(s)
- A Borsini
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
| | - N Hepgul
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
| | - V Mondelli
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
| | - T Chalder
- Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
| | - C M Pariante
- Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK
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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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17
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Naess H, Nyland M, Hausken T, Follestad I, Nyland HI. Chronic fatigue syndrome after Giardia enteritis: clinical characteristics, disability and long-term sickness absence. BMC Gastroenterol 2012; 12:13. [PMID: 22316329 PMCID: PMC3292445 DOI: 10.1186/1471-230x-12-13] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 02/08/2012] [Indexed: 02/07/2023] Open
Abstract
Background A waterborne outbreak of Giardia lamblia gastroenteritis led to a high prevalance of long-lasting fatigue and abdominal symptoms. The aim was to describe the clinical characteristics, disability and employmentloss in a case series of patients with Chronic Fatigue Syndrome (CFS) after the infection. Methods Patients who reported persistent fatigue, lowered functional capacity and sickness leave or delayed education after a large community outbreak of giardiasis enteritis in the city of Bergen, Norway were evaluated with the established Centers for Disease Control and Prevention criteria for CFS. Fatigue was self-rated by the Fatigue Severity Scale (FSS). Physical and mental health status and functional impairment was measured by the Medical Outcome Severity Scale-short Form-36 (SF-36). The Hospital Anxiety and Depression Scale (HADS) was used to measure co-morbid anxiety and depression. Inability to work or study because of fatigue was determined by sickness absence certified by a doctor. Results A total of 58 (60%) out of 96 patients with long-lasting post-infectious fatigue after laboratory confirmed giardiasis were diagnosed with CFS. In all, 1262 patients had laboratory confirmed giardiasis. At the time of referral (mean illness duration 2.7 years) 16% reported improvement, 28% reported no change, and 57% reported progressive course with gradual worsening. Mean FSS score was 6.6. A distinctive pattern of impairment was documented with the SF-36. The physical functioning, vitality (energy/fatigue) and social functioning were especially reduced. Long-term sickness absence from studies and work was noted in all patients. Conclusion After giardiasis enteritis at least 5% developed clinical characteristics and functional impairment comparable to previously described post-infectious fatigue syndrome.
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Affiliation(s)
- Halvor Naess
- Institute of Clinical Medicine, Department of Neurology, and Unit for Gastroenterology, Department for Medicine, Haukeland University Hospital, Bergen, Norway.
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18
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Ruiz E, Alegre J, García Quintana AM, Aliste L, Blázquez A, Fernández de Sevilla T. [Chronic fatigue syndrome: study of a consecutive series of 824 cases assessed in two specialized units]. Rev Clin Esp 2011; 211:385-90. [PMID: 21794854 DOI: 10.1016/j.rce.2011.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/04/2011] [Accepted: 02/20/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE The chronic fatigue syndrome (CFS) is a disabling disorder. Few studies are available in our area on the prevalence and characteristics of CFS. Therefore, we carried out a study of a consecutive series of 824 cases diagnosed in two specialized units. PATIENTS AND METHODS We evaluated all of the CFS patients seen from January 2008 to June 2010. We analyzed social and demographic data, employment status, time of clinical evolution, trigger factors and onset, Fukuda and Canadian criteria, associated comorbidities and treatment. RESULTS A total of 824 patients were included, 748 (91%) woman, mean age 48±9 years. Average age of onset of symptoms was 35±11 years, time to diagnosis 108±88 month. A precipitating factor was identified in 481 (58%) patients, the onset was gradual in 517 (63%) and 515 (62.5%) were not employed. The most outstanding diagnostic criteria of Fukuda were prolonged generalized fatigue after exercise, sleep disturbance and impairments in concentration and short-term memory. The different groups of symptoms defined by the Canadian consensus showed that CFS is a homogeneous entity. Accompanying comorbidity phenomena were anxiety 691 (83%), sicca syndrome 678 (82%), fibromyalgia 450 (55%). A total of 63% of patients (520) received pharmacological treatment. CONCLUSIONS CFS is an illness that preferentially affects young women and results in employment absenteeism. The most relevant clinical features were prolonged generalized fatigue after exercise, neurocognitive impairment and sleep disturbance. In the evaluation of the patient, it is very important to apply the Canadian criteria and to assess comorbidity.
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Affiliation(s)
- E Ruiz
- Servicio de Medicina Interna, Unidad de Urgencias, Hospital General Universitario Vall d'Hebron, Barcelona, España.
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Nacul LC, Lacerda EM, Campion P, Pheby D, Drachler MDL, Leite JC, Poland F, Howe A, Fayyaz S, Molokhia M. The functional status and well being of people with myalgic encephalomyelitis/chronic fatigue syndrome and their carers. BMC Public Health 2011; 11:402. [PMID: 21619607 PMCID: PMC3123211 DOI: 10.1186/1471-2458-11-402] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 05/27/2011] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome or ME/CFS is largely based on clinical history, and exclusion of identifiable causes of chronic fatigue. Characterization of cases and the impact of interventions have been limited due to clinical heterogeneity and a lack of reliable biomarkers for diagnosis and outcome measures. People with ME/CFS (PWME) often report high levels of disability, which are difficult to measure objectively. The well being of family members and those who care for PWME are also likely to be affected. This study aimed to investigate the functional status and well being of PWME and their lay carers, and to compare them with people with other chronic conditions. METHODS We used a cross sectional design to study 170 people aged between 18 and 64 years with well characterized ME/CFS, and 44 carers, using SF-36 v2™. Mean physical and mental domains scores (scales and component summaries) were calculated and compared internally and externally with reference standards for the general population and for population groups with 10 chronic diseases. RESULTS SF-36 scores in PWME were significantly reduced, especially within the physical domain (mean norm-based Physical Component Summary (PCS) score = 26.8), but also within the mental domain (mean norm-based score for Mental Component Summary (MCS) = 34.1). The lowest and highest scale scores were for "Role-Physical" (mean = 25.4) and "Mental Health" (mean = 36.7) respectively. All scores were in general lower than those for the general population and diseased-specific norms for other diseases. Carers of those with ME/CFS tended to have low scores in relation to population norms, particularly within the mental domain (mean = 45.4). CONCLUSIONS ME/CFS is disabling and has a greater impact on functional status and well being than other chronic diseases such as cancer. The emotional burden of ME/CFS is felt by lay carers as well as by people with ME/CFS. We suggest the use of generic instruments such as SF-36, in combination of other objective outcome measurements, to describe patients and assess treatments.
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Affiliation(s)
- Luis C Nacul
- Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
- Foundation for Genomics and Population Health (PHGF), Cambridge, CB1 8RN, UK
| | - Eliana M Lacerda
- Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Peter Campion
- Hull-York Medical School, University of Hull, Hull, HU6 7RX, UK
| | - Derek Pheby
- National ME Observatory Project Coordinator, and Buckinghamshire New University, Society and Health, Uxbridge Campus, 106, Oxford Road, Middlesex, UB8 1NA, UK
| | | | | | | | | | - Shagufta Fayyaz
- Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, London, WC1E 7HT, UK
| | - Mariam Molokhia
- Department of Primary Care & Public Health Sciences, Division of Health and Social Care Research. Kings College, London, SE1 3QD, UK
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Costigan A, Elliott C, McDonald C, Newton JL. Orthostatic symptoms predict functional capacity in chronic fatigue syndrome: implications for management. QJM 2010; 103:589-95. [PMID: 20534655 DOI: 10.1093/qjmed/hcq094] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To establish the relationship between the functional impairment experienced by Chronic fatigue syndrome (CFS) patients and the symptoms frequently experienced by those with CFS; specifically cognitive impairment, fatigue and orthostatic symptoms. DESIGN Cross sectional questionnaire survey. SETTING Specialist CFS Clinical Service. SUBJECTS Ninety-nine Fukuda diagnosed CFS and 64-matched controls. MAIN OUTCOME MEASURES Symptom and functional assessment tools completed and returned by post included; PROMIS HAQ (Patient-Reported Outcomes Measurement Information System, Health Assessment Questionnaire), CFQ (Cognitive Failures Questionnaire), FIS (Fatigue Impact Scale) and OGS (Orthostatic Grading Scale) assessment tools. RESULTS CFS patients experience greater functional impairment than controls [mean (95% CI) PROMIS HAQ scores CFS 36 (31-42) vs. controls 6 (2-10); P < 0.0001], especially in the functional domains of activities and reach. Poorer functional ability impairment is significantly associated with greater cognitive impairment (P = 0.0002, r = 0.4), fatigue (P < 0.0001, r = 0.5) and orthostatic symptoms (P < 0.0001, r = 0.6). However, only orthostatic symptoms (OGS) independently associated with functional impairment (beta = 0.4, P = 0.01). CONCLUSION Treatment of orthostatic symptoms in CFS has the potential to improve functional capacity and so improve quality of life.
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Affiliation(s)
- A Costigan
- NIHR Biomedical Research Centre in Ageing-Cardiovascular Theme, Newcastle University, Newcastle, UK
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Switzer WM, Jia H, Hohn O, Zheng H, Tang S, Shankar A, Bannert N, Simmons G, Hendry RM, Falkenberg VR, Reeves WC, Heneine W. Absence of evidence of xenotropic murine leukemia virus-related virus infection in persons with chronic fatigue syndrome and healthy controls in the United States. Retrovirology 2010; 7:57. [PMID: 20594299 PMCID: PMC2908559 DOI: 10.1186/1742-4690-7-57] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 07/01/2010] [Indexed: 11/30/2022] Open
Abstract
Background XMRV, a xenotropic murine leukemia virus (MuLV)-related virus, was recently identified by PCR testing in 67% of persons with chronic fatigue syndrome (CFS) and in 3.7% of healthy persons from the United States. To investigate the association of XMRV with CFS we tested blood specimens from 51 persons with CFS and 56 healthy persons from the US for evidence of XMRV infection by using serologic and molecular assays. Blinded PCR and serologic testing were performed at the US Centers for Disease Control and Prevention (CDC) and at two additional laboratories. Results Archived blood specimens were tested from persons with CFS defined by the 1994 international research case definition and matched healthy controls from Wichita, Kansas and metropolitan, urban, and rural Georgia populations. Serologic testing at CDC utilized a Western blot (WB) assay that showed excellent sensitivity to MuLV and XMRV polyclonal or monoclonal antibodies, and no reactivity on sera from 121 US blood donors or 26 HTLV-and HIV-infected sera. Plasma from 51 CFS cases and plasma from 53 controls were all WB negative. Additional blinded screening of the 51 cases and 53 controls at the Robert Koch Institute using an ELISA employing recombinant Gag and Env XMRV proteins identified weak seroreactivity in one CFS case and a healthy control, which was not confirmed by immunofluorescence. PCR testing at CDC employed a gag and a pol nested PCR assay with a detection threshold of 10 copies in 1 ug of human DNA. DNA specimens from 50 CFS patients and 56 controls and 41 US blood donors were all PCR-negative. Blinded testing by a second nested gag PCR assay at the Blood Systems Research Institute was also negative for DNA specimens from the 50 CFS cases and 56 controls. Conclusions We did not find any evidence of infection with XMRV in our U.S. study population of CFS patients or healthy controls by using multiple molecular and serologic assays. These data do not support an association of XMRV with CFS.
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Affiliation(s)
- William M Switzer
- Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Brimmer DJ, McCleary KK, Lupton TA, Faryna KM, Reeves WC. Continuing medical education challenges in chronic fatigue syndrome. BMC MEDICAL EDUCATION 2009; 9:70. [PMID: 19954535 PMCID: PMC2795739 DOI: 10.1186/1472-6920-9-70] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 12/02/2009] [Indexed: 05/28/2023]
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) affects at least 4 million people in the United States, yet only 16% of people with CFS have received a diagnosis or medical care for their illness. Educating health care professionals about the diagnosis and management of CFS may help to reduce population morbidity associated with CFS. METHODS This report presents findings over a 5-year period from May 2000 to June 2006 during which we developed and implemented a health care professional educational program. The objective of the program was to distribute CFS continuing education materials to providers at professional conferences, offer online continuing education credits in different formats (e.g., print, video, and online), and evaluate the number of accreditation certificates awarded. RESULTS We found that smaller conference size (OR = 80.17; 95% CI 8.80, 730.25), CFS illness related target audiences (OR = 36.0; 95% CI 2.94, 436.34), and conferences in which CFS research was highlighted (OR = 4.15; 95% CI 1.16, 14.83) significantly contributed to higher dissemination levels, as measured by visit rates to the education booth. While print and online courses were equally requested for continuing education credit opportunities, the online course resulted in 84% of the overall award certificates, compared to 14% for the print course. This remained consistent across all provider occupations: physicians, nurses, physician assistants, and allied health professionals. CONCLUSION These findings suggest that educational programs promoting materials at conferences may increase dissemination efforts by targeting audiences, examining conference characteristics, and promoting online continuing education forums.
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Affiliation(s)
- Dana J Brimmer
- Chronic Viral Diseases Branch, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | | | - Teresa A Lupton
- The CFIDS Association of America, Charlotte, NC 28222-0398, USA
| | | | - William C Reeves
- Chronic Viral Diseases Branch, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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McKay PG, Duffy T, Martin CR. Are chronic fatigue syndrome and fibromyalgia the same? Implications for the provision of appropriate mental health intervention. J Psychiatr Ment Health Nurs 2009; 16:884-94. [PMID: 19930362 DOI: 10.1111/j.1365-2850.2009.01464.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Chronic fatigue syndrome and fibromyalgia represent distinct diagnostic entities within both the clinical and research literature. A common feature of both presentations is that they are often accompanied by a significant mental health burden. A further salient feature of both conditions is that there is no consistent consensus on aetiology. Evaluation of the features of each disorder seems to present a convincing case that both disorders may indeed have a common aetiology and further, the possibility exists that chronic fatigue syndrome and fibromyalgia represent the same underlying disorder. Paradoxically, given this possibility it is remarkable that both patient groups are treated clinically with considerably different approaches to care and management. Mental health practitioners will come into contact with both groups of patients when support for the psychological consequences of diagnosis are necessary; however, many practitioners will be unaware of the debate regarding the aetiological ambiguities surrounding these presentations. The purpose of this review is to highlight the above issues in order to both facilitate awareness of the current aetiological/diagnostic impasse and facilitate provision of optimum mental health support.
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Affiliation(s)
- P G McKay
- School of Health, Nursing and Midwifery, University of West of Scotland, Ayr, UK
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Arruti Bustillo M, Avellaneda Fernández A, Barbado Hernández F, de la Cruz Labrado J, Díaz-Delgado Peñas R, Gutiérrez Rivas E, Izquierdo Martínez M, Palacín Delgado C, Pérez Martín Á, Ramón Giménez J, Rivera Redondo J. Síndrome de fatiga crónica. Semergen 2009. [DOI: 10.1016/s1138-3593(09)72676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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van't Leven M, Zielhuis GA, van der Meer JW, Verbeek AL, Bleijenberg G. Fatigue and chronic fatigue syndrome-like complaints in the general population. Eur J Public Health 2009; 20:251-7. [PMID: 19689970 DOI: 10.1093/eurpub/ckp113] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most knowledge on chronic fatigue (CF) and chronic fatigue syndrome (CFS) is based on clinical studies, not representative of the general population. This study aimed to assess the prevalence of fatigue in an adult general population and to identify associations with lifestyle factors. METHODS Total 22,500 residents of Nijmegen were selected at random and interviewed by questionnaire. Data on 9062 respondents (43% response) were analysed, taken into account age, gender and concomitant disease. Subjects were classified into four groups: not fatigued (NF, reference group), short-term fatigue (SF, <6 months), chronic fatigue (CF, >or=6 months) and CFS-like fatigue (in accordance with the Center for Disease Control criteria for CFS, without clinical confirmation). RESULTS Our study population showed the following breakdown: NF 64.4% (95% CI 63.6-65.6%), SF 4.9% (95% CI 4.5-5.4%), CF 30.5% (95% CI 29.5-31.4%) and CFS-like fatigue 1.0% (95% CI 0.8-1.2%). Compared with the NF group, more of the CFS respondents were female [odds ratio (OR) = 1.9], obese (OR = 4.1), using analgesics (OR = 7.8), had a low alcohol intake (OR = 0.4), were eating less healthy food (OR = 0.5) and were physically less active (OR = 0.1). These associations largely applied to the SF and CF group. The fatigue could have been due to a concomitant disease in 34 and 55.5% of the SF and CF cases, respectively. CONCLUSION The prevalence of CF in the general population appears to be much higher than previously indicated. Even with strict criteria for CFS, it is estimated that approximately 1% of the adult population experiences this condition. Interestingly, a large part of this group remains unrecognized by the general practitioner. A striking similarity in lifestyle pattern between SF, CF and CFS calls for further research.
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Affiliation(s)
- Marjolein van't Leven
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, the Netherlands
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27
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Raison CL, Lin JMS, Reeves WC. Association of peripheral inflammatory markers with chronic fatigue in a population-based sample. Brain Behav Immun 2009; 23:327-37. [PMID: 19111923 DOI: 10.1016/j.bbi.2008.11.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 11/25/2008] [Accepted: 11/26/2008] [Indexed: 12/19/2022] Open
Abstract
Alterations in the innate immune response may contribute to the pathogenesis of chronic fatigue syndrome (CFS). However, studies have been limited by small sample sizes, use of patients from tertiary care settings, inappropriate selection of controls, and failure to control for confounding demographic, medical and behavioral factors independently associated with immune activity. It is also not known whether specific symptoms account for observed associations between CFS and the innate immune response. To address these limitations, the current study examined plasma concentrations of high-sensitivity c-reactive protein (hs-CRP), white blood cell count (WBC) and a combined inflammation factor in a large population-based sample. Log-transformed mean plasma concentrations of hs-CRP were increased in subjects with CFS (n=102) and in subjects with unwellness symptoms that did not meet diagnostic criteria for CFS (defined as "insufficient fatigue" [ISF]) (n=240) when compared to subjects who were well (n=115). Log transformed WBC was increased in ISF and was increased at a trend level in CFS. The combined inflammation factor was increased in both CFS and ISF. Subjects with CFS and ISF did not differ on any of the inflammation measures. In the entire subject population, the physical component summary score (PCS), but not the mental component summary score (MCS), from the Medical Outcomes Study Short Form-36 (SF-36) was negatively associated with each of the inflammation measures. Depressive symptoms were also associated with increased log hs-CRP. After adjustment for age, sex, race, location of residence, BMI, depressive status and immune-modulating medications, subjects classified as ISF continued to demonstrate increased log hs-CRP, WBC and elevations on the inflammation factor when compared to well controls; however, associations between CFS and log hs-CRP and the inflammation factor were no longer statistically significant. After adjustment, PCS score also remained independently associated with each of the inflammation measures. These findings support a role for innate immune activation in unexplained fatigue and unwellness, but do not suggest that immune activation is specific to CFS.
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Affiliation(s)
- Charles L Raison
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365C Clifton Road, Room 5004, Atlanta, GA 30322, USA.
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Jason LA, Porter N, Brown M, Anderson V, Brown A, Hunnell J, Lerch A. CFS: A Review of Epidemiology and Natural History Studies. BULLETIN OF THE IACFS/ME 2009; 17:88-106. [PMID: 21243091 PMCID: PMC3021257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Almost all studies with samples of patients who have chronic fatigue syndrome (CFS) have relied on referrals from physicians or health facilities. Under-served minorities, who not only tend to manifest higher levels of chronic illness, but are also less likely to seek and receive adequate medical care, have not been represented in these studies (1). This may have contributed to an under-estimation of CFS among minority groups (2). Few studies have derived their samples from socioeconomically and ethnically diverse community-based populations. A technical report issued by the Agency for Healthcare Research and Quality (3) concluded that estimating rates of recovery/improvement or relapse from CFS are not possible because there are so few natural history studies and those that are available have involved selected referral populations. This paper provides a review of epidemiologic studies of CFS followed by a discussion of diagnostic issues and risk factors for the illness. Findings from Jason et al.'s (4) epidemiologic study in a multi-ethnic, economically diverse urban area are highlighted as this research group is now examining the natural course of CFS over the past 10 years with this community-based sample. The current study will add to current epidemiologic and risk factors research by assessing the course, progression, and risk factors of CFS among a demographically diverse sample of participants who are unbiased by illness, help-seeking behaviors, or differential access to the health care system.
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Nijrolder I, van der Windt DAWM, van der Horst HE. Prognosis of fatigue and functioning in primary care: a 1-year follow-up study. Ann Fam Med 2008; 6:519-27. [PMID: 19001304 PMCID: PMC2582478 DOI: 10.1370/afm.908] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Although fatigue is a common presenting symptom in primary care and its course and outcomes often remain unclear, cohort studies among patients seeking care for fatigue are scarce. We therefore aimed to investigate patterns in the course of fatigue and relevant secondary outcomes in a large cohort of patients who sought care for a main symptom of fatigue. METHODS We performed an observational cohort study in 147 primary care practices. Patients consulting their general practitioner for a new episode of fatigue were sent questionnaires at 1, 4, 8, and 12 months after baseline. We collected measures of fatigue, perceived health and functioning, absenteeism, psychological symptoms, and sleep using the Checklist Individual Strength, the 36-Item Short Form Health Survey, the Four-Dimensional Symptoms Questionnaire, and the Pittsburgh Sleep Questionnaire Inventory. Patients were classified into 4 subgroups based on fatigue severity scores over time. We assessed patterns in the course of all outcomes in these subgroups and in the total population, and tested changes over time and differences between subgroups. RESULTS A total of 642 patients were enrolled in the study. Response rates during follow-up ranged between 82% and 88%. For 75% of the patients, 4 distinct groups could be discerned: 26% of patients had continuously high scores for fatigue, 17% had a fast recovery, 25% had a slow recovery, and 32% initially improved but then had a recurrence of fatigue. Patterns for the secondary outcomes of symptoms and functioning were all similar to the pattern for fatigue within each of the subgroups. CONCLUSIONS The findings of this study suggest a longitudinal relationship between the severity of fatigue, impaired functioning, psychological symptoms, and poor sleep. Physicians should be aware that a substantial proportion of patients seeking care for fatigue have these additional health and psychosocial problems.
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Affiliation(s)
- Iris Nijrolder
- Department of General Practice, EMGO Institute, VU University Medical Centre, Amsterdam, The Netherlands.
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Brimmer DJ, McCleary KK, Lupton TA, Faryna KM, Hynes K, Reeves WC. A train-the-trainer education and promotion program: chronic fatigue syndrome--a diagnostic and management challenge. BMC MEDICAL EDUCATION 2008; 8:49. [PMID: 18922184 PMCID: PMC2576246 DOI: 10.1186/1472-6920-8-49] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 10/15/2008] [Indexed: 05/16/2023]
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is a complicated illness for providers and patients. Fewer than 20% of persons with CFS have been diagnosed and treated. For providers, compounding the issue are the challenges in making a diagnosis due to the lack of a biomedical marker. METHODS The objective of the CFS diagnosis and management curriculum was to instruct core trainers as to the evaluation, diagnosis, and management of CFS. Over a two year period, 79 primary care physicians, physician assistants, and nurse practitioners from diverse regions in the U.S. participated as core trainers in a two day Train-the-Trainer (TTT) workshop. As core trainers, the workshop participants were expected to show increases in knowledge, self-efficacy, and management skills with the primary goal of conducting secondary presentations. RESULTS The optimal goal for each core trainer to present secondary training to 50 persons in the health care field was not reached. However, the combined core trainer group successfully reached 2064 primary care providers. Eighty-two percent of core trainers responded "Very good" or "Excellent" in a post-tessurvey of self-efficacy expectation and CFS diagnosis. Data from the Chicago workshops showed significant improvement on the Primary Care Opinion Survey (p < 0.01) and on the Relevance and Responsibility Factors of the CAT survey (p = 0.03 and p = 0.04, respectively). Dallas workshop data show a significant change from pre- to post-test scores on the CFS Knowledge test (p = 0.001). Qualitative and process evaluation data revealed that target audience and administrative barriers impacted secondary training feasibility. CONCLUSION Data show the workshop was successful in meeting the objectives of increasing CFS knowledge and raising perceived self-efficacy towards making a diagnosis. The CFS TTT program informed an educational provider project by shifting the format for physicians to grand rounds and continuing medical education design while retaining TTT aspects for nurse practitioners and physicians assistants. Evaluations also indicate that secondary trainings may be more readily employed and accepted if administrative barriers are addressed early in the planning phases.
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Affiliation(s)
- Dana J Brimmer
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | | | - Kevin Hynes
- Illinois AHEC Program, Midwestern University, Downers Grove, IL, USA
| | - William C Reeves
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Dickson A, Knussen C, Flowers P. Stigma and the delegitimation experience: An interpretative phenomenological analysis of people living with chronic fatigue syndrome. Psychol Health 2007. [DOI: 10.1080/14768320600976224] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Friedberg F, Sohl S, Schmeizer B. Publication trends in chronic fatigue syndrome: comparisons with fibromyalgia and fatigue: 1995-2004. J Psychosom Res 2007; 63:143-6. [PMID: 17662750 DOI: 10.1016/j.jpsychores.2007.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In order to identify publishing patterns in chronic fatigue syndrome (CFS), we compared the annual number of peer review articles for CFS, fibromyalgia (FM), and non-CFS fatigue over a recent decade (1995-2004). METHOD Citations were drawn from Ovid/Medline, PsychInfo, and the Journal of Chronic Fatigue Syndrome for peer review articles focusing on CFS, FM, and fatigue for each year of the decade ending in 2004. Statistics included chi-square, tests for differences in proportions, and regression-based curve estimation. RESULTS The frequency of CFS peer review articles did not significantly change from the first half to the second half of the decade (1995-2004). By comparison, the output of both FM and fatigue articles significantly increased (P<.0001). A quadratic model (inverted U shape; P<.02) best fit the data for CFS annual publication frequency. By comparison, exponential models best fit the data for both FM (P<.0001) and fatigue (P<.0001) citations. The highest percentage of citations (15-16%) for both CFS and FM fell within the domains of diagnosis, physiopathology, and psychology. For fatigue, almost one third (31.4%) of the citations were focused on etiology, while psychology (11.5%) and physiopathology (10.4%) articles were the next most cited. Based on first-author affiliation, CFS articles were most likely to originate in the United States (37.7%), England (31.4%), and the Netherlands (4.9%). CONCLUSION The output of CFS peer review articles has not increased over the past decade, while the number of FM and fatigue articles has increased substantially.
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Affiliation(s)
- Fred Friedberg
- Department of Psychiatry and Behavioral Medicine, Stony Brook University, NY 11794-8790, USA.
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Abstract
Chronic fatigue syndrome (CFS) is an illness currently defined entirely by a combination of non-specific symptoms. Despite this subjective definition, CFS is associated with objective underlying biological abnormalities, particularly involving the nervous system and immune system. Most studies have found that active infection with human herpesvirus-6 (HHV-6)--a neurotropic, gliotropic and immunotropic virus--is present more often in patients with CFS than in healthy control and disease comparison subjects, yet it is not found in all patients at the time of testing. Moreover, HHV-6 has been associated with many of the neurological and immunological findings in patients with CFS. Finally, CFS, multiple sclerosis and seizure disorders share some clinical and laboratory features and, like CFS, the latter two disorders also are being associated increasingly with active HHV-6 infection. Therefore, it is plausible that active infection with HHV-6 may trigger and perpetuate CFS in a subset of patients.
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Affiliation(s)
- Anthony L Komaroff
- Division of General Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 10 Shattuck Street, Suite 602, Boston, MA 02115, USA.
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Fostel J, Boneva R, Lloyd A. Exploration of the gene expression correlates of chronic unexplained fatigue using factor analysis. Pharmacogenomics 2006; 7:441-54. [PMID: 16610954 DOI: 10.2217/14622416.7.3.441] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify biomarkers of chronic fatigue syndrome (CFS) and related disorders through analysis of microarray data, pathology test results and self-report symptom profiles. METHOD To empirically derive the symptom domains of the illnesses, factor analysis was performed on responses to self-report questionnaires (multidimensional fatigue inventory, Centers for Disease Control and Prevention (CDC) symptom inventory and Zung depression scale) before validation with independent datasets. Gene expression patterns that distinguished subjects across each factor dimension were then sought. RESULTS A four-factor solution was favored, featuring 'fatigue' and 'mood disturbance' factors. Scores on these factors correlated with measures of disability on the Short Form (SF)-36. A total of 57 genes that distinguished subjects along each factor dimension were identified, although the separation was significant only for subjects beyond the extreme (15th and 85th) percentiles of severity. Clustering of laboratory parameters with expression of these genes revealed associations with serum measurements of pH, electrolytes, glucose, urea, creatinine, and liver enzymes (aspartate amino transferase [AST] and alanine amino transferase [AST]); as well as hematocrit and white cell count. CONCLUSION CFS is a complex syndrome that cannot simply be associated with changes in individual laboratory tests or expression levels of individual genes. No clear association with gene expression and individual symptom domains was found. However, analysis of such multifacetted datasets is likely to be an important means to elucidate the pathogenesis of CFS.
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Affiliation(s)
- Jennifer Fostel
- National Center for Toxicogenomics, NIEHS MD F1-05, 111 Alexander Drive, PO Box 12233, Research Triangle Park, NC 27709-2233, USA.
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Vernon SD, Reeves WC. The challenge of integrating disparate high-content data: epidemiological, clinical and laboratory data collected during an in-hospital study of chronic fatigue syndrome. Pharmacogenomics 2006; 7:345-54. [PMID: 16610945 DOI: 10.2217/14622416.7.3.345] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic fatigue syndrome (CFS) is a debilitating illness characterized by multiple unexplained symptoms including fatigue, cognitive impairment and pain. People with CFS have no characteristic physical signs or diagnostic laboratory abnormalities, and the etiology and pathophysiology remain unknown. CFS represents a complex illness that includes alterations in homeostatic systems, involves multiple body systems and results from the combined action of many genes, environmental factors and risk-conferring behavior. In order to achieve understanding of complex illnesses, such as CFS, studies must collect relevant epidemiological, clinical and laboratory data and then integrate, analyze and interpret the information so as to obtain meaningful clinical and biological insight. This issue of Pharmacogenomics represents such an approach to CFS. Data was collected during a 2-day in-hospital study of persons with CFS, other medically and psychiatrically unexplained fatiguing illnesses and nonfatigued controls identified from the general population of Wichita, KS, USA. While in the hospital, the participants' psychiatric status, sleep characteristics and cognitive functioning was evaluated, and biological samples were collected to measure neuroendocrine status, autonomic nervous system function, systemic cytokines and peripheral blood gene expression. The data generated from these assessments was made available to a multidisciplinary group of 20 investigators from around the world who were challenged with revealing new insight and algorithms for integration of this complex, high-content data and, if possible, identifying molecular markers and elucidating pathophysiology of chronic fatigue. The group was divided into four teams with representation from the disciplines of medicine, mathematics, biology, engineering and computer science. The papers in this issue are the culmination of this 6-month challenge, and demonstrate that data integration and multidisciplinary collaboration can indeed yield novel approaches for handling large, complex datasets, and reveal new insight and relevance to a complex illness such as CFS.
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Affiliation(s)
- Suzanne D Vernon
- Centers for Disease Control and Prevention, National Center for Infectious Diseases, Atlanta, GA, USA.
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Vernon SD, Whistler T, Aslakson E, Rajeevan M, Reeves WC. Challenges for molecular profiling of chronic fatigue syndrome. Pharmacogenomics 2006; 7:211-8. [PMID: 16515400 DOI: 10.2217/14622416.7.2.211] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic fatigue syndrome (CFS) is prevalent, disabling and costly. Despite extensive literature describing the epidemiology and clinical aspects of CFS, it has been recalcitrant to diagnostic biomarker discovery and therapeutic intervention. This is due to the fact that CFS is a complex illness defined by self-reported symptoms and diagnosed by the exclusion of medical and psychiatric diseases that may explain the symptoms. Studies attempting to dissect the pathophysiology are challenging to design as CFS affects multiple body systems, making the choice of which system to study dependant on an investigators area of expertise. However, the peripheral blood appears to be facilitating the molecular profiling of several diseases, such as CFS, that involve bodywide perturbations that are mediated by the CNS. Successful molecular profiling of CFS will require the integration of genetic, genomic and proteomic data with environmental and behavioral data to define the heterogeneity in order to optimize intervention.
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Affiliation(s)
- Suzanne D Vernon
- Center for Infectious Diseases, Division of Viral and Rickettsial Diseases, National Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Abstract
During the past two decades, there has been heated debate about chronic fatigue syndrome (CFS) among researchers, practitioners, and patients. Few illnesses have been discussed so extensively. The existence of the disorder has been questioned, its underlying pathophysiology debated, and an effective treatment opposed; patients' organisations have participated in scientific discussions. In this review, we look back on several controversies over CFS with respect to its definition, diagnosis, pathophysiology, and treatment. We review issues of epidemiology and clinical manifestations, focusing on the scientific status of CFS. Modern neuroscience and genetics research offer interesting findings for new hypotheses on the aetiology and pathogenesis of the illness. We also discuss promising future issues, such as psychopathophysiology and mechanisms of improvement, and suggest multidisciplinary prospective studies of CFS and fatigue in the general population. These studies should pay particular attention to similarities to and differences from functional somatic syndromes and other fatiguing conditions.
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Affiliation(s)
- Judith B Prins
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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Reeves WC, Wagner D, Nisenbaum R, Jones JF, Gurbaxani B, Solomon L, Papanicolaou DA, Unger ER, Vernon SD, Heim C. Chronic fatigue syndrome--a clinically empirical approach to its definition and study. BMC Med 2005; 3:19. [PMID: 16356178 PMCID: PMC1334212 DOI: 10.1186/1741-7015-3-19] [Citation(s) in RCA: 183] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 12/15/2005] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The lack of standardized criteria for defining chronic fatigue syndrome (CFS) has constrained research. The objective of this study was to apply the 1994 CFS criteria by standardized reproducible criteria. METHODS This population-based case control study enrolled 227 adults identified from the population of Wichita with: (1) CFS (n = 58); (2) non-fatigued controls matched to CFS on sex, race, age and body mass index (n = 55); (3) persons with medically unexplained fatigue not CFS, which we term ISF (n = 59); (4) CFS accompanied by melancholic depression (n = 27); and (5) ISF plus melancholic depression (n = 28). Participants were admitted to a hospital for two days and underwent medical history and physical examination, the Diagnostic Interview Schedule, and laboratory testing to identify medical and psychiatric conditions exclusionary for CFS. Illness classification at the time of the clinical study utilized two algorithms: (1) the same criteria as in the surveillance study; (2) a standardized clinically empirical algorithm based on quantitative assessment of the major domains of CFS (impairment, fatigue, and accompanying symptoms). RESULTS One hundred and sixty-four participants had no exclusionary conditions at the time of this study. Clinically empirical classification identified 43 subjects as CFS, 57 as ISF, and 64 as not ill. There was minimal association between the empirical classification and classification by the surveillance criteria. Subjects empirically classified as CFS had significantly worse impairment (evaluated by the SF-36), more severe fatigue (documented by the multidimensional fatigue inventory), more frequent and severe accompanying symptoms than those with ISF, who in turn had significantly worse scores than the not ill; this was not true for classification by the surveillance algorithm. CONCLUSION The empirical definition includes all aspects of CFS specified in the 1994 case definition and identifies persons with CFS in a precise manner that can be readily reproduced by both investigators and clinicians.
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Affiliation(s)
- William C Reeves
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dieter Wagner
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rosane Nisenbaum
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- University of Toronto, Toronto, Canada
| | - James F Jones
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian Gurbaxani
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura Solomon
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Current Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dimitris A Papanicolaou
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Merck & Co., Inc., Rahway, NJ, USA
| | - Elizabeth R Unger
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Suzanne D Vernon
- Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christine Heim
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Jones JF, Kulkarni PS, Butera ST, Reeves WC. GB virus-C--a virus without a disease: we cannot give it chronic fatigue syndrome. BMC Infect Dis 2005; 5:78. [PMID: 16191201 PMCID: PMC1262718 DOI: 10.1186/1471-2334-5-78] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 09/28/2005] [Indexed: 11/24/2022] Open
Abstract
Background Chronic fatigue syndrome (CFS) is an illness in search of an infectious etiology. GB virus-C (GBV-C) virus is a flavivirus with cell tropism and host defense induction qualities compatible with a role in producing the syndrome. The GBV-C genome is detectable in 4% of the population and 12% of the population is seropositive. The present study evaluated the association between infection with GBV and CFS. Methods We used a commercial EIA to detect antibodies against the GBV-C E2 protein and a quantitative real-time RT-PCR assay to detect active GBV-C infection. Sera were from a case control study of CFS in Atlanta, Georgia. The Fisher's exact two-tailed test was used for statistical analysis. Results Two of 12 CFS patients and one of 21 controls were seropositive for prior GBV-C infection and one control had viral RNA detected, indicating active infection. The results are not statistically different. Conclusion We found no evidence that active or past infection with GBV is associated with CFS.
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Affiliation(s)
- James F Jones
- Viral Exanthems and Herpesvirus Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, mailstop A-15, Atlanta, Georgia, 30333, USA
| | - Prasad S Kulkarni
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, mailstop G-19, Atlanta, Georgia, 30333, USA
| | - Salvatore T Butera
- Laboratory Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd, mailstop G-19, Atlanta, Georgia, 30333, USA
| | - William C Reeves
- Viral Exanthems and Herpesvirus Branch, Division of Viral and Rickettsial Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, mailstop A-15, Atlanta, Georgia, 30333, USA
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Heim C, Bierl C, Nisenbaum R, Wagner D, Reeves WC. Regional prevalence of fatiguing illnesses in the United States before and after the terrorist attacks of September 11, 2001. Psychosom Med 2004; 66:672-8. [PMID: 15385690 DOI: 10.1097/01.psy.0000138116.12495.a2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stress or emotional traumas are considered risk factors for unexplained fatiguing illnesses. From July to December 2001, the Centers for Disease Control and Prevention conducted a multigeographical pilot study to test the feasibility of a survey to estimate the prevalence of fatiguing illnesses in the United States. We used data obtained during this survey to estimate the effect of the coincidentally occurring terrorist attacks of September 11, 2001, on the regional prevalence of fatiguing illnesses. METHODS Identified by random-digit dialing, 2,728 households in eight regional strata were interviewed, and 7,317 respondents were screened for severe fatigue of at least 1 month duration. Identified fatigued people of age 18 to 69 years (N = 440) and a sample of nonfatigued people of the same age range (N = 444) were interviewed in detail concerning fatigue, other symptoms, and medical and psychiatric histories. RESULTS Weighted prevalence estimates based on interviews performed after the attacks were significantly lower compared with estimates based on interviews performed before the attacks (prolonged fatigue: 5,450 vs. 1,530/100,000, p =.010; chronic fatigue: 18,510 vs. 10,070/100,000, p =.002; chronic fatigue syndrome-like illness: 2,510 vs. 960/100,000, p =.014). CONCLUSION Our findings suggest decreased regional prevalence of fatiguing illnesses in the aftermath of the terrorist attacks. The causes of this effect are unknown but might involve acute psychological and physiological adaptations that modify the perception or manifestation of fatigue. Future studies should be specifically designed to scrutinize the relationship between stress and fatiguing illnesses and the mediating mechanisms of such a relationship.
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Affiliation(s)
- Christine Heim
- Division of Viral and Rickettsial Diseases, Viral Exanthems and Herpesvirus Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Jones JF, Nisenbaum R, Reeves WC. Medication use by persons with chronic fatigue syndrome: results of a randomized telephone survey in Wichita, Kansas. Health Qual Life Outcomes 2003; 1:74. [PMID: 14651754 PMCID: PMC293479 DOI: 10.1186/1477-7525-1-74] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2003] [Accepted: 12/02/2003] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic fatigue syndrome (CFS) is characterized by profound fatigue, which substantially interferes with daily activities, and a characteristic symptom complex. Patients use a variety of prescribed and self-administered medications, vitamins, and supplements for relief of their symptoms. The objective of this study was to describe utilization of medications and supplements by persons with CFS and non-fatigued individuals representative of the general population of Wichita, Kansas. METHODS We used a random-digit dialing telephone survey to identify persons with CFS in the general population of Wichita, Kansas. Subjects who on the basis of telephone interview met the CFS case definition, and randomly selected non-fatigued controls, were invited for a clinic evaluation that included self-reported use of medications and supplements. Sex-adjusted odds ratios and 95% confidence interval were estimated to measure the association between CFS and use of various drug categories. RESULTS We clinically evaluated and classified 90 subjects as CFS during the study and also collected clinical data on 63 who never described fatigue. Subjects with CFS reported using 316 different drugs compared to 157 reported by non-fatigued controls. CFS subjects were more likely to use any drug category than controls (p = 0.0009). Pain relievers and vitamins/supplements were the two most common agents listed by both groups. In addition CFS persons were more likely to use pain relievers, hormones, antidepressants, benzodiazepines, gastro-intestinal, and central nervous system medications (Sex-adjusted odds ratios range = 2.97 - 12.78). CONCLUSION Although the reasons for increased use of these agents were not elucidated, the data indicated the CFS patients' need for symptom relief.
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Affiliation(s)
- James F Jones
- Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop A15, Atlanta, GA 30333
| | - Rosane Nisenbaum
- Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop A15, Atlanta, GA 30333
| | - William C Reeves
- Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop A15, Atlanta, GA 30333
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Bleijenberg G. Chronic fatigue and chronic fatigue syndrome in the general population. Health Qual Life Outcomes 2003; 1:52. [PMID: 14613570 PMCID: PMC269992 DOI: 10.1186/1477-7525-1-52] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2003] [Accepted: 10/06/2003] [Indexed: 11/10/2022] Open
Affiliation(s)
- Gijs Bleijenberg
- Expert Centre for Chronic Fatigue, University Medical Centre Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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