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Filippou K, Knappe F, Hatzigeorgiadis A, Morres ID, Tzormpatzakis E, Havas E, Pühse U, Theodorakis Y, Gerber M. Self-Reported Physical Activity and Mental Health Among Asylum Seekers in a Refugee Camp. J Phys Act Health 2024; 21:657-667. [PMID: 38621670 DOI: 10.1123/jpah.2023-0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 01/22/2024] [Accepted: 02/29/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Global forced displacement has been rising steeply since 2015 as a result of wars and human rights abuses. Forcibly displaced people are often exposed to physical and mental strain, which can cause traumatic experiences and poor mental health. Physical activity has been linked with better mental health, although such evidence is scarce among those populations. The purpose of the study was to examine the relationships of self-reported physical activity and fitness with mental health indices among people residing in a refugee camp in Greece as asylum seekers. METHODS Participants were 151 individuals (76 women, 75 men; mean age 28.90 y) displaced from their homes for an average of 32.03 months. Among them, 67% were from Afghanistan and countries from southwest Asia, and 33% from sub-Saharan African countries. Participants completed self-report measures assessing physical activity, fitness, symptoms of post-traumatic stress disorder, depression, anxiety, and well-being. RESULTS High prevalence of mental health disorder symptoms and poor well-being were identified, with women and Asians showing poorer mental health. Symptoms of post-traumatic stress disorder, depression, and anxiety were related to perceived fitness, but not to self-reported physical activity. Regression analysis showed that perceived fitness (β: 0.34; 95% CI, 0.43 to 1.52) and low-intensity physical activity (β: 0.24; 95% CI, 0.001 to 0.009) significantly positively predicted well-being, showing small to medium effect. CONCLUSIONS The findings provide useful insights regarding the link between physical activity and well-being; nevertheless, further research examining objectively measured physical activity is warranted to complement these data and further explore the associations between physical activity and mental health.
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Affiliation(s)
- Konstantinia Filippou
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Florian Knappe
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | | | - Ioannis D Morres
- Department of Nutrition and Dietetics, University of Thessaly, Trikala, Greece
| | | | - Elsa Havas
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Yannis Theodorakis
- Department of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Larisch R, Midgley JEM, Dietrich JW, Hoermann R. Effect of Radioiodine Treatment on Quality of Life in Patients with Subclinical Hyperthyroidism: A Prospective Controlled Study. Nuklearmedizin 2024; 63:176-187. [PMID: 38262472 DOI: 10.1055/a-2240-8087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Radioiodine treatment (RIT) has a high success rate in both the treatment of hyperthyroidism and improving the quality of life (QoL) of symptomatic patients. In asymptomatic patients with subclinical hyperthyroidism thyroid related QoL outcomes are less well known. METHODS Study aim was to evaluate thyroid-related QoL in patients with subclinical hyperthyroidism mostly due to toxic nodular goitre undergoing RIT, compared to a control group of euthyroid subjects. Study design was monocentric, prospective, controlled. Fifty control subjects were enrolled and 51 RIT patients. Most subjects were examined at least twice at an interval of 6 months, with visits immediately before and 6 months after treatment in the RIT group. QoL was estimated with the ThyPRO questionnaire, using its composite scale as primary outcome. Treatment effect was the mean adjusted difference (MAD) between groups over time, using repeated? measures mixed? effects models. RESULTS TSH concentrations were lower in the RIT group prior to treatment and recovered thereafter slightly above the level of the control group. Correspondingly, QoL improved significantly after 6 months from a worse level in the RIT group, compared to controls (MAD -10.3 [95% CI -14.9, -5.7], p<0.001). QoL improvements were strong for general items, but less pronounced for the hyperthyroid domain. Compared to controls, thyroid volume, thyroid functional capacity (SPINA-GT) and deiodinase activity (SPINA-GD) were significantly reduced in the RIT group. CONCLUSION Patients with subclinical hyperthyroidism improve both biochemically and in their QoL after RIT, compared to controls. QoL assessment should have a wider role in clinical practice to complement biochemical tests and help with treatment decisions.
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Affiliation(s)
- Rolf Larisch
- Clinic of Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - John E M Midgley
- North Lakes Clinical, Ilkley LS29 8PT, United Kingdom of Great Britain and Northern Ireland
| | - Johannes W Dietrich
- Medical Hospital I, Endocrinology and Diabetes Department, Ruhr University of Bochum, Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Bochum, Germany
| | - Rudolf Hoermann
- Clinic of Nuclear Medicine, Klinikum Lüdenscheid, Lüdenscheid, Germany
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3
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Gramont B, Goutte J, Féasson L, Millet G, Hupin D, Cathébras P. [Chronic fatigue: What investigations? And what for?]. Rev Med Interne 2023; 44:662-669. [PMID: 37248110 DOI: 10.1016/j.revmed.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
Chronic fatigue is a frequent complaint, expressed at all levels of the healthcare system. It is perceived as disabling in a high proportion of cases, and internists are frequently called upon to find "the" cause. The etiological diagnostic approach of an unexplained state of fatigue relies on the careful search for more specific clues by questioning and clinical examination. It is necessary to recognize the limited place of complementary examinations apart from the basic biological parameters. Simple rating scales can be useful in the etiological and differential diagnosis of fatigue. Chronic fatigue syndrome (CFS), in the current state of knowledge, cannot be considered as a specific pathological entity distinct from idiopathic chronic fatigue states, and does not have validated biomarkers. It is important to know that a state of chronic asthenia often results from several intricated etiological factors (biological, psychological and social), to be classified as predisposing, precipitating and perpetuating. The metabolic and cardiorespiratory exercise test has a major place in the assessment and management of fatigue, as a prerequisite for personalized retraining or adapted physical activity (APA), which are the treatments of choice for chronic fatigue.
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Affiliation(s)
- B Gramont
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France.
| | - J Goutte
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France
| | - L Féasson
- Service de physiologie clinique et de l'exercice, IRMIS, CHU de Saint-Étienne, université Jean-Monnet, Saint-Étienne, France
| | - G Millet
- STAPS, IRMIS, université Jean-Monnet, Saint-Étienne, France
| | - D Hupin
- Service de physiologie clinique et de l'exercice, IRMIS, CHU de Saint-Étienne, université Jean-Monnet, Saint-Étienne, France
| | - P Cathébras
- Service de médecine interne, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France
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Xu JB, Zheng QX, Jiang XM, Zhuo Q, Nian JX, Wang JT. Mediating effects of social support, mental health between stress overload, fatigue and turnover intention among operating theatre nurses. BMC Nurs 2023; 22:364. [PMID: 37803427 PMCID: PMC10559401 DOI: 10.1186/s12912-023-01518-z] [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: 05/18/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND The high rate of nurses turnover and nursing staff shortage have been an ongoing concern issue and a challenge for global health systems. To explore the turnover intention among operating theatre nurses, and to test the hypothetical model for estimating the effects of stress overload and fatigue between social support, mental health and turnover intention. DESIGN a multi-center and cross-sectional online survey. METHODS This study was conducted from October 2020 to March 2021 comprised 1060 operating theatre nurses from 76 Chinese hospitals. The descriptive analysis, independent sample t test and one-way analysis of variance and Spearman correlation analysis were used to explore the relationships among variables by the SPSS software, and stepwise multiple linear regression analysis was utilized to identify influencing factors of turnover intention and its dimensions among operating theatre nurses. A structural equation model was analyzed by the AMOS software. RESULTS Social support, mental health, stress overload and fatigue were important predictors of turnover intention among operating theatre nurses. Besides, stress overload positively affected fatigue, mental health and turnover intention; fatigue negatively affected social support, however, fatigue positively affected mental health; social support negatively affected mental health and turnover intention; mental health positively affected turnover intention. Moreover, social support, mental health mediated between stress overload, fatigue and turnover intention among operating theatre nurses. CONCLUSION Social support, mental health mediated between stress overload, fatigue and turnover intention among operating theatre nurses.
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Affiliation(s)
- Jia-Bin Xu
- Nursing Department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Street, Gulou District, Fuzhou City, Fujian Province, China
- Fujian Branch of Shanghai Children's Medical Center, Shanghai Jiaotong University school of Medicine, Fuzhou City, Fujian Province, China
- Fujian Children's Hospital, Fuzhou City, Fujian Province, China
| | - Qing-Xiang Zheng
- Nursing Department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Street, Gulou District, Fuzhou City, Fujian Province, China
- Fujian Obstetrics and Gynecology Hospital, Fuzhou City, Fujian Province, China
| | - Xiu-Min Jiang
- Nursing Department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Street, Gulou District, Fuzhou City, Fujian Province, China.
| | - Qing Zhuo
- Nursing Department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Street, Gulou District, Fuzhou City, Fujian Province, China
| | - Jin-Xia Nian
- Nursing Department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Street, Gulou District, Fuzhou City, Fujian Province, China
| | - Jie-Ting Wang
- Nursing Department, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No.18 Daoshan Street, Gulou District, Fuzhou City, Fujian Province, China
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Hennessey JV. Levothyroxine Monotherapy: What Works Better for the Individual With Hypothyroidism? Endocr Pract 2023; 29:572-580. [PMID: 37419564 DOI: 10.1016/j.eprac.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/16/2022] [Indexed: 07/09/2023]
Abstract
OBJECTIVE I explore objective data not supporting the addition of liothyronine (medication) (LT3) to levothyroxine (medication) (LT4) in patients with hypothyroidism. Accurate identification of patients with symptomatic (almost exclusively overt) hypothyroidism is important in evaluating clinical outcomes of therapies. Recent studies have documented that nearly a third of individuals who are offered thyroid hormone are euthyroid at the time of initiation. Additionally, others are clinically diagnosed without biochemical confirmation, so a sizable proportion of those started on LT4 are not hypothyroid. The assumption that nonhypothyroid symptoms will resolve with LT4 is problematic. The true underlying cause of these symptoms remains unidentified and untreated. METHODS In a narrative fashion I will review the positive predictive value of and correlation of symptoms consistent with hypothyroidism and confirmed hypothyroidism likely to favorably respond to thyroid hormone replacement. RESULTS Following a review of the reliability of thyroid-stimulating hormone (TSH) in predicting a euthyroid state, the correlation of circulating triiodothyronine (serum measurement) (T3) levels with symptoms and predictive value of T3 to forecast the outcome of adding LT3 to LT4 will be reviewed. The utility of striving for high, middle, or low TSH set points within the expected range to predict changes in clinical quality of life and the ability of blinded patients to sense subtle differences along this spectrum will be documented. In addition, the clinical impact of single nucleotide polymorphisms in the type 2 deiodinase gene will be reviewed. Finally, the overall satisfaction of selected patients with their thyroid hormone treatments will be outlined and preferences for T3-containing treatments from blinded studies will be summarized. CONCLUSION Basing thyroid hormone treatment decisions on patient symptoms likely results in missed diagnoses We should encourage primary care physicians to assess a differential diagnosis, exclude other diagnoses, and not assume a thyroid etiology when TSH is normal. Modifying treatment to a particular TSH target or adjusting based on a low T3 level does not seem to enhance patient outcomes. Finally, pending further trials of "symptomatic" participants, using sustained release LT3 to mimic normal physiology, and including monocarboxylate 10 transporter and Type 2 deiodinase polymorphisms and objective outcomes, I will continue to depend on therapy with LT4 monotherapy and seek alternative explanations for my patients' nonspecific symptoms.
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Affiliation(s)
- James V Hennessey
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.
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Wang S, Tang Q, Lv Y, Tao Y, Liu X, Zhang L, Liu G. The Temporal Relationship between Depressive Symptoms and Loneliness: The Moderating Role of Self-Compassion. Behav Sci (Basel) 2023; 13:472. [PMID: 37366723 DOI: 10.3390/bs13060472] [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: 05/11/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Loneliness and depression are significant mental health challenges among college students; however, the intricate relationship between these phenomena remains unclear, particularly in the context of self-compassion. In this comprehensive study, we employ a cross-lagged panel network (CLPN) analysis to investigate the symptom-level association between depression and loneliness while exploring the potential moderating influence of self-compassion. Our sample consisted of 2785 college students, who were categorized into high- and low-self-compassion groups based on scores from the Self-Compassion Scale. Depressive symptoms were assessed using the Patient Health Questionnaire-9, while the UCLA Loneliness Scale-8 measured loneliness expressions. Our findings indicate that self-compassion plays a crucial role in the relationship between depression and loneliness. Specifically, we observed distinctive patterns within the high and low-self-compassion groups. In the low-self-compassion group, "energy" emerged as the most influential symptom, whereas "motor function" exhibited the highest influence in the high-self-compassion group. Furthermore, among individuals with high self-compassion, the pathway from depression to loneliness was characterized by "guilt-being alone when desired," while the reverse path from loneliness to depression encompassed "left out-feeling sad" and "left out-anhedonia." Conversely, in the low-self-compassion group, depression and loneliness demonstrated a more intricate mutual triggering relationship, suggesting that self-compassion effectively moderates the association between these variables. This study provides valuable insights into the underlying mechanisms driving the interplay between depression and loneliness, shedding light on the pivotal role of self-compassion in this intricate dynamic.
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Affiliation(s)
- Shujian Wang
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China
| | - Qihui Tang
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China
| | - Yichao Lv
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China
| | - Yanqiang Tao
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China
| | - Xiangping Liu
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China
| | - Liang Zhang
- College Students' Mental Health Education Center, Northeast Agricultural University, Harbin 150030, China
| | - Gang Liu
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China
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Cudris-Torres L, Alpi SV, Barrios-Núñez Á, Gaviria Arrieta N, Mejía Gutiérrez J, Alvis Barranco L, Rios-Carlys G, Cuenca-Calderón SE, Bermúdez V, Hernández-Lalinde J, Riveira Zuleta CA, Bahamón MJ, Álvarez Herrera JS. Quality of life in the older adults: The protective role of self-efficacy in adequate coping in patients with chronic diseases. Front Psychol 2023; 14:1106563. [PMID: 37089743 PMCID: PMC10117781 DOI: 10.3389/fpsyg.2023.1106563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/13/2023] [Indexed: 04/09/2023] Open
Abstract
The purpose of the present study was to establish the association between self-efficacy, perception of disease, emotional regulation, and fatigue and the health-related quality of life in older adults living in the departments of Cesar and Atlántico in Colombia and who have been diagnosed with a chronic disease. The participants were 325 older adults of both sexes, with literacy and no presence of cognitive impairment in the Mini-Mental State Examination (MMSE); A non-probabilistic sampling was carried out. We used the MOS-SF-36 questionnaire, the Brief Illness Perception Questionnaire scale for measuring the perception of disease, the Stanford Patient Education Research Center’s Chronic Disease Self self-efficacy questionnaire for chronic patients, the Difficulties in Emotional Regulation Scale, and the Fatigue Severity Questionnaire as measurement instruments. The design was non-experimental cross-sectional with a correlational scope. The results indicate that self-efficacy, disease perception, emotional regulation and severity of fatigue are variables that could impact the physical function of quality of life, confirming that self-efficacy would work as a factor that decreases the probability that a participant score low on this dimension of quality of life. On the other hand, both the perception of the disease and the severity of fatigue were identified as factors that probably negatively influence quality of life.
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Affiliation(s)
- Lorena Cudris-Torres
- Programa de Psicología, Fundación Universitaria del Área Andina, Valledupar, Colombia
- *Correspondence: Lorena Cudris-Torres,
| | | | | | | | | | | | - Gerson Rios-Carlys
- Programa de Psicología, Universidad Popular del Cesar, Valledupar, Colombia
| | | | - Valmore Bermúdez
- Centro de Investigaciones en Ciencias de la Vida, Universidad Simón Bolívar, Barranquilla, Colombia
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White B, Renzi C, Barclay M, Lyratzopoulos G. Underlying cancer risk among patients with fatigue and other vague symptoms: a population-based cohort study in primary care. Br J Gen Pract 2023; 73:e75-e87. [PMID: 36702593 PMCID: PMC9888575 DOI: 10.3399/bjgp.2022.0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/17/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Presenting to primary care with fatigue is associated with slightly increased cancer risk, although it is unknown how this varies in the presence of other 'vague' symptoms. AIM To quantify cancer risk in patients with fatigue who present with other 'vague' symptoms in the absence of 'alarm' symptoms for cancer. DESIGN AND SETTING Cohort study of patients presenting in UK primary care with new-onset fatigue during 2007-2015, using Clinical Practice Research Datalink data linked to national cancer registration data. METHOD Patients presenting with fatigue without co-occurring alarm symptoms or anaemia were identified, who were further characterised as having co-occurrence of 19 other 'vague' potential cancer symptoms. Sex- and age-specific 9-month cancer risk for each fatigue-vague symptom cohort were calculated. RESULTS Of 285 382 patients presenting with new-onset fatigue, 84% (n = 239 846) did not have co-occurring alarm symptoms or anaemia. Of these, 38% (n = 90 828) presented with ≥1 of 19 vague symptoms for cancer. Cancer risk exceeded 3% in older males with fatigue combined with any of the vague symptoms studied. The age at which risk exceeded 3% was 59 years for fatigue-weight loss, 65 years for fatigue-abdominal pain, 67 years for fatigue-constipation, and 67 years for fatigue-other upper gastrointestinal symptoms. For females, risk exceeded 3% only in older patients with fatigue-weight loss (from 65 years), fatigue-abdominal pain (from 79 years), or fatigue-abdominal bloating (from 80 years). CONCLUSION In the absence of alarm symptoms or anaemia, fatigue combined with specific vague presenting symptoms, alongside patient age and sex, can guide clinical decisions about referral for suspected cancer.
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Affiliation(s)
- Becky White
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, UK
| | - Cristina Renzi
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, UK, and associate professor, Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy
| | - Matthew Barclay
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, UK
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Association of Anemia with Clinical Symptoms Commonly Attributed to Anemia-Analysis of Two Population-Based Cohorts. J Clin Med 2023; 12:jcm12030921. [PMID: 36769569 PMCID: PMC9918126 DOI: 10.3390/jcm12030921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/16/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Fatigue, dyspnea, and lack of energy and concentration are commonly interpreted as indicative of symptomatic anemia and may thus play a role in diagnostic and therapeutic decisions. OBJECTIVE To investigate the association between symptoms commonly attributed to anemia and the actual presence of anemia. METHODS Data from two independent cohorts of the Study of Health in Pomerania (SHIP) were analyzed. Interview data, laboratory data, and physical examination were individually linked with claims data from the Association of Statutory Health Insurance Physicians. A complete case analysis using logistic regression models was performed to evaluate the association of anemia with symptoms commonly attributed to anemia. The models were adjusted for confounders such as depression, medication, insomnia, and other medical conditions. RESULTS A total of 5979 participants (53% female, median age 55) were included in the analysis. Of those, 30% reported fatigue, 16% reported lack of energy, 16% reported lack of concentration, and 29% reported dyspnea and/or weakness. Anemia was prevalent in about 6% (379). The symptoms were more prevalent in participants with anemia. However, participants with anemia were older and had a poorer health status. There was no association in multivariate logistic regression models between the symptoms fatigue, lack of concentration, dyspnea, and/or weakness and anemia. Anemia was associated (OR: 1.45; 95% CI: 1.13-1.86) with lack of energy in the multivariate analysis. Other factors such as depression, insomnia, and medication were more strongly associated with the symptoms. CONCLUSION The clinical symptoms commonly attributed to anemia are unspecific and highly prevalent both in non-anemic and anemic persons. Even in the presence of anemia, other diagnoses should be considered as causes such as depression, heart failure, asthma, and COPD, which are more closely associated with the symptoms. Further diagnostic research is warranted to explore the association of symptoms in different subgroups and settings in order to help clinical decision making.
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Tokumasu K, Honda H, Sunada N, Sakurada Y, Matsuda Y, Yamamoto K, Nakano Y, Hasegawa T, Yamamoto Y, Otsuka Y, Hagiya H, Kataoka H, Ueda K, Otsuka F. Clinical Characteristics of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Diagnosed in Patients with Long COVID. Medicina (B Aires) 2022; 58:medicina58070850. [PMID: 35888568 PMCID: PMC9325226 DOI: 10.3390/medicina58070850] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives: COVID-19 can be serious not only in the acute phase but also after the acute phase and some patients develop ME/CFS. There have been few studies on patients with long COVID in whom ME/CFS was diagnosed by physicians based on standardized criteria after examinations and exclusion diagnosis and not based on only subjective symptoms. The purpose of this study was to elucidate the detailed characteristics of ME/CFS in patients with long COVID. Materials and Methods: A retrospective descriptive study was performed for patients who visited a COVID-19 aftercare clinic established in Okayama University Hospital during the period was from February 2021 to April 2022. Results: Clinical data were obtained from medical records for 281 patients, and 279 patients who met the definition of long COVID were included. The overall prevalence rate of ME/CFS diagnosed by three sets of ME/CFS criteria (Fukuda, Canadian and IOM criteria) was 16.8% (48.9% in male and 51.1% in females). The most frequent symptoms in ME/CFS patients were general fatigue and post-exertional malaise (89.4% of the patients), headache (34.0%), insomnia (23.4%), dysosmia (21.3%) and dysgeusia (19.1%). Dizziness, chest pain, insomnia and headache were characteristic symptoms related to ME/CFS. The male to female ratio in ME/CFS patients was equal in the present study, although ME/CFS was generally more common in women in previous studies. Given that patients with ME/CFS had more severe conditions in the acute phase of COVID-19, the severity of the acute infectious state might be involved in the pathophysiology of ME/CFS. Conclusions: The prevalence rate of ME/CFS and the characteristic sequelae in the long COVID condition were revealed in this study.
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Affiliation(s)
- Kazuki Tokumasu
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Hiroyuki Honda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Naruhiko Sunada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Yasue Sakurada
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Yui Matsuda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Koichiro Yamamoto
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Yasuhiro Nakano
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Toru Hasegawa
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Yukichika Yamamoto
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Hitomi Kataoka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
| | - Keigo Ueda
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
- Clinical & Educational Center for Kampo Medicine, Okayama University Hospital, Okayama 700-8558, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (K.T.); (H.H.); (N.S.); (Y.S.); (Y.M.); (K.Y.); (Y.N.); (T.H.); (Y.Y.); (Y.O.); (H.H.); (H.K.); (K.U.)
- Clinical & Educational Center for Kampo Medicine, Okayama University Hospital, Okayama 700-8558, Japan
- Correspondence: ; Tel.: +81-86-235-7342; Fax: +81-86-235-7345
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11
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White B, Rafiq M, Gonzalez-Izquierdo A, Hamilton W, Price S, Lyratzopoulos G. Risk of cancer following primary care presentation with fatigue: a population-based cohort study of a quarter of a million patients. Br J Cancer 2022; 126:1627-1636. [PMID: 35181753 PMCID: PMC9130200 DOI: 10.1038/s41416-022-01733-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The management of adults presenting with fatigue presents a diagnostic challenge, particularly regarding possible underlying cancer. METHODS Using electronic health records, we examined cancer risk in patients presenting to primary care with new-onset fatigue in England during 2007-2013, compared to general population estimates. We examined variation by age, sex, deprivation, and time following presentation. FINDINGS Of 250,606 patients presenting with fatigue, 12-month cancer risk exceeded 3% in men aged 65 and over and women aged 80 and over, and 6% in men aged 80 and over. Nearly half (47%) of cancers were diagnosed within 3 months from first fatigue presentation. Site-specific cancer risk was higher than the general population for most cancers studied, with greatest relative increases for leukaemia, pancreatic and brain cancers. CONCLUSIONS In older patients, new-onset fatigue is associated with cancer risk exceeding current thresholds for urgent specialist referral. Future research should consider how risk is modified by the presence or absence of other signs and symptoms. Excess cancer risk wanes rapidly after 3 months, which could inform the duration of a 'safety-netting' period. Fatigue presentation is not strongly predictive of any single cancer, although certain cancers are over-represented; this knowledge can help prioritise diagnostic strategies.
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Affiliation(s)
- Becky White
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, UK.
| | - Meena Rafiq
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, UK
| | - Arturo Gonzalez-Izquierdo
- Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
| | - Willie Hamilton
- University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Sarah Price
- University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, UK
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Allik A, Pilt K, Viigimäe M, Fridolin I, Jervan G. A Novel Physical Fatigue Assessment Method Utilizing Heart Rate Variability and Pulse Arrival Time towards Personalized Feedback with Wearable Sensors. SENSORS 2022; 22:s22041680. [PMID: 35214582 PMCID: PMC8924887 DOI: 10.3390/s22041680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/29/2022] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
This paper proposes a novel method for physical fatigue assessment that can be applied in wearable systems, by utilizing a set of real-time measurable cardiovascular parameters. Daylength measurements, including a morning test set, physical exercise during the day, and an afternoon test set were conducted on 16 healthy subjects (8 female and 8 male). To analyze cardiovascular parameters for physical fatigue assessment, electrocardiography, pulse wave and blood pressure were measured during the test sets. The fatigue assessment questionnaire score, reaction time, countermovement jump height and hand grip strength were also measured and used as reference parameters. This study demonstrates that (i) the compiled test battery can selectively assess the rested vs. physically-fatigued states; (ii) the obtained linear support-vector machine, trained using the heart rate variability based parameter (F-score 0.842, accuracy 0.813) and pulse arrival time based parameter (F-score 0.875, accuracy 0.875) shows a promising ability to classify between the physically mildly fatigued and significantly fatigued states. Despite the somewhat limited study group size, the results of the study are unique and provide a significant advancement on the existing physical fatigue assessment methods towards a personalized and continuous real-time fatigue monitoring system with wearable sensors.
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Affiliation(s)
- Ardo Allik
- Department of Health Technologies, Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia; (K.P.); (M.V.); (I.F.)
- Correspondence:
| | - Kristjan Pilt
- Department of Health Technologies, Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia; (K.P.); (M.V.); (I.F.)
| | - Moonika Viigimäe
- Department of Health Technologies, Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia; (K.P.); (M.V.); (I.F.)
| | - Ivo Fridolin
- Department of Health Technologies, Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia; (K.P.); (M.V.); (I.F.)
| | - Gert Jervan
- Department of Computer Systems, Tallinn University of Technology, Ehitajate tee 5, 19086 Tallinn, Estonia;
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13
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Putilina MV. [Asthenic disorders as a manifestation of chronic fatigue syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:125-130. [PMID: 34481448 DOI: 10.17116/jnevro2021121081125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article explains the changes in terminology and diagnostic criteria for asthenic disorders as manifestations of chronic fatigue syndrome CFS (myalgic encephalomyelitis). Chronic fatigue syndrome is defined as neuroimmune endocrine dysfunction with a purely clinical diagnosis. Probably, viral infections can play a leading role in the pathogenesis. Published diagnostic criteria reveal possible correlations between chronic fatigue syndrome and COVID-19 disease. A promising strategy for the therapy and rehabilitation of patients is the use of smart peptides, a representative of which is the drug cortexin.
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Affiliation(s)
- M V Putilina
- Pirogov Russian National Research Medical University, Moscow, Russia
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14
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Hooda R, Joshi V, Shah M. A comprehensive review of approaches to detect fatigue using machine learning techniques. Chronic Dis Transl Med 2021; 8:26-35. [PMID: 35620159 PMCID: PMC9128560 DOI: 10.1016/j.cdtm.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 07/21/2021] [Indexed: 11/21/2022] Open
Abstract
In the past decades, there have been numerous advancements in the field of technology. This has led to many scientific breakthroughs in the field of medical sciences. In this, rapidly transforming world we are having a difficult time and the problem of fatigue is becoming prevalent. So, this study aimed to understand what is fatigue, its repercussions, and techniques to detect it using machine learning (ML) approaches. This paper introduces, discusses methods and recent advancements in the field of fatigue detection. Further, we categorized the methods that can be used to detect fatigue into four diverse groups, that is, mathematical models, rule‐based implementation, ML, and deep learning. This study presents, compares, and contrasts various algorithms to find the most promising approach that can be used for the detection of fatigue. Finally, the paper discusses the possible areas for improvement.
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Affiliation(s)
- Rohit Hooda
- Gandhinagar Institute of Technology, Gujarat Technological UniversityGandhinagarGujaratIndia
| | - Vedant Joshi
- LJ Institute of Engineering and Technology, Gujarat Technological UniversityAhmedabadGujaratIndia
| | - Manan Shah
- Department of Chemical EngineeringSchool of Technology, Pandit Deendayal Energy UniversityGandhinagarGujaratIndia
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15
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Maisel P, Baum E, Donner-Banzhoff N. Fatigue as the Chief Complaint – Epidemiology, Causes, Diagnosis, and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:566-576. [PMID: 34196270 DOI: 10.3238/arztebl.m2021.0192] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 07/30/2020] [Accepted: 03/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fatigue is a main or secondary reason for 10-20% of all consultations with a primary care physician. METHODS This review is based on pertinent publications retrieved by a comprehensive, selective literature search on the epidemiology, etiology, and diagnostic evaluation of fatigue as a leading symptom of disease, as well as on the treatment of its common causes. Information was also included from the literature search we conducted for the German clinical practice guideline on fatigue that was issued by the German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, DEGAM). RESULTS Fatigue can be due to any of a broad spectrum of diseases, including decompensation of already known conditions. Sleep disorders and sleep-related disorders of breathing, depression (18.5%), and excessive psychosocial stress are the most common causes of persistent fatigue. Previously undiagnosed cancer is a rare cause, accounting for only 0.6% of cases (95% confidence interval [0.3; 1.3]). Anemia and other organic causes are rare as well (4.3% [2.7; 6.7]). Investigations beyond the history, physical examination, and simple laboratory tests are needed only in the presence of additional symptoms or findings. If the diagnosis remains unclear, watchful waiting and regularly scheduled follow-up help prevent an excessive focus on somatic causes, leading to overdiagnosis. Irrespective of specific causes, psychoeducative and psychotherapeutic approaches should be discussed with the patient, as well as an individually adapted exercise program. CONCLUSION The work-up of fatigue as a chief complaint should be guided by investigating common and/or potentially dangerous disorders. Since the latter are rare, an exclusively somatic focus should be avoided in order to prevent overdiagnosis.
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16
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Bergmann M, Haasenritter J, Beidatsch D, Schwarm S, Hörner K, Bösner S, Grevenrath P, Schmidt L, Viniol A, Donner-Banzhoff N, Becker A. Prevalence, aetiologies and prognosis of the symptom cough in primary care: a systematic review and meta-analysis. BMC FAMILY PRACTICE 2021; 22:151. [PMID: 34253179 PMCID: PMC8274469 DOI: 10.1186/s12875-021-01501-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022]
Abstract
Background Cough is a relevant reason for encounter in primary care. For evidence-based decision making, general practitioners need setting-specific knowledge about prevalences, pre-test probabilities, and prognosis. Accordingly, we performed a systematic review of symptom-evaluating studies evaluating cough as reason for encounter in primary care. Methods We conducted a search in MEDLINE and EMBASE. Eligibility criteria and methodological quality were assessed independently by two reviewers. We extracted data on prevalence, aetiologies and prognosis, and estimated the variation across studies. If justifiable in terms of heterogeneity, we performed a meta-analysis. Results We identified 21 eligible studies on prevalence, 12 on aetiology, and four on prognosis. Prevalence/incidence estimates were 3.8–4.2%/12.5% (Western primary care) and 10.3–13.8%/6.3–6.5% in Africa, Asia and South America. In Western countries the underlying diagnoses for acute cough or cough of all durations were respiratory tract infections (73–91.9%), influenza (6–15.2%), asthma (3.2–15%), laryngitis/tracheitis (3.6–9%), pneumonia (4.0–4.2%), COPD (0.5–3.3%), heart failure (0.3%), and suspected malignancy (0.2–1.8%). Median time for recovery was 9 to 11 days. Complete recovery was reported by 40.2- 67% of patients after two weeks, and by 79% after four weeks. About 21.1–35% of patients re-consulted; 0–1.3% of acute cough patients were hospitalized, none died. Evidence is missing concerning subacute and chronic cough. Conclusion Prevalences and incidences of cough are high and show regional variation. Acute cough, mainly caused by respiratory tract infections, is usually self-limiting (supporting a “wait-and-see” strategy). We have no setting-specific evidence to support current guideline recommendations concerning subacute or chronic cough in Western primary care. Our study presents epidemiological data under non non-pandemic conditions. It will be interesting to compare these data to future research results of the post-pandemic era. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01501-0.
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Affiliation(s)
- Milena Bergmann
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany.
| | - Jörg Haasenritter
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Dominik Beidatsch
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Sonja Schwarm
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Kaja Hörner
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Stefan Bösner
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Paula Grevenrath
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Laura Schmidt
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Annika Viniol
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Annette Becker
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
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17
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Bergmann M, Haasenritter J, Beidatsch D, Schwarm S, Hörner K, Bösner S, Grevenrath P, Schmidt L, Viniol A, Donner-Banzhoff N, Becker A. Coughing children in family practice and primary care: a systematic review of prevalence, aetiology and prognosis. BMC Pediatr 2021; 21:260. [PMID: 34088294 PMCID: PMC8176681 DOI: 10.1186/s12887-021-02739-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND For evidence-based decision making, primary care physicians need to have specific and reliable information on the pre-test probabilities of underlying diseases and a symptom's course. We performed a systematic review of symptom-evaluating studies in primary care, following three research questions: (1) What is the prevalence of the symptom cough in children consulting primary care physicians? (2) What are the underlying aetiologies of cough and the respective frequencies? (3) What is the prognosis of children with cough? METHODS Following a pre-defined algorithm and independent double reviewer ratings we searched MEDLINE and EMBASE. All quantitative original research articles in English, French or German were included if they focused on unselected study populations of children consulting a primary care physician for cough. We used the random effects model for meta-analysis in subgroups, if justifiable in terms of heterogeneity. RESULTS We identified 14 eligible studies on prevalence, five on aetiology and one on prognosis. Prevalence estimates varied between 4.7 and 23.3% of all reasons for an encounter, or up to estimates of 60% when related to patients or consultations. Cough in children is more frequent than in adults, with lowest prevalences in adolescents and in summer. Acute cough is mostly caused by upper respiratory tract infections (62.4%) and bronchitis (33.3%); subacute or chronic cough by recurrent respiratory tract infection (27.7%), asthma (up to 50.4% in cough persisting more than 3 weeks), and pertussis (37.2%). Potentially serious diseases like croup, pneumonia or tuberculosis are scarce. In children with subacute and chronic cough the total duration of cough ranged from 24 to 192 days. About 62.3% of children suffering from prolonged cough are still coughing two months after the beginning of symptoms. CONCLUSION Cough is one of the most frequent reasons for an encounter in primary care. Our findings fit in with current guideline recommendations supporting a thoughtful wait-and-see approach in acute cough and a special awareness in chronic cough of the possibility of asthma and pertussis. Further evidence of aetiological pre-test probabilities is needed to assess the diagnostic gain based on patient history and clinical signs for differential diagnoses of cough in children.
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Affiliation(s)
- Milena Bergmann
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Jörg Haasenritter
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Dominik Beidatsch
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Sonja Schwarm
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Kaja Hörner
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Stefan Bösner
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Paula Grevenrath
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Laura Schmidt
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Annika Viniol
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Annette Becker
- Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany.
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Abstract
Owing to the broad differential diagnoses that can present as fatigue, a rational approach to diagnosis is paramount. Performance of a battery of diagnostic tests is unlikely to assist with diagnosis, highlighting the importance of a thorough history and physical examination. Fatigue can be a sequela of an underlying medical disease or exists as a primary condition. Management of secondary fatigue largely depends on treatment of the underlying condition. There are no FDA-approved medications for primary fatigue, now known as system exertion intolerance disease. Treatment is focused on individualized exercise therapy and cognitive behavioral therapy.
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Affiliation(s)
- Jason C Dukes
- Internal Medicine Department, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 565, Norfolk, VA 23507, USA.
| | - Matthew Chakan
- Internal Medicine Department, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 481, Norfolk, VA 23507, USA
| | - Aaron Mills
- Internal Medicine Department, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 483, Norfolk, VA 23507, USA
| | - Maurice Marcaurd
- Internal Medicine Department, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 572, Norfolk, VA 23507, USA
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A Literature Review of GP Knowledge and Understanding of ME/CFS: A Report from the Socioeconomic Working Group of the European Network on ME/CFS (EUROMENE). ACTA ACUST UNITED AC 2020; 57:medicina57010007. [PMID: 33374291 PMCID: PMC7823627 DOI: 10.3390/medicina57010007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 01/02/2023]
Abstract
Background and Objectives: The socioeconomic working group of the European myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs’ knowledge and understanding of ME/CFS; Materials and Methods: A MEDLINE search was carried out. The papers identified were reviewed following the synthesis without meta-analysis (SWiM) methodology, and were classified according to the focus of the enquiry (patients, GPs, database and medical record studies, evaluation of a training programme, and overview papers), and whether they were quantitative or qualitative in nature; Results: Thirty-three papers were identified in the MEDLINE search. The quantitative surveys of GPs demonstrated that a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it. It should be noted, though, that these papers were mostly from the United Kingdom. Patient surveys indicated that a similar proportion of patients was dissatisfied with the primary medical care they had received. These findings were consistent with the findings of the qualitative studies that were examined, and have changed little over several decades; Conclusions: Disbelief and lack of knowledge and understanding of ME/CFS among GPs is widespread, and the resultant diagnostic delays constitute a risk factor for severe and prolonged disease. Failure to diagnose ME/CFS renders problematic attempts to determine its prevalence, and hence its economic impact.
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20
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Gupta R, Kundu K, Khayyam K, Saini LK. Not what it seems to be: Depression versus periodic limb movement disorder. Indian J Psychiatry 2020; 62:437-439. [PMID: 33165358 PMCID: PMC7597704 DOI: 10.4103/psychiatry.indianjpsychiatry_450_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/23/2019] [Accepted: 04/06/2020] [Indexed: 11/04/2022] Open
Abstract
Sleep disorders often disturb sleep. Daytime symptoms of disturb sleep mimic that of depression, somatoform disorder, fibromyalgia and chronic fatigue syndrome. We are presenting a case of depression who was not responding to antidepressant therapy. Based on clinical history, diagnosis was changed to chronic fatigue syndrome and in view of prominent sleep disturbances, polysomnography was done. Based on sleep study data, diagnosis of periodic limb movement disorder was made and he was started on ropinirole, that improved his symptoms.
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Affiliation(s)
- Ravi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kaustuv Kundu
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Khwaja Khayyam
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Lokesh Kumar Saini
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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22
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Sandler CX, Lloyd AR. Chronic fatigue syndrome: progress and possibilities. Med J Aust 2020; 212:428-433. [DOI: 10.5694/mja2.50553] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Carolina X Sandler
- UNSW Fatigue ClinicUNSW Sydney NSW
- Queensland University of Technology Brisbane QLD
| | - Andrew R Lloyd
- Kirby Institute for Infection and Immunity in SocietyUNSW Sydney NSW
- UNSW Medicine Sydney NSW
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Simon J, Takács E, Orosz G, Berki B, Winkler I. Short-term cognitive fatigue effect on auditory temporal order judgments. Exp Brain Res 2020; 238:305-319. [PMID: 31900505 PMCID: PMC7007914 DOI: 10.1007/s00221-019-05712-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/12/2019] [Indexed: 12/30/2022]
Abstract
Fatigue is a core symptom in many psychological disorders and it can strongly influence everyday productivity. As fatigue effects have been typically demonstrated after long hours of time on task, it was surprising that in a previous study, we accidentally found a decline of temporal order judgment (TOJ) performance within 5–8 min. After replicating prior relevant findings we tested whether pauses and/or feedback relating the participant’s performance to some “standard” can eliminate or reduce this short-term performance decline. We also assessed whether the performance decline is specific to the processes evoked by the TOJ task or it is a product of either general inattentiveness or the lack of willingness to thoroughly follow the task instructions. We found that both feedback and introducing pauses between successive measurements can largely reduce the performance decline, and that these two manipulations likely mobilize overlapping capacities. Performance decline was not present in a similar task when controlling for the TOJ threshold and it was not a result of uncooperative behavior. Therefore, we conclude that the TOJ threshold decline is either specific to temporal processing in general or to the TOJ task employed in the study. Overall, the results are compatible with the notion that the decline of TOJ threshold with repeated measures represents a short-term cognitive fatigue effect. This objective fatigue measure did not correlate with subjective fatigue. The latter was rather related to perceived difficulty/effort, the reduction of positive affectivity, heightened sensitivity to criticism, and the best TOJ threshold.
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Affiliation(s)
- Júlia Simon
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary. .,Department of Cognitive Science, Faculty of Natural Sciences, Budapest University of Technology and Economics, Budapest, Hungary. .,Faculty of Humanities and Social Sciences, Pázmány Péter Catholic University, Budapest, Hungary.
| | - Endre Takács
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary.,Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.,Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Gábor Orosz
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Borbála Berki
- Department of Cognitive Science, Faculty of Natural Sciences, Budapest University of Technology and Economics, Budapest, Hungary.,Multidisciplinary Doctoral School of Engineering Sciences, Széchenyi István University, Győr, Hungary
| | - István Winkler
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Magyar Tudósok Körútja 2, Budapest, 1117, Hungary
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Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options. Drugs Context 2019; 8:212597. [PMID: 31516533 PMCID: PMC6726361 DOI: 10.7573/dic.212597] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022] Open
Abstract
Levothyroxine (LT4) therapy has a long history, a well-defined pharmacological profile and a favourable safety record in the alleviation of hypothyroidism. However, questions remain in defining the threshold for the requirement of treatment in patients with subclinical hypothyroidism, assessing the dose adequacy of the drug, and selecting the best treatment mode (LT4 monotherapy versus liothyronine [LT3]/LT4 combinations) for subpopulations with persisting complaints. Supplied as a prodrug, LT4 is enzymatically converted into the biologically more active thyroid hormone, triiodothyronine (T3). Importantly, tetraiodothyronine (T4) to T3 conversion efficiency may be impaired in patients receiving LT4, resulting in a loss of thyroid-stimulating hormone (TSH)-mediated feed-forward control of T3, alteration of the interlocking equilibria between serum concentrations of TSH, free thyroxine (FT4), and free triiodothyonine (FT3), and a decrease in FT3 to FT4 ratios. This downgrades the value of the TSH reference system derived in thyroid health for guiding the replacement dose in the treatment situation. Individualised conditionally defined setpoints may therefore provide appropriate biochemical targets to be clinically tested, together with a stronger focus on clinical presentation and future endpoint markers of tissue thyroid state. This cautionary note encompasses the use of aggregated statistical data from clinical trials which are not safely applicable to the individual level of patient care under these circumstances.
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Affiliation(s)
- Rudolf Hoermann
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
| | - Johannes W Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Buerkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.,Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, Germany
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Martinez-Martin P, Wetmore JB, Arbelo JM, Catalán MJ, Valldeoriola F, Rodriguez-Blazquez C. Validation study of the Parkinson's Fatigue Scale in advanced Parkinson's disease. PATIENT-RELATED OUTCOME MEASURES 2019; 10:141-152. [PMID: 31114412 PMCID: PMC6497829 DOI: 10.2147/prom.s196042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/12/2019] [Indexed: 11/29/2022]
Abstract
Purpose: To validate the Parkinson’s Fatigue Scale (PFS-16) in advanced Parkinson Disease (APD) patients using the scale’s Spanish version. Patients and methods: In a clinical study for Levodopa-Carbidopa Intestinal Gel (LCIG), 59 patients were assessed over six months using the PFS-16 and other instruments. The psychometric properties of the PFS-16 were then analyzed. Results: Patients (60.7% men) were aged 68.02±7.43 years. PD duration was 12.57±5.97 years. Median Hoehn and Yahr (HY) stage of patients in “on” was 2 (range: 1–4). There were excellent data quality and acceptability for the PFS-16 as a whole, except for moderate-to-high ceiling effects in its items. Two factors explained 67% of the variance, yet parallel analysis demonstrated the unidimensional nature of the PFS-16, whose internal consistency was satisfactory (Cronbach’s alpha=0.93; item homogeneity coefficient=0.19, and item total-corrected correlations=0.50–0.84). PFS-16 total score showed moderate-to-high correlations with fatigue-specific questions within clinical tools, namely item 20 of the Beck Depression Inventory (rS=0.65) and item 4 of the Non-Motor Symptoms Scale (rS=0.33). Weak-to-moderate correlations were observed between the PFS-16 and measures of anxiety, depression, apathy, and quality of life. There were no significant differences in PFS-16 total scores when grouped by age, sex, time from diagnosis, HY, and CGI-S. After treatment with LCIG, the relative change in PFS-16 total score was −17.6% and the effect size (Cohen’s d) was 0.92. Moderate correlations between changes in the PFS-16 and several other clinical tools were also found. Conclusion: In APD patients, the PFS-16 showed satisfactory acceptability, internal consistency, construct validity, and responsiveness.
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Affiliation(s)
- Pablo Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - John B Wetmore
- National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - José Matías Arbelo
- Movement Disorders Unit, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Carmen Rodriguez-Blazquez
- National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
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Midgley JEM, Toft AD, Larisch R, Dietrich JW, Hoermann R. Time for a reassessment of the treatment of hypothyroidism. BMC Endocr Disord 2019; 19:37. [PMID: 30999905 PMCID: PMC6471951 DOI: 10.1186/s12902-019-0365-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 04/04/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In the treatment for hypothyroidism, a historically symptom-orientated approach has given way to reliance on a single biochemical parameter, thyroid stimulating hormone (TSH). MAIN BODY The historical developments and motivation leading to that decision and its potential implications are explored from pathophysiological, clinical and statistical viewpoints. An increasing frequency of hypothyroid-like complaints is noted in patients in the wake of this directional shift, together with relaxation of treatment targets. Recent prospective and retrospective studies suggested a changing pattern in patient complaints associated with recent guideline-led low-dose policies. A resulting dramatic rise has ensued in patients, expressing in various ways dissatisfaction with the standard treatment. Contributing factors may include raised problem awareness, overlap of thyroid-related complaints with numerous non-specific symptoms, and apparent deficiencies in the diagnostic process itself. Assuming that maintaining TSH anywhere within its broad reference limits may achieve a satisfactory outcome is challenged. The interrelationship between TSH, free thyroxine (FT4) and free triiodothyronine (FT3) is patient specific and highly individual. Population-based statistical analysis is therefore subject to amalgamation problems (Simpson's paradox, collider stratification bias). This invalidates group-averaged and range-bound approaches, rather demanding a subject-related statistical approach. Randomised clinical trial (RCT) outcomes may be equally distorted by intra-class clustering. Analytical distinction between an averaged versus typical outcome becomes clinically relevant, because doctors and patients are more interested in the latter. It follows that population-based diagnostic cut-offs for TSH may not be an appropriate treatment target. Studies relating TSH and thyroid hormone concentrations to adverse effects such as osteoporosis and atrial fibrillation invite similar caveats, as measuring TSH within the euthyroid range cannot substitute for FT4 and FT3 concentrations in the risk assessment. Direct markers of thyroid tissue effects and thyroid-specific quality of life instruments are required, but need methodological improvement. CONCLUSION It appears that we are witnessing a consequential historic shift in the treatment of thyroid disease, driven by over-reliance on a single laboratory parameter TSH. The focus on biochemistry rather than patient symptom relief should be re-assessed. A joint consideration together with a more personalized approach may be required to address the recent surge in patient complaint rates.
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Affiliation(s)
| | | | - Rolf Larisch
- Department for Nuclear Medicine, Klinikum Lüdenscheid, Paulmannshöherstr. 14, 58515 Lüdenscheid, Germany
| | - Johannes W. Dietrich
- Medical Department I, Endocrinology and Diabetology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Buerkle-de-la-Camp-Platz 1, D-44789 Bochum, Germany
- Ruhr Center for Rare Diseases (CeSER), Ruhr University of Bochum and Witten/Herdecke University, Alexandrinenstr. 5, D-44791 Bochum, Germany
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Horne CE, Johnson S, Crane PB. Comparing comorbidity measures and fatigue post myocardial infarction. Appl Nurs Res 2019; 45:1-5. [PMID: 30683244 DOI: 10.1016/j.apnr.2018.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/15/2018] [Accepted: 11/05/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE/AIMS The purpose of this study was to examine comorbidity measures that may relate to the symptom of fatigue post MI: self-reported comorbidities, medication-validated comorbidities, weighted comorbidities for fatigue, and number of comorbidities. DESIGN Using a cross sectional design, we interviewed a convenience sample of 98 adults, 65 and older, who were 6 to 8 months post myocardial infarction. METHODS Participants self-reported their comorbidities using a list of 23 comorbid conditions. All medications were visually inspected, and medications were reviewed by a geriatric pharmacist for a common side effect of fatigue. The Revised Piper Fatigue Scale was used to measure fatigue. RESULTS The mean age of the participants was 76 (SD = 6.3), and most of the sample were White (84%). Neither medication-validated comorbidities nor those medications with fatigue as a common side effect explained fatigue. When controlling for age, sex, and marital status, self-reported comorbidities explained 10% of the variance in fatigue (F (4, 93) = 2.65; p = 0.04). Having 5 or more self-reported comorbidities explained 7% of variance in fatigue scores (F (1, 96) = 7.53; p = 0.007). CONCLUSION Comorbidities are associated with fatigue post MI. Adults post MI with 5 or more comorbidities should be screened for fatigue.
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Affiliation(s)
- Carolyn E Horne
- College of Nursing, East Carolina University, Greenville, NC 27858, United States of America.
| | - Sharona Johnson
- Vidant Health, Greenville, NC 27858, United States of America.
| | - Patricia B Crane
- College of Nursing, East Carolina University, Greenville, NC 27858, United States of America.
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Affiliation(s)
- Harm van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
| | - Wesley Scott-Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton, UK
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Hughes A, Kumari M. Age modification of the relationship between C-reactive protein and fatigue: findings from Understanding Society (UKHLS). Psychol Med 2018; 48:1341-1349. [PMID: 28994356 PMCID: PMC6088542 DOI: 10.1017/s0033291717002872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/05/2017] [Accepted: 09/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Systemic inflammation may play a role in the development of idiopathic fatigue, that is, fatigue not explained by infections or diagnosed chronic illness, but this relationship has never been investigated in community studies including the entire adult age span. We examine the association of the inflammatory marker C-reactive protein (CRP) and fatigue assessed annually in a 3-year outcome period for UK adults aged 16-98. METHODS Multilevel models were used to track fatigue 7, 19, and 31 months after CRP measurement, in 10 606 UK individuals. Models accounted for baseline fatigue, demographics, health conditions diagnosed at baseline and during follow-up, adiposity, and psychological distress. Sensitivity analyses considered factors including smoking, sub-clinical disease (blood pressure, anaemia, glycated haemoglobin), medications, ethnicity, and alcohol consumption. RESULTS Fatigue and CRP increased with age, and women had higher values than men. CRP was associated with future self-reported fatigue, but only for the oldest participants. Thus, in those aged 61-98 years, high CRP (>3 mg/L) independently predicted greater fatigue 7, 19, and 31 months after CRP measurement [odds ratio for new-onset fatigue after 7 months: 1.88, 95% confidence interval (CI) 1.21-2.92; 19 months: 2.25, CI 1.46-3.49; 31 months: 1.65, CI 1.07-2.54]. No significant longitudinal associations were seen for younger participants. CONCLUSIONS Our findings support previously described CRP-fatigue associations in older individuals. However, there are clear age modifications in these associations, which may reflect a contribution of unmeasured sub-clinical disease of limited relevance to younger individuals. Further work is necessary to clarify intervening processes linking CRP and fatigue in older individuals.
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Affiliation(s)
- A. Hughes
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, UK
| | - M. Kumari
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, UK
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Hensley CP, Emerson AJ. Non-Small Cell Lung Carcinoma: Clinical Reasoning in the Management of a Patient Referred to Physical Therapy for Costochondritis. Phys Ther 2018; 98:503-509. [PMID: 29361051 DOI: 10.1093/ptj/pzy011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 01/17/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE Chest pain, a frequent complaint for seeking medical care, is often attributed to musculoskeletal pathology. Costochondritis is a common disorder presenting as chest pain. Initial physical therapist examination emphasizes red flag screening. Reexamination throughout the episode of care is critical, particularly when patients are not progressing and/or in the presence of complex pain presentations. The purpose of this case report is to describe the clinical reasoning process in the management of a patient referred to physical therapy with a medical diagnosis of costochondritis. CASE DESCRIPTION A 59-year-old woman presented with a 5-month history of left-sided chest pain that had progressed to include the cervical and shoulder regions. She reported multiple psychosocial stressors; a depression screen was positive. She reported a history of asthma and smoking and improvement in recent fatigue, coughing, dyspnea, and sweating. At the initial visit, shoulder, cervical, and thoracic active and passive range of motion and joint mobility testing reproduced her pain. Allodynia was present throughout the painful areas in the left upper quarter. OUTCOMES The patient demonstrated improvement over 30 days (4 visits). On her fifth visit (day 35), she reported an exacerbation of her chest and upper extremity pain and noted increased fatigue, sweating, dyspnea, and loss of appetite. Even though her pain was again reproduced with musculoskeletal testing, the physical therapist contacted the patient's physician regarding the change in presentation. A subsequent chest computed tomography scan revealed a non-small cell lung adenocarcinoma. DISCUSSION Cancer can masquerade as a musculoskeletal condition. This case highlights the importance of screening, clinical reasoning, and communication throughout the episode of care, particularly in the presence of chronic pain and psychosocial stressors.
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Affiliation(s)
- Craig P Hensley
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Ste 1100, Chicago, IL 60611 (USA)
| | - Alicia J Emerson
- Department of Physical Therapy, High Point University, High Point, North Carolina
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Zabar S. Using Unannounced Standardized Patients to Explore Variation in Care for Patients With Depression. J Grad Med Educ 2018; 10:285-291. [PMID: 29946385 PMCID: PMC6008039 DOI: 10.4300/jgme-d-17-00736.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/31/2018] [Accepted: 03/14/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Physicians across specialties need to be skilled at diagnosing and treating depression, yet studies show underrecognition and inadequate treatment. Understanding the reasons requires specifying the influence of patient presentation, screening, and physician competence. OBJECTIVE We deployed an unannounced standardized patient (SP) case to assess clinic screening and internal medicine (IM) residents' practices in identifying, documenting, and treating depression. METHODS The SP represented a new patient presenting to the outpatient clinic, complaining of fatigue, with positive Patient Health Questionnaire (PHQ) items 2 and 9 and a family history of depression. The SPs assessed clinic screening and IM resident practices; appropriate treatment was assessed through chart review and defined as the resident doing at least 1 of the following: prescribing a selective serotonin reuptake inhibitor (SSRI), making a referral, or scheduling a 2-week follow-up. RESULTS Of 129 IM residents, 85 (66%) provided appropriate treatment, 79 (61%) appropriately referred, 59 (46%) prescribed an SSRI, and 49 (38%) scheduled a 2-week follow-up, while 40 (31%) did not add depression to the problem list. The IM residents who used PHQ-2 and PHQ-9 were more likely to appropriately (89%) versus inappropriately (50%) treat (P < .001). Compared with those who did not, residents who treated appropriately assessed depression symptoms more (P < .001) and had better communication (73% versus 50%, P = .02), patient centeredness (74% versus 42%, P = .03), and patient activation skills (35% versus 11%, P < .001). CONCLUSIONS The use of unannounced SPs helps identify targets for training residents to provide evidence-based treatment of depression.
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Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc 2018. [PMID: 28648901 DOI: 10.1016/j.jamda.2017.04.018] [Citation(s) in RCA: 374] [Impact Index Per Article: 62.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. METHODS An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. RECOMMENDATIONS Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. CONCLUSIONS The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.
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Affiliation(s)
- Elsa Dent
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia.
| | - Christopher Lien
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Chin Wong
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jean Woo
- The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Birong Dong
- Geriatrics Center Huaxi Hospital, Sichuan University, Chengdu, China
| | - Shelley de la Vega
- University of the Philippines College of Medicine, Manila, Philippines; Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Philip Jun Hua Poi
- Division of Geriatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - Chang Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Li Cao
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Piu Chan
- Department of Geriatrics, Neurology, and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Edward Leung
- Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | | | - Linda P Fried
- Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University, St. Louis, MO
| | | | - Leon Flicker
- Western Australia Center for Health and Aging, University of Western Australia, Perth, Australia
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Kristjánsdóttir J, Sundelin C, Naessen T. Health-related quality of life in young women starting hormonal contraception: a pilot study. EUR J CONTRACEP REPR 2018; 23:171-178. [PMID: 29671353 DOI: 10.1080/13625187.2018.1455179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jóna Kristjánsdóttir
- Department of Women’s and Children’s Health, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden
| | - Claes Sundelin
- Department of Women’s and Children’s Health, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden
| | - Tord Naessen
- Department of Women’s and Children’s Health, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden
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Yurtsever C, Set T, Ateş E. The fatigue perception and its role in patient management. DICLE MEDICAL JOURNAL 2018. [DOI: 10.5798/dicletip.407248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mathis J. [Narcolepsy and Other 'Central Disorders of Hypersomnolence']. PRAXIS 2018; 107:1161-1167. [PMID: 30326812 DOI: 10.1024/1661-8157/a003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Narcolepsy and Other 'Central Disorders of Hypersomnolence' Abstract. 'Excessive daytime sleepiness', 'hypersomnia' in the sense of prolonged sleep need, 'tiredness' or 'fatigue' are frequent complaints in primary care, requiring a careful separation in view of a correct diagnostic. After exclusion of various internistic and neurologic causes by clinical and laboratory investigations and after exclusion of sleep apnoea syndrome or other causes of disturbed sleep by polysomnography, the ambiguous group of 'Central Disorders of Hypersomnolence' remains, including narcolepsy with and without cataplexy, idiopathic hypersomnia, and non-organic hypersomnia. Due to the important therapeutic consequences, these diseases must be differentiated and distinguished from insufficient sleep and from chronic fatigue syndrome, often requiring interdisciplinary diagnostics including objective assessment of the reported complaints.
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Affiliation(s)
- Johannes Mathis
- 1 Universitäres Schlaf-Wach-Epilepsie Zentrum des Inselspitals Bern
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