Fatigue: Biomedicine, Health & Behavior - Volume 6, Issue 4, 2018

Titles and abstracts for the journal, Fatigue: Biomedicine, Health & Behavior, Volume 6, Issue 4, 2018.

Volume 6, Issue 4, 2018

• Passive standing tests for the office diagnosis of postural tachycardia syndrome: New methodological considerations

  Abstract - Background:Passive standing tests are a first-line, practical means of assessing individuals with chronic orthostatic symptoms. Purpose: To identify the proportion reaching heart rate (HR) criteria for postural tachycardia syndrome (POTS) during a 10-minute passive standing test (PST) if measurement of the lowest supine HR incorporated a 2-minute period of post-test monitoring, rather than being restricted to the 5-minute pre-test values only, and to determine the proportion whose POTS would be missed by shorter periods upright. Methods: Consecutive individuals ≥ 12 years from 2008 to 2017 who presented with chronic fatigue or lightheadedness and whose PST met criteria for POTS. Results: Of the 93 enrolled (70% female, median age 17 years), the mean (SD) HR was higher in the 5 min supine before the 10 min upright than in the 2 min supine afterwards (67.6 [10.0] vs. 65.7 [10.9]; P = 0.01). Thirteen (14%; 95% CI, 7–21%) satisfied HR criteria for POTS using the supine HR from only the post-test period. The median time to reaching the HR criteria for POTS was 3 min. Of those reaching HR criteria, 53% (95% CI, 43–63%) would be missed by a 2-minute and 27% (95% CI, 19–37%) by a 5-minute test. Interpretation: More adolescents and young adults are diagnosed with POTS during a 10-minute PST when the definition of their lowest supine HR includes a 2-minute post-test measurement along with the conventional pre-test measure. A full 10 min of standing is required to avoid underdiagnosing POTS in both clinical and epidemiologic studies.

• Evaluation of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) education materials in local health departments

  Abstract - Purpose: To identify methods used by local health departments (LHDs) for reaching providers and the public with information about myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Methods: During 2009–2012, we conducted LHD outreach in three stages: 1) materials needs assessment with LHDs in 18 states – 85% of 90 targeted LHDs; 2) dissemination to LHDs in 15 states – distributed 67,850 copies of ME/CFS printed materials to 121 LHDs; and 3) follow-up calls with LHDs 6 months after dissemination – 75% of 118 LHDs. The follow-up interview included 18 questions about ME/CFS material use, perception, and knowledge. Results: Ninety-three percent of LHDs had no ME/CFS program or materials. ME/CFS was not rated a public health priority, yet 90% were interested in receiving ME/CFS materials. Of 89 LHDs completing the follow-up interview, 50% were in rural areas, 74% had heard about ME/CFS, and 80% had used the CDC-provided ME/CFS materials. LHDs incorporated these ME/CFS materials into existing programs and dissemination formats (e.g. kiosks and printed materials were preferred). Past use of provided materials did not impact LHDs’ plan to use materials in the future. Regardless of prior ME/CFS awareness, LHDs rated ME/CFS as an important health issue. Conclusions: This paper highlights criteria to consider when developing outreach methods for LHDs including materials and dissemination. We learned materials should be concise and easily transportable to facilitate use in the community. Materials and outreach methods might require tailoring to LHDs as competing health priorities was the most common reason given by LHDs for not using ME/CFS materials.

• Similarities and differences between health-related quality of life in patients with exhaustion syndrome and chronic fatigue syndrome

  Abstract - Background: Patients with exhaustion syndrome (ES), the clinical equivalent of long-lasting burnout, and chronic fatigue syndrome (CFS) report overlapping symptoms such as exhaustion, fatigue, cognitive deficits and intolerance to stressors. Additionally, patients with CFS experience somatic symptoms, including bodily pain, immune symptoms, and post-exertional malaise. Clinically, patients with CFS often have reduced functioning as compared to ES, but studies comparing quality of life have not been reported. Purpose: To compare quality of life between patients with ES (n = 31), CFS (n = 38) and healthy controls (HC) (n = 30) by using the Short Form 36 questionnaire (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results: Patients with CFS scored lower in all quality of life dimensions on the SF-36 as compared to the ES and HC groups, except for the role emotional and mental health subscales. Patients with ES scored lower on the subscales of physical role, vitality, social functioning and role emotional as compared to HC. Physical Component Summary scores were lower in CFS, while the Mental Component Summary scores were lower in ES as compared to CFS and HC. Higher scores for depression symptoms on the HADS and group membership explained the major part of variance. Conclusion: Findings indicated both similarities and differences on the SF-36 in patients with ES as compared to CFS. Both groups showed a substantial reduction in quality of life as compared to controls. Perhaps surprisingly, mental health was less affected in patients with CFS. Emotional status appears to be important in affecting health-related quality of life in both illnesses.

• ME/CFS, case definition, and serological response to Epstein-Barr virus. A systematic literature review

  Abstract - Background: The levels of antibodies to Epstein–Barr virus (EBV) in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) have been compared to healthy controls in many studies. However, the results are inconsistent. Purpose: The objective of this systematic literature review was to determine whether differences in EBV serology between ME/CFS patients and controls vary with the case definition that is used. Methods: MEDLINE, EMBASE, and earlier reviews were searched for studies in which the serum levels of antibodies to EBV-antigens in ME/CFS patients were compared with those in persons without ME/CFS. Results: 27 studies were identified. The levels of antibodies to EBV in ME/CFS patients differed from those in controls in 14 studies. The differences in EBV serology that were revealed, were almost exclusively signs that may indicate higher EBV activity in the patient group. The serological differences between patients and controls were seen in the 2 studies in which ME/CFS was defined using the Canadian criteria, in 5 of the 9 studies using the Holmes criteria, in 1 of the 2 studies using modified Holmes criteria, in 2 of the 6 studies using the Fukuda criteria, and in 4 of the 7 studies using less known criteria. The single study using the Oxford criteria, showed no difference between cases and controls. Conclusions: There seems to be increased EBV activity in subset(s) of ME/CFS patients. The data do not allow firm conclusions about EBV antibody levels varying with the illness case definition used.

• Letter to the Editor by F.N.M. Twisk
• Identifying subtypes of ME and CFS: a rebuttal

See also

• Fatigue: Biomedicine, Health & Behavior

tachycardia An unusually rapid heart beat. Can be caused by exercise or illness. A symptom of postural orthostatic tachycardia syndrome (POTS). (Learn more: www.heart.org)

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

postural orthostatic tachycardia syndrome (POTS) - A form of orthostatic intolerance where the cardinal symptom is excessive tachycardia due to changing position (e.g. from lying down to sitting up).

supine lying on the back or with the face upward

lightheadedness the condition of being dizzy or on the verge of fainting

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

cognition Thought processes, including attention, reasoning, and memory.

somatic symptoms Physical or bodily symptoms. May be used to mean bodily symptoms that are not the result of a known physical or biological illness.

somatic symptoms Physical or bodily symptoms. May be used to mean bodily symptoms that are not the result of a known physical or biological illness.

somatic An adjective relating to the physical body or physical symptoms. It is often contrasted with the adjective "psychological", which refers to the human mind or mental symptoms. In biology, "somatic cells" refer to all the cells of the body, except those which form an egg or sperm.

post-exertional malaise (PEM) - A notable exacerbation of symptoms brought on by small physical or cognitive exertions. PEM may be referred to as a "crash" or "collapse" and can last for days or weeks. Symptoms can include cognitive impairments, muscle pain, trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, and others.

Short Form 36-Item Health Survey (SF-36) - A 36-item patient-reported questionnaire, used to determine patient health status and quality of life.

antibodies Antibody/immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

antibodies Antibody/immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

serum The clear yellowish fluid that remains from blood plasma after clotting factors have been removed by clot formation. (Blood plasma is simply blood that has had its blood cells removed.)

antibodies Antibody/immunoglobulin refers to any of a large number of specific proteins produced by B cells that act against an antigen in an immune response.