TGI Friday! Recently published research study abstracts that haven’t made the headlines will be published here every Friday.
Ned Tijdschr Geneeskd. 2012;156(37):A4541.
How do patients interpret terms for medically unexplained symptoms?]. [Article in Dutch]
Kingma EM, Moddejonge R, Rosmalen JG.
Rijksuniversiteit Groningen, Universitair Medisch Centrum Groningen, Interdisciplinair Centrum Psychopathologie en Emotieregulatie (ICPE),
Groningen.
Abstract
OBJECTIVE:
To investigate how primary care patients interpret the existing terminology used to describe medically unexplained symptoms; to
contribute to the current academic discussion on unequivocal
terminology.
DESIGN: Descriptive cohort study.
METHODS:
We approached patients in the waiting rooms of two general medical practices in the city of Groningen and in the province of Drenthe. Based on a fictitious case, the patients were asked to assign connotations to a number of possible diagnoses for medically unexplained tiredness.
The patients could choose from seven predetermined connotations. Among the diagnoses for medically unexplained tiredness were ‘functional fatigue', ‘chronic fatigue syndrome', ‘psychosomatic tiredness', and ‘medically unexplained tiredness'. From the seven connotations, we labeled three connotations as being negative. When patients gave at least one negative connotation to a possible diagnosis, the diagnosis was labeled as ‘offensive'.
RESULTS:
A total of 184 patients participated in the study. From the alternative diagnoses for medically unexplained tiredness, ‘psychosomatic tiredness' had the most negative connotations: at least one negative connotation for 65 (35%) patients. ‘Chronic fatigue syndrome' and ‘functional fatigue' had the fewest negative connotations: at least one negative connotation for respectively 17 (9%) and 24 (13%) patients.
CONCLUSION:
The terms ‘chronic fatigue syndrome' and ‘functional fatigue' were less offensive. Our results could imply that terms for medically unexplained tiredness that refer less to a psychological basis are most acceptable for the patient.
PMID: 22971428 [PubMed – in process]
International Journal of Behavioural Medicine. 2012 Sep 13. [Epub ahead of print]
A Cross-Cultural Perspective on Psychological Determinants of Chronic Fatigue Syndrome: a Comparison Between a Portuguese and a Dutch Patient Sample.
Marques M, De Gucht V, Leal I, Maes S.
Health Psychology, Leiden University, Wassenaarseweg 52, P.O. BOX 955,
2300 RB, Leiden, The Netherlands,
Abstract
BACKGROUND:
Few studies focus on cross-cultural differences in Chronic fatigue syndrome (CFS).
PURPOSE:
This study aimed to (1) compare fatigue severity and impairment, somatic complaints, psychological distress, and quality of life (QoL) in a population of Portuguese and Dutch patients; (2) explore the differential contribution of behavioral and cognitive
determinants of fatigue severity; and (3) investigate the relation between fatigue severity and somatic complaints on one hand and QoL on the other in both populations.
METHOD:
Eighty-five female patients from Portugal (Mean age = 47.54) and 167 female CFS patients from The Netherlands (Mean age = 44.93)
participated in the study. All participants were surveyed for demographic and clinical characteristics, fatigue severity, somatic
symptoms, psychological distress, (physical and psychological) QoL, physical activity, behavior regulation patterns, and illness
representations.
RESULTS:
Cross-cultural differences were found in relation to working status, duration of fatigue symptoms, psychological distress, somatic complaints, and psychological QoL.
Although behavioral characteristics and illness representations were significantly associated with fatigue severity in both Portuguese and Dutch patients, there were important differences in the determinants of CFS. Moreover, higher levels of fatigue and severity of other somatic complaints were related to poor QoL.
CONCLUSIONS:
These findings show cross-cultural similarities and differences in clinical characteristics and psychological determinants of CFS that are important in view of diagnosis and treatment.
PMID: 22972378 [PubMed – as supplied by publisher]
From Journal of Translational Medicine. 2012 Sep 13;10(1):191. [Epub ahead of print]
Cytokine expression profiles of immune imbalance in post-mononucleosis chronic fatigue.
Broderick G, Katz BZ, Fernandes H, Fletcher MA, Klimas NG, Smith FA, O'Gorman MR, Vernon SD, Taylor R.
Abstract
BACKGROUND:
As Chronic Fatigue Syndrome (CFS) has been known to followEpstein-Bar virus (EBV) and other systemic infections; our objective was to describe differences in immune activation in post-infective CFS(PI-CFS) patients and recovered controls. We studied 301 adolescents prospectively over 24 months following the diagnosis of monospot-positive infectious mononucleosis (IM). We found an incidence of CFS at 6, 12 and 24 months of 13%, 7% and 4% respectively.
METHODS:
Using chemiluminescent imaging we measured the concentrations of IL-1a, 1b, 2, 4, 5, 6, 8, 10, 12 (p70), 13, 15, 17 and 23, IFN-gamma, TNF-alpha and TNF-beta in duplicate plasma samples available in bio-bank from 9 PI-CFS subjects and 12 recovered controls
at 24 months post-infection.
RESULTS:
Standard comparative analysis indicated significant differences in IL-8 and 23 across subject groups. In constructing a linear classification model IL-6, 8 and 23 were selected by two different statistical approaches as discriminating features, with IL-1a, IL-2 and IFN-gamma also selected in one model or the other. This supported an assignment accuracy of better than 80% at a
confidence level of 0.95 into PI-CFS versus recovered controls.
CONCLUSION:
These results suggest that co-expression patterns in as few as 5 cytokines associated with Th17 function may hold promise as a tool for the diagnosis of post-infectious CFS.
PMID:22973830[PubMed – as supplied by publisher]
Arthritis Care and Research (Hoboken). 2012 Sep 10. doi: 10.1002/acr.21845. [Epub ahead of print]
Neuromuscular fatigue and exercise capacity in fibromyalgia syndrome.
Bachasson D, Guinot M, Wuyam B, Favre-Juvin A, Millet GY, Levy P, Verges S.
Université Joseph Fourier, Laboratoire HP2, Grenoble, France; INSERM, U1042, Grenoble, France.
Abstract
OBJECTIVE:
To assess quadriceps strength and fatigability by using femoral nerve magnetic stimulation (FNMS) and its relationship with exercise capacity in patients with fibromyalgia syndrome (FMS) and healthy controls.
METHODS:
22 women (11 FMS, 11 controls) performed a maximal incremental cycling test and a quadriceps fatigue test on two separated visits. For quadriceps assessment, we used FNMS during and after maximum voluntary contraction (MVC) to evaluate central and peripheral factors of neuromuscular fatigue. Subjects performed sets of 10 intermittent (5-s on/5-s off) isometric contractions starting at 10% MVC, with 10% MVC increment from one set to another until exhaustion. Neuromuscular fatigue was assessed with FNMS after each set.
RESULTS:
FMS [ patients] had reduced initial MVC compared to controls (102±18 versus 120±24 Nm, respectively; P<0.05) without significant impairment of voluntary activation (93.5±3.0 versus 93.1±3.4%; P<0.05).During the fatiguing task, FMS exhibited a greater [drop] in evoked muscular responses (e.g. -26±6 versus -16±8% at set 50% MVC; P<0.05) but not in MVC (e.g. -24±7% versus -19±4% at set 50% MVC; P=0.12).During the cycling test, FMS had lowered maximal exercise capacity and enhanced rate of perceived exertion (RPE) compared to controls. Percentage reduction in evoked muscular responses during the quadriceps fatigue test correlated with maximal oxygen consumption (r=0.56; P<0.05) and RPE at submaximal intensity (r=0.84; P<0.05) during cycling.CONCLUSION:Larger impairment in muscle contractility is associated with enhanced perception of exertion and reduced maximal exercise capacity in FMS patients. Neuromuscular impairments should be considered as an important factor underlying functional limitations in FMS patients.Copyright © 2012 by the American College of Rheumatology. PMID: 22965792 [PubMed - as supplied by publisher]
My goodness, what a contrast between the nebulous, inconsequential twaddle in the first two items and the solid, empirical scientific methodology in the second two.
Is there a cross-cultural differentiation of perceptual attributes between psychos and scientists?! Or is the last sentence just pretentious tripe – as practised by the psycho-twaddlers?)
Bravo! Well said, Soloman.
The study from Broderick, Klimas, Fletcher and Vernon used the Reeves CDC definition of fatigue. There is hardly a difference.
Ah, a meeting of minds!
Ah, for the wisdom of Soloman! A rare gift.
Re: Post-infectious CFS trial and chronic latent EBV
Another useful biomarker is to test the monocyte levels of ME patients suffering with ongoing fever and swollen lymph nodes. Although, if your bloods results persistently present with marked monocytosis over the course of four long years, the typical response within the NHS is to stop doing any blood tests and ignore it for the next four years. Those embarassing monocytes … But I’m sure that certain quarters are capable of explaining even monocytosis away. Could it be that the first two trials are all the empirical evidence we need to see how psychologists turn discursive obfuscation into an art form?