From the Journal of Psychosomatic Research, 3 June 2013.
Differences in physical functioning between relatively active and passive patients with Chronic Fatigue Syndrome
Desirée C.W.M. Vos-Vromans, Ivan P.J. Huijnen, Albère J.A. Köke, Henk A.M. Seelen, et al.
Revant Rehabilitation Centre Breda, Brabantlaan 1, 4817 JW Breda, The Netherlands
According to the Cognitive behavioral therapy (CBT) protocol for patients with Chronic Fatigue Syndrome (CFS), therapists are advised to categorize patients in relatively active and passive patients. However, evidence to support the differences in physical functioning between these subgroups is limited. Using the baseline data from a multicentre randomized controlled trial (FatiGo), the differences in actual and perceived physical functioning between active and passive patients with CFS were evaluated.
Sixty patients, who received CBT during the FatiGo trial were included. Based on the expert opinion and using the definitions of subgroups defined in the CBT protocols, the therapist categorized the patient. Data from an activity monitor was used to calculate actual physical functioning, physical activity, daily uptime, activity fluctuations and duration of rest during daily life. Perceived physical functioning was assessed by measuring physical activity, physical functioning and functional impairment with the Checklist Individual Strength, Short Form-36 and Sickness-Impact Profile 8.
Relatively active patients have a significantly higher daily uptime and show significantly less fluctuations in activities between days. Passive patients experience a significantly lower level of physical functioning and feel more functionally impaired in their mobility. However, no significant differences were found in the other actual or perceived physical functioning indices.
A clear difference in actual and perceived physical functioning between relatively active and passive patients with CFS as judged by their therapists could not be found. Future research is needed to form a consensus on how to categorize subgroups of patients with CFS.
From the Journal of Clinical Rheumatology, 5 June 2013 [Epub ahead of print].
Cognitive performance is of clinical importance, but is unrelated to pain severity in women with chronic fatigue syndrome.
Ickmans K, Meeus M, Kos D, Clarys P, Meersdom G, Lambrecht L, Pattyn N, Nijs J.
Pain in Motion Research Group (PIM), Department of Human Physiology, Faculty of Physical Education and Physiotherapy, Vrije Universiteit, Brussel, Building L, Pleinlaan 2, 1050, Brussels, Belgium.
In various chronic pain populations, decreased cognitive performance nis known to be related to pain severity. Yet, this relationship has not been investigated in patients with chronic fatigue syndrome (CFS).
This study investigated the relationship between cognitive performance and (1) pain severity, (2) level of fatigue, and (3) self-reported symptoms and health status in women with CFS.
Examining the latter relationships is important for clinical practice, since people with CFS are often suspected to exaggerate their symptoms. A sample of 29 female CFS patients and 17 healthy controls aged 18 to 45 years filled out three questionnaires (Medical Outcomes Study 36-Item Short-Form Health Survey, Checklist Individual Strength (CIS), and CFS Symptom List) and performed three performance-based cognitive tests (psychomotor vigilance task, Stroop task, and operation span task), respectively.
In both groups, pain severity was not associated with cognitive performance. In CFS patients, the level of fatigue measured with the CFS Symptom List, but not with the CIS, was significantly correlated with sustained attention. Self-reported mental health was negatively correlated with all investigated cognitive domains in the CFS group.
These results provide evidence for the clinical importance of objectively measured cognitive problems in female CFS patients. Furthermore, a state-like measure (CFS Symptom List) appears to be superior over a trait-like measure (CIS) in representing cognitive fatigue in people with CFS.
Finally, the lack of a significant relationship between cognitive performance and self-reported pain severity suggests that pain in CFS might be unique.
From Frontiers in Physiology, 30 May 2013.
Multiscale analysis of heart rate variability in non-stationary environments.
Jianbo Gao(1,2), Brian M. Gurbaxani(3), Jing Hu(1), Keri J. Heilman(4), Vincent A. Emanuele II(3), Greg F. Lewis(4,5), Maria Davila(4), Elizabeth R. Unger(3) and Jin-Mann S. Lin(3)
1) PMB Intelligence LLC, West Lafayette, IN, USA
2) Mechanical and Materials Engineering, Wright State University, Dayton, OH, USA
3) Chronic Viral Diseases Branch, Division of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, GA, USA
4) College of Medicine, Brain-Body Center, University of Illinois, Chicago, IL, USA
5) Research Triangle Institute, Raleigh, NC, USA
Heart rate variability (HRV) is highly non-stationary, even if no perturbing influences can be identified during the recording of the data. The non-stationarity becomes more profound when HRV data are measured in intrinsically non-stationary environments, such as social stress.
In general, HRV data measured in such situations are more difficult to analyze than those measured in constant environments.
In this paper, we analyze HRV data measured during a social stress test using two multiscale approaches, the adaptive fractal analysis (AFA) and scale-dependent Lyapunov exponent (SDLE), for the purpose of uncovering differences in HRV between chronic fatigue syndrome (CFS) patients and their matched-controls.
CFS is a debilitating, heterogeneous illness with no known biomarker.
HRV has shown some promise recently as a non-invasive measure of subtle physiological disturbances and trauma that are otherwise difficult to assess. If the HRV in persons with CFS are significantly different from their healthy controls, then certain cardiac irregularities may constitute good candidate biomarkers for CFS.
Our multiscale analyses show that there are notable differences in HRV between CFS and their matched controls before a social stress test, but these differences seem to diminish during the test. These analyses illustrate that the two employed multiscale approaches could be useful for the analysis of HRV measured in various environments, both stationary and non-stationary.
From the Journal of Comprehensive Psychiatry, 5 June 2013.
The role of neuroticism, perfectionism and depression in chronic fatigue syndrome. A structural equation modeling approach.
Sergi Valero(a), Naia Sáez-Francàs(a), Natalia Calvo(a), José Alegre(b), Miquel Casas(c,a),
(a) Department of Psychiatry, Hospital Universitari Vall d’Hebron, CIBERSAM, Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron 119–129, 08035 Barcelona, Catalonia, Spain
(b) Department of Internal Medicine, Hospital Universitari Vall D´Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig de la Vall d’Hebron 119–129, 08035 Barcelona, Catalonia, Spain
© Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Campus de Bellaterra s/n 08193, Bellaterra, Catalonia, Spain
Previous studies have reported consistent associations between Neuroticism, maladaptive perfectionism and depression with severity of fatigue in Chronic Fatigue Syndrome (CFS). Depression has been considered a mediator factor between maladaptive perfectionism and fatigue severity, but no studies have explored the role of neuroticism in a comparable theoretical framework. This study aims to examine for the first time, the role of neuroticism, maladaptive perfectionism and depression on the severity of CFS, analyzing several explanation models.
A sample of 229 CFS patients were studied comparing four structural equation models, testing the role of mediation effect of depression severity in the association of Neuroticism and/or Maladaptive perfectionism on fatigue severity.
The model considering depression severity as mediator factor between Neuroticism and fatigue severity is the only one of the explored models where all the structural modeling indexes have fitted satisfactorily (Chi square = 27.01, p = 0.079; RMSE = 0.047, CFI = 0.994; SRMR = 0.033). Neuroticism is associated with CFS by the mediation effect of depression severity. This personality variable constitutes a more consistent factor than maladaptive perfectionism in the conceptualization of CFS severity.
CFS, Chronic fatigue syndrome;
RMSE, Root Mean Squared Error;
CFI, Confirmatory Fit Index;
SRMR, Standardized Root Mean Residual;
FIS, Fatigue Impact Scale;
U-FIS, Unidimensional Fatigue Impact Scale;
ZKPQ, Zuckerman–Kuhlman Personality Questionnaire;
MPS-F, Frost Multidimensional Perfectionism Scale;
HADS, Hospital Anxiety–Depression Scale
From the European Journal of Pediatrics, June 2013.
Clinical Practice: Chronic fatigue syndrome
Charlotte L. Werker, Sanne L. Nijhof, Elise M. van de Putte
The diagnosis chronic fatigue syndrome (CFS) was conceptualized in the mid-1980s. It is a clinically defined condition characterized by severe and disabling new onset fatigue with at least four additional symptoms: impaired memory or concentration, sore throat, tender cervical or axillary lymph nodes, muscle pain, multi-joint pain, new headaches, unrefreshing sleep or post-exertion malaise.
Chronic fatigue syndrome in adolescents is a rare condition compared to symptomatic fatigue. The estimated prevalence of adolescent CFS ranges between 0.11 and 1.29 % in Dutch, British, and US populations.
Diagnosis of the chronic fatigue syndrome is established through exclusion of other medical and psychiatric causes of chronic fatiguing illness. Taking a full clinical history and a full physical examination are therefore vital.
In adolescence, CFS is associated with considerable school absence with long-term detrimental effects on academic and social development. One of the most successful potential treatments for adolescents with CFS is cognitive behavioural therapy, which has been shown to be effective after 6 months in two thirds of the adolescents with CFS. This treatment effect sustains at 2–3-year follow-up.
In conclusion, the diagnosis CFS should be considered in any adolescent patient with severe disabling long-lasting fatigue. Cognitive behavioural therapy is effective in 60–70 % of the patients. Prompt diagnosis favours the prognosis.
From JAMA Psychiatry, 12 June 2013 (Epub before print).
Autoimmune Diseases and Severe Infections as Risk Factors for Mood Disorders: A Nationwide Study
Michael E. Benros, MD; Berit L. Waltoft, MSc; Merete Nordentoft, DrMedSc; Søren D. Østergaard, MD; William W. Eaton, PhD; Jesper Krogh, MD; Preben B. Mortensen, DrMedSc
Mood disorders frequently co-occur with medical diseases that involve inflammatory pathophysiologic mechanisms. Immune responses can affect the brain and might increase the risk of mood
disorders, but longitudinal studies of comorbidity are lacking.
To estimate the effect of autoimmune diseases and infections on the risk of developing mood disorders.
Nationwide, population-based, prospective cohort study with 78 million person-years of follow-up. Data were analyzed with survival analysis techniques and adjusted for calendar year, age, and sex.
SETTING Individual data drawn from Danish longitudinal registers.
A total of 3.56 million people born between 1945 and 1996 were followed up from January 1, 1977, through December 31, 2010, with 91 637 people having hospital contacts for mood disorders.
MAIN OUTCOMES AND MEASURES
The risk of a first lifetime diagnosis of mood disorder assigned by a psychiatrist in a hospital, outpatient clinic, or emergency department setting. Incidence rate ratios (IRRs) and accompanying 95% CIs are used as measures of relative risk.
A prior hospital contact because of autoimmune disease increased the risk of a subsequent mood disorder diagnosis by 45% (IRR, 1.45; 95% CI, 1.39-1.52). Any history of hospitalization for infection increased the risk of later mood disorders by 62% (IRR, 1.62; 95% CI, 1.60-1.64).
The 2 risk factors interacted in synergy and increased the risk of subsequent mood disorders even further (IRR, 2.35; 95% CI, 2.25-2.46). The number of infections and autoimmune diseases increased the risk of mood disorders in a dose-response relationship.
Approximately one-third (32%) of the participants diagnosed as having a mood disorder had a previous hospital contact because of an infection, whereas 5% had a previous hospital contact because of an autoimmune disease.
CCONCLUSIONS AND RELEVANCE
Autoimmune diseases and infections are risk factors for subsequent mood disorder diagnosis. These associations seem compatible with an immunologic hypothesis for the development of mood disorders in subgroups of patients.
From the Journal of Biological Psychiatry, 9 June 2013.
Psychobiotics: A Novel Class of Psychotropic
Timothy G. Dinan(*), Catherine Stanton, John F. Cryan
– Alimentary Pharmabiotic Centre, University College Cork and Teagasc Moorepark, Cork, Ireland
* Address correspondence to Timothy G. Dinan, M.D., Ph.D., Cork University Hospital, Department of Psychiatry, College Road, Wilton, Cork, Ireland
Here, we define a psychobiotic as a live organism that, when ingested in adequate amounts, produces a health benefit in patients suffering from psychiatric illness.
As a class of probiotic, these bacteria are capable of producing and delivering neuroactive substances such as gamma-aminobutyric acid and serotonin, which act on the brain-gut axis. Preclinical evaluation in rodents suggests that certain psychobiotics possess antidepressant or anxiolytic activity.
Effects may be mediated via the vagus nerve, spinal cord, or neuroendocrine systems.
So far, psychobiotics have been most extensively studied in a liaison psychiatric setting in patients with irritable bowel syndrome, where positive benefits have been reported for a number of organisms including Bifidobacterium infantis.
Evidence is emerging of benefits in alleviating symptoms of depression and in chronic fatigue syndrome. Such benefits may be related to the anti-inflammatory actions of certain psychobiotics and a capacity to reduce hypothalamic-pituitary-adrenal axis activity. Results from large scale placebo-controlled studies are awaited.
From Biological Psychology, 12 June 2013.
Norepinephrine and epinephrine responses to physiological and pharmacological stimulation in chronic fatigue syndrome,
Jana Strahler(a), Susanne Fischer(a), 1, Urs M. Nater(a), Ulrike Ehlert(b), Jens Gaab(c)
a) Clinical Biopsychology, Department of Psychology, University of Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany
b) Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Binzmuehlestrasse 14, 8050 Zuerich, Switzerland
c) Clinical Psychology and Psychotherapy, Institute of Psychology, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland
• CFS patients showed diminished catecholaminergic responses to an exercise stressor.
• They showed unaltered catecholaminergic responses to a pharmacological stressor.
• Exercise seems to be an important stressor for CFS patients.
• Inadequate catecholaminergic responses to physical exertion might contribute to CFS symptoms.
Chronic fatigue syndrome (CFS) is characterized by fatigue lasting 6 months or longer. CFS has been associated with a disturbed (re-)activity of the autonomic nervous system. However, the sympathetic adrenomedulla (SAM) remains under-examined in CFS.
To investigate SAM reactivity, we implemented a submaximal cycle ergometry (ERGO) and a pharmacological test (Insulin Tolerance Test, ITT) in 21 CFS patients and 20 age-, sex-, and BMI-matched controls. Plasma norepinephrine and epinephrine were collected once before and twice after the tests (+10/+20, and +30 min).
Lower baseline levels and attenuated responses of epinephrine to the ERGO were found in CFS patients compared to controls, while the groups did not differ in their responses to the ITT. To conclude, we found evidence of altered sympathetic-neural and SAM reactivity in CFS. Exercise stress revealed a subtle catecholaminergic hyporeactivity in CFS patients. It is conceivable that inadequate catecholaminergic responses to physical exertion might contribute to CFS symptoms.
From the Journal of Disability and Rehabilitation, 4 June 2013.
Use of an online survey to explore positive and negative outcomes of rehabilitation for people with CFS/ME
Peter William Gladwell(1), Derek Pheby(2), Tristana Rodriguez(3), and Fiona Poland(4).
1) North Bristol NHS Trust, Bristol, UK,
2) Buckinghamshire New University, Society and Health, Uxbridge, UK,
3) Action for ME, Bristol, UK, and
4) Health and Society, University of East Anglia, Norwich, UK
First, to explore the experiences of people with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) of rehabilitation therapies so as to build an understanding of reasons for the discrepancy between the notably mixed experiences regarding effectiveness reported in patient surveys and the RCT evidence about the efficacy of Graded Exercise Therapy (GET). GET is a form of structured and supervised activity management that aims for gradual but progressive increases in physical activity.
Second, to review patient experiences of two related rehabilitation approaches, Exercise
on Prescription (EoP) and Graded Activity Therapy (GAT).
An online survey conducted by the charity Action for ME generated qualitative data about 76 patient experiences of rehabilitation undertaken during or after 2008, examined using thematic analysis.
Both positive and negative experiences of rehabilitation were reported. Positive themes included supportive communication, the benefits of a routine linked with baseline setting and pacing, the value of goal setting, and increasing confidence associated with exercise. Negative themes included poor communication, feeling pushed to exercise beyond a sustainable level, having no setback plan, and patients feeling blamed for rehabilitation not working.
The negative themes may help explain the negative outcomes from rehabilitation reported by previous patient surveys. The negative themes indicate rehabilitation processes which contradict the NICE (National Institute for Health and Clinical Excellence) Guideline advice regarding GET, indicating that some clinical encounters were not implementing these. These findings suggest areas for improving therapist training, and for developing quality criteria for rehabilitation in CFS/ME.
From Medical Hypotheses, 21 June 2013.
Chronic fatigue syndrome from vagus nerve infection: A psychoneuroimmunological hypothesis.
Michael B. VanElzakker
Tufts University Psychology, Massachusetts General Hospital Psychiatric Neuroscience, 490 Boston Avenue, Medford, MA 02155, USA
Chronic fatigue syndrome (CFS) is an often-debilitating condition of unknown origin. There is a general consensus among CFS researchers that the symptoms seem to reflect an ongoing immune response, perhaps due to viral infection. Thus, most CFS research has focused upon trying to uncover that putative immune system dysfunction or specific pathogenic agent. However, no single causative agent has been found.
In this speculative article, I describe a new hypothesis for the etiology of CFS: infection of the vagus nerve.
When immune cells of otherwise healthy individuals detect any peripheral infection, they release proinflammatory cytokines. Chemoreceptors of the sensory vagus nerve detect these localized proinflammatory cytokines, and send a signal to the brain to initiate sickness behavior.
Sickness behavior is an involuntary response that includes fatigue, fever, myalgia, depression, and other symptoms that overlap with CFS. The vagus nerve infection hypothesis of CFS contends that CFS symptoms are a pathologically exaggerated version of normal sickness behavior that can occur when sensory vagal ganglia or paraganglia are themselves infected with any virus or bacteria.
Drawing upon relevant findings from the neuropathic pain literature, I explain how pathogen-activated glial cells can bombard the sensory vagus nerve with proinflammatory cytokines and other neuroexcitatory substances, initiating an exaggerated and intractable sickness behavior signal. According to this hypothesis, any pathogenic infection of the vagus nerve can cause CFS, which resolves the ongoing controversy about finding a single pathogen. The vagus nerve infection hypothesis offers testable hypotheses for researchers, animal models, and specific treatment strategies.
From the Journal of Molecular Neurobiology, 13 June 2013 [Epub ahead of print].
Coenzyme Q10 Depletion in Medical and Neuropsychiatric Disorders: Potential Repercussions and Therapeutic Implications.
Morris G, Anderson G, Berk M, Maes M.
Tir Na Nog, Bryn Road seaside 87, Llanelli, SA152LW, Wales, UK.
Coenzyme Q10 (CoQ10) is an antioxidant, a membrane stabilizer, and a vital cofactor in the mitochondrial electron transport chain, enabling the generation of adenosine triphosphate. It additionally regulates gene expression and apoptosis; is an essential cofactor of uncoupling proteins; and has anti-inflammatory, redox modulatory, and neuroprotective effects.
This paper reviews the known physiological role of CoQ10 in cellular metabolism, cell death, differentiation and gene regulation, and examines the potential repercussions of CoQ10 depletion including its role in illnesses such as Parkinson's disease, depression, myalgic encephalomyelitis/chronic fatigue syndrome, and fibromyalgia.
CoQ10 depletion may play a role in the pathophysiology of these disorders by modulating cellular processes including hydrogen peroxide formation, gene regulation, cytoprotection, bioenegetic performance, and regulation of cellular metabolism. CoQ10 treatment improves quality of life in patient!
s with Parkinson's disease and may play a role in delaying the progression of that disorder.
Administration of CoQ10 has antidepressive effects. CoQ10 treatment significantly reduces fatigue and improves ergonomic performance during exercise and thus may have potential in alleviating the exercise intolerance and exhaustion displayed by people with myalgic encepholamyletis/chronic fatigue syndrome. Administration of CoQ10 improves hyperalgesia and quality of life in patients with fibromyalgia.
The evidence base for the effectiveness of treatment with CoQ10 may be explained via its ability to ameliorate oxidative stress and protect mitochondria.
From Current Biomarker Findings, 17 June 2013.
Immune biomarkers in irritable bowel syndrome: a review
Beatriz Gras-Miralles, Efi Kokkotou
Gastroenterology Department, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder that affects about 9%–13% of the general population. IBS is one of the main reasons to consult a primary care physician, and nearly 30% of visits to a gastroenterologist are for IBS.
The diagnosis of IBS relies on subjective, patient-reported symptoms, thus making urgent the need for IBS-specific biomarkers. The same biomarkers, or perhaps different ones, can also be used to monitor disease evolution and response to treatment.
A significant number of studies have looked in the immune system for establishing IBS biomarkers, based on the concept that IBS might represent a condition of immune dysregulation somewhere in the spectrum between health and inflammatory bowel disease. Such biomarkers can be detected in blood, intestinal biopsies, or luminal contents.
Overall, results are rarely consistent between studies; small sample size, patient and disease heterogeneity, presence of comorbidities, and variation in sampling might contribute to these discrepancies.
So far, studies have failed to provide a diagnostic immune biomarker for IBS, but they have considerably advanced our understanding of the disease pathophysiology, including the role of the individual's genetic make-up, and of the host–microbial interactions. High throughput analysis of a large number of well characterized patients holds promise for developing appropriate biomarkers for IBS.
From BMC Immunology, 25 June 2013. Link downloads full provisional PDF.
A comparison of sex-specific immune signatures in Gulf War illness and chronic fatigue syndrome.
Anne Liese Smylie(1), Gordon Broderick(1,4), Henrique Fernandes(1), Shirin Razdan(2), Zachary Barnes(2), Fanny Collado(3), Connie Sol(3). Mary Ann Fletcher(2), Nancy Klimas(3)
1) Department of Medicine, University of Alberta, Edmonton, AB, Canada
2) Department of Medicine, University of Miami, Miami, FL, USA
3) Department of Clinical Immunology, Miami Veterans Affairs Medical Center, Miami, FL, USA
4) Institute for Neuro-immune Medicine, Nova South eastern University, Suite 3440 University Park Plaza, 3424 South University Drive, Fort Lauderdale 33328, FL, USA
Though potentially linked to the basic physiology of stress response we still have no clear understanding of Gulf War Illness (GWI), a debilitating condition presenting complex immune, endocrine and neurological symptoms. Here we compared male (n = 20) and female (n = 10) veterans with GWI separately against their healthy counterparts (n = 21 male, n = 9 female) as well as subjects with chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME) (n = 12 male, n = 10 female).
Subjects were assessed using a Graded eXercise Test (GXT) with blood drawn prior toexercise, at peak effort (VO2 max) and 4-hours post exercise. Using chemiluminescent imaging we measured the concentrations of IL-1a, 1b, 2, 4, 5, 6, 8, 10, 12 (p70), 13, 15, 17and 23, IFNγ, TNFα and TNFβ in plasma samples from each phase of exercise. Linear classification models were constructed using stepwise variable selection to identify cytokine co-expression patterns characteristic of each subject group.
Classification accuracies in excess of 80% were obtained using between 2 and 5 cytokine markers. Common to both GWI and CFS, IL-10 and IL-23 expression contributed in anillness and time-dependent manner, accompanied in male subjects by NK and Th1 markers IL-12, IL-15, IL-2 and IFNγ. In female GWI and CFS subjects IL-10 was again identified as a delineator but this time in the context of IL-17 and Th2 markers IL-4 and IL-5. Exercise response also differed between sexes: male GWI subjects presented characteristic cytokine signatures at rest but not at peak effort whereas the opposite was true for female subjects.
Though individual markers varied, results collectively supported involvement of the IL-23/Th17/IL-17 axis in the delineation of GWI and CFS in a sex-specific way.
Mediators of the Effects on Fatigue of Pragmatic Rehabilitation for Chronic Fatigue Syndrome.
Wearden AJ, Emsley R.
University of Manchester
To examine potential mediators of the effect of pragmatic rehabilitation on improvements in fatigue following a randomized controlled trial for patients with chronic fatigue syndrome (CFS/ME) in primary care (IRCTN 74156610).
Patients fulfilled the Oxford criteria for CFS. Ninety-five patients were randomized to pragmatic rehabilitation and 100 to general practitioner (GP) treatment as usual.
The outcome was the Chalder fatigue scale score (0123 scoring) at end of treatment (20 weeks) and 1-year follow up (70 weeks).
First, the effect of treatment on potential mediators was assessed. Then fatigue was regressed on significant mediators, treatment allocation, and baseline measures of fatigue and significant mediators.
Reduction in limiting activities at 20 weeks mediated the positive effect of pragmatic rehabilitation on fatigue at 70 weeks (mediated effect size = -2.64, SE = 0.81, p = .001, proportion of effect mediated = 82.0%).
Reduction in catastrophizing at 20 weeks mediated the positive effect of pragmatic rehabilitation on fatigue at 70 weeks (mediated effect size = -1.39, SE = 0.61, p = .023, proportion of effect mediated = 43.2%).
Reductions in 70-week measures of fear avoidance, embarrassment avoidance, limiting activities, and all-or-nothing behavior all mediated improvement in fatigue at 70 weeks, although the causal direction of these cross-sectional effects cannot be determined. There were no between-group differences on measures of exercise capacity (a timed step test).
Improvements in fatigue following pragmatic rehabilitation are related to changes in behavioral responses to and beliefs about fatigue.
From the Scandinavian Journal of Infectious Diseases, 9 June 2013. [Epub ahead of print]
An uncommon cause of Staphylococcus aureus sepsis.
Martje L. Maas(1), Peter C. Wever(2), Arjan W. Plat(3) & Ellen K. Hoogeveen(1)
1) Department of Internal Medicine
2) Department of Medical Microbiology and Infection Control
3) Department of Orthopaedics, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
We describe a case of Staphylococcus aureus sepsis after acupuncture for chronic fatigue syndrome (CFS). Sepsis is a rare, but potentially fatal complication of acupuncture. The most common cause of bacterial infection after acupuncture is S. aureus. The effectiveness of acupuncture for the treatment of CFS is not proven, therefore the potential benefits should be weighed against the risks.