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Contains fulltext : 81256.pdf (Publisher’s version ) (Closed access) BACKGROUND: Little is known about the lifestyle of patients with chronic fatigue syndrome (CFS) and its influence on symptoms of CFS. The present study aimed to investigate the lifestyle of patients with CFS, and to assess whether lifestyle factors are related to fatigue and functional impairments. METHODS: Two hundred and forty-seven patients fulfilling the Center for Disease Control criteria for CFS were included. Validated questionnaires were used to collect data on lifestyle factors, smoking, intake of alcohol, fat, fibres, fruit and vegetables, body mass index (BMI), fatigue severity and functional impairments. RESULTS: Of the CFS patients, 23% smoked, 32% had an unhealthy BMI, and none had an unhealthy alcohol intake. A majority had an unhealthy food intake: 70% had unhealthy fat, fruit and vegetable intake, and 95% had unhealthy fibre intake. Compared with the general Dutch population, significantly fewer CFS patients were overweight. Significantly more female CFS patients abstained from alcohol, and fewer male CFS patients smoked. Unhealthy lifestyle factors were not significantly associated with fatigue severity or functional impairments. CONCLUSIONS: CFS patients tend to lead a healthier lifestyle compared to the general Dutch population. However, no relationship was found between lifestyle factors and fatigue severity and functional impairments in CFS.

Lichamelijk onverklaarde vermoeidheid die langer dan een jaar na de curatieve behandeling voor kanker nog aanwezig is, komt voor bij ten minste 25% van de ziektevrije kankerpatienten en heeft grote gevolgen voor het dagelijks leven. Deze vermoeidheid kan niet meer verklaard worden door de aard van de behandeling (chemotherapie of radiotherapie) of het soort kanker. Hier is het onderscheid zinvol tussen uitlokkende factoren (de behandeling van kanker) en instandhoudende factoren. Diverse factoren kunnen de vermoeidheid in stand houden, zoals verwerkingsproblemen, angst voor een recidief, disfunctionele cognities, onregelmatig slaap-waakritme, over- of onderactiviteit, en irreele verwachtingen van de omgeving. Beinvloeding van deze factoren door middel van cognitieve gedragstherapie leidt tot vermindering van vermoeidheid.

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Contains fulltext : 57392.pdf (Publisher’s version ) (Closed access) BACKGROUND: There is some evidence that cognitive behaviour therapy (CBT) is efficacious in chronic fatigue syndrome (CFS), but little data on its cost-effectiveness. DESIGN: Prospective economic analysis alongside a randomized clinical trial. METHODS: CFS patients were randomly assigned to CBT, guided support groups (SG), or the 'natural course' (NC, no protocol-based interventions). Patients were treated for 8 months and followed-up for another 6 months. Costs per patient showing clinically significant improvement, based on the CIS fatigue scale, and costs per quality-adjusted life year, were determined for a time period of 14 months. RESULTS: Data were available for 171 patients at 8 months and for 128 at 14 months. At 8 and 14 months, the percentages of improved patients were 31% and 27% for CBT, 9% and 11% for SG, and 12% and 20% for NC. Mean QALYs gained at 14 months were, for CBT, SG and NC, respectively, 0.0737, -0.0018 and 0.0458. CBT and SG mean treatment costs were euro1490 and euro424. Other medical costs for CBT, SG, and NC, respectively, were euro324, euro623 and euro412 for the first period, and euro232, euro561 and euro378 for the second period. Non-medical costs for these periods for CBT, SG and NC were euro262, euro550, euro427 and euro226, euro439, euro287, respectively. Productivity costs were considerable, but not significantly different between groups. DISCUSSION: CBT was less costly and more effective than SG. Compared to NC, the baseline incremental cost-effectiveness of CBT was euro20 516 per CFS patient showing clinically significant improvement, and euro21 375 per QALY. The bootstrap ratios showed considerable uncertainty regarding the results. Future research should focus on productivity costs, and follow patients prospectively over a longer period.

Item does not contain fulltext BACKGROUND: Data on the prevalence of orthostatic intolerance (OI) in patients with chronic fatigue syndrome (CFS) are limited and controversial. We tested the hypothesis that a majority of CFS patients exhibit OI during head-up tilt. METHODS: Hemodynamic and neurohumoral responses to 40 minutes of head-up tilt were studied in 36 CFS patients and 36 healthy controls. Changes in stroke volume, cardiac output and peripheral vascular resistance were estimated from finger arterial pressure waveform analysis (Modelflow). Blood samples were drawn before and at the end of head-up tilt for measurement of plasma catecholamines. RESULTS: At baseline, supine heart rate was higher in CFS patients (CFS: 66.4 +/- 8.4 bpm; controls: 57.4 +/- 6.6 bpm; p < 0.001) as was the plasma epinephrine level (CFS: 0.11 +/- 0.07 nmol/l; controls: 0.08 +/- 0.07 nmol/l: p = 0.015). An abnormal blood pressure and/or heart rate response to head-up tilt was seen in 10 (27.8 %) CFS patients (6 presyncope, 2 postural tachycardia, 2 tachycardia and presyncope) and 6 (16.7 %, p = 0.26) controls (5 presyncope, 1 tachycardia, 2 tachycardia and presyncope). Head-up tilt-negative CFS patients showed a larger decrease in stroke volume during tilt (-46.9 +/- 10.6) than head-up tilt-negative controls (-40.3 +/- 13.6 %, p = 0.008). Plasma catecholamine responses to head-up tilt did not differ between these groups. CONCLUSION: Head-up tilt evokes postural tachycardia or (pre)syncope in a minority of CFS patients. The observations in head-up tilt-negative CFS patients of a higher heart rate at baseline together with a marked decrease in stroke volume in response to head-up tilt may point to deconditioning.

Item does not contain fulltext BACKGROUND: Dutch (ex-)servicemen who encounter health problems since return from the 1992-3 peace operation UNTAC, commonly complain of reduced activity levels, decreases in physical fitness and aggravation of symptoms after strenuous exercise. AIM: To evaluate these symptoms. DESIGN: A prospective study of 26 symptomatic Cambodia veterans and 26 matched controls (healthy Cambodia veterans). METHODS: Using an actometer and diaries, both groups were followed for a 12-day baseline period prior to an incremental maximal exercise test on a bicycle ergometer, followed by 7 days of post-ergometer data. RESULTS: During baseline, symptomatic Cambodia veterans reported more symptoms, had lower levels of physical activity and took longer periods of rest after high activity periods. Symptomatic veterans did not perceive the exercise test needing more exertion than healthy veterans did, although their physical fitness was decreased. Post-ergometer, daily observed symptoms did not aggravate in symptomatic veterans. Four days post-ergometer, actometer and daily observed activity scores were lowered in both groups. As compared to baseline, one day post-ergometer, levels of physical activity were changed in healthy veterans, but not in controls. DISCUSSION: Complaints about reduced activity levels and decreases in physical fitness in symptomatic Cambodia veterans were confirmed. Post-exertion malaise was not found. The observed post-exertion effects were traced back to weekday patterns.

Rheumatoid arthritis (RA) fatigue is not being well-managed currently, and evidence of effective interventions is limited. Aerobic exercise may provide benefit to treat fatigue in RA. Therefore, the purpose of this meta-analysis is to analyze the effect of aerobic land-based exercise on fatigue in RA.A literature search was conducted using PubMed, Cochrane Library, Embase, and trial registers to identify randomized controlled trials (RCTs) with a supervised land-based aerobic exercise program performed with an intensity between 50% and 90% of maximal heart rate, of at least 15 minutes' duration, performed at least 2 times a week, and lasting for a time period of at least 4 consecutive weeks. Risk of bias was assessed using the Cochrane tool. A meta-analysis of fatigue outcomes was performed by calculating the standardized mean difference (SMD) using a random-effects model.Five RCTs were included. None of the trials selected patients with RA for having fatigue. Risk of bias was low in 3 RCTs and unclear in 2. Land-based aerobic exercise programs had a positive effect on fatigue in RA compared to no exercise at 12 weeks, SMD -0.31 (95% confidence interval [95% CI] -0.55, -0.06). At 24 weeks, the effect of aerobic land-based exercise was smaller and not statistically significant: SMD -0.15 (95% CI -0.33, 0.02).There is evidence with low risk of bias that an aerobic exercise program is effective in reducing fatigue among patients with RA, especially in the short term; however, effects are small. To substantiate the evidence, RCTs should be performed in patients with RA selected for having fatigue.

Although most patients with operated Hirschsprung's disease (HD) have good continence in adulthood, a majority have postoperative defection problems during school age. Persistence of chronic constipation and/or incontinence may have considerable consequences for psychosocial development, parent-child interactions, quality of life, and the child's general condition. Considering these consequences, it is important to treat these problems as early as possible. From a biopsychosocial view, we developed a multidisciplinary treatment aimed at resolving defecation problems by teaching the child bowel self-control, primarily by training optimal defecation skills and subsequently toilet behavior. This treatment, carried out by a child psychologist, a pediatric physiotherapist, and a pediatric surgeon, consists of five steps: explanation; extinction of fear and avoidance behavior; learning new defecation behavior; learning an adequate straining technique; and generalization toward daily life. The effect of the treatment was investigated retrospectively in 16 boys with operated HD. The children improved significantly in all aspects during treatment, suggesting that multidisciplinary treatment can significantly reduce the postoperative chronic bowel problems of most children with operated HD. The treatment was as effective in young children (2-5 years) as in older children (5-14 years).

Since the end of the American Civil War, unexplained symptoms in military personnel arising after a war or peace mission have frequently been described. The pattern of symptoms is highly similar for all of the various war syndromes although the conditions of each war or peace mission are widely different. Many somatic hypotheses have been formulated to explain these syndromes; a considerable proportion of them are already outdated. In the last few years much attention has been given to Gulf War Syndrome and to unexplained symptoms of military personnel who were sent to Cambodia, Rwanda, Burundi, Zaire, or the former Yugoslavia. In this review the symptoms of war syndromes will be considered in more detail and the suggested somatic explanations will be discussed. During the last decade the following somatic causes have been suggested as possible explanations for these symptoms: (persistent) infection, abnormal immune response, administration of multiple vaccinations within a short period of time, use of malaria chemoprophylaxis, neurological abnormalities, exposure to toxicological substances and environmental factors. The various investigations performed to study these hypotheses are discussed. The fact that bias regularly occurs in the course of these investigations is pointed out. For the future, a reliable investigation of a war syndrome should be a prospective multidisciplinary study and should distinguish between causative and sustaining factors.

Background: Chronic Fatigue Syndrome (CFS) is characterized by severe debilitating fatigue for at least six months. The lack of a known origin could have consequences for the way general practitioners deal with the diagnosis CFS and their perception of CFS patients. The aims of the study were to investigate the use of the diagnosis CFS by GPs and their reactions to self-diagnosis and to explore opinions of GPs about causes of CFS and the communication with CFS patients as well as opinions of CFS patients about their GPs.Method: One hundred twenty-one GPs completed questionnaires and 12 were interviewed. Data of 211 CFS patients were analyzed as well.Results: Only half of the GPs used the diagnosis CFS. The main reason for not diagnosing CFS was ignorance of the criteria. GPs reported self-diagnosis in 68% of the CFS patients. More than half of the GPs could sympathize less with the complaints of CFS patients compared with other patients. These GPs experienced more problems in communicating with CF...

De Verkorte VermoeidheidsVragenlijst (VVV) is in de huisartsenpraktijk een bruikbaar instrument om de ernst van een (aanhoudende) vermoeidheid vast te stellen. De lijst telt slechts vier vragen, is zeer betrouwbaar en laat het gebruik van een afkapwaarde toe. De gevolgen van de vermoeidheid – beperkingen in het dagelijks leven – kunnen het best met behulp van een anamnese bepaald worden.

Fatigue is generally associated with low physical activity in patients with various chronic medical conditions. However, such an association has not been reported among patients with rheumatoid arthritis (RA). The objectives of this study were to investigate whether daily activity level is associated with fatigue in patients with RA, and whether pain, disability, coping, and/or cognition are associated with the level of daily activity.Patients with RA who visited our outpatient clinic were recruited consecutively. Fatigue severity was measured using the Checklist Individual Strength (CIS20). Physical activity was measured for 14 consecutive days using an ankle-worn actometer. The daily activity level of each patient was calculated, and each patient was classified as having a low or high activity level with respect to the group average. Data were analyzed by linear regression.A total of 167 patients were included in the analysis; 25% had a low activity level and 75% had a high activity level. A regression analysis revealed that higher activity levels were associated with reduced fatigue (P = 0.008). The mean ± SD CIS fatigue score was 30.9 ± 12.3 among the patients with a high activity level and 35.7 ± 12.8 among the patients with a low activity level (P = 0.03). Pain, disability, coping, and cognition were not associated significantly with daily activity level.Among patients with RA, a higher level of daily physical activity was associated with reduced levels of fatigue. This relationship was not explained by differences in sex, age, disease duration, pain, disability, or other fatigue-related factors.

Fatigue and pain are important symptoms for patients with rheumatoid arthritis (RA), but their temporal association is unknown. Therefore, the objective of this study was to investigate the longitudinal relationship between fatigue and pain in patients with RA using time-lag models.Consecutive RA outpatients (n = 228) were enrolled for this 1-year study. Fatigue was assessed monthly with the Checklist Individual Strength (CIS; range 8-56) and pain was assessed monthly with the bodily pain subscale (inverted, range 0-100) of the Short Form 36. The association between monthly changes in fatigue and pain was analyzed using longitudinal regression (mixed models), using the same months and with a 1-month time lag.A total of 198 patients were included in the analyses. At baseline, the mean ± SD pain score was 35.23 ± 19.82 and the mean ± SD CIS fatigue score was 31.0 ± 12.4. Severe fatigue at baseline (CIS score ≥35) was present in 42% of the patients. The mean ± SD patient-averaged CIS fatigue score over 1 year was 30.9 ± 6.0 and the mean ± SD patient-averaged pain score over 1 year was 36.4 ± 18.3. The longitudinal regression analysis showed a significant positive relationship between fatigue and pain during the same month (β = 2.04; 95% confidence interval 1.82, 2.27). The models using a time lag showed no significant association between changes in pain and changes in fatigue.In established RA, pain and fatigue show monthly fluctuations that are synchronous rather than showing a temporal relationship with a time lag; within this timeframe, the results do not indicate that one precedes the other.

We spreken over chronische vermoeidheid als deze klacht ten minste zes maanden bestaat. Ernstige chronische vermoeidheid doet zich bij talloze chronische ziekten veelvuldig voor. Ook na succesvolle behandeling van kanker komt chronische vermoeidheid voor. Het chronischvermoeidheidssyndroom (CVS) is een aandoening, waarbij de vermoeidheid gepaard gaat met aanzienlijke beperkingen in het dagelijks functioneren, zonder dat een lichamelijke verklaring gevonden is. CVS moet niet verward worden met de chronische vermoeidheid die optreedt bij een chronische ziekte of met chronische vermoeidheid na kanker; we spreken dan niet van CVS.

T Brieff interventions can reduce alcohol consumption and problems for early-stage problem drinkers. Brieff motivational interventions are a subcategory of brief alcohol interventions, which aim mainly too increase the awareness of alcohol problems and enhance the motivation to change. The Motivationall Drinker's Check-Up is an example of a brief motivational intervention, which consists off an assessment session followed by a feedback session. The assessment tests are selected to detect earlyy manifestations of alcohol-related impairment. Shortly after the assessment, the drinker returns forr the second session, which consists of personalized feedback of the assessment results. The preferredd style for the feedback session is motivational interviewing, a directive, client-centred style whichh elicits behaviour change by helping the client to explore and resolve ambivalence, and appliess stage specific strategies according to the stages of change model. This chapter presents the Dutchh Motivational Drinker's Check-Up (DVA), an adaptation of Miller's original Drinker's Check-Upp

Contains fulltext : 73178.pdf (Publisher’s version ) (Closed access) Chronic fatigue syndrome (CFS) is a disabling disorder, characterized by persistent or relapsing fatigue. Recent studies have detected a decrease in cortical grey matter volume in patients with CFS, but it is unclear whether this cerebral atrophy constitutes a cause or a consequence of the disease. Cognitive behavioural therapy (CBT) is an effective behavioural intervention for CFS, which combines a rehabilitative approach of a graded increase in physical activity with a psychological approach that addresses thoughts and beliefs about CFS which may impair recovery. Here, we test the hypothesis that cerebral atrophy may be a reversible state that can ameliorate with successful CBT. We have quantified cerebral structural changes in 22 CFS patients that underwent CBT and 22 healthy control participants. At baseline, CFS patients had significantly lower grey matter volume than healthy control participants. CBT intervention led to a significant improvement in health status, physical activity and cognitive performance. Crucially, CFS patients showed a significant increase in grey matter volume, localized in the lateral prefrontal cortex. This change in cerebral volume was related to improvements in cognitive speed in the CFS patients. Our findings indicate that the cerebral atrophy associated with CFS is partially reversed after effective CBT. This result provides an example of macroscopic cortical plasticity in the adult human brain, demonstrating a surprisingly dynamic relation between behavioural state and cerebral anatomy. Furthermore, our results reveal a possible neurobiological substrate of psychotherapeutic treatment.

Patienten met somatoforme stoornissen presenteren zich met lichamelijke klachten die een medische conditie doen vermoeden of met een lichamelijke preoccupatie.

Contains fulltext : 52976.pdf (Publisher’s version ) (Closed access) OBJECTIVES: To study the presence of psychiatric comorbidity assessed by the use of a structured clinical interview and self-reported questionnaires in a large sample of patients with adult-onset myotonic dystrophy (DM), facioscapulohumeral muscular dystrophy (FSHD), and hereditary motor and sensory neuropathy type I (HMSN-I), and to assess whether psychiatric comorbidity is related to fatigue severity and/or muscle strength. METHODS: In a cohort of 217 patients with a neuromuscular disorder (79 DM, 65 FSHD and 73 HMSN-I patients) overall psychiatric comorbidity was studied cross-sectionally with the structured clinical interview for DSM-IV axis I disorders. Self-reported psychopathology, fatigue severity and muscle strength were assessed with the Beck Depression Inventory, Symptom Checklist-90, General Health Questionnaire-12, Checklist Individual Strength and muscle strength [Medical Research Council (MRC)-scale]. RESULTS: In all three neuromuscular disorders (DM, FSHD and HMSN), 10-12% of the patients met DSM IV clinical criteria for current psychiatric disorders. Lifetime psychiatric disorders were found in 32% of patients in all three patient groups. The most common psychiatric disorders were depression and phobias. A comparison of patients with and without current psychiatric disorder showed that fatigue severity and muscle strength (MRC) were not related to psychiatric comorbidity. CONCLUSION: Psychiatric disorders appear equally in patients with DM, FSHD and HMSN-I and are not related to fatigue or muscle strength in these patients.

In this article several suggestions on how to optimise interventions for problem drinking among hospital outpatients are enumerated. These interventions are especially important for patients with diagnoses that are alcohol related. The intervention has to be brief and easy to integrate into medical specialist's routine practice; an active role for the medical specialist and flexible involvement of a specialised nurse are suggested. Key elements of the intervention are: early identification of problem drinking; raising the issue of problem drinking; assessment of the drinking behaviour; reaching an agreement about change; follow-up; evaluation of the change. A feasible and attractive option is integrating the intervention into a broader lifestyle intervention. Those who perform the brief alcohol intervention need to be specially educated and trained.

Voor het chronisch vermoeidheidssyndroom (CVS) is met internationale consensus een definitie opgesteld. Het gaat dan om tenminste zes maanden bestaande, lichamelijk onverklaarde, aanhoudende vermoeidheid, die geleid heeft tot aanzienlijke beperkingen in beroepsmatig, sociaal en/ of persoonlijk functioneren (1).

Chronisch vermoeidheidssyndroom (CVS) is een belangrijk medisch en maatschappelijk probleem met verregaande consequenties voor de kwaliteit van leven. Voor CVS bestaat een internationale consensusdefinitie. Men spreekt van CVS bij tenminste zes maanden bestaande, door de patient zelf gerapporteerde, moeheidsklachten waarvoor geen medische verklaring kan worden gevonden en die leiden tot aanzienlijke beperkingen in het dagelijks functioneren (1).

Contains fulltext : 48713.pdf (Publisher’s version ) (Closed access) AIMS: To test the effectiveness of a brief psychological intervention for problem drinking among outpatients in a hospital setting. METHODS: Over a period of 3 years physicians screened patients who visited an outpatient clinic for general internal medicine for problem drinking. Of the 4728 patients screened, 284 (6%) scored positive on problem drinking of whom 123 participated in the study. They received a computerized baseline assessment and were randomly allocated to a brief psychosocial intervention given by a psychologist (Dutch version of W. R. Millers' Drinker's Check-Up) (n = 61) or to 'care as usual' (n = 62). They were followed up at 6 months. The outcome measures were alcohol consumption and the increase in motivation to reduce alcohol consumption. RESULTS: Most patients reduced their alcohol consumption over time, but no differences were found between the intervention and control groups. A slightly, but not significantly, larger proportion of patients who received the intervention increased their motivation to change. CONCLUSIONS: No conclusive evidence was found for the effectiveness of adding a brief psychological intervention to the physician's advice for problem drinking among outpatients in a hospital setting.

Moeheidklachten vormen een belangrijk medisch en maatschappelijk probleem. Voor de patient betekent deze klacht in het algemeen dat de kwaliteit van leven vermindert, zeker wanneer er beperkingen in het dagelijks leven zijn. Bij de huisarts is moeheid een veelgehoorde klacht. Zoals blijkt uit de Nationale Studie naar ziekten en verrichtingen in de huisartsenpraktijk lijkt er een toename van vermoeidheidsklachten in Nederland te zijn. Vaak verdwijnen de klachten van vermoeidheid spontaan, maar in ongeveer 10% van de gevallen persisteren de vermoeidheidsklachten een half jaar of langer. Bij de internist wordt de klacht moeheid vaak geuit in de context van andere chronische aandoeningen.

Contains fulltext : 48819.pdf (Publisher’s version ) (Closed access) BACKGROUND: It has been demonstrated that individual cognitive behaviour therapy is an effective treatment for chronic fatigue syndrome (CFS). The aim of the present study was to investigate the effectiveness of cognitive behaviour group therapy (CBGT) in an unselected group of CFS patients. Additionally, pretreatment characteristics of CFS patients who improve after CBGT were explored. METHODS: In a non-randomised waiting list controlled design, 31 patients were allocated to CBGT and 36 to the waiting list condition. CBGT consisted of 12 two-hour sessions during 6 months. Main outcome measures were fatigue (Checklist Individual Strength) and functional impairment (Sickness Impact Profile). RESULTS: A moderate effect on fatigue in favour of CBGT was found. For functional impairment, the effect was opposite to what was expected. Patients who improved after CBGT had less complaints at baseline compared to patients who did not improve. CONCLUSIONS: An explanation for the moderate effect might be that during CBGT, rest and relaxation were too much emphasised. Furthermore, an unselected group of CFS patients and therapists inexperienced in CB(G)T for CFS participated. Suggestions to improve CBGT for future research are given.

PURPOSE: This study was undertaken to assess biofeedback treatment (active sphincter exercises under direct electromyography vision) in neurogenic fecal incontinence. METHODS: Twelve patients with neurogenic fecal incontinence have been studied prospectively. External sphincter contractions were exercised under direct electromyographic vision twice per day for 30 minutes during 12 weeks. Manometry was done at the beginning and after 12 weeks of training to evaluate objectively changes in sphincter functions. RESULTS: No patient experienced any improvement in fecal control. Mean resting pressure increased from 7 to 9 kPa and mean squeeze pressure from 3.9 to 4.9 kPA, which was of no statistical significance (P=0.20 andP=0.46, respectively). CONCLUSIONS: External sphincter contraction exercises under direct electromyographic vision are not effective in neurogenic fecal incontinence. Degree of continence does not improve, and external sphincter function is not increased significantly.

Chronic fatigue is a symptom of diseases such as cancer, multiple sclerosis, Parkinson's and cerebrovascular disease. Fatigue can also be present in people with no demonstrable somatic disease. If certain criteria are met, chronic-fatigue syndrome may be diagnosed in these cases. Fatigue is a multi-dimensional concept with physiological and psychological dimensions. The 'Short Fatigue Questionnaire' consisting of 4 questions is a tool to measure fatigue with a high degree of reliability and validity. Within the group of neuromuscular disorders, fatigue has been reported by patients with post-polio syndrome, myasthenia gravis, and Guillain-Barré syndrome. The percentage of neuromuscular patients suffering from severe fatigue (64%) is comparable with that of patients with multiple sclerosis, a disease in which fatigue is an acknowledged symptom. Now that reliable psychological and clinical neurophysiological techniques are available, a multidisciplinary approach to fatigue in patients with well-defined neuromuscular disorders may contribute towards the elucidation of the pathophysiological mechanisms of chronic fatigue, with the ultimate goal being to develop methods of treatment for fatigue in neuromuscular patients.

Three patients suffered from somatic complaints related to excessive alcohol use. For the first patient, a 42-year-old man, the simple advice to quit drinking was enough for him to stop. A second patient, a 61-year-old woman, continued to deny drinking excessively despite several signs of excessive alcohol use. The third patient, a 45-year-old man, changed his drinking behaviour after receiving lifestyle intervention from the internist. All three patients needed a structural intervention to tackle the drinking problems in addition to medical treatment. The first lifestyle-intervention session takes 10 minutes and subsequent sessions take 5 minutes each. The intervention includes five elements: screening, placing on the agenda, inventory, making an appointment about change and reverting to the appointment about change. A trained nurse could also perform part of the intervention. Although lifestyle interventions seem to be expensive and time-consuming activities in the short-term, in the longer term they save time and money and lead to a satisfactory result for both the patient and physician.

Our objectives were to study the temporal correlation of physical activity time series in patients with chronic fatigue syndrome (CFS) during normal daily life and to examine if it could identify the altered physical activity in these patients.Fractal scaling exponents of diurnal and nocturnal physical activity time series in 10 CFS patients and 6 healthy control subjects (CON) were calculated by the detrended fluctuation analysis (DFA) and the wavelet transform modulus maxima (WTMM) method. We hypothesized that, due to their illness- and/or fatigue-induced resting episodes, altered physical activity patterns in CFS patients might be observed at the interruption of activity bursts. Thus, we further developed a new method, the wavelet transform negative modulus maxima (WTNMM) method, which could evaluate the temporal correlation at the interruption of activities. We compared the fractal scaling exponents for CFS and CON by each method.Both for CFS and CON, we found the fractal time structures in their diurnal physical activity records for at least up to 35 minutes. No group difference was found in nocturnal activities. The WTNMM method revealed that, in diurnal activities, CFS patients had significantly (p0.01) smaller fractal scaling exponent (0.87 +/- 0.03) compared to controls (1.01 +/- 0.03). Such a difference was identified neither by the DFA nor WTMM method.CFS patients had more abrupt interruptions of voluntary physical activity during diurnal periods in normal daily life, probed by the decreased correlation in the negative modulus maxima of the wavelet-transformed activity data, possibly due to their exaggerated fatigue.

Contains fulltext : 58620.pdf (Publisher’s version ) (Open Access) OBJECTIVE: To determine the effectiveness of opportunistic brief interventions for problem drinking in a general hospital setting. DESIGN: Systematic review. DATA SOURCES: Medline, PsychInfo, Cochrane Library, reference lists from identified studies and review articles, and contact with experts. MAIN OUTCOME MEASURE: Change in alcohol consumption. RESULTS: Eight studies were retrieved. Most had methodological weaknesses. Only one study, with a relatively intensive intervention and a short follow up period, showed a significantly large reduction in alcohol consumption in the intervention group. CONCLUSIONS: Evidence for the effectiveness of opportunistic brief interventions in a general hospital setting for problem drinkers is still inconclusive.

To explore the effect of granisetron, a 5-HT3 antagonist, on fatigue and functional impairment in patients with chronic fatigue syndrome (CFS).Five female patients were eligible to receive oral granisetron for one month (1 mg a day for the first two weeks and 2 mg a day for the second two weeks). The patients had to be between 18 and 65 years of age and suffering from CFS according to the CDC criteria. The effect was assessed by pre- and post-testing, using validated instruments designed to assess the different dimensions of CFS. Treatment response was also evaluated by visual analogue scales (VAS) for fatigue. Analysis was based on intention to treat.Treatment with granisetron resulted in significant improvement in fatigue severity and functional impairment. Activity level showed no significant increase.The promising results of this study have encouraged us to perform a placebo-controlled, double-blind study to evaluate the efficacy of 5-HT3 receptor antagonists in the treatment of CFS.

In the context of outpatient care and within the framework of scientific research, guidelines and measuring instruments have been developed to help improve CFS diagnostics. The purpose of this study was to measure the agreement between the evaluations of chronically fatigued patients by physicians using a CFS protocol and by researchers using computerised questionnaires.The sample consisted of 516 patients referred to an internal medicine outpatient clinic with complaints of chronic fatigue. Retrospectively the medical records and the computerised questionnaires were checked separately and compared to see whether the criteria for diagnosis of CFS had been met. In addition, the reasons for not diagnosing CFS were evaluated.Agreement between the physicians' and the researchers' evaluations was 84%. Disagreement mostly concerned severity of fatigue and functional impairment, or premorbid exclusion criteria. A physical cause for the chronic fatigue was only found in 3% of the cases.For physicians, questionnaire assessment may be complementary to the CFS protocol in optimising the process of diagnosing CFS.

BACKGROUND: Many patients visit their general practitioner (GP) because of problems that are psychosocial in origin. However, for many of these problems there is no evidence-based treatment available in primary care, and these patients place time-consuming demands on their GP. Therefore, GPs could benefit from tools to help these patients more effectively and efficiently. In this light, it is important to assess whether structured psychosocial interventions might be an appropriate tool for GPs. Previous reviews have shown that psychosocial interventions in primary care seem more effective that usual care. However, these interventions were mostly performed by health professionals other than the GP. OBJECTIVES: To present a systematic review of the literature addressing the effectiveness of psychosocial interventions by general practitioners by assessing the clinical outcomes and the methodological quality of selected studies. SEARCH STRATEGY: The literature search was conducted using the CCDAN Trials Register, the Cochrane Library and reference lists of relevant studies for citation tracking. Also, personal communication with experts took place. SELECTION CRITERIA: Randomised controlled trials, controlled clinical trials and controlled patient preference trials addressing the effectiveness of psychosocial interventions by GPs for any problem or disorder. Studies published before January 2002 were eligible for entry. DATA COLLECTION AND ANALYSIS: Methodological quality was independently be assessed by two reviewers using the Maastricht-Amsterdam Criteria List and the CCDAN Quality Rating Scale. The qualitative and quantitative characteristics of selected trials were independently extracted by two reviewers using a standardised data extraction form. Levels of evidence were used to determine the strength of the evidence available. Results from studies that reported similar interventions and outcome measures were meta-analysed. MAIN RESULTS: Eight studies were included in the review. Selected studies addressed different psychosocial interventions for four distinct disorders or health complaints. There is good evidence that problem-solving treatment by general practitioners is effective for major depression. The evidence concerning the remaining interventions for other health complaints (reattribution or cognitive behavioural group therapy for somatisation, counselling for smoking cessation, behavioural interventions to reduce alcohol reduction) is either limited or conflicting. REVIEWER'S CONCLUSIONS: In general, there is little available evidence on the use of psychosocial interventions by general practitioners. Of the psychosocial interventions reviewed, problem-solving treatment for depression seems the most promising tool for GPs, although a stronger evidence-base is required and the effectiveness in routine practice remains to be demonstrated. More research is required to improve the evidence-base on this subject. Language: en

To determine whether patients previously diagnosed as chronic fatigue syndrome (CFS) actually have primary haemochomatosis (PH).The setting was a Dutch referral centre. Transferrin saturation (TS) was retrospectively evaluated in banked blood samples of 88 patients diagnosed as CFS. Patients with elevated TS values were asked to provide a new overnight fasting blood sample for a second determination of TS and measurement of serum ferritin. The DNA was investigated for mutations in the HFE gene when one of these iron parameters was elevated.For 19 out of 88 patients with CFS an elevated TS was found. A new blood sample was obtained from 11 of these 19: six had increased TS and two had elevated serum ferritin values. These eight patients were neither C282Y homozygotes nor compound C282Y-H63D heterozygotes. In the eight cases where no new blood samples could be obtained, the TS was50% for two of the five men and45% for the three female patients.In a group of 88 CFS patients we could exclude PH in all but two of them (prevalence 2.3%; 95% confidence interval 0-5.5%). In our population of CFS patients PH is not more common than in a control population of northern European descent (prevalence 0.25-0.50%).

Research on the relationship between cancer and fatigue has increased considerably in recent years. In this review, we focus on fatigue observed in patients during and after treatment for cancer, using data from empirical studies. The results from these studies indicate that fatigue is mostly studied during active treatment for cancer, and is an important problem during this period. Studies that focused on fatigue in disease-free cancer patients, although less prominent, also indicate fatigue is an important complaint in this time period. It is hard to draw conclusions with regard to the relationships between fatigue and disease- and treatment-related characteristics, because these relationships are seldom properly investigated. Relationships between fatigue and psychological, social, behavioural and physical factors have been established in several studies. However, most studies focused on the depression-fatigue association. Finally, most intervention studies to reduce fatigue appear to be successful, but the follow-up analyses are lacking.

Constipation, faecal incontinence, soiling and difficult toilet training remain significant problems in children with Hirschsprung's disease after corrective surgery. Chronic defecation problems can have various negative implications. At the University Medical Centre Nijmegen, a multidisciplinary behavioural treatment was developed to treat defecation problems. In this paper, a prospective controlled study is presented concerning the effect of this treatment upon children suffering from chronic defecation problems following corrective surgery for Hirschsprung's disease. The effect of treatment was studied in 27 children (21M, 6F, mean age 5.2y, range 2-11 y). Fourteen children were allocated to the experimental treatment group. The 13 children allocated to the waiting-list control group were also treated following a waiting period of 6 mo. On all outcome variables, children in the experimental treatment group had significantly better results after treatment than children in the waiting-list control group after the waiting period. No effect of age upon treatment was found. The effect of treatment remained significant on all outcome variables at a mean follow-up of 7 mo after the end of treatment.Multidisciplinary behavioural treatment is successful in decreasing chronic defecation problems in children with Hirschsprung's disease.

Background/Purpose: The most frequent consequences of being born with an anorectal malformation (ARM) are problems with fecal continence and constipation, which can have various negative implications. In this prospective, controlled study the effect of multidisciplinary behavioral treatment dealing with these problems is evaluated. Methods: The effect of multidisciplinary behavioral treatment was studied in 24 children (15 boys, 9 girls; mean age 5.8 years). Thirteen children were allocated to the treatment condition. The 11 children allocated to the waiting list control group also were treated after a waiting period of 6 months. Children underwent follow-up after treatment. Results: Compared with a waiting list control group, the experimental treatment group scores significantly better on 2 important measures (“Templeton,” “Percentage of feces in toilet”). Although young children had poorer scores than older children before treatment, no significant differences in the favorable outcome of treatment were found between both groups after treatment. No effect of type of ARM on treatment was found either. The results of multidisciplinary behavioral treatment remain stable over a mean follow-up period of 7 months. Conclusion: Multidisciplinary behavioral treatment is an important and valuable supplement to the standard medical treatment of children born with ARM suffering from chronic defecation problems. J Pediatr Surg 36:1350-1356. Copyright © 2001 by W.B. Saunders Company.

Item does not contain fulltext Constipation, faecal incontinence, soiling and difficult toilet training remain significant problems in children with Hirschsprung's disease after corrective surgery. Chronic defecation problems can have various negative implications. At the University Medical Centre Nijmegen, a multidisciplinary behavioural treatment was developed to treat defecation problems. In this paper, a prospective controlled study is presented concerning the effect of this treatment upon children suffering from chronic defecation problems following corrective surgery for Hirschsprung's disease. The effect of treatment was studied in 27 children (21M, 6F, mean age 5.2y, range 2-11 y). Fourteen children were allocated to the experimental treatment group. The 13 children allocated to the waiting-list control group were also treated following a waiting period of 6 mo. On all outcome variables, children in the experimental treatment group had significantly better results after treatment than children in the waiting-list control group after the waiting period. No effect of age upon treatment was found. The effect of treatment remained significant on all outcome variables at a mean follow-up of 7 mo after the end of treatment. CONCLUSION: Multidisciplinary behavioural treatment is successful in decreasing chronic defecation problems in children with Hirschsprung's disease.

Background. Dutch (ex-)servicemen were deployed in the 1992–3-peace operation UNTAC in Cambodia. Since their return, they have voiced concerns about the health consequences of their service and they have reported symptoms such as fatigue and cognitive problems. The natural course of symptoms in Dutch Cambodia veterans was evaluated in a prospective study.Methods. At 18-months follow-up, a questionnaire was sent to 354 veterans who met a set case definition for symptoms in Cambodia veterans or who had sub-threshold scores. Initial measurement of fatigue severity, psychological well-being, depression, post-traumatic stress disorder, trait-anxiety, self-efficacy and causal attributions, was used to evaluate predictors for self-reported improvement and low levels of fatigue at follow-up.Results. At follow-up, 19% of the respondents reported complete recovery, 20% felt much better, 57% had the same complaints and 4% had become worse compared with their initial assessment. Self-reported improvement and less severe fatigue at follow-up were predicted by less severe fatigue at initial assessment and more perceived control over symptoms.Conclusions. Self-reported improvement was reported in a considerable percentage of Cambodia veterans, whereas another substantial percentage of Cambodia veterans continued to suffer with severe levels of fatigue and related symptoms. Predictors of improvement in Cambodia veterans and patients with chronic fatigue syndrome show similarities and also seem to bear importance for Gulf War veterans.

In a retrospective study, we examined whether multidisciplinary treatment based on a biopsychosocial approach and carried out by a pediatric surgeon, a child psychologist, and a pediatric physiotherapist is successful in reducing defecation problems (incontinence and/or constipation) in children with operated anal atresia (AA) (mean age 6.9 +/- 4.01 years). A second question was whether this treatment is successful in young children aged 2-5 years. The multidisciplinary approach consisted of standard medical treatment and a behavioral program to teach children and their parents adequate defecation behavior including an adequate straining technique. Forty-three children aged 2-16 years were included: 27 boys and 16 girls with AA, of whom 26 had high or intermediate and 17 low AA. Besides continence and constipation, defecation behavior and straining technique were evaluated. The children improved significantly during treatment in all aspects of defecation. No differences in effect of treatment were found between young children (2-5 years) and older ones, so this treatment seems to be equally effective in both age groups. This study demonstrates that both somatic and behavioral factors contribute to the persistence of chronic defecation problems. It is concluded that treatment of these problems in patients with operated AA should include behavioral modification techniques.

The aim of this study was to assess the potential impact of effort in comparative studies assessing neurocognitive dysfunction in patients with and without a neurologic diagnosis.It was hypothesized that a subgroup within a group of patients with prominent neurocognitive complaints but without a neurologic diagnosis would have impaired performance on a task originally designed to detect malingering.We compared the neuropsychological performance of a group of 40 patients with a definite diagnosis of multiple sclerosis (MS) with that of 67 patients with chronic fatigue syndrome (CFS). The Amsterdam Short-Term Memory Test, a forced-choice memory task, served as measure to detect submaximal effort. In addition, we administered a regular neuropsychological task generally considered to be sensitive for cognitive deterioration.Compared with the MS group (13%), a larger proportion of the matched CFS group (30%) obtained scores indicative of reduced effort. In contrast, the proportions of patients scoring below the cutoff value on a conventional neuropsychological test did not differ significantly (17% of MS patients and 16% of CFS patients).The results obtained raise the question of to what extent abnormal test findings in the absence of documented neurologic impairment should be interpreted as a sign of cerebral impairment. The suggestion has been made to screen more often for biased results in comparative research studies so as to enhance valid interpretation of neuropsychological findings.

Since the end of the American Civil War, unexplained symptoms in military personnel arising after a war or peace mission have frequently been described. The pattern of symptoms is highly similar for all of the various war syndromes although the conditions of each war or peace mission are widely different. Many somatic hypotheses have been formulated to explain these syndromes; a considerable proportion of them are already outdated. In the last few years much attention has been given to Gulf War Syndrome and to unexplained symptoms of military personnel who were sent to Cambodia, Rwanda, Burundi, Zaire, or the former Yugoslavia. In this review the symptoms of war syndromes will be considered in more detail and the suggested somatic explanations will be discussed. During the last decade the following somatic causes have been suggested as possible explanations for these symptoms: (persistent) infection, abnormal immune response, administration of multiple vaccinations within a short period of time, use of malaria chemoprophylaxis, neurological abnormalities, exposure to toxicological substances and environmental factors. The various investigations performed to study these hypotheses are discussed. The fact that bias regularly occurs in the course of these investigations is pointed out. For the future, a reliable investigation of a war syndrome should be a prospective multidisciplinary study and should distinguish between causative and sustaining factors.

Dutch soldiers who have participated in the peace keeping operation United Nations Transitional Authority in Cambodia (UNTAC) have reported various somatic and psychological symptoms since their return. Their symptoms show similarities to the Gulf War Syndrome. The question arises whether Gulf War Syndrome, symptoms in UNTAC soldiers and other symptoms after acts of war and peace operations are unique syndromes or comparable complaints? From an historical overview it is not plausible that new and unique syndromes will occur with each war or peace operation. On the other hand it also seems unlikely that war syndromes can be reduced to one diagnostic category. The post-Cambodia complaints may be described in four hypothetical models: the somatic start model, the psychotrauma start model, the premorbidity model and the complaints-not-related-to-Cambodia model. These models are expected to be applicable, after further validation, to other symptoms after acts of war and peace operations. Also they will provide points of application for prevention and treatment of symptoms after future wars and peace operations.