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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Self-report depression scales include items concerning somatic symptoms, such as fatigue, pain, and inability to work, which may be symptoms of depression in individuals who do not have a chronic disease. However, in patients with somatic diseases such as rheumatoid arthritis, these symptoms may reflect disease rather than depression. Interpretation of responses to these items in patients with chronic disease as indicating depression is known as "criterion contamination". Criterion contamination has been described in responses of patients with rheumatoid arthritis on many widely-used depression scales, including the Minnesota Multiphasic Personality Inventory (MMPI), the Beck Depression Inventory, and the Center for Epidemiologic Studies Depression Index (CES-D). Evidence for criterion contamination in responses of patients with rheumatoid arthritis on these depression scales is summarized in this essay.
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PMID:Depression scales in rheumatoid arthritis: criterion contamination in interpretation of patient responses. 833 90

Myasthenia gravis should be entertained as a possible diagnosis in any patient who presents with muscle weakness or visual disturbance. The most common symptom is exacerbation of muscle fatigue with repeated use of the muscle and improvement with rest. Several inexpensive diagnostic tests for myasthenia gravis that can be performed by primary care physicians are available. Standard therapy in most cases is early thymectomy, followed by a highly individualized medication program that usually includes the anticholinesterase drug pyridostigmine bromide (Mestinon, Regonol). Corticosteroids and other immunosuppressive agents (usually azathioprine [Imuran]) may be added or substituted if response to anticholinesterase therapy is inadequate. Although myasthenia gravis is a chronic disease, it can be well controlled in most patients, provided they comply with treatment. Patient education is therefore essential.
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PMID:Myasthenia gravis. Diagnostic methods and control measures for a chronic disease. 841 29

One commonly used instrument for evaluating general health and functional status is the medical outcomes survey short form 36 (MOS). Scores obtained from this instrument are known to vary with chronic diseases and depression. However, the degree to which these health dimensions may be influenced by sleep quality or sleepiness is not well understood. A cross-sectional study was performed on the association between general health status, as determined by the MOS, with sleepiness, assessed using a standardized questionnaire [the Epworth sleepiness scale (ESS)] and the multiple sleep latency test (MSLT). One hundred twenty-nine subjects (68 women), aged 25-65 years, without severe chronic medical or psychiatric illnesses, underwent an overnight sleep study, followed by an MSLT (consisting of a series of four attempts at napping at 2-hour intervals), and completed the MOS and the ESS. The mean MSLT score was 11 +/- 2 minutes, (range 2-20) and the mean ESS score was 10 +/- 5 (range 0-24). Scores for the MOS dimensions "general health perceptions", "energy/fatigue", and "role limitations due to emotional problems" were correlated significantly with ESS scores (r = -0.30, -0.41, and -0.30, respectively; p values were all < 0.001). The MSLT was also significantly correlated with "energy/fatigue" (r = -0.19; p < 0.05). After considering the effects of chronic illness and/or body mass index in a multiple hierarchical regression analysis, sleepiness, as assessed by the ESS score, explained 8% of the variance in general health perceptions, 17% of the variance in energy/fatigue, 6% of the variance in the summary measure of well-being, and 3% of the variance in the summary measure of functional status. The variation of MOS scores with sleepiness, unrelated to age or chronic disease, suggests that measures of general health status may be broadly influenced by sleepiness and sleep quality. These data suggest that 1) sleepiness has an important impact on general health and functional status, specifically influencing self-perceptions regarding energy/fatigue; 2) a more specific assessment of sleepiness in general health evaluations may help explain some of the observed variability in these measures across subjects; and 3) general health measures may be useful in the evaluations of patients with sleep disorders.
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PMID:Relationship between sleepiness and general health status. 889 38

Patients with rheumatic diseases often exhibit sleep disturbance. Identification of primary sleep disorders; medical, neurologic, and psychologic illnesses; circadian factors; and the use and effect of medications, drugs, and alcohol will provide a strong basis for pursuing both pharmacologic and nonpharmacologic intervention. Recent clinical research confirms the frequent comorbidity of sleep disturbance, pain, fatigue, stress, and mood disturbance in patients with rheumatic disease. It is essential for effective management to recognize these "symptom syndromes" that are often responsive to treatment (suggesting a common biologic action and effect of the drugs used) despite a continuing presence of underlying chronic disease. The pathophysiologic relationships of these comorbid symptoms are mostly unknown, so this is an area for further study.
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PMID:Sleep and rheumatic disease. 899 11

A 39-year-old woman was admitted with fatigue, weight loss, and fever. Nothing, except skin pallor could be found on physical examination. Her haemoglobin (Hb) was 6.3 g/dl. The blood picture showed dimorphic red cell changes and there were dyserythropoiesis and ring sideroblasts in the bone marrow. After detailed investigations, she was diagnosed with tuberculosis, and anaemia was assigned to chronic disease. With anti-tuberculosis therapy (including isoniazid), her Hb and bone marrow findings returned to normal. After cessation of therapy, Hb fell to 8.9 g/dl. Bone marrow examination again showed dyserythropoietic morphologic abnormalities and ring sideroblasts. No reason could be identified to explain the recurrence of anaemia. When we realised that preparations of isoniazid included vitamin B6 to prevent the development of sideroblastic anaemia, we challenged with pyridoxin 200 mg daily. Her Hb rose to 14.6 g/dl. We suggest that in any cases with sideroblastic anaemia, if no cause can be identified, or anaemia persists or recurs despite therapy, pyridoxine therapy should be instituted.
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PMID:Vitamin B6 responsive sideroblastic anaemia in a patient with tuberculosis. 915 74

Health-care workers now accept quality of life (QOL) as an important outcome to evaluate in clinical research and as a useful measure of quality care. Indeed, current demand for QOL assessment in clinical practice has outpaced the availability of valid, streamlined, cost-effective methods for carrying out such assessment, although new tools are in the offing. This paper will highlight some of the major challenges facing outcomes management and outcomes research, with particular focus on the development of a QOL instrument to evaluate and manage anemia and fatigue in cancer patients--the Functional Assessment of Cancer Therapy-Anemia (FACT-An). The newest version of broader QOL assessment system, the Functional Assessment of Chronic Illness Therapy (FACIT), will also be described.
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PMID:Linking outcomes management to quality-of-life measurement. 943 Jan 93

The human body is exposed to a wide array of xenobiotics in one s lifetime, from food components to environmental toxins to pharmaceuticals, and has developed complex enzymatic mechanisms to detoxify these substances. These mechanisms exhibit significant individual variability, and are affected by environment, lifestyle, and genetic influences. The scientific literature suggests an association between impaired detoxification and certain diseases, including cancer, Parkinson's disease, fibromyalgia, and chronic fatigue/immune dysfunction syndrome. Data regarding these hepatic detoxification enzyme systems and the body s mechanisms of regulating them suggests the ability to efficiently detoxify and remove xenobiotics can affect these and other chronic disease processes. This article reviews the myriad detoxification enzyme systems, their regulatory mechanisms, and the dietary, lifestyle, and genetic factors influencing their activities, as well as laboratory tests available to assess their functioning.
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PMID:The detoxification enzyme systems. 963 Jul 36

Anemia is common in patients infected with the human immunodeficiency virus (HIV). The etiology is often multifactorial and may include the HIV infection itself, opportunistic infections, cancer, medications (particularly zidovudine and sulfa-containing drugs), or anemia of chronic disease. Epoetin alfa therapy may play a supportive role in some HIV-infected patients by increasing hemoglobin, decreasing fatigue, and reducing the need for exposure to red blood cell transfusions. A large, placebo-controlled trial in the United States for anemic patients with the acquired immunodeficiency syndrome taking zidovudine demonstrated a statistically significant improvement in hematocrit in patients treated with epoetin alfa compared with placebo. Transfusion requirements decreased in epoetin alfa-treated patients over a 3-month period compared with placebo with a trend toward improvement in quality of life. Epoetin alfa was effective, however, only in patients whose pretreatment erythropoietin levels were less than 500 mU/mL. These advantages of epoetin alfa treatment may become especially important as HIV becomes more of a chronic disease, with the concern that red blood cell transfusion may accelerate progression of HIV.
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PMID:Experience with epoetin alfa and acquired immunodeficiency syndrome anemia. 967 34

In this study the authors try to clarify the ambiguities in previous studies on demographic and social factors and fatigue. We have divided people with fatigue complaints and associated symptoms into those who have chronic and non-chronic complaints, and into men and women. The research is based on diaries kept by Dutch citizens over a 21-day period, and uses univariate and discriminant analyses. The results show the utility of stratification for chronicity, gender and age. Compared to non-chronically fatigued subjects (NCFd) the chronically fatigued subjects (CFd) reveal multiple sources of vulnerability: physical, psychological, psycho-social and socio-economic. They report more days of fatigue, they tend to be older, and their physical health is characterized by significantly more acute complaints and chronic disease. Their sum scores on psychological and psycho-social problems are above average. Their health histories are worse, they express greater feelings of frustration and irritation due to their ailments and report more health-related initiatives. The socio-economic profile of the CFd is disadvantaged: their educational level, occupational classification and income are lower than that of the NCFd, and they are more frequently unemployed. CFd women are more frequently divorced or widowed than NCFd women. The factors predicting chronic vs non-chronic fatigue vary with the age and gender of the population. It is easier to predict non-chronic than chronic fatigue. Additional stratification within the group of CFd is recommended.
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PMID:Distinguishing between chronic and nonchronic fatigue, the role of gender and age. 969 Aug 45

Primary pulmonary hypertension presents a challenge to practicing physicians, in both diagnosis and management. Exposure to anorexigens and complaints of dyspnea and fatigue should prompt careful physical examination and Doppler echocardiography to assess patients for pulmonary hypertension. The burden on office practitioners is heavy, considering how often fatigue and dyspnea are reported, but the key is recognizing when these findings are out of proportion to the patient's well appearance. The discovery of epoprostenol therapy has revolutionized the approach to primary pulmonary hypertension. It has markedly improved quality of life and extended survival in patients with the condition, and it has changed the physician's role from providing emotional support to dying patients to providing management of a chronic disease.
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PMID:How to manage primary pulmonary hypertension. Giving hope to patients with a life-threatening illness. 1008 33


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