UMLS:C0015672 - FACTA Search

Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015672 (fatigue)
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Persons who suffered poliomyelitis 3 or more decades ago now report functional decline and symptoms designated as "post-polio syndrome". The objects of this investigation were to identify subjects fulfilling the criteria of this syndrome, to describe their motor impairment and resulting disabilities/handicaps, to study the adaptive changes in the muscle structure and effects of a resistance exercise program. Forty-one late-polio subjects, 40-65 years old, volunteered for the studies of motor impairment, subgroups of those volunteered to further studies of long-term and short-term adaptations. Seventy-five per cent of the subjects met the criteria for the post-polio syndrome. Complete manual muscle tests and dynamometer measurements of knee muscle strength revealed severe motor impairment predominantly in the lower extremities, the strength of the latter correlating to the degree of mobility handicap. In biopsies from the vastus lateralis muscle, type grouping was frequent. Half of the subjects demonstrated over 70% occurrence of type I fibers with negative significant correlation to strength in the female subjects. Cross-section areas of muscle fibers were on average twice the normal, with negative significant correlation to strength values in male subjects. Muscle enzymatic activity values showed large individual variations; oxidative activities (citrate synthase) were low or very low, while average glycolytic activities were nearly normal. Macro EMG and single-fiber EMG measurements in the vastus lateralis muscle demonstrated large macro motor unit potentials and increased fiber density. Neuromuscular transmission was disturbed as identified by jitter and blockings in most subjects regardless of the occurrence of new muscular symptoms. A statistically significant increase in strength (25-30%) resulted from a 6 weeks' heavy resistance exercise program, utilizing a dynamometer, without any obvious side-effects. Strength improvement was maintained for 6-12 months after training while fatigue index increased. A substantial impact on intermediate (secondary or instrumental) ADL, most severely affecting the quality of mobility, was generally found, while little effect was found on primary ADL as revealed by the Katz' ADL index, the Functional Status Questionnaire and the WHO ICIDH Classification of Handicap. The impaired motor function confirms findings in earlier studies. It also corresponds with the locomotor disabilities and handicaps. The negative correlation of strength to cross-section fiber area might result from excessive use of remaining fibers leading to a prominent hypertrophy in the weakest subjects. Enzyme activities probably reflect the pattern of everyday activities with little demands on endurance.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Muscle adaptation and disability in late poliomyelitis. 183 29

Physical signs, medical history and social factors were analyzed and evaluated in 52 patients (17 women and 35 men) with chronic low back pain, in order to determine if any factors were predictive for return to work after rehabilitation. Factors discriminating between the working and sick-disabled groups were: Sex (only men returned to full time work), Duration of sick-leave (the older half of the study population exhibited a negative correlation between time on sick-leave and frequency of return to work), Reported need for analgesics (the working group reported less need of analgesics), Pain in the cervical and dorsal areas of the spine as well as in the lumbar region (less frequent in the working group), The patients' attitude to his own ADL-capacity (those who returned to full-time work were more positive), After work fatigue (less frequent in the working group).
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PMID:Clinical and social factors in rehabilitation of patients with chronic low back pain. 294 Jun 78

A new measure of Instrumental Activities of Daily Living (IADL), which is able to discriminate among the large group of elderly who do not depend on help, was tested for content validity and construct validity. Most assessments of functional ability include Physical ADL (PADL) and Instrumental ADL (IADL). PADL-scales assess the basic capacity of persons to care for themselves. IADL-scales are used to assess somewhat higher levels of performance, such as the ability to perform household chores or go shopping. Data were collected from 734 70-year-old people in Denmark in the county of Copenhagen. The measure of Instrumental ADL included 30 activities in relation to tiredness and reduced speed. Construct validity was tested by the Rasch model for item analysis; internal validity was specifically addressed by assessing the homogeneity of items under different conditions. The Rasch item analysis of IADL showed that 14 items could be combined into two qualitatively different additive scales. The IADL-measure complies with demands for content validity, distinguishes between what the elderly actually do, and what they are capable of doing, and is a good discriminator among the group of elderly persons who do not depend on help. It is also possible to add the items in a valid way. However, to obtain valid IADL-scales, we omitted items that were highly relevant to especially elderly women, such as house-work items. We conclude that the criteria employed for this IADL-measure are somewhat contradictory.
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PMID:The measurement of instrumental ADL: content validity and construct validity. 812 98

The purpose of this study was to investigate health-related quality of life (HRQOL) and functional ability among the least dependent elderly in residential care, and to compare them with information on the general population. A stratified systematic sample (n = 1,587) was drawn from a one-day census of patients in all public residential homes in Finland on December 2, 1991. Sixty-nine per cent of residents in 1992 were able to participate (n = 1,097) and 86% of them returned the questionnaire (n = 948), of which n = 795 were acceptable, the response rate being 72%. A postal survey was used for data collection. The personnel of residential homes were allowed to help residents complete the questionnaire, and 90% of respondents received such help. HRQOL was measured by the Nottingham Health Profile (NHP) and functional ability by a 14-item questionnaire. Finnish studies among the general population were used for comparisons. According to the NHP, the HRQOL appeared lower in institutional care and this was associated with the dependency level. Similarly, for most ADL items the general population had less restrictions than the least dependent residential care patients. In general, women expressed more difficulties in physical mobility and lack of energy than men. The longest stay elderly expressed better HRQOL. In multivariate models adjusted for age and gender those with poor vision had worse HRQOL in almost every dimension of NHP. Difficulties in speech were connected with emotional reactions and social isolation. Chronic illness limiting normal daily life predicted more problems in energy, pain, physical mobility, and emotional reactions. The married or widowed experienced less social isolation than single elderly. Higher education was related to better HRQOL in all NHP dimensions. Poorer perceived health was associated with lack of energy, pain, and emotional reactions. We conclude from these results that there are only a few clients in residential care whose HRQOL or functional ability compare with the non-institutionalized population.
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PMID:Health-related quality of life among the least dependent institutional elderly compared with the non-institutional elderly population. 876 4

This study examined long-term outcome in traumatically brain-injured individuals following discharge from a comprehensive rehabilitation programme. Of 254 traumatic brain injury (TBI) patients reviewed at 2 years, 103 have been followed up at 5 years using a structured interview format detailing neurological symptoms, mobility, independence in ADL, productivity status, relationship issues, communication and the presence of cognitive, behavioural and emotional changes. Visual difficulties, headache and fatigue were persistent in a significant number of patients. Between 2 and 5 years there was increased independence in personal, domestic and community ADL and the use of transport. Ten more patients had returned to driving. On the other hand there was a slightly higher incidence of cognitive, behavioural and emotional changes reported at 5 years. Thirty-two per cent of those working at 2 years were not employed at 5 years. Many students had also become unemployed. These findings suggest the need for intermittent lifelong intervention following TBI. Systems of rehabilitation need to be adapted to provide this.
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PMID:Outcome following traumatic brain injury: a comparison between 2 and 5 years after injury. 890 61

The present study was made not only to clarify endogenous factors (physical and psychological factor of the subjects) and exogenous factors (caregiver residential environment, social assistance) in the urinary incontinence of elderly persons at home undergoing public visiting nursing, both by sexes and by age-groups [65-74 years (young old), 75-84 years (middle old), more than 85 years (old old)], but also to examine nursing care problems at home. The subjects were 252 elderly persons > 65 years (46.8% of all subjects), who were detected for urinary incontinence by incontinence screening examination from among 538 subjects (224 males, 314 females), who underwent visiting nursing by Public Health Centers, and the health and welfare department of intra-metropolitan S Ward from April 1992 to August 1994. The screening examination was made via visiting interview and hearing by Public Health Nurses in charge, about items for examination such as disease, treatment, degree of independency for ADL, residence, utilization of social resources. nursing burden sensation, etc. The analysis was made comparatively by age-groups and by sexes, as mentioned above. The following information was obtained; 1) In terms of the incidence of urinary incontinence, female subjects showed higher incidence for higher age-grade (36.5%, for YO group, 45.1% for MO group and 61.4% for OO group), and male subjects showed higher incidence than female subjects (56.8% for YO group, 54.4% for MO group and 74.5% for OO group). 2) A few subjects were found within 3 months of the onset of urinary incontinence. Incontinence-favorite time zone was predominantly the midnight zone of 0-6 o'clock a.m. (23.5-52.2%). Care approach by caregiver was predominantly "use of diaper" (52.2-90.2%) and "use of diaper even with micturition" represented 30-50%. 3) Endogenous factors involved onset of cerebrovascular disease or dementia, narrow range of ADL, symptoms such as numbness and pain, bedsores, constipation, low social activity, etc. 4) Exogenous factors involved elderly caregiver persons, residual care fatigue sensation, inconvenient toilet and other housing condition, etc. 5) Endogenous-exogenous compound factors in possible urinary incontinence involved paralysis, contrature, social activity, start of visiting for morbid state observational nursing, guidance and utilization of social services for YO group, suggesting strong factor involving the care rather than physical problems of the subject concerned for elder group. From the above, suggestions for the subject concerned were made as follows; 1) start of visiting aiming at the prevention and improvement of urinary incontinence in early stage of onset of cerebrovascular disease (especially for males) or dementia (especially for females) and 2) promotion of rehabilitation for tension provocation of pelvic muscular group and enlargement of ADL and walking distance, and suggestions for caregiver were made as follows; 1) giving appropriate advice for excretory nursing at home and 2) assessment of the relationship with the subject concerned. From the viewpoint of housing environment, reconstruction of such a toilet as is easily usable by both an elderly person and its nursing person and from the viewpoint of regional system, necessary preparation of 24-hour approach to diminution of nocturnal excretory nursing burden was suggested.
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PMID:[A study of endogenous-exogenous factors in urinary incontinence and home care nursing of the elderly at home]. 928 14

This study was done to estimated work intensity during working hours and different types of care to obtain basic data for making a care program. The subjects were care workers in good health (n = 8, 24-45 years) who worked in a special nursing home. The estimated maximal oxygen intake level, which is the maximal aerobic capacity, of each subject was assessed as normal to very good. The energy expenditure was 1787 +/- 534kcal during working hours. The work intensity was 0.061 +/- 0.011kcal/kg/min, 2.7 +/- 0.7RMR, 98 +/- 6beats/min, and 30.3 +/- 2.0% VO2max. Among the duties assessed for work intensity, bathing had the highest intensity, followed by transferring, changing diapers, feeding, and dressing. The work intensity of bathing was 0.081 +/- 0.31kcal/kg/min, 3.9 +/- 1.0RMR, and 40.0 +/- 6.1 VO2 max, which was significantly higher than feeding, dressing, and transferring(p < 0.05). Care giving at the time of bathing was significantly longer than the other care types (p < 0.05). Feeding and transferring by inexperienced care workers were significantly low intensity (p < 0.05). Work intensity of care was at high levels within the maximal permissible level in which fatigue doesn't make an appearance during working hours and in five types of care. Furthermore, care work intensity increased according to a decrease in the ADL level among the elderly. It is concluded that when making a care program, it is important to consider the ADL level of the elderly, work intensity and the amount of care-giving time, not only to maintain the health of care workers, but, also, to give superior quality care to the elderly.
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PMID:[Work intensity during working hours and different types of care done by special nursing home workers]. 938 62

Many patients with Parkinson's disease (PD) have clinically significant anxiety, depression, fatigue, sleep disturbance, or sensory symptoms. The comorbidity of these nonmotor symptoms and their relationship to PD severity has not been extensively evaluated. Ninety- nine nondemented PD patients were evaluated with the following battery of tests: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), a sensory symptom questionnaire, Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn & Yahr (H/Y) Stage, and the Schwab & England ADL scale (S/E). The comorbidity of the nonmotor symptoms and their relationship to PD severity was analyzed. Thirty-six percent of the study population had depression (BDI > or =10), 33% had anxiety (BAI > or =10), 40% had fatigue (FSS > 4), 47% had sleep disturbance (PSQI > 5), and 63% reported sensory symptoms. Only 12% of the sample had no nonmotor symptoms. Fifty-nine percent of the patients had two or more nonmotor symptoms, and nearly 25% had four or more. Increased comorbidity was associated with greater PD severity (P < 001). This study reveals that the nonmotor symptoms of PD frequently occur together in the same patients. Increased comorbidity of the five nonmotor symptoms was associated with greater PD severity. These results suggest that recognition of these diverse nonmotor symptoms may be enhanced by looking for others when one nonmotor symptom has been identified.
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PMID:Comorbidity of the nonmotor symptoms of Parkinson's disease. 1139 46

In studies conducted on polio survivors with late effects of poliomyelitis, new fatigue is frequently reported. The main purpose of the present study was to examine the characteristics of polio survivors reporting severe fatigue versus those reporting mild or no fatigue. From a survey among 276 representative Norwegian polio survivors, we recruited all patients with mild/no fatigue and those with severe fatigue, without other diseases than poliomyelitis. Out of 276 polio survivors, 43 reported mild, 113 moderate and 118 severe fatigue (2 were missing). Only 12 with mild fatigue, 21 with moderate and 14 with severe fatigue had no other diseases and health problems related to fatigue. Six of these patients with mild/no and 9 with severe fatigue, and 16 healthy persons participated in the study. The subjects were assessed with the Fatigue Questionnaire, Fatigue Severity Scale, Visual Analog Scale for pain and fatigue, SCL-90-R, cognitive tests, event-related brain potentials (ERPs), blood and urine parameters, spirometry, exercise and muscle strength tests, 24-hour pulse registration, Sunnaas ADL-index and the Rivermead Mobility Index. The group with severe fatigue had significantly more elevated scores on SCL-90-R, measuring obsessive-compulsive behaviour, depression and anxiety than both the mild fatigue group and the controls. They also had higher scores on the somatization scale than the control group. No other test results showed significant differences between the mild/no and the severe fatigue polio groups. The present results give no support to the hypothesis of "brain fatigue in polio survivors, assessed by cognitive tests or ERPs. Moreover, the physical test results did not correspond to perceived fatigue. Thus, the only characteristics distinguishing polio survivors with severe fatigue from those with mild/no fatigue in this study were psychological characteristics. However, a larger group of polio survivors suffer from additional diseases, and such diseases should be ruled out during a comprehensive rehabilitation program.
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PMID:Mild versus severe fatigue in polio survivors: special characteristics. 1239 41

OBJECTIVES: To examine the levels of life satisfaction for patients with chronic obstructive disease (COPD) and to explore the relationships between life satisfaction, lung function, walking distance test/exercise capacity and quality of life. STUDY DESIGN: The population comprised 91 patients with COPD, 28 patients with COPD using long term oxygen therapy (LTOT) and a reference group (R) of 150 healthy individuals. Before the study, a number of the COPD patients had been tested with regard to spirometry, walking distance and quality of life using the Chronic Respiratory Disease Questionnaire (CRQ). All subjects filled in an eight-item checklist on levels of life satisfaction. RESULTS: Significantly lower levels of satisfaction were reported by both patient groups than the R group for satisfaction with life as a whole and satisfaction derived from vocational/occupational situation, sexual life and ADL, and by the LTOT group, furthermore, also with family life. Only 10% of the patients were satisfied with their health. The LTOT group reported significantly lower levels of satisfaction than the COPD group for life as a whole, satisfaction with their vocational/occupational situation, leisure, ADL situation and their satisfaction with family life and partnership relation. Factor analyses demonstrated different patterns between the R group and the patient group. No correlation was found between satisfaction with life as a whole and lung function parameters whereas three of the CRQ dimensions; emotional function, fatigue and mastery correlateded significicantly with satisfaction with life as a whole and several of the domains. No relationships was found between satisfaction with life as a whole or any of the domains and the CRQ dimension dyspnea. CONCLUSIONS: The low levels of satisfaction with life as a whole, in addition to low levels of satisfaction with several domains, indicate that the majority of the patients had not managed to cope successfully with the consequences of their impairment. More attention must, thus, be given to these patients in the rehabilitation work.
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PMID:Life satisfaction in subjects with chronic obstructive pulmonary disease. 1244 24

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