Caru James talks in Welsh on S4C’s Prynhawn Da about her experience of ME and employment with ME.
Prynhawn Da episode 53 (available until 20 June) Caru’s interview begins at 27 minutes for 5 minutes.
Caru James interview about ME on S4C
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ME recognition & care ‘lacking’ in Wales
An ITV news report on 13th May 2013 highlighted the problems faced by people with ME in finding health and social care in Wales:
People with the condition ME in Wales say they suffer from an absence of specialist care, and have found a lack of sympathy and knowledge in the NHS and social services.
Michelle Penny is 28 and from Dinas Powys in the Vale of Glamorgan. She describes how her “day-to-day life is really difficult”, and that she has been “pushed to the back and ignored”.
“We have a growing recognition and a growing investment in conditions such as Alzheimer’s, but conditions such as ME are not so readily recognised or invested in” says Ana Palazon, Chair of the Wales Neurological Alliance. “We want parity and equity of recognition and services for all conditions.”
The Welsh Government says “progress has not been universal across Wales” since it published a care strategy for the treatment of patients with ME in 2011.
The Welsh Government requires Health Boards to put in place measures to ensure prompt diagnosis and treatment for patients with ME. A care pathway was set out in 2011, with the involvement of the Chronic Fatigue Syndrome Task and Finish Group commissioned by the Minister for Health and Social Services in 2010.
Last year, the Welsh Government asked all Health Boards for updates on service developments since the publication of this guidance. The responses received show that there have been some improvements, but that progress has not been universal across Wales.
Therefore the Task and Finish Group will be reconvened this year to consider how services can be further developed to meet the needs of people with CFS and ME in Wales.
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Internet CBT no more effective long term than usual care
Abstract
OBJECTIVE: Cognitive behavioral therapy (CBT) is known to be an effective treatment of adolescents with chronic fatigue syndrome (CFS), but its availability is limited. Fatigue in Teenagers on the Internet (FITNET), an Internet-based CBT program for adolescents with CFS, has been developed as an alternative to face-to-face CBT. Recently, its short-term effectiveness has been proven in a randomized clinical trial. Here we aimed to assess the long-term outcome of CFS in adolescents after FITNET treatment and after usual care. In addition, factors related to recovery at long-term follow-up (LTFU) for adolescents treated with the FITNET program were investigated.
METHODS: The study was an LTFU of participants of the FITNET trial. Data were completed for 112 (88.2%) of 127 approached FITNET study participants. Primary outcomes were fatigue severity (Checklist Individual Strength–20), physical functioning (87-item Child Health Questionnaire), and school/work attendance.
RESULTS: After a mean follow-up of 2.7 years, 66 (58.9%) adolescents had recovered from CFS. Most adolescents who recovered directly after treatment with FITNET were still recovered at LTFU. At LTFU there was no difference between the recovery rates for the different treatment strategies (original randomization: FITNET [64%] versus any form of usual care [52.8%]). Per additional month of “pretreatment disease duration,” the odds for recovery were 4% lower (odds ratio: 0.96; 95% confidence interval: 0.93–0.99; P = .016), and per added point on “focus on bodily symptoms” (Body Consciousness Scale) of the mother (0–20 points) the odds for recovery were 11% lower (odds ratio: 0.89; 95% confidence interval: 0.80–0.99; P = .029).
CONCLUSIONS: The short-term effectiveness of Internet-based CBT on adolescent CFS is maintained at LTFU. At LTFU, usual care led to similar recovery rates, although these rates were achieved at a slower pace.
Internet-Based Therapy for Adolescents With Chronic Fatigue Syndrome: Long-term Follow-up SL Nijhof et al Pediatrics 2012-2007
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Fatigue associated with daily cytokine fluctuations
Abstract
Background
Chronic fatigue syndrome (CFS) is a debilitating disorder characterized by persistent fatigue that is not alleviated by rest. The lack of a clearly identified underlying mechanism has hindered the development of effective treatments. Studies have demonstrated elevated levels of inflammatory factors in patients with CFS, but findings are contradictory across studies and no biomarkers have been consistently supported. Single time-point approaches potentially overlook important features of CFS, such as fluctuations in fatigue severity. We have observed that individuals with CFS demonstrate significant day-to-day variability in their fatigue severity.
Methods
Therefore, to complement previous studies, we implemented a novel longitudinal study design to investigate the role of cytokines in CFS pathophysiology. Ten women meeting the Fukuda diagnostic criteria for CFS and ten healthy age- and body mass index (BMI)-matched women underwent 25 consecutive days of blood draws and self-reporting of symptom severity. A 51-plex cytokine panel via Luminex was performed for each of the 500 serum samples collected. Our primary hypothesis was that daily fatigue severity would be significantly correlated with the inflammatory adipokine leptin, in the women with CFS and not in the healthy control women. As a post-hoc analysis, a machine learning algorithm using all 51 cytokines was implemented to determine whether immune factors could distinguish high from low fatigue days.
Results
Self-reported fatigue severity was significantly correlated with leptin levels in six of the participants with CFS and one healthy control, supporting our primary hypothesis. The machine learning algorithm distinguished high from low fatigue days in the CFS group with 78.3% accuracy.
Conclusions
Our results support the role of cytokines in the pathophysiology of CFS.
Daily cytokine fluctuations, driven by leptin, are associated with fatigue severity in chronic fatigue syndrome: evidence of inflammatory pathology Elizabeth Ann Stringer et al
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29% of children with CFS suffer significant psychological distress
Abstract
Objective To describe the prevalence of depression in children with chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) and investigate the relationship between depression in CFS/ME and clinical symptoms such as fatigue, disability, pain and school attendance.
Design Cross-sectional survey data using the Hospital Anxiety and Depression Scale (HADS) collected at assessment.
Setting Specialist paediatric CFS/ME service in the South West of England.
Patients Children aged 12–18 years with CFS/ME.
Main outcome measure Depression was defined as scoring >9 on the HADS depression scale.
Results 542 subjects had complete data for the HADS and 29% (156/542) (95% CI 25% to 33%) had depression. In a univariable analysis, female sex, poorer school attendance, and higher levels of fatigue, disability, pain, and anxiety were associated with higher odds of depression. Age of child and duration of illness were not associated with depression. In a multivariable analysis, the factors most strongly associated with depression were disability, with higher scores on the physical function subscale of the 36 item Short Form (SF-36).
Conclusions Depression is commonly comorbid with CFS/ME, much more common than in the general population, and is associated with markers of disease severity. It is important to screen for, identify and treat depression in this population.
Depression in pediatric chronic fatigue syndrome. Archives of Disease in Childhood doi:10.1136/archdischild-2012-303396. Helen Bould, Simon M Collin, Glyn Lewis, Katharine Rimes, Esther Crawley
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Does the energy envelope theory improve function?
Abstract
Objective/Hypothesis: The objective of this study was to examine sub-types of individuals with chronic fatigue syndrome based on variables that are associated with the energy envelope theory and to examine the role of coping strategies in explaining the differences found between the subtypes.
Methods: Cluster analysis was used. Grouping variables included physical functioning, post-exertional malaise severity, and the extent to which an individual was outside of the energy envelope. These clusters were evaluated using discriminant function analysis to determine whether they could be differentiated based on coping styles.
Results: Cluster analysis identified three groups. Clusters 1 and 2 were consistent with the energy envelope theory. However, Cluster 3 was characterized by patients with the most impairment, but they were to a lesser extent exceeding their energy envelope. Coping strategies explained a small percentage (10%) of the variance in differentiating the clusters.
Discussion: Energy maintenance may be associated with improved functioning and less severe symptoms for some. However, patients in Cluster 3 were closer to remaining within their energy envelope and also used higher levels of adaptive coping but were more impaired than Cluster 2. This suggests that adaptive coping strategies were not associated with improved health, as members of Cluster 3 were severely limited in functioning.
Examining the energy envelope and associated symptom patterns in chronic fatigue syndrome: does coping matter? Brown AA, Evans MA, Jason LA Chronic Illness 2013 Apr 12. [Epub ahead of print]
Energy Conservation/Envelope Theory Interventions to Help Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Jason LA et al Fatigue. 2013 Jan 14;1(1-2):27-42
Energy Conservation/Envelope Theory Interventions to Help Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
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Couples’ experiences of interacting with others in CFS: a qualitative study
Abstract
Objectives: Social isolation and stigma are frequently reported by patients with chronic fatigue syndrome/myalgic encephalomyelitis and relationships in the home environment with those close to the patients (their ‘significant others’) may thus be particularly important. Rather little attention has yet been paid to the beliefs and experiences of ‘significant others’ themselves in this context. This study sought to explore in-depth the beliefs and experiences of both patients and ‘significant others’ in relation to chronic fatigue syndrome/myalgic encephalomyelitis.
Methods: In-depth interviews using a semi-structured interview schedule designed around the core constructs of the Common-Sense Model of self-regulation were conducted with two patients with chronic fatigue syndrome/myalgic encephalomyelitis and their spouses. Interpretative Phenomenological Analysis was used to analyse interview data.
Results: Experiences of social interactions in relation to chronic fatigue syndrome/myalgic encephalomyelitis with others outside of the relationship dyad emerged as a key issue for all participants when reflecting on their experiences of living with the condition. These concerns are presented under two themes: interactions with healthcare professionals and interactions with the social world.
Conclusions: It is evident that significant others play an important role in the lived experience of chronic fatigue syndrome/myalgic encephalomyelitis. For both patients and significant others, the wider social world and interactions with outside others may be important influences on dyadic coping in chronic fatigue syndrome/myalgic encephalomyelitis. Both future research and treatment interventions could usefully include a ‘significant other’ perspective.
Couples’ experiences of interacting with outside others in chronic fatigue syndrome: a qualitative study. Joanna Brooks, Nigel King, Alison Wearden Chronic Illness April 12, 2013 [Epub ahead of print]
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Ginseng can improve fatigue
Abstract
The present study investigated the antifatigue effects of Panax ginseng C.A. Meyer in 90 subjects (21 men and 69 women) with idiopathic chronic fatigue (ICF) in a randomised, double-blind, placebo-controlled and parallel designed trial.
A bespoke 20% ethanol extract of P. ginseng (1 g or 2 g day–1) or a placebo was administered to each group for 4 weeks, and then fatigue severity was monitored using a self-rating numeric scale (NRS) and a visual analogue scale (VAS) as a primary endpoint. Serum levels of reactive oxygen species (ROS), malondialdehyde (MDA), total glutathione (GSH) contents and glutathione reductase (GSH-Rd) activity were determined.
After 4-week, P. ginseng administration decreased the total NRS score, but they were not statistically significant compared with placebo (P>0.05). Mental NRS score was significantly improved by P. ginseng administrations as 20.4±5.0 to 15.1±6.5 [95% CI 2.3~8.2] for 1 g and 20.7±6.3 to 13.8±6.2 [95% CI −0.1~4.2] for 2 g compared with placebo 20.9±4.5 to 18.8±2.9 [95% CI 4.1~9.9, P<0.01].
Only 2 g P. ginseng significantly reduced the VAS score from 7.3±1.3 to 4.4±1.8 [95% CI 0.7~1.8] compared with the placebo 7.1±1.0 to 5.8±1.3 [95% CI 2.2 ~3.7, P<0.01]. ROS and MDA levels were lowered by P. ginsengcompared to placebo. P. ginseng 1 g increased GSH concentration and GSH-Rd activity.
Our results provide the first evidence of the antifatigue effects of P. ginseng in patients with ICF, and we submit that these changes in antioxidant properties contribute in part to its mechanism.
Antifatigue Effects of Panax ginseng C.A. Meyer: A Randomised, Double-Blind, Placebo-Controlled Trial, by Hyeong-Geug Kim et al in PLoS ONE April 2013 8(4): e61271
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Biological breakthrough reported
The TIMES newspaper reported on the launch of the UK CFS/ME Research Collaborative (UK CMRC) on 23 April 2013:
Scientists have found compelling new evidence of an underlying biological cause for the constant fatigue suffered by ME patients.
The study revealed abnormalities in the muscle cells of ME patients, which are likely to contribute to feelings of tiredness and the inability to cope with sustained physical activity that many experience.
An analysis of muscle biopsies suggested that the cells had undergone substantial changes, making them less able to cope with exertion.
The finding shows that, whatever the initial trigger for ME, which affects more than 600,000 in Britain, the condition leads to a cascade of physical changes right down to the cellular level.
Some patients still report facing stigma due to popular misconceptions that the condition is “all in the mind”, despite growing evidence that ME has real physical symptoms.
Julia Newton, Dean for Clinical Medicine at Newcastle University who led the study, said that the latest science was changing “people’s perception of this terrible symptom”.
Professor Newton presented the findings at a meeting in London yesterday marking the launch of a collaboration aimed at generating more research into the disease.
In the study, scientists took muscle biopsies from ten patients and ten healthy but sedentary volunteers.
The muscle cells were grown into small pieces of muscle and then subjected to “exercise” in the form of electrical impulses.
The cells from ME patients produced on average 20 times as much acid when exercised, suggesting an underlying cause for the aching muscles that patients often experience as soon as they begin to exercise.
The cells also showed other abnormalities, such as reproducing more slowly.
“We have found very real abnormalities”, said Professor Newton.
Times article: Biological breakthrough offers fresh hope for ME sufferers
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Monitoring cytokines
Cytokines have been identified as playing a key role in the dysfunction found in ME.
Abstract
Serum and intracytoplasmic cytokines are mandatory in host defense against microbes, but also play a pivotal role in the pathogenesis of autoimmune diseases by initiating and perpetuating various cellular and humoral autoimmune processes.
The intricate interplay and fine balance of pro- and anti-inflammatory processes drive, whether inflammation and eventually organ damage will occur, or the inflammatory cascade quenches.
In the early and late, as well as inactive and active stages of autoimmune diseases, different cellular and molecular patterns can dominate in these patients. However, the simultaneous assessment of pro- and anti-inflammatory biomarkers aids to define the immunological state of a patient.
A group of the most useful inflammatory biomarkers are cytokines, and with increasing knowledge during the last decade their role have been well-defined in patients with autoimmune diseases and immunodeficiencies.
Multiple pathological processes drive the development of autoimmunity and immunodeficiencies, most of which involve quantitative and qualitative disturbances in regulatory cells, cytokine synthesis and signalling pathways.
The assessment of these biomarkers does not aid only in the mechanistic description of autoimmune diseases and immunodeficiencies, but further helps to subcategorize diseases and to evaluate therapy responses.
Here, we provide an overview, how monitoring of cytokines and regulatory cells aid in the diagnosis and follow-up of patients with autoimmune diseases and immunodeficiencies furthermore, we pinpoint novel cellular and molecular diagnostic possibilities in these diseases.
Assessment of intracellular cytokines and regulatory cells in patients with autoimmune diseases and primary immunodeficiencies – novel tool for diagnostics and patient follow-up, by LT Osnes, B Nakken, E Bodolay, P Szodoray in Autoimmune Reviews, 12 August 2013 [Epub 2013 Mar 26]
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