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Predictors of post-infectious chronic fatigue syndrome in adolescents

biophile

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Saw this on Co-Cure (Tate Mitchell).

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Predictors of post-infectious chronic fatigue syndrome in adolescents

Leonard A. Jason*, Ben Z. Katz, Yukiko Shiraishi, Cynthia J. Mears, Young Im & Renee R. Taylor

Health Psychology and Behavioral Medicine: An Open Access Journal
Volume 2, Issue 1, 2014, pages 41-51.

DOI: 10.1080/21642850.2013.869176

Received: 27 Oct 2013
Accepted: 20 Nov 2013
Published online: 02 Jan 2014

Abstract

This study focused on identifying risk factors for adolescent post-infectious chronic fatigue syndrome (CFS), utilizing a prospective, nested case–control longitudinal design in which over 300 teenagers with infectious mononucleosis (IM) were identified through primary care sites and followed. Baseline variables that were gathered several months following IM, included autonomic symptoms, days in bed since IM, perceived stress, stressful life events, family stress, difficulty functioning and attending school, family stress, and psychiatric disorders. A number of variables were predictors of post-infectious CFS at six months; however, when autonomic symptoms were used as a control variable, only days spent in bed since mono was a significant predictor. Step-wise logistic regression findings indicated that baseline autonomic symptoms as well as days spent in bed since mono, which reflect the severity of illness, were the only significant predictors of those who met CFS criteria at six months.

free full-text : http://www.tandfonline.com/doi/full/10.1080/21642850.2013.869176
 
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Bob

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It's nice to see them using a control variable. I don't recall that any other similar CFS studies (that have investigated psycho-social predictors) have used a control variable. I don't understand the methodology, so will be interesting to read the full paper to understand how they designed the control.

It's also nice to see that they have stated that 'days spent in bed' is related to symptom severity and not to maladaptive psycho-social factors (i.e. they don't suggest that it's a maladaptive response to illness, but implicitly suggest that it's an adaptive response.) I can see the psycho-social school twisting this to conclude that chronic fatigue (or CFS) develops only in lazy patients who have a maladaptive reaction to the trigger event (infection), and spend too much time in bed, and therefore patients must never be allowed to malinger in bed however ill they say they are. :rolleyes:
 
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Bob

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I think this answers my question re methodology in relation to the control variable:
Jason et al. said:
Additionally, these predictors were analyzed a second time, while statistically controlling for autonomic symptoms as measured by the ASC [Autonomic Symptoms Checklist], so as to allow for examination of the role of autonomic symptoms which is a measure of baseline illness severity.

Jason et al. said:
Autonomic Symptoms Checklist – Patient Version (ASC) was adapted from the Autonomic Symptom Profile (Suarez et al.,1999), and has been validated for CFS (Newton et al., 2007) and has been used down to age 12 (Biegstraaten, van Schaik, Wieling, Wijburg, & Hollak, 2010). Scoring was decided a priori; items were graded from 1 to 7 and then weighted from 1 to 4. The ASC was selected as a measure of the severity of illness, and it measures different types of autonomic symptoms, which can include problems with the regulation of heart rate, blood pressure, body temperature, perspiration, and bowel and bladder functions, and experiencing fatigue, lightheadedness, feeling faint or passing out, and/or weakness. This measure provides an overall score of deficits in the autonomic domain.

References given, above, in relation to the ASC:

Suarez, G. A., Opfer-Gehrking, T. L., Offord, K. P., Atkinson, E. J., O'Brien, P. C., & Low, P. A. (1999). The autonomic symptom profile: A new instrument to assess autonomic symptoms.Neurology, 52, 523–528. doi: 10.1212/WNL.52.3.523
http://www.ncbi.nlm.nih.gov/pubmed/10025781

Newton, J. L., Okonkwo, O., Sutcliffe, K., Seth, A., Shin, J., & Jones, D. E. J. (2007). Symptoms of autonomic dysfunction in chronic fatigue syndrome. Quarterly Journal of Medicine, 100, 519–526. doi: 10.1093/qjmed/hcm057
http://www.ncbi.nlm.nih.gov/pubmed/17617647

Biegstraaten, M., van Schaik, I. N., Wieling, W., Wijburg, F. A., & Hollak, C. E. M. (2010). Autonomic neuropathy in Fabry disease: A prospective study using the autonomic symptom profile and cardiovas
cular autonomic function tests. BMC Neurology, 10, 38. doi:10.1186/1471-2377-10-38 doi: 10.1186/1471-2377-10-38
http://www.biomedcentral.com/1471-2377/10/38


I'm not familiar with the Autonomic Symptoms Checklist (ASC). It seems to me that such a questionnaire could potentially be very useful in many CFS studies e.g. instead of psychiatric questionnaires. It would be useful to determine whether autonomic (i.e. ASC) scores correlate directly with psychiatric scores in CCC ME patients.

I wonder why it was used in this study, whereas Jason hasn't used it in other CFS studies as a control variable. (I'm particularly thinking of the Jason study in which the conclusion was that ICC ME patients had increased psychiatric comorbidity. But I might have mis-remembered the details of the study.)

Note that the (cited) Newton study seems to investigate the Composite Autonomic Symptom Scale (COMPASS) rather than the Autonomic Symptoms Checklist (ASC). I'm not familiar with either of them.
 
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Bob

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On the down side, this study is looking at predictors for CFS (including: days in bed, perceived stress, stressful life events, family stress, difficulty functioning and attending school, family stress, and psychiatric disorders) which really isn't helpful research.
 

A.B.

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On the down side, this study is looking at predictors for CFS (including: days in bed, perceived stress, stressful life events, family stress, difficulty functioning and attending school, family stress, and psychiatric disorders) which really isn't helpful research.

I think it's a good example how psychology studies can easily get out of control. Without the control variable, the results could be interpreted as supporting the view that CFS correlates with psychosocial factors, and that therefore, the patient is to blame. After the control variable is taken into account, the picture is that of CFS correlating with severity of infection. Big difference! It appears that these authors do not have the anti-reality attitude so prevalent in psychology. At least that's my impression after reading the abstract.
 

alex3619

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What would be really useful is a prospective study following a wide range of immune and other parameters, from pre-illness to about five years sick. We might learn a lot from that. Yet this appears to be a good example of this type of study, though I may say more later when I have read the whole paper.
 

Seven7

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Firestormm

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I think it's a good example how psychology studies can easily get out of control. Without the control variable, the results could be interpreted as supporting the view that CFS correlates with psychosocial factors, and that therefore, the patient is to blame. After the control variable is taken into account, the picture is that of CFS correlating with severity of infection. Big difference! It appears that these authors do not have the anti-reality attitude so prevalent in psychology. At least that's my impression after reading the abstract.

Doesn't severity of infection only relate to number of days spent in bed though - in this context? I mean that's hardly an objective or biomedical measure is it? Surely severity of infection would be best measured by determining the length of time the virus remained present, and the 'strength' of said virus and weakness of the immune system etc. before the patient felt able to rise from bed.
 

A.B.

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Doesn't severity of infection only relate to number of days spent in bed though - in this context? I mean that's hardly an objective or biomedical measure is it? Surely severity of infection would be best measured by determining the length of time the virus remained present, and the 'strength' of said virus and weakness of the immune system etc. before the patient felt able to rise from bed.

I agree with the points you're raising. Severity of illness could be defined much more clearly, but that's a job for doctors. I'm just going with the authors here who seem to define it as days spent since mono.