Functional status,neuropsychological functioning,and mood in chronic fatigue syndrome (CFS): relationship to psychiatric disorder

Individuals with chronic fatigue syndrome (CFS) face chronic physical debilitation, reduced neuropsychological functioning, and changes in emotional well-being that significantly detract from quality of life. The role of psychiatric disturbance in reducing quality of life in CFS remains unclear. In the current investigation, the role of psychiatric status in reducing health-related quality of life in CFS was examined. Four subject groups were compared on measures of functional well-being, mood, and neuropsychological status: individuals with CFS and no history of psychiatric illness, individuals who had current symptoms of psychiatric illness that began after their CFS diagnosis, individuals who had current symptoms of psychiatric illness that began before their CFS diagnosis, and a healthy sedentary control group. Overall, it was found that individuals with CFS suffer from profound physical impairment. Concurrent psychiatric illness, however, did not adversely affect physical functional capacity. Physical functional capacity was not worse in individuals with a concurrent psychiatric illness. As expected, concurrent psychiatric illness was found to reduce emotional well-being. Moreover, individuals with a psychiatric illness that predated the onset of CFS suffered the greatest emotional distress. Thus, an individual's psychiatric history should be considered when attempting to understand the factors maintaining disability in CFS.     

Current status of genetic testing for colorectal cancer susceptibility

Over 130,000 new cases of colon cancer are diagnosed annually. Approximately 20% to 30% of these are attributable to familial risk, and 3% to 5% belong to a hereditary colorectal cancer predisposition syndrome. Recent discoveries of the genes responsiblefor the inherited colorectal cancer conditions have expanded the field of commercial genetic testing. Health-care providers who use genetic testing in clinical practice are aware of the benefits that genetic testing can confer on screening, prevention, and treatment options for patients with a personal and/or family history of colon cancer. When genetic test results are correctly interpreted, the information they provide can offer medical guidance for the entire family. The psychological impact, however, of presymptomatic testing can be multifaceted. There are unprecedented benefits but also complex issues surrounding genetic testing. For these reasons, the practice of offering genetic testing to individuals at high risk for colon cancer is heavily fortified with guidelines and recommendations. This review covers the current availability and limitations of genetic testing for inherited colorectal cancer syndromes and focuses on guidelines that address the psychological, ethical, and social concerns stemming from genetic testing.     

Waist circumference predicts cardiovascular risk in young Australian children

Aim: It has been shown that compared with healthyweight children, overweight and obese primary school‐aged children have a higher incidence of hyperinsulinism, dyslipidaemia and hypertension. It is therefore important to investigate clinically relevant markers of cardiovascular risk in children. Waist circumference is a simple, non‐invasive anthropometric measure, but its association with cardiovascular risk profile in young Australian children is not clear. Methods: This study presents cross‐sectional data from the Growth and Development Study. The sample included 70 healthy weight children, 50 overweight children and 28 obese children (n = 148, 9.6 ± 1.9 years). All children had a medical assessment which included a physical examination (waist circumference, blood pressure), and investigations including glycated haemoglobin, total cholesterol, high‐density lipoprotein, low‐density lipoprotein, triglycerides, insulin, glucose and total homocysteine levels. An oral glucose tolerance test was performed in a subgroup of children (n = 119). Body mass index (BMI) was determined and BMI Z‐scores calculated. Results: In a multilevel model, waist circumference was the only significant anthropometric predictor of lipid profile (high‐density lipoprotein β = ?0.01, P < 0.05; triglycerides β = 0.01, P < 0.005), systolic blood pressure (β = 0.29, P < 0.05), fasting insulin (β = 0.16, P < 0.005), insulin concentrations throughout the oral glucose tolerance (60 min β = 1.07, P < 0.005; 120 min β = 1.42, P < 0.001) and insulin resistance (homeostasis model assessment (HOMA‐IR): β = 0.03, P < 0.05), with increasing waist circumference associated with increasing cardiovascular risk. In contrast, BMI Z‐score was only predictive of 120‐min glucose concentrations during the OGTT (β = 0.34, P < 0.05). Conclusions: Waist circumference is a better anthropometric indicator than BMI Z‐score of cardiovascular risk in Australian primary school‐aged children. Even in young children, measurement of waist circumference represents a simple, non‐invasive screening tool to identify children with an increased cardiovascular risk profile.     

Older, Hypertensive, and Hypercholesterolemic Fairgoers Visit more Booths and Differ in Their Health Concerns at a Community Health Fair

The purpose of this study was to determine whether persons attending a community health fair had different health concerns and booth visitation patterns based on their risk factor profiles. All fairgoers were encouraged to complete an anonymous survey of demographic information, top 4 health concerns, and selected cardiac risk factors. Over the five-hour duration of the fair, 329 surveys were collected from about 450 fairgoers. There were no exclusion criteria for the survey. The fair was sponsored by the Maryland Chapter of the American College of Physicians, organized by medical students from the University of Maryland and Johns Hopkins University, and included 23 booths on a variety of health topics. Older fairgoers and fairgoers with a self-reported history of high blood pressure or elevated cholesterol showed an increased interest in hypertension and heart disease (p < 0.05). Older fairgoers also showed an increased interest in health topics related to aging, such as estrogen replacement therapy and geriatric medicine. Older, hypertensive and hypercholesterolemic fairgoers visited an increased mean number of total booths when compared to other respondents (p < 0.05). Most booths reported a higher percentage of older, hypertensive, and hypercholesterolemic visitors than the overall percentage of fairgoers who reported these risk factors. These results suggest that booth visitation patterns of health fair participants may be viewed as a deliberate attempt by at-risk populations to access health information particular to their needs.     

Precision and accuracy of an ankle-worn accelerometer-based pedometer in step counting and energy expenditure

BACKGROUND: Walking is a widely used approach to increase physical activity levels in obese patients. In this paper, we investigate the precision and accuracy of an ankle-worn dual-axis accelerometer (Stepwatch) and investigate its potential application as a predictor of energy expenditure. METHODS: Twenty healthy subjects (10 lean, 10 obese) wore spring-levered (Accusplit), piezoelectric (Omron HF-100), and Stepwatch pedometers. Subjects walked on a treadmill at 1, 2, and 3 mph and in a hallway at 1 and 1.85 mph, during which energy expenditure was measured. RESULTS: The Stepwatch counted 99.7 +/- 0.67% (mean +/- SEM) of the manual counts. In comparison, the Omron pedometer counted 61 +/- 3.3% and the Accusplit counted 26 +/- 2.8% of the manual counts at 1 mph although all pedometers were accurate (> 98% of counts) at 3 mph. In repeated measures, the Stepwatch produced negligible variance (SD = 0.36) over all speed whereas the other pedometers showed a large amount of variance at all speed (SD = 4-13). Stepwatch counts were predictive of walking energy expenditure corrected by weight (r2 > 0.8). CONCLUSION: The counts from the Stepwatch were virtually identical to the manual counts from a trained investigator and provided a reliable predictor of walking energy expenditure.     

Effects of exercise and stress management training on markers of cardiovascular risk in patients with ischemic heart disease: a randomized controlled trial

Context  Observational studies have shown that psychosocial factors are associated with increased risk for cardiovascular morbidity and mortality, but the effects of behavioral interventions on psychosocial and medical end points remain uncertain. Objective  To determine the effect of 2 behavioral programs, aerobic exercise training and stress management training, with routine medical care on psychosocial functioning and markers of cardiovascular risk. Design, Setting, and Patients  Randomized controlled trial of 134 patients (92 male and 42 female; aged 40-84 years) with stable ischemic heart disease (IHD) and exercise-induced myocardial ischemia. Conducted from January 1999 to February 2003. Interventions  Routine medical care (usual care); usual care plus supervised aerobic exercise training for 35 minutes 3 times per week for 16 weeks; usual care plus weekly 1.5-hour stress management training for 16 weeks. Main Outcome Measures  Self-reported measures of general distress (General Health Questionnaire [GHQ]) and depression (Beck Depression Inventory [BDI]); left ventricular ejection fraction (LVEF) and wall motion abnormalities (WMA); flow-mediated dilation; and cardiac autonomic control (heart rate variability during deep breathing and baroreflex sensitivity). Results  Patients in the exercise and stress management groups had lower mean (SE) BDI scores (exercise: 8.2 [0.6]; stress management: 8.2 [0.6]) vs usual care (10.1 [0.6]; P = .02); reduced distress by GHQ scores (exercise: 56.3 [0.9]; stress management: 56.8 [0.9]) vs usual care (53.6 [0.9]; P = .02); and smaller reductions in LVEF during mental stress testing (exercise: –0.54% [0.44%]; stress management: –0.34% [0.45%]) vs usual care (–1.69% [0.46%]; P = .03). Exercise and stress management were associated with lower mean (SE) WMA rating scores (exercise: 0.20 [0.07]; stress management: 0.10 [0.07]) in a subset of patients with significant stress-induced WMA at baseline vs usual care (0.36 [0.07]; P = .02). Patients in the exercise and stress management groups had greater mean (SE) improvements in flow-mediated dilation (exercise: mean [SD], 5.6% [0.45%]; stress management: 5.2% [0.47%]) vs usual care patients (4.1% [0.48%]; P = .03). In a subgroup, those receiving stress management showed improved mean (SE) baroreflex sensitivity (8.2 [0.8] ms/mm Hg) vs usual care (5.1 [0.9] ms/mm Hg; P = .02) and significant increases in heart rate variability (193.7 [19.6] ms) vs usual care (132.1 [21.5] ms; P = .04). Conclusion  For patients with stable IHD, exercise and stress management training reduced emotional distress and improved markers of cardiovascular risk more than usual medical care alone.