Biomedical subjects

G Bleijenberg

Publications and source records attributed to G Bleijenberg.

At least 55 records · Page 3Linked to original sources

PubMed2000

Identifying physical activity patterns in chronic fatigue syndrome using actigraphic assessment.

OBJECTIVE: Changes in physical activity are thought to play an important role in maintaining symptoms in chronic fatigue syndrome (CFS). The aim of this study was to describe intraindividual physical activity patterns in more detail and to identify pervasively passive patients. METHODS: With help of a movement-sensing device, physical activity levels were registered continuously over a 12-day period in 277 CFS patients. Within this registration period, the 10 largest activity peaks were computed. The intensity and duration of these activity peaks and their subsequent rest periods were described and compared to those of 47 healthy controls. In addition, the patients' 12 daily activity scores were used to identify patients who were characterised by low levels of physical activity throughout the registration period. RESULTS: The CFS sample had less intense and shorter activity peaks, while the average rest periods that followed these peaks lasted longer. Approximately one-fourth of the CFS sample differed distinctly from the control group and was labelled as pervasively passive. CONCLUSION: The measurements and classification of actual physical activity levels were found to reduce heterogeneity in the CFS population and therefore could provide the opportunity to optimise behavioural intervention protocols for CFS.

Adolescent↗

PubMed2000

Normal carnitine levels in patients with chronic fatigue syndrome.

BACKGROUND: Patients with chronic fatigue syndrome (CFS) complain of muscle pain and impaired exercise tolerance. Previous studies show that this is due to systemic carnitine deficiency. We investigated the hypothesis that carnitine deficiency plays an important role in CFS in female CFS patients and compared their results with neighbourhood controls. METHODS: The level of total carnitine, free carnitine, acylcarnitine and carnitine esters were measured in 25 female CFS patients and 25 healthy matched neighbourhood controls in a blinded fashion. RESULTS: The previously reported decreased level of acylcarnitine in CFS patients was not confirmed. There were also no significant differences in levels of total carnitine, free carnitine and 20 carnitine esters between CFS patients and controls. CONCLUSIONS: The present study demonstrates that serum carnitine deficiency does not contribute to or causes the symptoms in many CFS patients.

Adult↗

PubMed2000

Measurement of prolonged fatigue in the working population: determination of a cutoff point for the checklist individual strength.

In the Netherlands, a large-scale prospective cohort study was started on prolonged fatigue in the working population. The 1st issue that had to be addressed was the determination of a cutoff point for fatigue for use in the working population. Fatigue is measured with the Checklist Individual Strength (CIS), a 20-item self-report questionnaire. This article demonstrates the process of decision making in the determination of the cutoff point. Total CIS scores were calculated, sensitivity and specificity were compared for potential cutoff points, and a receiver operating characteristics analysis was conducted. A CIS total cutoff point for fatigue of >76 was determined, with a specificity of 90% and a sensitivity of 73%. Limitations regarding the use of cutoff points are discussed. It is concluded that the defined cutoff point seems to be appropriate for use in the working population.

Adult↗

PubMed2000

Somatic hypotheses of war syndromes.

Since the end of the American Civil War, unexplained symptoms in military personnel arising after a war or peace mission have frequently been described. The pattern of symptoms is highly similar for all of the various war syndromes although the conditions of each war or peace mission are widely different. Many somatic hypotheses have been formulated to explain these syndromes; a considerable proportion of them are already outdated. In the last few years much attention has been given to Gulf War Syndrome and to unexplained symptoms of military personnel who were sent to Cambodia, Rwanda, Burundi, Zaire, or the former Yugoslavia. In this review the symptoms of war syndromes will be considered in more detail and the suggested somatic explanations will be discussed. During the last decade the following somatic causes have been suggested as possible explanations for these symptoms: (persistent) infection, abnormal immune response, administration of multiple vaccinations within a short period of time, use of malaria chemoprophylaxis, neurological abnormalities, exposure to toxicological substances and environmental factors. The various investigations performed to study these hypotheses are discussed. The fact that bias regularly occurs in the course of these investigations is pointed out. For the future, a reliable investigation of a war syndrome should be a prospective multidisciplinary study and should distinguish between causative and sustaining factors.

Combat Disorders↗

PubMed2000

Fatigue in Cambodia veterans.

In 1992 and 1993, Dutch military personnel were deployed in the peace operation UNTAC in Cambodia. Since returning, Cambodia veterans have reported health complaints which they perceive to be related to their service. Their symptoms strikingly resemble health problems reported by Gulf War veterans. Four years post-return, a cross-sectional survey on health symptoms in Cambodia veterans was initiated. Questionnaires were sent to all Cambodia veterans and four comparison groups. Forgetfulness, difficulty concentrating and fatigue were the symptoms most commonly endorsed. An operational case definition was constructed using a validated fatigue severity questionnaire. Cases were not uniquely found in Cambodia veterans (17%). In Rwanda and Bosnia veterans, respectively, 28% and 11% also met our case definition. Fatigue severity level was predicted by pre-mission, during-mission and post-mission variables, of which retrospective recollection of side-effects of vaccines and causal attributions also have been shown to be relevant in studies on Gulf-related illness.

Adult↗

PubMed2000

Fatigue among working people: validity of a questionnaire measure.

OBJECTIVES: To evaluate the validity of the checklist individual strength questionnaire (CIS) in the working population. This 20 item self reported questionnaire has often been used in patients with chronic fatigue. To date, no research has focused on the validity of the CIS in occupational groups. METHODS: To evaluate the discriminant validity the CIS was filled out by five groups of employees with expected differences in fatigue. The convergent validity was evaluated by comparing the results of the CIS with the results of three related measures: measured unidimensional fatigue, burnout, and need for recovery. RESULTS: The CIS was able to discriminate between fatigued and non-fatigued employees in occupational groups. The expected agreement between the results of the CIS and related measures was confirmed. CONCLUSIONS: The CIS seems to be an appropriate instrument for measuring fatigue in the working population.

Adult↗

PubMed2000

Abnormal neuropsychological findings are not necessarily a sign of cerebral impairment: a matched comparison between chronic fatigue syndrome and multiple sclerosis.

OBJECTIVE: The aim of this study was to assess the potential impact of effort in comparative studies assessing neurocognitive dysfunction in patients with and without a neurologic diagnosis. BACKGROUND: It was hypothesized that a subgroup within a group of patients with prominent neurocognitive complaints but without a neurologic diagnosis would have impaired performance on a task originally designed to detect malingering. METHOD: We compared the neuropsychological performance of a group of 40 patients with a definite diagnosis of multiple sclerosis (MS) with that of 67 patients with chronic fatigue syndrome (CFS). The Amsterdam Short-Term Memory Test, a forced-choice memory task, served as measure to detect submaximal effort. In addition, we administered a regular neuropsychological task generally considered to be sensitive for cognitive deterioration. RESULTS: Compared with the MS group (13%), a larger proportion of the matched CFS group (30%) obtained scores indicative of reduced effort. In contrast, the proportions of patients scoring below the cutoff value on a conventional neuropsychological test did not differ significantly (17% of MS patients and 16% of CFS patients). CONCLUSIONS: The results obtained raise the question of to what extent abnormal test findings in the absence of documented neurologic impairment should be interpreted as a sign of cerebral impairment. The suggestion has been made to screen more often for biased results in comparative research studies so as to enhance valid interpretation of neuropsychological findings.

Adult↗

PubMed1999

[Somatic and psychological symptoms in soldiers after military clashes and peace-keeping missions].

Dutch soldiers who have participated in the peace keeping operation United Nations Transitional Authority in Cambodia (UNTAC) have reported various somatic and psychological symptoms since their return. Their symptoms show similarities to the Gulf War Syndrome. The question arises whether Gulf War Syndrome, symptoms in UNTAC soldiers and other symptoms after acts of war and peace operations are unique syndromes or comparable complaints? From an historical overview it is not plausible that new and unique syndromes will occur with each war or peace operation. On the other hand it also seems unlikely that war syndromes can be reduced to one diagnostic category. The post-Cambodia complaints may be described in four hypothetical models: the somatic start model, the psychotrauma start model, the premorbidity model and the complaints-not-related-to-Cambodia model. These models are expected to be applicable, after further validation, to other symptoms after acts of war and peace operations. Also they will provide points of application for prevention and treatment of symptoms after future wars and peace operations.

Adult↗

PubMed1999

Autonomic function in patients with chronic fatigue syndrome.

Subtle signs of autonomic dysfunction and orthostatic intolerance have been reported in patients with chronic fatigue syndrome (CFS). To assess cardiovascular autonomic function noninvasively in an unselected group of patients with CFS, we examined responsiveness to several cardiovascular reflex tests in 37 CFS patients and 38 healthy control subjects. Blood pressure and heart rate (HR) were recorded continuously by a Finapres device before and during forced breathing, standing up, Valsalva maneuver, and sustained handgrip exercise (HG). In addition, a mental arithmetic test was carried out and questionnaires to assess the severity of CFS symptoms were completed. At rest, there were no significant differences in blood pressure or in HR between the two groups. The in- and expiratory difference in HR tended to be lower in CFS patients (28.4 +/- 10.5 beats) than in healthy controls (32.2 +/- 9.5) (p = 0.11). The maximal increase in HR during standing up was not significantly different between the CFS group (37.6 +/-8.9 beats) and the control group (40.2 +/- 8.9 beats). There were no significant differences between both groups with regard to the Valsalva ratio, but the systolic and diastolic blood pressure responses were significantly larger in CFS patients, despite the fact that many CFS patients were not able to sustain the Valsalva maneuver. The HR response to MA was significantly less in the CFS group (22.6 +/- 9.9) than in the control group (29.5 +/- 16.7) (p < 0.05), suggesting impaired cardiac sympathetic responsiveness to mental stress. The lower HR responses could not be explained by the level of concentration in the CFS group. During HG exercise, the hemodynamic responses were lower in the CFS group than in the control group, but this might be attributed to the lower level of muscle exertion in CFS patients. There were no significant differences between CFS patients with and without symptoms of autonomic dysfunction regarding the hemodynamic responses to the cardiovascular reflex tests. The findings of the study suggest that there are no gross alterations in cardiovascular autonomic function in patients with CFS.

Adult↗

PubMed1999

Cognitive behavior therapy for chronic fatigue syndrome: a case study.

The case of a 26-year old woman with Chronic Fatigue Syndrome (CFS) is presented. Multidimensional assessment showing severe debilitating fatigue and considerable psychological, social and occupational impairment confirmed the diagnosis. Cognitive behavior therapy (CBT) was based on a tested causal model of CFS and individual behavioral analyses. Key elements in CBT were process variables from the CFS model, like sense of control, causal attributions, physical activity and focusing on bodily functions. Goals were recovery from fatigue, returning to work and relapse prevention. The course of therapy is described in detail to illustrate difficulties in treating CFS. Assessments were made five times, at baseline and at 8, 14, 21 and 33 months. Comparison of the pretest, post-test and follow-up scores of the outcome variables, fatigue and functional impairment and of the process variables showed clinically significant improvement from the range of CFS patients to the range of healthy controls.

Adult↗

PubMed1999

Persistent symptoms in former UNTAC soldiers are not associated with shifted cytokine balance.

BACKGROUND: The pathogenesis of post-combat syndromes, such as Gulf War syndrome, is poorly understood. Recently, it has been postulated that the symptoms of veterans with such syndromes are due to a disturbed cytokine balance shifted towards a T-helper (Th) 2 profile. We investigated this hypothesis in 21 symptomatic former UNTAC soldiers and compared their results with those obtained in 21 healthy former UNTAC soldiers matched for age, sex and military force. DESIGN: The numbers of intracellular interleukin 4 (IL-4) and interferon gamma- (IFN-gamma) producing CD4+ and CD8+ T lymphocytes (CD3+) were determined after in vitro stimulation with phorbol myristate acetate and calcium ionophore in the presence of brefeldin to block secretion of induced cytokines. Circulating concentrations and lipopolysaccharide- (LPS) or phytohaemagglutinin- (PHA) stimulated whole-blood production of the proinflammatory cytokines IL-1beta, IL-1ra, tumour necrosis factor alpha (TNF-alpha) and IL-10 and IFN-gamma were measured. RESULTS: The numbers of CD4+ and CD8+ T lymphocytes positive for IL-4 or IFN-gamma production were not significantly different in patients and control subjects. After stimulation with LPS or PHA, the in vivo circulating concentration and concentration of IL-10 and IFN-gamma were also similar. CONCLUSIONS: The present study demonstrates that there is no shift in cytokine balance towards a Th2 profile in former UNTAC soldiers with symptoms similar to those of the Gulf War syndrome.

Adult↗

PubMed1999

Chronic Fatigue Syndrome and Primary Fibromyalgia Syndrome as recognized by GPs.

BACKGROUND: Prevalence studies on Chronic Fatigue Syndrome (CFS) are rare. Because of the similarity in symptoms, the prevalence of Primary Fibromyalgia Syndrome (PFS) was investigated at the same time. OBJECTIVES: To determine the prevalence of CFS and PFS as recognized by GPs in The Netherlands and to inform them of the existence of CFS. METHODS: A postal questionnaire was sent to all GPs. RESULTS: The questionnaire was returned by 60% of the GPs. Seventy-three per cent reported one or more CFS patients and 83% one or more PFS patients in their practice. CONCLUSION: The estimated prevalence of CFS as recognized by GPs of 112 (PFS 157) patients per 100,000 is a minimum estimate.

Adult↗

PubMed1999

[Mediative behavior therapy in complex behavioral problems. Illustrative cases from a psychogeriatric nursing home].

An application in a psychogeriatric nursing home. This article describes the application of mediative behaviour therapy in a psychogeriatric nursing home. Behavioural interventions carried out by the nursing team addressed a variety of problems: quarreling between an institutionalised woman and her visiting husband, complaining about this staff by the husband to team members of another department, and the patient who let herself drop on the floor about once a week. Special regard is given to the analysis of the problems, the learning of appropriate responses by team members, as well as changing their cognitions and emotions about the problem behaviours. A meaningful reduction of the problem behaviours and of the burden experienced by team members was achieved.

Accidental Falls↗

PubMed1998

Fatigue in multiple sclerosis: interrelations between fatigue complaints, cerebral MRI abnormalities and neurological disability.

Although fatigue is a frequent complaint of patients with multiple sclerosis (MS), little is known about the origins of multiple-sclerosis-associated fatigue. Our primary focus was to study if the extent of cerebral abnormalities, as shown on magnetic resonance imaging (MRI), had any relation with the frequency and intensity of fatigue complaints of patients with a definite diagnosis of MS. Fatigue severity was rated by the patients with the use of a 2-week diary and a fatigue questionnaire, while conventional T1- and T2-weighted MRI provided several measures for cerebral abnormalities. In total, 72% of 45 patients reported to be seriously fatigued at least several times a week over the last 3-month period. Fatigue severity was not related to the total extent of cerebral abnormalities, or to MRI-based atrophy measures. Regional lesion load did not differ between fatigued and non-fatigued subjects. Although neurological disability, as measured by the Expanded Disability Status Scale (EDSS) and Neurological Rating Scale (NRS), did correlate significantly with most MRI measures, it showed no relation with fatigue severity. Neurological progression rates and number of exacerbations in the 2-year period prior to assessment were not significantly associated with the fatigue measures. Therefore, our findings suggest that differences in levels of self-reported fatigue in patients with multiple sclerosis cannot merely be explained by the degree of clinical disease activity, neurological disability or the extent of MRI abnormalities. These results are compared to other research findings and the possible role of alternative factors influencing fatigue in multiple sclerosis are discussed.

Adult↗

PubMed1998

[Improved prognosis of functional abdominal complaints by attending to psychic factors].

OBJECTIVE: To determine the assessment by physicians of psychic factors in patients with functional abdominal complaints, and the relationship between the assessment and the evolution of the abdominal complaints. DESIGN: Prospective, descriptive. SETTING: Outpatient Clinic Internal Medicine, University Hospital Nijmegen, the Netherlands. METHODS: 120 patients with functional abdominal complaints were asked to indicate by questionnaires the severity and meaning of their complaints prior to and at the end of the visits to their internist. Internists were asked how they rated the somatic and non-somatic complaint dimensions in their patients. RESULTS: Overall, internists perceived the severity and details of the abdominal complaints correctly. Prognostically unfavourable complaint-related cognitions and emotions were perceived less correctly. During the outpatient consulting period, patients' anxiety and somatic attributions diminished, especially when the internist had perceived these aspects correctly. Six months after the first outpatient visit the abdominal complaints of these reassured patients had improved, compared with patients with persistent somatic attributions; the latter made more frequent use of health care services at follow-up (GP visits, drug use). CONCLUSION: Systematic exploration of somatic and non-somatic complaint dimensions by physicians could be an important tool in improving the prognosis and diminishing the medical consumption in patients with functional abdominal complaints.

Abdominal Pain↗

PubMed1998

The persistence of fatigue in chronic fatigue syndrome and multiple sclerosis: development of a model.

The cause of chronic fatigue syndrome (CFS) is unknown. With respect to factors perpetuating fatigue, on the other hand, a model has been postulated in the literature in which behavioral, cognitive, and affective factors play a role in perpetuating fatigue. In the present study, this hypothesized model was tested on patients with CFS and on fatigued patients with multiple sclerosis (MS). The model was formulated in terms of cause-and-effect relationships and an integral test of this model was performed by the statistical technique, "structural equation modeling," in 51 patients with chronic fatigue syndrome and 50 patients with multiple sclerosis matched for age, gender, and education. Attributing complaints to a somatic cause produced low levels of physical activity, which in turn had a causal effect on fatigue severity. Depression had to be deleted from the model. Sense of control over symptoms and focusing on bodily symptoms each had a direct causal effect on fatigue. The model showed an excellent fit for CFS patients, but was rejected for MS patients. Therefore, a new model for MS patients had to be developed in which sense of control had a causal effect on fatigue. In the MS model, no causal relationship was found between the physical state as measured by the Expanded Disability Status Score (EDSS) and fatigue or functional impairment. The present study shows that cognitive and behavioral factors are involved in the persistence of fatigue. Treatment should be directed at these factors. The processes involved in the subjective experience of fatigue in CFS were different from the processes related to fatigue in MS.

Adult↗

PubMed1998

Yersinia enterocolitica and the chronic fatigue syndrome.

OBJECTIVES: To investigate the potential role of Yersinia enterocolitica in patients with chronic fatigue syndrome (CFS). METHODS: An immunoblot technique was used to detect antibodies to various Yersinia outer membrane proteins (YOPs) in serum samples from 88 patients with CFS and 77 healthy neighbourhood controls, matched for gender and age. RESULTS: The prevalence of IgG and IgA antibodies to various Yersinia outer membrane proteins (YOPs) did not differ between patients with CFS and healthy controls. Twenty-four patients (27%) and nineteen controls (25%) had IgG antibodies to one or more YOPs. Four patients and two controls had both serum IgG and IgA antibodies to at least two different YOPs, compatible with a recent or persistent infection. Although all patients with positive IgG and IgA reactions to two or more YOPs had symptoms that could point to persistent Yersinia infection, these symptoms were also found frequently in patients without antibodies to YOPs. CONCLUSIONS: We conclude that Y. enterocolitica is unlikely to play a major role in the aetiology of CFS.

Adult↗

PubMed1998

Managing patients with irritable bowel syndrome in general practice. How to promote and reinforce self-care activities.

In this paper the development and implementation of a set of guidelines for the management of irritable bowel syndrome (IBS) patients in primary care is presented. The guidelines are based on the knowledge that has emerged from research in the past decade on factors that influence the course and prognosis of IBS. These include lifestyle factors, avoidance behaviour and reaction patterns from family and friends. The guidelines contain elements of psychotherapeutic techniques that have been found to be successful in outpatients with IBS. They comprise instructions to promote and reinforce self-care activities. The guidelines have been applied in daily practice by a group of Dutch general practitioners and various aspects of the feasibility of the guidelines are discussed.

Colonic Diseases, Functional↗