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Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS) are serious, debilitating conditions that affect millions of people in the United States and around the world. ME/CFS can cause significant impairment and disability. Despite substantial efforts by researchers to better understand ME/CFS, there is no known cause or effective treatment. Diagnosing the disease remains a challenge, and patients often struggle with their illness for years before an identification is made. Some health care providers have been skeptical about the serious physiological - rather than psychological - nature of the illness. Once diagnosed, patients often complain of receiving hostility from their health care provider as well as being subjected to treatment strategies that exacerbate their symptoms.
Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome proposes new diagnostic clinical criteria for ME/CFS and a new term for the illness - systemic exertion intolerance disease(SEID). According to this report, the term myalgic encephalomyelitis does not accurately describe this illness, and the term chronic fatigue syndrome can result in trivialization and stigmatization for patients afflicted with this illness. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome stresses that SEID is a medical - not a psychiatric or psychological - illness. This report lists the major symptoms of SEID and recommends a diagnostic process.One of the report's most important conclusions is that a thorough history, physical examination, and targeted work-up are necessary and often sufficient for diagnosis. The new criteria will allow a large percentage of undiagnosed patients to receive an accurate diagnosis and appropriate care.
Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome will be a valuable resource to promote the prompt diagnosis of patients with this complex, multisystem, and often devastating disorder; enhance public understanding; and provide a firm foundation for future improvements in diagnosis and treatment.
eBook
0481 Impact of Lemborexant on Fatigue Severity in Subjects with Clinically Significant Levels of Fatigue at Baseline
Abstract
Introduction
In Phase 3 SUNRISE-1 (NCT02783729; E2006-G000-304) and SUNRISE-2 (NCT02952820; E2006-G000-303), lemborexant (LEM) provided significant benefit versus placebo on sleep diary-based sleep onset/maintenance outcomes over 1mo and 6mo, respectively, in subjects with insomnia disorder. The impact of LEM on patient-reported fatigue, assessed using the Fatigue Severity Scale (FSS), in subjects with clinically significant fatigue (CSF) at baseline was examined for each study.
Methods
SUNRISE-1 was a 1mo, randomized, double-blind, placebo- and active-controlled, parallel-group study in female (≥55y) and male (≥65y) subjects (n=1006); subjects received placebo, LEM 5mg (LEM5), LEM 10mg (LEM10) or zolpidem tartrate extended-release (not reported here). SUNRISE-2 was a 12mo, randomized, double-blind study in subjects age ≥18y (n=949). Subjects received placebo, LEM5, or LEM10 for 6mo. Placebo subjects were rerandomized to LEM5 or LEM10 for another 6mo; LEM subjects continued assigned treatment. CSF was defined as FSS total score (FSSts) ≥36.
Results
In subjects with baseline CSF, in SUNRISE-1, baseline FSSts was 46.8, 46.5, and 46.6 in placebo (n=117), LEM5 (n=157), and LEM10 (n=153) groups, respectively, and, in SUNRISE-2, was 45.7, 46.4, and 45.8 in placebo (n=169), LEM5 (n=181), and LEM10 (n=173) groups, respectively. At 1mo, mean changes from baseline in FSSts were not significantly different vs placebo for LEM5 in both studies, and for LEM10 in SUNRISE-1. In SUNRISE-2, LEM10 significantly decreased mean [SD] FSSts from baseline vs placebo at 1mo (LEM10, −11.2[13.9] vs placebo, −8.7[10.5]; P=0.03). By 6mo in SUNRISE-2, both LEM5 and LEM10 significantly decreased mean [SD] FSSts from baseline versus placebo (LEM5, −15.4[13.8]; LEM10, −15.0[14.2] vs placebo, −11.2[11.6]; both P<0.05). At 12mo, mean [SD] FSSts improvements were sustained for LEM5 (−20.4[12.8]) and LEM10 (−18.1[14.7]).
Conclusion
In subjects with CSF, longer treatments (>1mo) may be needed to observe significant FSSts improvements, which were evident at 6mo and sustained at 12mo with continuous LEM treatment.
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Journal Article
The Handbook of Operator Fatigue
Fatigue is a recognized problem in many facets of the human enterprise. It is not confined to any one area of activity but enters all situations in which humans have to perform for extended intervals of time. Most problematic are the circumstances in which obligatory action is continuous and the results of failure are evidently serious or even catastrophic. Therefore, the modern media especially highlights fatigue-related failures in industries such as transportation, materials processing and healthcare. It can be, and indeed is, no coincidence that most of the spectacular failures in process control that have resulted in the world's largest industrial accidents have occurred in the small hours of the morning when the circadian rhythm is lowest and operator fatigue itself peaks. While there have been legislative efforts made at state, federal and international levels to regulate working hours of employees, the appropriate implementation of such legislation is still a long way off. The Handbook of Operator Fatigue provides a comprehensive account of the subject to serve as the definitive reference work for researchers, students and practitioners alike. The volume features 30 chapters written by experts from around the world to address each important facet of fatigue, including: the scale of the fatigue problem (Section I), the nature of fatigue (Section II), how to assess fatigue (Section III), the impact of fatigue on health (Section IV), fatigue in the workplace (Section V), the neurological basis of fatigue (VI), sleep disorders (VII), and the design of countermeasures to fatigue (VIII).
eBook
The Perrin technique : how to beat chronic fatigue syndrome/ME
After many years of careful study coupled with practical hands-on experience, Perrin has arrived at the firm conclusion that M.E. is a structural disorder with definite diagnosable physical signs. This technique gives you the chance to take charge of your own structural health and rid yourself of years of toxin build-up.
Book
163 Alteration of dynamic postural control of lower extremity after fatigue
BackgroundSince majority of lower extremity injury occur in the second half accompanying muscle fatigue specifically in soccer, fatigue effect on the lower extremity biomechanics during dynamic task may be investigated thoroughly.ObjectiveTo investigate the effect of fatigue induced by functional fatigue protocol on lower extremity neuromuscular control.DesignPretest-posttest control group design.SettingLaboratory.Participants24 physically active males (age 28.08±4.29 years; height 178.17±5.59 cm; mass 80.33±9.26 kg; BMI 25.25±2.09 kg/m2) without any history of musculoskeletal injuries volunteered.InterventionsFatigue protocol including forward running, L-shaped running, running in various directions, and jump tasks were developed and used to induce fatigue.Main outcome measurements3D kinematics and kinetics of each lower extremity joint were measured in dominant leg during drop vertical jump task. A paired t-test was performed to analyze pre-post effect.ResultsFlexion angle of the hip at initial contact [(IC), (pre: 44.8°±8.16°, post: 40.2°±6.65°)], at peak vertical ground reaction force [(PVGRF), (pre: 55.36°±9.21°, post: 49.25°±8.34°)], and at 30° of knee flexion (pre: 45.77°±8.31°, post: 42.42°±6.58°) decreased. Flexion angle of the knee at IC (pre: 27.24°±8.74°, post: 23.21°±8.97°) and at PVGRF (pre: 52.86°±10.01°, post: 43.17°±11.41°) decreased. Maximum dorsiflexion angle of the ankle (pre: 34.99°±4.71°, post: 31.36°±4.03°) increased and dorsiflexion angle of the ankle at PVGRF (pre: 10.42°±6.17°, post: 6.85°±6.02°) increased. PVGRF (unit: N/body weight) (pre: 2.49±.56, post: 3.29±.78) increased after fatigue.ConclusionsResults showed a tendency of stiffer and more upright landing strategy which resulted in a greater impact on the lower extremity during landing after fatigue. These biomechanical changes due to fatigue may be considered as a risk factor of lower extremity injury. Therefore, first, a less stiffer landing strategy need to be trained, second, muscle endurance training may be an important intervention to prevent traumatic knee injury after fatigue.
Journal Article