RESUMEN
PURPOSE: To see if self-reported exposures were associated with health in early-onset Gulf War illnesses (GWIs) cases and healthy Gulf War veteran controls. METHODS: Forty-nine cases and 44 controls completed questionnaires about wartime exposures and symptoms experienced. Odds ratios were calculated using 2 x 2 tables and logistic regression. The incubation curve of fatigue onsets in cases was drawn to highlight exposure/health associations using Sartwell's method and tested with the Shapiro-Wilk test. The incubation period was defined as the time from arrival in the Persian Gulf to fatigue onset. RESULTS: The incubation curve was right skewed and lognormally distributed (p = 0.48; p > 0.05 indicates lognormality), suggesting an association between a wartime exposure and fatigue. Exposure to oil fire smoke, pesticides, contaminated food or water, dead animals, scud missile attacks, dead bodies, prisoners of war, artillery or small arms fire, and chemical suits was significantly associated with GWIs. Pyridostigmine bromide (PB) was the only continuous exposure significantly associated with GWIs. The odds of having GWIs increased by 1.3% for every PB pill taken (95% confidence interval 1.001-1.02). There were significant trends toward worse health with greater intake of PB. CONCLUSIONS: These analyses suggest that wartime exposures, including exposure to PB, are associated with fatigue.
Asunto(s)
Exposición a Riesgos Ambientales , Fatiga , Síndrome del Golfo Pérsico/epidemiología , Tiempo de Reacción , Veteranos , Adulto , Estudios de Casos y Controles , Exposición a Riesgos Ambientales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Personal Militar , Oportunidad Relativa , Bromuro de Piridostigmina/efectos adversos , Encuestas y Cuestionarios , Estados UnidosAsunto(s)
Síndrome de Fatiga Crónica/epidemiología , Hipotensión Ortostática/epidemiología , Taquicardia/epidemiología , Estudios de Casos y Controles , Comorbilidad , Síndrome de Fatiga Crónica/diagnóstico , Femenino , Humanos , Hipotensión Ortostática/diagnóstico , Masculino , Prevalencia , Valores de Referencia , Medición de Riesgo , Sensibilidad y Especificidad , Taquicardia/diagnóstico , Pruebas de Mesa InclinadaRESUMEN
AIMS: We hypothesized that family history of fainting is a risk factor for adult-onset neurally mediated hypotension (NMH) in patients who present with chronic fatigue rather than fainting. METHODS AND RESULTS: A nested case-control study of Gulf War veterans gathered fainting histories directly from 197 first-degree relatives of 16 fatigued NMH cases, 26 fatigued controls, and 17 healthy controls. NMH status was determined by tilt testing. Female relatives of fatigued controls reported more fainting than female relatives of cases (P<0.01); there were no significant differences in the frequency of fainting in male relatives by case or control status, or in either gender by age at first faint or by familial relationship to the proband. The odds of NMH patients giving any family history of fainting were 0.56 (95% CI 0.15, 2.07). Recurrence risks calculated using lifetime prevalences of fainting in male military personnel of similar age to our participants were low (1.5-1.7) and did not differ by case or control status. CONCLUSION: Family history of fainting is not a risk factor for adult-onset NMH in fatigued veterans. Our findings may differ from other studies of familial aggregation in NMH because of study methods or because NMH-fatiguers may differ from NMH-fainters.
Asunto(s)
Fatiga/complicaciones , Hipotensión/etiología , Síncope/genética , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Factores de Riesgo , VeteranosAsunto(s)
Hipotensión/fisiopatología , Síndrome del Golfo Pérsico/fisiopatología , Taquicardia/fisiopatología , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Hipotensión/etiología , Masculino , Persona de Mediana Edad , Síncope , Taquicardia/etiología , Pruebas de Mesa Inclinada , VeteranosRESUMEN
OBJECTIVE: To determine whether there is an association between hypotension and incident cases of idiopathic chronic fatigue. DESIGN: A prospective study. SETTING: Johns Hopkins Precursors Study. PARTICIPANTS: Medical students (n = 876) in graduating classes from 1948 to 1964. MAIN OUTCOME MEASURE: 'Easy fatigability' reported by participants at 5- or 10-year follow-up after graduation. RESULTS: The unadjusted risk in women was 5.0 (95% exact confidence interval = 1.4 to 17.4) and in men was 1.7 (95% exact confidence interval = 0.8, to 3.5). CONCLUSION: These preliminary findings suggest that hypotension may be a risk factor for the development of idiopathic chronic fatigue in women.
Asunto(s)
Fatiga/complicaciones , Hipotensión/fisiopatología , Adulto , Intervalos de Confianza , Fatiga/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Hipotensión/epidemiología , Incidencia , Modelos Lineales , Estudios Longitudinales , Masculino , Estudios Prospectivos , Factores de Riesgo , Factores Sexuales , Fumar/efectos adversos , Estudiantes de Medicina/estadística & datos numéricos , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
BACKGROUND AND PURPOSE: During head-up tilt (HUT), patients with chronic fatigue syndrome (CFS) have higher rates of neurally mediated hypotension (NMH) and postural tachycardia syndrome (POTS) than healthy controls. The authors studied whether patients with CFS were also more likely to have abnormal cerebral blood flow velocity (CBFV) compared with controls in response to orthostatic stress. METHODS: Transcranial Doppler monitoring of middle cerebral artery (MCA) CBFV was performed during 3-stage HUT prospectively in 26 patients with CFS and 23 healthy controls. At the same time, continuous monitoring of arterial blood pressure (BP), heart rate (HR), endtidal CO2 (ET-CO2) were performed. Results are reported as mean +/- SD. RESULTS: NMH developed in 21 patients with CFS and in 14 controls (P = .22). POTS was present in 9 CFS patients and 7 controls (P = .76). Supine HR was higher in CFS patients, but all other hemodynamics and CBFV measures were similar at baseline. The median time to hypotension did not differ, but the median time to onset of orthostatic symptoms was shorter in those with CFS (P < .001). The CBFV did not differ between groups in the supine posture, at 1 or 5 minutes after upright tilt, at 5 or 1 minute before the end of the test, or at termination of the test. Mean CBFV fell at termination of tilt testing in those with CFS and controls. ET-CO2 was lower at termination of the test in those with CFS versus controls (P = .002). CONCLUSIONS: The results of this study are not consistent with the hypothesis that patients with CFS have a distinctive pattern of MCA CBFV changes in response to orthostatic stress.