THURSDAY, Feb. 17 (HealthDay News) — Patients struggling with chronic fatigue syndrome may be helped the most when standard treatment is coupled with cognitive behavior therapy or exercise therapy, new British research suggests.

The apparent promise of cognitive behavior therapy and "graded exercise therapy" offers considerable hope to patients combating the complex condition characterized by profound tiredness, impaired concentration, diminished memory, sleep difficulties and muscle and joint pain, the study authors said.

The findings also support the somewhat controversial notion that incremental adjustments in physical behavior and/or mental attitude can ultimately have a positive impact on the disorder, the authors said.

The standard intervention, known as specialist medical care, is centered around giving patients information about their condition, advice on how to manage symptoms and assistance with coping approaches.

The research team behind the new study found little appreciable benefit with a third alternate therapeutic approach that focuses on helping patients strictly structure their activity and relaxation routines to match their severely reduced energy levels. this strategy, known as "adaptive pacing therapy," assumes that chronic fatigue syndrome is not, in fact, reversible with behavioral changes.

"Patients who received either graded exercise therapy or cognitive behavior therapy reported less fatigue and better function than those who received either adaptive pacing therapy or specialist medical care alone," said study author Dr. Peter D. White, a professor of psychological medicine at Barts and the London School of Medicine, and a psychiatrist at St Bartholomew's Hospital in London.

White and his colleagues report their findings in the Feb. 18 online edition of The Lancet.

The authors noted that it is not yet understood what gives rise to chronic fatigue syndrome (CFS).

The cognitive behavioral therapy targets the building fear and avoidance of activity that can exacerbate CFS. In effect, it seeks to break a vicious cycle in which mental inhibitions actually perpetuate and aggravate the underlying chronic fatigue.

Exercise therapy, also known as "GET," tries to reduce fatigue and disability by gradually helping patients increase their activity levels to improve their overall physical fitness.

To explore which therapies or combinations of therapies might be best, 641 chronic fatigue patients from four different rehabilitation centers in Britain were divided up into one of four groups. over the course of a year, all got standard specialist medical care, while three of the groups received one additional treatment: pacing therapy, cognitive therapy or exercise therapy.

White and his team found the greatest improvements in terms of both fatigue levels and physical function were experienced by those patients who were treated with standard therapy in combination with either cognitive therapy or exercise therapy.

What's more, patients who got a combination of standard treatment and pacing therapy fared no better than those who got standard treatment alone.

Specifically, 60 percent of the standard/cognitive or standard/GET patients experienced fatigue and function improvements, while 30 percent reported "normal levels" of fatigue and function. half as many of the standard therapy alone or standard/pacing patients reported normal fatigue and function levels.

White noted that all the treatments were equally safe, and serious reactions were rare.

"Patients now have a choice of two moderately effective and safe treatments that can help them towards a healthier life," he said.

Dr. Nancy Klimas, chief medical officer at the Chronic Fatigue Center at the University of Miami Miller School of Medicine, noted that the merits of various therapeutic approaches to chronic fatigue syndrome are still a matter of debate.

"But here Dr. White is saying that cognitive behavioral therapy and graded exercise are moderately helpful, but not curative," she said. "and I would agree with that."

"On the other hand, it's also important to note that when we talk about helping patients increase their activity levels, we're talking about people who have very limited amounts of energy," Klimas added. "and you have to work within this 'energy envelope,' because if you push beyond the threshold they will relapse. So often, what we're talking about is about five minutes of exercise before taking a rest."

"In any case, I look at this as a first step," she said, "and anticipate more effective therapies, based on a better understanding of the biology of the illness, in the future."

More information

For more on chronic fatigue syndrome, visit the U.S. Centers for Disease Control and Prevention.

WEDNESDAY, Feb. 23 (HealthDay News) — In a European study that echoes the findings of other scientists, researchers have found that children who grow up on farms are less likely to develop childhood asthma.

The risk of asthma was reduced by as much as 51 percent for children living on farms, and researchers suspect that it's the diversity of exposure to different microbes that may offer protection against the airway disease.

"The risk of asthma decreased with an increase in the diversity of microbial exposure," said study author Dr. Markus Ege, a researcher at Munich University Children's Hospital in Germany.

"Within the microbial spectrum under investigation, several germs with a potential for asthma prevention were identified," he added.

Results of the study are published in the Feb. 24 issue of the New England Journal of Medicine.

Asthma is a chronic lung disease that causes inflammation of the airways. This inflammation narrows the airways, making it difficult to breathe. Symptoms include wheezing, coughing, chest pain and tightness, and shortness of breath, according to the National Heart, Lung, and Blood Institute (NHLBI).

The exact cause of asthma remains unknown. People with a family history of the disease are more likely to develop asthma, suggesting a possible genetic component to the disease. but environmental exposures, such as encountering certain viruses, are also associated with the development of the condition, according to the NHLBI.

Numerous studies have also found that exposure to a variety of microbes in the environment, such as bacteria or fungi, appear to provide protection against asthma, perhaps by helping the body create a tolerance for allergens.

And, other research has found that children living on farms — especially those exposed to cows, pigs and hay — seem to be less likely to have asthma and allergies.

Exactly how exposure to a variety of microbes might protect against asthma is still unclear, researchers noted.

"How these microorganisms reduce the asthma risk remains largely unknown," said Ege. "a combination of environmental microorganisms might stimulate the innate immune system and counterbalance an asthma-prone immune status. Alternatively, the diversity of microbial exposure might prevent specific [disease-causing] microorganisms with an asthma-inducing potential."

The current study assessed the incidence of asthma in children living on farms compared to children without farm exposure in two different groups of youngsters. The researchers also tested dust samples from the children's bedrooms and mattresses to get an idea of what type of microbes the children were regularly exposed to.

The first group of children included 6,843 rural and suburban elementary school children from southern Germany. This study, dubbed PARSIFAL, also included dust samples from 489 children's mattresses. The second study, called GABRIELA, included 9,668 elementary school kids from rural areas of Austria, South Germany and Switzerland. Dust samples were collected from 444 children's bedrooms in this study.

House dust from farm homes had a greater variety of bacteria and fungi, a finding that was statistically related to a lower rate of asthma.

In both study populations, youngsters who lived on farms had lower rates of asthma and allergies, according to the study. In the PARSIFAL group, the risk of asthma was reduced by 51 percent in children living on farms. In GABRIELA, the reduction was 24 percent, according to Ege.

The researchers also found that diversity of microbial exposure lowered the odds of asthma by 38 percent in the PARSIFAL population and by 14 percent in GABRIELA, according to the study.

"not all microbes are detrimental; some are beneficial for asthma and allergies," explained Ege. but, he cautioned that this doesn't mean that dirt or microbes in general should be considered healthy, or that parents should try to deliberately expose their children to microbes.

"there are enormous numbers of different microorganisms which affect human health by various measures and in opposite directions. there are still dangerous infections, which should be prevented by vaccination or treated with antibiotics," Ege stressed.

One expert who wrote an accompanying editorial in the same journal noted that it was "of critical importance" to figure out how microbe exposure affects the biology of the lungs and immune system.

"This study shows that kids who grow up on farms are less likely to develop asthma, but I don't think there's anything that can be applied to treatment right now," said Dr. James Gern, a professor of pediatrics and medicine at the University of Wisconsin School of Medicine and Public Health in Madison.

"As we learn more about what these protective exposures are," he said, "it's possible we could come up with ways to prevent asthma in the future."

More information

Read more about the causes of asthma from the National Heart, Lung, and Blood Institute.

Latest Depression News

TUESDAY, Feb. 8 (HealthDay News) — People whose genetic make-up produces lower levels of a brain molecule called neuropeptide Y (NPY) may be at increased risk for major depression, says a new study.

Previous research has shown that NPY helps people calm down after experiencing stressful events.

This study found that when exposed to negative stimuli, people with gene variations that cause them to produce lower levels of NPY have stronger responses in key brain circuits related to emotion. this means they have less resilience to stress and a stronger psychological response to pain; they were also overrepresented in a population diagnosed with a major depressive disorder, the researchers said.

The study was published Feb. 7 in the Archives of General Psychiatry.

“We’ve identified a biomarker — in this case genetic variation — that is linked with increased risk of major depression,” senior author Dr. Jon-Kar Zubieta, a professor of psychiatry and radiology, and a research professor at the University of Michigan Molecular and Behavioral Neurosciences Institute, said in a university news release.

“This appears to be another mechanism, independent of previous targets in depression research, such as serotonin, dopamine and norepinephrine,” he added.

In the study, researchers used functional magnetic resonance imaging (fMRI) to look at the brain activity of participants as they read neutral words (such as “material”) negative words (“murderer”) or positive words (“hopeful”).

Participants who had lower NPY levels showed lots of activity in the prefrontal cortex, which is involved with processing emotion, compared to those with higher NPY levels.

“This tells us that individuals with the risk-associated NPY gene variant tend to activate this key brain region more than other people, even in the absence of stress and before psychiatric symptoms are present,” said lead study author Dr. Brian Mickey, an assistant professor of psychiatry at the University of Michigan Medical School.

Researchers then injected participants’ jaw muscles with a saline solution that causes brief moderate pain. the level of pain was adjusted for each person until they rated it a 4 on a 10-point scale.

Participants were asked to describe how they felt before and after the injection. Participants in the low NPY group reported more negative emotions both before and after the injection, suggesting they were more emotionally affected while both anticipating and thinking about the painful experience later.

The finding may eventually help with early diagnosis and treatment for depression, including individualized therapies based on a patient’s genetic profile, the researchers said.

– Robert Preidt

Copyright © 2011 HealthDay. All rights reserved.

SOURCE: University of Michigan Health System, news release, Feb. 7, 2011

Latest Cancer News

TUESDAY, Oct. 26 (HealthDay News) — Children who survive cancer face an increased risk for gastrointestinal complications later on, a new study suggests.

The findings highlight the increased need for long-term surveillance of GI problems among childhood cancer survivors, the researchers said.

“Current treatments have dramatically increased survival rates for children with cancer, but we know that many cancer therapies — including surgery, radiation, and chemotherapy — can cause significant gastrointestinal complications for patients,” study senior author Dr. Lisa Diller, director of the Perini Family Survivors Center at the Dana-Farber/Children’s Hospital Cancer Center, said in a Dana-Farber news release.

“Little is known, however, about the long-term GI consequences for childhood cancer survivors,” she added.

The authors examined data on nearly 14,400 childhood cancer survivors. All had been diagnosed with cancer between 1970 and 1986, and all had survived at least five years post-treatment.

Most had undergone chemotherapy, and about one-third radiation, sometimes in combination with chemotherapy.

Patients faced a higher risk for liver complications, such as cirrhosis, gallstones, and jaundice as well. lower GI problems — including colitis, constipation, diarrhea, and intestinal polyps or blockage — also occurred among survivors at a higher rate.

The risks were higher among patients diagnosed with cancer at an older age and who were exposed to more aggressive radiation and/or chemotherapy treatment or more extensive surgery.

The findings prompted the research team to advise physicians to review all GI problems in childhood cancer survivors to see if they could be symptoms of a serious disease. They also encouraged patients to discuss their childhood cancer treatment with doctors when seeking care for GI complications.

Diller and her colleagues were to present the results of their investigation, funded by the National Cancer Institute, at this week’s meeting of the International Society of Paediatric Oncology in Boston.

– Alan Mozes

Copyright © 2010 HealthDay. All rights reserved.

SOURCE: Dana-Farber/Children’s Hospital Cancer Center, news release, Oct. 21, 2010

MONDAY, Aug. 23 (HealthDay News) — Another study has found evidence that a mouse virus may play a role in chronic fatigue syndrome, a poorly understood disorder that causes incapacitating exhaustion and malaise.

Using blood samples collected in the mid-1990s from chronic fatigue sufferers from the new England area, researchers found evidence of gene sequences for murine leukemia virus (MLV)-related virus in the blood of 32 of 37 patients, or 86.5 percent.

Evidence of the virus was detected in only three of 44 healthy controls, or 6.8 percent of people who did not have chronic fatigue syndrome, the researchers noted.

The team also did genetic testing on fresh blood samples from eight of the chronic fatigue patients and found evidence of MLV in seven of them.

The study, published in the Aug. 23-27 online edition of the Proceedings of the National Academy of Sciences, was conducted by researchers from the U.S. Food and Drug Administration, Brigham and Women's Hospital in Boston, and the U.S. National Institutes of Health.

About one million people in the United States have chronic fatigue syndrome, according to the Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) Association of America. Symptoms include debilitating exhaustion that lasts for months and is not alleviated by sleep and often made worse by physical activity.

People with chronic fatigue can also experience joint aches and muscle pain, headaches, enlarged lymph nodes and sore throat. at the same time, many have to battle with the disbelief (from some quarters) that CFS is a "real" disease.

The saga of MLV-related viruses and chronic fatigue syndrome began last October, when a different team of researchers reported in the journal Science that they had found a mouse virus called xenotropic murine leukemia virus-related virus, or XMRV, in the blood of 68 of 101 patients with chronic fatigue syndrome, but in only eight of 218 healthy patients.

Previously, the same team had reported that they found the virus in some prostate cancer patients.

After decades of confusion about the illness, finally, it seemed, researchers were honing in on a biological cause for the mysterious condition, said Kim McCleary, president and CEO of the CFIDS Association of America.

Yet four subsequent teams of researchers failed to find a similar link, leaving patients even more confused. so, the new findings are an important confirmation that an MLV-related virus may indeed play a role, McCleary said.

"this study is certainly vindication for the disbelief that has been so pervasive over the past 20 years," McCleary said. "but as so often happens with science, every answer begs more questions."

Experts don't know if the presence of MLV-related virus gene sequences reflect an underlying immune disorder, if the virus alters the immune system and allows in other viruses, or if it's the virus itself that is making people sick, McCleary said.

Also unexplained is why some healthy people have MLV-related virus in their blood but don't fall ill, said Dr. Celia Witten, director of the Office of Cellular, Tissue and Gene Therapies at the U.S. Food and Drug Administration.

And the current findings differ from the previous research in one important respect. While the findings reported in Science identified xenotropic murine leukemia virus-related virus (XMRV) in the blood of those with chronic fatigue, the current study did not did find XMRV.

Instead, researchers found gene sequences for polytropic mouse endogenous retroviruses, which are in the same family of retroviruses but is not identical to XMRV, explained lead study author Dr. Shyh-Ching Lo, director of the Tissue Safety Laboratory Program at the U.S. Food and Drug Administration.

A retrovirus is a specific kind of virus that can integrate itself into the host genome. Researchers don't know how it's transmitted.

"our study very much supports the earlier findings that MLV-related viruses are found in the chronic fatigue syndrome patients, although the virus sequence we identified is not the same as XMRV and is a much more heterogenous group," Lo said.

XMRV is a newly identified form of the MLV-related virus that has been shown to infect human cells but not mouse cells, Witten said, while polytropic MLV-related virus can infect both human cells and mouse cells.

"difference in sequences can cause difference in the virus' function and pathology," Witten said. "but exactly how pathogenic they are in people, how they cause infection or even whether they can all remains to be seen."

More information

the U.S. Centers for Disease Control and Prevention has more on chronic fatigue.