[Favourable results of a rehabilitation programme with cognitive behavioural therapy and graded physical activity in patients with the chronic-fatigue syndrome]. / Gunstige resultaten van een revalidatieprogramma met cognitieve gedragstherapie en gedoseerde fysieke activiteit bij patiënten met het chronische-vermoeidheidssyndroom.

OBJECTIVE: To determine whether a specific course of interdisciplinary rehabilitation might lead to clinically significant changes in fatigue, experienced disability and physical function in patients with the chronic-fatigue syndrome (CFS). DESIGN: Prospective and uncontrolled. METHOD: 'Het Roessingh', a rehabilitation centre in Enschede, the Netherlands, has developed an interdisciplinary clinical rehabilitation programme for patients with CFS in cooperation with the 'Nijmeegs Kenniscentrum Chronische Vermoeidheid' [Chronic-Fatigue Knowledge Centre] in Nijmegen, the Netherlands. In this programme, physical, mental and social activities are gradually increased on the basis of cognitive behavioural principles and graded activity. Of the 127 successive persons who enrolled for the therapy during the period from August 2000 to December 2004, 99 fulfilled the inclusion criteria; they had a median duration of symptoms of 6 years. The results of treatment were evaluated by a measurement with the 'Checklist individuele spankracht' [Checklist individual muscle tone] before and after treatment and the scores on the 'Patiëntspecifieke beperkingen' [Patient-specific disability] and the Short form-36. The measured data were complete in 74 patients. RESULTS: Before rehabilitation, the levels of fatigue, disability and distress were high. After treatment, the studied population showed significant improvement in fatigue, experienced disability and physical function. The magnitude of the improvement was generally 'average'. At the end of treatment, 70% of the patients were clinically less fatigued, 68% experienced less disability and 55% functioned better physically. In 34% the level of fatigue was normalised after treatment, but 9.5% of the patients was more fatigue. CONCLUSION: The rehabilitation programme offered for CFS led to significant improvements in function and fatigue.

Impact of AIDS on rural livelihoods in Benue State, Nigeria.

This study addresses the socio-economic impact of AIDS on rural livelihoods in Benue State, Nigeria, where HIV prevalence is 9.3% but the number of AIDS cases is still relatively low. About 6% of the study households had experienced illness and death classified as AIDS, and reported high costs in terms of expenditures and time spent on care, funerals and mourning. These demands on time affected income and productivity, while the diversion of resources had implications for investments and savings. Coping strategies varied between households, mainly as a reflection of asset levels, which were often related to the gender of the household head. Reported coping strategies also differed between ethnic groups. First-line relatives were the most important source of support for households under pressure. Erosive coping strategies that undermined the sustainability of livelihoods were used by more vulnerable households following multiple cases of illness and death. Mourning practices, rules of inheritance and stigma tended to increase a household's vulnerability. Currently, Benue State is facing growing adult morbidity and mortality because of HIV infections. A context-specific study of its possible impact in a setting with a still relatively low number of AIDS cases is therefore important for informing local policy development and for building advocacy.

Anthropometric measurements and body silhouette of women: validity and perception.

OBJECTIVE: To examine the validity of self-reported values for current anthropometric measurements and factors related to misreporting. DESIGN: E3N, a prospective cohort study of cancer risk factors, conducted in France and part of the European Prospective Investigation on Cancer. E3N comprises 100,000 women, born between 1925 and 1950, followed with self-administered questionnaires sent every 18 to 24 months starting in 1990. SUBJECTS: 152 women for the validation study of self-reported anthropometric measurements, and 91,815 women selected to evaluate factors affecting misreporting of body silhouette. STATISTICAL ANALYSIS: Paired t tests, Pearson and Spearman correlations were applied to evaluate the validity of self-reported measures, and analysis of variance and logistic regression were used to assess the factors influencing misreporting of silhouette. RESULTS: The correlation coefficients between self- and external measurements were high. All but sitting height (r = 0.56) were more than 0.80, with weight and bust (nipples) measurement correlation coefficients attaining 0.94. The correlation between body mass index (BMI), measured by the technician and the self-reported silhouette, was 0.78. Small height was always associated with misclassification. Specific factors related to a more favorable perception of body silhouette were: being overweight, small height, younger age, and a lower level of education. These women were also more frequently unmarried, more physically active, and had had a slender body shape during adolescence. Results denoting a less favorable perception of body shape were reversed. CONCLUSION/APPLICATIONS: Self-reported measurements (made with or without help) are valid measures in epidemiological studies. Body silhouettes are simple and useful indicators of body mass index. However they should be interpreted with caution in certain instances, especially for overweight subjects.

Relative validity and reproducibility of a French dietary history questionnaire.

BACKGROUND: A self-administered dietary history questionnaire, especially developed for use in a large French prospective cohort study, was tested for accuracy of food intake measurement by comparing it to the average of 9-12 24-hour recalls. This questionnaire was structured according to the French meal pattern. An important feature of the questionnaire was the separation into a quantification part and qualification part. The first part quantifies consumption by frequency and portion sizes per food group or food item. The second part provides more detailed qualitative information on separate items within one food group. The total number of food items in the questionnaire was 238. METHODS: The questionnaire was administered twice to 119 study subjects, with an interval of approximately one year (1990-1991). During that year, 24-hour recalls were carried out monthly. Reproducibility and relative validity of the questionnaire were assessed. RESULTS: The correlation coefficients for reproducibility ranged from 0.40 to 0.74 for foods and from 0.54 to 0.75 for nutrients. The correlation coefficients for relative validity ranged from 0.10 to 0.71 for foods and from 0.29 to 0.81 for nutrients (adjustment for total energy and attenuation for nutrients). Percentage of subjects classified in the same or adjacent quintile by questionnaire as well as by 24-hour recall was on average 76% for foods and 72% for nutrients. CONCLUSIONS: These data indicate that this questionnaire can be used to classify study subjects according to their food or nutrient intake over a one-year period, within a known degree of precision.

E3N, a French cohort study on cancer risk factors. E3N Group. Etude Epidémiologique auprès de femmes de l'Education Nationale.

This paper describes the design of E3N, a prospective cohort study conducted in France on risk factors for female cancers. The cohort comprises 100,000 women, aged 40-65 years at baseline in 1990. Participants were asked to complete questionnaires every 18 months. The main hypotheses studied concern the relationship between diet and cancer and between hormonal treatments and cancer. All cancers diagnosed are registered, together with other diseases (cardiovascular diseases, diabetes, osteoporosis). The study population and the follow-up procedure are described.

The significance of socio-economic characteristics for adult seasonal body-weight fluctuations: a study in north-western Benin.

Large variations in seasonal body-weight fluctuations have been described for individuals from different households living and working under comparable circumstances. In the present study the relationship between socio-economic household characteristics and seasonal body-weight fluctuations of individual members of rural Beninese households were studied. No significant correlation was found for body-weight fluctuation between the two study years, nor for body-weight fluctuation of men and women belonging to the same household. When comparing dichotomized socio-economic classes for relative body-weight fluctuation of men and women in both study years, no consistent trends were observed for both years nor for both sexes. The distribution of subjects with a consistent high weight fluctuation over the two study years did not differ between socio-economic groups. In conclusion it may be stated that there were no indications that socio-economic characteristics play a determining role in the magnitude of body-weight fluctuation of this study population, despite the large variations observed in the latter. Therefore it is most likely that other factors decide the weight fluctuations of individuals, health and sanitation being the most likely candidates.