A systematic review of English-language literature published from 1988 to 2001 yielded 3840 citations, with 37 studies of adults with chronic fatigue syndrome (CFS) reporting employment status and some measure of mental or physical impairment associated with disability. Only depression appeared to be associated with unemployment in CFS patients. No other measurable impairment appeared to be consistently associated with disability or work outcomes, and no specific patient characteristics were identified as best predictors of positive employment outcomes. For questions of disability and employment in CFS, the limitations inherent in the current literature are extensive. Methodologically rigorous, longitudinal, and interventional studies are needed to determine what baseline characteristics are associated with inability to work and what interventions are effective in restoring the ability to work in the CFS population. Simple and consistent evaluations of functional capacity in CFS patients are needed.
Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis and intervention to adequately restore mesenteric blood flow and to prevent bowel necrosis and patient death. The underlying cause is varied, and the prognosis is dependent on the precise pathologic findings. Despite the progress in understanding the pathogenesis of mesenteric ischemia and development of modern treatment modalities, acute mesenteric ischemia remains a diagnostic challenge for clinicians, and the delay in diagnosis contributes to the continued high mortality. Early diagnosis and prompt effective treatment is essential to improve the clinical outcome.
Menopause is a critical period in women's lives. However, there is growing evidence that physical exercise may be helpful to compensate at least some of the negative effects on health associated with (early) menopause. Kemmler et al present positive effects of exercise on bone loss, coronary heart disease risk factors, physical fitness, back pain, and menopausal symptoms in early postmenopausal women with osteopenia.
The National Osteoporosis Risk Assessment (NORA) evaluated 149 524 white postmenopausal women without a prior diagnosis of osteoporosis with a baseline bone mineral density (BMD) measurement at a peripheral skeletal site and a 1-year follow-up questionnaire that recorded fractures since baseline. New fractures were reported by 2259 women. Although fracture rates were highest in women whose initial BMD was −2.5 or less, only 6.4% of women with fractures were in this category; 82% of osteoporotic fractures and 74% of hip fractures occurred in women with better T scores. By National Osteoporosis Foundation treatment guidelines, 23% of NORA women had a T score of −2 or less than −1.5 with 1 or more risk factors. Although their fracture rates were somewhat lower, 45% of osteoporotic fractures and 53% of hip fractures occurred in these women. A reduction in the number of fragility fractures will require targeted treatment intervention strategies in women with less severe low bone mass.
There is consensus that women with osteoporosis require intervention to reduce future fracture risk, but the situation is less clear among women with BMD that is low but not yet osteoporotic. Using data from a population of 57 421 postmenopausal white women with "osteopenia," as well as baseline risk factor information and 1-year follow up data on incident fractures, Miller et al developed an algorithm for predicting which women were at increased risk for fracture. A total of 32 risk factors for fracture were examined. Prior fracture, peripheral T score of −1.8 or less, poor health, and poor mobility were the most important determinants. Women with a prior fracture had a 1-year fracture risk similar to that of women with T score of −2.5 or less. Women with either T score of −1.8 or less or poor health or poor mobility had a fracture risk approximately twice that of women with normal BMD, and osteopenic women without any of the 4 determinants had a 1-year fracture risk that was similar to that of the women with T scores greater than −1.0 in the cohort. This algorithm offers an approach to identifying those women with less severe levels of low bone mass.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2004;164(10):1043. doi:10.1001/archinte.164.10.1043