CFS in Chinese middle-school students, 2018, Shi et al

Kalliope

Kalliope

Senior Member (Voting Rights)
Chronic fatigue syndrome in Chinese middle-school students

Abstract (my bolding):
The objective of the present study was to determine the prevalence of chronic fatigue syndrome (CFS) and its associated factors in middle-school students in Suzhou, China. From September 2010 to January 2011, across-sectional study was conducted in junior- and senior middle-school students aged 10 to 18 years using a battery of confidential questionnaires. Our results indicate that 18,139 completed the questionnaires effectively, of whom 163 (0.9%) met the definition of CFS, with senior high-school students and male students predominating. The prevalence of CFS in the middle-school students increased steadily with age. The main symptoms of CFS in these students included being afraid of going to school, despondency, and irritability in addition to those specified in the Centers for Disease Control and Prevention (CDC). Our study shows that CFS is prevalent among Chinese teenagers, and requiring proper intervention and treatment.
 
Kalliope said:
The main symptoms of CFS in these students included being afraid of going to school, despondency, and irritability in addition to those specified in the Centers for Disease Control and Prevention (CDC)
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Is it me, or is the whole sentence odd?

It makes it seem almost as if being afraid to go to school, despondency and irritability are symptoms that carry more weight than the CDC definition.

What do they mean afraid to go to school? Because they physically or cognitively can't cope, are concerned about the way their physical condition affects their schoolwork?

Or is it written this way so that the reader will assume the kids are anxious about schoolwork and so have developed ME?

Or was something lost in translation?

ETA: most people would be irritable and despondent if they couldn't keep up with all their friends - especially at that age!
 
This uses Fukuda and the "Chaldea [sic] fatigue scale" as well as the SF-36 for physical function.The reference for the depression scale is an article referenced from 1965 entitled "A self-eating depression scale". (Say what???)


Self-report by the students with the help of trained investigators. So no physical exam. No description of post-exertional malaise.

The study says Fukuda is the only accepted guideline for case definition at present. (????)

I can't go any further....

I think the investigators need some education.
 
Studies based on questionnaire assessment seem to yield higher prevalence than those based on interviews.
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Yep. That could possibly be because the questions are deliberately phrased to elicit a certain response.

The CFQ is a self-report questionnaire inquiring about various physical and mental fatigue symptoms specifically related to fatigue, and has been validated in large community samples.
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Well...no, no comment. The guys have already put together a great critique on that. Just in case anyone missed it:

https://s4me.info/threads/s4me-subm...-with-the-chalder-fatigue-questionnaire.2065/


Basically they say:
. Our study found that being afraid of going to school, despondency and irritability are 3 major specific symptoms of CFS in children and adolescents.
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Total pile of...
 
CFS was defined if the subjects met the criteria of both CDC-94 and CFQ, and at the same time the school health workers excluded the fatigue symptoms that may be associated with other medical conditions after reviewing their yearly routine physical examination records.
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As well as the questionnaire, they did use this.
 
It is odd to see that only 20.7% of those classified as having CFS reported having unrefreshing sleep. Unrefreshing sleep is usually one of the most most frequently reported symptoms in CFS cohorts.

14% of those not satisfying the CFS criteria also reported unrefreshing sleep.
 
Denise said:
The reference for the depression scale is an article referenced from 1965 entitled "A self-eating depression scale". (Say what???)
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It's this one apparently https://psychology-tools.com/zung-depression-scale/

This scale is interesting because there is no option to indicate that a symptom is not present. A symptom is always present "a little of the time" or more, never absent.

If I select "a little of the time" for all symptoms, then I get a score of 50 out of 80, indicating mild depression. Something seems fishy about this.
 
strategist said:
If I select "a little of the time" for all symptoms, then I get a score of 50 out of 80, indicating mild depression. Something seems fishy about this.
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It's one of those tricksy scales where the "right" answer is sometimes no and sometimes yes. But the minimum score is still 20 apparently: "Scores in the 20 - 44 range indicate slight to no Depression." according to that site, but it's the "Normal range" according to Wikipedia.
 
For further characterization, all the students were also asked to complete the MOS 36-item short form health survey (SF-36) to define the physical function,[17] and self-rating depression scale (DSD) to identify the depressive symptoms.[18]
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These don't seem to have been used with regard to diagnosis or exclusions.

Also they don't seem to have published any data on them in the paper.
 
According to the CDC-94, CFS occurs when a person experiences fatigue for 6 months or is accompanied with at least 4 of the 8 CFS symptoms. It is important that each symptom should be rated frequently or constantly to meet the criteria, but this “persistence index” has not been well defined in previous criteria. In the present study, we defined these symptoms as 1, not present; 2, occasionally present; 3, sometimes present; 4, frequently present; and 5, always present.
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I don't believe they specify which threshold they used.
 
An overall CFQ score ≥4 and duration of symptoms ≥3 months represent persistent fatigue, whereby it should be able to differentiate a sample with CFS from a healthy sample.
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It would have been interesting if they'd also used and reported on a more strict threshold such as a score greater than or equal to 6, as was used as an entry criterion in PACE Trial.
 
99.4% of those classified as having CFS reported postexertional malaise.

However 53.9% of those who were not classified as having CFS also reported the symptom. This figure for controls seems very high and makes me question the validity of whatever question was used. They may have translated something into Chinese but perhaps the translation is problematic (or of course the original might be problematic).
 
The main symptoms of CFS in these students included being afraid of going to school, despondency, and irritability in addition to those specified in the Centers for Disease Control and Prevention (CDC).
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Here are the 12 areas they asked about:
The 12 associative symptoms of children and adolescents, including diarrhea, feverishness, rash, abdomen pain, constipation, sensitivity to light, being afraid of going to school, newonset allergy, despondency, eating more than before, unwillingness to eat, and irritability were screened from previous studies in children and adolescents.[11–14]
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If they had asked about other symptoms, other things may have come up higher than the 3 they highlighted
 
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