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Objectives-To examine cognitive function in chronic fatigue syndrome. Methods-Twenty patients with chronic fatigue syndrome recruited from primary care and 20 matched normal controls were given CANTAB computerised tests of visuospatial memory, attention, and executive function, and verbal tests of letter and category fluency and word association learning. Results-Patients with chronic fatigue syndrome were impaired, predominantly in the domain of memory but their pattern of performance was unlike that of patients with amnesic syndrome or dementia. They were normal on tests of spatial and pattern recognition memory, simultaneous and delayed matching to sample, and pattern-location association learning. They were impaired on tests of spatial span, spatial working memory, and a selective reminding condition of the pattern-location association learning test. An executive test of planning was normal. In an attentional test, eight subjects with chronic fatigue syndrome were unable to learn a response set; the remainder exhibited no impairment in the executive set shifting phase of the test. Patients with chronic fatigue syndrome were also impaired on verbal tests of unrelated word association learning and letter fluency. Conclusion-Patients with chronic fatigue syndrome have reduced attentional capacity resulting in impaired performance on effortful tasks requiring planned or self ordered generation of responses from memory. (7 Neurol Neurosurg Psychiatry 1996;60:495-503)

Changes in roles and responsibilities brought about by community care and the reorganization of the UK National Health Service (NHS) have resulted in higher levels of stress and insecurity amongst residential nursing staff working with people with intellectual disability. In the light of these organizational changes, questions have arisen about the relationship between role clarity, perception of the organization and occupational stress. A number of studies have investigated these issues amongst staff working with people with intellectual disability, although there have been few investigations in the UK. The present study examines the relationship between these variables in the context of the differences between the employees of an NHS trust and a charitable organization. The present study involved constructing a measure of role clarity and perception of the organization, and the use of the Maslach Burnout Inventory (MBI). The results indicated that most support workers regarded their role as being clear and their levels of burnout to be comparable with UK nursing norms. Charity staff were more likely to view their organization positively and rated their emotional exhaustion as significantly lower than NHS trust staff. A within-service comparison of homes revealed differences amongst NHS trust and charity homes on sub-scales of the MBI. The results are discussed in the context of previous research and changes in working practices in the field.

IN A RECENT SURVEY OF THE AMERICAN PUBLIC, 78% OF RESPONDENTS reported that their body weights were not a serious health concern. 1 Approximately one third of these respondents were obese, two thirds were overweight, and 15% of their children were overweight. This indifference is not appropriate. Obesity may soon replace smoking as the leading cause of preventable death in the United States. Obesity may be responsible for approximately 300000 US deaths per year, and, unlike smoking, the prevalence of obesity is rapidly increasing. 2 Public health officials now refer to obesity as an epidemic. Unlike infectious diseases, obesity kills and disables by gradually increasing the risk for diseases like diabetes, heart disease, stroke, and cancer. Recent studies estimate that obesity is more strongly associated with chronic medical conditions, and reduced health-related quality of life, than smoking, heavy drinking, or poverty. 3 Articles in this issue of MSJAMA emphasize the importance of societal change to address obesity. Tarayn Grizzard examines the undertreatment of obesity by American physicians. Susan Blumenthal, Jennifer Hendi, and Lauren Marsillo argue that a public health approach is required to address the myriad environmental and sociocultural factors contributing to obesity. Lawsuits have recently emerged to uncover and redress alleged food industry misconduct that may be contributing to the obesity problem. Richard Daynard, Lauren Hash, and Anthony Robbins discuss the future of this food litigation.The prevalence of obesity among children is also rapidly increasing and has been associated with hyperlipidemia, hypertension, and impaired glucose tolerance. 2 Robert Carter reviews the rationale and the results of school-based obesity interventions. Ellen Fried and Marion Nestle argue that soda consumption makes an important contribution to childhood obesity. They describe marketing practices designed to increase soda consumption among schoolchildren and discuss recent political initiatives to restrict these practices.The burden imposed by overweight and obesity on the United States is very high. The estimated total cost of overweight and obesity in 2000 is estimated to have been $117 billion, nearly 10% of the US health care expenditure. 2 By contrast, the United Nations estimates that the yearly costs of HIV/AIDS prevention and care in Africa, Asia, and Latin America will be $9.7 billion by 2005. 4 Given the exorbitant costs of obesity, more effective interventions are urgently needed to decrease its prevalence. The fact that most Americans are overweight, yet are not concerned about the health importance of their own body weights, suggests that there remains much room for improvement.

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