Validity and reliability of a scale to assess fatigue

Novel uses of healthcare technology for individuals with mild to moderate hip or knee osteoarthritis: The technology, exercise and activity prescription for enhanced mobility (TEAM) study randomized controlled trial protocol

Objectives

Patient education, physical activity, and exercise are recommended as first-line treatments for mild to moderate hip and knee osteoarthritis (OA). We developed two novel healthcare interventions: an electronic medical record-embedded physical activity prescription tool (PARx) for physicians, and a free, online educational platform (Joint Management (JM)) with exercise programming and optional telerehabilitation with a physiotherapist for patients. Objectives: 1) Determine the effectiveness of PARx ​± ​JM on patient-reported outcomes, physical activity levels, and performance-based functional outcomes in individuals with mild to moderate hip or knee OA, versus usual care; 2) evaluate engagement and adherence to PARx ​+ ​JM; and 3) explore the feasibility of PARx and PARx ​+ ​JM.

Registration

NCT04544904.

Methods

Randomized controlled trial (type 1 hybrid implementation effectiveness). We will recruit 339 (113/group) participants ≥40 years old with mild to moderate hip or knee OA and randomize them into three groups: PARx, PARx ​+ ​JM, or control (usual care). Follow-up appointments will be completed at 2-, 6-, and 12-months. Primary outcome: Knee Injury/Hip Disability and OA Outcome Score. Secondary outcomes: physical activity levels, anthropometric measurements, physical function, and other patient-reported outcomes. We will assess intervention feasibility and hold focus groups with patients and providers to explore perceptions of the interventions.

Conclusion

Two novel healthcare interventions will be used to provide physical activity and exercise programming for individuals with mild-moderate knee and hip OA. This study will allow us to determine the effectiveness of these interventions on patient-reported outcomes, physical activity levels, and performance-based functional outcomes.

Examination of the impact of curiosity and fatigue on brain condition

With a growing emphasis on cognitive well-being, this study investigates factors influencing brain health, measured by Fractional Anisotropy Brain Healthcare Quotient (FA-BHQ). We find a positive correlation between curiosity, assessed by the Curiosity and Exploration Inventory-II (CEI-II), and brain health as indicated by FA-BHQ. Conversely, fatigue, evaluated using the Chalder Fatigue Scale (CFS), demonstrates a negative correlation with brain health. Furthermore, curiosity and fatigue serve as significant mediators in the relationship between these factors and FA-BHQ, respectively. Specific brain regions, including the corpus callosum, internal capsule, fornix, and posterior thalamic radiation, show significant negative correlations with fatigue, while the corpus callosum, fornix, internal capsule, corona radiata, external capsule, cingulum, and posterior thalamic radiation exhibit significant positive correlations with curiosity. Notably, this study highlights that more brain regions exhibit significant correlations with curiosity compared to fatigue, shedding light on the growing recognition of curiosity's role in influencing brain health and emphasizing the importance of considering curiosity in the research on cognitive well-being.

Greater Symptom Burden and Poorer Quality of Life Outcomes Are Associated With The Co-Occurrence of Anxiety and Depression During Cancer Chemotherapy

OBJECTIVES

Anxiety and depression are common symptoms in oncology patients undergoing chemotherapy. Study purpose was to evaluate for differences in severity of common symptoms (ie, fatigue, energy, sleep disturbance, cognitive function, pain) and quality of life (QOL) outcomes among three subgroups of oncology outpatients with distinct joint anxiety and depression profiles.

METHODS

Oncology outpatients (N = 1328) completed measures of state anxiety and depression, six times over two cycles of chemotherapy. Latent profile analysis was done to identify subgroups of patients with distinct joint state anxiety AND depression profiles. Patients completed measures of trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain, as well as generic and disease-specific measures of QOL at enrollment. Differences among the classes in symptom severity scores and QOL scores were evaluated using parametric and non-parametric tests.

RESULTS

Three distinct joint anxiety AND depression profiles were identified and named: Low Anxiety and Low Depression (57.5%, Both Low), Moderate Anxiety and Moderate Depression (33.7%, Both Moderate), and High Anxiety and High Depression (8.8%, Both High). All of the symptom severity scores showed a "dose-response effect" (ie, as the joint anxiety AND depression profiles worsened, the severity of all of the symptoms increased). Likewise, for both the general and disease-specific QOL (except spiritual well-being) measures, all of the scores decreased as the joint anxiety AND depression profiles worsened. Compared to the Both Low classes, the other two classes reported lower scores for the spiritual well-being domain.

CONCLUSIONS

More than 40% of patients receiving chemotherapy experience moderate to high levels of both anxiety AND depression. These patients report an extremely high symptom burden and significant decrements in all domains of QOL.

IMPLICATIONS FOR NURSING PRACTICE

Clinicians need to perform comprehensive assessments of depression and anxiety and other common symptoms and QOL outcomes during chemotherapy. In addition, referrals for targeted interventions are needed to manage multiple symptoms and improve patients' QOL.

The effect of aromatherapy applied to pregnant women on sleep quality and fatigue level: A randomized clinical trial

INTRODUCTION

Sleep disturbances and fatigue can negatively impact pregnancy. The purpose of this study is to assess changes in sleep quality and fatigue levels pre- and post-aromatherapy intervention using lavender oil inhalation in pregnant women in the third trimester.

MATERIALS AND METHODS

The research was conducted in the gynecology and obstetrics outpatient clinic of a training and research hospital between October 2022 and March 2023. The study was designed as a randomized controlled experimental trial with a pretest-posttest control group. The sample consisted of a total of 74 pregnant women (37 intervention and 37 control). Aromatherapy with lavender oil was applied to pregnant women in the intervention group for one month using the "Inhalation Application Form." "Personal Information Form", "Visual Analog Scale (VAS)", "Pittsburg Sleep Quality Index (PSQI)" and " Visual Analogue Scale for Fatigue (VASF)" were used to collect data. Percentage distributions, chi-square significance test, t-test in independent groups, and Mann-Whitney U and Wilcoxon tests were used to evaluate the data.

RESULTS

In the study, the post-test PSQI score average of the pregnant women in the intervention group who received lavender oil inhalation was 4.10±1.36, it was 5.45±2.48 in the control group. The post-test fatigue score average of the pregnant women in the intervention group was 65.91±7.02, it was 75.40±10.79 in the control group. A statistically significant difference was found between the post-test PSQI and VAS-F total score averages of the pregnant women in the intervention and control groups (p < 0.05).

CONCLUSION

The study findings indicate that aromatherapy applied via inhalation to pregnant women improved sleep quality and reduced fatigue levels. According to these findings, lavender oil aromatherapy can be recommended to improve sleep quality and reduce fatigue levels in pregnant women during the third trimester.

The restorative effects of working individually in a vegetated office space: A crossover controlled experimental study in real-life workplace setting

BackgroundExamining the restorative effects of indoor nature exposure that can be controlled through management and design in work settings is crucial for public health. However, concerns about the external validity of existing findings persist due to insufficiency of studies with ecologically sound experimental designs.ObjectiveThrough an experiment that prioritized higher ecological validity, this study aimed to explore the effects of working in an office room vegetated with green plants on employees' physiological and psychological well-being, and their attentional performance.MethodsThis controlled experimental study employed a crossover design in real-life work environments, involving 40 working individuals. It assessed changes in perceived fatigue, psychological and physiological stress, and attentional performance after individual work in either a vegetated or plant-free office room, with other environmental factors kept constant.ResultsAfter an hour of individual work in a vegetated room, participants reported decreased perceived stress and fatigue, supported by changes in measures of systolic blood pressure and heart rates when compared to a plant-free room. Gender differences emerged, with females experiencing greater relief in perceived stress and males showing more noticeable reductions in stress-related physiological indicators. Enhanced attentional reactions were noted solely among males.ConclusionsThis study accentuated the immediate emotional well-being benefits of indoor plants at work, highlighting the importance of considering diverse user groups in indoor workspace design. It also proposes potential explanations for how indoor plants induce restorative effects on working individuals, suggesting further research.

Effects of mental fatigue on isometric mid-thigh pull performance and muscle activities

This study investigated the effects of mental fatigue on rate of force development (RFD) and peak force during an isometric mid-thigh pull (IMTP), as well as its impact on muscle activation measured by electromyography (EMG) median frequency. Sixteen healthy, resistance-trained males completed two sessions: a control condition and a mentally fatigued state induced by a 30-minute modified Stroop task. IMTP performance and muscle activation were assessed before and after the mental fatigue task. Mental fatigue significantly reduced RFD in the later phase of force generation, specifically within the 20%-80% of maximum force interval (RFD2080) (p =  0.022, d =  0.638). In contrast, no significant changes were observed in RFD within the initial 0-100 milliseconds (RFD100) or 0-200 milliseconds (RFD200) of contraction, nor in peak force. Additionally, mental fatigue led to a significant increase in EMG median frequency for the rectus femoris during the initial 0-1 second interval (p =  0.040, d =  -0.609), with no significant changes in the medial gastrocnemius or other time intervals. These findings suggest that mental fatigue primarily impacts the later stages of force development, affecting the ability to sustain and develop force over time without compromising peak force. The increase in EMG median frequency for the rectus femoris indicates a possible compensatory response to mental fatigue, underscoring the complex influence of cognitive stress on neuromuscular function. This study highlights the importance of considering mental fatigue in activities requiring sustained or progressively increasing force production.

Rheumatoid arthritis and psoriatic arthritis: is the disease impact different? A large matching study at diagnosis and after 1 year of treatment

OBJECTIVE

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are currently treated similarly. However, it is unclear which patient-reported outcome (PRO) domains need specific attention in the management of RA and PsA. Therefore, we aimed to determine the difference in disease impact between matched RA and PsA patients at diagnosis and after 1 year in two different regions.

METHODS

RA patients from the treatment in the Rotterdam Early Arthritis CoHort trial (tREACH), PsA patients from the Dutch southwest Early PsA cohoRt (DEPAR) and RA and PsA patients from the Leiden Early Arthritis Clinic (EAC) were included. The difference in disease impact between RA and PsA was measured with the following PROs: pain (Visual Analogue Scale (VAS), 0-100), fatigue (VAS), activity limitation (Health Assessment Questionnaire-Disability Index) and health impact (general health (VAS) and 36-item Short-Form Health Survey (SF-36)). Propensity scores were used to match RA and PsA patients, after which inverse probability weights (IPWs) were calculated. IPW-weighted linear regression models were used to measure PRO differences.

RESULTS

391 RA patients from tREACH, 416 PsA patients from DEPAR, 702 RA and 99 PsA patients from the EAC were included. At diagnosis, PsA-DEPAR patients scored 5.04 units worse (95% CI 2.21 to 7.87) on SF-36 mental health compared with RA-tREACH patients. This difference still existed after 1 year of treatment (3.88 (95% CI 1.90 to 5.86)). PsA-EAC patients had more activity limitations after 1 year of treatment compared with RA-EAC patients (-0.30 (95% CI -0.50 to -0.10)). No significant differences were present in the other PRO domains.

CONCLUSION

The disease impact of early RA patients is similar to matched early PsA patients on most PRO domains, except for mental health and functional limitations, which were worse in PsA after 1 year of treatment.

Changes in gene expression in healthcare workers during night shifts: implications for immune response and health risks

BACKGROUND

Shift work is common in healthcare, especially in emergency and intensive care, to maintain the quality of patient care. Night shifts are linked to health risks such as cardiovascular disease, metabolic disorders, and poor mental health. It has been suggested that inflammatory responses due to the disruption of circadian rhythm may contribute to health risks, but the detailed mechanisms remain unclear. This study aimed to analyze changes in gene expression in whole blood of healthcare workers before and after a night shift and investigate the molecular pathogenesis of these changes and their impact on health.

METHODS

This was a single-center, prospective, observational study of four medical doctors working night shifts in the emergency department. Blood samples from the subjects were collected before and after the night shift, and RNA sequencing was performed to analyze changes in gene expression in whole blood. The data obtained were analyzed via Ingenuity Pathway Analysis (IPA) core analysis that included canonical pathway analysis, upstream regulator analysis, and functional network analysis. RNA bulk deconvolution was performed to estimate the relative abundance of immune cells. The IPA analysis match feature was also used to assess similarities of gene expression patterns with other diseases.

RESULTS

We identified 302 upregulated and 78 downregulated genes (p < 0.05, |log2-fold change|> 0.5) as genes whose expression changed after the night shift. Canonical pathway analysis revealed that Toll-like receptors and other innate immune response pathways were activated. Upstream regulator analysis and functional network analysis also consistently indicated a predicted activation of innate immune and inflammatory responses. RNA bulk deconvolution showed changes in the proportions of several immune cells. IPA analysis match indicated that gene expression patterns after night shifts were highly correlated with several diseases, including major depressive disorder, in terms of immune and inflammatory responses.

CONCLUSION

The results revealed that innate immune and inflammatory responses are elicited after night shifts in healthcare workers and that gene expression patterns correlate with several diseases in terms of immune and inflammatory responses. These findings suggest that shift work may affect health risks through innate immune and inflammatory responses.

Multi-layer transfer learning algorithm based on improved common spatial pattern for brain-computer interfaces

In the application of brain-computer interface, the differences in imaging methods and brain structure between subjects hinder the effectiveness of decoding algorithms when applied on different subjects. Transfer learning has been designed to solve this problem. There have been many applications of transfer learning in motor imagery (MI), however the effectiveness is still limited due to the inconsistent domain alignment, lack of prominent data features and allocation of weights in trails. In this paper, a Multi-layer transfer learning algorithm based on improved Common Spatial Patterns (MTICSP) was proposed to solve these problems. Firstly, the source domain data and target domain data were aligned by Target Alignment (TA)method to reduce distribution differences between subjects. Secondly, the mean covariance matrix of the two classes was re-weighted by calculating the distance between the covariance matrix of each trial in the source domain and the target domain. Thirdly, the improved Common Spatial Patterns (CSP) by introducing regularization coefficient was proposed to further reduce the difference between source domain and target domain to extract features. Finally, the feature blocks of the source domain and target domain were aligned again by Joint Distribution Adaptation (JDA) method. Experiments on two public datasets in two transfer paradigms multi-source to single-target (MTS) and single-source to single-target (STS) verified the effectiveness of our proposed method. The MTS and STS in the 5-person dataset were 80.21% and 77.58%, respectively, and 80.10% and 73.91%, respectively, in the 9-person dataset. Experimental results also showed that the proposed algorithm was superior to other state-of-the-art algorithms. In addition, the generalization ability of our algorithm MTICSP was validated on the fatigue EEG dataset collected by ourselves, and obtained 94.83% and 87.41% accuracy in MTS and STS experiments respectively. The proposed method combines improved CSP with transfer learning to extract the features of source and target domains effectively, providing a new method for combining transfer learning with motor imagination.

Factors associated with quality of life in long-COVID syndrome

Approximately 10% of patients experience persistent symptoms following COVID-19, known as long-COVID syndrome. This cross-sectional study explored factors of quality of life (QoL) in 53 long-COVID patients. QoL was measured using the World Health Organization-Five Well-Being Index, fatigue with the Fatigue Visual Analogue Scale, and psychological health with the Depression-Anxiety-Stress-21 questionnaire. Six neuropsychological tests assessed information processing speed, verbal memory, visual memory, working memory, attention, language, fluency, recall, and visuospatial function with a composite score calculated by averaging z scores. Patients (76% female, mean age: 54.1 years) were assessed 8.7 months postinfection. Cognitive impairment, present in 49% of the sample, was not associated with QoL. In multiple linear regression, gender, fatigue, and psychological distress accounted for 42% of QoL variance, with fatigue and distress contributing 7% and 11%, respectively. Further studies are needed to determine if fatigue and psychological distress are causally related to QoL in long-COVID and could be treatment targets.

Evaluation of body image perception, pain, fatigue and anxiety levels of individuals on hemodialysis and waiting for kidney transplantation and individuals with kidney transplantation

OBJECTIVE

This study was conducted to evaluate the body image perception, pain, fatigue and anxiety levels of individuals with kidney transplantation and undergoing hemodialysis and waiting for kidney transplantation.

MATERIALS AND METHODS

This cross-sectional study was conducted with 240 individuals who applied to the nephrology outpatient clinic and dialysis unit between 29 August 2021 and 20 May 2022. Data in the study were collected using Patient Information Form, LANSS Pain Scale, Visual Similarity Scale for Fatigue, Beck Anxiety Scale and Body Image Scale.

RESULTS

The Body Image Scale total score average of individuals undergoing hemodialysis is 104.8 ± 15.4, the LANSS Pain Scale total score average is 18.7 ± 5.4, the Visual Similarity Scale total score average for Fatigue is 29.5 ± 1.2, and the Beck Anxiety Scale total score average is 104.8 ± 15.4. The total score average is 47.6 ± 6.8. The LANSS Pain Scale total mean score of individuals with kidney transplantation is 8.2 ± 2.0, the Body Image Scale total score mean is 75.6 ± 3.5, the Visual Similarity Scale total score mean for Fatigue is 24.3 ± 1, and the Beck Anxiety Scale total score mean is 24.3 ± 1. The mean total score of the scale was found to be 25.6 ± 4.1.

CONCLUSION

It has been determined that hemodialysis patients waiting for a kidney transplant are not satisfied with their body image, experience more pain, and have higher levels of fatigue and anxiety than patients who have had a kidney transplant.

Mental fatigue increases perception of effort but does not compromise the inhibitory control of football referees during a match simulation physical task

Executive functioning (EF) in referees is associated with their decision-making during a match and can be affected by mental fatigue (MF), a psychobiological state induced by prolonged periods of cognitive activity or high cognitive demand within a short timeframe. Therefore, the aim of this study was to investigate the impact of MF on EF and the perception of effort during a physical task for football referees. Twelve male professional football referees were recruited (32 ± 7.3 years; 1.75 ± 0.06 cm; 85 ± 13.32 kg; 41.4 ± 5.92 mL kg-1 min-1 VO2max), visiting the laboratory on three occasions: one for characterization and familiarization and two experimental manipulations: high cognitive load (MF) and low cognitive load. After manipulations, they performed a physical task designed to replicate the physical demands of an official match. During the physical task, executive functioning was tested with a reaction time task and the ratings of perceived effort were assessed using subjective scales. The results revealed no effect of MF on response time performance (p = 0.395). However, higher perceptions of effort were observed in the high cognitive load condition (p = 0.018), which may impact physical performance. Despite the alteration in the perception of effort due to mental fatigue, executive function performance of football referees remained unimpaired.

Higher Levels of Multiple Types of Stress Are Associated With Worse State Anxiety and Morning Fatigue Profiles in Patients Receiving Chemotherapy

BACKGROUND

Anxiety and fatigue are common problems in patients receiving chemotherapy. Unrelieved stress is a potential cause for the co-occurrence of these symptoms.

OBJECTIVES

The aims of this study were to identify subgroups of patients with distinct state anxiety and morning fatigue profiles and evaluate for differences among these subgroups in demographic and clinical characteristics, as well as measures of global, cancer-specific, and cumulative life stress and resilience and coping.

METHODS

Patients (n = 1335) completed measures of state anxiety and morning fatigue 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was used to identify the state anxiety and morning fatigue profiles.

RESULTS

Three distinct joint profiles were identified: Low Anxiety and Low Morning Fatigue (59%), Moderate Anxiety and Moderate Morning Fatigue (33.4%), and High Anxiety and High Morning Fatigue (7.6%). Patients in the 2 highest classes were younger, were less likely to be married/partnered, and had a higher comorbidity burden. All of the stress scores demonstrated a dose-response effect (ie, as anxiety and morning fatigue profiles worsened, stress increased). Patients in the 2 highest classes reported higher rates of emotional abuse, physical neglect, physical abuse, and sexual harassment.

CONCLUSIONS

More than 40% of these patients experienced moderate to high levels of both anxiety and morning fatigue. Higher levels of all 3 types of stress were associated with the 2 highest profiles.

IMPLICATIONS FOR PRACTICE

Clinicians need to perform comprehensive evaluations of patients' levels of stress and recommend referrals to psychosocial services.

Evidence of physiological changes associated with single-session pre-frontal tDCS: a pilot study

Objective

Transcranial direct current stimulation (tDCS), a non-invasive, painless method of applying direct current electrical stimulation to specific areas of the brain, is an effective method for enhancing attention and post-stroke fatigue, as shown by behavioral improvements in post-stroke populations. While behavioral evidence supports this method, there is a paucity of physiological data corroboration of this improvement. The current study is designed to investigate if a single session of tDCS will improve attention and fatigue as shown by relevant physiological methods in persons with post-stroke aphasia.

Methods

Ten participants (5 male; mean age: 62.8) engaged in two identically structured data collection sessions with at least a 3-day wash-out period between them. Sessions started with a sustained attention task with simultaneous electroencephalography (EEG) and pupillometry data collection, followed by an attention training program with simultaneous active or sham tDCS. Following tDCS, participants repeated the sustained attention task with simultaneous EEG and pupillometry data collection. Participants received active tDCS during one session, and sham tDCS during the other, with the order randomized.

Results

No differences between conditions were found for either behavioral results from the sustained attention task (i.e., reaction time of correct responses; n = 9 p = 0.39) or EEG measured attention state data for any of the four attention states: no attention (n = 10, p = 0.83), distracted attention (n = 10, p = 0.20), moderate attention (n = 10, p = 0.95), or high attention (n = 10, p = 0.62). Pupil dilation was significantly greater in the post-active tDCS stimulation condition than in either pre-training condition (n = 10, p < 0.01). tDCS stimulation lessened the increase in task-based fatigue from the beginning to the end of the session such that there was a significant increase in task-based fatigue when participants received sham tDCS (n = 10, p = 0.01) but no significant change in task-based fatigue during the active condition session (n = 10, p = 0.12).

Conclusion

Changes in pupil diameter observed in the active stimulation condition suggest activation of the locus coeruleus-norepinephrine (LC-NE) pathway within a single session of tDCS administration, but the lack of significant changes for either response time or attention states indicate no direct effect on behaviorally measured or EEG measured attention within the same timeframe. Responses to active stimulation in terms of subjective fatigue rating varied between individual participants; overall, active tDCS mitigated task-based fatigue. More research is needed to investigate this relationship.

Effectiveness of pain neuroscience education, motivational interviewing and cognition targeted exercise therapy in patients with chronic neck pain: protocol for a multicentre randomised controlled trial (the COGMO-AP study)

INTRODUCTION

In primary care, the prevalence of neck pain has increased substantially. Evidence regarding treatment of chronic neck pain (CNP) is scarce, and its effectiveness is not entirely proven in different stages of chronicity, nor for different types of cervical disorders. The goal of this study is to evaluate the effectiveness of a complex intervention (COGMO intervention) compared with usual practice in primary care physiotherapy to improve neck pain intensity, severity and disability in patients with CNP.

METHODS AND ANALYSIS

Design: a pragmatic cluster-randomised clinical trial design with a 12-month follow-up.

SETTING

primary care.

PARTICIPANTS

physiotherapists as randomisation unit, and patients as analysis unit.

INCLUSION CRITERIA

individuals aged 18 to 65 years suffering from moderate to severe CNP. Sample size expected: 142 patients. Recruitment: patients referred from primary care physicians to physiotherapy.

INTERVENTION

pain neuroscience education (PNE), motivational interviewing (MI) and cognition targeted exercise therapy (CTE) compared with the standard treatment in primary care.

OUTCOMES

the main variable is reduction in pain intensity; secondary variables include pain severity, conditioned pain modulation, temporal summation, neck disability, fear/avoidance behaviour, kinesiophobia, catastrophising, therapeutic alliance and quality of life. Sociodemographic information and adherence to the intervention will be recorded.

DATA COLLECTION

baseline, and follow-up at 3, 6 and 12 months.

ANALYSIS

it will follow intention-to-treat principles, and difference in percentage of subjects achieving success on the primary endpoint at 12 months. A model with multilevel analysis will be adjusted through logistic regression (being the dependent variable pain intensity, and the independent, the intervention).

ETHICS AND DISSEMINATION

Ethical approval has been awarded by the Regional Ethics Committee of Madrid (code: COGMO-AP) and the primary health care central commission of research (code: 20210011). The results of the study will be disseminated through international peer-reviewed journals, international conferences, press and social media.

TRIAL REGISTRATION NUMBER

NCT05785455.

Distinct Morning and Evening Fatigue Profiles in Patients With Gynecologic Cancers Receiving Chemotherapy

OBJECTIVES

To identify distinct morning and evening fatigue profiles in patients with gynecologic cancers and evaluate for differences in demographic and clinical characteristics, common symptoms, and quality-of-life outcomes.

SAMPLE & SETTING

Outpatients with gynecologic cancers (N = 233) were recruited before their second or third cycles of chemotherapy at four cancer centers in San Francisco Bay and New York.

METHODS & VARIABLES

The Lee Fatigue Scale was completed six times over two cycles of chemotherapy in the morning and in the evening. Latent profile analysis was used to identify distinct morning and evening fatigue profiles.

RESULTS

Four distinct morning and two distinct evening fatigue classes were identified. Common risk factors for morning and evening fatigue included younger age, higher body mass index, lower functional status, and higher comorbidity burden. Patients in the worst morning and evening fatigue classes reported higher levels of anxiety, depression, and sleep disturbance; lower levels of energy and cognitive function; and poorer quality of life.

IMPLICATIONS FOR NURSING

Clinicians can use this information to identify higher-risk patients and develop individualized interventions for morning and evening fatigue.

Comparative Study Between Cognitive Phenotypes of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Multiple Sclerosis

Objective: Cognitive impairments are one of the most common and disabling symptoms associated with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Here, we address the possibility of a specific cognitive profile inherent to ME/CFS. Due to the occurrence of cognitive deficits, fatigue, and pain in both pathologies, multiple sclerosis (MS) is a relevant comparison model. For this purpose, we carried out a comparative study between cognitive profiles of patients with ME/CFS and patients suffering from MS. Methods: In total, 40 ME/CFS and 40 MS patients were included. A complete screening of all cognitive functions was carried out through an extensive battery of tests routinely used in clinical practice. Results: ME/CFS and MS patients showed deficits in episodic memory retrieval, visual selective attention and reading speed. ME/CFS patients also elicited a lower level of performance than MS patients regarding consolidation. For both groups, levels of performance on these cognitive tests did not correlate with levels of fatigue, pain, and depression. Conclusions: This study highlighted both similarities and differences in the cognitive profiles of ME/CFS and MS patients. While both groups exhibited deficits in episodic memory retrieval, visual selective attention, and reading speed, ME/CFS patients showed distinct impairment in consolidation processes. These cognitive deficits were not correlated with fatigue, pain, or depression, reinforcing the hypothesis of intrinsic cognitive dysfunction in ME/CFS. These findings define a specific cognitive phenotype for ME/CFS, which could improve diagnostic accuracy and therapeutic strategies. Future research, particularly in functional imaging, may elucidate the neurobiological mechanisms underlying these impairments.

The effect of the EXOPULSE Mollii Suit on pain and fibromyalgia-related symptoms-A randomized sham-controlled crossover trial

BACKGROUND

Fibromyalgia pain and related symptoms are poorly managed by approved pharmacological and alternative interventions. This trial aimed to evaluate the effects of the EXOPULSE Mollii Suit-a multisite transcutaneous electrical nerve stimulation device-on fibromyalgia pain, fatigue, affective symptoms, disease impact, and quality of life.

METHODS

Adult patients with fibromyalgia were enrolled. Phase 1 implied a randomized, sham-controlled, cross-over, double-blind trial, applying daily 1 h sessions of active or sham intervention, over 2 weeks (2-week washout). In the open-label phase 2, all patients received daily active intervention for 4 weeks. Comparisons on pain, fatigue, disease impact, affective symptoms, quality of life, clinical impression, and comfort ratings were performed using Friedman, Wilcoxon signed rank, and Chi2 tests.

RESULTS

Thirty-three patients completed the study (93.9% female, mean age: 51.3 years). Pain (primary endpoint assessed via a visual analog scale) was significantly reduced after the active (pre-active: 6.9 ± 1.4, post-active: 5.9 ± 1.8, pre-sham: 6.8 ± 1.4, post-sham: 6.6 ± 1.5) versus the sham intervention (X2 = 10.60, p = 0.014). This was also the case of other secondary endpoints (i.e., fatigue, anxiety, and disease impact), except depression and quality of life. The Clinical Global Impression of Change (CGI-C) was significantly different between the active and sham intervention periods (X2 p = 0.035), and the different proportions of categories were as follows: 'worsening' (sham: 18.2% vs. active: 0.0%), 'improvement' (sham: 48.5% vs. active 63.6%) or 'no change (sham: 33.3% vs. active 36.4%) respectively. After phase 2, significant positive effects were observed for most of the outcomes, and 78.8% of patients reported improvement according to CGI-C.

CONCLUSIONS

This study suggests the clinical benefits of the EXOPULSE Mollii Suit in alleviating pain and fibromyalgia-related fatigue, emotional symptoms, and disease impact. It is worth noting that the study has several limitations related to the low number of participants, the short-term analysis of effects in the first blinded and controlled phase, and the open-label nature of phase 2. Future studies with a larger cohort and longer protocol treatment are needed, to further confirm the current results, and evaluate the long-term effects of this technique.

SIGNIFICANCE

Patients with fibromyalgia suffer from pain as well as fatigue, sleep impairment, emotional disturbances, and altered quality of life. Transcutaneous electrical nerve stimulation might help manage those symptoms, but the available systems are limited by the fact that they could be applied at best over two sites. This randomized controlled study is the first to apply a multi-site transcutaneous electrical nerve stimulation device, the EXOPULSE Mollii Suit, with significant effects on fibromyalgia pain and related symptoms.

Implicit and explicit learning strategies and fatigue: an evaluation of throwing task performance

Introduction

This study aimed to determine the effects of implicit (errorless) and explicit (errorful) training strategies on a throwing task under physiological and mental fatigue conditions.

Methods

Thirty-two participants, equally divided between the explicit and implicit learning groups, participated in a throwing task. The explicit learning group began at a significant distance from the target and gradually moved closer. In contrast, the implicit learning group started close to the target and progressively increased their distance. The initial session referred to as the acquisition phase, comprised 150 throws from five different distances. Subsequent sessions included a retention test and two transfer tests conducted under conditions of both physiological and mental fatigue. Mental fatigue was induced using a 30-minute color-word Stroop task, while physical fatigue was elicited by requiring subjects to maintain 50% of their maximum voluntary isometric contraction (MVC) in elbow extension for a 2-minute duration.

Results

The results revealed that the implicit learning group exhibited improved performance under fatigue conditions and outperformed the explicit learning group significantly, regardless of the type of fatigue.

Conclusion

This results suggests that implicit learning may improve motor performance even under fatigue conditions.

Association of high complement and low immunoglobulins with the clinical symptoms of patients with fibromyalgia

BACKGROUND

Fibromyalgia (FM) is a disease characterized by chronic widespread pain concomitant with various symptoms such as fatigue and anxiety. Although chronic inflammation has been implicated in the immunological abnormalities of FM, there are few human studies on complement and immunoglobulins. In this study, we investigated the immunological characteristics of FM patients and the association between their clinical symptoms and immunological indices, including complement and immunoglobulins.

METHODS

1) The serum 50% hemolytic complement activity (CH50), C3, C4, IgG, IgM, and hsCRP of 36 FM patients and 30 healthy sex- and age-matched controls (HC) were measured and compared. 2) Data from the Brief Pain Inventory (pain intention and pain interference subscales), the visual analog scale (VAS) (low back pain, knee pain, and fatigue), the State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale (anxiety and depression), and CH50, IgG, and hsCRP as immunological indices were acquired for 41 FM patients. Correlation analysis was done of the clinical symptom and immunological indices.

RESULTS

1) The FM group had significantly higher CH50 and lower IgG and IgM than the HC group after adjusting for body mass index (BMI). 2) Correlation analysis of immunological indices and clinical symptoms showed a positive, partial correlation between CH50 and fatigue and trait anxiety after adjusting for sex, age, and BMI.

CONCLUSIONS

FM patients had higher CH50 and lower immunoglobulin levels than HCs. CH50 was also associated with the fatigue and trait anxiety of FM patients. Further studies are needed to determine whether changes in these immunological indices can be used as biomarkers and/or therapeutic targets for FM.

Does music counteract mental fatigue? A systematic review

INTRODUCTION

Mental fatigue, a psychobiological state induced by prolonged and sustained cognitive tasks, impairs both cognitive and physical performance. Several studies have investigated strategies to counteract mental fatigue. However, potential health risks and contextual restrictions often limit these strategies, which hinder their practical application. Due to its noninvasive and portable nature, music has been proposed as a promising strategy to counteract mental fatigue. However, the effects of music on performance decrements vary with different music styles. Synthesizing studies that systematically report music style and its impact on counteracting performance decrements is crucial for theoretical and practical applications.

OBJECTIVES

This review aims to provide a comprehensive systematic analysis of different music styles in counteracting mental fatigue and their effects on performance decrements induced by mental fatigue. Additionally, the mechanisms by which music counteracts mental fatigue will be discussed.

METHODS

A comprehensive search was conducted across five databases-Web of Science, PubMed, SCOPUS, SPORTDiscus via EBSCOhost, and the Psychological and Behavioral Sciences Collection via EBSCOhost-up to November 18, 2023. The selected studies focused solely on music interventions, with outcomes including subjective feelings of mental fatigue, physiological markers, and both cognitive and behavioral performance.

RESULTS

Nine studies met the predetermined criteria for inclusion in this review. The types of music interventions that counteract mental fatigue include relaxing, exciting, and personal preference music, all of which were associated with decreased subjective feelings of mental fatigue and changes in objective physiological markers. Cognitive performance, particularly in inhibition and working memory tasks impaired by mental fatigue, was countered by both relaxing and exciting music. Exciting music was found to decrease reaction time more effectively than relaxing music in working memory tasks. The physiological marker of steady-state visually evoked potential-based brain-computer interface (SSVEP-BCI) amplitude increased, confirming that exciting music counteracts mental fatigue more effectively than relaxing music. Behavioral performance in tasks such as arm-pointing, the Yo-Yo intermittent test, and the 5 km time-trial, which were impaired by mental fatigue, were counteracted by personal preference music.

CONCLUSION

Relaxing music, exciting music, and personal preference music effectively counteract mental fatigue by reducing feelings of fatigue and mitigating performance decrements. Individuals engaged in mentally demanding tasks can effectively counteract concurrent or subsequent cognitive performance decrements by simultaneously listening to relaxing or exciting music without lyrics or by using music during recovery from mental fatigue. Exciting music is more effective than relaxing music in counteracting mental fatigue. Personal preference music is effective in counteracting behavioral performance decrements in motor control and endurance tasks. Mentally fatigued individuals could apply personal preference music to counteract subsequent motor control performance decrements or simultaneously listen to it to counteract endurance performance decrements. Future studies should specify and examine the effects of different music genres, tempos, and intensities in counteracting mental fatigue. Additionally, the role of music in counteracting mental fatigue in contexts such as work productivity, traffic accident risk, and sports requires further investigation, along with the underlying mechanisms.

Impact of CPAP Therapy on Cognition and Fatigue in Patients with Moderate to Severe Sleep Apnea: A Longitudinal Observational Study

Continued solicitation of cognitive resources eventually leads to cognitive fatigue (CF), i.e., a decrease in cognitive efficiency that develops during sustained cognitive demands in conditions of constrained processing time, independently of sleepiness. The expression of CF and its impact on cognition are partly contingent upon prior sleep quality and its restorative effects. Sleep in obstructive sleep apnea (OSA) may be largely restored through the use of continuous positive airway pressure (CPAP) treatment, contributing to a gradual improvement in sleep quality. In this longitudinal observational study, we investigated immediate and longer-term behavioral effects of CPAP treatment on cognitive functioning, evaluating outcomes after the initiation of treatment, and at three and six months, in compliant CPAP-treated OSA patients. Results indicate that CPAP therapy significantly enhances subjective sleep quality and cognitive functions, including episodic memory, inhibition, sustained attention, working memory, and executive control. Noticeable performance improvements were observed in CF-inducing tasks, particularly after six months of CPAP use. Participants also reported substantial gains in quality of life, reduced daytime sleepiness, and improved mood. These results confirm that CPAP therapy not only alleviates immediate physiological disturbances associated with OSA, but also supports cognitive recovery and enhanced overall daily functioning.

Research progress on assessment tools related to occupational fatigue in nurses: a traditional review

Nurse occupational fatigue is a significant factor affecting nursing quality and medical safety. Scientific and effective assessment of occupational fatigue is beneficial for strengthening nurse occupational health management, improving the quality of life for nurses, and ensuring patient safety. This article provides a narrative review of the content, reliability, validity, characteristics, application status, and advantages and disadvantages of assessment tools related to nurse occupational fatigue. These tools include single-dimensional assessment scales (Fatigue Severity Scale, Chinese version of Li Fatigue Scale), multidimensional assessment scales (Fatigue Scale-14, Fatigue Assessment Scale, Multidimensional Fatigue Scale, etc.), and other assessment tools. Our review reveals limitations in existing occupational fatigue assessment tools, such as variability in accuracy and applicability across different populations, and potential biases. These findings underscore the critical role of these tools in nursing management and occupational health, advocating for continuous refinement and innovation. Future research should focus on developing more comprehensive, context-specific tools to address the multifaceted nature of nurse occupational fatigue. Nursing managers must carefully select appropriate tools to effectively identify and mitigate fatigue, thereby enhancing nurse well-being and patient care quality.

Inhalation of Hydrogen-rich Gas before Acute Exercise Alleviates Exercise Fatigue: A Randomized Crossover Study

Hydrogen, as an antioxidant, may have the potential to mitigate fatigue and improve selected oxidative stress markers induced by strenuous exercise. This study focused on a previously unexplored approach involving pre-exercise inhalation of hydrogen-rich gas (HRG). Twenty-four healthy adult men first completed pre-laboratories to determine maximum cycling power (Wmax) and maximum cycling time (Tmax). Then they were subjected to ride Tmax at 80% Wmax and 60-70 rpm on cycle ergometers after inhaled HRG or placebo gas (air) for 60-minute in a double-blind, counterbalanced, randomized, and crossover design. The cycling frequency in the fatigue modeling process and the rating of perceived exertion (RPE) at the beginning and end of the ride were recorded. Before gas inhalation and after fatigue modeling, visual analog scale (VAS) for fatigue and counter-movement jump (CMJ) were tested, and blood samples were obtained. The results showed that compared to a placebo, HRG inhalation induced significant improvement in VAS, RPE, the cycling frequency during the last 30 seconds in the fatigue modeling process, the ability to inhibit hydroxyl radicals, and serum lactate after exercise (p<0.028), but not in CMJ height and glutathione peroxidase activity. The cycling frequency during the last 30 seconds of all other segments in the fatigue modeling process was within the range of 60-70 rpm. In conclusion, HRG inhalation prior to acute exercise can alleviate exercise-induced fatigue, maintain functional performance, and improve hydroxyl radical and lactate levels.

The effects of AG1® supplementation on the gut microbiome of healthy adults: a randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

This study aimed to examine the effect of a commercially available multi-ingredient powder (AG1Ⓡ) on the gut microbiome and assess the impact of AG1Ⓡ on GI tolerability and other clinical safety markers in healthy men and women.

METHODS

Using a double-blind, randomized, two-arm, placebo-controlled, parallel design, we examined a 4-week daily supplementation regimen of AG1Ⓡ vs. placebo (PL). Fifteen men and 15 women provided stool samples for microbiome analysis, questionnaires for digestive quality of life (DQLQ), and completed visual analog scales (VAS) and Bristol stool charts to assess stool consistency and bowel frequency before and after the 4-week intervention. Participant's blood work (CBC, CMP, and lipid panel) was also assessed before and after the 4-week intervention. Alpha diversity was determined by Shannon and Chao1 index scores and evaluated by a two-way ANOVA, beta diversity in taxonomic abundances and functional pathways was visualized using partial least squares-discriminant analyses and statistically evaluated by PERMANOVA. To identify key biomarkers, specific feature differences in taxonomic relative abundance and normalized functional pathway counts were analyzed by linear discriminant analysis (LDA) effect size (LEfSe). Questionnaires, clinical safety markers, and hemodynamics were evaluated by mixed factorial ANOVAs with repeated measures. This study was registered on clinicaltrials.gov (NCT06181214).

RESULTS

AG1Ⓡ supplementation enriched two probiotic taxa (Lactobacillus acidophilus and Bifidobacterium bifidum) that likely stem from the probiotics species that exist in the product, as well as L. lactis CH_LC01 and Acetatifactor sp900066565 ASM1486575v1 while reducing Clostridium sp000435835. Regarding community function, AG1Ⓡ showed an enrichment of two functional pathways while diminishing none. Alternatively, the PL enriched six, but diminished five functional pathways. Neither treatment negatively impacted the digestive quality of life via DQLQ, bowel frequency via VAS, or stool consistency via VAS and Bristol. However, there may have been a greater improvement in the DQLQ score (+62.5%, p = 0.058, d = 0.73) after four weeks of AG1Ⓡ supplementation compared to a reduction (-50%) in PL. Furthermore, AG1Ⓡ did not significantly alter clinical safety markers following supplementation providing evidence for its safety profile.

CONCLUSIONS

AG1Ⓡ can be consumed safely by healthy adults over four weeks with a potential beneficial impact in their digestive symptom quality of life.

Patient-reported outcomes in early phase trials for patients with myelodysplastic syndromes

Patients with myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) experience a wide range of symptoms due both to their underlying disease and the effects of treatment. Designing early phase trials to explore effective therapies in these patients should not only examine anti-tumor activity, but also consider the effects of treatments on how patients feel and function. Assessing symptomatic toxicities associated with new therapies in early phase trials from the patient perspective is best measured using patient-reported outcomes (PROs) and offers valuable insight and complementary information to the traditional adverse event reporting in cancer clinical trials. This review describes PROs, highlights their importance in MDS drug development, and outlines the key psychometric properties and practical considerations that make PROs essential and desirable in evaluating the impact of new therapies. We will provide a general overview of PROs and follow with application of PROs in MDS/AML including strategies to be considered in early phase trials. Finally, we describe the creation of the Office of Patient-Centered Outcomes Research at the US National Institutes of Health which has developed a standardized PROs methodology for early phase trials conducted in the Center for Cancer Research at the US National Cancer Institute.

Conflict Adaptation in Aphasia: Upregulating Cognitive Control for Improved Sentence Comprehension

PURPOSE

This study investigated conflict adaptation in aphasia, specifically whether upregulating cognitive control improves sentence comprehension.

METHOD

Four individuals with mild aphasia completed four eye tracking sessions with interleaved auditory Stroop and sentence-to-picture matching trials (critical and filler sentences). Auditory Stroop congruency (congruent/incongruent across a male/female voice saying "boy"/"girl") was crossed with sentence congruency (syntactically correct sentences that are semantically plausible/implausible), resulting in four experimental conditions (congruent auditory Stroop followed by incongruent sentence [CI], incongruent auditory Stroop followed by incongruent sentence [II], congruent auditory Stroop followed by congruent sentence [CC], and incongruent auditory Stroop followed by congruent sentence [IC]). Critical sentences were always preceded by auditory Stroop trials. At the end of each session, a five-item questionnaire was administered to assess overall well-being and fatigue. We conducted individual-level mixed-effects regressions on reaction times and growth curve analyses on the proportion of eye fixations to target pictures during incongruent sentences.

RESULTS

One participant showed conflict adaptation indicated by faster reaction times on active sentences and more rapid growth in fixations to target pictures on passive sentences in the II condition compared to the CI condition. Incongruent auditory Stroop also modulated active-sentence processing in an additional participant, as indicated by eye movements.

CONCLUSIONS

This is the first study to observe conflict adaptation in sentence comprehension in people with aphasia. The extent of adaptation varied across individuals. Eye tracking revealed subtler effects than overt behavioral measures. The results extend the study of conflict adaptation beyond neurotypical adults and suggest that upregulating cognitive control may be a potential treatment avenue for some individuals with aphasia.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27056149.

Decrements in Morning and Evening Energy Are Associated With a Higher Symptom Burden in Patients With Gynecologic Cancers Receiving Chemotherapy

BACKGROUND

Decrements in energy are a significant problem associated with chemotherapy. To date, no study examined the variability of energy in patients with gynecologic cancers.

OBJECTIVE

To identify distinct morning and evening energy profiles in patients with gynecologic cancers and evaluate for differences in demographic and clinical characteristics, other common symptoms, and quality-of-life (QOL) outcomes.

METHODS

A sample of 232 patients with gynecologic cancers completed questionnaires 6 times over 2 cycles of chemotherapy. Latent profile analysis was used to identify distinct morning and evening energy profiles. Differences in demographic and clinical characteristics, other common symptoms, and QOL outcomes were evaluated using parametric and nonparametric tests.

RESULTS

Three distinct morning (ie, high [9.2%], low [63.1%], very low [27.1%]) and 2 distinct evening (moderate [30.6%], very low [69.4%]) energy classes were identified. Clinical risk factors associated with the worst morning energy profiles included lower functional status and a higher comorbidity burden. Less likely to exercise on a regular basis was the only characteristic associated with the worst evening energy profile. For both symptoms, the worst profiles were associated with higher levels of depression and sleep disturbance, lower levels of cognitive function, and poorer QOL.

CONCLUSIONS

Approximately 70% of patients with gynecologic cancers experienced decrements in morning and evening energy. The study identified modifiable risk factors associated with more decrements in morning and evening energy.

IMPLICATIONS FOR PRACTICE

Clinicians can use these findings to identify higher-risk patients and develop individualized energy conservation interventions for these vulnerable patients.

Real-time EEG-based detection of driving fatigue using a novel semi-dry electrode with self-replenishment of conductive fluid

A novel semi-dry electrode that can realize self-replenishment of conductive liquid is proposed in this study. Driving fatigue is detected by extracting the refined composite multiscale fluctuation dispersion entropy (RCMFDE) features in electroencephalogram (EEG) signals collected by this electrode. The results show that the new semi-dry electrode can automatically complete the conductive fluid supplement according to its own humidity conditions, which not only notably improves the effective working time, but also significantly reduces the skin impedance. By comparing with the classical entropy algorithms, the computational speed and the stability of the RCMFDE method are Substantially enhanced.

The Effects of Mental Fatigue Induced by the Stroop Test on Muscular Endurance Performance and Neuromuscular Activation in Division III Female Athletes

The purpose of this study was to investigate the effect that mental fatigue, as induced by a Stroop test, has on resistance training performance outcomes such as muscular endurance, power output, and neuromuscular activation. Seven female college-aged NCAA Division III student-athletes with at least one year of resistance training experience and were within the 50th percentile for maximal aerobic capacity provided informed consent for participation. During two separate visits, using a within-subject crossover experimental design, subjects completed either the experimental or control condition. Subjects then completed a to-failure leg press test at 50% of their 1-repetition maximum (1RM) followed by an isometric midthigh pull (IMTP) attempt with electromyography (EMG) analysis. The experimental condition consisted of a 30-minute Stroop test, while the control condition consisted of watching 30 minutes of a sitcom. Both activities were completed while cycling at 40% of their aerobic capacity. A NASA Task Load Index (TLX) inventory was administered following the completion of each cycling session to determine the perceived workload and mental fatigue of each activity. While the mentally fatiguing condition was significantly more mentally fatiguing (p = 0.02) than the control condition, mental fatigue did not statistically affect any of the evaluated performance outcomes (p>0.05). These findings suggest that mental fatigue, a common symptom of psychological stress, does not affect resistance-training-related performance outcomes among female athletic populations.

Function, cognition, and quality of life among older adults with lung cancer who live alone: A prospective cohort study

INTRODUCTION

Among older adults without cancer, living alone is associated with poor health outcomes. However, among older adults with non-small cell lung cancer (NSCLC) who live alone, data on function, cognition, and quality of life (QOL) during systemic treatment remain limited.

MATERIALS AND METHODS

We enrolled adults aged ≥65 with advanced NSCLC starting a new chemotherapy, immunotherapy, and/or targeted therapy regimen with non-curative intent. Patients completed geriatric assessments including instrumental activities of daily living (IADL), Montreal Cognitive Assessment, and QOL pretreatment and at 1, 2, 4, and 6 months, or until treatment discontinuation, whichever occurred earlier. We categorized change in IADL, cognition, and QOL as stable/improved, declined with recovery, or declined without recovery using clinically meaningful definitions of change. We used multinomial logistic regression to compare change between patients who lived alone versus with others.

RESULTS

Among 149 patients, median age was 73; 21% lived alone. Pretreatment IADL, cognition, and QOL scores were similar between older adults who lived alone versus with others. During NSCLC treatment, older adults who lived alone had similar trajectories of function (52% functional decline vs 38%), cognition (43% cognitive decline vs 50%), and QOL (45% QOL decline vs 44%) compared with those who lived with others. In unadjusted analyses, patients who lived alone were more likely to develop functional decline with recovery (reference category: stable/improved function) than those who lived with others (relative risk ratio 4.07, 95% CI 1.14-14.6, p = 0.03). However, this association was not observed after adjusting for age, race, prior NSCLC treatment, current treatment group, and pretreatment geriatric assessment differences. There were no differences in cognitive or QOL trajectories in unadjusted or adjusted analyses.

DISCUSSION

Approximately half of older adults with advanced NSCLC who lived alone were able to maintain their function, cognition, and QOL during NSCLC treatment, which was similar to older adults who lived with others. Many older adults with advanced NSCLC who live alone can receive systemic treatment with individualized supportive care.

A systematic literature review of the measurement of patient-reported fatigue in studies of disease modifying therapies for multiple sclerosis

BACKGROUND

Fatigue is the most commonly experienced symptom among people with multiple sclerosis (MS) and has the greatest impact in reducing quality of life. It is important to measure change in MS-related fatigue (MS-fatigue) in response to treatment, particularly the more recent disease modifying therapies (DMTs). To date there has been no systematic literature review of the patient reported outcome (PRO) tools used to measure MS- fatigue specifically in the context of DMTs.

METHODS

MEDLINE, Embase and Clinicaltrials.gov were searched from 01 January 2000 to 13 April 2021 to identify published studies of the treatment of MS with DMTs. Studies where MS-fatigue was measured as an outcome using a PRO tool were included in the review. Further literature searches were undertaken to provide information about the development and validation of each PRO tool.

RESULTS

739 abstracts and 96 clinical trials were manually screened resulting in 68 articles for full text screening. 48 studies were identified for the review; 10 of these were RCTs that considered MS-fatigue as a secondary outcome (4 were Phase 3 trials). The PRO instruments used in the 10 RCTs were the Fatigue Scale for Motor and Cognitive Functions, Fatigue Impact Scale, Modified Fatigue Impact Scale, Fatigue Severity Scale, and Fatigue Symptoms and Impacts Questionnaire - Relapsing Multiple Sclerosis. The other 38 studies were all open-label, longitudinal, non-randomized studies and used the following PRO instruments in addition to those listed above: the Visual Analogue Scale for Fatigue, the Fatigue Descriptive Scale, Modified Fatigue Impact Scale (5 items) and the Würzburger Fatigue Inventory for MS. All these PRO tools were specifically developed for MS-fatigue. Of these 9 PRO tools, 7 were of good methodological quality according to the existing validation studies using the Consensus-based standards for the selection of health measurement instruments (COSMIN) check list and were used in the majority of the MS DMT studies (44/48, 92%). The median follow-up time from baseline to PRO measurement was 12 months (range 1-36 months). Most studies reported on MS fatigue in terms of its change from baseline and whether the change was statistically significant. 5 studies also reported what they considered to be a clinically meaningful difference.

CONCLUSIONS

Although fatigue has the greatest impact on quality of life in people with MS, few studies have rigorously investigated the impact of DMTs on fatigue. Comparisons between study outcomes using different PRO tools is challenging due to the variety of psychometric constructs addressed by the questionnaires and differences in the recall period for fatigue symptoms and the measurement scale. Furthermore most of the PRO tools used to quantify MS-fatigue in studies of DMTs are descended from PRO tools developed during the 1990s before DMTs emerged and before widespread patient involvement in PRO development. New PRO tools should involve patients in their development as recommended by the US Food and Drug Administration and the validation process should consider the sensitivity of the PRO tool to change in fatigue over time or between groups.

Worse Depression Profiles Are Associated With Higher Symptom Burden and Poorer Quality of Life in Patients With Gynecologic Cancer

BACKGROUND

Depression is a pervasive symptom in patients with gynecological cancer undergoing chemotherapy.

OBJECTIVES

Purposes were to identify subgroups of patients with distinct depression profiles and evaluate for differences in demographic and clinical characteristics, severity of common symptoms, and quality of life (QOL) outcomes among these subgroups.

METHODS

Patients with gynecological cancer (n = 231) completed the Center for Epidemiologic Studies-Depression Scale 6 times over 2 cycles of chemotherapy. All of the other measures were completed prior to the second or third cycle of chemotherapy. Latent profile analysis was done to identify the distinct depression profiles. Differences were evaluated using parametric and nonparametric tests.

RESULTS

Three distinct profiles were identified: low (60.1%), high (35.1%), and very high (4.8%). Compared with low class, the other 2 classes had lower functional status and were more likely to self-report a diagnosis of depression. Patients in the 2 worse profiles reported a higher comorbidity burden, higher levels of trait and state anxiety, sleep disturbance, and fatigue, as well as lower levels of cognitive function and poorer QOL. State and trait anxiety, evening fatigue, and sleep disturbance scores exhibit a "dose-response effect" (ie, as the depression profile worsened, the severity of these symptoms increased).

CONCLUSIONS

Almost 40% of our sample experienced high or very high levels of depression across 2 cycles of chemotherapy.

IMPLICATIONS FOR PRACTICE

Clinicians can use the identified risk factors to identify high patients risk and provide tailored psychological interventions aimed to decrease symptom burden and prevent decrements in QOL.

Functional Capacity, Functional Performance, and Symptoms in People With Heart Failure: An Integrative Review

BACKGROUND

Heart failure (HF) is a clinical syndrome that has a negative effect on functional status, a multidimensional concept characterizing one's ability to provide for the necessities of life. Symptoms might be associated with different aspects of functional status in HF. However, the terms functional capacity and performance have been misused interchangeably, and no previous review has focused on the extent to which symptoms contribute to functional capacity and performance among people with HF.

OBJECTIVE

The aim of this study was to comprehensively review and synthesize the existing literature on the relationship between symptoms, functional capacity, and functional performance in people with HF.

METHODS

We conducted an integrated review of observational studies in which authors examined the relationship between at least 1 symptom and at least 1 aspect of functional capacity or performance in people with HF 18 years or older. The Joanna Briggs Institute's critical appraisal tools were used to analyze the quality of studies.

RESULTS

We included 23 studies with 7219 participants and an age range of 40 to 86 years. Fifteen symptom measures were used to measure dyspnea, fatigue, pain, insomnia symptoms, depressive symptoms, and anxiety symptoms. Three functional capacity measures were assessed in 9 studies, and 7 functional performance measures were assessed in 17 studies. As often measured with the Six-Minute Walk Test, functional capacity was inversely associated with pain/discomfort, insomnia symptoms, and psychological symptoms. Functional performance, often measured by the New York Heart Association functional class and Medical Outcome Scale Short Form 36, was associated with sleep difficulties, fatigue, depressive symptoms, and anxiety. Four studies combined functional capacity and performance measures to elicit functional status. Depressive symptoms, fatigue, pain, and insomnia symptoms are associated with decreased functional performance and capacity.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Commonly, symptoms experienced in HF are associated with declining functional status. However, this finding depends on the measures or metrics used to assess symptoms, functional capacity, and performance. The observed dissimilarities in the relationship between symptoms and functional capacity and performance highlight the conceptual distinctions, suggesting that authors of future studies should judiciously select appropriate dimensions and measures of functional status based on the study's purposes, design, and available resource.

Sleep Fragmentation Modulates the Neurophysiological Correlates of Cognitive Fatigue

Cognitive fatigue (CF) is a critical factor affecting performance and well-being. It can be altered in suboptimal sleep quality conditions, e.g., in patients suffering from obstructive sleep apnea who experience both intermittent hypoxia and sleep fragmentation (SF). Understanding the neurophysiological basis of SF in healthy individuals can provide insights to improve cognitive functioning in disrupted sleep conditions. In this electroencephalographical (EEG) study, we investigated in 16 healthy young participants the impact of experimentally induced SF on the neurophysiological correlates of CF measured before, during, and after practice on the TloadDback, a working memory task tailored to each individual's maximal cognitive resources. The participants spent three consecutive nights in the laboratory two times, once in an undisrupted sleep (UdS) condition and once in an SF condition induced by non-awakening auditory stimulations, counterbalanced and performed the TloadDback task both in a high (HCL) and a low (LCL) cognitive load condition. EEG activity was recorded during wakefulness in the 5 min resting state immediately before and after, as well as during the 16 min of the TloadDback task practice. In the high cognitive load under a sleep-fragmentation (HCL/SF) condition, high beta power increased during the TloadDback, indicating heightened cognitive effort, and the beta and alpha power increased in the post- vs. pre-task resting state, suggesting a relaxation rebound. In the low cognitive load/undisturbed sleep (LCL/UdS) condition, low beta activity increased, suggesting a relaxed focus, as well as mid beta activity associated with active thinking. These findings highlight the dynamic impact of SF on the neurophysiological correlates of CF and underscore the importance of sleep quality and continuity to maintain optimal cognitive functioning.

Unveiling Post-COVID-19 syndrome: incidence, biomarkers, and clinical phenotypes in a Thai population

BACKGROUND

Post-COVID- 19 syndrome (PCS) significantly impacts the quality of life of survivors. There is, however, a lack of a standardized approach to PCS diagnosis and management. Our bidirectional cohort study aimed to estimate PCS incidence, identify risk factors and biomarkers, and classify clinical phenotypes for enhanced management to improve patient outcomes.

METHODS

A bidirectional prospective cohort study was conducted at five medical sites in Hatyai district in Songkhla Province, Thailand. Participants were randomly selected from among the survivors of COVID-19 aged≥18 years between May 15, 2022, and January 31, 2023. The selected participants underwent a scheduled outpatient visit for symptom and health assessments 12 to 16 weeks after the acute onset of infection, during which PCS was diagnosed and blood samples were collected for hematological, inflammatory, and serological tests. PCS was defined according to the World Health Organization criteria. Univariate and multiple logistic regression analyses were used to identify biomarkers associated with PCS. Moreover, three clustering methods (agglomerative hierarchical, divisive hierarchical, and K-means clustering) were applied, and internal validation metrics were used to determine clustering and similarities in phenotypes.

FINDINGS

A total of 300 survivors were enrolled in the study, 47% of whom developed PCS according to the World Health Organization (WHO) definition. In the sampled cohort, 66.3% were females, and 79.4% of them developed PCS (as compared to 54.7% of males, p-value <0.001). Comorbidities were present in 19% (57/300) of all patients, with 11% (18/159) in the group without PCS and 27.7% (39/141) in the group with PCS. The incidence of PCS varied depending on the criteria used and reached 13% when a quality of life indicator was added to the WHO definition. Common PCS symptoms were hair loss (22%) and fatigue (21%), while mental health symptoms were less frequent (insomnia 3%, depression 3%, anxiety 2%). According to our univariate analysis, we found significantly lower hematocrit and IgG levels and greater ALP levels in PCS patients than in patients who did not develop PCS (p-value < 0.05). According to our multivariable analysis, adjusted ALP levels remained a significant predictor of PCS (OR 1.02, p-value= 0.005). Clustering analysis revealed four groups characterized by severe clinical symptoms and mental health concerns (Cluster 1, 4%), moderate physical symptoms with predominant mental health issues (Cluster 2, 9%), moderate mental health issues with predominant physical symptoms (Cluster 3, 14%), and mild to no PCS (Cluster 4, 77%). The quality of life and ALP levels varied across the clusters.

INTERPRETATION

This study challenges the prevailing diagnostic criteria for PCS, emphasizing the need for a holistic approach that considers quality of life. The identification of ALP as a biomarker associated with PCS suggests that its monitoring could be used for early detection of the onset of PCS. Cluster analysis revealed four distinct clinical phenotypes characterized by different clinical symptoms and mental health concerns that 'exhibited varying impacts on quality of life. This finding suggested that accounting for the reduced quality of life in the definition of PCS could enhance its diagnosis and management and that moving toward personalized interventions could both improve patient outcomes and help reduce medicalization and optimally target the available resources.

FUNDING

The research publication received funding support from Medical Council of Thailand (Police General Dr. Jongjate Aojanepong Foundation), Hatyai Hospital Charity and Wellcome Trust.

Worse Morning Energy Profiles Are Associated with Significant Levels of Stress and Decrements in Resilience in Patients Receiving Chemotherapy

OBJECTIVES

Evidence suggests that lower levels of morning energy are associated with higher levels of stress and lower levels of resilience in patients receiving chemotherapy. Study purposes were to identify subgroups of patients with distinct morning energy profiles; evaluate for differences among the profiles in demographic and clinical characteristics, as well as measures of stress, resilience, and coping.

METHODS

A total of 1,343 outpatients receiving chemotherapy completed a demographic questionnaire and measures of global, cancer-related, and cumulative life stress, and resilience at study enrollment. Morning energy was assessed using the Lee Fatigue Scale at six time points over two cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct morning energy profiles. Differences among the subgroups were evaluated using parametric and nonparametric tests.

RESULTS

Three morning energy profiles were identified (i.e., High (17.3%), Low (60.3%), Very Low (22.4%)). Compared to High class, the other two morning energy classes were less likely to be employed; had a lower functional status and a higher comorbidity burden; and were more likely to self-report depression and back pain. For all three types of stress, significant differences were found among the three classes with scores that demonstrated a dose response effect (i.e., High < Low < Very Low; as decrements in morning energy increased, stress scores increased). Compared to High class, Very Low class reported higher rates of physical and sexual abuse. The resilience scores exhibited a dose response effect as well (i.e., High > Low > Very Low). Patients with the two worst energy profiles reported a higher use of disengagement coping strategies.

CONCLUSIONS

Findings highlight the complex relationships among decrements in morning energy, various types of stress, resilience, and coping in patients undergoing chemotherapy.

IMPLICATIONS FOR NURSING PRACTICE

Clinicians need to assess for stress and adverse childhood experiences to develop individualized management plans to increase patients' energy levels.

Assessment of fatigue and its impact in chronic liver disease

Patient-reported outcomes (PROs), such as health-related quality of life (HRQL), are important outcome measures for patients with chronic liver diseases (CLDs). Presence of cirrhosis and advanced liver disease have been associated with worsened HRQL and fatigue. On the other hand, some patients with earlier stages of CLD also experience fatigue, causing PRO impairment. Treatment for some CLDs may improve HRQL and, sometimes, levels of fatigue. We aimed to provide an in-depth expert review of concepts related to fatigue and HRQL in patients with primary biliary cholangitis, hepatitis C virus and MASLD (metabolic dysfunction-associated steatotic liver disease). A panel of experts in fatigue and CLD reviewed and discussed the literature and collaborated to provide this expert review of fatigue in CLD. Herein, we review and report on the complexity of fatigue, highlighting that it is comprised of peripheral (neuromuscular failure, often in conjunction with submaximal cardiorespiratory function) and central (central nervous system dysfunction) causes. Fatigue and HRQL are measured using validated self-report instruments. Additionally, fatigue can be measured through objective tests (e.g. grip strength). Fatigue has deleterious effects on HRQL and one's ability to be physically active and socially engaged but does not always correlate with CLD severity. Treatments for hepatitis C virus and MASLD can improve levels of fatigue and HRQL, but current treatments for primary biliary cholangitis do not seem to affect levels of fatigue. We conclude that obtaining PRO data, including on HRQL and fatigue, is essential for determining the comprehensive burden of CLD and its potential treatments.

Long-Term Functional Limitations and Predictors of Recovery After COVID-19: A Multicenter Prospective Cohort Study

BACKGROUND

Limited data exist on post-severe COVID-19 functional trajectory, particularly considering premorbid status. We characterized 1-year functional recovery post-hospitalization for COVID-19, highlighting predictors of long-term recovery.

METHODS

We enrolled adult patients with lab-confirmed SARS-CoV-2 infection and hospitalized for COVID-19 sequelae, from five major Ontario, Canada hospitals in a prospective cohort study. Assessments included telephone interviews on admission followed by telephone and in-person assessments at 3-, 6-, 9-, and 12-months post-discharge. The Activity-Measure for Post-Acute Care (AM-PAC) Mobility and Cognition scales were administered at baseline and every 3 months for 1 year. Secondary outcomes included symptoms, spirometry, physical performance, dyspnea, fatigue, distress, anxiety and depression, and quality of life.

RESULTS

A total of 254 patients (57.1% male) with a mean age of 60.0 (±13.1) years and an average hospital stay of 14.3 (±19.7) days agreed to participate. At 12 months, 55.3% demonstrated clinically important deficits in mobility and 38.8% had cognitive deficits compared to premorbid levels. Fatigue was reported in 44.2%, followed by difficulty walking long distances in 35.8% and dyspnea in 33.0%. Almost 40% of patients had an FEV1(% Pred) < 80% at 12 months, 60.3% had impairments in physical performance, and 44.5% had problems with anxiety or depression. Predictors of better mobility at 12 months included higher premorbid mobility status, male sex, shorter hospital stay, fewer comorbidities, and higher FEV1 (% pred) at the 3-month follow-up.

CONCLUSIONS

Our study provides compelling evidence of the long-term impact of COVID-19 on functional and cognitive status 1-year post-infection.

Relations Among Multiple Dimensions of Self-Reported Listening Effort in Response to an Auditory Psychomotor Vigilance Task

PURPOSE

Listening effort is a broad construct, and there is no consensus on how to subdivide listening effort into dimensions. This project focuses on the subjective experience of effortful listening and tests if cognitive workload, mental fatigue, and mood are interrelated dimensions.

METHOD

Two online studies tested young adults (n = 74 and n = 195) and measured subjective workload, fatigue (subscales of fatigue and energy), and mood (subscales of positive and negative mood) before and after a challenging listening task. In the listening effort task, participants responded to intermittent 1-kHz target tones in continuous white noise for approximately 12 min.

RESULTS

Correlations and principal component analysis showed that fatigue and mood were distinct but interrelated constructs that weakly correlated with workload. Effortful listening provoked increased fatigue and decreased energy and positive mood yet did not influence negative mood or workload.

CONCLUSIONS

The findings suggest that self-reported listening effort has multiple dimensions that can have different responses to the same effortful listening episode. The results can help guide evidence-based development of clinical listening effort tests and may reveal mechanisms for how listening effort relates to quality of life in those with hearing impairment.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26418976.

Assessments scales for the evaluation of health-related quality of life in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy: a systematic review

Background

The concept of wellbeing is expansive and intricate, making it challenging to define precisely. Similarly, the instruments employed to assess wellbeing are complex and multifaceted. Therefore, it is more appropriate to refer to the notion of wellbeing as Health-Related Quality of Life (HRQoL), which is the central focus of many measures used to assess the feeling of wellbeing. This review aimed to identify the tools most commonly used to evaluate HRQoL in individuals with Parkinsonism-a group of movement disorders that negatively impact the quality of life due to the intricate interplay of symptoms, socio-demographic characteristics, and psychological factors. The main aim was to assess the psychometric properties of these measures in terms of validity and reliability.

Methods

A literature review was conducted, focusing on research related to the assessment of HRQoL in connection to symptoms of Parkinsonism. This review included all studies that examined HRQoL using evaluation scales, exams, or self-reported questionnaires. The literature review was conducted using the databases Scopus and Web of Science and the search engine PubMed to identify studies published between 1996 and 2023. Only records that assessed HRQoL in individuals with Parkinson's disease and Parkinsonism were selected for evaluation.

Results

A total of 393 records were examined, and eight tools were identified as the most frequently used in the evaluation of HRQoL.

Discussion

The results show a significant gap in knowledge regarding the latent structure and measurement invariance of HRQoL measurements, which may have a significant influence on the interpretation of test outcomes. Moreover, there is a lack of clear divergent validity between HRQoL assessments and other tests used as predictors of HRQoL. This could represent a significant limitation, affecting the construct and criterion validity of HRQoL measures.

Symptoms and Health-Related Quality of Life Among Older Adults Living With HIV

BACKGROUND

As individuals living with HIV age, they often experience both physical and psychological symptoms-along with potential reductions in social support-which can significantly affect their health-related quality of life (HRQOL)-a crucial measure in HIV care. However, research exploring the potential predictive roles of social support and symptom experiences in HRQOL among older people living with HIV (PLWH) is limited.

OBJECTIVES

This cross-sectional study aimed to investigate relationships between social support, symptom experiences, and HRQOL in older adults with HIV.

METHODS

Older adults with HIV aged ≥50 years completed surveys on demographic and HIV-related characteristics, social support, four symptoms, and HRQOL. Hierarchical multiple linear regression analyses were used to determine predictors for six HRQOL domains.

RESULTS

Among the 141 PLWH, significant associations were found between fatigue and health perceptions, physical functioning, and role functioning. Sleep disturbance was a significant predictor of health perceptions and social functioning. Anxiety displayed associations with physical functioning, role functioning, mental health, and pain. Depression was linked to health perceptions and mental health aspects of HRQOL. Notably, social support was not associated with any HRQOL domains.

DISCUSSION

These findings underscore the importance of assessing a range of common symptoms to enhance HRQOL among older adults living with HIV, necessitating tailored symptom management strategies for this growing population.

A Multimodal Approach to Measuring Listening Effort: A Systematic Review on the Effects of Auditory Task Demand on Physiological Measures and Their Relationship

OBJECTIVES

Listening effort involves the mental effort required to perceive an auditory stimulus, for example in noisy environments. Prolonged increased listening effort, for example due to impaired hearing ability, may increase risk of health complications. It is therefore important to identify valid and sensitive measures of listening effort. Physiological measures have been shown to be sensitive to auditory task demand manipulations and are considered to reflect changes in listening effort. Such measures include pupil dilation, alpha power, skin conductance level, and heart rate variability. The aim of the current systematic review was to provide an overview of studies to listening effort that used multiple physiological measures. The two main questions were: (1) what is the effect of changes in auditory task demand on simultaneously acquired physiological measures from various modalities? and (2) what is the relationship between the responses in these physiological measures?

DESIGN

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, relevant articles were sought in PubMed, PsycInfo, and Web of Science and by examining the references of included articles. Search iterations with different combinations of psychophysiological measures were performed in conjunction with listening effort-related search terms. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies.

RESULTS

A total of 297 articles were identified from three databases, of which 27 were included. One additional article was identified from reference lists. Of the total 28 included articles, 16 included an analysis regarding the relationship between the physiological measures. The overall quality of the included studies was reasonable.

CONCLUSIONS

The included studies showed that most of the physiological measures either show no effect to auditory task demand manipulations or a consistent effect in the expected direction. For example, pupil dilation increased, pre-ejection period decreased, and skin conductance level increased with increasing auditory task demand. Most of the relationships between the responses of these physiological measures were nonsignificant or weak. The physiological measures varied in their sensitivity to auditory task demand manipulations. One of the identified knowledge gaps was that the included studies mostly used tasks with high-performance levels, resulting in an underrepresentation of the physiological changes at lower performance levels. This makes it difficult to capture how the physiological responses behave across the full psychometric curve. Our results support the Framework for Understanding Effortful Listening and the need for a multimodal approach to listening effort. We furthermore discuss focus points for future studies.

An improved SSVEP-based brain-computer interface with low-contrast visual stimulation and its application in UAV control

Efficient communication and regulation are crucial for advancing brain-computer interfaces (BCIs), with the steady-state visual-evoked potential (SSVEP) paradigm demonstrating high accuracy and information transfer rates. However, the conventional SSVEP paradigm encounters challenges related to visual occlusion and fatigue. In this study, we propose an improved SSVEP paradigm that addresses these issues by lowering the contrast of visual stimulation. The improved paradigms outperform the traditional paradigm in the experiments, significantly reducing the visual stimulation of the SSVEP paradigm. Furthermore, we apply this enhanced paradigm to a BCI navigation system, enabling two-dimensional navigation of unmanned aerial vehicles (UAVs) through a first-person perspective. Experimental results indicate the enhanced SSVEP-based BCI system's accuracy in performing navigation and search tasks. Our findings highlight the feasibility of the enhanced SSVEP paradigm in mitigating visual occlusion and fatigue issues, presenting a more intuitive and natural approach for BCIs to control external equipment.NEW & NOTEWORTHY In this article, we proposed an improved steady-state visual-evoked potential (SSVEP) paradigm and constructed an SSVEP-based brain-computer interface (BCI) system to navigate the unmanned aerial vehicle (UAV) in two-dimensional (2-D) physical space. We proposed a modified method for evaluating visual fatigue including subjective score and objective indices. The results indicated that the improved SSVEP paradigm could effectively reduce visual fatigue while maintaining high accuracy.

The effects of mental fatigue on explicit and implicit contributions to visuomotor adaptation

The goal of the current research was to establish the impact of mental fatigue on the contributions of explicit (i.e., conscious strategy) and implicit (unconscious) processes to visuomotor adaptation. Participants were divided into two groups, a Mental Fatigue (MF) group who completed a cognitively demanding 32-minute time load dual back task (TLDB), and a Control group who watched a documentary for a similar length of time. Following the TLDB task or documentary watching, participants trained to reach with a visuomotor distortion, such that cursor feedback was rotated 40º clockwise relative to hand motion. Explicit and implicit contributions to visuomotor adaptation were assessed following 3 blocks of 45 rotated reach training trials and again following a 20-minute rest. Levels of mental fatigue, as indicated on a self-report scale, increased significantly for the MF group following the TLDB task. The Control group did not display a similar increase in mental fatigue following the documentary watching. Results then revealed a decrease in visuomotor adaptation early in training for the MF group compared to the Control group, as well as decreased retention of visuomotor adaptation immediately following the 20-minute rest. Furthermore, correlational analyses revealed that greater levels of mental fatigue reported by participants in the MF group were associated with less explicit adaptation and greater implicit adaptation. Similar trends were not observed for the Control group. Taken together, the decreased visuomotor adaptation observed early in training, as well as the moderate correlation between increased mental fatigue and decreased explicit adaptation, suggest that mental fatigue decreases one's ability to engage in explicit processing, limiting the overall extent of initial visuomotor adaptation achieved.

Effects of peanut ball use on perceived labor pain, fatigue, and mother's perception of childbirth: a randomized controlled trial

PURPOSE

The aim of this study was to evaluate the effects of using peanut balls on labor pain, fatigue, and the mother's perception of labor.

METHODS

This is a randomized controlled intervention trial. Data were collected from the Intervention (peanut ball) and Control groups between July 2022 and June 2023, with 45 pregnant women in each group. Data were collected using a personal information form, the Visual Analog Scale-Pain (VAS-P), the Visual Analog Scale for Fatigue (VAS-F), and the Maternal Perception of Childbirth Scale (MPCS).

RESULTS

The VAS-P scores of the intervention group were statistically significantly lower than those of the control group 15 min after peanut ball application (p = .000). Immediately after and 15 min after peanut ball application, the mean fatigue score of the Intervention group was statistically significantly lower than that of the Control group (p = .000). There was no statistically significant difference between the mean duration of labor minutes in the two groups (p = .177). The mean MPCS scores of the intervention group and control groups were 62.73 + 7.30 and 47.17 + 9.12, respectively, and the difference was statistically significant (p = .000).

CONCLUSIONS

The findings of this study indicate that the use of peanut balls during labor can effectively reduce labor pain and fatigue in pregnant women, without affecting the duration of labor. Additionally, the use of peanut balls has been shown to positively influence the perception of labor among pregnant women. Therefore, it is recommended that midwives educate pregnant women about the use of peanut balls during labor and provide support in their use.

Trajectories of Depressive Symptoms Among Patients Undergoing Chemotherapy for Breast, Gastrointestinal, Gynecological, or Lung Cancer

BACKGROUND

Individuals who undergo chemotherapy for cancer are at elevated risk of developing depressive symptoms, yet substantial interindividual variation exists in trajectories of these symptoms.

OBJECTIVE

To examine interindividual variations in trajectories of depressive symptoms during 2 cycles of chemotherapy and to evaluate associations between demographic and clinical characteristics, symptom severity scores, psychological adjustment characteristics (eg, stress and coping), and initial levels and trajectories of depressive symptoms.

METHODS

Patients (n = 1323) diagnosed with breast, gynecologic, lung, or gastrointestinal cancer completed the Center for Epidemiological Studies-Depression Scale 6 times, over 2 cycles of chemotherapy. At enrollment, patients provided demographic information and completed a broad range of symptom, stress, and coping measures. Hierarchical linear modeling was used to identify characteristics associated with initial levels and trajectories of depressive symptoms.

RESULTS

Interindividual differences in initial levels of depressive symptoms were associated with marital status, functional status, level of comorbidity, chemotherapy toxicity, sleep disturbance, morning fatigue, cognitive function, global and cancer-related stress, and coping characteristics (ie, sense of coherence, venting, behavioral disengagement, and self-blame). Interindividual differences in depression trajectories were associated with education, cancer type, chemotherapy toxicity, sleep disturbance, evening energy, evening fatigue, cognitive function, global and cancer-related stress, and self-blame.

CONCLUSIONS

We present new findings concerning the trajectories and predictors of depressive symptoms during chemotherapy.

IMPLICATIONS FOR PRACTICE

Modifiable risk factors (eg, stress and coping) are important targets for intervening to address depressive symptoms in oncology patients.

Vision-based estimation of fatigue and engagement in cognitive training sessions

Computerized cognitive training (CCT) is a scalable, well-tolerated intervention that has promise for slowing cognitive decline. The effectiveness of CCT is often affected by a lack of effective engagement. Mental fatigue is a the primary factor for compromising effective engagement in CCT, particularly in older adults at risk for dementia. There is a need for scalable, automated measures that can constantly monitor and reliably detect mental fatigue during CCT. Here, we develop and validate a novel Recurrent Video Transformer (RVT) method for monitoring real-time mental fatigue in older adults with mild cognitive impairment using their video-recorded facial gestures during CCT. The RVT model achieved the highest balanced accuracy (79.58%) and precision (0.82) compared to the prior models for binary and multi-class classification of mental fatigue. We also validated our model by significantly relating to reaction time across CCT tasks (Waldχ2=5.16,p=0.023). By leveraging dynamic temporal information, the RVT model demonstrates the potential to accurately measure real-time mental fatigue, laying the foundation for future CCT research aiming to enhance effective engagement by timely prevention of mental fatigue.

Chronic Decrements in Energy in Women with Breast Cancer are Associated with Cytokine Gene Polymorphisms

OBJECTIVES

Decrements in energy were found in 67% of women who underwent breast cancer surgery. However, no information is available on chronic decrements in energy and associations with inflammation. Purposes were to identify latent classes of patients with distinct average energy profiles from prior to through 12 months after breast cancer surgery; evaluate for differences in demographic and clinical characteristics between the two extreme average energy classes; and evaluate for polymorphisms for cytokine genes associated with membership in the Low energy class.

METHODS

Women (n = 397) completed assessments of energy prior to and for 12 months following breast cancer surgery. Growth mixture modeling was used to identify classes of patients with distinct average energy profiles. Eighty-two single nucleotide polymorphisms (SNPs) among 15 cytokine genes were evaluated.

RESULTS

Three distinct energy profiles were identified (ie, Low [27.0%], Moderate [54.4%], Changing [18.6%]). Data from patients in the Low and Moderate energy classes were used in the candidate gene analyses. Five SNPs and one haplotype in six different genes remained significant in logistic regression analyses (ie, interleukin [IL]-1β rs1143623, IL1 receptor 1 rs3917332 IL4 rs2243263, IL6 HapA1 [that consisted of rs1800795, rs2069830, rs2069840, rs1554606, rs2069845, rs2069849, and rs2069861], nuclear factor kappa beta subunit 1 rs170731, tumor necrosis factor rs1799964). For several SNPs for IL6, expression quantitative trait locis were identified in subcutaneous and visceral adipose tissue and thyroid tissue. In addition, skeletal muscle was identified as an expression quantitative trait loci for nuclear factor kappa beta subunit 1.

CONCLUSIONS

Findings suggest that cytokine genes are involved in the mechanisms that underlie chronic decrements in energy in women following breast cancer surgery. Given the roles of subcutaneous and visceral adipose and thyroid tissues in metabolism and energy balance, the findings related to IL6 suggest that these polymorphisms may have a functional role in the development and maintenance of chronic decrements in energy.

Psychiatric sequelae after SARS-Cov-2 infection: trajectory, predictors and associations in a longitudinal Australian cohort

A relationship between SARS-CoV-2 infection and psychiatric symptoms has been identified but is still being fully investigated. Neuropsychiatric sequalae have been reported for several infectious agents and are not unexpected for SARS-CoV-2 infection. This study follows for 12 months a sample (N = 144) of people who have had a confirmed infection of SARS-CoV-2. Medical and neuropsychiatric data and biological specimens are collected at 6 study visits. The 34-item SPHERE questionnaire, the Depression in the Medically Ill instrument, the EQ-5D-5L quality of life instrument and the visual analogue scale of fatigue were administered at multiple timepoints and associations with measures of illness and inflammatory biomarkers were investigated using the generalised estimating equation. Associations between inflammatory biomarkers and mental health measures of various effect sizes were identified. A robust inverse association was found between mental health outcomes and long covid status, but not between mental health outcomes and covid illness severity. This study suggests that long covid may be the strongest predictor of neuropsychiatric symptoms amongst people who have been infected with SARS-CoV-2.