Stress and coping styles are associated with severe fatigue in medical students

An Explainable Student Fatigue Monitoring Module with Joint Facial Representation

Online fatigue estimation is, inevitably, in demand as fatigue can impair the health of college students and lower the quality of higher education. Therefore, it is essential to monitor college students' fatigue to diminish its adverse effects on the health and academic performance of college students. However, former studies on student fatigue monitoring are mainly survey-based with offline analysis, instead of using constant fatigue monitoring. Hence, we proposed an explainable student fatigue estimation model based on joint facial representation. This model includes two modules: a spacial-temporal symptom classification module and a data-experience joint status inferring module. The first module tracks a student's face and generates spatial-temporal features using a deep convolutional neural network (CNN) for the relevant drivers of abnormal symptom classification; the second module infers a student's status with symptom classification results with maximum a posteriori (MAP) under the data-experience joint constraints. The model was trained on the benchmark NTHU Driver Drowsiness Detection (NTHU-DDD) dataset and tested on an Online Student Fatigue Monitoring (OSFM) dataset. Our method outperformed the other methods with an accuracy rate of 94.47% under the same training-testing setting. The results were significant for real-time monitoring of students' fatigue states during online classes and could also provide practical strategies for in-person education.

Coping styles with stress and its relations to psychiatric and clinical symptoms in patients with sarcoidosis: A latent profile analysis

OBJECTIVE

Although stress and styles of coping with it can have a major impact on one's health and can determine the course and management of chronic diseases, no previous studies have evaluated coping strategies and their relation to emotional distress and clinical symptoms in sarcoidosis.

METHODS

In two consecutive studies, we investigated differences in coping styles of sarcoidosis patients in comparison to healthy control subjects and the association of identified profiles to an objective measurement of disease (Forced Vital Capacity) and symptoms such as dyspnoea, pain, anxiety and depressive symptoms in 36 patients with sarcoidosis (study 1) and 93 patients with sarcoidosis (study 2).

RESULTS

Across two studies we found that patients with sarcoidosis used emotion-focused and avoidant coping significantly less often than healthy individuals, and that in both groups the profile with dominant problem (task)-focus style was the most beneficial in terms of mental health. Further, the profile of sarcoidosis patients characterized by the lowest intensity of all coping strategies was found to be superior in terms of physical health status (dyspnoe, pain and FVC level).

CONCLUSION

These findings suggest that successful management of sarcoidosis should include coping styles assessment and call for a multidisciplinary approach in diagnosis and treatment of sarcoidosis patients.

Sex Differences in the Correlation between Fatigue Perception and Regional Gray Matter Volume in Healthy Adults: A Large-Scale Study

The relationship between fatigue perception and regional gray matter volume (rGMV) has seldom been studied in healthy adults. Therefore, this study aimed to analyze sex differences in the correlation between rGMV and fatigue perception using Chalder’s fatigue questionnaire (CFQ). The CFQ was used to analyze the sexual features of rGMV related to the degree of perceived fatigue in 2955 healthy adults (male = 1560, female = 1395) of various ages (20–89 years, median 56). A higher CFQ score denotes a higher perceived fatigue level by the participant. According to the CFQ scores in males, the volumes of the right orbital part of the inferior frontal gyrus and left precuneus were negatively correlated (i.e., smaller rGMV had a higher CFQ score), whereas the left angular gyrus was positively correlated. In females, the right inferior temporal gyrus was negative, whereas the left middle temporal gyrus and right putamen were positive (i.e., larger rGMV had a higher CFQ score). The lack of identified regions in this large-scale study between males and females might be related to sex differences in clinical or pathological fatigue morbidities. Additionally, the sex differences in the negative or positive correlations between rGMV and fatigue perception may contribute to a better understanding of the neuronal mechanism in the early stages of fatigue development.

Cross-sectional and prospective association between internet addiction and risk of fatigue among Chinese college students

Severe internet addiction (IA) is associated with a higher risk of musculoskeletal pain, but whether there is a significant prospective association between IA and fatigue is unclear. This study aimed to examine the association between IA and fatigue level among Chinese college students. A cross-sectional (n = 1011) and prospective study (n = 653) was conducted to examine the association between IA and risk of fatigue. IA was measured using Young internet addiction test. Fatigue level was evaluated using the Chalder fatigue scale. Multivariate logistic regression analyses showed a cross-sectional association between IA and the risk of fatigue. The odds ratios (95% CIs) of fatigue for normal, mild, and moderate to severe groups were 1.00 (reference), 1.88 (1.20, 2.95), and 5.60 (3.33, 9.42), respectively (P for trend: <0.001). Similarly, multivariate logistic regression analyses also revealed a significant prospective relationship between IA and the risk of fatigue during the 1-year follow-up period. The odds ratios (95% CIs) of fatigue for normal, mild, and moderate to severe groups were 1.00 (reference), 1.56 (0.67, 3.67), and 3.29 (1.08, 10.04), respectively (P for trend: 0.046). Our findings indicate that IA is positively related to risk of fatigue among Chinese college students. Further interventional studies are needed to explore the causality underlying the effects of IA on fatigue.

Randomized Pilot Trial Using External Yarrow Liver Compress Applications With Metastatic Cancer Patients Suffering From Fatigue: Evaluation of Sympathetic Modulation by Heart Rate Variability Analysis

Background:

Liver compresses are commonly applied in complementary medicine during cancer treatment and are believed to have an energizing effect. We conducted a pilot study to investigate the influence of external application of yarrow liver compresses on the autonomous nervous system by analyzing the heart rate variability (HRV) in metastatic cancer patients undergoing radiation therapy and suffering from cancer-related fatigue (CRF).

Methods:

A randomized pilot trial was undertaken with patients suffering from CRF receiving palliative radiation therapy for bone or brain metastasis over 2 weeks. CRF patients were randomized into an intervention group receiving yarrow liver compresses and a control group receiving no external application. HRV was analyzed at the beginning (T1) and end (T2) period of the study during daytime (d) and nighttime (n) in both groups and quantified using time-, frequency-, and nonlinear dynamics domains.

Results:

A total of 39 patients were randomized between September 2017 and August 2019 and a total of 20 patients (10 per group) were available for analysis. For both groups, significant differences in HRV analyses were found in the comparison over the timeline between the first and second measurement (T1d→T2d) during daytime. Specifically, the intervention group showed decreased HRV and complexity of heart rate regulation, indicating increased sympathetic activity at time T2d, whereas the control group showed increased HRV and complexity of heart rate regulation, indicating increased vagal activity at time T2d. Furthermore, the observed HRV analyses showed almost no significant differences between the 2 groups in a direct comparison at the beginning and the end of the study (exception: T2d).

Conclusions:

Yarrow liver compresses led to increased sympathetic activity during daytime in the intervention group, whereas in the control group, which did not receive any external application, increased parasympathetic activity was observed.

Stress and its correlates among medical students in six medical colleges: an attempt to understand the current situation

Abstract

Background

Medical students encounter various stressors during their studies. The study aimed to assess stress levels, sources, and associated determinants among Sudanese medical students. An online questionnaire-based study was conducted among 617 undergraduate medical students of 6 different universities in Sudan. A 19-item questionnaire was utilized to assess stress sources, in addition to demographics, stress manifestations, and coping strategies.

Results

The overall prevalence of stress was 31.7% (p < 0.01). The main sources of stress were time pressure, heavy workload, fear of failure, and examination frequency. One-third of students indicated that they experienced at least one source of psychosocial- and teaching-related stress. Female medical students were more significantly stressed due to academics than males. Also, fourth- and fifth-year students were academically more stressed in comparison to the first-year students. Poisson regression analysis model showed that first-year students were less stressed than the final-year students in relation to academics (odds = 0.888, P = 0.003). Male medical students, across all study years, were far less stressed than females (odds = 0.901, P = 0.000153). Expectedly, ‘studying medicine by choice’ was associated with decreased odds for psychosocial stressors (odds = 0.885, P = 0.00781), and improved model-fit (chi-squared = 6.8952, P = 0.008643). Also, the year of study was a predictor of teaching-related stress development.

Conclusions

Female medical students were more stressed due to academics than males. On the other hand, final-year students were more academically stressed than first-year students. Female medical students were likely having stress related to academic stress development, while being first-year medical student was a predictor of not developing academic stress. Studying medicine by choice’ was associated with ability to cope against stress.

Prediction model for abnormal eating behaviour among hospital nurses: A structural equation modelling approach

BACKGROUND

Nurses are at a high risk of developing abnormal eating behaviour. However, few studies have attempted to identify the factors that influence such behaviour.

AIM

This study identifies factors that can predict abnormal eating behaviour in hospital nurses.

DESIGN

This study adopted a cross-sectional, descriptive correlational research design.

METHODS

A literature review was used to establish a hypothetical model, comprising the eight factors of shift work, job stress, depression, sleep quality, fatigue, coping strategy (active coping and passive coping) and abnormal eating behaviour. A convenience sample of 298 nurses aged less than 45 was recruited from two university hospitals, and structured questionnaire was administered between March and April 2017. The hypothesized model was tested using structural equation modelling.

RESULTS

Sleep quality and passive coping directly affect abnormal eating behaviour, which implies that poor sleep quality and increased passive coping worsens the behaviour. Shift work and depression indirectly affect abnormal eating behaviours.

CONCLUSION

Nursing managers and health policy makers should adopt strategies such as improving the shift-work pattern, providing adequate rest time after a night shift and enabling coping strategies by providing educational programs for hospital nurses.

Perceived Stress and Cyberloafing among College Students: The Mediating Roles of Fatigue and Negative Coping Styles

Cyberloafing has increasingly attracted the attention of scholars because of the widespread use of digital devices in educational environments. This research was conducted to investigate the roles of fatigue and negative coping styles in mediating the relationship between perceived stress and cyberloafing. A total of 730 undergraduates (reduced to 716 due to incomplete data) completed self-report questionnaires measuring perceived stress, fatigue, negative coping styles, and cyberloafing. Perceived stress was shown to be a significant predictor of cyberloafing. Furthermore, negative coping styles played a unique mediating role and fatigue and negative coping styles exerted a sequential mediating effect on the association between perceived stress and cyberloafing. We envision the findings as being helpful in guiding educators develop interventions for minimizing cyberloafing by college students and its disrupting effects.

Mental fatigue is linked with attentional bias for sad stimuli

Previous studies have revealed that patients with chronic fatigue syndrome and affective disorders (such as depression and anxiety disorders) exhibit a vigilant attentional bias toward negative emotional stimuli. However, it remains unclear whether the change in an attentional bias for negative emotional stimuli can be induced by mental fatigue in healthy individuals. To address this question, we examined healthy participants’ (n = 27) performance in a visual probe task and emotional Stroop task before and after the mental-fatigue-inducing task. We demonstrated that acute mental fatigue induced by the long-lasting working memory task led to the alteration of cognitive processing of negative emotional information in the healthy volunteers.

Modeling the Effects of Stress, Anxiety, and Depression on Rumination, Sleep, and Fatigue in a Nonclinical Sample

Stress and affective distress have previously been shown to predict sleep quality, and all the factors have been shown to predict fatigue severity. However, few prior studies have examined the likely indirect mediational relationships between stress, affective distress, and sleep quality in predicting fatigue severity, and the potential role played by ruminative thinking. A short questionnaire asked 229 participants about their recent experiences of stress, affective distress, rumination, sleep, and fatigue in a community sample. High stress, anxiety, and depression were related to more ruminative thinking, which in turn was related to poor sleep quality (composed of subjective sleep quality, daytime dysfunction, sleep latency, and sleep disturbance) and poor sleep quality predicted worse fatigue. The results suggest that rumination parsimoniously explains the tendency of stress and affective distress to contribute to poor sleep quality, and together with poor sleep, it may also contribute to worse fatigue in some individuals.

Assessment of Physician Well-being, Part Two: Beyond Burnout

Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.

Pupil light reflex evoked by light-emitting diode and computer screen: Methodology and association with need for recovery in daily life

OBJECTIVES

Pupil light reflex (PLR) has been widely used as a method for evaluating parasympathetic activity. The first aim of the present study is to develop a PLR measurement using a computer screen set-up and compare its results with the PLR generated by a more conventional setup using light-emitting diode (LED). The parasympathetic nervous system, which is known to control the 'rest and digest' response of the human body, is considered to be associated with daily life fatigue. However, only few studies have attempted to test the relationship between self-reported daily fatigue and physiological measurement of the parasympathetic nervous system. Therefore, the second aim of this study was to investigate the relationship between daily-life fatigue, assessed using the Need for Recovery scale, and parasympathetic activity, as indicated by the PLR parameters.

DESIGN

A pilot study was conducted first to develop a PLR measurement set-up using a computer screen. PLRs evoked by light stimuli with different characteristics were recorded to confirm the influence of light intensity, flash duration, and color on the PLRs evoked by the system. In the subsequent experimental study, we recorded the PLR of 25 adult participants to light flashes generated by the screen set-up as well as by a conventional LED set-up. PLR parameters relating to parasympathetic and sympathetic activity were calculated from the pupil responses. We tested the split-half reliability across two consecutive blocks of trials, and the relationships between the parameters of PLRs evoked by the two set-ups. Participants rated their need for recovery prior to the PLR recordings.

RESULTS

PLR parameters acquired in the screen and LED set-ups showed good reliability for amplitude related parameters. The PLRs evoked by both set-ups were consistent, but showed systematic differences in absolute values of all parameters. Additionally, higher need for recovery was associated with faster and larger constriction of the PLR.

CONCLUSIONS

This study assessed the PLR generated by a computer screen and the PLR generated by a LED. The good reliability within set-ups and the consistency between the PLRs evoked by the set-ups indicate that both systems provides a valid way to evoke the PLR. A higher need for recovery was associated with faster and larger constricting PLRs, suggesting increased levels of parasympathetic nervous system activity in people experiencing higher levels of need for recovery on a daily basis.

Low Back Pain among Medical Students in Belgrade (Serbia): A Cross-Sectional Study

Aim

To examine the prevalence of low back pain, to identify self-perceived triggers of low back pain, and to investigate the impact of perceived pain on the daily activities and mood among medical students.

Methods

This cross-sectional study enrolled 459 fourth year students at the Faculty of Medicine in Belgrade during December 2014. The anonymous questionnaire was used for data collection. In data analysis, the chi-square test and t-test were used.

Results

The lifetime prevalence of low back pain was 75.8%, 12-month prevalence 59.5%, and point prevalence 17.2%. Chronic low back pain was experienced by 12.4% of the students. Both the lifetime (p=0.001) and the 12-month (p=0.001) low back pain prevalence rates were significantly higher among female medical students. Mental stress during an exam period (p=0.001), sitting at the university (p=0.002), fatigue (p=0.043), improper body posture (p=0.005), and lack of exercise (p=0.001) as self-perceived triggers of low back pain were significantly more often reported by female students, compared to males. Regarding daily functioning, the experience of low back pain mostly affects students sleeping (14.6%) and walking (12.0%).

Conclusions

The prevalence of LBP is high among Belgrade medical students and significantly affects their everyday functioning.

Fit to Perform: An Investigation of Higher Education Music Students' Perceptions, Attitudes, and Behaviors toward Health

Making music at the highest international standards can be rewarding, but it is also challenging, with research highlighting pernicious ways in which practicing and performing can affect performers' health and wellbeing. Several studies indicate that music students' perceptions, attitudes, and behaviors toward health and healthy living are less than optimal, especially considering the multiple physical and psychological demands of their day-to-day work. This article presents the results of a comprehensive screening protocol that investigated lifestyle and health-related attitudes and behaviors among 483 undergraduate and postgraduate students (mean age = 21.29 years ± 3.64; 59% women) from ten conservatoires. The protocol included questionnaires measuring wellbeing, general health, health-promoting behaviors, perfectionism, coping, sleep quality, and fatigue. On each measure, the data were compared with existing published data from similar age groups. The results indicate that music students have higher levels of wellbeing and lower fatigue than comparable samples outside of music. However, they also reveal potentially harmful perceptions, attitudes, and behaviors toward health. Specifically, engagement in health responsibility and stress management was low, which along with high perfectionistic strivings, limited use of coping strategies, poor sleep quality, and low self-rated health, paints a troubling picture both for the music students and for those who support their training. The findings point to the need for more (and more effective) health education and promotion initiatives within music education; in particular, musicians should be better equipped with mental skills to cope with constant pressure to excel and high stress levels. In part, this calls for musicians themselves to engage in healthier lifestyles, take greater responsibility for their own health, and be aware of and act upon health information in order to achieve and sustain successful practice and performance. For that to happen, however, music educators, administrators, and policy makers must play an active role in providing supportive environments where health and wellbeing is considered integral to expert music training.

Participating in university entrance exam despite repeated failure: a qualitative study of participants' experiences

OBJECTIVES

To explore the experiences of general practitioners who continue to sit a highly-competitive residency entrance examination, despite repeated failure.

METHODS

This qualitative, exploratory study employed semi-structured, in-depth interviews with 35 candidates of a residency entrance exam who had failed the examination at least twice and were preparing to sit it again. Interview questions addressed the challenges they faced and how they managed these challenges. Interview data were audiotaped, transcribed, and analysed to identify themes.

RESULTS

The results demonstrated that more than 50% (n=19) of candidates struggled continuously and internally with different aspects of the exam. These include being under a great deal of pressure to succeed, failing to prioritize study materials, inefficient review during the final days  of preparation, and sitting the exam with an afflicted body. Furthermore, during the examination, they frequently used inefficient strategies to answer questions. Afterwards, they experienced feelings of freedom associated with having finished the exam.

CONCLUSIONS

Participation in a highly-competitive examination exerts a considerable amount pressure on low-performing candidates. This climate not only results in burn out of participants, but it also influences their learning styles and identities as future physicians. It is therefore necessary to design a syllabus for both test candidates and policy makers, in order better to manage this environment. Candidates also should be aware of their individual weaknesses in order to improve their studying skills.

The impact of a sense of self-efficacy on the level of stress and the ways of coping with difficult situations in Polish nursing students

INTRODUCTION

During their first practical classes at a clinical ward nursing students face a new environment; they take on new roles which is associated with stress and a need to handle it.

OBJECTIVE

The aim of this study was to evaluate the effect of a sense of self-efficacy on the level of stress and the ways of coping by Polish nursing students during the first practical classes at a clinical ward.

MATERIAL AND METHODS

The study included 394 undergraduate subjects studying nursing at two universities in Southern Poland. The study used the method of diagnostic questionnaire and estimation. The research tools included: an original questionnaire, Stress Scale (PSS10), Inventory to measure coping with stress (Mini Cope) and Generalized Self-efficacy Scale (GSES). Data analysis was performed using the IBM Statistical Package for Social Sciences, version 21 for Windows. The verification of differences between variables was performed using χ(2) independence test, Kruskal-Wallis test, and Spearman rank correlation coefficient. The level of significance was accepted at α=0.005.

RESULTS

The level of stress and a sense of self-efficacy in majority of tested nursing students were high. The people with low levels of perceived stress had a significantly higher sense of self-efficacy (rhoSpearman=-0.196; p=0.0001). The people with a higher sense of self-efficacy significantly more often used active strategies in stressful situations, such as Active coping (rhoSpearman=0.284; p<0.0001), Planning (rhoSpearman=0.318, p≤0.0001), Positive revaluation (rhoSpearman=0.228, p<0.0001), Acceptance (rhoSpearman=0.188; p=0.0002), Seeking Emotional Support (rhoSpearman=0.123; p=0.0143).

CONCLUSIONS

A sense of self-efficacy had a significant impact on the level of stress and the ways of coping with difficult situations in nursing students.

Frontier studies on fatigue, autonomic nerve dysfunction, and sleep-rhythm disorder

Fatigue is defined as a condition or phenomenon of decreased ability and efficiency of mental and/or physical activities, caused by excessive mental or physical activities, diseases, or syndromes. It is often accompanied by a peculiar sense of discomfort, a desire to rest, and reduced motivation, referred to as fatigue sensation. Acute fatigue is a normal condition or phenomenon that disappears after a period of rest; in contrast, chronic fatigue, lasting at least 6 months, does not disappear after ordinary rest. Chronic fatigue impairs activities and contributes to various medical conditions, such as cardiovascular disease, epileptic seizures, and death. In addition, many people complain of chronic fatigue. For example, in Japan, more than one third of the general adult population complains of chronic fatigue. It would thus be of great value to clarify the mechanisms underlying chronic fatigue and to develop efficient treatment methods to overcome it. Here, we review data primarily from behavioral, electrophysiological, and neuroimaging experiments related to neural dysfunction as well as autonomic nervous system, sleep, and circadian rhythm disorders in fatigue. These data provide new perspectives on the mechanisms underlying chronic fatigue and on overcoming it.

Association of fatigue with emotional-eating behavior and the response to mental stress in food intake in a young adult population

Fatigue is a common complaint among young adults. We investigated whether eating behaviors are associated with fatigue in this population. The participants consisted of 117 healthy students attending Osaka City University. They completed questionnaires assessing fatigue and eating behaviors. To identify the factors associated with the prevalence of fatigue, multivariate logistic regression analysis adjusted for gender was performed. The Emotional Eating subscale score of the Japanese version of Three-Factor Eating Questionnaire Revised 21-item and stress response in food intake (large decrease vs. no change) were positively associated with the prevalence of fatigue assessed by the Japanese version of the Chalder Fatigue Scale. The finding suggests that emotional eating and decrease in amount of food intake under mental stress were associated with fatigue in healthy young adults. Our findings may help to clarify the mechanisms underlying fatigue-eating coupling as well as the etiology of diseases related to abnormal eating behavior.

Predictors of Taiwanese baccalaureate nursing students' physio-psycho-social responses during clinical practicum

The nursing educational process may contribute to stress in nursing students, particularly during clinical rotations. This descriptive study explored the relationships between perceived stress, coping behaviors, personality traits, and physio-psycho-social responses in a clinical practicum among baccalaureate nursing students and identified predictors for physio-psycho-social responses. A cross-sectional design was employed. One hundred and one juniors enrolled in a four-year baccalaureate nursing program in Taiwan participated in this study. Four structured questionnaires were utilized to collect data. Multiple regression analysis showed that three predictors accounted for 53.2% of the variance in students' physio-psycho-social responses, including perceived stress, students' gender, and personality traits. The implication for nursing educators is providing immediate assistance and appropriate support to guide students through difficult learning when they need. Nursing instructors also should pay attention to students' gender-linked differences and be aware of individuals' personality traits, especially those with emotional instability, unsocial behaviors, and depressive signs.

Effect of a human-type communication robot on cognitive function in elderly women living alone

Background

Considering the high prevalence of dementia, it would be of great value to develop effective tools to improve cognitive function. We examined the effects of a human-type communication robot on cognitive function in elderly women living alone.

Material/Methods

In this study, 34 healthy elderly female volunteers living alone were randomized to living with either a communication robot or a control robot at home for 8 weeks. The shape, voice, and motion features of the communication robot resemble those of a 3-year-old boy, while the control robot was not designed to talk or nod. Before living with the robot and 4 and 8 weeks after living with the robot, experiments were conducted to evaluate a variety of cognitive functions as well as saliva cortisol, sleep, and subjective fatigue, motivation, and healing.

Results

The Mini-Mental State Examination score, judgement, and verbal memory function were improved after living with the communication robot; those functions were not altered with the control robot. In addition, the saliva cortisol level was decreased, nocturnal sleeping hours tended to increase, and difficulty in maintaining sleep tended to decrease with the communication robot, although alterations were not shown with the control. The proportions of the participants in whom effects on attenuation of fatigue, enhancement of motivation, and healing could be recognized were higher in the communication robot group relative to the control group.

Conclusions

This study demonstrates that living with a human-type communication robot may be effective for improving cognitive functions in elderly women living alone.

Effects of chewing gum on the stress and work of university students

Recent research has indicated that chewing gum can relieve perceptions of stress in an occupational sample (Smith, 2009). In the present study, 72 students completed 2 weeks of either chewing gum or refraining from chewing gum. They completed scales measuring perceived stress, anxiety, depression, and single item measures of work levels and tiredness. These were completed both pre- and post-treatment. Perceived stress decreased as a function of the amount of gum chewed. The chewing gum condition was also associated with a decrease in not getting enough academic work done. There were no significant effects of chewing gum on mental health outcomes. These results confirm some of findings from previous studies of chewing gum and stress in other samples.

Autonomic nervous alterations associated with daily level of fatigue

BACKGROUND

Fatigue is a common symptom in both sick and healthy people. We examined autonomic nervous alterations associated with fatigue to clarify the mechanisms underlying fatigue.

METHODS

The study group consisted of 19 healthy participants who performed a 2-back test for 30 min as a fatigue-inducing mental task session. Before and after the session, they completed the advanced trail making test (ATMT) for 30 min for mental fatigue evaluation, subjective scales to measure fatigue sensation, and underwent electrocardiography to allow assessment of autonomic nerve activities.

RESULTS

After the fatigue-inducing task, the total error counts on the ATMT tended to increase (P = 0.076); the ATMT for total trial counts (P = 0.001), the subjective level of fatigue (P < 0.001), and the % low-frequency power (%LF) (P = 0.035) increased significantly; and the % high-frequency power (%HF) decreased compared with before the fatigue-inducing task although this did not reach the statistical significance (P = 0.170). Although LF measured in absolute units did not change significantly before and after the fatigue-inducing task (P = 0.771), and HF measured in absolute units decreased after the task (P = 0.020). The %LF and LF/HF ratio were positively associated with the daily level of fatigue evaluated using Chalder's fatigue scale. In addition, %HF was negatively associated with the fatigue score.

CONCLUSIONS

Increased sympathetic activity and decreased parasympathetic activity may be characteristic features of both acute and daily levels of fatigue. Our findings provide new perspectives on the mechanisms underlying fatigue.

Relationship between cognitive functions and prevalence of fatigue in elementary and junior high school students

BACKGROUND

Fatigue is a common complaint among elementary and junior high school students, and is related to poor academic performance. Since grade-dependent development of cognitive functions also influences academic performance, we attempted to determine whether cognitive functions were associated with the prevalence of fatigue.

METHODS

Participants were 148 elementary school students from 4th- to 6th-grades and 152 junior high school students from 7th- to 9th-grades. Participants completed a questionnaire about fatigue (Japanese version of the Chalder Fatigue Scale) and paper-and-pencil and computerized cognitive tests which could evaluate the abilities of motor processing, immediate, delayed and working memory, selective, divided and alternative attention, retrieve learned material, and spatial construction.

RESULTS

We found that in multivariate logistic regression analyses adjusted for grade and gender, slow motor processing was positively correlated with the prevalence of fatigue in the elementary school students and decreases in working memory and divided and alternative attention processing were positively correlated with the prevalence of fatigue in the junior high school students.

CONCLUSION

The grade-dependent development of cognitive function influences the severity of fatigue in elementary and junior high school students.

Relationship between fatigue and photosensitivity

It is considered that photosensitivity is one of the most important factors to cause video-game epilepsy. Since photosensitivity is thought to cause various signs of hypersensitivity in the central nervous system and hypersensitivity is believed to be related to fatigue, whether fatigue is associated with photosensitivity was determined. The study group consisted of 68 healthy medical students attending Osaka City University Graduate School of Medicine. They completed questionnaires dealing with fatigue (Chalder Fatigue Scale) and photosensitivity. On simple regression analyses, fatigue score was positively associated with photosensitivity score. Similarly, on multiple regression analyses adjusted for age, gender, and sleeping hours, fatigue score was positively associated with photosensitivity score. Fatigue is associated with photosensitivity. Our findings provide new perspectives on fatigue.