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Lie JAS, Zienolddiny-Narui S, Bråtveit M. Effects of the combined exposure to chemicals and unusual working hours. Ann Work Expo Health 2024:wxae033. [PMID: 38708995 DOI: 10.1093/annweh/wxae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE Both exposure to occupational chemicals and to unusual working hours have well documented effects on health. Determination of occupational exposure limits is, however, usually based on chemical-only exposure and assumes an 8-h workday, 5 days/week and a 40-h work week. A significant proportion of the workforce is exposed to chemicals while working in other work schedules. This review thus aimed to synthesize and evaluate the scientific support for a combined effect of unusual working hours and chemical exposure and, if possible, give recommendations for OEL adjustments to account for unusual working hours. METHODS The search for articles was made as part of the preparation of a report for the Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals. In this report, unusual working hours were categorized as shift work or extended (>8 h) working hours. Inclusion criteria were observational studies in the English language published up to November 2021 in peer-reviewed journals, with explicit metrics of exposure (chemicals and unusual working hours) and of health outcome, and which explicitly tested the association between exposure and outcome. Search engines of seven databases were used. RESULTS Of the initially 15 400 identified papers, 9 studies published between 1985 and 2021 met the inclusion criteria, 7 of which showed significant associations. Results from a few of the studies, i.e. regarding effects of dust and endotoxin on lung function, effects of acetone on sleep quality and tiredness, effects of carbon disulphide on coronary artery disease and effects of chemicals on spontaneous abortion, suggested more pronounced effects during night shifts compared to during day shifts. DISCUSSION The reviewed data is considered insufficient to conclude on recommendations for OEL adjustment for shift work. Suggested areas of future studies are mentioned. CONCLUSION Further studies about the effects of the combined exposure to unusual working hours and chemical exposure are essential for risk assessment, and for recommendation of potential OEL adjustments. What is important about this paper? Effects of chemical agents at the workplace may depend not only on exposure level and duration but also on the time of exposure in relation to the circadian rhythm. This study reviewed the scientific support for a combined effect of unusual working hours and chemical exposure and revealed an obvious need for additional studies regarding the complex interplay of the two different exposures with respect to adverse health effects.
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Affiliation(s)
- Jenny-Anne S Lie
- Group of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Shan Zienolddiny-Narui
- Group of Occupational Toxicology, National Institute of Occupational Health, Oslo, Norway
| | - Magne Bråtveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Pires L, Reis C, Mesquita Facão AR, Moniri A, Marreiros A, Drummond M, Berger-Estilita J. Fatigue and Mental Illness Symptoms in Long COVID: Protocol for a Prospective Cohort Multicenter Observational Study. JMIR Res Protoc 2024; 13:e51820. [PMID: 38241071 PMCID: PMC10837758 DOI: 10.2196/51820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/13/2023] [Accepted: 12/06/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND The aftermath of the COVID-19 pandemic continues to affect millions worldwide, resulting in persisting postvirus complaints and impacting peoples' quality of life. Long COVID, characterized by lingering symptoms like fatigue and mental illness, can extend beyond a few months, necessitating further research to understand its implications. OBJECTIVE This study aims to quantify the degree of physical and psychological fatigue in patients following COVID-19 infection and examine its correlation with mental health disorders. METHODS Using a consecutive nonrandom sampling technique, we will conduct a prospective cohort multicenter observational study in 5 Portuguese hospitals. Symptomatic adult patients with previous COVID-19 attending follow-up consultations will be enrolled. We will include patients who had mild, moderate, and severe acute disease. We will assess clinical outcomes related to COVID-19, including the type of respiratory support such as high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation. The exclusion criteria will include previous severe psychiatric disorders confirmed by a psychiatrist; refusal or inability to respond to the questionnaire; concomitant neurological disorder; persistent fatigue symptoms during the 6 months before infection; and the need for invasive mechanical ventilation during COVID-19 infection due to a high prevalence of postintensive care syndrome. Our primary outcome is the prevalence of fatigue in patients with post-COVID-19 depression and/or anxiety, as measured by the Chalder Fatigue Scale (CFQ-11) and the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes will include an assessment of health-related quality of life via the EQ-5D questionnaire and an exploration of the prevalence of symptoms of posttraumatic stress disorder (PTSD) using the 14-item Posttraumatic Stress Scale (PTSS-14). We will also examine the association between mental health symptoms and the severity of acute COVID-19. The post-COVID-19 data will be collected at least 6 months after the positive test and no longer than 9 months during the clinical appointment. RESULTS We expect our multicenter study on patients post COVID-19 to reveal a significant link between mental illness symptoms and both physical and psychological fatigue. Patients with heightened depression and anxiety may report increased levels of fatigue. Additionally, we expect to find persistent PTSD symptoms in a subset of participants, indicating the enduring psychological impact of the virus. CONCLUSIONS This study may underscore the need for integrated care addressing physical and mental health in patients post COVID-19. The observed connections emphasize the importance of considering mental well-being for long-term health outcomes. Despite study limitations, our findings contribute valuable insights for future treatment strategies and highlight the necessity for comprehensive mental health support in post-COVID-19 care. This research provides valuable insights into the mental health implications of COVID-19 and its impact on post-COVID-19 fatigue and the overall well-being of affected individuals. TRIAL REGISTRATION ClinicalTrials.gov NCT05323318; https://clinicaltrials.gov/study/NCT05323318. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51820.
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Affiliation(s)
- Ligia Pires
- Serviço de Pneumologia, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Cláudia Reis
- Serviço de Psiquiatria, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Ana Rita Mesquita Facão
- Serviço de Psiquiatria, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Armin Moniri
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
- Regenerative Medicine Program, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
- Algarve Biomedical Center, University of Algarve, Faro, Portugal
- Hospital Particular do Algarve, Faro, Portugal
| | - Ana Marreiros
- Regenerative Medicine Program, Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Marta Drummond
- Centro de Responsabilidade Integrada Sono e VNI, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Joana Berger-Estilita
- Institute of Anaesthesiology and Intensive Care, Salem Spital, Hirslanden Medical Group, Bern, Switzerland
- Institute for Medical Education, University of Bern, Bern, Switzerland
- Centre for Health Technology and Services Research (CINTESIS), Faculty of Medicine, Universidade do Porto, Porto, Portugal
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Verhoef VTR, Smolders KCHJ, Remmelswaal L, Peeters G, Overeem S, de Kort YAW. Match and Mismatch between Lived Experiences of Daytime Sleepiness and Diagnostic Instruments: A Qualitative Study amongst Patients with Sleep Disorders. Clocks Sleep 2024; 6:24-39. [PMID: 38247883 PMCID: PMC10801535 DOI: 10.3390/clockssleep6010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
Excessive daytime sleepiness is a common symptom of sleep disorders. Despite its prevalence, it remains difficult to define, detect, and address. The difficulties surrounding sleepiness have been linked to an ambiguous conceptualization, a large variety of scales and measures, and the overlap with other constructs, such as fatigue. The present study aims to investigate patients' descriptions of sleepiness-related daytime complaints and their phenomenology. We performed semi-directed interviews with patients diagnosed with obstructive sleep apnea (N = 15) or narcolepsy (N = 5). The interviewers took care of utilizing the participants' terminology when describing daytime complaints related to their sleep disorder. Various aspects of the daytime complaints were investigated, such as their description and temporality. The transcribed content was thematically analyzed using an eclectic coding system, yielding five themes. The participants used different interchangeable descriptors (tired, sleepy, fatigued, exhausted) to express their daytime complaints. They enriched their description with indexes of magnitude (ranging from 'not especially' to 'most gigantic, extreme'), oppositions to other states (using antipodes like energy, alertness, wakefulness, or rest), and indications of fluctuations over the day. Interestingly, the participants often used metaphors to express their experiences and their struggles. The lived experiences of the patients were found to not always align with common self-reported monitoring tools of sleepiness and to relate only in part with current conceptions. In practice, it is important to probe daytime complaints, such as daytime sleepiness, with a broader consideration, for example, by exploring antipodes, consequences, and time-of-day fluctuations.
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Affiliation(s)
- Vaida T. R. Verhoef
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
| | - Karin C. H. J. Smolders
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
| | - Lysanne Remmelswaal
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
| | - Geert Peeters
- Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands; (G.P.); (S.O.)
| | - Sebastiaan Overeem
- Center for Sleep Medicine Kempenhaeghe, 5591 VE Heeze, The Netherlands; (G.P.); (S.O.)
- Department of Electrical Engineering, Eindhoven University of Technology, 5612 AP Eindhoven, The Netherlands
| | - Yvonne A. W. de Kort
- Human-Technology Interaction, Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands; (K.C.H.J.S.)
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Goh HT, Stewart J, Becker K. Validating the Fatigue Scale for Motor and Cognitive Function (FSMC) in chronic stroke. NeuroRehabilitation 2024; 54:275-285. [PMID: 38143385 DOI: 10.3233/nre-230189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Post-stroke fatigue can manifest as both physical and mental fatigue. The Fatigue Scale for Motor and Cognitive Functions (FSMC) evaluates fatigue on the motor and cognitive domains separately, however, the psychometric properties of this measure in stroke have not been reported. OBJECTIVE To determine the internal consistency, test-retest reliability, and concurrent validity of the FSMC in chronic stroke. METHODS Thirty-four participants with chronic stroke (55.26±12.27 years of age; 59.53±89.21 months post-stroke) completed the FSMC on two separate visits. Internal consistency and reliability of the FSMC were examined using Cronbach's alpha and two-way mixed effects intraclass correlation coefficients (ICC), respectively. Correlation between the FSMC and the Fatigue Severity Scale and Visual Analog Scale-Fatigue was used to assess concurrent validity. RESULTS Internal consistency was excellent (Cronbach's alpha > 0.9) and reliability was moderate to good (ICC = 0.72-0.81) for all FSMC scores. The FSMC demonstrated moderate to good concurrent validity with the Fatigue Severity Scale (ρ= 0.66-0.72) but only fair concurrent validity with the Visual Analog Scale-Fatigue (ρ= 0.37-0.44). CONCLUSION The FSMC is a valid and reliable measure of post-stroke fatigue and may be a useful tool to examine physical fatigue and cognitive fatigue in chronic stroke.
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Affiliation(s)
- Hui-Ting Goh
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Jill Stewart
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbus, SC, USA
| | - Kevin Becker
- Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA
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Knobbe TJ, Kremer D, Eisenga MF, van Londen M, Annema C, Bültmann U, Kema IP, Navis GJ, Berger SP, Bakker SJL. Sleep quality, fatigue, societal participation and health-related quality of life in kidney transplant recipients: a cross-sectional and longitudinal cohort study. Nephrol Dial Transplant 2023; 39:74-83. [PMID: 37418245 PMCID: PMC10730797 DOI: 10.1093/ndt/gfad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Fatigue and impaired health-related quality of life (HRQoL) are common among kidney transplant recipients (KTR). We hypothesized that both may partially be attributable to poor sleep. METHODS Cross-sectional and longitudinal data of KTR enrolled in the TransplantLines Biobank and Cohort Study were used. Sleep quality was assessed using the Pittsburgh Sleep Quality Index questionnaire. Individual strength (i.e. a composite of fatigue, concentration, motivation and physical activity), societal participation and HRQoL were assessed using validated questionnaires. RESULTS We included 872 KTR (39% female, age 56 ± 13 years) and 335 healthy controls. In total, 33% of male KTR and 49% of female KTR reported poor sleep quality, which was higher compared with male and female healthy controls (19% and 28%, respectively, P < .001 for both). In logistic regression analyses, female sex, anxiety, active smoking, low protein intake, physically inactive lifestyle, low plasma magnesium concentration, using calcineurin inhibitors, not using mTOR inhibitors and using benzodiazepine agonists were associated with poor sleep quality. In adjusted linear regression analyses, poor sleep was strongly and independently associated with lower individual strength [standardized β (st.β) = 0.59, 95% confidence interval (CI) 0.45 to 0.74, P < .001], poorer societal participation (frequency: st.β = -0.17, 95% CI -0.32 to -0.01, P = .04; restrictions: st.β = -0.36, 95% CI -0.51 to -0.21, P < .001; satisfaction: st.β = -0.44, 95% CI -0.59 to -0.28, P < .001) and lower HRQoL (physical: st.β = -0.53, 95% CI -0.68 to -0.38, P < .001; mental: st.β = -0.64, 95% CI -0.78 to -0.50, P < .001). The associations with poorer societal participation and lower HRQoL were strongly mediated by individual strength (P < .001 for all), yet the suggested direct effects of poor sleep quality on HRQoL remained significant (Pphysical = .03, Pmental = .002). Longitudinal data of 292 KTR showed that sleep quality improves after kidney transplantation in males (P < .001), but not in females (P = .9). CONCLUSIONS Poor sleep quality is common among KTR, and may be a potential target to improve fatigue, societal participation and HRQoL among KTR.
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Affiliation(s)
- Tim J Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Knoop V, Costenoble A, Debain A, Van der Meulen K, De Vriendt P, Gorus E, Bravenboer B, Jansen B, Scafoglieri A, Bautmans I. Impact of COVID-19 on Physical Activity, Fatigue, and Frailty in Community-Dwelling Older Adults: A Cross-Sectional Study. J Aging Phys Act 2023; 32:172-184. [PMID: 38016449 DOI: 10.1123/japa.2021-0366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/27/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023]
Abstract
This study aimed to describe the level of physical activity and its relation to fatigue and frailty during the COVID-19 pandemic in community-dwelling older adults aged 80 years and over. Three hundred and ninety-one older adults (aged 86.5 ± 3.00) completed a survey including physical activity, the Mobility Tiredness scale, and the FRAIL scale. Linear regression analysis was conducted to assess whether the variables age, sex, and physical activity (independent factors) were significantly related to fatigue and frailty. Respectively, 30.5% and 24.7% of the participants reported a decrease in walking and in energy-intensive activities; 25.4% reported increased sedentary behavior. A lower level of physical activity was associated with higher levels of fatigue and increased frailty risk (p < .05), independently from psychological symptoms. These results are important because participants with lower levels of physical activity and more sedentary behavior are more likely to feel fatigued and have higher risk to be frail.
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Affiliation(s)
- Veerle Knoop
- Department of Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Aging (FRIA) Research, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Axelle Costenoble
- Department of Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Aging (FRIA) Research, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Aziz Debain
- Department of Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Aging (FRIA) Research, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Kristof Van der Meulen
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Patricia De Vriendt
- Department of Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Aging (FRIA) Research, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Arteveldehogeschool, Ghent, Belgium
| | - Ellen Gorus
- Department of Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Aging (FRIA) Research, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Bert Bravenboer
- Frailty in Aging (FRIA) Research, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Bart Jansen
- Department of Electronics and Informatics ETRO, Vrije Universiteit Brussel (VUB), Elsene, Belgium
- IMEC, Leuven, Belgium
| | - Aldo Scafoglieri
- Frailty in Aging (FRIA) Research, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Supporting Clinical Science Department and Research Department of Experimental Anatomy (EXAN), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ivan Bautmans
- Department of Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Frailty in Aging (FRIA) Research, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
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López-Muñoz P, Torres-Costoso AI, Fernández-Rodríguez R, Guzmán-Pavón MJ, de Arenas-Arroyo SN, Basco-López JÁ, Reina-Gutiérrez S. Effect of Vitamin D Supplementation on Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:2861. [PMID: 37447189 DOI: 10.3390/nu15132861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Vitamin D supplementation has been considered a possible treatment to reduce the risk of disease activity and progression in people with multiple sclerosis (MS). However, its effect on disease symptoms remains unclear. The aim of this meta-analysis was to conduct a systematic review to assess the effect of vitamin D on fatigue in this population. The systematic review was conducted using the MEDLINE, Cochrane Library, Embase and Web of Science databases from inception to May 2023. Randomized controlled trials (RCTs) reporting pre-post changes in fatigue after vitamin D supplementation were included. Pooled effect sizes and 95% confidence intervals (95% CIs) were calculated by applying a random effects model with Stata/SE (Version 16.0; StataCorp., College Station, TX, USA). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. A total of five studies with 345 individuals (271 females; age range: 25.4-41.1 years) were included. A significant reduction in fatigue was perceived when vitamin D supplementation was compared with a control group: -0.18 (95% CI: -0.36 to -0.01; I2 = 0%). Thus, our findings show that the therapeutic use of vitamin D on fatigue in people with MS could be considered. Nevertheless, due to the lack of agreement on the dose to be applied, it is recommended to use it under medical prescription.
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Affiliation(s)
- Purificación López-Muñoz
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, 45071 Toledo, Spain
- Research Group in Pediatric and Neurologic Physiotherapy, ImproveLab, University of Castilla La Mancha, 45071 Toledo, Spain
| | - Ana Isabel Torres-Costoso
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, 45071 Toledo, Spain
- Health and Social Research Center, University of Castilla-La Mancha, 16071 Cuenca, Spain
| | | | | | | | - Julián Ángel Basco-López
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, 45071 Toledo, Spain
- Research Group in Pediatric and Neurologic Physiotherapy, ImproveLab, University of Castilla La Mancha, 45071 Toledo, Spain
| | - Sara Reina-Gutiérrez
- Health and Social Research Center, University of Castilla-La Mancha, 16071 Cuenca, Spain
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CHATRENET ANTOINE, PICCOLI GIORGINA, ANTHIERENS AGATHE, TORREGGIANI MASSIMO, AUDEBRAND JEANMICHEL, MOREL BAPTISTE, BEAUNE BRUNO, DURAND SYLVAIN. Neural Drive Impairment in Chronic Kidney Disease Patients Is Associated with Neuromuscular Fatigability and Fatigue. Med Sci Sports Exerc 2023; 55:727-739. [PMID: 36508212 PMCID: PMC9997639 DOI: 10.1249/mss.0000000000003090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) patients have a high degree of fatigue relating to neuromuscular symptoms. There is a lack of evidence regarding the etiology of neuromuscular fatigability in elderly CKD patients. METHODS Inclusion criteria are as follows: age ≥60 yr, glomerular filtration rate (GFR) <45 mL·min -1 per 1.73 m 2 in CKD patients, and GFR >60 mL·min -1 ·1.73 m -2 in controls. The fatigability protocol consisted in a submaximal handgrip task at 40% peak force. Fatigue was assessed using the Multidimensional Fatigue Inventory-20 items (MFI-20) and the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaires. Peak rate of force development (RFD peak , normalized: NRFD peak ) and rate of EMG rise (RER) were measured during explosive contractions; peak force and mean surface EMG were measured during maximum voluntary contractions. Multilevel models tested neuromuscular parameters adjusted for clinical and Multidimensional Fatigue Inventory-20 items subscales. Neuromuscular fatigability contribution to fatigue description was tested using model comparison. RESULTS The study included 102 participants; 45 CKD patients and 57 controls. CKD mainly affected the mental and the reduced motivation subscales of fatigue. CKD was associated with greater neuromuscular fatigability assessed using NRFD peak (group-time interaction, -16.7 % MVF·s -1 , P = 0.024), which increased with fatigue severity ( P = 0.018) and with a higher rate of decrement in RER compared with controls (RER at 50 ms: β = -121.2 μV·s -1 , P = 0.016, and β = -48.5 μV·s -1 , P = 0.196, respectively). Furthermore, these patients show an association between the reduced motivation subscale and the RER (e.g., 30 ms: β = -59.8% EMG peak ·s -1 , P < 0.001). Only peak force fatigability contributed to fatigue variance, whereas RFD peak did not. CONCLUSIONS In CKD patients, the neuromuscular fatigability assessed using RFD peak is related to an impairment in motor-unit recruitment or discharge rates, whereas only peak force fatigability was related to fatigue. This suggests that targeting exercise interventions might lessen fatigue and improve quality of life in CKD patients.
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Affiliation(s)
- ANTOINE CHATRENET
- Le Mans Université, Movement–Interactions–Performance, Le Mans, FRANCE
- Nephrology, Centre Hospitalier Le Mans, Le Mans, FRANCE
| | | | - AGATHE ANTHIERENS
- Le Mans Université, Movement–Interactions–Performance, Le Mans, FRANCE
| | | | | | - BAPTISTE MOREL
- Inter-University Laboratory of Human Movement Biology, Université Savoie Mont Blanc, Chambéry, FRANCE
| | - BRUNO BEAUNE
- Le Mans Université, Movement–Interactions–Performance, Le Mans, FRANCE
| | - SYLVAIN DURAND
- Le Mans Université, Movement–Interactions–Performance, Le Mans, FRANCE
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Knobbe TJ, Kremer D, Douwes RM, Eisenga MF, Gomes-Neto AW, Annema C, Swarte JC, Klont F, Navis G, Berger SP, Bakker SJL, Bodewes FAJA, de Boer MT, Damman K, de Borst MH, Diepstra A, Dijkstra G, Doorenbos CSE, Erasmus ME, Gan CT, Hak E, Hepkema BG, Leuvenink HGD, Lexmond WS, de Meijer VE, Niesters HGM, Pelt LJV, Pol RA, Porte RJ, Ranchor AV, Sanders JSF, Siebelink MJ, Slart RJHJA, Touw DJ, van den Heuvel MC, van Leer-Buter C, van Londen M, Verschuuren EAM, Vos MJ, Weersma RK. Proton Pump Inhibitor Use, Fatigue, and Health-Related Quality of Life in Kidney Transplant Recipients: Results From the TransplantLines Biobank and Cohort Study. Am J Kidney Dis 2023:S0272-6386(23)00532-2. [PMID: 36801431 DOI: 10.1053/j.ajkd.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/21/2022] [Indexed: 02/19/2023]
Abstract
RATIONALE & OBJECTIVE Prior studies report that the use of proton pump inhibitors (PPIs) can adversely affect gut microbiota and gastrointestinal uptake of micronutrients, in particular iron and magnesium, and are used frequently by kidney transplant recipients. Altered gut microbiota, iron deficiency, and magnesium deficiency have been implicated in the pathogenesis of chronic fatigue. Therefore, we hypothesized that PPI use may be an important and underappreciated cause of fatigue and reduced health-related quality of life (HRQoL) in this population. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS Kidney transplant recipients (≥1 year after transplantation) enrolled in the TransplantLines Biobank and Cohort Study. EXPOSURE PPI use, PPI type, PPI dosage, and duration of PPI use. OUTCOME Fatigue and HRQoL, assessed using the validated Checklist Individual Strength 20 Revised questionnaire and Short Form-36 questionnaire. ANALYTICAL APPROACH Logistic and linear regression. RESULTS We included 937 kidney transplant recipients (mean age 56±13 years, 39% female) at a median of 3 (1-10) years after transplantation. PPI use was associated with fatigue severity (regression coefficient 4.02, 95% CI, 2.18 to 5.85, P<0.001), a higher risk of severe fatigue (OR 2.05, 95% CI, 1.48 to 2.84, P<0.001), lower physical HRQoL (regression coefficient-8.54, 95% CI, -11.54 to-5.54, P<0.001), and lower mental HRQoL (regression coefficient-4.66, 95% CI, -7.15 to-2.17, P<0.001). These associations were independent of potential confounders including age, time since transplantation, history of upper gastrointestinal disease, antiplatelet therapy, and the total number of medications. They were present among all individually assessed PPI types and were dose dependent. Duration of PPI exposure was only associated with fatigue severity. LIMITATIONS Residual confounding and inability to assess causal relationships. CONCLUSIONS PPI use is independently associated with fatigue and lower HRQoL among kidney transplant recipients. PPI use might be an easily accessible target for alleviating fatigue and improving HRQoL among kidney transplant recipients. Further studies examining the effect of PPI exposure in this population are warranted.
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Affiliation(s)
- Tim J Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen.
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Rianne M Douwes
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - António W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Research, University Medical Center Groningen
| | - J Casper Swarte
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Frank Klont
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen; Unit of PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen
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10
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Orjatsalo M, Toppila J, Heimola M, Tuisku K, Simola P, Ämmälä AJ, Räisänen P, Parkkola K, Paunio T, Alakuijala A. Snoring was related to self-reported daytime sleepiness and tiredness in young adults performing compulsory conscript service. J Clin Sleep Med 2023; 19:243-251. [PMID: 36111359 PMCID: PMC9892747 DOI: 10.5664/jcsm.10294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES In young adults performing compulsory military service, fatigue and somnolence are common and presumably associated with objective or self-reported sleep deprivation. We aimed to find out whether objective sleep parameters from ambulatory polysomnography could explain their self-reported tiredness and sleepiness and whether habits were associated with sleep parameters or tiredness. METHODS Seventy (67 male, age 18-24 years) participants had their sleep assessed with polysomnography. Their self-reported symptoms and demographic data were obtained from online survey including Epworth Sleepiness Scale, Beck's Depression Inventory, items from Basic Nordic Sleep Questionnaire, Internet Addiction Scale, and lifestyle questions. RESULTS Snoring (audio recording, percentage of total sleep time) was associated with self-reported sleepiness (P = .010) and tiredness (P = .030) and snoring seemed to, partially, explain sleepiness (P = .029). Twenty-six percent of the conscripts had self-reported sleep deprivation (mismatch between reported need for sleep and reported sleep). Self-reported sleep deprivation was significantly associated with somnolence (P = .016) and fatigue (P = .026). Smartphone usage, both average time (P = .022) and frequency of usage (P = .0093) before bedtime, was associated with shorter total sleep time. On average, objective sleep time was rather short (7 hours, 6 minutes), sleep efficiency high (94.9%), proportion of N3 sleep high (27.7%), and sleep latency brief (9 minutes)-suggesting that many of the conscripts might have chronic partial sleep deprivation. CONCLUSIONS Snoring might predispose to tiredness in presumably healthy young adults. Conscripts may have partial sleep deprivation. CITATION Orjatsalo M, Toppila J, Heimola M, et al. Snoring was related to self-reported daytime sleepiness and tiredness in young adults performing compulsory conscript service. J Clin Sleep Med. 2023;19(2):243-251.
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Affiliation(s)
- Maija Orjatsalo
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Toppila
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Heimola
- Department of Psychiatry, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Katinka Tuisku
- Department of Psychiatry, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helskinki, Finland
| | - Petteri Simola
- Finnish Defence Research Agency, Human Performance Division, Tuusula, Finland
| | - Antti-Jussi Ämmälä
- Department of Psychiatry, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- Centre for Military Medicine, The Finnish Defence Forces, Riihimäki, Finland
| | - Pekka Räisänen
- Centre for Military Medicine, The Finnish Defence Forces, Riihimäki, Finland
| | - Kai Parkkola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, and National Defence University, Helsinki, Finland
| | - Tiina Paunio
- Department of Psychiatry, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helskinki, Finland
| | - Anniina Alakuijala
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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11
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Chikersal P, Venkatesh S, Masown K, Walker E, Quraishi D, Dey A, Goel M, Xia Z. Predicting Multiple Sclerosis Outcomes During the COVID-19 Stay-at-home Period: Observational Study Using Passively Sensed Behaviors and Digital Phenotyping. JMIR Ment Health 2022; 9:e38495. [PMID: 35849686 PMCID: PMC9407162 DOI: 10.2196/38495] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has broad negative impact on the physical and mental health of people with chronic neurological disorders such as multiple sclerosis (MS). OBJECTIVE We presented a machine learning approach leveraging passive sensor data from smartphones and fitness trackers of people with MS to predict their health outcomes in a natural experiment during a state-mandated stay-at-home period due to a global pandemic. METHODS First, we extracted features that capture behavior changes due to the stay-at-home order. Then, we adapted and applied an existing algorithm to these behavior-change features to predict the presence of depression, high global MS symptom burden, severe fatigue, and poor sleep quality during the stay-at-home period. RESULTS Using data collected between November 2019 and May 2020, the algorithm detected depression with an accuracy of 82.5% (65% improvement over baseline; F1-score: 0.84), high global MS symptom burden with an accuracy of 90% (39% improvement over baseline; F1-score: 0.93), severe fatigue with an accuracy of 75.5% (22% improvement over baseline; F1-score: 0.80), and poor sleep quality with an accuracy of 84% (28% improvement over baseline; F1-score: 0.84). CONCLUSIONS Our approach could help clinicians better triage patients with MS and potentially other chronic neurological disorders for interventions and aid patient self-monitoring in their own environment, particularly during extraordinarily stressful circumstances such as pandemics, which would cause drastic behavior changes.
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Affiliation(s)
- Prerna Chikersal
- School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Shruthi Venkatesh
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Karman Masown
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth Walker
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Danyal Quraishi
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anind Dey
- Information School, University of Washington, Seattle, Seattle, WA, United States
| | - Mayank Goel
- School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, United States
| | - Zongqi Xia
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
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12
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Dean R. Can improving quality of sleep reduce the symptoms of cancer-related fatigue in adults?: A systematic review. Eur J Cancer Care (Engl) 2022; 31:e13597. [PMID: 35474359 PMCID: PMC9541520 DOI: 10.1111/ecc.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/03/2021] [Accepted: 12/02/2021] [Indexed: 12/01/2022]
Abstract
Purpose Cancer‐related fatigue (CRF) results in reduced quality of life for cancer patients. The relationship between tiredness and fatigue has been established in cancer patients and has been shown to be reciprocal, meaning the relationship is somewhat ‘chicken or the egg’ with tiredness influencing fatigue and vice versa. The aim of this study is to determine whether an improvement in sleep quality can ease the symptoms of CRF and whether this can support the theory that CRF symptoms stem from the effect of tiredness. Method Three databases were searched producing 259 papers. The papers were filtered using several inclusion criteria, resulting in a final list of 20 papers for analysis. The remaining papers (20) were critically appraised using the Critical Appraisals Skills Programme (CASP) randomised control trial checklist and assessed for bias using the Cochrane Collaboration's tool for assessing risk of bias in randomised trials. Results Fourteen papers showed an increase in sleep quality that also resulted in an improvement in fatigue symptoms. Cognitive behavioural therapy was shown to be the most effective intervention with a statistically significant decrease in fatigue alongside significant improvement in sleep quality shown in six of the papers (p < 0.05). Sleep education also had a positive impact on both sleep and fatigue scores with three papers showing significant improvements. Three papers focusing on exercise interventions produced a significant improvement in fatigue symptoms and quality of sleep. Conclusion Improving quality of sleep does ease the symptoms of CRF; however, the ‘chicken or the egg’ question regarding CRF and tiredness cannot be answered at this stage.
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Affiliation(s)
- Rogan Dean
- Warwick Medical School, University of Warwick, Coventry, UK
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13
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Rosander M, Nielsen MB. Workplace bullying and tiredness at work: A cross-lagged prospective study of causal directions and the moderating effects of a conflict management climate. J Occup Health 2022; 64:e12327. [PMID: 35388598 PMCID: PMC9176713 DOI: 10.1002/1348-9585.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/10/2022] [Accepted: 03/19/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To prospectively investigate the reciprocal associations between tiredness at work (TAW) and exposure to bullying behaviors and to determine the role of conflict management climate (CMC) as a moderator of these associations. METHODS A two-wave national probability sample of employees in Sweden (18 months between waves, 921 participated at both waves) measuring TAW, workplace bullying, and CMC. Structural equation modelling was used to test four hypotheses about the longitudinal associations between feeling tired at work and bullying, and CMC as a moderator for the two directions. RESULTS In the analyses of cross-lagged effects, tiredness was significantly associated with an increase in subsequent bullying (β = 0.08, P = .01). Exposure to bullying was not associated with changes in tiredness. CMC moderated the association between tiredness and subsequent bullying (β = -0.13, 95% CI [-0.19, -0.08]), showing an increased risk of exposure to bullying behaviors following tiredness when CMC was low and decreased risk when CMC was high. CONCLUSIONS TAW is a risk factor for subsequent bullying. Finding ways to help employees to reduce tiredness not only will help them perform better at work but also reduce the risk of them becoming targets of bullying. A strong CMC can act as a buffer if a tired person provoke aggression from co-workers.
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Affiliation(s)
- Michael Rosander
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Morten Birkeland Nielsen
- National Institute of Occupational Health, Oslo, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
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14
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Tsirigotis S, Polikandrioti M, Alikari V, Dousis E, Koutelekos I, Toulia G, Pavlatou N, Panoutsopoulos GI, Leftheriotis D, Gerogianni G. Factors Associated With Fatigue in Patients Undergoing Hemodialysis. Cureus 2022; 14:e22994. [PMID: 35415031 PMCID: PMC8992877 DOI: 10.7759/cureus.22994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 01/08/2023] Open
Abstract
Background and objective Fatigue is frequently experienced by patients undergoing hemodialysis and it has a negative effect on their quality of life. The aim of this study was to investigate the factors associated with fatigue in patients undergoing hemodialysis. Methods In this quantitative cross-sectional study, 100 patients on hemodialysis participated. Fatigue was evaluated via the Modified Fatigue Impact Scale (MFIS). Participants also completed a questionnaire about demographics and clinical characteristics. The Kruskal-Wallis test, the Mann-Whitney U test, and Spearman's rho criterion were used to assess the association between fatigue score and patient characteristics. Multiple linear regression was performed to assess the effect of the characteristics on patients' fatigue. Results Statistically significant high levels of physical or mental fatigue were found in older patients (p=0.001 and p=0.001), divorced/widowed patients (p=0.001 and p=0.014), those who had children (p=0.019), those who had primary education (p=0.015), those who were not informed about their health problems (p=0.003 and p=0.006), those who had comorbid diseases (p=0.001 and p=0.001), those who believed that regular information did not help to reduce stress (p=0.005 and p=0.004), patients who had insomnia (p=0.001 and p=0.001), patients who felt tired after hemodialysis (p=0.001 and p=0.001), those who thought they had a change in body image (p=0.001 and p=0.001), those who often felt stiffness (p=0.001 and p=0.001), those who sometimes felt nausea (p=0.015 and p=0.038), and those who had limitations in the clothes they could wear (p=0.001 and p=0.001). Conclusions The findings of this study showed that physical or mental fatigue had a strong association with advanced age, comorbidities, marital status, level of education, inadequate information about the disease, insomnia, and change in body appearance. Hence, renal professionals need to properly educate dialysis patients on the complicated nature of fatigue in order to manage it effectively and improve their physical, cognitive, and social wellbeing.
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Affiliation(s)
- Stavros Tsirigotis
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | - Maria Polikandrioti
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | - Victoria Alikari
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | - Evangelos Dousis
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | - Ioannis Koutelekos
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | - Georgia Toulia
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | - Niki Pavlatou
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
| | | | | | - Georgia Gerogianni
- Department of Nursing, Postgraduate Program "Applied Clinical Nursing", University of West Attica, Athens, GRC
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15
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De Nardi L, Lanzetta MA, Ghirigato E, Barbi E, Gortani G. Approach to the child with fatigue: A focus for the general pediatrician. Front Pediatr 2022; 10:1044170. [PMID: 36533226 PMCID: PMC9755349 DOI: 10.3389/fped.2022.1044170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/16/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Fatigue is a common, nonspecific complaint commonly used to describe various conditions, ranging from a vague, subjective sense of weariness to muscular weakness, fatigability, exercise intolerance or excessive daytime somnolence. Despite its high frequency in the general population, literature addressing the approach to the child with fatigue from a general pediatrician perspective is poor. We herein propose a review of the available evidence on the topic, providing a practical framework to assist physicians in dealing with the issue. METHODS Data were identified by searches of MEDLINE, UpToDate, Google Scholar and references from relevant articles. Articles published between 1990 and 2021 were considered, prioritizing systematic reviews and meta-analyses. Then, an empirically-based model of approaching the tired child was proposed according to our center experience. RESULTS To correctly characterize the meaning of fatigue reporting, specific clues from history and physical examination should be emphasized. Duration, severity, and the age at onset are to be considered. Then, specific queries about everyday activities, sleep hygiene and social domain could be useful in reaching a specific diagnosis and offering an appropriate treatment. CONCLUSIONS We suggest a pragmatic approach to fatigue in children based on age assessment, targeted questions, physical examination clues, and some laboratory first-level tests. This could provide pediatricians with a useful tool to discriminate the broad etiology of such a complaint, disentangling between psychological and organic causes. Further studies are needed to investigate the predictive value, specificity and sensitivity of this diagnostic workflow in managing the child with fatigue.
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Affiliation(s)
- Laura De Nardi
- University of Trieste, Clinical Department of Medical Surgical and Health Science, Trieste, Italy
| | - Maria Andrea Lanzetta
- University of Trieste, Clinical Department of Medical Surgical and Health Science, Trieste, Italy.,Department of Pediatrics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Elena Ghirigato
- University of Trieste, Clinical Department of Medical Surgical and Health Science, Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Clinical Department of Medical Surgical and Health Science, Trieste, Italy.,Department of Pediatrics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giulia Gortani
- Department of Pediatrics, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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16
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Brennan PA, Jarvis S, Oeppen RS. European Association of Oral Medicine 2021 Conference - Crispian Scully Lecture: Applying Human Factors to Improve Patient Safety and Performance. J Oral Pathol Med 2021; 51:13-17. [PMID: 34704293 DOI: 10.1111/jop.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND This paper is a synopsis of the Crispian Scully Lecture, presented by one of the authors (PAB), at the 2021 European Association of Oral Medicine (EAOM) Conference in Lisbon, Portugal. It provides an overview of human factors that affect individuals and teams, highlighting ways to reduce the chances of error and improve patient safety. DISCUSSION AND CONCLUSION Error is an inevitable and 'normal' part of being human, and it can never be completely eliminated, though learning from mistakes is essential. Human factor application in health care can greatly improve patient safety and lead to better team working and staff morale. Personal factors including tiredness, hunger, dehydration and stress can all reduce performance and raise the risk of clinical error. It is also important to understand and optimise interaction within the clinical team. Poor communication, steep hierarchy and loss of situational awareness can all potentially compromise patient safety.
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Affiliation(s)
- Peter A Brennan
- Maxillofacial Unit, Portsmouth Hospitals University Trust, Portsmouth, UK
| | | | - Rachel S Oeppen
- Department of Clinical Radiology, University Hospitals Southampton, Southampton, UK
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17
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Goh HT, Stewart JC, Becker K, Hung CJ. Perceived effort for reaching is associated with self-reported fatigue. J Mot Behav 2021; 54:14-26. [PMID: 33468019 DOI: 10.1080/00222895.2021.1871877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Perceived effort for goal-directed reaching may be impacted by the level of self-reported fatigue, however, the relationship between self-reported fatigue and perceived effort has not been examined. We examined how perceived effort changed under varied reach conditions and the relationship between fatigue, perceived effort and reach performance. Twenty-three young adults performed reach actions toward 9 different targets on a digitizing tablet. Perceived effort was measured using the Borg Rate of Perceived Exertion and Paas Mental Effort Rating Scale. Self-reported fatigue was quantified using the Fatigue Scales for Motor and Cognitive Functions. As reach conditions became more difficult, perceived effort increased significantly. Further, individuals who reported greater fatigue also reported greater perceived effort and showed greater endpoint error during reaching.
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Affiliation(s)
- Hui-Ting Goh
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
| | - Jill C Stewart
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Kevin Becker
- School of Health Promotion and Kinesiology, Texas Woman's University, Denton, Texas
| | - Cheng-Ju Hung
- School of Health Promotion and Kinesiology, Texas Woman's University, Denton, Texas
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18
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Gialluisi A, Di Castelnuovo A, Bracone F, De Curtis A, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Associations between systemic inflammation and somatic depressive symptoms: Findings from the Moli-sani study. Depress Anxiety 2020; 37:935-943. [PMID: 32627260 DOI: 10.1002/da.23070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/21/2020] [Accepted: 06/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The link between systemic inflammation and depression has been deeply investigated, but relatively few studies explored symptom-specific associations, mostly focusing on common inflammatory biomarkers like C-reactive protein (CRP) levels. METHODS We investigated associations of low-grade inflammation with depressive symptoms assessed through a reduced version of Patient Health Questionnaire 9 (PHQ-9) in a large population-based cohort of adult Italians (N = 13 301). We built logistic regressions between each depressive symptom and composite index of systemic inflammation based on four circulating biomarkers, namely CRP, Plt, WBC, and GLR (INFLA)-score, a composite blood-based inflammation index, and with its component biomarkers, namely CRP, platelets count (Plt), white blood cells count (WBC), and granulocyte-to-lymphocyte ratio (GLR). RESULTS We observed a strong association of the altered appetite/eating symptom with standardized INFLA-score (OR [95% CI] = 1.19 [1.12-1.26]; corrected p = 3.0 × 10-7 ), CRP (1.28 [1.20-1.36]; p = 1.9 × 10-13 ), and WBC (1.13 [1.06-1.20]; p = 2.3 × 10-3 ), and of tiredness/low energy with GLR (1.11 [1.05-1.17]; p = 9.4 × 10-3 ). These associations remained stable within nondepressed participants (PHQ-9 < 10), and after adjustment for the use of antidepressants, main chronic conditions, and lifestyle factors; while they were notably attenuated within depressed participants (PHQ-9 ≥ 10) and-for altered appetite only-by adjustment for obesity. CONCLUSIONS This study provides a robust replication of the association previously reported between CRP and altered appetite in a large US population cohort, and supports a link between systemic inflammation, altered appetite, and tiredness. Moreover, it extends this evidence to inflammatory markers other than CRP and suggests new targets for the treatment of atypical depression.
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Affiliation(s)
| | | | - Francesca Bracone
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Amalia De Curtis
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Chiara Cerletti
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | | | | | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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19
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van der Gaag E, van der Palen J, Schaap P, van Voorthuizen M, Hummel T. A Lifestyle (Dietary) Intervention Reduces Tiredness in Children with Subclinical Hypothyroidism, a Randomized Controlled Trial. Int J Environ Res Public Health 2020; 17:E3689. [PMID: 32456236 DOI: 10.3390/ijerph17103689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/26/2022]
Abstract
Purpose: Subclinical hypothyroidism (SH) in children and adults is a subject for discussion in terms of whether to treat it or not with respect to the short-term clinical implications and consequences of SH and in the long term. If treatment with thyroxine supplementation is not indicated, no other treatment is available. We investigated whether a lifestyle (dietary) intervention improves or normalizes SH or decreases the presence of Thyroid Stimulating Hormone (TSH) and/or tiredness. Methods: We randomized children aged 1–12 years with SH to the control group (standard care = no treatment) or intervention group (dietary intervention). The dietary intervention consisted of green vegetables, beef, whole milk and butter for 6 months. The rest of the diet remained unchanged. We measured TSH, FreeT4, Lipid profile, Body Mass Index (BMI) and Pediatric Quality of Life (PedQL) multidimensional fatigue scale scores. Results: In total, 62 children were included. After 6 months, TSH decreased in both groups without a significant difference between the groups (p = 0.98). PedQL fatigue scores for sleep (p = 0.032) and total fatigue scores (p = 0.039) improved significantly in the intervention group, compared to the control group. No unfavorable effects occurred in the lipid profile or BMI. Conclusion: The lifestyle (dietary) intervention did not normalize SH and TSH levels, but it significantly reduced tiredness. These results suggest that children’s well-being can be improved without medication.
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Flament F, Belkebla S, Adam AS, Abric A, Amar D. Gender-related differences in the facial aging of Caucasian French subjects and their relations with perceived ages and tiredness. J Cosmet Dermatol 2020; 20:227-236. [PMID: 32315489 DOI: 10.1111/jocd.13446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVES (a) To assess and compare the changes in five facial signs with age between genders of Caucasian subjects and (b) to evaluate their links with perceived ages and tiredness. MATERIAL AND METHODS Once zoomed from standardized digital photographs, five facial signs of 518 Caucasian French subjects of both genders and different ages (18-69 years) were graded by 15 experts, using a referential Skin Aging Atlas. A large naïve panel of 1000 French subjects (500 men and 500 women) was asked to attribute a perceived age and a degree of tiredness to 200 subjects (among the 518). RESULTS The severity of the facial signs increases with time at a linear-like rate. The changes in marionette lines significantly differ between genders, much more pronounced in women, and nasolabial fold was found more pronounced in men at older ages (>50 years). Before 50's, Forehead wrinkles present a slightly higher severity in men whereas at 50's women present more severe ptosis. Crow's feet wrinkles did not show significant changes. Perceived ages were found significantly correlated with the severities of the facial signs and the perception of tiredness was associated with perceived ages in men, but not in women older than 40 years. The gender-related perceptions from the naïve panel in both perceived ages and tiredness showed a low discrepancy. Interestingly, as for changes in facial signs, the upper-half face seems more affected for men and lower-half face for women; after 40 years, the naïve panel seems more focusing on the same areas to predict a perceived age. CONCLUSION As compared to the previous Chinese study, the present work reveals some slight ethnical-related differences, indicating that the facial signs of the lower face play a major role in the assessment of perceived age of both genders from different ethnicity.
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Affiliation(s)
| | | | | | | | - David Amar
- L'Oréal Research and Innovation, Shanghai, China
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Dardin LP, Garcia ABA, Gazoni FM, dos Santos FC, de Mello MT, Trevisani VFM. Correlation of sleep quality with fatigue and disease activity among patients with primary Sjögren's syndrome: a cross-sectional study. SAO PAULO MED J 2020; 138:146-151. [PMID: 32159602 PMCID: PMC9662840 DOI: 10.1590/1516-3180.2019.0251.r1.1912019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Fatigue is a frequent symptom in patients with primary Sjögren's syndrome (pSS) and can be a cause of or be associated with sleep disorders. OBJECTIVE To assess the sleep quality of pSS patients and its relationship with fatigue and disease activity. DESIGN AND SETTING Analytical observational study conducted at an exercise psychobiology laboratory. METHODS Sleep quality was evaluated using the Pittsburg sleep quality index (PSQI) and actigraphy. Fatigue was evaluated through the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI-SF) and a visual analogue scale for fatigue (VAS-fatigue). Disease activity was evaluated using a visual analogue scale for pain (VAS-pain), EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) and Disease Activity Index (ESSDAI). We summarized the data through descriptive statistics. RESULTS A total of 50 female patients with pSS, of average age 56.4 years, were included in the study; 80% presented low disease activity. The total PSQI score showed that 74% had poor sleep. The actigraphy showed mean sleep latency of 26.2 minutes and mean nightly awakening of 48.2 minutes (duration of wakings after sleep onset, WASO). There were correlations between PSQI and VAS-pain, VAS-fatigue, PROFAD-SSI and ESSPRI. Actigraphy showed a correlation between the duration of WASO and ESSDAI. CONCLUSION The present study provides important information regarding correlations between sleep disorders and disease activity. There is a need for proper control over disease activity and for development of strategies to help patients to sleep better in order to diminish their fatigue.
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Affiliation(s)
- Luciana Paula Dardin
- PT. Physiotherapist and Doctoral Student, Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Ana Beatriz Andreo Garcia
- MD. Physician, Department of Ophthalmology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Fernanda Martins Gazoni
- MD. Physician, Discipline of Geriatrics and Gerontology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; and Doctoral Student, Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Fania Cristina dos Santos
- MD, PhD. Professor, Discipline of Geriatrics and Gerontology, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Marco Tulio de Mello
- PhD. Professor, Physical Education School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil.
| | - Virginia Fernandes Moça Trevisani
- MD, PhD. Professor, Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil; and Professor, Discipline of Rheumatology, Universidade Santo Amaro (UNISA), São Paulo (SP), Brazil.
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Levy AR, Xing S, Brunelli SM, Cooper K, Finkelstein FO, Germain MJ, Kimel M, Platt RW, Belozeroff V. Symptoms of Secondary Hyperparathyroidism in Patients Receiving Maintenance Hemodialysis: A Prospective Cohort Study. Am J Kidney Dis 2019; 75:373-383. [PMID: 31629575 DOI: 10.1053/j.ajkd.2019.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 07/17/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Although multiple lines of evidence suggest a negative impact of secondary hyperparathyroidism on patients with kidney failure treated by hemodialysis, it is uncertain whether patients can detect associated symptoms. The objective was to determine whether changes in parathyroid hormone (PTH) levels are associated with changes in symptoms within this patient population. STUDY DESIGN Prospective cohort. SETTING & PARTICIPANTS 165 adults with hyperparathyroidism secondary to kidney failure diagnosed, a range of dialysis vintages, and receiving regular hemodialysis from a US single-provider organization. EXPOSURE Change in PTH levels over 24 weeks. OUTCOMES 19 putative symptoms of secondary hyperparathyroidism measured up to 4 times using a self-administered questionnaire that assessed severity on a 5-level ordinal scale. ANALYTICAL APPROACH Longitudinal associations between changes in PTH levels and symptom severity were assessed using generalized additive models. RESULTS The 165 participants studied represented 81% of enrollees (N=204) who had sufficiently complete data for analysis. Mean age was 56 years and 54% were women. Increases in PTH levels over time were associated (P<0.1) with worsening of bone aches and stiffness, joint aches, muscle soreness, overall pain, itchy skin, and tiredness, and the effects were more pronounced with larger changes in PTH levels. LIMITATIONS Findings may have been influenced by confounding by unmeasured comorbid conditions, concomitant medications, and multiple testing coupled with a P value threshold of 0.10. CONCLUSIONS In this exploratory study, we observed that among patients with secondary hyperparathyroidism, increases in PTH levels over time were associated with worsening of 1 or more cluster of symptoms. Replication of these findings in other populations is needed before concluding about the magnitude and shape of these associations. If replicated, these findings could inform clinically useful approaches for measuring patient-reported outcomes related to secondary hyperparathyroidism.
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Affiliation(s)
| | - Shan Xing
- Takeda Pharmaceuticals U.S.A, Cambridge, MA
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Abstract
Seeking to improve the working conditions in the reception of the emergency department, a hospital team has implemented a protocol aiming to promote and encourage the practice of napping for all medical and paramedical staff. Under less stress, even if successive 24- or 12-hour on-call shifts remain difficult, the professionals perceive a benefit in terms of quality of working life. This helps them make lucid decisions and perform procedures with dexterity, at any time of the day or night.
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Affiliation(s)
- Arnaud Depil Duval
- Département urgences-UHCD-Smur-USS site d'Évreux et de Vernon, rue Léon-Schwartzenberg, 27000 Evreux, France.
| | - François Haupais
- Service d'accueil, des urgences, site d'Évreux, CH Eure-Seine, hôpital d'Évreux, rue Léon-Schwartzenberg, 27015 Évreux cedex, France
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Abstract
OBJECTIVES To identify, appraise and synthesise qualitative studies on the experience of living with rheumatoid arthritis (RA)-related fatigue. METHODS We conducted a qualitative metasynthesis encompassing a systematic literature search in February 2017, for studies published in the past 15 years, in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, SveMed, PsychINFO and Web of Science. To be included, the studies had to report the experience of living with fatigue among adults with RA. The analysis and synthesis followed Malterud's systematic text condensation. RESULTS Eight qualitative articles were included, based on 212 people with RA (69% women) and aged between 20 and 83 years old. The synthesis resulted in the overall theme 'A vicious circle of an unpredictable symptom'. In addition, the synthesis derived four subthemes: 'being alone with fatigue'; 'time as a challenge'; 'language as a tool for increased understanding' and 'strategies to manage fatigue'. Fatigue affects all areas of everyday life for people with RA. They strive to plan and prioritise, pace, relax and rest. Furthermore, they try to make use of a variety of words and metaphors to explain to other people that they experience that RA-related fatigue is different from normal tiredness. Despite this, people with RA-related fatigue experience feeling alone with their symptom and they develop their own strategies to manage fatigue in their everyday life. CONCLUSIONS The unpredictability of RA-related fatigue is dominant, pervasive and is experienced as a vicious circle, which can be described in relation to its physical, cognitive, emotional and social impact. It is important for health professionals to acknowledge and address the impact of fatigue on the patients' everyday lives. Support from health professionals to manage fatigue and develop strategies to increase physical activity and maintain work is important for people with RA-related fatigue.
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Affiliation(s)
- Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Research department, Sygehus Sønderjylland, Aabenraa and King Christian X’s Hospital for Rheumatic Diseases, Graasten, Denmark
| | - Annette Hegelund
- Center of COPD Competences, Hospital of Naestved, Slagelse, Denmark
| | - Annette Gøntha Lorenzen
- Department of Quality, Research, Innovation and Education, Odense Universitetshospital, Odense, Denmark
| | | | - Emma Dures
- Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Bente Appel Esbensen
- Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, VRR, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Di Muzio M, Reda F, Diella G, Di Simone E, Novelli L, D'Atri A, Giannini A, De Gennaro L. Not only a Problem of Fatigue and Sleepiness: Changes in Psychomotor Performance in Italian Nurses across 8-h Rapidly Rotating Shifts. J Clin Med 2019; 8:jcm8010047. [PMID: 30621274 PMCID: PMC6352064 DOI: 10.3390/jcm8010047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 12/26/2018] [Accepted: 12/29/2018] [Indexed: 02/05/2023] Open
Abstract
Although many studies have detailed the consequences of shift work in nurses concerning health, fatigue, sleepiness, or medical errors, no study has been carried out trying to disentangle the contribution of sleepiness and fatigue associated to shift work from the attentional performance. The aim of this pilot study is (A) to investigate the effects of an 8-h rapidly rotating shift on fatigue and sleepiness among staff nurses and (B) how these factors affect their psychomotor performance. Fourteen nurses were selected for a within-subject cross-sectional study according to this sequence of shifts: morning⁻afternoon⁻night, which were compared as function of tiredness, sleepiness, and performance at the Psychomotor Vigilance Task (PVT). Subsequently, a within-subject Analysis of Covariance (ANCOVA) evaluated if the observed differences between shifts persist when the contribution of sleepiness is controlled. Our results clearly indicate that night shifts are associated with significant greater sleepiness and tiredness, and worsened performance at the PVT. As hypothesized, ANCOVA showed that these differences disappear when the contribution of sleepiness is controlled. Results point to a lower psychomotor performance in night compared to day shifts that depends on sleepiness. Hence, interventions to minimize the consequences of the night shift should consider a reduction of sleepiness.
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Affiliation(s)
- Marco Di Muzio
- Department of Clinical and Molecular Medicine, St. Andrea Hospital, University of Rome "Sapienza", I-00118 Rome, Italy.
| | - Flaminia Reda
- Department of Psychology, University of Rome "Sapienza", I-00185 Rome, Italy.
| | - Giulia Diella
- Department of Clinical and Molecular Medicine, St. Andrea Hospital, University of Rome "Sapienza", I-00118 Rome, Italy.
| | - Emanuele Di Simone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, I-00133 Rome, Italy.
| | - Luana Novelli
- Department of Psychology, University of Rome "Sapienza", I-00185 Rome, Italy.
| | - Aurora D'Atri
- Department of Psychology, University of Rome "Sapienza", I-00185 Rome, Italy.
| | - Annamaria Giannini
- Department of Psychology, University of Rome "Sapienza", I-00185 Rome, Italy.
| | - Luigi De Gennaro
- Department of Psychology, University of Rome "Sapienza", I-00185 Rome, Italy.
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Pirovino CA, Giger R, Landis BN. Sleep apnea: Do not forget to inspect the throat! Clin Case Rep 2019; 7:143-145. [PMID: 30656028 PMCID: PMC6333070 DOI: 10.1002/ccr3.1927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/21/2018] [Accepted: 10/31/2018] [Indexed: 11/06/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a widespread and underdiagnosed disease. Causes are mostly related to obesity and anatomy with oro-pharyngeal narrowing. Parapharyngeal tumors are rare but can easily be treated. Careful oro-pharyngeal examination in OSAS patient is cheap, easy to perform by non-ENT specialists, quick, and avoids inadequate treatment.
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Affiliation(s)
- Christian Alain Pirovino
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryBern University Hospital, InselspitalBernSwitzerland
| | - Roland Giger
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryBern University Hospital, InselspitalBernSwitzerland
| | - Basile Nicolas Landis
- Rhinology‐Olfactology Unit, Department of Otorhinolaryngology ‐ Head and Neck SurgeryUniversity Hospital of GenevaGenevaSwitzerland
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Olson K, Zimka O, Pasiorowski A, Iregbu S, Boulé NG. Tiredness, Fatigue, and Exhaustion as Perceived by Recreational Marathon Runners. Qual Health Res 2018; 28:1997-2010. [PMID: 29986641 DOI: 10.1177/1049732318785360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this article, we report the results of a study that was part of a five-study concept development project. Our goal was to learn about the nature of illness by exploring variations in the manifestations of fatigue, a symptom that is prevalent in both ill (cancer, depression, chronic fatigue syndrome) and selected nonill (recreational marathon runners, shift workers) populations. In this article, we report results of our study of recreational marathon runners, obtained from unstructured interviews with 13 runners between the ages 19 and 49 years using ethnoscience as the design. Key findings with implications for practice are the importance of planning recovery periods following large energy expenditures, the value of using dissociative strategies to manage tiredness, and the usefulness of associative strategies and support systems to manage fatigue. Future studies could explore whether these strategies would be useful for management of tiredness and fatigue in other populations.
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Affiliation(s)
- Karin Olson
- 1 University of Alberta, Edmonton, Alberta, Canada
| | - Oksana Zimka
- 2 McKenzie Towne Retirement by Revera, Calgary, Alberta, Canada
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Akram U, Robson A, Ypsilanti A. Sleep-Related Attentional Bias for Faces Depicting Tiredness in Insomnia: Evidence From an Eye-Tracking Study. J Clin Sleep Med 2018; 14:959-965. [PMID: 29852902 DOI: 10.5664/jcsm.7160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 02/21/2018] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES To date, evidence of an attentional bias in insomnia has mostly been obtained through reaction time tasks, with a limited number of studies using eye tracking. Here, using an eye-tracking paradigm, this study sought to determine whether individuals with insomnia display an attentional bias for novel faces depicting tiredness. METHODS Individuals with insomnia (n = 20) and normal sleepers (n = 20) viewed a series of face pairs depicting neutral and tired expressions each for periods of 4000 milliseconds. Eye movements were recorded using eye tracking, and first fixation onset, first fixation duration, total fixation duration, and total gaze duration were examined for three interest regions (eyes, nose, mouth). RESULTS Significant group × face interactions for total fixation duration and total gaze duration indicated that, regardless of interest-region, participants with insomnia spent more time fixating on and observing tired faces relative to neutral faces when compared with normal sleepers. Additionally, significant group × face × interest-region interactions for total fixation duration and total gaze duration indicated that participants with insomnia spent more time observing the eye region of the tired faces than the eye region of the neutral faces when compared with normal sleepers. CONCLUSIONS Individuals with insomnia display an attentional bias toward tired faces, more specifically for the eye region compared to normal sleepers. These findings contribute to our understanding of face perception in insomnia and provide more objective support for cognitive models of insomnia, suggesting that individuals with insomnia selectively attend to faces for tiredness cues.
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Affiliation(s)
- Umair Akram
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, United Kingdom
| | - Anna Robson
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, United Kingdom
| | - Antonia Ypsilanti
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, United Kingdom
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Hughes A, Kumari M. Age modification of the relationship between C-reactive protein and fatigue: findings from Understanding Society (UKHLS). Psychol Med 2018; 48:1341-1349. [PMID: 28994356 PMCID: PMC6088542 DOI: 10.1017/s0033291717002872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/05/2017] [Accepted: 09/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Systemic inflammation may play a role in the development of idiopathic fatigue, that is, fatigue not explained by infections or diagnosed chronic illness, but this relationship has never been investigated in community studies including the entire adult age span. We examine the association of the inflammatory marker C-reactive protein (CRP) and fatigue assessed annually in a 3-year outcome period for UK adults aged 16-98. METHODS Multilevel models were used to track fatigue 7, 19, and 31 months after CRP measurement, in 10 606 UK individuals. Models accounted for baseline fatigue, demographics, health conditions diagnosed at baseline and during follow-up, adiposity, and psychological distress. Sensitivity analyses considered factors including smoking, sub-clinical disease (blood pressure, anaemia, glycated haemoglobin), medications, ethnicity, and alcohol consumption. RESULTS Fatigue and CRP increased with age, and women had higher values than men. CRP was associated with future self-reported fatigue, but only for the oldest participants. Thus, in those aged 61-98 years, high CRP (>3 mg/L) independently predicted greater fatigue 7, 19, and 31 months after CRP measurement [odds ratio for new-onset fatigue after 7 months: 1.88, 95% confidence interval (CI) 1.21-2.92; 19 months: 2.25, CI 1.46-3.49; 31 months: 1.65, CI 1.07-2.54]. No significant longitudinal associations were seen for younger participants. CONCLUSIONS Our findings support previously described CRP-fatigue associations in older individuals. However, there are clear age modifications in these associations, which may reflect a contribution of unmeasured sub-clinical disease of limited relevance to younger individuals. Further work is necessary to clarify intervening processes linking CRP and fatigue in older individuals.
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Affiliation(s)
- A. Hughes
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, UK
| | - M. Kumari
- Institute for Social and Economic Research, University of Essex, Wivenhoe Park, Colchester, Essex, UK
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30
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Ju A, Unruh M, Davison S, Dapueto J, Dew MA, Fluck R, Germain M, Jassal SV, Obrador G, O'Donoghue D, Josephson MA, Craig JC, Viecelli A, O'Lone E, Hanson CS, Manns B, Sautenet B, Howell M, Reddy B, Wilkie C, Rutherford C, Tong A. Establishing a Core Outcome Measure for Fatigue in Patients on Hemodialysis: A Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) Consensus Workshop Report. Am J Kidney Dis 2018; 72:104-112. [PMID: 29551585 DOI: 10.1053/j.ajkd.2017.12.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/23/2017] [Indexed: 11/11/2022]
Abstract
Fatigue is one of the most highly prioritized outcomes for patients and clinicians, but remains infrequently and inconsistently reported across trials in hemodialysis. We convened an international Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) consensus workshop with stakeholders to discuss the development and implementation of a core outcome measure for fatigue. 15 patients/caregivers and 42 health professionals (clinicians, researchers, policy makers, and industry representatives) from 9 countries participated in breakout discussions. Transcripts were analyzed thematically. 4 themes for a core outcome measure emerged. Drawing attention to a distinct and all-encompassing symptom was explicitly recognizing fatigue as a multifaceted symptom unique to hemodialysis. Emphasizing the pervasive impact of fatigue on life participation justified the focus on how fatigue severely impaired the patient's ability to do usual activities. Ensuring relevance and accuracy in measuring fatigue would facilitate shared decision making about treatment. Minimizing burden of administration meant avoiding the cognitive burden, additional time, and resources required to use the measure. A core outcome measure that is simple, is short, and includes a focus on the severity of the impact of fatigue on life participation may facilitate consistent and meaningful measurement of fatigue in all trials to inform decision making and care of patients receiving hemodialysis.
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Affiliation(s)
- Angela Ju
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Mark Unruh
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM
| | - Sara Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Juan Dapueto
- Departamento de Psicología Médica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Richard Fluck
- Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom
| | - Michael Germain
- Renal and Transplant Associates of New England, Division of Nephrology, Baystate Medical Center, Tufts University School of Medicine, Boston, MA
| | - Sarbjit V Jassal
- Division of Nephrology, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gregorio Obrador
- Universidad Panamericana School of Medicine, Mexico City, Mexico
| | - Donal O'Donoghue
- Department of Renal Medicine, Salford Royal Hospital, Salford, United Kingdom
| | | | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrea Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia
| | - Emma O'Lone
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Braden Manns
- Department of Medicine and Community Health Sciences, Libin Cardiovascular Institute and O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Benedicte Sautenet
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia; Department of Nephrology and Clinical Immunology, University Francois Rabelais, Tours Hospital; INSERUM, U1246, Tours, Franc Tours, France
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Bharathi Reddy
- Department of Medicine, University of Chicago, Chicago, IL
| | - Caroline Wilkie
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; University of North Carolina at Charlotte, Charlotte, NC
| | - Claudia Rutherford
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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Violanti JM, Owens SL, Fekedulegn D, Ma CC, Charles LE, Andrew ME. An Exploration of Shift Work, Fatigue, and Gender Among Police Officers: The BCOPS Study. Workplace Health Saf 2018; 66:530-537. [PMID: 29480763 DOI: 10.1177/2165079918754586] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study examined the association between shift work and fatigue among male ( n = 230) and female ( n = 78) police officers. A 15-year work history database was used to define dominant shifts as day, afternoon, or night. A 10-item questionnaire created from the Standard Shiftwork Index (SSI) assessed fatigue. Gender-stratified analyses of variance and covariance and Poisson regression were used to compare means and prevalence of individual items across shifts. No significant differences in total fatigue scores were observed across shifts. However, the prevalence of the fatigue item "feelings of tiredness" was 89% higher among male officers working the afternoon shift compared with officers working the day shift (prevalence ratio [PR] = 1.89, 95% confidence interval [CI] = [1.12, 3.23], p = .020), after adjustment for covariates. Women reported a lower prevalence of tiredness than men on the afternoon shift. Organizations with afternoon shift workers should consider reducing fatigue at work through education and other methods.
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Affiliation(s)
| | | | - Desta Fekedulegn
- 3 Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Claudia C Ma
- 3 Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Luenda E Charles
- 3 Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
| | - Michael E Andrew
- 3 Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention
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Krabbe D, Ellbin S, Nilsson M, Jonsdottir IH, Samuelsson H. Executive function and attention in patients with stress-related exhaustion: perceived fatigue and effect of distraction. Stress 2017; 20:333-340. [PMID: 28554267 DOI: 10.1080/10253890.2017.1336533] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Cognitive impairment has frequently been shown in patients who seek medical care for stress-related mental health problems. This study aims to extend the current knowledge of cognitive impairments in these patients by focusing on perceived fatigue and effects of distraction during cognitive testing. Executive function and attention were tested in a group of patients with stress-related exhaustion (n = 25) and compared with healthy controls (n = 25). Perceived fatigue was measured before, during and after the test session, and some of the tests were administered with and without standardized auditory distraction. Executive function and complex attention performance were poorer among the patients compared to controls. Interestingly, their performance was not significantly affected by auditory distraction but, in contrast to the controls, they reported a clear-cut increase in mental tiredness, during and after the test session. Thus, patients with stress-related exhaustion manage to perform during distraction but this was achieved at a great cost. These findings are discussed in terms of a possible tendency to adopt a high-effort approach despite cognitive impairments and the likelihood that such an approach will require increased levels of effort, which can result in increased fatigue. We tentatively conclude that increased fatigue during cognitive tasks is a challenge for patients with stress-related exhaustion and plausibly of major importance when returning to work demanding high cognitive performance.
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Affiliation(s)
- David Krabbe
- a Neurorehabilitation Unit , Sahlgrenska University Hospital , Gothenburg , Sweden
| | | | - Michael Nilsson
- c Department of Clinical Neuroscience, Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology , Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
- d Florey Institute of Neuroscience and Mental Health , Melbourne , Australia
- e Hunter Medical Research Institute (HMRI) and University of Newcastle , Newcastle , Australia
| | | | - Hans Samuelsson
- a Neurorehabilitation Unit , Sahlgrenska University Hospital , Gothenburg , Sweden
- f Department of Psychology , University of Gothenburg , Gothenburg , Sweden
- g Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology , The Sahlgrenska Academy at the University of Gothenburg , Gothenburg , Sweden
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Akram U, Ellis JG, Myachykov A, Barclay NL. Preferential attention towards the eye-region amongst individuals with insomnia. J Sleep Res 2016; 26:84-91. [PMID: 27624588 DOI: 10.1111/jsr.12456] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/14/2016] [Indexed: 11/29/2022]
Abstract
People with insomnia often perceive their own facial appearance as more tired compared with the appearance of others. Evidence also highlights the eye-region in projecting tiredness cues to perceivers, and tiredness judgements often rely on preferential attention towards this region. Using a novel eye-tracking paradigm, this study examined: (i) whether individuals with insomnia display preferential attention towards the eye-region, relative to nose and mouth regions, whilst observing faces compared with normal-sleepers; and (ii) whether an attentional bias towards the eye-region amongst individuals with insomnia is self-specific or general in nature. Twenty individuals with DSM-5 Insomnia Disorder and 20 normal-sleepers viewed 48 neutral facial photographs (24 of themselves, 24 of other people) for periods of 4000 ms. Eye movements were recorded using eye-tracking, and first fixation onset, first fixation duration and total gaze duration were examined for three interest-regions (eyes, nose, mouth). Significant group × interest-region interactions indicated that, regardless of the face presented, participants with insomnia were quicker to attend to, and spent more time observing, the eye-region relative to the nose and mouth regions compared with normal-sleepers. However, no group × face × interest-region interactions were established. Thus, whilst individuals with insomnia displayed preferential attention towards the eye-region in general, this effect was not accentuated during self-perception. Insomnia appears to be characterized by a general, rather than self-specific, attentional bias towards the eye-region. These findings contribute to our understanding of face perception in insomnia, and provide tentative support for cognitive models of insomnia demonstrating that individuals with insomnia monitor faces in general, with a specific focus around the eye-region, for cues associated with tiredness.
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Affiliation(s)
- Umair Akram
- Northumbria Centre for Sleep Research, Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Jason G Ellis
- Northumbria Centre for Sleep Research, Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Andriy Myachykov
- Northumbria Centre for Sleep Research, Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Nicola L Barclay
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, Sir William Dunn School of Pathology, University of Oxford, Oxford, UK
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Yang Y, Rowen D, Brazier J, Tsuchiya A, Young T, Longworth L. An exploratory study to test the impact on three "bolt-on" items to the EQ-5D. Value Health 2015; 18:52-60. [PMID: 25595234 PMCID: PMC4309886 DOI: 10.1016/j.jval.2014.09.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 09/16/2014] [Accepted: 09/25/2014] [Indexed: 05/07/2023]
Abstract
BACKGROUND Generic preference-based measures were criticized for being inappropriate in some conditions. One solution is to include "bolt-on" dimensions describing additional specific health problems. OBJECTIVES This study aimed to develop bolt-on dimensions to the EuroQol five-dimensional questionnaire (EQ-5D) and assess their impact on health state values. METHODS Bolt-on dimensions were developed for vision problems, hearing problems, and tiredness. Each bolt-on dimension had three severity levels to match the EQ-5D. Three "core" EQ-5D states across a range of severity were selected, and each level of a bolt-on item was added, resulting in nine states in each condition. Health states with and without the bolt-on dimensions were valued by 300 members of the UK general public using time trade-off in face-to-face interviews, and mean health state values were compared using t tests. Regression analysis examined the impact of the bolt-on variants and the level of the bolt-on items after controlling for sociodemographic characteristics. RESULTS Bolt-on dimensions had an impact on health state values of the EQ-5D; however, the size, direction, and significance of the impact depend on the severity of the core EQ-5D state and of the bolt-on dimension. Regression analysis demonstrated that after controlling for possible differences in sociodemographic characteristics between the groups, there were no significant differences in health state values between the three bolt-on dimensions but confirmed that the impact depended on the severity of the EQ-5D health state and the levels of bolt-on dimensions. CONCLUSIONS The impact of a bolt-on dimension on the EQ-5D depends on the core health state and the level of the bolt-on dimension. Further research in this area is encouraged.
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Affiliation(s)
- Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Donna Rowen
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Brazier
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Aki Tsuchiya
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK; Department of Economics, University of Sheffield, Sheffield, UK
| | - Tracey Young
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Louise Longworth
- Health Economics Research Group, Brunel University, Uxbridge, UK
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Kronholm E, Puusniekka R, Jokela J, Villberg J, Urrila AS, Paunio T, Välimaa R, Tynjälä J. Trends in self-reported sleep problems, tiredness and related school performance among Finnish adolescents from 1984 to 2011. J Sleep Res 2014; 24:3-10. [PMID: 25367818 DOI: 10.1111/jsr.12258] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/04/2014] [Indexed: 01/20/2023]
Abstract
The aim of this study was to investigate long-term trends in insomnia symptoms, tiredness and school performance among Finnish adolescents. A time-series from 1984 to 2011 was analysed from two large-scale survey studies, the Finnish School Health Promotion Study and the Health Behavior in School-Aged Children study. A total of 1,136,583 adolescents aged 11-18 years answered a standardized questionnaire assessing frequency of insomnia symptoms, tiredness and school performance. A clear approximately twofold increasing trend in insomnia symptoms and tiredness was found from the mid-1990s to the end of the 2000s. The increase was evident in all participating age groups and in both genders. After 2008, the increase seems to have stopped. Insomnia symptoms and tiredness were associated with lower school performance and they were more prevalent among girls (11.9 and 18.4%) compared to boys (6.9 and 9.0%, respectively). Unexpectedly, we also observed an increasingly widening gap in school performance between normally vigilant and chronically tired pupils. The underlying causes of these phenomena are unknown, but may concern changes in the broader society. The observed recent increasing trend in adolescents' sleep problems is worrisome: poor sleep quality has also been suggested to associate with clinical or subclinical mood or anxiety disorders and behavioural problems and predispose to sleep and psychiatric disorders later in life. Our results justify further studies and call for serious attention to be paid to adolescent's sleep in the Finnish educational system and society at large.
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Affiliation(s)
- Erkki Kronholm
- National Institute for Health and Welfare, Turku, Finland
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Sterling K, Gallop K, Swinburn P, Flood E, French A, Al Sawah S, Iikuni N, Naegeli A, Nixon A. Patient-reported fatigue and its impact on patients with systemic lupus erythematosus. Lupus 2013; 23:124-32. [PMID: 24197552 DOI: 10.1177/0961203313511554] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fatigue is a hallmark symptom of systemic lupus erythematosus (SLE), often associated with flares, side effects of treatment, and extensive organ damage and may have a significant impact on health-related quality of life (HrQoL). To date, the experience of fatigue in patients with SLE is underexplored. This study explored the experience of fatigue in patients with SLE and its impact on their lives through qualitative interviews. This cross-sectional qualitative study was conducted with 22 adult patients with SLE, recruited from two clinical sites in the United States. In-person semi-structured interviews were conducted and thematic analysis was performed focusing on the experience of fatigue in SLE. Results indicated that 21 out of 22 patients experienced fatigue due to SLE. Patients reported that fatigue was variable in nature in terms of both severity and frequency. Fatigue was described as having an impact on multiple aspects of a patient's life: emotions, cognition, work, activities of daily living, leisure activities, social activities, and family activities. Understanding how patients with SLE describe the symptom of fatigue and how it impacts their lives is the key to better understanding how to measure fatigue in clinical studies evaluating new treatments for SLE.
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Affiliation(s)
- Kl Sterling
- 1Eli Lilly and Company, Indianapolis, IN, USA
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Abstract
OBJECTIVES Although fatigue is experienced by everyone, its definition and classification remains under debate. METHODS A review of the previously published data on fatigue. RESULTS Fatigue is influenced by age, gender, physical condition, type of food, latency to last meal, mental status, psychological conditions, personality type, life experience, and the health status of an individual. Fatigue may not only be a symptom but also a measurable and quantifiable dimension, also known as fatigability. Additionally, it may be classified as a condition occurring at rest or under exercise or stress, as physiologic reaction or pathologic condition, as spontaneous phenomenon or triggerable state, as resistant or irresistant to preconditioning, training, or attitude, as prominent or collateral experience, and as accessible or inaccessible to any type of treatment or intervention. Fatigue may be the sole symptom of a disease or one among others. It may be also classified as acute or chronic. Quantification of fatigability is achievable by fatigue scores, force measurement, electromyography, or other means. Fatigue and fatigability need to be delineated from conditions such as sleepiness, apathy, exhaustion, exercise intolerance, lack of vigor, weakness, inertia, or tiredness. Among neurological disorders, the prevalence of fatigue is particularly increased in multiple sclerosis, amyotrophic lateral sclerosis, Parkinson disease, traumatic brain injury, stroke, and bleeding and also in neuromuscular disorders. Fatigue may be influenced by training, mental preconditioning, or drugs. CONCLUSIONS Fatigue needs to be recognized as an important condition that is not only a symptom but may also be quantified and can be modified by various measures depending on the underlying cause.
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Affiliation(s)
| | - Sinda Zarrouk Mahjoub
- Laboratory of Biochemistry, UR "Human Nutrition and Metabolic Disorders" Faculty of Medicine Monastir, Monastir, Tunisie
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Buchowski MS, Simmons SF, Whitaker LE, Powers J, Beuscher L, Choi L, Ikizler TA, Chen K, Shnelle JF. Fatigability as a function of physical activity energy expenditure in older adults. Age (Dordr) 2013; 35:179-187. [PMID: 22113348 PMCID: PMC3543733 DOI: 10.1007/s11357-011-9338-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 10/25/2011] [Indexed: 05/31/2023]
Abstract
Increased fatigue is a predictor of morbidity and mortality in older adults. Fatigability defines a change in performance or self-reported fatigue in response to physical activity (PA). However, the relationship of fatigability to PA-related energy expenditure (PAEE) is unknown. Changes in performance, fatigue, and energy expenditure were measured simultaneously in 17 adults (11 females, 74-94 years old) performing eight standardized PA tasks with various energy expenditure requirements in a whole-room indirect calorimeter. Change in performance was objectively measured using a PA movement monitor and change in fatigue was self-reported on a seven-point scale for each task. Performance and perceived fatigability severity scores were calculated as a ratio of change in performance and fatigue, respectively, and PAEE. We found that change in both objective performance and self-reported fatigue were associated with energy expenditure (Spearman rho = -0.72 and -0.68, respectively, p < 0.001) on a task requiring relatively high level of energy expenditure. The performance and perceived fatigability severity scores were significantly correlated (rho = 0.77, p < 0.001) on this task. In summary, results of this proof of concept pilot study show that both perceived and performance fatigability severity scores are related to PAEE-induced fatigue on a task requiring relatively high level of energy expenditure. We conclude that fatigability severity is a valid measure of PAEE-induced fatigue in older adults.
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Affiliation(s)
- Maciej S Buchowski
- Energy Balance Laboratory, Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Vanderbilt University, 1161 21st Avenue South, Nashville, TN 37232, USA.
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Sarkar S, Jiang Z, Evon DM, Wahed AS, Hoofnagle JH. Fatigue before, during and after antiviral therapy of chronic hepatitis C: results from the Virahep-C study. J Hepatol 2012; 57:946-52. [PMID: 22760009 PMCID: PMC3477271 DOI: 10.1016/j.jhep.2012.06.030] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/04/2012] [Accepted: 06/26/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Fatigue is the most frequent and often debilitating symptom of chronic hepatitis C. It is unclear whether successful therapy of hepatitis C leads to its clinical improvement. In the Virahep-C study, patients with hepatitis C virus (HCV) genotype 1 infection were treated with peginterferon alfa-2a and ribavirin for up to 48 weeks while undergoing assessment of viral kinetics and clinical symptoms. METHODS Fatigue measurements were conducted, before, during and after therapy, as 'presence' (yes/no) and 'severity' (visual analog scale: 0-100mm). The clinical, histologic, and virologic features that correlated with the presence and degree of fatigue were assessed focusing upon changes associated with sustained virological response (SVR). RESULTS At baseline, 52% (n=401) of participants reported having fatigue, which was more common in women than men (59% vs. 48%, p=0.02) and slightly more severe (30 vs. 22 mm, p=0.056). Fatigue was frequent and worse in cirrhotics versus those with lesser fibrosis (66% vs. 49%; 34 vs. 24 mm). Fatigue did not correlate with other parameters. The proportion of patients and median fatigue scores increased on treatment (52-78%; 25-40 mm, p<0.0001) with higher fatigue noted amongst those who ultimately achieved SVR (p<0.0001). On achieving SVR, there was a significant decrease in both frequency and severity of fatigue compared to their baseline (53-33%; 27-13 mm, both p<0.0001). CONCLUSIONS Fatigue is common in patients with chronic hepatitis C but is poorly associated with biochemical parameters. Sustained response is accompanied by substantial improvement of fatigue.
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Affiliation(s)
- Souvik Sarkar
- Liver Disease Branch, Division of Intramural Research and the National Institutes of Health, Bethesda, Maryland
| | - Zhen Jiang
- Department of Biostatistics, Graduate School of Public Health at the University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Donna M. Evon
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Abdus S. Wahed
- Department of Biostatistics, Graduate School of Public Health at the University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jay H. Hoofnagle
- Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Chotinaiwattarakul W, O'Brien LM, Fan L, Chervin RD. Fatigue, tiredness, and lack of energy improve with treatment for OSA. J Clin Sleep Med 2009; 5:222-7. [PMID: 19960642 PMCID: PMC2699166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Many patients with obstructive sleep apnea complain of fatigue, tiredness, or lack of energy in addition to sleepiness, or instead of sleepiness. We explored whether self-defined fatigue, tiredness, and lack of energy improve, like sleepiness, after treatment with positive airway pressure (PAP). METHODS We conducted a prospective survey of adults referred to a University-based sleep disorders center and confirmed to have obstructive sleep apnea on polysomnography. Surveys were mailed to 1539 patients 6 months to 3 years after they were prescribed PAP for home use. RESULTS Participants (n = 313) included 183 who reported using PAP > or = 5 hours per night, 96 who were considered inadequately treated because they had no active treatment or used PAP < 5 hours per night, and 34 treated by surgery or other means and therefore excluded from subsequent analysis. At follow-up in comparison to baseline, subjects adherent to PAP reported less fatigue, tiredness, lack of energy, and sleepiness (p < 0.05 for each). Improvement of each symptom except for lack of energy was significantly better (p < 0.05) among PAP-adherent subjects than among inadequately treated subjects. CONCLUSIONS Patients' complaints of fatigue, tiredness, and lack of energy, like sleepiness, can improve substantially with good adherence to PAP for obstructive sleep apnea. Therefore, patients who prefer a range of common, related terms other than sleepiness to describe their problem may benefit from investigation and treatment for any underlying sleep-disordered breathing.
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Affiliation(s)
| | - Louise M. O'Brien
- Sleep Disorders Center and Department of Neurology
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Ludi Fan
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
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