Implementing a Fatigue Risk Management Program in Chilean Transport: A Multifactorial and Participatory Case Study

Objectives: Sleep plays a critical role in optimizing physical and mental health. The aim of this clinical study was to evaluate the efficacy and safety of Nyumi beauty sleep gummies for improvement in sleep quality in healthy adult subjects with sleep deprivation. Materials and Methods: A single-arm, clinical study was conducted. Sleep quality was assessed by the Sleep Quality Scale (SQS), Insomnia Severity Index, Perceived Stress Scale (PSS), and Daytime fatigue using Fatigue Severity Scale (FSS), along with improvement in sleep and skin quality using a subjective assessment questionnaire. In addition, skin radiance using the Modified Griffiths scale by Dermatologist and Skin Glow by Skin Glossymeter GL 200 instrument was assessed. Changes in serum cortisol levels were also recorded. Results: After consuming Nyumi beauty sleep gummies for 15 days and 25 days, a statistically significant reduction was observed in the SQS score by 35.2% and 60.8%, Insomnia Severity Index score by 52.7% and 100.0%, PSS score by 44.6% and 93.4%, and in FSS score by 33.9% and 81.0% (all P < 0.0001), respectively, implying an improvement in sleep quality. Significant improvement by 25.2% on day 15 and 53.7% on Day 25 for dermatological assessment of skin radiance by Modified Griffiths Scale and 1.16-folds on day 15 and 2.11-folds on day 25 (all P < 0.0001) for skin glow by Skin Glossymeter GL200 instrument was also recorded. Improvement in sleep quality and skin glow was recorded by subjective assessment from baseline to the end of the study. Furthermore, no adverse event was recorded during the study conduction. Conclusion: Nyumi beauty sleep gummies significantly improved the sleep quality (in terms of total sleep time, sleep latency, sleep efficiency, time to sleep onset, number of awakenings, wake time after sleep onset, and sleep efficiency), daytime mood, ability to function at work, concentration, memory; reduced perceived stress, fatigue severity, and insomnia severity score. It also helped in improving skin glow and skin radiance.

ABSTRACTObjectiveTo evaluate the quality of sleep in women with urinary incontinence before and after sling surgery.MethodsA prospective study of case series of women with urodynamic diagnosis of stress urinary incontinence. To evaluate the subjective quality of sleep, two specific questionnaires were used and validated for the Portuguese Language: Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. The questionnaires were applied before and 6 months after surgical repair.ResultsWhen analyzing the Epworth Sleepiness Scale, there was an improvement in sleep quality (p=0.0401). For the Pittsburgh Sleep Quality Index, only for sleep disorder there was improvement in quality of sleep after surgery (p=0.0127).ConclusionWomen with urinary incontinence, submitted to surgery with sling, showed improvement in both quality of sleep and sleep disorder.

Many studies have suggested that multidisciplinary care is an effective pain management method; however, this care mode is still not commonly seen in Taiwan. The current study focused on patients within the first multidisciplinary pain management program in Taiwan. The first aim of this study was to investigate the effectiveness of the first multidisciplinary pain management program in Taiwan in terms of improving chronic pain patients' mood, sleep quality, and pain. The second aim was to determine whether improvement in mood or sleep quality was predictive of improvement in pain, and vice versa. Patients from a pain clinic were invited to join a multidisciplinary pain management program. They were assessed each month for improvement in mood, pain, and sleep quality. This study reviewed the medical records of these patients. Twenty male and thirteen female chronic non-malignant pain patients aged between 23 and 64 from a pain clinic. During the first visit, a clinical psychologist assessed the mental health of patients before patients undertook education delivered by nine other professionals in the program. Participants' mood, pain, and sleep quality were assessed monthly. The study used repeated measures analysis of variance to identify changes in patients' mood, pain, and sleep quality after three months of multidisciplinary care. We used linear regression to assess whether changes in mood or sleep quality could predict improvement in pain, and vice versa. The level of anxiety decreased, and sleep quality improved significantly, over the duration of care. The severities of depression and sleep disturbance decreased as the least pain experienced in the past week showed improvement. Improvement in sleep quality was predictive of improvement in least pain. The multidisciplinary pain management program was effective in improving patients' anxiety and sleep quality. Decreased pain brought about improvement in mood. We also found a reciprocal association between improvements in the least pain experienced in the past week and sleep quality.

Kratom (Mitragyna speciosa) is a psychoactive botanical native to Southeast Asia increasingly used in the United States for various self-reported benefits, including sleep improvement. However, empirical evidence concerning kratom's effects on sleep is limited. Here, we examined the association between bedtime kratom use and self-reported sleep outcomes in naturalistic settings across consecutive days, while also exploring sex and chronic pain status as potential moderators. A secondary analysis was conducted using the data from a 15-day ecological momentary assessment study of 357 U.S. adults who reported regularly using kratom. Participants made daily reports of their bedtime kratom use and rated their sleep duration and quality. Linear mixed-effects models assessed associations between bedtime kratom use and sleep outcomes, with sex and chronic pain status as moderators, controlling for age. Bedtime kratom use occurred on 23.4% of days and was associated with modest increases in sleep duration (13 min) and perceived quality (5.93-point increase on a 0-100 scale). Female respondents reported greater improvements in sleep quality (but not duration) than male respondents. Participants with chronic pain reported greater improvements in sleep duration and quality compared to those without chronic pain. Bedtime kratom use is associated with modest sleep duration and quality improvements, particularly in adults with chronic pain, and better sleep quality in female respondents. These findings among experienced kratom consumers suggest the need for human laboratory studies in kratom-naïve participants to determine causality and underlying mechanisms, which could help inform clinical guidance and policy as kratom use continues to rise. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Clinical leadership training: a clinician's perspective

Poor sleep, depression, and anxiety are common in patients with inflammatory bowel diseases (IBD) and associated with increased risk of relapse and poor outcomes. The effectiveness of therapies in improving such psychosocial outcomes is unclear but is an important question to examine with increasing selectivity of therapeutic agents. This prospective cohort enrolled patients with moderate-to-severe CD or UC starting biologic therapy with vedolizumab or anti-tumor necrosis factor α agents (anti-TNF). Sleep quality, depression, and anxiety were measured using validated short-form NIH PROMIS questionnaires assessing sleep and mood quality over the past 7days. Disease activity was assessed using validated indices. Improvement in sleep and mood scores from baseline was assessed, and regression models were used to identify determinants of sleep quality. Our study included 160 patients with IBD (49 anti-TNF, 111 Vedolizumab) among whom half were women and the mean age was 40.2years. In the combined cohort, we observed a statistically significant and meaningful decrease in mean scores from baseline (52.8) by week 6 (49.8, p=0.002). Among vedolizumab users, sleep T-score improved from baseline (53.6) by week 6 (50.7) and persisted through week 54 (46.5, p=0.009). Parallel reductions in depression and anxiety were also noted (p<0.05 by week 6). We observed no difference in improvement in sleep, depression, and anxiety between vedolizumab and anti-TNF use at week 6. Both vedolizumab and anti-TNF biologic therapies were associated with improvement in sleep and mood quality in IBD.

AimDescribing the 1-year evolution of symptoms and health status in COPD patients enrolled in the STORICO study (observational study on characterization of 24-h symptoms in patients with COPD) classified in multidimensional phenotypes (m-phenotypes).MethodsIn our previous study, we performed an exploratory factor analysis to identify clinical and pathophysiological variables having the greatest classificatory properties, followed by a cluster analysis to group patients into m-phenotypes (mild COPD (MC), mild emphysematous (ME), severe bronchitic (SB), severe emphysematous (SE), and severe mixed COPD (SMC)). COPD symptoms were recorded at baseline, 6-, and 12-month follow-up and their evolution was described as frequency of patients with always present, always absent, arising’, ‘no more present symptoms. QoL and quality of sleep were evaluated using the SGRQ and CASIS questionnaires, respectively.ResultsWe analyzed 379 subjects (144 MC, 71 ME, 96 SB, 14 SE, 54 SMC). M-phenotypes were stable over time in terms of presence of symptoms and health status with selected differences in evolution of symptoms in mild vs severe m-phenotypes. Indeed, 28.1% SB, 50.0% SE and 24.1% SMC vs 0.7% MC and 5.6% ME with night-time symptoms at baseline had no more symptoms at 6-month (p-value night-time symptom evolution MC vs SB, SE, SMC and ME vs SB, SE, SMC <0.0001). All m-phenotypes improved in quality of sleep, more markedly the severe than the mild ones (p-values CASIS score change between baseline and 6- or 12-month in MC, ME vs SB, SE, SMC <0.0001). QoL did not change during observation, irrespectively of m-phenotype.ConclusionOver 1 year, severe m-phenotypes showed an improvement in night-time symptoms and quality of sleep, but not QoL. Being stable over time, m-phenotypes seem worthy of testing for classificatory and prognostic purposes.

We studied the effect of the location of electrical stimulation on the acute analgesic response to percutaneous neuromodulation therapy in patients with nonradiating neck pain. Sixty-eight patients received three different nonpharmacologic modalities, namely "needles only" (neck), local (neck) dermatomal stimulation, and remote (lower back) dermatomal stimulation in a random sequence over the course of an 11-wk study period. All treatments were given for 30 min, 3 times per week for 3 wk, with 1 wk "off" between each modality. The assessment tools included the health status survey short form (SF-36) questionnaire, as well as 10-cm visual analog scales for assessing pain, physical activity, and quality of sleep. The pain visual analog scale was repeated 5-10 min after each treatment session. The daily oral nonopioid analgesic requirements were recorded in the patient diary during the entire study period. At the end of each 3-wk treatment block, the SF-36 questionnaire was repeated. Compared with needles only and remote dermatomal stimulation, local dermatomal stimulation produced a significantly greater decrease in pain (38%+/-17% vs 9%+/- 16% and 13%+/-18%), increase in physical activity (41%+/-21% vs 11% +/-17% and 16%+/-15%), and improvement in the quality of sleep (34% +/-18% vs 7%+/-17% and 10%+/-18%) compared with baseline values (P<0.05). The need for oral analgesic medications was decreased by an average of 6%+/-15%, 37%+/-18%, and 9%+/-13% during the 3-wk treatment period with the needle only, local dermatomal, and remote dermatomal stimulation, respectively. The posttreatment SF-36 test results revealed that all three modalities produced improvements compared with the prestudy scores for both the physical component summary and mental component summary. However, the magnitude of the changes in the physical component summary and mental component summary with local dermatomal stimulation was significantly greater (+7.9 and +3.6, respectively) than needle only (+3.4 and +1.7, respectively) or remote dermatomal stimulation (+3.7 and +1.9, respectively). No side effects were reported at the needle insertion sites. We conclude that electrical stimulation at the specific dermatomal levels corresponding to the local pathology produces greater short-term improvements in pain control, physical activity, and quality of sleep in patients with chronic neck pain.

To assess whether sleep quality (SQ) at baseline is associated with improvement in pain and disability at 3 months. Four hundred twenty-two subacute and chronic patients with neck pain (NP) were recruited in 32 physiotherapy, primary care, and specialized centers. NP, referred pain, disability, catastrophizing, depression, and SQ were assessed through validated questionnaires, upon recruitment and 3 months later. Correlations between baseline scores were calculated through the Spearman coefficient. Improvements in NP, disability, and SQ were defined as a reduction of ≥30% of baseline score. Six estimative logistic regression models were developed to assess the association between baseline SQ and improvement of NP, baseline SQ and improvement of disability, baseline NP and improvement of SQ, baseline disability and improvement of SQ, the evolutions of NP and SQ, and the evolutions of disability and SQ. Most patients were subacute and mildly impaired. Regression models showed that better SQ at baseline was associated with improvement of NP (odds ratio=0.91 [95% confidence interval, 0.83-0.99]), but not disability (1.04 [0.95-1.13]); the improvement of SQ was associated with more severe NP at baseline (1.26 [1.07-1.49)], but not with baseline disability (0.99 [0.97-1.02]); and that improvement in SQ was associated with improvements in NP (3.48 [1.68-7.20]), and disability (5.02 [2.39-10.11]). NP is less likely to improve in patients with poorer SQ, irrespective of age, sex, catastrophizing, depression, or treatments prescribed for NP. Future studies should confirm these results with more severely impaired patients.

Poor or insufficient sleep adversely affects various physiological and psychological functions, impacting body systems such as the endocrine, metabolic, and immune systems. Despite available pharmacological and non-pharmacological treatments, the impact of chronic yoga interventions on sleep quality in individuals with sleep problem syndrome remains underexplored. This scoping review aims to consolidate existing research on yoga interventions and their effects on sleep quality, providing evidence for yoga as a non-pharmacological alternative to reduce reliance on medications. A systematic search across PubMed, Web of Science, and Scopus identified 1,559 studies, with 57 meeting inclusion criteria for yoga's effects on sleep quality. Overall, the included studies reported either significant improvements in sleep quality (or related) parameters or no change. Moderator analyses revealed that intervention duration and session frequency can influence sleep outcomes. Short-duration interventions (≤6 weeks) showed a large mean effect on sleep quality (9.41%; 95% CI 3.06 to 15.42%), with 54% of studies reporting statistically significant improvements. Medium-duration interventions (7-16 weeks) demonstrated consistent benefits, including a large mean effect on sleep quality (8.74%; 95% CI 2.93 to 14.55%) and a very large reduction in insomnia severity (13.19%; 95% CI 11.10 to 15.98%). However, sleep efficiency exhibited smaller effects (0.73%; 95% CI -1.99 to 3.45%). Long-duration interventions (≥17 weeks) produced the most robust results, with 100% of the studies reporting significant improvements, including a 7.92% increase in sleep quality (95% CI 3.23 to 12.60%). With regard to session frequency, low-frequency sessions (1-2 per week) yielded significant improvements in insomnia severity (13.66%; 95% CI 8.72 to 18.59%) and sleep quality (8.13%; 95% CI 2.67 to 13.59%). Moderate-frequency sessions (3-4 per week) balanced accessibility and efficacy, producing a large mean effect on sleep quality (9.21%; 95% CI 3.66 to 14.76%). High-frequency sessions (≥5 per week) demonstrated a similarly large effect on sleep quality (8.24%; 95% CI 2.28 to 14.20%), although the data were limited. Tailoring yoga interventions by duration and frequency is valuable, with chronic practice offering a safe, effective alternative to medication. Future research should refine protocols for specific populations and sleep challenges.

This article studied the effect of the location of electrical stimulation on the acute analgesic response to percutaneous neuromodulation therapy in patients with nonradiating neck pain. Sixty‐eight patients received 3 different nonpharmacologic modalities, namely “needles only (neck), local (neck) dermatomal stimulation, and remote (lower back) dermatomal stimulation in a random sequence over the course of an 11‐week study period. All treatments were given for 30 min, 3 times per week for 3 weeks with 1 week “off” between each modality. The assessment tools included the health status survey short form (SF‐36) questionnaire as well as 10‐cm visual analog scales for assessing pain, physical activity, and quality of sleep. The pain visual analog scale was repeated 5‐10 min after each treatment session. The daily oral nonopioid analgesic requirements were recorded in the patient diary during the entire study period. At the end of each 3‐week treatment block, the SF‐36 questionnaire was repeated. Compared with needles only and remote dermatomal stimulation, local dermatomal stimulation produced a significantly greater decrease in pain, increase in physical activity, and improvement in the quality of sleep compared with baseline values (P &lt; 0.05). The posttreatment SF‐36 test results revealed that all 3 modalities produced improvements compared with the prestudy scores for both the physical component summary and mental component summary. However, the magnitude of the changes in the physical component summary and mental component summary with local dermatomal stimulation was significantly greater than needle only or remote dermatomal stimulation. No side effects were reported at the needle insertion sites. Conclude that electrical stimulation at the specific dermatomal levels corresponding to the local pathology produces greater short‐term improvements in pain control, physical activity, and quality of sleep in patients with chronic neck pain.Comment by Alan Kaye, M.D. Percutaneous neuromodulation is a therapy in which percutaneous electrical nerve stimulation is applied for short‐term relief of various pain syndromes. In this study involving 68 patients by White et al, the effects of neuromodulation therapy were studied with nonradiating neck pain. Local dermatomal stimulation consisted of placement of 10 32‐gauge stainless steel acupuncture needle probes to a depth of 2‐4 cm into the soft tissue and paraspinous muscles in the cervical region. For electrical therapy, 10 probes were connected to 5 bipolar leads from a low‐output electrical generator and stimulated for 30 min at 15 and 30 cycles/s. Finally, remote dermatomal electrical therapy consisted of placement of 10 32‐gauge stainless steel acupuncture‐like needle probes to a depth of 2‐4 cm into the soft tissue and/or paraspinous muscle in the lower back region. Each modality was administered to all patients 3 times per week for 3 consecutive weeks with 1 week off between each modality. Most parameters compared after demonstrated improvement locally and a reduction in daily usage of oral nonopioid analgesic medications. Future studies are warranted, in particular those in which long‐term benefits are assessed. The authors should be commended for studying this alternative treatment strategy and its role in mediating or modulating complex pain syndromes.

Background & AimsThe search for integrative and natural therapies that favor homeostasis to boost sleep and diet quality took place for young adult populations as a non-pharmacological strategy for long-term good quality of life. Thus, the present pilot study aims to investigate the effects of 90-day consumption of a nutraceutical composition on the neuro-immune-endocrine axis, providing better sleep quality and health improvement. MethodsFor this, from March 2021 to June 2021, twenty-two Brazilian young adult volunteers (women and men) with BMI between 18.5 to 34.9 kg/m2 were divided into three distinct supplementation groups: NSupple; NSupple plus_S, and NSupple plus. Briefly, the supplement compositions included yeast β-glucan, prebiotics, and minerals in different concentrations associated or not with the herbal medicine silymarin.Neither nutritional nor physical activity interventions were performed during this pilot study period. The anthropometrics measures, questionnaires answer data, and harvest blood for metabolic, inflammatory, and hormonal tests were collected at baseline time (day zero-T0) and day 90 (T90) post-supplementation. ResultsOur results highlight that the supplementation reduced body mass index (BMI), Waist-to-height ratio (WHtR), waist circumference, AST/ALT ratio, alkaline phosphatase, and HbA1c. Post-supplementation the IL-6 and IL-10 levels and the sleep, humor, and quality of life scores were suggested to improve. Sleep quality improvement seems to predict the reduction of adiposity-related body measures. ConclusionIn sum, the nutraceutical supplementation might be related to anthropometric, metabolic, and endocrine parameters after 90 days reflecting on perception of humor, sleep, and life quality enhancement. However, it is important to recognize the limitation of the data presented considering that this was a pilot study. Clinical trial registrationClinicalTrials.gov, identifier NCT04810572 registered on 20th February 2021.

The Impact of Nasal Surgery on Sleep Quality: A Prospective Outcomes Study

In order to explore reasonable prebedtime interventions to improve the sleep quality of the youth population, this experiment comprehensively investigated the effect of prebedtime footbath on the improvement of youth sleep quality. The experimental conditions of the experimental group were to take a 30‐min footbath at 40°C 1 h before bedtime, to compare the experiment with the control group that did not take footbath, and to strictly control other environmental parameters that may affect sleep quality. We recorded the sleep of 16 male subjects using a subjective sleep quality questionnaire and polysomnography (PSG) and recorded their distal skin temperature (DST) and proximal skin temperature (PST) during footbath and sleep using temperature records. The skin temperature data showed that footbath before bedtime helped to increase DST and accelerate heat dissipation from the terminal skin, which in turn increased the distal–proximal skin temperature gradient (DPG), and we found that the DPG of the experimental group was higher than that of the control group for 84.8% of the time during the whole night’s sleep. Both subjective questionnaire and PSG monitoring results showed that sleep quality and sleep calmness could be effectively improved by taking a 30‐min 40°C bedtime footbath 1 h before bedtime. The subjective sleep quality questionnaire score of the control group was only 84.1% of that of the experimental group. There were significant differences between the control and experimental groups in total sleep time (TST), sleep‐onset latency (SOL), wake after sleep onset (WASO), and arousal index (AI) (p &lt; 0.05). Compared to the control group, the experimental group showed a 43.4‐min increase in TST, a 14.9‐min decrease in SOL, a 32‐min decrease in WASO, a 3.28 beats/hour decrease in AI, and a 9.0% increase in sleep efficiency by performing a prebedtime footbath. This study quantitatively describes the effect of prebedtime footbath on the improvement of sleep quality in young men and provides an effective reference for the rational improvement of sleep quality in young people.

Context: Cervicogenic headache (CeH) originates from cervical spine disorders, often associated with neck pain and structures innervated by cervical nerves. Kinesiotaping (KT) has emerged as a noninvasive treatment for musculoskeletal pain management. Aim: The aim of this study was to evaluate the clinical efficacy of KT on pain, headache disability, and sleep in CeH patients. Settings and Design: Comparative experimental study conducted at Delhi Pharmaceutical Sciences and Research University. Subjects and Methods: Thirty patients were divided into control (conventional treatment) and experimental (conventional treatment with KT) groups. Outcome measures included Visual Analog Scale for pain, Headache Disability Index for headache disability, and Pittsburgh Sleep Quality index for sleep quality, assessed at baseline, after 2 weeks, and 4 weeks. Statistical Analysis: Comparative analysis was done using an Independent samples t-test; within-group improvements were assessed using repeated measures ANOVA, with post hoc tests identifying significant time points (P &lt; 0.05). Results: Both experimental and control groups showed significant improvements in pain, sleep quality, and headache-related disability. The experimental group experienced a 75.3% reduction in pain and an 87.5% improvement in sleep quality (P &lt; 0.01). The control group had a 51.5% reduction in pain and a 26.4% improvement in sleep quality (P &lt; 0.01). Both groups experienced an improvement in headache-related disability, but the difference between them was not statistically significant (P &gt; 0.05). Conclusions: The experimental group, receiving KT with conventional treatment, showed greater reductions in pain and sleep disturbances than the control group. Although both groups improved in headache-related disability, no significant difference was found between them. These findings suggest that KT may be an effective adjunct for managing CeH.