Daily Fatigue Research Articles

Efficacy of Physiologically Active nutrients in the Treatment of Asthenic Disorders in Patients with Chronic Diffuse Liver Diseases

Over the period after an exacerbation of chronic liver diseases, patients often retain common symptoms (weakness or fatigue, bad mood, sleep disorder, vegetative disorders — asthenic syndrome). In the context of prevention and treatment of these symptoms, such nutraceutical products as enriched foods in the form of tablets, sachets, etc, have been increasingly attracting research attention.Aim.To study the efficacy of the “Hepato Smart” nutraceutical product for the treatment of asthenic syndrome in outpatients suffering from chronic diffuse liver diseases with compensated function and functional disorders of the gallbladder over the period after exacerbation.Materials and methods. The study included 50 patients, with 41 of them having completed the program. The nutraceutical product (curcumin, piperine, tanshinone IIA, choline; standardized for curcumin and choline) was assigned 1 pill 3 times a day with meals for 4 weeks. To objectify common symptoms, we used a D-FIS questionnaire (Daily Fatigue Impact Scale), a 4DSQ Four-Dimensional Symptom Questionnaire for assessing distress, depression, anxiety and somatization, and a SF-36 questionnaire for assessing the quality of life.Results.Following 4 weeks of the “Hepato Smart” course, a statistically significant decrease in fatigue was noted by D-FIS scores (p = 0.003), as well as a decrease in the level of distress, depression, anxiety and somatization by 4DSQ scores (p = 0.005; p = 0.006; p = 0.003; p = 0.003, respectively). The quality of patients’ life according to the SF36 questionnaire also improved due to both physical and psychological components (p = 0.003). 16 patients continued taking the preparation for another 8 weeks to maintain the achieved result. As an additional effect, the disappearance of pain in the right hypochondrium was noted in those cases when patients presented this complaint at the time of inclusion in the observation program. The safety profile was good, 1/3 of the patients noted the appearance of heartburn, which was eliminated when taking the product with food.Conclusion. The “Hepato Smart” nutraceutical product improves the general condition of patients with chronic diffuse liver diseases and functional disorders of the gallbladder due to a significant reduction in fatigue and anxiety. It also improves the quality of patients’ life due to the physical and mental components of health.

New factors that affect quality of life in patients with aphasia.

Aphasia severity is known to affect quality of life (QoL) in stroke patients, as is mood disorders, functional limitations, limitations on activities of daily life, economic status and level of education. However, communication limitation or fatigue has not been explored in this specific population. We aimed to investigate whether these factors were associated with QoL in patients with aphasia after stroke. Patients with aphasia were included from April 2014 to November 2017 after a first stroke and were followed for 2 years post-stroke. QoL was assessed at follow-up by the French Sickness Impact Profile 65 (SIP-65). We explored predictors such as mood disorders, communication impairment, fatigue, limitations on activities of daily life, and aphasia severity in addition to socio-demographic factors. We included 32 individuals (22 men; mean age 60.7 [SD 16.6] years) with aphasia after a first stroke. Poor QoL as assessed by the SIP-65 was significantly associated (Pearson correlations) with increased severity of aphasia initially (P=0.008) and at follow-up (P=0.01); increased communication activity limitations at follow-up (P<0.001); increased limitations on activities of daily life at baseline (P=0.008) and follow-up (P<0.001); increased fatigue at follow-up (P=0.001); and increased depression symptoms at follow-up (P=0.001). On multivariable analysis, QoL was associated with communication activity limitations, limitations on activities of daily life, fatigue and depression, explaining more than 75% of the variance (linear regression R2=0.756, P<0.001). The relative importance in predicting the variance was 32% for limitations on activities of daily life, 21% fatigue, 23% depression and 24% communication activity limitations. Aphasia severity, mood disorders and functional limitations may have a negative effect on QoL in patients with aphasia. Also, for the first time, we show that fatigue has an important impact on QoL in this population. Specific management of this symptom might be beneficial and should be explored in future studies.

Heart rate variability mediates motivation and fatigue throughout a high-intensity exercise program.

High-intensity exercise interventions are often promoted as a time-efficient public health intervention to combat chronic disease. However, increased physical effort and subsequent fatigue can be barriers to long-term maintenance of high-intensity exercise programs. The purpose of the present study was to determine if heart rate variability (HRV) mediated state traits related to exercise program adherence. Fifty-five healthy men and women (ages 19-35 years) used a commercially available smartphone application to monitor daily HRV status throughout a 6-week high-intensity exercise intervention. Participants reported state motivation to exercise and global physical fatigue immediately prior to each exercise session. Temporary shifts toward increased parasympathetic reactivation (p = 0.030) resulted in significant increases in daily fatigue (p < 0.001) and decreases in motivation to exercise (p = 0.028). Through modulation of exercise volume, in response to these temporary shifts in HRV, these effects were reversed (p < 0.001) via increased parasympathetic withdrawal (p = 0.018). For the first time, these data demonstrate a mediating effect of HRV on adherence-related trait states throughout a high-intensity exercise program. Applied strategies, such as appropriately timed exercise volume moderation, may be able to leverage this effect and help facilitate long-term exercise program maintenance. Novelty These data establish a link between expected shifts in HRV throughout high-intensity exercise programs with motivation to participate and physical fatigue. Modulation of training volume, in response to these shifts, can optimize adherence-related behavioral responses during high-exercise programs.

Spontaneous Aneurysmal Subarachnoid Hemorrhage and Related Cortisol and Immunologic Alterations: Impact on Patients' Health-related Quality of Life

To highlight the impact of aneurysmal subarachnoid hemorrhage (SAH) on surviving patients' health-related quality of life (HRQoL) with respect to cortisol and interleukin (IL)-6 alterations and also to identify possible clinical predictors for a better HRQoL. Fifty surviving patients treated in our hospital for aneurysmal SAH in a 2-year period with sufficient HRQoL data were enrolled. A good clinical outcome was represented by the modified Rankin Scale (mRS) 0 to 2. The patient's HRQoL was assessed using the Short Form health survey questionnaire, the Beck Depression Inventory, and the Daily Fatigue Impact Scale at 6 and 12 months. The results were analyzed regarding possible correlation to 24-hour urinary free cortisol, serum, and cerebrospinal fluid IL-6 levels. A reduction of HRQoL in up to 35% of survivors was observed at 6 months and in a high proportion of patients (47.2%) with an assumable good outcome (mRS 0-2). Reduced HRQoL in survivors was found in terms of SF-36 (34.9%), depression (26.8%), and fatigue (14%) at 6 months and 18.4%, 39.4%, and 18.9% at 12 months, respectively. Improvement was recorded at 12 months, mainly in SF-36. Early elevated 24-hour urinary free cortisol and IL-6 levels showed a significant positive impact on HRQoL. Early cortisol and IL-6 levels may predict patients' HRQoL after SAH. Twelve months after SAH, a considerable percentage of patients with a presumably good outcome (mRS 0-2) had a lower HRQoL compared with the general population. Implementing corresponding tests at discharge and 12-month follow-up is recommended.

Hope-related goal cognitions and daily experiences of fatigue, pain, and functional concern among lung cancer patients.

Cross-sectional research suggests that thinking about multiple ways to reach goals (hope pathways) and the belief that one can reach them (hope agency) may be adaptive for lung cancer patients. We examined the between-person and within-person associations among aspects of hope agency and pathways thinking, daily fatigue, pain, and functional concerns (e.g., sense of independence, usefulness) among lung cancer patients during active treatment. Data from a daily diary study were used to examine relations among hope agency, hope pathways, fatigue, pain, and functional concern in 50 patients with advanced lung cancer. Participants were accrued from one outpatient cancer center and completed the study between 2014 and 2015. Adjusting for covariates and the previous day's symptoms or concern, patients who engaged in higher pathways thinking reported lower daily symptoms, whereas those who engaged in higher agency thinking reported less functional concern. Within-person increases in pathways thinking were associated with less daily fatigue, pain, and functional concern; within-person increases in agency thinking were associated with less daily fatigue and pain. Models examining symptoms and concerns as predictors of hope suggested within-person increases in functional concern and fatigue and pain were related to lower agency and pathways thinking the same day. Patients with higher fatigue and pain did not report lower agency or pathways thinking, but patients with more functional concern did. Increases in hope pathways thinking may be associated with lower symptoms and better functioning in lung cancer patients. This suggests that it is important to determine the efficacy of interventions that emphasize the pathways the component of hope.

The Effect Of Acute Chronic Training Load Ratio On Daily Stress, Fatigue, And Soreness Level In A Ncaa Division 1 Soccer Players

PURPOSE: To investigate the effect of acute chronic work load ratio (ACWL) on daily stress, fatigue, and soreness throughout a collegiate men’s soccer season. METHODS: Sixty-four male collegiate soccer players (mean±SD; age, 20±2y; body mass, 77.3±6.7kg; height, 179.9±6.4cm; VO2max, 53.0±5.0ml•kg-1•min-1) participated in this study, which took place during the 2016 and 2017 NCAA soccer season. During each training session and match, players donned a heart rate and GPS enabled chest strap to measure training impulse (TRIMP). Daily stress, fatigue, and soreness levels were collected using 1 to 10 Likert-scales before each training session and match. ACWL was calculated for TRIMP using the ratio of the previous 7-day average to the previous 28-day average. ACWL values were categorized into three groups: low, ACWL<0.8; medium, 0.8≦ACWL<1.5; high, ACWL≧1.5. Stress, fatigue, soreness levels were transformed to corresponding z-scores to account for individual differences. One-way ANOVA with Tukey pairwise comparison was used to assess stress, fatigue, soreness levels in different ACWL groups. Mean difference (MD), 95% confidence interval (95%CI) and effect size (ES), suggested by Cohen were calculated. RESULTS: Stress levels were significantly higher when ACWL was high compared to low (MD=0.47, 95%CI=0.34-0.60, ES=0.44) and medium (MD=0.37, 95%CI=0.25-0.48, ES=0.28) (p=0.001). Fatigue levels were significantly higher when ACWL was high (0.36±1.15) compared to low (MD=0.56, 95%CI=0.42-0.69, ES=0.55) and medium (MD=0.38, 95%CI=0.26-0.49, ES=0.36) (p=0.001). Fatigue levels were also significantly higher when ACWL was medium compared to low (MD=0.18, 95%CI=0.07-0.29, ES=0.20, p=0.001). Soreness level was significantly higher when ACWL was high compared to low (MD=0.51, 95%CI=0.37-0.64, ES=0.49) and medium (MD=0.38, 95%CI=0.26-0.50, ES=0.31) (p=0.001). CONCLUSIONS: ACWL could impact daily stress, fatigue, and soreness levels. A large change in ACWL (≧1.5) was associated with moderate to large changes in stress, fatigue, and soreness levels compared to low ACWL. Thus, ACWL may be used to manage athlete’s daily stress, fatigue, and soreness levels and optimize periodization. However, other factors should be also considered, such as sleep.

Effects of Short-term Exposure to Electromagnetic Fields Emitted by 3G and 4G Mobile Phones on Reaction Time and Short-term Memory

Introduction: There have been many studies conducted on the effects of mobile phones radiations on people’s health due to increasing number of mobile phones users. The present study aimed to investigate the effects of electromagnetic waves generated from 3G and 4G mobile phone radiations on student’s reaction time and short-term memory. Material and Methods: This was a cross-sectional and descriptive-analytic study. A sample of 85 medical students from Shiraz University of Medical Sciences in the age range of 18-22 years was selected. After 10-min exposure to 3G and 4G mobile waves without any prognoses if mobile phone was on or off, response time and short-term memory tests were taken at once. The groups then left laboratory for about 2 h to take a rest, and they came back to laboratory to carry out the second mode of testing after two h (mobile phones on or off related to previous test). Both tests were performed in the afternoon to make students almost identical in terms of daily fatigue conditions. The data were analyzed in SPSS software (version 19) using t-test technique. The difference was statistically considered significant (p <0.05). Results: The results revealed that the reaction time and average short-term memory following the exposure to electromagnetic waves emitted from mobile 3G and 4G mobile phones increased and decreased, respectively. However, this difference was only significant in the reaction time. The electromagnetic waves generated by the 3G and 4G mobile phones led to slower response time among students under emission, compared to the control group. Conclusion: According to our findings, it can be concluded that the frequency of electromagnetic waves increased the response to stimulus time.

Variability in daily self-reported emotional symptoms and fatigue measured over eight weeks in community dwelling individuals with traumatic brain injury

ABSTRACTObjective: To investigate within-person variability in daily self-reported emotional and fatigue symptoms and factors associated with high within-person variability among individuals with chronic traumatic brain injury (TBI).Design: This was a prospective descriptive pilot study of n = 18 adults with chronic TBI (2–27 years post-injury) who owned and could independently use an Apple or Android device.Methods: Participants completed daily assessments for 8 weeks via smartphone. Outcome measures included the Positive and Negative Affect Schedule, Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, and a 7-point fatigue rating. We examined within-person variability over time using individual Multilevel Linear Models. We categorized within-person variability as High or Low based on individual standard deviations in relationship to sample standard deviation.Results: Significant temporal within-person variability occurred for all measures. High variability was associated with more symptom reporting versus Low variability, and variability was associated with sex (High variability: 88% women; Low variability 90% men).Conclusions: Symptom measurement at a single time point among adults with chronic TBI may not capture day-to-day symptom fluctuation and may misidentify individuals in need of intervention. Assessing symptom profiles over time to capture temporal and individual variability may provide a more ecologically valid measure for managing long-term symptoms after TBI.

Professional burnout and workload of doctors

The purpose of the research was to establish the relationship patterns of acute and chronic (professional burnout, PV) fatigue of doctors with the workload that was characterized by a combination of the length of the working week and the intensity of the labor process. The study involved 325 women doctors. A special questionnaire was used to identify the symptoms of acute and chronic fatigue, duration and intensity of work, to assess the professional and non-professional causes of usual fatigue at work. It was found that the average workload of doctors was 44.9 hours per week, taking into account the physiological intensity of labor — 50.3 normalized hours (NH). The frequency of most of the symptoms of PV increases by 2–3 times at NH &gt; 58 hours, compared with the load at NH &lt; 42 hours. In case NH &gt; 47 hours on a daily fatigue doctors are largely influenced by the factors: work in evening and night shifts; the imbalance of effort and reward; the uncertainty of the obligations; extra-working load; lack of free time. The daily fatigue of doctors is also significantly affected by their individual characteristics — health and anxiety type of behavior.

Reciprocal associations between daily need-based experiences, energy, and sleep in chronic fatigue syndrome.

Previous findings indicate that patients with chronic fatigue syndrome (CFS) report significant day-to-day fluctuations in subjective energy and sleep. Herein, we examined whether daily variation in the satisfaction and frustration of the basic psychological needs for autonomy, competence, and relatedness would contribute to daily variation in subjective energy and quality and quantity of sleep. In addition, we examined whether daily variation in sleep would contribute to daily need-based experiences through (i.e., mediated by) daily fluctuations in subjective energy. CFS patients (N = 120; 92% female; Mage = 42.10 years, SD = 10.46) completed a diary for 14 days which assessed their need-based experiences and subjective energy every evening and sleep every morning. Results indicated that subjective energy, sleep, and need experiences fluctuated significantly from day to day. Daily need satisfaction related to less daily fatigue and more daily vitality, while the opposite pattern was observed for daily need frustration. Daily need frustration was also uniquely related to poorer daily sleep quality. Lastly, better daily sleep quality was also uniquely related to more daily need satisfaction and less daily need frustration via (i.e., mediated by) daily variation in subjective energy. These reciprocal within-day associations remained significant after controlling for the previous day's level of each outcome, with the exception of the relation between need frustration and sleep quality. The present findings underscore the reciprocal day-to-day association between need-based experiences and subjective energy in CFS. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Antioxidants in the Treatment of Chronic Diffuse Liver Diseases (the Results of the “MAXAR” Observational Program)

In the Russian Federation, liver diseases are most frequently represented by two their nosological forms, i.e., nonalcoholic and alcoholic fatty liver disease (NAFLD and ALD). A successful management of such patients, along with improving the functional state of the liver, requires a careful analysis of patients’ nonspecific complaints. In particular, it is important to investigate asthenic syndrome, which can indirectly result in the exacerbation of liver diseases, thus incurring additional economic costs to national healthcare systems. Therefore, the elucidation of the nature of asthenic syndrome and a search for methods for its resolution seem to be highly relevant research tasks.Aim.This study aims to investigate the effect of the antioxidant drug (the extract of the Amur maackia wood) on the organic and functional components of asthenic syndrome in patients with NAFLD and ALD, who do not show signs of the disease decompensation.Materials and methods. An observational program was carried out under the conditions of daily clinical practice in three Russian cities: Moscow, Chelyabinsk and Vladivostok. 80 patients (40 with NAFLD, 40 with ALD) were comprehensively examined according to a developed program. A number of laboratory indicators that reveal inflammatory processes in the liver were studied, including leukocytes, ESR, ALT, AST, GGTP and CRP. The patients’ psycho-emotional status was assessed using a Daily Fatigue Impact Scale (D-FIS) and a four-dimensional scale for assessing distress, depression, anxiety and somatisation (4DSQ).Results.According to the D-FIS questionnaire, all the patients showed fatigue. According to the 4DSQ questionnaire, a correlation of distress with the level of laboratory indicators was revealed among all the patients. No such a correlation was noted for depression and anxiety in the patients with NAFLD. On the contrary, in the case of ALD, all psycho-emotional disorders (except for somatisation) were positively correlated with the markers of inflammation. It is shown that asthenic syndrome in patients with both NAFLD and ALD has a complex origin, being associated both with inflammatory processes in the liver and psycho-emotional disorders. In all cases under study, the prescription of the preparation led to a decrease in the studied laboratory indicators (inflammation markers) and an increase in the patients’ psycho-emotional status. The latter improvement was manifested in the reduction of distress, depression, anxiety and somatisation, according to the 4DSQ questionnaire, as well as in the reduction of fatigue, according to the D-FIS questionnaire.Conclusion.The results of the observational program have shown that patients with NAFLD and ALD frequently experience such components of asthenic syndrome as distress, depression, anxiety, somatisation and fatigue. The prescription of the preparation is found to result in a decrease in laboratory inflammatory indicators. In addition, the preparation is determined to positively affect the components of asthenic syndrome in patients with NAFLD and ALD. In the course of the treatment, no clinically significant side effects were documented.

Assessing the relationship between heavy vehicle driver sleep problems and confirmed driver behavior measurement tools in Iran

Road traffic crashes have become an important public health problem. By studying the statistics of heavy vehicle crashes in the world, it becomes obvious that although heavy vehicle drivers experience fewer crashes than private car drivers, a large percentage of heavy vehicle crashes leads to death. So, it is important to identify the driving characteristics of heavy vehicle drivers. In this study, 474 Iranian truck drivers were interviewed face to face. Response rate of the survey was 80%, the participants who answered the questions on two behavioral questionnaires: Driver Behavior Questionnaire (DBQ) and Attention-Related Driving Error Scale (ARDES). Also, two sleep assessing questionnaires, Global Dissatisfaction with Sleep (GSD) and the Berlin Questionnaire, were completed. Confirmatory Factor Analysis (CFA) was used to confirm the validity of DBQ and ARDES for Iranian heavy vehicle drivers. After that, a Structural Equation Modeling (SEM) was used to identify the influence of sleep characteristics on truck driver behaviors. Results showed that more truck drivers are dissatisfied with their sleep, the more daily fatigue they suffer, and consequently, the more errors, slips, violations, and inattention they exhibit. Similar result trend was obtained for driver exposure. Also, the results showed that the more expensive a truck is, the less daily fatigue felt by the driver of the truck. Consequently, this leads to less aberrant driving behavior and inattention during driving.

Буддийские ценности как возможная экономическая детерминанта развития тувинского общества

В статье актуализируется изучение буддийских ценностей в свете их благотворного влияния на социально-экономическое развитие общества Тувы. Этому способствуют имеющиеся научные исследования успешных экономик мира, обзор которых приводится в работе.После распространения буддизма на Западе в середине XX века древние знания и практики стали доступны для урбанизированного населения развитых стран. Зарубежные исследователи обратили внимание на актуальный их потенциал при ведение финансовой, производственной деятельности. Среди западных экономистов начало разработки этой тематики положил Э. Шумахер (1973). Среди азиатских исследователей важный вклад сделал тайский монах и философ П. Пайотто.В имеющихся исследованиях, связывающих религию и экономическую культуру, буддизм как не поощряет к бедности, и не призывает отказу от материальных благ. Его неверно интерпретировать как аскетичную религию. В буддийских текстах существуют прямые указания, касающиеся способа зарабатывания денег, смысла благосостояния. Современные учителя также дают советы мирянам относительно экономической активности. Хотя в буддизме практикующие стремятся, прежде всего, к духовным целям — освобождению от страданий, достижению состояния Будды, миряне включены в социальную жизнь и Учение учитывает это. В буддизме считается, что богатство не способно принести подлинное счастье. Поэтому для практикующего мирянина достижение высокого материального благосостояния не является жизненной целью.В статье приводятся результаты современных исследований экономистов, психологов нейробиологов, подтверждающих, что эмпирическая корреляция между увеличением доходов и счастьем является незначительно. Приводятся примеры того, как буддийские ценности помогают предпринимателям. Так, в результате веры в закон кармы проявляется большая степень честности при деловом взаимодействии, появляется долгосрочная ориентация на бизнес. Убежденность в непостоянстве помогает принимать рискованные решения, необходимые в предпринимательской деятельности. Актуальность показывают и буддийские практики управления эмоциональными состояниями. Во многих мировых корпорациях (Google, Twitter, Ebay) внедряют программы по практикам осознанности. Это помогает сотрудникам справляться с ежедневным стрессом, усталостью.Все это побуждает обратиться к обществу тувинцев, для которых буддизм является традиционной религией. Сегодня в Туве повышается престиж буддизма, наблюдается живой интерес со стороны молодежи. Формируется сообщество мирян, получивших современное образование и компетентных в области буддизма. Автор делает вывод, что молодое поколение тувинцев в перспективе сможет применить духовные ценности в практической экономической деятельности.

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

ObjectivesPupil light reflex (PLR) has been widely used as a method for evaluating parasympathetic activity. The first aim of the present study is to develop a PLR measurement using a computer screen set-up and compare its results with the PLR generated by a more conventional setup using light-emitting diode (LED). The parasympathetic nervous system, which is known to control the ‘rest and digest’ response of the human body, is considered to be associated with daily life fatigue. However, only few studies have attempted to test the relationship between self-reported daily fatigue and physiological measurement of the parasympathetic nervous system. Therefore, the second aim of this study was to investigate the relationship between daily-life fatigue, assessed using the Need for Recovery scale, and parasympathetic activity, as indicated by the PLR parameters.DesignA pilot study was conducted first to develop a PLR measurement set-up using a computer screen. PLRs evoked by light stimuli with different characteristics were recorded to confirm the influence of light intensity, flash duration, and color on the PLRs evoked by the system. In the subsequent experimental study, we recorded the PLR of 25 adult participants to light flashes generated by the screen set-up as well as by a conventional LED set-up. PLR parameters relating to parasympathetic and sympathetic activity were calculated from the pupil responses. We tested the split-half reliability across two consecutive blocks of trials, and the relationships between the parameters of PLRs evoked by the two set-ups. Participants rated their need for recovery prior to the PLR recordings.ResultsPLR parameters acquired in the screen and LED set-ups showed good reliability for amplitude related parameters. The PLRs evoked by both set-ups were consistent, but showed systematic differences in absolute values of all parameters. Additionally, higher need for recovery was associated with faster and larger constriction of the PLR.ConclusionsThis study assessed the PLR generated by a computer screen and the PLR generated by a LED. The good reliability within set-ups and the consistency between the PLRs evoked by the set-ups indicate that both systems provides a valid way to evoke the PLR. A higher need for recovery was associated with faster and larger constricting PLRs, suggesting increased levels of parasympathetic nervous system activity in people experiencing higher levels of need for recovery on a daily basis.

Investigating daily fatigue scores during two-week offshore day shifts

ObjectivesThis study examined daily scores of fatigue and circadian rhythm markers over two-week offshore day shift periods. MethodsA prospective cohort study among N = 60 offshore day-shift workers working two-week offshore shifts was conducted. Offshore day shifts lasted from 07:00 – 19:00 h. Fatigue was measured objectively with pre- and post-shift scores of the 3-minute psychomotor vigilance tasks (PVT-B) parameters (reaction times, number of lapses, errors and false starts) and subjectively with pre- and post-shift Karolinska Sleepiness Scale (KSS) ratings. Evening saliva samples were collected on offshore days 2,7 and 13 to measure circadian rhythm markers such as dim-light melatonin onset times and cortisol. Generalized and linear mixed model analyses were used to examine daily fatigue scores over time. ResultsComplete data from N = 42 offshore day shift workers was analyzed. Daily parameters of objective fatigue, PVT-B scores (reaction times, average number of lapses, errors and false starts), remained stable over the course of the two-week offshore day shifts. Daily subjective post-shift fatigue scores significantly increased over the course of the two-week offshore shifts. Each day offshore was associated with an increased post-shift subjective fatigue score of 0.06 points (95%CI: .03 - .09 p < .001). No significant statistical differences in subjective pre-shift fatigue scores were found. Neither a circadian rhythm phase shift of melatonin nor an effect on the pattern and levels of evening cortisol was found. ConclusionDaily parameters of objective fatigue scores remained stable over the course of the two-week offshore day shifts. Daily subjective post-shift fatigue scores significantly increased over the course of the two-week offshore shifts. No significant changes in circadian rhythm markers were found. Increased post-shift fatigue scores, especially during the last days of an offshore shift, should be considered and managed in (offshore) fatigue risk management programs and fatigue risk prediction models.

Morning Cortisol Is Associated With Stress and Sleep in Elite Military Men: A Brief Report.

Accumulating evidence suggests that trends in salivary cortisol after awakening may be reliable biological predictors of morbidity and mortality. In a sample of elite military men, our lab recently established summary parameters of morning cortisol as well as their stability across 2 d of repeated sampling. In this follow-on study, we evaluated summary parameters and their relationships to theoretically relevant demographic (i.e., age, body mass index) and biobehavioral correlates (i.e., blood pressure [BP], sleep parameters, fatigue, and perceived stress). Fifty-eight male active duty U.S. Navy SEALs self-collected salivary samples on 2 consecutive, midweek workdays upon waking (WAKE), WAKE+30 min, WAKE+60 min, 4 p.m., and 9 p.m. in a nondeployed, free-living setting. Resting BP was measured manually, and sleep-wake periods were objectively derived using actigraphy. Daily fatigue and perceived stress were measured by self-report. Summary parameters of morning cortisol magnitude (i.e., peak value [Peak], area under the curve in terms of ground [AUCG], and average of morning samples [AVE]) were assessed with respect to each demographic and biobehavioral item via correlational analyses. A subgroup of 29 participants was selected for compliance with salivary sampling in the morning across 2 d. Perceived stress was positively associated with Peak (r[27] = 0.437, p < 0.05), AUCG (r[25] = 0.500, p < 0.01), and AVE (r[25] = 0.506, p < 0.01). Total sleep time was also positively associated with Peak (r[26] = 0.378, p < 0.05). There were borderline associations between some summary parameters and diastolic BP, percent sleep, and wake after sleep onset. Age, systolic BP, body mass index, time in bed, sleep efficiency, and fatigue did not associate with morning cortisol. Preliminary evidence of morning cortisol summary parameters as biobehavioral indicators was established, and these parameters appeared to associate with stress and sleep in elite military men.

Trajectories and predictors of women's health-related quality of life during pregnancy: A large longitudinal cohort study.

The objective of this study was to identify distinct trajectories and their predictors of health-related quality of life (HRQOL) of women during pregnancy in a prospective mother and child cohort. Analyses were based on 3936 Dutch pregnant women in Rotterdam area, the Netherlands. Information on potential predictors was collected in early pregnancy by questionnaire. Latent Class Mixture Modelling and Multinomial Logistic Regression were applied to assess the trajectory and predictors of HRQOL during pregnancy. HRQOL was measured by SF-12 in early, mid- and late pregnancy; physical and mental component summary (PCS-12/MCS-12) scores were calculated. Four physical HRQOL trajectories were identified: a healthy trajectory (‘healthy’) in 63.3%, consistently low (‘vulnerable’) in 10.8%; a small increase (‘recovering’) in 12.8% and a large decrease (‘at risk’) in 13.1%. Three mental HRQOL trajectories were identified: a healthy trajectory (‘healthy’) in 86.1%; a large increase (‘recovering’) in 7.5%; and a large decrease (‘at risk’) in 6.4%. Compared with healthy trajectories, the likelihood of following the ‘vulnerable’ physical HRQOL trajectory rather than a healthy trajectory was increased by daily fatigue(OR: 4.82[2.76, 8.40]), pelvic pain (OR:4.76[2.91, 7.78]) and back pain (OR:5.29[3.21, 8.70]); pregnancy-specific anxiety increased the likelihood of following the ‘at risk’ mental HRQOL trajectory (OR:7.95[4.84, 13.05]). Healthy physical and mental HRQOL trajectories during pregnancy were most common. Predictors indicative of poor HRQOL trajectories included pregnancy-related symptoms and anxiety.

Relationships Between Training Load, Sleep Duration, and Daily Well-Being and Recovery Measures in Youth Athletes.

To assess the relationships between training load, sleep duration, and 3 daily well-being, recovery, and fatigue measures in youth athletes. Fifty-two youth athletes completed 3 maximal countermovement jumps (CMJs), a daily well-being questionnaire (DWB), the perceived recovery status scale (PRS), and provided details on their previous day's training loads (training) and self-reported sleep duration (sleep) on 4 weekdays over a 7-week period. Partial correlations, linear mixed models, and magnitude-based inferences were used to assess the relationships between the predictor variables (training and sleep) and the dependent variables (CMJ, DWB, and PRS). There was no relationship between CMJ and training (r = -.09; ±.06) or sleep (r = .01; ±.06). The DWB was correlated with sleep (r = .28; ±.05, small), but not training (r = -.05; ±.06). The PRS was correlated with training (r = -.23; ±.05, small), but not sleep (r = .12; ±.06). The DWB was sensitive to low sleep (d = -0.33; ±0.11) relative to moderate; PRS was sensitive to high (d = -0.36; ±0.11) and low (d = 0.29; ±0.17) training relative to moderate. The PRS is a simple tool to monitor the training response, but DWB may provide a greater understanding of the athlete's overall well-being. The CMJ was not associated with the training or sleep response in this population.

(181) - The relationship between quantitative sensory testing (qst), mindfulness, fatigue, and pain in fibromyalgia

Fibromyalgia (FM) is a chronic pain condition characterized by heightened sensitivity to mechanical (as well as other modalities) stimuli. While on average FM patients display substantial hyperalgesia, inter-patient variability is large, and the degree of hyperalgesia is known to associate with the magnitude of patients' spontaneous daily pain. To date however, little research has investigated the potential moderating effects of patient characteristics on the association between experimental pain and daily clinical pain. The present study used a diary-based micro-longitudinal design to examine this question in fibromyalgia patients. Patients completed baseline measures of mindfulness (FFMQ), followed by daily surveys of fibromyalgia pain, symptoms, and catastrophizing for a period of 7 days. In addition, FM patients underwent Quantitative Sensory Testing measuring Pressure Pain Thresholds (PPTs), measured on the lower leg using cuff algometry. Multilevel modeling (MLM) analyses indicated that high mechanical pain sensitivity was associated with heightened levels of daily pain interference (B = .63, p < .01). In addition, more cuff pain sensitivity was associated with elevated levels of daily fatigue (B = .33, p < .01). Results of a multilevel moderation analysis revealed a significant interaction between cuff pain sensitivity and mindfulness on daily pain interference (B = .04, p < .01) as well as fatigue (B = .02, p < .05). Overall, the findings are congruent with other studies showing that mechanical hyperalgesia is correlated with daily pain and fatigue in FM and these novel results suggest that characteristics of mindfulness may be most effective in reducing pain in patients who suffer from relatively less hyperalgesia.

Co-variation of fatigue and psychobiological stress in couples’ everyday life

ObjectiveThere is limited knowledge about how fatigue develops and worsens and what influences fluctuations in daily fatigue. Stress was found to influence fatigue, and being in a relationship seems to either increase or decrease stress depending on the couple interaction. In this study, co-variation of fatigue, self-reported stress, and biological stress markers in couples’ everyday lives was investigated. Specifically, we examined a) whether momentary couple interactions moderated dyadic outcomes and b) whether and how stress and relationship measures influenced individual momentary fatigue. MethodsForty heterosexual couples (age: 28 ± 5 years) reported subjective fatigue and stress levels 4 times a day for 5 consecutive days (1600 measures). Furthermore, participants reported whether they had interacted with their partner since the last data entry and, if so, they rated the valence of this interaction. Salivary cortisol (a measure of HPA axis activity) and alpha amylase (a measure of ANS activity) were analyzed as biological stress markers from saliva samples obtained at the same time points. Moment-to-moment data were analyzed using dyadic multilevel models to account for the nested design. ResultsStress (women and men: p ≤ 0.001) and fatigue (women: p = .003, men: p = .020) showed patterns of co-variation within couples, especially if partners had interacted with each other since the previous data entry. Cortisol was also found to co-vary between partners (women: unstandardized coefficient (UC) = 0.12, p ≤ .001, men: UC = 0.18, p ≤ .001), whereas the regulation of alpha-amylase levels depending on the partner’s levels was only present in women (UC = 0.11, p = .002). Valence of couple interaction was negatively associated with fatigue (women: UC = −0.13, p ≤ .001, men: UC = −0.06, p = .011). There was no momentary association of fatigue with an individual’s own or the partner’s subjective or biological stress markers. ConclusionsFatigue and stress levels during the day seem to co-vary within couples. These associations were particularly strong when the partners had interacted with each other since the last measurement. These data underline the importance of social factors in fatigue and stress in everyday life.