Fatigue Status Research Articles

Musculoskeletal pain and physical health status among confirmed COVID-19 patients of Bangladesh

COVID-19 pandemic is now a great headache for the world population. Respiratory symptoms are the main presentation of COVID-19. However, musculoskeletal pain, headache, loss of taste and smell sense, and neurological manifestations may occur. Identification of patterns of musculoskeletal pain, fatigue and physical health status in COVID-19 is crucial. In this cross sectional study, a total 380 individuals with COVID-19 were recruited from the population following selection criteria. Pain varied widely in hip, neck, leg and calf muscles, back and spine, shoulder, arms and hand, and other parts of the body among the respondents. Inconstant, among respondents of younger age group (aged ≤50 year), 37.59% had moderate pain, 6.77% had severe pain, 13.91% had mild pain, and 41.17% had no pain. On the other hand, among older respondents (aged >50 year) 47.37% had moderate pain, 25.44% had severe pain, 13.15% had mild pain, and 14.03% had no pain. The differences between two groups was statistically significant (p<0.05). However, there was no difference in frequency of pain between males and females. Those respondents who had pain was reported having physical health worse than the average compared to that of those who had no pain. BSMMU J 2021; 14 (COVID -19 Supplement): 1-7

Health-related quality of life in locally advanced hepatocellular carcinoma treated by either radioembolisation or sorafenib (SARAH trial)

BackgroundThe aim of this ancillary study of the SARAH trial is to compare health-related quality of life (HRQoL) in patients with locally advanced or inoperable hepatocellular carcinoma (HCC) treated with transarterial radioembolisation (TARE) or sorafenib. MethodsThis study included randomised patients who received either TARE or at least one dose of sorafenib with no major deviation in the protocol and who had at least one QoL follow-up assessment in addition to the baseline evaluation. QoL was assessed from the date of randomisation using the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire, until disease progression or other reasons for stopping study participation. Data were analysed using linear mixed and time-dependent models. ResultsA total of 285 patients were included (122 and 163, in the TARE and sorafenib groups, respectively). Questionnaire completion rates were similar (77.5% versus 80.4%, in the TARE and sorafenib groups, respectively, p = 0.25). Longitudinal HRQoL analysis showed a significant treatment and time effects for fatigue and global health status, and significant treatment, time and treatment by time interaction effects for appetite loss, diarrhoea and social functioning. The median time to deterioration for the global health status was 3.9 months (95% confidence interval [CI] 3.7–4.3) versus 2.6 months (95% CI 2.0–3.0) in the TARE and sorafenib groups, respectively. ConclusionsHRQoL was preserved longer with TARE than with sorafenib in locally advanced HCC. These data could be used to optimise management of patients with advanced or inoperable HCC.

A causal model of functional status among persons with liver cirrhosis from four public hospitals in Thailand

PurposeThe purpose of this study is to develop and test the causal relationships between alcohol consumption, social support, illness perception, fatigue and functional status among persons with liver cirrhosis. The hypothesized model was developed based on the theory of unpleasant symptoms.Design/methodology/approachA cross-sectional study was conducted among 400 persons with liver cirrhosis by stratified random sampling. Data were collected at outpatient departments from four public hospitals across three regions in Thailand. Six self-report questionnaires were utilized to collect data from March to August 2020. The developed model was verified via a structural equation modeling analysis.FindingsThe proposed model fit with the empirical data considering from χ2/df = 2.397 (p = 0.061), root mean square error of approximation (RMSEA) = 0.056, comparative fit index (CFI) = 0.985, Tucker–Lewis index (TLI) = 0.981, and standardized root mean square residual (SRMR) = 0.048. The model explained 71.30% of the total variance in functional status. Social support was the most influential factor affecting functional status both directly and indirectly through illness perception. Illness perception had a negative direct effect on functional status and a positive indirect effect on functional status through fatigue. Fatigue had a negative direct effect on functional status. Alcohol consumption was found as the lowest influential factor affecting functional status.Originality/valueThis is the first study that explores the characteristics of functional status among persons with liver cirrhosis comprehensively. A causal relationship among various variables found in this study would shed light as important fundamental data for developing interventions to enhance functional status among this population.

Research on Fatigue Detection Method of Equipment Operators Based on Multi-Source Physiological Signals

In order to effectively detect the fatigue status of equipment operators, this paper proposes a fatigue detection model that integrates multi-source physiological signals to evaluate the fatigue level of equipment operators in order to improve the efficiency of military operations and training. This method selects various physiological signals such as human heart rate, heart rate variability, body temperature, respiratory rate, blood oxygen concentration, etc. according to the working environment and working characteristics of the equipment operator, and establishes the relationship between the characteristic values of various physiological parameters and fatigue levels, And then use the optimized support vector machine to perform fusion judgment on the feature values of multi-source physiological parameters, and obtain the fatigue state of the equipment operator. Experimental results show that this method can make a more accurate judgment on the fatigue state of equipment operators, and is of great significance for ensuring the efficiency of equipment operators’ work and training.

Selection of wearable sensor measurements for monitoring and managing entry-level construction worker fatigue: a logistic regression approach

PurposeThe identification of fatigue status and early intervention to mitigate fatigue can reduce the risk of workplace injuries. Off-the-shelf wearable sensors capable of assessing multiple parameters are available. However, using numerous variables in the fatigue prediction model can elicit data issues. This study aimed at identifying the most relevant variables for measuring occupational fatigue among entry-level construction workers by using common wearable sensor technologies, such as electrocardiogram and actigraphy sensors.Design/methodology/approachTwenty-two individuals were assigned different task workloads in repeated sessions. Stepwise logistic regression was used to identify the most parsimonious fatigue prediction model. Heart rate variability measurements, standard deviation of NN intervals and power in the low-frequency range (LF) were considered for fatigue prediction. Fast Fourier transform and autoregressive (AR) analysis were employed as frequency domain analysis methods.FindingsThe log-transformed LF obtained using AR analysis is preferred for daily fatigue management, whereas the standard deviation of normal-to-normal NN is useful in weekly fatigue management.Research limitations/implicationsThis study was conducted with entry-level construction workers who are involved in manual material handling activities. The findings of this study are applicable to this group.Originality/valueThis is the first study to investigate all major measures obtainable through electrocardiogram and actigraphy among current mainstream wearables for monitoring occupational fatigue in the construction industry. It contributes knowledge on the use of wearable technology for managing occupational fatigue among entry-level construction workers engaged in material handling activities.

Integrating External and Internal Load for Monitoring Fitness and Fatigue Status in Standard Microcycles in Elite Rink Hockey.

The aims of this study were 3-fold: firstly, to present an integrative approach to external and internal load dynamics for monitoring fitness and fatigue status of specific in-court rink hockey training sessions in a standard microcycle; secondly, to assess the differences between training sessions and matches; the third and final aim was to assess the association between external and internal load metrics. The external load, using a local positioning system, and internal load, using the declared rate of perceived exertion, were measured during 23 in-season microcycles for nine top-level players. Training load data were analysed with regard to the number of days before or after a match [match day (MD) minus or plus]. In relation to the first aim, internal and external load metrics merged into a single integrated system using pooled data z-scores provided an invisible monitoring tool that places the players in the fitness-fatigue continuum throughout the different microcycle sessions. In this regard, MD-4 and MD-1 sessions tend to place, with a low dispersion, the players in a “low external and internal load” zone. On the contrary, in MD-3 and MD-2 sessions, as well as in MD, in which higher loads were recorded, most of the players were within a “high external and internal load” zone with a tendency towards dispersion towards the fitness or fatigue zones. Finally, and with regard to the second and third aims, an inverted “U-shape” load dynamic related to the specific goals of each training session was the main finding in terms of comparison between MD; a load peak between MD-3 and MD-2 sessions and a significant decrease in all the load variables in MD-1 sessions were found; and high-to-low correlations were found between external and internal load metrics. This study presents an integrative approach to the external and internal load of players for monitoring fitness and fatigue status during a standard microcycle in rink hockey that might provide team sport staff members with a deeper understanding of load distribution in the microcycle in relation to the match.

The effects of spirulina (Arthrospira platensis) supplementation on anthropometric indices, blood pressure, sleep quality, mental health, fatigue status and quality of life in patients with ulcerative colitis: A randomised, double-blinded, placebo-controlled trial.

An emerging body of evidence has highlighted the protective role of spirulina in human health. Thus, we conducted a randomised controlled trial to discern the effects of spirulina supplementation on anthropometric indices, blood pressure, sleep quality, mood, fatigue status and quality of life among ulcerative colitis patients. Eighty participants with ulcerative colitis were randomly allocated to receive, either, 1g/day (two 500mg capsules) spirulina (n=40) or placebo (n=40), in a clinical trial for eight weeks. Dietary intake, physical activity, sleep quality, mental health, fatigue status and quality of life were assessed for each participant at baseline and trial cessation. Anthropometric indices and blood pressure were also assessed. Seventy-three participants completed the intervention. Our results revealed that spirulina supplementation significantly reduced sleep disturbances (P=.03), while no significant changes occurred in the sleep quality score or other sleep parameters, vs the placebo group (P>.05). Furthermore, a significant reduction in stress score (P=.04) and increase in quality of life (P=.03) was detected; but not anxiety, depression or fatigue scores (P>.05). Additionally, anthropometric indices and blood pressure did not significantly change (P>.05). An improved quality of life was observed among ulcerative colitis patients following spirulina supplementation, which could be attributed to improved sleep disturbance and stress status. Further clinical studies, with longer duration interventions and suitably powered sample sizes, are necessary to elucidate the veracity of our findings.

Effects of Eculizumab Treatment on the Quality of Life in Patients with Paroxysmal Nocturnal Hemoglobinuria Treated in Japan

Introduction: PNH is a hematopoietic stem cell disorder with the expansion of a PIGA mutated clone(s). PNH clones are deficient in the membrane expression of GPI-anchored proteins including CD55 and CD59, which leave erythrocytes susceptible to complement attack, resulting in intravascular hemolysis. Many symptoms experienced by PNH patients such as fatigue, dyspnea, and stomachache have been found to be associated with serum free hemoglobin (Hb) released from erythrocytes by intravascular hemolysis (JAMA. 2005;293(13):1653-1662). Eculizumab (Soliris®), a humanized monoclonal antibody against Complement Factor C5, has shown dramatic effect in blocking intravascular hemolysis. Previous reports have revealed that eculizumab has not only improved anemia but also patients' quality of life (QoL) (N Engl J Med. 2006; 355: 1233-1243, Blood. 2008; 111: 1840-1847, Int J Hematol. 2011; 93: 36-46). However, factors which may be associated with improvement of QoL have yet to be fully understood. To clarify the clinical significance of QoL improvement in PNH patients treated with eculizumab, we analyzed the change in QoL in 54 PNH patients treated with eculizumab based on the data from the post-marketing surveillance (PMS) of eculizumab in Japan.Methods: All PNH patients treated with eculizumab have been registered in PMS based on the revised Pharmaceutical Affairs Law in Japan since June 2010. Of 491 patients registered as at March 2017, QoL questionnaires were obtained from 225 patients. 54 patients who received both baseline and one-year assessment of QoL were analyzed in this study. QoL was assessed using Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) instruments. Summary statistics were obtained from the figures of QoL scoring systems and the lab values, and paired Student's t-test was used for the change of the values in one year from the baseline. Canonical correlation analysis was performed among QoL variates (consisted of 16 items) and lab data variates (LDH, Hb, and platelets).Results: There was no bias in the baseline characteristics between the total (491) and the analyzed (54) patients. One-year administration of eculizumab improved serum LDH level (mean: from 1435.3 to 289.5 U/L), Hb level (mean: from 8.22 to 9.46 g/dL), and QoL in most of their items in comparison with the baseline. In particular, significant improvement of EORTC QLQ-C30 was shown in the items of fatigue, dyspnea, physical function, and global health status. Canonical correlation analysis revealed a high correlation between QoL variates and lab data variates (Canonical R=0.8393, p=0.004). Of the lab data variates, LDH (Canonical correlation coefficient: -0.91) and Hb (0.76) showed strong correlations with QoL improvement as expected. Interestingly, QoL improvement was independent of patient's baseline characteristics such as the coexistence of aplastic anemia and/or myelodysplastic syndrome and the degree of lactate dehydrogenase (LDH) (Fig. 1, 2).Conclusion: In this study, QoL improvement following treatment with eculizumab was statistically strongly correlated to the degree of hemolysis, which is consistent with the previous reports. Herein we also demonstrated, for the first time, that the degree of improvement was independent of the baseline serum LDH level before eculizumab treatment and of the presence or absence of bone marrow failure. Those PNH patients without eculizumab treatment due to mild hemolysis might benefit from eculizumab treatment regardless of the presence of bone marrow failure syndromes. [Display omitted] DisclosuresUeda:Alexion Pharma GK: Honoraria, Research Funding. Obara:Alexion Pharma GK: Honoraria, Research Funding. Yonemura:Alexion Pharma GK: Honoraria, Research Funding. Noji:Alexion Pharma GK: Honoraria, Research Funding. Matsuda:Alexion Pharma G.K.: Employment. Akiyama:Alexion Pharma G.K.: Employment. Chiba:Nippon Shinyaku: Honoraria, Research Funding. Kawaguchi:Alexion Pharma G.K.: Honoraria; Novartis,Pfizer: Consultancy, Honoraria. Shichishima:Alexion Pharma GK: Honoraria. Okamoto:Bristol-Myers K.K: Honoraria; Pfizer Japan: Speakers Bureau; Alexion Pharma G.K.: Honoraria; Astellas: Honoraria; Pfizer: Research Funding; Chugai Pharmaceutical Co.: Research Funding; Novartis: Research Funding; Bristol-Myers K.K: Research Funding. Nishimura:Alexion Pharma GK: Honoraria, Research Funding. Kanakura:Fujimotoseiyaku: Research Funding; Alexion Pharmaceuticals, Inc.: Honoraria, Research Funding; Kyowa Hakko Kirin: Research Funding; Astellas: Research Funding; Eisai: Research Funding; Shionogi: Research Funding; Chugai Pharmaceutical: Research Funding; Nippon Shinyaku: Research Funding; Pfizer: Research Funding; Bristol Myers: Research Funding; Toyama Chemical: Research Funding. Ninomiya:Alexion Pharma GK: Honoraria.

Theta-burst versus 20 Hz repetitive transcranial magnetic stimulation in neuropathic pain: A head-to-head comparison

ObjectiveHigh-frequency repetitive transcranial magnetic stimulation (rTMS) has been shown to reduce neuropathic pain, but intermittent “theta-burst” stimulation (iTBS) could be a better alternative because of shorter duration and greater ability to induce cortical plasticity. Here we compared head-to-head the pain-relieving efficacy of the two modalities when applied daily for 5 days to patients with neuropathic pain. MethodsForty-six patients received 20 Hz-rTMS and/or iTBS protocols and 39 of them underwent the full two procedures in a random cross-over design. They rated pain intensity, sleep quality, fatigue and general health status daily during 5 consecutive weeks. ResultsPain relief during the month following stimulation was superior after 20 Hz-rTMS relative to iTBS (F(1,38) = 4.645; p = 0.037). Correlation between respective levels of maximal relief showed a significant deviation toward the 20 Hz-rTMS effect. A greater proportion of individuals responded to 20 Hz-rTMS (52% vs 32%, 95 %CI[0.095–3.27]; p = 0.06), and reports of fatigue significantly improved after 20 Hz-rTMS relative to iTBS (p = 0.01). General health and sleep quality scores did not differentiate both techniques. ConclusionsHigh-frequency rTMS appeared superior to iTBS for neuropathic pain relief. SignificanceAdequate matching between the oscillatory activity of motor cortex and that of rTMS may increase synaptic efficacy, thus enhancing functional connectivity of motor cortex with distant structures involved in pain regulation.

MO613EFFECT OF 12 WEEK TRAINIG ON PHYSICAL ACTIVITY ON PATIENT ON A LOW PROTEIN DIET

Abstract Background and Aims Symptoms such as fatigue, muscle weakness and impaired nutritional status are common in CKD and lead to decreased exercise tolerance. The aim of the study was to study the effect of 12-week training on physical activity in patients with pre-dialysis stages of CKD on a low-protein diet. Method The study included 119 patients with CKD C3 and C4 stages. Clinical data included anthropometric data: body mass index (BMI), mid-thigh circumference and mid-shoulder circumference, laboratory data: urea, creatinine, electrolytes, albumin, total protein, hemoglobin. All patients underwent instrumental research methods: ECG, EchoCG, cardiopulmonary stress test. The patients included in the study were offered three dietary options - with a low protein content (0.6 g / kg / day;) and a limited protein content (0.6-0.8 g / kg / day;), and low protein diet with keto analogs (1 tab / 5 kg body weight / day). The physical exercise program was designed for independent home use and included cardiovascular exercises (primarily walking, morning exercises) and strength training exercises with dumbbells 1 and 3 kg. The training frequency was at least 3 times a week and had a duration of at least 20–30 minutes. The patients kept exercise diaries, which were reviewed by the doctor at each subsequent visit. The training exercise was adjusted depending on the self-perception of the patients; if necessary, the training time was increased to 60 minutes. Results The 1 group 24% of patients received a diet with a low protein content, the second group consisted of 40% of patients, the third group consisted of 37% of patients receiving a diet with a limited protein content. The male to female ratio, mean glomerular filtration rate, daily proteinuria and BMI did not differ significantly between groups. In the dynamics of 12 weeks of training, an increase in the mid-thigh and upper arm circumference was recorded. The study of physical activity of patients with different types of diet showed that in patients of the 1st group, even with a low nutritional status in the dynamics of 12 weeks of training, there was an improvement in such physical indicators as the circumference of the mid-thigh and upper arm, and also a slight improvement in the BMD. When comparing the groups of patients who received and did not receive ketoanologs (groups 2 and 3, respectively), physical training for 12 weeks instilled a significant improvement in indicators such as mid-arm circumference and maximum oxygen consumption(peak VO2). However, in the group receiving keto analogs, there was a significantly greater improvement in maximum oxygen consumption (peak VO2). Conclusion Regular dosed exercise has a positive effect on physical fitness in CKD patients on a low-protein diet. Correction of nutrition with keto analogs improves the cardiorespiratory status of patients.

Prevalence of distress, its associated factors and referral to support services in people with cancer.

Aims and objectivesTo (i) characterise prevalence of distress amongst people diagnosed with cancer, (ii) determine factors associated with increasing distress, (iii) describe reported problems for those with clinically significant distress and (iv) investigate the factors associated with referral to support services.BackgroundInternational studies report a high prevalence of clinically significant distress in people with cancer. Australian studies are notably lacking. Additionally, clinicians still do not fully understand the factors associated with cancer‐related distress.DesignPeriod prevalence study.MethodsDistress screening data were analysed for 1,071 people accessing the Cancer Council Western Australia information and support line between 01/01/2016–31/12/2018. These data included people's demographics, cancer diagnoses, level of distress, reported problems and the service to which they were referred. Distress and reported problems were measured using the National Comprehensive Cancer Network Distress Thermometer and Problem List. A partial proportional logistic regression model was constructed to determine which factors were associated with increasing levels of distress. Standard binary logistic regression models were used to investigate factors associated with referral to support services. The STROBE checklist was followed.ResultsPrevalence of clinically significant distress was high. Self‐reported depression, sadness, worry and a lack of control over treatment decisions were significantly associated with increasing distress. Emotional problems were the most prevalent problems for people with clinically significant distress. Most people were referred to emotional health services, with depression, fatigue, living regionally and higher socioeconomic status associated with referral.ConclusionsEmotional problems such as depression, sadness and worry are associated with increasing levels of distress.Relevance to clinical practiceNot all factors associated with referral to support services were those associated with increasing levels of distress. This suggests that other factors may be more influential to referral decisions.

Identification of Pilots’ Fatigue Status Based on Electrocardiogram Signals

Fatigue is an important factor affecting modern flight safety. It can easily lead to a decline in pilots’ operational ability, misjudgments, and flight illusions. Moreover, it can even trigger serious flight accidents. In this paper, a wearable wireless physiological device was used to obtain pilots’ electrocardiogram (ECG) data in a simulated flight experiment, and 1440 effective samples were determined. The Friedman test was adopted to select the characteristic indexes that reflect the fatigue state of the pilot from the time domain, frequency domain, and non-linear characteristics of the effective samples. Furthermore, the variation rules of the characteristic indexes were analyzed. Principal component analysis (PCA) was utilized to extract the features of the selected feature indexes, and the feature parameter set representing the fatigue state of the pilot was established. For the study on pilots’ fatigue state identification, the feature parameter set was used as the input of the learning vector quantization (LVQ) algorithm to train the pilots’ fatigue state identification model. Results show that the recognition accuracy of the LVQ model reached 81.94%, which is 12.84% and 9.02% higher than that of traditional back propagation neural network (BPNN) and support vector machine (SVM) model, respectively. The identification model based on the LVQ established in this paper is suitable for identifying pilots’ fatigue states. This is of great practical significance to reduce flight accidents caused by pilot fatigue, thus providing a theoretical foundation for pilot fatigue risk management and the development of intelligent aircraft autopilot systems.

Self-maintenance and automatic identification of the fatigue status of the human body based on Internet of Things technology

This paper designs and manufactures a complete set of intelligent recognition system based on the Internet of Things (IoT), which can evaluate the fatigue status of the leg muscles based on the surface EMG signals of multiple parts of the leg muscles. The data set is pre-processed by slicing and other pre-processing to obtain a set of fatigue examples suitable for model training input. The fatigue examples can be used as input to build and train a multi-layer two-way leg muscle fatigue status recognition model based on Long Short-Term Memory (LSTM). The experimental results on the test set show that the overall recognition system works stably during running, but its ability to recognize and generalize the fatigue status of the legs is not good, after the fatigue status is stabilized, the discrimination accuracy is improved, the model can make highly accurate status recognition judgments on the fatigue instance set, with an accuracy of 87.54%.

Computer Audition for Fighting the SARS-CoV-2 Corona Crisis-Introducing the Multitask Speech Corpus for COVID-19.

Computer audition (CA) has experienced a fast development in the past decades by leveraging advanced signal processing and machine learning techniques. In particular, for its noninvasive and ubiquitous character by nature, CA-based applications in healthcare have increasingly attracted attention in recent years. During the tough time of the global crisis caused by the coronavirus disease 2019 (COVID-19), scientists and engineers in data science have collaborated to think of novel ways in prevention, diagnosis, treatment, tracking, and management of this global pandemic. On the one hand, we have witnessed the power of 5G, Internet of Things, big data, computer vision, and artificial intelligence in applications of epidemiology modeling, drug and/or vaccine finding and designing, fast CT screening, and quarantine management. On the other hand, relevant studies in exploring the capacity of CA are extremely lacking and underestimated. To this end, we propose a novel multitask speech corpus for COVID-19 research usage. We collected 51 confirmed COVID-19 patients’ in-the-wild speech data in Wuhan city, China. We define three main tasks in this corpus, i.e., three-category classification tasks for evaluating the physical and/or mental status of patients, i.e., sleep quality, fatigue, and anxiety. The benchmarks are given by using both classic machine learning methods and state-of-the-art deep learning techniques. We believe this study and corpus cannot only facilitate the ongoing research on using data science to fight against COVID-19, but also the monitoring of contagious diseases for general purpose.

Is the association between physical activity and fatigue mediated by physical function or depressive symptoms in symptomatic knee osteoarthritis? The Multicenter Osteoarthritis Study

Objectives: To examine whether physical activity (PA) was associated with fatigue, and quantify the extent of potential mediation through depressive symptoms or physical function (PF) on the relationship between PA and fatigue in symptomatic knee osteoarthritis (KOA). Method: This longitudinal study used data from the Multicenter Osteoarthritis Study (n = 484), comprising subjects aged ≥ 50 years. Baseline PA was quantified via an ankle-worn accelerometer. The outcome was fatigue, measured using a 0–10 rating scale at 2 year follow-up. Mediators included gait speed as a measure of PF and depressive symptoms at 2 year follow-up. Mediation analysis was carried out after adjustment for baseline confounders. Stratified analysis by baseline fatigue status [no/low (< 4) and high (≥ 4) fatigue] was performed. Results: A significant direct association was found between PA and fatigue at 2 years [unstandardized coefficient (B) = −0.054; 95% confidence interval (CI) −0.107, −0.002, p = 0.041]. The PA–fatigue relationship was not mediated by gait speed (B = −0.006; 95% CI −0.018, 0.001) or depressive symptoms (B = 0.009; 95% CI 0.009, 0.028). In the subgroup with high baseline fatigue, direct associations were found between PA and fatigue (gait speed model:, B = −0.107; 95% CI −0.212, −0.002, p = 0.046; depressive symptoms model: B = −0.110; 95% CI −0.120, −0.020, p = 0.017); but in the no/low baseline fatigue group, no significant association was found between PA and fatigue. Conclusion: In the symptomatic KOA population, higher baseline PA was directly associated with reduced fatigue 2 years later, especially in those with high baseline fatigue. However, this relationship was not mediated by depressive symptoms or PF.

Factors Associated With Time to Achieve Employment Through Occupational Support Programs in Patients With Mood Disorders: 1 Year Naturalistic Study.

Objective: Mood disorders cause significant work performance disability in sufferers and often lead to adverse employment outcomes in working individuals. The aim of this study was to explore factors associated with time to achieve employment through the occupational support program (OSP) for patients with mood disorders.Methods: The participants were patients admitted to the Kyorin university hospital from April 2016 to April 2019. Patients who met the criteria for major depressive disorder and depressive episode of bipolar I or II disorder according to DSM-5 and participated in the occupational therapy-based OSP for at least three sessions (one course) were included in this study. We collected demographic and clinical variables at the baseline of this study through medical records and OSP records; the variables included age, gender, diagnosis, scores of Quick Inventory of Depressive Symptomatology and Global Assessment of Functioning, the number of times of participation in the OSP, word count of the transcription task in the OSP, typographical deficiency, fatigue status and mood status after the OSP. The primary outcome was set as the time to achieve the employment within 1 year after the discharge.Results: Of the 211 patients who participated in the OSP during the survey period, 49 participants met the criteria in this study. The results showed that 14 patients achieved and the other 35 patients did not achieve the employment within 1 year of discharge from the hospital. A multivariate cox regression analysis revealed that the word count of the transcription task in the OSP (HR = 1.03, 95% CI = 1.01–1.05, p = 0.016) and mood status after the OSP (HR = 2.77, 95% CI = 1.18–6.51, p = 0.019) were significantly associated with time to achieve the employment.Conclusion: In conclusion, this study suggested that work speed and mood response in the OSP could be significant predictors for achieving employment in patients with mood disorders.

Self-Reported Fatigue in Chinese Children and Adolescents During Cancer Treatment.

Background: Fatigue is a prevalent and distressing symptom in children and adolescents with cancer. Objectives: This study aimed to (1) investigate the current fatigue status reported by Chinese children and adolescents with cancer during active cancer treatment and (2) examine whether sociodemographic information, disease and treatment information, co-occurring symptoms, function and related clinical data are significantly associated with fatigue according to the biopsychosocial model. Methods: Participants were children aged 8-17 years, who had undergone treatment for cancer at four hospitals in China. Children completed the Chinese version of the Pediatric Patient-Reported Outcomes Measurement Information System short forms. Results: In total, 187 children (33.16% female, mean age 10.28 years) participated. The mean T-score for child-reported fatigue was 48.52 (34-72). Multiple linear regression analysis showed that fatigue in pediatric active cancer treatment could be significantly predicted by greater child-reported pain interference (β = 0.391, p < .001), greater depressive symptoms (β = 0.443, p < .001), and reduced mobility (β = -0.226, p = .004) (adjusted R2 = 0.613, F = 16.476, p < .001). Conclusions: Children and adolescents with cancer experience multiple, intersecting troubling symptoms during their treatment. There is a need to attend to the biopsychosocial aspects of care for children and adolescents during active cancer treatment. To reduce pediatric oncology patients' fatigue level, clinicians could develop culturally sensitive interventions to alleviate children's pain interference, treat depressive symptoms, and maximize their physical mobility.

Evaluation of evidence for exercise intervention in patients with cancer‐related fatigue during chemoradiotherapy

This systematic review evaluated evidence quality for exercise intervention in patients with cancer-related fatigue(CRF) during chemoradiotherapy to provide evidence-based clinical guidance. CRF is one of the most common symptoms in patients undergoing chemoradiotherapy. There is mounting evidence suggests exercise can relieve CRF and clinical practice guidelines for its management have been published in several countries. However, more specific exercise programs need to be extracted to guide the clinical practice. The review was presented by PRISMA guidelines. Research questions and strategies were established using evidence-based nursing criteria. 11 websites and databases were searched. Appraisal of Guidelines for Research and Evaluation II, the JBI literature quality assessment tool, and the JBI evidence pre-classification and evidence recommendation level system were used. 13 systematic reviews, 4 guidelines, and 1 evidence summary were included. The overall guideline quality score was 5.71, indicating high quality, with the following average scores on the six dimensions: scope and purpose, 86.81%; stakeholder group, 71.53%; rigor of the writing, 76.56%; clarity of presentation, 88.19%; applicability, 68.23%; and independence, 72.92%. We summarized 18 pieces of evidence including screening and assessment of CRF and exercise risk, health education, sports program, sports protection, and termination index. There were 12, 1, 1, and 4 pieces of evidence in grades I, II, III, and IV, respectively. The evidence recommendation was strong for 15 and weak for 3 articles. Although a normal adult exercise intensity level is considered safe for patients during chemoradiotherapy, our synthesis suggests that 18 pieces of evidence shall be followed. Future research should focus on more cancer types and more targeted exercise program design. CRF status and exercise risk should be screened and evaluated throughout exercise interventions. Interventions should be individualized, initiated at a low intensity and duration, and increased progressively.

Heart rate-based indices to detect parasympathetic hyperactivity in functionally overreached athletes. A meta-analysis.

Investigations into the sensitivity of heart rate-(HR) derived indices for tracking parasympathetic nervous system (PNS) changes in functionally overreached (F-OR) endurance-trained athletes have produced equivocal findings. Lack of clarity may be a result of methodological inconsistencies. Therefore, the aims of this systematic review and meta-analysis were (a) to determine the sensitivity of resting and post-exercise vagal-related HR variability (HRV) and HR recovery (HRR) indices to detect PNS modulation in F-OR and non-overreached (non-OR) athletes, and (b) to investigate the influence of methodological factors on the sensitivity of HR-based indices to detect PNS hyperactivity in F-OR athletes. We searched CENTRAL, Scopus, PubMed, Embase, and Web of Science up to May 2020 for the following terms: male and female endurance-trained athletes, controlled and uncontrolled studies that carried out an overload training period, and PNS modulation measured in resting and post-exercise, pre- and post-overload training period. A random-effects model of standardized mean difference (SMD) was estimated for each outcome measure based on the training-induced fatigue status (F-OR vs non-OR athletes), and the influence of methodological issues to detect PNS hyperactivity in F-OR was assessed by subgroup analyses. Pooled analysis showed that resting vagal-related HRV indices did not detect PNS hyperactivity in F-OR athletes (SMD+ = -0.01; 95% confidence interval [CI] = -0.51, 0.50), and no statistical difference (P=.600) was found with non-OR athletes (SMD+ = 0.15; 95% CI = -0.14, 0.45). However, subgroup analysis based on HRV parameter showed a moderate statistical increase in weekly averaged HRV in F-OR athletes (SMD+ = 0.81; 95% CI=0.35, 1.26), while isolated HRV values did not reach statistical significance (SMD+ = -0.45; 95% CI = -0.96, 0.06). We observed a moderate and statistically significant increase in HRR indices among F-OR athletes (SMD+ = 0.65; 95% CI=0.44, 0.87), no changes for non-OR athletes (SMD+ = 0.10; 95% CI=-0.15, 0.34), and statistically significant differences between F-OR and non-OR athletes (P<.001). Insufficient data prevented meta-analysis for post-exercise vagal-related HRV indices. Our findings show that when methodological factors are considered, HR-based indices are sensitive to increased PNS modulation in F-OR.

Fatigue and sleep quality in different trimesters of pregnancy.

ObjectivesFatigue is one of the most common and persistent complaints of pregnant women. Increased severity of fatigue during pregnancy can increase the risk of preterm labor, prolonged labor, cesarean section, and postpartum depression. Therefore, this study aimed to determine the fatigue status in different trimesters of pregnancy and its relationship with sleep quality in pregnant women.Material and MethodsThis cross-sectional study was performed by two-stage cluster sampling on pregnant women referred to Tabriz health centers. Data were collected using socio-demographic questionnaire, multidimensional assessment of fatigue and Pittsburgh sleep quality index.ResultsAmong the 605 pregnant women studied, 94.2% of women suffered from fatigue during pregnancy. The mean (standard deviation) of fatigue score in the first, second and third trimesters of pregnancy was 23.53 (8.05), 25.78 (6.56) and 26.46 (6.72), respectively. There was also significant reverse correlation between total fatigue score with total sleep quality score (p=0.031) and with an increase in fatigue, sleep quality was reduced.DiscussionThe findings of this study may be used to design interventional measures for fatigue and medical care to improve quality of sleep in pregnancy.