Higher Levels Of Fatigue Research Articles

The effect of total ankle arthroplasty on mechanical energy exchange

Total ankle arthroplasty (TAA) is a common surgical solution for patients with debilitating arthritis of the ankle. Prior to surgery patients experience high levels of pain and fatigue and low mechanical energy recovery. It is not known if TAA restores healthy levels of mechanical energy recovery in this patient population. This study was designed to determine whether mechanical energy recovery was restored following TAA. Ground reaction forces during self-selected speed walking were collected from patients with symptomatic, unilateral ankle arthritis (N = 29) before and one and two years after primary, unilateral TAA. The exchange of potential (PE) and kinetic (KE) energy was examined, and direction of change (%congruity) and energy exchange (%recovery) between the two curves was calculated, with those subjects with low congruity experiencing high energy recovery. Linear regressions were used to examine the impact of walking speed, congruity, and amplitude of the center of mass (COM) displacement on %recovery, while ANOVA and ANCOVA models were used to compare energy recovery and congruity across the three time points. Gender, BMI, and age at surgery had no effect in this study. TAA improved walking speed (p = 0.001), increased energy recovery (p = 0.020), and decreased congruity (p = 0.002), and these levels were maintained over at least two years. Differences in congruity were independent of walking speed. In some patients, especially those who are severely debilitated by ankle arthritis, TAA is effective in restoring mechanical energy recovery to levels similar to an asymptomatic population of a similar age recorded by other studies.

Pandemia de COVID-19: Sono e fadiga em profissionais da saúde mental

Abstract Objective To analyze the relationship between fatigue and sleep quality in mental health professionals during the COVID-19 pandemic. Method This cross-sectional and correlational study was carried out between October 2021 and July 2022 with professionals from mental health services in Rio Grande do Sul, Brazil. Socio-occupational and health questionnaires, the Pittsburgh Sleep Quality Index and the Fatigue Assessment Scale were used. The analysis was descriptive and analytical, and chi-square, Fischer’s exact, Spearman’s correlation and logistic binary regression analysis (5% significance level) were used. Results A total of 141 professionals took part, with a prevalence of poor sleep quality and high fatigue. Poor sleep quality was associated with sick leave in the last six months (p=0.023), tiredness at the end of the working day (p=0.011), health treatment (p=0.012) and fatigue (p=0.006). High fatigue was associated with feeling tired at the end of the working day (p=0.017). Multivariate models showed that professionals with high fatigue and frequent and/or constant tiredness were twice as likely to have poor sleep quality. Conclusion Fatigue and sleep quality are significantly associated, with a greater chance of poor sleep quality among those with high levels of fatigue. Strategies to reduce work overload, improve sleep quality and promote a healthy environment are recommended.

The Impact of Parental Stress among the Quality of Life of mothers of children with Autism Spectrum Disorder and Down Syndrome

For most parents, the birth of their child is a reason for joy because the child is the center of their Universe. He is light, hope, smile, change, and future. Raising a child with a disability can have a profound impact on the family. This causes great stress for parents, especially for the mother. Prolonged stress negatively influences their quality of life, causing health problems and having a high level of fatigue, anxiety, and depression. This research aimed to investigate the level of parental stress among mothers of children with autism spectrum disorder respectively, among mothers of children with Down syndrome. The results of this study demonstrated significant differences regarding the measured variables among mothers of children with ASD and Down syndrome. Regarding coping mechanisms, mothers of children with ASD use religious coping more frequently compared to mothers of children with Down syndrome, who use the following coping mechanisms: active coping, planning, seeking instrumental support, seeking emotional support, acceptance, mental disengagement, and venting. Additionally, the level of parental stress is higher among mothers of children with ASD, and their quality of life is lower; the tendency of social isolation is at a fairly high level.

Correlation of Work Fatigue and Mental Workload in Train Drivers: A Cross-sectional Study.

Evidence suggests that train drivers experience a high level of fatigue and mental workload. The present study aimed to assess overall, physical, and mental fatigue levels and their correlations with the mental workload in the metro train operation. Study Design: A cross-sectional study. This study was conducted on all 1194 train drivers in the Tehran Metro. The train drivers completed the Samn-Perelli Fatigue Scale and the Fatigue Assessment Scales at the beginning and end of the shift. In addition, they completed the National Aeronautics and Space Administration Task Load Index in the middle and at the end of the shift. Correlation and regression analyses were performed on the data to test the study hypothesis. Overall, physical, and mental fatigue levels increased significantly at the end of the shift compared to the onset of the shift (P<0.001). The mental workload and related dimensions were significantly increased at the end of the shift compared to the middle of the shift (P<0.001). Mental demand was the most important workload problem among the train drivers. The highest correlation was found between overall workload and time pressure (R=0.68, P<0.001). The mental workload had a significant correlation with work fatigue in the train drivers. Control measures should be focused on the mental workload and related dimensions, especially mental demand and time pressure.

The mediation effect of treatment fatigue in the association between memory and health-related quality of life in men with HIV who have sex with men

Approximately half of all adults living with the Human Immunodeficiency Virus (HIV) experience cognitive alterations related to difficulties in treatment adherence and, therefore, to a significant decrease in quality of life. In this sense, new studies are needed to identify potential mediators related to treatment in this association, such as treatment fatigue. This fact is especially important in at specific groups of individuals with HIV, namely men with HIV who have sex with men (MSM). The objective of this study was to analyze the association between cognitive functioning, Health-Related Quality of Life (HRQoL), and treatment fatigue in MSM with HIV. A cross-sectional study was developed with a sample of 70 MSM, from the Infectious Diseases Unit of the General University Hospital of Alicante (Spain). Participants completed questionnaires related to sociodemographic data, HRQoL, and treatment fatigue in an initial phase; in a second phase, they were administered a computerized cognitive evaluation. Our results demonstrate a significant relationship between a lower cognitive performance in the memory domain and worse HRQoL. Mediation analysis has revealed the total mediation effect of treatment fatigue, specifically, the treatment cynicism domain, on this relationship. This mediation effect remained significant after controlling the sociodemographic and clinical HIV-related variables in the model. No significant mediation effects of the rest of evaluated cognitive domains (attention, perception, reasoning, or coordination) were found in this relationship. The results of this study highlight how MSM with a significant deterioration of memory are at greater risk of developing high levels of treatment fatigue, and, therefore, a lower adherence to the same and a significant deterioration in their HRQoL.

Using PROMIS-29 to determine symptom burdens in the context of the Type 1 and 2 systemic lupus erythematosus (SLE) model: a cross sectional study

ObjectiveTo account for heterogeneity in systemic lupus erythematosus (SLE) and bridge discrepancies between patient- and physician-perceived SLE activity, we developed the Type 1 and 2 SLE model. We examined PROMIS-29 scores, a composite patient-reported outcome (PRO) measure, through the lens of the model.MethodsPatients completed PROMIS-29 and the polysymptomatic distress scale (PSD). Rheumatologists completed the SLE disease activity index (SLEDAI), and physician’s global assessments (PGAs) for Type 1 and 2 SLE. We defined Type 1 SLE using SLEDAI, Type 1 PGA, and active nephritis, and Type 2 SLE using PSD and Type 2 PGA. We compared PROMIS-29 T-scores among Type 1 and 2 SLE groups and explored whether PROMIS-29 can predict Type 1 and 2 SLE activity.ResultsCompared to the general population, patients with isolated Type 1 SLE reported greater pain and physical dysfunction but less depression and improved social functions; patients with high Type 2 SLE (irrespective of Type 1 activity) reported high levels of pain, fatigue, and social and physical limitations. Patients with minimal Type 1 and 2 SLE had less depression and greater physical functioning with other domains similar to national norms. PROMIS-29 predicted Type 2 but not Type 1 SLE activity.ConclusionPROMIS-29 similarities in patients with high Type 2 SLE, with and without active Type 1 SLE, demonstrate the challenges of using PROs to assess SLE inflammation. In conjunction with the Type 1 and 2 SLE model, however, PROMIS-29 identified distinct symptom patterns, suggesting that the model may help clinicians interpret PROs.

Lockdown fatigue among the university students at Nueva Ecija during the COVID-19 pandemic

One of the control measures to stop the transmission of COVID-19 was the implementation of a lockdown. However, after a few months of lockdown, previous research has found significant evidence of lockdown-related fatigue. Hence, the current study aimed to determine the lockdown fatigue of the students. A descriptive research design and total sampling were used. A questionnaire was developed to collect data about the sex and monthly income of the respondents and their level of lockdown fatigue and feelings after the lockdown. Permission to conduct and informed consent were obtained. Data were analyzed using various statistical tools. A total of 629 respondents participated in the study. Many of them were female and had a monthly income less than P11,690. Most of them had a moderate to high level of lockdown fatigue, and the difference in their profile was insignificant. After the lockdown period, they sometimes felt powerless, stressed, and angry, their problems were getting worse, and something unexpected would happen. Last, their feelings and lockdown fatigue level, after lockdown, had a significant positive relationship. Further studies regarding the efficacy and effectiveness of lockdowns, as well as any restriction that may jeopardize students’ health should be continually assessed by government authorities.

Factors influencing burnout among Korean nurses caring for patients with COVID-19: a cross-sectional study

Purpose: The purpose of this study was to investigate the levels of fatigue, social support, and burnout among nurses caring for coronavirus disease 2019 (COVID-19) patients, and to identify factors that affect burnout. Methods: Data were collected from 115 nurses who were caring for COVID-19 patients in Gyeonggi Province and Seoul from December 2021 to February 2022. Results: The mean scores for fatigue, social support, and burnout were 63.31 ± 11.48 (of 95), 48.34 ± 6.97 (of 60), and 81.90 ± 15.50 (of 132) points, respectively. The level of burnout of nurses caring for patients with COVID-19 was high. Fatigue (β = .49, p &lt; .001) and social support (β = -.21, p = .012) were significantly associated with burnout. Conclusion: Higher levels of fatigue and lower levels of social support were associated with higher levels of burnout. Reducing fatigue among nurses and strengthening their social support can be a strategy to reduce nurse burnout.

Message Fatigue and COVID-19 Vaccine Booster Uptake in the United States

Dissemination of public health information plays an essential role in communicable disease control and prevention. However, widespread and repeated messaging could become counterproductive if it leads to avoidance and disengagement due to message fatigue. Americans have been inundated with accurate and inaccurate COVID-19 information from myriad sources since the start of the pandemic. Using the health belief model (HBM) as a guiding framework, this study examines COVID-19-related message fatigue among adults in the United States who have gotten at least one dose of a COVID-19 vaccine and the association between message fatigue and COVID-19 booster uptake and intentions. A special survey module of The COVID States Project was fielded between August and September 2022 (n = 16,546). Results showed moderately high levels of message fatigue among vaccinated individuals. Message fatigue was negatively associated with the likelihood of having gotten a COVID-19 booster and intentions to do so among those who had not yet received a booster, above and beyond variance explained by the HBM constructs. These findings underscore the importance of monitoring and mitigating COVID-19-related message fatigue in encouraging the public to stay up to date with COVID-19 vaccination.

Circulating Mitochondrial DNA Is Associated With High Levels of Fatigue in Two Independent Sarcoidosis Cohorts

Patients with sarcoidosis who develop severe clinical phenotypes of pulmonary fibrosis or multiorgan disease experience debilitating symptoms, with fatigue being a common chief complaint. Studies that have investigated this patient-related outcome measure (PROM) have used the Fatigue Assessment Scale (FAS), a self-reported questionnaire that reflects mental and physical domains. Despite extensive work, its cause is unknown and treatment options remain limited. Previously, we showed that the plasma of patients with sarcoidosis with extrapulmonary disease endorsing fatigue was enriched for mitochondrial DNA (mtDNA), a ligand for the innate immune receptor toll-like receptor 9 (TLR9). Through our cross-disciplinary platform, we investigated a relationship between sarcoidosis-induced fatigue and circulating mtDNA. Is there a psychobiologic mechanism that connects sarcoidosis-induced fatigue and mtDNA-mediated TLR9 activation? Using a local cohort of patients at Yale (discovery cohort) and the National Institutes of Health-sponsored Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis study (validation cohort), we scored the FAS and quantified in the plasma, mtDNA concentrations, TLR9 activation, and cytokine levels. Although FAS scores were independent of corticosteroid use and Scadding stage, we observed a robust association between FAS scores, which included mental and physical domains, and multiorgan sarcoidosis. Subsequently, we identified a significant correlation between plasma mtDNA concentrations and all domains of fatigue. Additionally, we found that TLR9 activation is associated with all aspects of the FAS and partially mediates this PROM through mtDNA. Last, we found that TLR9-associated soluble mediators in the plasma are independent of all facets of fatigue. Through our cross-disciplinary translational platform, we identified a previously unrecognized psychobiologic connection between sarcoidosis-induced fatigue and circulating mtDNA concentrations. Mechanistic work that investigates the contribution of mtDNA-mediated innate immune activation in this PROM and clinical studies with prospective cohorts has the potential to catalyze novel therapeutic strategies for this patient population and those with similar conditions.

Staff Turnover Intention at Long-Term Care Facilities: Implications of Resident Aggression, Burnout, and Fatigue

ObjectivesStaff shortages and the high turnover rate of nursing assistants pose great challenges to long-term care. This study examined the effects of aggression from residents of long-term care facilities, burnout, and fatigue on staff turnover intention. The findings will help managers to devise effective measures to retain their staff. DesignCross-sectional descriptive study design. Setting and ParticipantsA total of 800 nursing assistants were recruited from 70 long-term care facilities using convenience sampling. MethodsThe participants were individually interviewed and provided information about their turnover intention, resident aggression witnessed and experienced, self-efficacy, neuroticism, burnout, fatigue, and personal and facility characteristics. ResultsHierarchical multiple regression analysis revealed that the size and organizational practices of long-term care facilities were not associated with staff turnover intention. Staff who spent less time in the industry reported witnessing resident-to-resident aggression, experienced resident-to-staff aggression, reported high levels of burnout, had acute or chronic fatigue, and had low levels of inter-shift recovery were more likely than others to report a high turnover intention. Conclusions and ImplicationsStaff turnover poses great challenges to staff, residents, and organizations. This study identified important factors that may help support staff in long-term care facilities. Specific measures, such as person-centered care to diminish resident aggression by addressing residents’ unmet needs, work-directed programs to mitigate burnout and improve staff mental health, and flexible schedules to prevent fatigue should also be advocated to prevent staff turnover.

Impact of itch on quality of life in people with primary biliary cholangitis: A plain language summary

What is this summary about? This is a summary of an article about people with primary biliary cholangitis (PBC) who also suffer from itch. PBC is a disease that affects the liver; itching is common in PBC and can dramatically reduce a person's quality of life. People in a study called TARGET-PBC filled in surveys about their PBC symptoms, including itching, and the effects the symptoms had on their lives. Information was also collected on the medications people were taking for their PBC and itch. What were the results? Out of 211 people with PBC who filled in the surveys, 170 (81%) had itching. More than one-third of them (37%) had itch that was clinically significant. Clinically significant itch has been defined as an itch that sometimes affects a person's sleep, makes them scratch until their skin is raw, or causes embarrassment. These people would benefit from a discussion about treatment options. Clinically significant itch was linked with worse scores on the surveys, meaning poorer quality of life. This link was true for all areas looked at, but particularly for social aspects and cognition, such as memory and concentration. Sleep was affected in most people with clinically significant itch and there were high levels of fatigue. People with clinically significant itch were more likely to be taking anti-itch medication compared with those with mild itch, but onethird of them still had not received any treatment for itch. When itch medication was used, the stepwise guidelines suggested by specialty professional societies was not usually followed. What do the results mean? Itching is problematic for the people in this study. Those with clinically significant itch have a worse quality of life compared with those with mild itch and this affects all areas of their life measured. The study also shows that people do not always receive medication for their itch, and that treatment guidelines are not always followed.

Literature Review of Burnout Syndrome in Intensive Care Unit (ICU) Staffs During The COVID-19 Pandemic

Introductions: Burnout syndrome becomes a special concern for health workers during COVID-19 pandemic that has been exposed to increased workload and intense working hours with COVID-19 patients, stating having a high risk of getting infected with COVID-19 as well. Methods: This literature review paper reviewed scientific journals with prevalence and burnout syndrome profile data. The journals were obtained through the search engines GoogleScholar, the MEDLINE (PubMed) database and PsychINFO. From the search, there are 13 articles in total that meet the required data criteria. Results: Prevalence of burnout syndrome were found severely high in ICU settings, it reached more than 50% from most of the survey. Burnout syndrome rate can be influenced by working conditions, age and gender, time of work and working experience. Burnout syndrome can manifest as higher fatigue level and decrease of cognitive function that can increase the risk of medical mistake. Conclusions: High prevalence and severity of burnout syndrome oblige us to pay attention to symptoms that can affect professional intensive care unit staff and its service to patients. Further research should review prevention therapy and how to apply to health workers and also the prevalence of prevention that has been done in other studies.

Associations between patient reported fatigue and remotely monitored activity in patients with prostate cancer receiving androgen deprivation therapy.

593 Background: Androgen deprivation therapy (ADT) is commonly used for the management of prostate cancer (PCa). Despite its benefits, ADT can lead to a range of side effects that have prominent determents on patient quality of life, specifically fatigue. Fatigue is a multidimensional symptom that influences a patient’s psychological and physical well-being, including the inability to perform daily activities due to lack of energy. This analysis evaluates associations between patient-reported fatigue and remotely monitored objective activity in PCa patients. Methods: This is a secondary analysis ofa multi-site observational cohort study (DigiPRO) among men diagnosed with advanced PCa, initiating ADT within 6 months, conducted between 12/2020 and 4/2023. Eligible patients wore an activity monitor (Fitbit Charge HR 4) continuously for the 12-week study and completed NIH PROMIS fatigue surveys via REDCap, which included Likert-scale questions (8 items, range 1-5 (worse)) about fatigue severity and interference, at baseline, 4, 8, and 12 weeks. PROMIS scores were converted to standardized T-scores (mean 50: SD: 10). Pearson correlation coefficients were calculated, and multivariable logistic regression models were fit to evaluate associations between activity and fatigue T-scores. Results: 40 patients were included in the analysis (median age: 70 yrs, range 51-85; 37% Black or African American/63% White, 10% Hispanic/90% non-Hispanic White). 11 patients reported high levels of fatigue (T-Score&gt;60) at least once over the course of the study and 20% of patients experienced an increase &gt; 5 T-score points from baseline, indicating clinically meaningful deterioration. Higher fatigue T-scores were negatively correlated with higher daily step counts (r=-0.6, p=0.003) and calories expended (r=-0.5, p=0.002) and positively correlated with increased sedentary time (r=0.5, p=0.002) at baseline. Lower baseline step counts were significantly associated with any occurrence of worsening patient fatigue over the study period (OR: 2.08, 95% CI 1.12-3.8, per 1000 step decrease, p=0.02) after adjusting for age and race. Patients who reported worsening fatigue had a mean step count of 3,426 compared to 5,664 steps/day among those who reported stable or improving fatigue (p=0.02). Conclusions: Findings from this analysis suggest that objective measures of daily activityare correlated with patient-reported fatigue and predict worsening fatigue over time. Routine collection and monitoring of patient-reported fatigue and daily activity during ADT may help identify patients at increased risk for worsening fatigue. More research is needed to determine the role of wearable activity monitors as potential interventions and for real time monitoring to help manage fatigue and other symptoms during ADT. Clinical trial information: NCT04575402 .

Predictors of Dizziness and Hearing Disorders in People with Long COVID.

Background and Objectives: Individuals report persistent symptoms after becoming infected by SARS-CoV-2 (COVID-19) that last for >4 weeks (long-COVID syndrome). Dizziness and hearing loss have been reported among long-COVID symptoms. However, little is known about the potential predictors of dizziness and hearing loss in individuals with long COVID. This study aimed to explore the presence and correlates of dizziness and hearing loss in a sample of people with long-COVID syndrome. Materials and Methods: Individuals aged 18 years and older who were infected with COVID-19 at least 8 weeks prior to the start of the study were included if they were not diagnosed with dizziness or hearing loss before getting COVID-19. Demographics and COVID-19-related information were collected. Participants completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence (ABC) scale, Falls Efficacy Scale International (FES-I), Modified Fatigue Impact Scale (MFIS), and Medical Outcomes Study Short Form 12 (SF-12). Finally, hearing was assessed using pure-tone audiometry (PTA) in a subsample. Results: Two hundred and nine individuals (66% female) with a mean (SD) age of 27 (9) participated in the study. Perceived dizziness and hearing loss were reported in 26 and 15.3% of the sample, respectively. Logistic regression was conducted to identify potential predictors of dizziness and hearing loss separately. After controlling for age and severity of dizziness, female sex and high fatigue severity were associated with an increased likelihood of reporting dizziness (R2 = 31%). The severity of dizziness and neurological symptoms during the acute stage of COVID-19 were associated with an increased likelihood of reporting hearing loss (R2 = 10.4%) after controlling for age. Conclusions: Dizziness and hearing loss present in long COVID and can be disabling. Females with high levels of fatigue should be questioned about persistent dizziness. Hearing loss should be considered in individuals with neurological symptoms and severe dizziness as a consequence of long COVID.

Sleep quality assessment in emergency health professionals

Objective To assess emergency service professionals’ sleep quality and its association with the level of fatigue and quality of life. Methods A descriptive, cross-sectional and correlational study, carried out in the units of the Mobile Emergency Care Service (SAMU) and in the Emergency Care Unit (ECU), in 2021, with 108 participants. To assess sleep quality, the Pittsburgh Sleep Quality Index, Brazilian version (PSQI-BR), was used; to assess fatigue, the Chalder Fatigue Scale was used, together with the Need for Recovery Scale (NFR); and to assess quality of life, the World Health Organization Quality of Life Brief Version (WHOQOL-bref) was used, and the instruments used were adapted to Portuguese in previous studies. Association tests were applied for statistical analysis, using Pearson’s chi-square test, Mann-Whitney U test or Kruskal Wallis and Spearman’s correlation. P-values &lt;0.05 were considered significant. Results It was identified that 72.2% of participants had poor sleep quality and 75.9% were fatigued. A significant association was observed between sleep quality and fatigue, the need for recovery and quality of life. Conclusion It was identified that health professionals working in emergency services have poor sleep quality and life, and high levels of fatigue and need for recovery, which can directly impact their personal and professional activities.

The Effects of Organizational Characteristics, Individual Nurse Characteristics, and Occupational Fatigue on Missed Care at Night.

Missed care is defined as the omission or delay of necessary patient care and is internationally reported by nurses as a significant safety risk. Nurses working at night also report high levels of occupational fatigue that, coupled with inadequate staffing and practice environment support, may impede a nurse's ability to carry out the nursing process and lead to more missed care. The study's objective was to examine the interrelationships among organizational and nurse characteristics, occupational fatigue, and missed care among nurses working at night. A cross-sectional design was used. Participants included registered nurses (RNs) who worked at night in New Jersey acute care hospitals. Multiple linear regression and simple moderation analyses were performed to examine the associations. Nurses reported missing necessary care at night. Unsupportive practice environments, high RN workloads, high patient-RN ratios, high chronic fatigue levels, and low intershift recovery were individually associated with missed care at night. High patient-to-RN ratios and chronic fatigue were independently associated with missed care. However, patient-to-registered-staffing levels had the most considerable effect on missed care at night. Nurses' years of experience and the number of hours of sleep between shifts were significant moderators of the relationship between occupational fatigue states and missed care. This study is the first to examine the interrelationship between occupational fatigue levels, organizational and nurse characteristics, and missed care at night. There is an urgent need to implement strategies in hospital organizations that foster work schedules and adequate staffing patterns that lessen nurses' occupational fatigue levels to ensure our workforce's and patients' safety.

A - 120 Fatigue Moderates the Relationship between Negative Attributional Style and Depression Symptoms in Multiple Sclerosis.

To investigate whether fatigue moderates the relationship between negative attributional style and depression symptoms in persons with Multiple Sclerosis (PwMS). Forty-seven PwMS (39 Female) completed a comprehensive neuropsychological test battery and psychosocial questionnaires. The Attributional Style Questionnaire was utilized to create internal, stable, and global attribution dimension scores, and an overall attributional style score combining the three dimensions. Overall, physical, psychosocial, and cognitive fatigue were measured using the Fatigue Impact Scale (FIS). The Beck Depression Inventory-Fast Screen was used to measure depression symptoms. Separate regressions with depression symptoms as the outcome were conducted with attributional style, each type of fatigue, and their interactions included as predictors. Regression analyses revealed that the interaction between attributional style and overall fatigue significantly predicted depression symptoms (p = 0.049). Simple effects tests showed that overall attributional style significantly predicted depression symptoms when overall fatigue was high (p = 0.008). The interactions between attributional style and both physical fatigue (p = 0.003) and psychosocial fatigue (p = 0.039) also significantly predicted depression symptoms. Simple effects tests showed that attributional style was associated with depression symptoms only in PwMS with high physical fatigue (p < 0.001) and high psychosocial fatigue (p = 0.018). Fatigue moderated the relationship between overall attributional style and depression symptoms in PwMS. Specifically, attributional style was only significantly associated with depression symptoms in PwMS reporting high levels of overall, physical, and psychosocial fatigue. Interventions aimed at targeting fatigue may reduce the risk that negative attributional style will lead to depressive symptoms in MS.

The cross-cutting edge: Medical selection and education viewed through the lens of emotional intelligence.

Evidence suggesting the benefits of compassionate, person-centred care, for both patients and physicians is accruing. Medical selection, for example, aims to choose future health professionals that possess the correct attitudes, beliefs and personal attributes to deliver such care. Moreover, once in training, these desirable personal qualities should be developed and maintained, sometimes in the face of adverse health care service conditions. However, advances in selecting for, and developing, these abilities and attributes in health care have been hindered by a lack of clarity regarding how the relevant skills and traits should be defined, measured, developed and maintained in clinicians. In this article, we demonstrate how developments in the emotional intelligence (EI) field can be applied to the challenge of selecting for, and developing, relevant interpersonal care skills in medical students and physicians. The concept of EI itself has been somewhat controversial. However, a more nuanced understanding of EI has evolved in the light of research findings that can be applied to medical selection and education. Specifically, we propose modifications to the existing 'cascading' model of EI. This model identifies, and relates, several key socioemotional skills and traits that could be considered as 'the elementary particles' of EI required to deliver compassionate, person-centred care. Our model of EI, which is relevant to care delivery, identifies putative targets for both medical selection and training. Selection for medical school and subsequent clinical education should focus on screening out those with low levels of the traits and abilities less amenable to training. Conversely, medical education should be concerned with developing and maintaining the socioemotional skills, attitudes and behaviours critical to the delivery of compassionate, person-centred care. This is especially important for specialties characterised by high levels of emotional labour and possible resultant compassion fatigue.

Correlation of fatigue with disability and accelerometer-measured daily physical activity in patients with relapsing-remitting MS.

Fatigue is one of the most common symptoms in patients with multiple sclerosis (MS). Furthermore, measuring its effects on patients in daily life is challenging. This study aimed to discover the association between relapsing-remitting MS (RRMS) patients' disability, fatigue, and accelerometer-measured physical activity. A total of 41 patients with RRMS with an Expanded Disability Status Scale (EDSS) level of 0-5.5 and 20 healthy controls completed the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS) questionnaires. The EDSS was evaluated for all patients with RRMS, and all participants performed the MS Functional Composite (MSFC) test and six-min walk test and wore an accelerometer for seven days. Patients with an EDSS level of 0-2.5 were found to have higher fatigue levels (p < 0.001) than healthy controls but lower levels than patients with an EDSS level of 3-5.5 (p < 0.001). A significant correlation was found to exist between fatigue and disability level measured by the EDSS (EDSS/FSS, r=0.750/p=0.001; EDSS/MFIS, r=0.661/p=0.001) and with the MSFC test in the patient group (MSFC/FSS, r=-0.350 p=0.025; MSFC/MFIS, r=-0.423/p=0.007). Total daily activity correlated with fatigue as measured by the FSS (MVPS/FSS r=-0.357/p=0.028, step count/FSS r=-0.463/p=0.003), but no correlation was found between the EDSS or the MSFC. A lower disability rate, better physical condition, and higher daily-living activity were found to predict lower fatigue levels.