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Purpose: Fatigue negatively alters dynamic knee control, and the functional hamstring/quadriceps ratio (H/QFUNC) plays an important role in stabilizing the joint. The aim of this study was to investigate the influence of soccer-specific exercise on H/QFUNC in under (U) 13-, U15-, and U17-year-old female soccer players. Methods: A total of 36 female players performed concentric and eccentric actions of the hamstrings at 60°, 120°, and 180°/s before and after an age group--specific field-based soccer protocol. H/QFUNC was determined in the first 30° of knee flexion. Results: Significant angle x velocity (P = .001) and time x angle (P = .033) interaction effects were found indicating a lower H/QFUNC with increased movement velocity at 0°--10° as opposed to greater knee flexion angles. Fatigue-related effects were only evident near full knee extension. Probabilistic inferences indicated that changes in H/QFUNC were generally unclear in U13s, likely detrimental in U15s, and very likely beneficial in U17s. Conclusions: Altered muscular control following soccer-specific exercise is age dependent with players' 1-year post-peak height velocity at greatest risk of injury. Injury prevention and screening need to be age and maturation appropriate, should consider the effects of fatigue, and include movements near full extension. [ABSTRACT FROM AUTHOR]

Aims and objectives: To synthesise empirical studies on factors related to fatigue and its impact on diabetes self‐management (DSM) and quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM). Background: Fatigue is commonly reported in people with T2DM, a chronic condition that is highly prevalent worldwide. However, a holistic understanding of the consequences and factors related to fatigue in adults with T2DM is not well synthesised. Design: This integrative review used Whittemore and Knafl's methodology and was reported according to the Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines and checklist. Methods: The theory of unpleasant symptoms (TOUS) was used as a conceptual model to guide the review. The PubMed, PsychINFO and CINAHL databases were searched to identify studies that recruited adults with T2DM, were peer‐reviewed, written in English and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data. Results: Twenty‐nine articles met the inclusion criteria: 23 observational studies, two randomised controlled trials, one quasi‐experimental study and three qualitative studies. All articles were of high quality. Physiological (e.g. T2DM duration, complications and inflammatory biomarkers), psychological (e.g. diabetes distress, depression and sleep quality) and situational factors (e.g. race/ethnicity, education and social support) were related to fatigue. Studies reported fatigue as a barrier to physical activity, healthy eating behaviours and the physical aspect of QOL. Conclusions: Multiple factors are related to fatigue in adults with T2DM. Gaps in the literature include the multiple dimensions of fatigue, the effectiveness of interventions to alleviate fatigue and fatigue experiences in under‐represented populations. Relevance to clinical practice: This integrative review supports the complex origin of fatigue and its impact on adults with T2DM. Nurses should evaluate modifiable factors related to fatigue and provide support to help improve DSM and QOL in this population. [ABSTRACT FROM AUTHOR]

Aim: Unpredictable nature of infant sleep–wake cycles go against that of the adult sleep. Maternal sleep quality is acknowledged as a main factor to postpartum fatigue. This study explored the effects of infant sleep patterns on maternal postpartum fatigue. Methods: A total of 319 mothers of infants from two teaching hospitals in the Nantong City were enrolled. Maternal fatigue status and infant sleep patterns were assessed by the Fatigue Scale (FS‐14) and the Brief Infant Sleep Questionnaire (BISQ). Generalized estimating equation analyses were perform to explored the effect of infant sleep patterns on maternal fatigue. Results: Sleep‐onset time later than 10 p.m., and nocturnal wakefulness more than 60 min were risk factors of postpartum fatigue. After controlling the confounding variables, infant sleep patterns were still the determinant factors of postpartum fatigue. Conclusion: Infant sleep pattern is a factor of maternal postpartum fatigue. It is recommended to promote infant sleep so as to improve maternal sleep quality and finally alleviate postpartum fatigue. [ABSTRACT FROM AUTHOR]

BACKGROUND: Breast cancer treatment can negatively affect psychosocial outcomes for breast cancer survivors (BCS), but these outcomes present differently for younger and older survivors. OBJECTIVES: The objective of this study was to compare psychosocial outcomes between younger and older BCS and identify predictors of loneliness in younger BCS. METHODS: This cross-sectional descriptive study of 90 BCS evaluated data on sociodemographic and clinical characteristics and self-reported measures of psychosocial outcomes (fatigue, depressive symptoms, anxiety, loneliness, daytime sleepiness, and stress). Participants were dichotomized into two groups by age (aged less than 50 years and aged 50 years or older). Descriptive statistics, bivariate correlations, and multiple regression were also examined. FINDINGS: Younger BCS reported greater fatigue, loneliness, daytime sleepiness, and stress than older BCS. No between-group differences were found in depressive symptoms or anxiety. Having children and less time since chemotherapy completion were significant predictors of less loneliness in younger BCS. [ABSTRACT FROM AUTHOR]

Introduction: Shift work and demanding work schedules contribute to occupational fatigue, negatively affecting patient safety and nurses' well-being, consequently placing nurses and patients at risk for injury and adverse health outcomes. For preventing fatigue and minimizing its negative consequences, information about its characteristics and associated factors is required. Objectives: This study aimed to assess occupational fatigue "acute fatigue, chronic fatigue, and inter-shift recovery" among Saudi nurses working 8-h shifts. Further, we explored factors associated with fatigue from nurses' perspectives. Methods: We conducted a mixed-method study with a convenience sample of Saudi nurses (N = 282) working in four public hospitals in Saudi Arabia. Data were collected using the nurses' profile form; the occupational fatigue exhaustion recovery (OFER) scale, for relevant quantitative data; and open-ended questions for qualitative data. We used descriptive and inferential statistics for analysing the quantitative data and content analysis of the qualitative data. Results: The results showed that Saudi nurses rated themselves moderately fatigued with working 8-h shifts. The inter-shift recovery subscale showed a negative correlation with chronic fatigue and acute fatigue (r = −0.518, r = −0.356, P < 0.001). Sleeping problems, meals per day, and frequency of exercise showed significant relations with chronic fatigue among nurses (p < 0.05). In addition, three categories were derived from the qualitative content analysis. Saudi nurses reported work-related, psychosocial, and individual factors as major contributors to fatigue and recovery. Conclusion: Occupational fatigue is a multidimensional issue, and nurses and nurse managers are challenged with reducing its prevalence and negative impact on nurses and patients. Our quantitative and qualitative findings suggest the need for a comprehensive approach to fatigue management and mitigation, including organizational support, creative workforce planning, flexible work schedules, and psychosocial support. Fatigue reduction and prevention policies and educational programs are vital strategies to improve nurses' well-being and inter-shift recovery. [ABSTRACT FROM AUTHOR]

BACKGROUND Global nations have enforced strict health protocols because of the COVID-19's high transmission, infectivity, and mortality. As shown by increased online learning and video conferencing, the employment and education sectors are shifting to home-based activities. Video conferencing as a communication medium has subtly led to zoom fatigue. This study aimed to analyze the risk factors of zoom fatigue for early prevention and treatment. METHODS This cross-sectional study was conducted on 335 Indonesian university students selected by purposive sampling in July 2021. Data were collected using a demographic questionnaire including online courses duration during the COVID-19 pandemic; Pittsburgh sleep quality index; depression, anxiety and stress scale-21; and zoom & exhaustion fatigue (ZEF) scale through Google Form (Google LLC, USA) distributed via social media and student forums. Association and correlation tests were used, and the model was developed using linear regression. RESULTS The respondents were aged 21.3 (1.8) years with 12.8 (5.1) months of online courses during the COVID-19 pandemic and a ZEF scale of 2.8 (0.9). Students with higher ZEF had irregular physical exercise, poorer sleep quality, longer video conferencing sessions, longer months of courses during the COVID-19 pandemic, and higher mental illness (i.e., stress, anxiety, and depression). Smoking negatively correlated with fatigue (r = -0.12). The model for ZEF showed good predictability for zoom fatigue (p<0.001, R² = 0.57). CONCLUSIONS Daily exposure to video conferencing in educational settings throughout the pandemic has drastically increased zoom fatigue. The stakeholders must act immediately to minimize the risks while providing maximum benefits. [ABSTRACT FROM AUTHOR]

Front-line bevacizumab (BEV) in combination with taxanes offers benefit in progression-free survival (PFS) in metastatic breast cancer (mBC). The medical records of mBC patients, treated with front-line BEV-based chemotherapy, were retrospectively reviewed in order to generate real life safety and efficacy data. Patients with human epidermal growth factor receptor 2 (HER2)-negative mBC treated with front-line BEV in combination with chemotherapy were eligible. Maintenance therapy with BEV and/or hormonal agents was at the physicians' discretion. Among the 387 included patients, the most common adverse events were anemia (61.9%, mainly grade 1), grade 3/4 neutropenia (16.5%), grade 1/2 fatigue (22.3%), and grade 1/2 neuropathy (19.6%). Dose reductions were required in 164 cycles (7.1%) and toxicity led to treatment discontinuation in 21 patients (5.4%). The median PFS and the median overall survival (OS) were 13.3 (95% CI: 11.7–14.8) and 32.3 months (95% CI: 27.7–36.9), respectively. Maintenance therapy, with hormonal agents (ET) and/or BEV, was associated with longer OS versus no maintenance therapy (47.2 versus 23.6 months; p < 0.001) in patients with hormone receptor (HR)-positive disease and BEV maintenance offered longer OS versus no maintenance in patients with HR-negative disease (52.8 versus 23.3; p = 0.023). These real-life data show that front-line BEV-based chemotherapy in HER2-negative mBC patients is an effective treatment with an acceptable toxicity profile. The potential benefit of maintenance treatment, especially ET, is important and warrants further research. [ABSTRACT FROM AUTHOR]

Background: Multicentre studies focussing on specific long-term post-COVID-19 symptoms are scarce. Objective: The aim of this study was to determine the levels of fatigue and dyspnoea, repercussions on daily life activities, and risk factors associated with fatigue or dyspnoea in COVID-19 survivors at long term after hospital discharge. Methods: Age, gender, height, weight, symptoms at hospitalization, pre-existing medical comorbidity, intensive care unit admission, and the presence of cardio-respiratory symptoms developed after severe acute respiratory syndrome coronavirus 2 infection were collected from patients who recovered from COVID-19 at 4 hospitals in Madrid (Spain) from March 1 to May 31, 2020 (first COVID-19 wave). The Functional Impairment Checklist was used for evaluating fatigue/dyspnoea levels and functional limitations. Results: A total of 1,142 patients (48% women, age: 61, standard deviation [SD]: 17 years) were assessed 7.0 months (SD 0.6) after hospitalization. Fatigue was present in 61% patients, dyspnoea with activity in 55%, and dyspnoea at rest in 23.5%. Only 355 (31.1%) patients did not exhibit fatigue and/or dyspnoea 7 months after hospitalization. Forty-five per cent reported functional limitations with daily living activities. Risk factors associated with fatigue and dyspnoea included female gender, number of pre-existing comorbidities, and number of symptoms at hospitalization. The number of days at hospital was a risk factor just for dyspnoea. Conclusions: Fatigue and/or dyspnoea were present in 70% of hospitalized COVID-19 survivors 7 months after discharge. In addition, 45% patients exhibited limitations on daily living activities. Being female, higher number of pre-existing medical comorbidities and number of symptoms at hospitalization were risk factors associated to fatigue/dyspnoea in COVID-19 survivors 7 months after hospitalization. [ABSTRACT FROM AUTHOR]

Myasthenia gravis (MG) is an autoimmune disease characterized by fatigable muscle weakness. Despite full spontaneous or pharmacological remission some MG patients still complain of physical and mental fatigue. Fatigue has been related to autonomic dysregulation. The aim of this study was to assess autonomic responses in a group of MG patients in complete remission but complaining of persistent fatigue. Seventeen well-regulated but persistently fatigued MG patients and 17 individually matched controls underwent echocardiography assessing systolic and diastolic heart function. Beat to beat cardiovascular responses at rest and to 30° head-up tilt, tilt-back, and 2-min static handgrip contraction were recorded. Fatigued MG patients had a statistically significant higher resting HR than their matched controls (p=0.03). The difference in resting heart rate between MG patients not using acetylcholine esterase inhibitors (AChEi) and their matched controls was even more pronounced (p=0.007). The autonomic cardiovascular adjustments to head-up tilt, tilt-back and handgrip contraction were not statistically significant different between patients and controls. We found a higher resting heart rate in all well-regulated but fatigued MG patients compared with controls. The difference was more pronounced between patients not taking AChEi compared to their matched controls. This finding may reflect a disturbed resting sympathovagal balance and this might be a contributing factor to the fatigue symptoms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Computer-intensive office work associations with health challenges may intensify following COVID-19 pandemic-related changes to home-based office work. OBJECTIVE: To determine working conditions, perception and physical elements affecting health after pivoting to full time home-work. METHODS: An online questionnaire addressed physical, productivity, motivation, and work-practice factors. Photos of the worker in their home-work environment showed side and front-back perspectives. RESULTS: Sixteen questionnaires were received, and 12 respondents supplied photos. Home and office workplace differences varied. Ten felt productivity was affected, most often positively. Four noted increased pain or fatigue intensity, particularly in the eyes, neck / head, lower back, and shoulders. Working posture was not optimal; six didn't use traditional chair-sitting for up to half the day. Forward and backward trunk inclination accounted for at least 10% of the workday for 12 respondents; lateral inclination affected ten and eight had unsupported legs. Fifteen used an adjustable chair, but photos revealed ergonomic recommendations were not consistently followed. Fourteen participants communicated regularly by telephone, eight only for moderate duration and ten using adapted telephone equipment. Half of the ROSA scores were high. CONCLUSIONS: Workers forced into telework during the pandemic experience positive and negative impacts. Postures vary more than in offices, potentially increasing health risk. [ABSTRACT FROM AUTHOR]

It has been suggested that improper post-exercise recovery or improper sequence of training may result in an 'accumulation' of fatigue. Despite this suggestion, there is a lack of clarity regarding which physiological mechanisms may be proposed to contribute to fatigue accumulation. The present paper explores the time course of the changes in various fatigue-related measures in order to understand how they may accumulate or lessen over time following an exercise bout or in the context of an exercise program. Regarding peripheral fatigue, the depletion of energy substrates and accumulation of metabolic byproducts has been demonstrated to occur following an acute bout of resistance training; however, peripheral accumulation and depletion appear unlikely candidates to accumulate over time. A number of mechanisms may contribute to the development of central fatigue, postulating the need for prolonged periods of recovery; however, a time course is difficult to determine and is dependent on which measurement is examined. In addition, it has not been demonstrated that central fatigue measures accumulate over time. A potential candidate that may be interpreted as accumulated fatigue is muscle damage, which shares similar characteristics (i.e., prolonged strength loss). Due to the delayed appearance of muscle damage, it may be interpreted as accumulated fatigue. Overall, evidence for the presence of fatigue accumulation with resistance training is equivocal, making it difficult to draw the conclusion that fatigue accumulates. Considerable work remains as to whether fatigue can accumulate over time. Future studies are warranted to elucidate potential mechanisms underlying the concept of fatigue accumulation. [ABSTRACT FROM AUTHOR]

Aims: Fatigue is a state in which a person's energy is completely depleted due to excessive physical or mental work. In addition to the importance of women workers and the effects of fatigue on them, limited studies have been conducted in this field in the world, especially in Iran. The present study was conducted to investigate the prevalence of fatigue and related factors among women workers in one of the cities of Iran. Materials and Methods: A cross-sectional study was performed among women workers in Kashan in 2018. The sample size was 265 participants from 300 workers. The data collection tool was the multidimensional fatigue inventory questionnaire. Data were analyzed via SPSS version 16. Results: The lowest and highest total score was 38 and 78, respectively. The mean score of activity decrease was 11.78, which was the highest score among questionnaire. Factors such as overtime, number of children, and work experience showed a statistically significant relationship with the total fatigue score (P < 0.05). Conclusion: According to the results, a large percentage of participants had a high score of fatigue. Managements should identify and modify the factors affecting fatigue to reduce the worker's fatigue. It seems that further studies are needed to reveal the relationship between fatigue and other variables to provide a deeper understanding of the causes of fatigue. [ABSTRACT FROM AUTHOR]

Active duty military members have significant service-related risks for developing pain from injury. Although estimates for neuropathic pain (NP) are available for civilian populations, the incidence and prevalence for NP in military members is less clear. Understanding correlates of pain in military members is vital to improving their physical, mental, and social health. Using a comparative design, a secondary analysis was conducted on longitudinal PASTOR data from 190 pain management center patients. The objectives were to compare trends in patient-reported outcomes over time between those screening positive and negative for NP (NP+, NP−, respectively) based on PROMIS Neuropathic Pain Scale T-scores. Findings showed improvements in fatigue, sleep-related impairment, and anger over time. There was a difference between those screening NP+ and NP− for sleep-related impairment, and the cross-level interaction effect showed sleep-related impairment worsening over time. These results emphasize the need to identify NP and implement and evaluate targeted therapies. [ABSTRACT FROM AUTHOR]

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Purpose: The purpose of this study was to examine if classroom noise levels and perceived listening difficulty were related to fatigue reported by children with and without hearing loss. Method: Measures of classroom noise and reports of classroom listening difficulty were obtained from 79 children (ages 6-12 years) at two time points on two different school days. Forty-four children had mild to moderately severe hearing loss in at least one ear. Multiple regression analyses were conducted to evaluate if measured noise levels, perceived listening difficulty, hearing status, language abilities, or grade level would predict self-reported fatigue ratings measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale. Results: Higher perceived listening difficulty was the only predictor variable that was associated with greater self-reported fatigue. Conclusions: Measured classroom noise levels showed no systematic relationship with fatigue ratings, suggesting that actual classroom noise levels do not contribute to increased reports of subjective fatigue. Instead, perceived challenges with listening appears to be an important factor for consideration in future work examining listening-related fatigue in children with and without hearing loss. [ABSTRACT FROM AUTHOR]

Objectives: Ongoing calls to implement fatigue risk management in residency education assume a shared understanding of physician fatigue as a workplace hazard, yet we lack empirical evidence that all health care team members maintain this assumption. Thus, this study seeks to explore how health care team members understand the role of physician fatigue in an effort to inform the implementation of fatigue risk management in residency training and medical practice. Methods: This study uses constructivist grounded theory to explore perceptions of workplace fatigue and its impact on clinical practice. We conducted individual semistructured interviews with physicians, nurses and senior residents across four hospitals in 8 different specialties for a total of 40 participants. Constant comparative analysis guided data analysis and led to the final grounded theory. Results: While participants outlined multiple problematic manifestations of physician fatigue on clinical performance, they were reluctant to acknowledge any negative impact of fatigue on patient care. We refer to these contradictions as the fatigue paradox. Four key themes sustain the fatigue paradox: the indefatigable physician, blind spots, faith in safety nets and the minimisation of fatigue- related events. Conclusions: This study suggests that health care team members do not universally feel that physician fatigue is problematic for patient care, despite providing multiple examples to the contrary. This paradoxical understanding of fatigue likely exists because the system relies on fatigued physicians, particularly trainees, and provides few mechanisms to critically examine fatigue. Successful implementation of fatigue risk management in residency training may prove elusive if clinical supervisors are skeptical of the potentially negative impact of workplace fatigue. [ABSTRACT FROM AUTHOR]

Objectives The aims of this study were to examine the longitudinal and bi-directional associations of pain and fatigue with sedentary, standing and stepping time in RA. Methods People living with RA undertook identical assessments at baseline (T1, n  = 104) and 6-month follow-up (T2, n  = 54). Participants completed physical measures (e.g. height, weight, BMI) and routine clinical assessments to characterize RA disease activity (DAS-28). Participants also completed questionnaires to assess physical function (HAQ), pain (McGill Pain Questionnaire) and fatigue (Multidimensional Assessment of Fatigue Scale). Participants' free-living sedentary, standing and stepping time (min/day) were assessed over 7 days using the activPAL3µ™. For the statistical analysis, hierarchical regression analysis was employed to inform the construction of path models, which were subsequently used to examine bi-directional associations of pain and fatigue with sedentary, standing and stepping time. Specifically, where significant associations were observed in longitudinal regression analysis, the bi-directionality of these associations was further investigated via path analysis. For regression analysis, bootstrapping was applied to regression models to account for non-normally distributed data, with significance confirmed using 95% CIs. Where variables were normally distributed, parametric, non-bootstrapped statistics were also examined (significance confirmed via β coefficients, with P  < 0.05) to ensure all plausible bi-directional associations were examined in path analysis. Results Longitudinal bootstrapped regression analysis indicated that from T1 to T2, change in pain, but not fatigue, was positively associated with change in sedentary time. In addition, change in pain and fatigue were negatively related to change in standing time. Longitudinal non-bootstrapped regression analysis demonstrated a significant positive association between change in fatigue with change in sedentary time. Path analysis supported the hypothesized bi-directionality of associations between change in pain and fatigue with change in sedentary time (pain, β = 0.38; fatigue, β = 0.44) and standing time (pain, β = –0.39; fatigue, β = –0.50). Conclusion Findings suggest pain and fatigue are longitudinally and bi-directionally associated with sedentary and standing time in RA. [ABSTRACT FROM AUTHOR]

Background: Activity pacing is a behavioral strategy for coping with fatigue, optimizing physical activity (PA) levels, and achieving a paced approach to lifestyle and sustainable self-regulated exercise practice to optimize health and well-being. Yet little is known about how activity pacing affects PA and health-related quality of life (HRQOL) while controlling for fatigue and demographic characteristics over time in adults with multiple sclerosis (MS). This study examined the natural use of activity pacing and how it is associated with PA and HRQOL over time in adults with MS. Methods: Sixty-eight adults with MS (mean ± SD age, 45.2 ± 10.9 years) completed questionnaires on their activity pacing, fatigue, PA, and HRQOL 14, 33, and 52 weeks after rehabilitation. Associations between the variables were examined using multilevel models. Results: No associations were found between activity pacing and PA ( β = -0.01, P = .89) or between activity pacing and HRQOL ( β = -0.15, P = .09). Conclusions: This study provides an initial understanding of how activity pacing relates to PA and HRQOL in people with MS over time and indicates that there is no clear strategy among adults with MS that is successful in improving PA and HRQOL in the short or long term. Persons with MS may benefit from goal-directed activity pacing interventions to improve longitudinal engagement in PA, and the present study provides a foundation for further intervention development. [ABSTRACT FROM AUTHOR]

Background. Both fatigue and depression are common health problems in ageing. Aim. To explore the effect of depressive symptomatology on the presence of fatigue in home-care patients aged 65 years old and over. Methodology. A cross-sectional study was conducted on three "Help at Home" programs in the region of Crete, Greece. The sample consisted of 300 beneficiaries' elders. Depressive symptomatology was assessed using the Greek version of the BECK Depression Inventory scale (BECK DI) and the presence of fatigue was assessed by the Modified Fatigue Impact Scale (MFIS). Results. The majority of the participants were female (55.3%), mean age was 78.3 ± 7.4 years, 43% were aged >80 years old and 11.3% were bedridden. Fatigue incidence (MFIS score>46) was 58.7%. Depression was significantly associated with higher rates of fatigue (betas=0.687, p<0.001). Also, fatigue was respectively increased as the number of chronic diseases increased (p =0.031). Conclusions. Depression is independently associated with fatigue and thus health professionals caring for older people should be suspected of the presence of depression whether fatigue is expressed as a complaint. [ABSTRACT FROM AUTHOR]

The article provides information on long COVID as a continuation of symptoms after the initial infection stage of COVID-19 and its effect to the mental health of a patient. Topics include the connection between long COVID and mental health issues like anxiety and depression, the psychological therapies that can help treat the mental health symptoms of long COVID, and the role of primary care in assessing the patient for symptoms and risk factors.

Cognitive fatigue is a common and disabling symptom following a traumatic brain injury (TBI). Literature on cognitive fatigue has distinguished between two types of fatigue: "state" fatigue refers to the acute experience of fatigue, whereas "trait" fatigue refers to the susceptibility to fatigue over an extended period. However, it is not clear whether state and trait fatigue are distinguishable constructs. Here, we examine the relationship between state and trait fatigue in individuals with TBI, hypothesizing that trait and state measures assess different constructs. Twenty-one participants with moderate-severe TBI were recruited. Participants underwent a cognitively fatiguing task while in an MRI scanner and completed self-report measures examining trait and state fatigue. No correlation was found between state and trait fatigue. However, the two measures of trait fatigue, Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS), correlated with one another; additionally only trait fatigue correlated with depression scores, consistent with the literature. These findings suggest that trait and state fatigue may not be interdependent and that it is important to carefully define the type of fatigue under consideration when assessing fatigue in individuals with TBI. [ABSTRACT FROM AUTHOR]

The article discusses potential exposure sources to workers during remote teleconferencing and discusses measures to reduce exposure and prevent potential harms. Topics discussed include demonstrated that electric and magnetic field (EMF) from RF sources results in electric, magnetic, and associated currents that permeate into tissues of the body from the surrounding areas; and Regarding personal exposure levels, there are two primary factors that determine the magnitude of current.

Objective. This paper aims to systematically evaluate the intervention effect of mind-body exercise on cancer-related fatigue in breast cancer patients. Methods. Databases including PubMed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, and SINOMED were retrieved to collect randomized controlled trials on the effects of mind-body exercise on relieving cancer-related fatigue in breast cancer patients. The retrieval period started from the founding date of each database to January 6, 2021. Cochrane bias risk assessment tools were used to evaluate the methodological quality assessment of the included literature, and RevMan 5.3 software was used for meta-analyses. Results. 17 pieces of researches in 16 papers were included with a total of 1133 patients. Compared with the control group, mind-body exercise can improve cancer-related fatigue in breast cancer patients. The combined effect size SMD = 0.59, 95% CI was [0.27, 0.92], p < 0.00001. Doing Tai Chi for over 40 minutes each time with an exercise cycle of ≤6 weeks can improve cancer-related fatigue in breast cancer patients more significantly. Sensitivity analysis shows that the combined effect results of the meta-analysis were relatively stable. Conclusion. Mind-body exercise can effectively improve cancer-related fatigue in breast cancer patients. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic has strained healthcare systems and how best to address post-COVID health needs is uncertain. Here we describe the post-COVID symptoms of 675 patients followed up using a virtual review pathway, stratified by severity of acute COVID infection. Methods COVID-19 survivors completed an online/telephone questionnaire of symptoms after 12+ weeks and a chest X-ray. Dependent on findings at virtual review, patients were provided information leaflets, attended for investigations and/or were reviewed face-to-face. Outcomes were compared between patients following high-risk and low-risk admissions for COVID pneumonia, and community referrals. Results Patients reviewed after hospitalisation for COVID pneumonia had a median of two ongoing physical health symptoms post-COVID. The most common was fatigue (50.3% of highrisk patients). Symptom burden did not vary significantly by severity of hospitalised COVID pneumonia but was highest in community referrals. Symptoms suggestive of depression, anxiety and post-traumatic stress disorder were common (depression occurred in 24.9% of high-risk patients). Asynchronous virtual review facilitated triage of patients at highest need of face-to-face review. Conclusion Many patients continue to have a significant burden of post- COVID symptoms irrespective of severity of initial pneumonia. How best to assess and manage long COVID will be of major importance over the next few years. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the association of oral parafunctions with the presence of signs and symptoms of craniomandibular disorder in children with cleft lip and palate (CLP). A cross-sectional study was performed in which one hundred and eighty-eight children with CLP and absence of associated syndromes or malformations were investigated. During clinical examination, the presence of wear facets and dental occlusion were observed and palpation was performed in the temporomandibular joint region (TMJ) and orofacial musculature. The children and their guardians were interviewed regarding the presence of oral parafunctional habits (bruxism, the act of biting the lips and/or cheeks, nail biting, sucking of fingers and pacifiers) and signs and symptoms of craniomandibular dysfunction (headache, ear and/or neckache, tiredness or crack in the TMJ during mouth opening and chewing movements). The data were analyzed by means of absolute and relative frequency measurements, and bivariate analysis using Pearson's chi-square test and likelihood ratio test were performed, considering the significance level of 5%. A higher prevalence of cleft lip and palate type (76.0%) and the presence of malocclusion (61.7%) was observed, highlighting the anterior crossbite (58.7%) and midline deviation (48.9%). There was a higher occurrence of teeth grinding (40.4%), onychophagy (28.7%) and biting lips and/or cheeks (28.7%). Onychophagia was associated with headache (p <0.05) and with pain or cracking during mouth opening (p <0.05). It was concluded that parafunctional oral habits may be associated with signs and symptoms of craniomandibular disorder in children with cleft lip and palate. [ABSTRACT FROM AUTHOR]

Background: Fatigue is a common symptomin adults with inflammatory bowel disease (IBD) and is influenced bymany physiological, psychological, and situational factors. However, the influencing factors of fatigue associated with IBD have not been evaluated. Objective: This study aims to examine factors associated with fatigue during IBD and develop a parsimonious model that describes the influencing factors of fatigue. Methods: The study was a secondary analysis of cross-sectional data obtained from IBD Partners, an online cohort of adults with the disease, including 12,053 eligible participants. Data were collected using the Patient-Reported Outcomes Measurement Information System short-form scales measuring fatigue, sleep disturbances, pain interference, anxiety, depression, and satisfaction with social roles. Physical activity was measured using a single question. Demographic and clinical variables were collected. Path analysis was computed to identify the direct and indirect effects of situational, physiological, and psychological factors on IBD--fatigue based on the middle range theory of unpleasant symptoms' conceptual framework. Results: Most of the participants were White females. The data best fit a model with situational factors (physical activity and satisfaction with social roles as the mediators). The direct effect of IBD activity, age, sleep disturbances, pain interference, anxiety, and depression on IBD--fatigue was significant. Significant indirect effects were noted on IBD--fatigue from sleep disturbances, pain interference, and depression via physical activity and satisfaction with social roles. Discussion: The study identified two important intervening variables fromthe testedmodel. In addition, other symptoms such as sleep, pain, anxiety, and depression are essential and also influence IBD--fatigue. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to clarify (a) the association of the delivery mode (i.e., epidural anesthesia or no epidural) with women's changes in longitudinal salivary oxytocin (OT) levels from late pregnancy to early postpartum, and (b) the association of these changes with postpartum maternity blues (MB) and fatigue. Methods: We used a longitudinal observational design. We performed measurements of the saliva samples at four measurement points: (a) 36-37 gestational weeks, (b) 38-39 gestational weeks, (c) 1-2 days after birth, and (d) 4-5 days after birth. The inclusion criterion was low-risk primiparous women who were planning to have vaginal delivery. We used Stein's MB scale to evaluate postpartum data and a visual analog scale to examine "postpartum fatigue". We determined the association between the MB/fatigue scores and the changes in the OT levels by Spearman's rank correlation coefficient. Results: There were 29 women who delivered with epidural anesthesia and 29 women who did not. A significantly higher mean salivary OT level was observed in the women with epidural anesthesia at 1-2 days after birth than at 36-37 gestational weeks. The mean OT level at 4-5 days postpartum was significantly lower than that at 1-2 days postpartum. The correlation of the MB score with the salivary OT level at 4-5 days postpartum was p = -0.33, p = .01. Conclusions: Early postpartum OT level decreased with epidural anesthesia and showed a negative correlation with postpartum MB and fatigue. Healthcare providers should recognize that women who had epidural anesthesia need specific supportive care. [ABSTRACT FROM AUTHOR]

Purpose: To quantify the relationship between sleep difficulties and poor mental health among student athletes using validated measures. Methods: Data were collected from 190 National Collegiate Athletic Association Division I student athletes. Sleep assessments included measures of sleep duration, sleep quality, insomnia, fatigue, and sleep apnea symptoms. Mental well-being was assessed as depression, anxiety, mental health days, stress, and social support from family, friends, significant other, and teammates. Results: Shorter sleep duration, poor sleep quality, insomnia, and fatigue were consistently and independently associated with stress, depression, anxiety, mental health days, and social support. Sleep apnea symptoms were associated with stress, depression, and social support. Conclusions: Short sleep duration, poor sleep quality, and daytime fatigue in student athletes are all associated with depression, anxiety, stress, poor mental health days, and decreased social support. These associations are not accounted for solely by stress. [Athletic Training & Sports Health Care. 2021;13(4):e159–e167.] [ABSTRACT FROM AUTHOR]

This study examined how objective measures of sleep change across shift-cycles, and the impact of this on sleep quality and fatigue. Forty maritime pilots were recruited from Australian ports. Sleep wake-behaviour (timing and length), and self-reported sleep quality and fatigue, were assessed to determine any impact of roster status and 'on-call' status. On-roster pilots experienced reduced night time sleep duration compared to those off-roster (57 ± 8.8 min), while working on-call also diminished night time sleep duration (126 ± 11.3 min) and quality, compared to workers not on-call. Fatigue scores indicated that participants were not fully recovered prior to commencing rostered night shift, while sleep quality was significantly worse following sleep that occurred after a night shift, compared to after a day shift. These findings potentially support workplace negotiations to change future shift cycles, and to adopt monitoring systems that may mitigate the risk of fatigue-related accidents and chronic health outcomes. Practitioner summary: Long and irregular work hours of maritime pilotage can compromise worker performance and safety. This observational study found that on-roster pilots experience reduced sleep duration compared to those off-roster, while working on-call further diminishes sleep duration and quality. Future workload/fatigue monitoring systems may mitigate fatigue-related accidents and adverse chronic health outcomes. Abbreviations: ANOVA: analysis of variance; ANCOVA: analysis of covariance; BMI: body mass index; CVD: cardiovascular disease; h: hours; mins: minutes; SE: standard error of the mean; SD: standard deviation; SO: sleep opportunities; TST: total sleep time; WASO: wake after sleep onset [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease (COVID-19) represents a devastating crisis continuing for more than a year up till now with new emerging presentations and complications every now and then. Aim: to spot the light on long-term symptoms in healthcare staff who are the first defence line in this pandemic and whose medical and psychological sufferings are underrepresented in studies. Methods: 120 male and female participants working in Ain-Shams University and Ministry of health and population hospitals who had been infected with COVID-19 virus at least 3 months ago were recruited. Presenting symptoms, staging, medications, symptoms 1 month and more than 3 months after infection were recorded. Results: The study participants aged between 23 and 62 years. fever was the most common presentation 57.5% followed by body aches in 44.2% and then anosmia in 41.7% of participants. Cough, dyspnea, fatigue and diarrhea were present in 37.5%, 33.3%, 35% and 19.2% respectively. Facial palsy and transient ischemic attack were presented each in one participant. Five participants experienced myocardial and pulmonary infarctions. Still 26.7% and 33.3% had dyspnea and fatigue after 3 months, 3 participants received antidepressants, 4 had memory problems. Parosmia, hair loss, oral ulcers and syncopal attacks emerged months after recovery. Odds ratio for symptoms after 3 months was 2.4 higher in participants aged ≥ 35 years. Conclusion: COVID-19 infection is unique in presentation and long-term symptoms which needs further large number of studies. Even young people and those with mild disease experience long term problems. [ABSTRACT FROM AUTHOR]

Background: Coronavirus-2 (COVID-19) has caused a worldwide pandemic since December 2019. Since then, clinical trials with vaccines have been started and completed, and at present, 3 COVID-19 vaccines have been approved for use in the United States. Healthcare providers were among the first to get vaccinated, but the precise attitudes of healthcare workers toward vaccination are uncertain. Objective: To understand residents and fellows' attitudes toward vaccination and record any side effects after vaccination. Methods: We conducted an anonymous survey that was open from 3-1-2021 to 3-12-2021 using distribution lists from the Graduate Medical Education office on the Lubbock campus of the Texas Tech University Health Sciences Center after getting approval from the Institutional Review Board (L21-088). Results: Eighty-one residents and fellows (26.6% out of 304) responded to our survey. Among those who responded, 63 (77.8 %) were between 25 and 35 years old, and 41 (50.6%) were males. Seventy-seven (95.1%) received the vaccine (Pfizer-BioNTech), 78 (96.3%) reported that they supported vaccination, and 3 (3.7%) reported that they did not want vaccination. Eight members (9.8%) had tested positive for COVID-19 infection before vaccination, but only 1 (1.23%) had tested positive for COVID-19 antibodies. All residents and fellows reported side effects after the vaccination, including pain at the injection site (77; 100%), local redness (9; 11.6%), local swelling (13; 16.8%), fever (25; 32.5%), fatigue (25; 32.5%), chills (34; 44.1 %), headache (38; 49.4%). Conclusions: Most medical trainees have a high interest in COVID-19 vaccination; however, a few reported that they did not want vaccination. [ABSTRACT FROM AUTHOR]

Background: Two new drugs, abiraterone and enzalutamide, had recently shown beneficial effects on survival in patients with metastatic castration-resistant prostate cancer. We systematically reviewed the efficacy and safety of abiraterone and enzalutamide in metastatic castration-resistant prostate cancer in real-world practice. Methods: A search from PubMed, Web of Science, Cochrane, Embase was conducted up to 6 March 2019. Available articles from conferences were searched. The endpoint was prostate-specific antigen response, overall survival, progression-free survival, number of patients with any adverse event. Results: Fourteen cohort studies involving 3469 participants were included. Pooled result showed that prostate-specific antigen response was higher for patients receiving enzalutamide than abiraterone (790 patients, odds ratio (OR) 0.47, 95% confidence interval (CI) 0.29–0.77, P = 0.003, I2=59%). Enzalutamide was significantly associated with increased adverse events rate in comparison with abiraterone (730 patients, OR 0.35, 95%CI 0.13–0.92, P = 0.03, I2=65%). There was no statistical difference between abiraterone and enzalutamide with respect to perceived cognitive impairments (1856 patients, OR 0.90, 95%CI 0.29–2.76, P = 0.85, I2=5%). Enzalutamide was significantly associated with increased fatigue risk in comparison with abiraterone (2477 patients, OR 0.46, 95%CI 0.34–0.63, P＜0.00001, I2=0%). Conclusions: Our results demonstrated that enzalutamide was more efficacious than abiraterone for patients with metastatic castration-resistant prostate cancer, but was associated with a significantly elevated risk of side effects, particularly fatigue. [ABSTRACT FROM AUTHOR]

To explore the self-reported factors that generate fatigue and to describe fatigue self-management strategies from the perspectives of adolescents and adults with cerebral palsy (CP). Text responses to open-ended questions of the Fatigue Impact and Severity Self-Assessment from 160 participants (mean age 22.4 years) across all GMFCS levels were coded using inductive line-by-line coding and then grouped together to generate larger categories for each question. Frequency counts associated with each category were then summarized descriptively by Gross Motor Function Classification System level. The most commonly reported contributors to fatigue included the following: activity-related factors, general demands of life, sleep/rest, general health concerns, CP-related factors, mental health concerns, and environmental factors. The top five strategies participants reported to manage fatigue included rest or relaxation, sleeping or napping, changing or limiting their activities, being physically active, or using specific adaptations or assistive devices. Results from this study suggest that there are potentially modifiable factors, including activity level and sleep, that significantly contribute to fatigue for persons with CP; these could form the basis of interventions targeted at the prevention and management of fatigue. As individuals with cerebral palsy who are physically active experience significant fatigue, clinicians need to address fatigue to enable these individuals to reap the health benefits of physical activity. Providing education and support to integrate self-management techniques, such as planning and pacing, may be an effective long-term strategy to support individuals to complete highly valued tasks. Interventions targeting modifiable fatigue-generating factors such as activity level, sleep, and mental health concerns are needed. [ABSTRACT FROM AUTHOR]

Objectives: Fatigue is the most frequently reported symptom experienced by cancer patients and has a profound effect on their quality of life (QOL). The study aimed to determine the impact of fatigue on QOL among breast cancer patients receiving chemotherapy and to identify the risk factors associated with severe fatigue incidence. Methods: This was an observational prospective study carried out at multiple centers. In total, 172 breast cancer patients were included. The Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire was used to measure QOL, while the Brief Fatigue Inventory (BFI) was used to assess the severity of fatigue. Results: The total average mean and standard deviation of QOL were 84.58±18.07 and 4.65±1.14 for BFI scores, respectively. A significant association between fatigue and QOL was found in linear and multiple regression analyses. The relationships between fatigue severity and cancer stage, chemotherapy dose delay, dose reduction, chemotherapy regimen, and ethnicity were determined using binary logistic regression analysis. Conclusion: The findings of this study are believed to be useful for helping oncologists effectively evaluate, monitor, and treat fatigue related to QOL changes. [ABSTRACT FROM AUTHOR]

Post‐viral fatigue is the most common long‐term health issue facing survivors of COVID‐19, according to initial reports. Here, Dr Gaber discusses the risk, diagnosis and principles of management of post‐viral fatigue and its chronic variant – myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) –within the context of the pandemic and highlights that further research is urgently needed to guide clinical practice. [ABSTRACT FROM AUTHOR]

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This study assessed the consequences of childhood traumatic brain injury (TBI) on sleep, fatigue, depression, and quality of life (QoL) outcomes and explored the relationships between these variables at 20 years following childhood TBI. We followed up 54 young adults with mild, moderate, and severe TBI, and 13 typically developing control (TDC) participants, recruited at the time of TBI. Sleep was assessed with the Pittsburgh Sleep Quality Index and actigraphy. At 20 years postinjury, results showed no significant difference between whole TBI group and TDC participants on subjective sleep quality; however, the moderate TBI group reported significantly poorer subjective sleep quality compared to those with severe TBI. Poorer subjective sleep was associated with increased symptoms of fatigue, depression, and poorer perceptions of General Health in the TBI group. Actigraphic sleep efficiency, fatigue, depression, and QoL outcomes were not significantly different between TBI and TDC or among TBI severity groups. These preliminary findings underscore associations between subjective sleep disturbance, fatigue, depression, and QoL in this TBI sample, and mostly comparable outcomes in sleep, fatigue, depression, and QoL between the TBI and TDC groups. Further research is required to clarify these findings. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the association between fatigue and phase angle (PA) in patients with chronic kidney disease (CKD) on hemodialysis (HD). Methods: A cross-sectional study with older patients than 18 years diagnosed with CKD undergoing HD. From 160 (58.36±15.05 years) patients, (n=96; 60%) are men. Body mass and height were assessed using a portable scale and stadiometer, followed by body mass index (BMI) calculus. The bioimpedance electrical analysis was performed using the Bodystat QuadScan 4000. The sample size was dichotomized in two groups, using the median of our sample, either normal when PA ≥5.4°, or low when the PA <5.4°. The Chalder fatigue questionnaire was used the assess the fatigue. The multiple regression was applied to assess the association between fatigue questionnaire and PA. Results: Were considered normal PA≥5.4° (n=78, 48.8%) and low PA<5.4° (n=82, 51.2%). The patients of the PA<5.4° group are older compared to the PA≥5.4° group (63.1±15.1 vs. 53.3±13.4 years, p<0.001). There was no association between PA and fatigue score in the crude model (OR: 1.02, 95%CI: 0.96–1.08, p=0.47) and after confounding variables (OR: 1.03, CI: 0.95–1.12, p=0.43). Conclusions: In HD patients, we found that patients with lower PA values are older. In addition, we did not find association between fatigue and PA. [ABSTRACT FROM AUTHOR]

Fatigue, pain, sleep difficulties, and depressive symptoms are common in people with type 2 diabetes (T2DM). However, most studies of diabetes symptoms are not conducted with Mexican- or Chinese Americans. We aim to compare the symptoms between the two ethnic groups and examine the predictors of fatigue. This is a secondary analysis of two datasets (72 Mexican Americans and 134 Chinese Americans with T2DM). The Theory of Unpleasant Symptoms guided variable selection. We used χ2 tests to compare symptoms (measured by the Illness Perception Questionnaire-Revised and CES-D) between the two ethnic groups, and logistic regression to predict fatigue. Compared to Chinese Americans, Mexican Americans reported more fatigue, sleep difficulties, and pain. Depressive symptoms (OR = 6.13, p < 0.001) and medium acculturation (OR = 2.45, p = 0.017) significantly predicted fatigue. The two ethnic groups demonstrated differences in symptoms. Fatigue and related symptoms should be further evaluated in Mexican- and Chinese Americans with T2DM. [ABSTRACT FROM AUTHOR]

Background and Purpose. Patients undergoing kidney transplantation surgeries suffer from postoperative pain, fatigue, and sleep disorders. Therefore, it is necessary to use different interventions in addition to modern medicine to reduce their symptoms. The present study aimed to investigate the effect of foot reflexology on pain, fatigue, and quality of sleep after kidney transplantation surgery. Materials and Methods. The study was a parallel randomized controlled trial. Patients admitted to the transplantation ward participated in the study. Fifty-three eligible patients were allocated into the foot reflexology group (n = 26) and the control group (n = 27) by using the stratified randomization method. Finally, 25 participants in each group finished the study. The intervention group received foot reflexology for 30 minutes once a day for three consecutive days, and no reflexology was applied in the control group. The intervention started on the second day after surgery. Pain, fatigue, and quality of sleep were measured on the first, second (before intervention), third, fourth, and eleventh days after surgery. Data were collected using visual analogue scale for measuring pain and fatigue and Verran and Snyder-Halpern sleep scale for measuring quality of sleep. Results. In each group, 25 patients finished the study. The mean pain score in the foot reflexology and control groups decreased from 9.44 ± 0.96 and 9.36 ± 0.91 on the day of surgery to 1.32 ± 0.94 and 4.32 ± 1.68 on the eleventh day after surgery, respectively. The mean fatigue score in the reflexology and control groups decreased from 8.76 ± 1.27 and 8.6 ± 1.26 on the day of surgery to 1.24 ± 1.2 and 3.92 ± 1.63 on the eleventh day after surgery, respectively. The mean sleep score in the foot reflexology and control groups increased from 33.38 ± 11.22 and 39.59 ± 12.8 on the day of surgery to 69.43 ± 12.8 and 56.27 ± 8.03 on the eleventh day after surgery, respectively. While pain, fatigue, and sleep quality scores improved in both groups, those in the intervention group showed significantly greater improvement compared with the control group (P < 0.001). No significant difference was found between the two groups in the use of acetaminophen on the first, second, third, fourth, and eleventh days after surgery (P > 0.05). Conclusion. Foot reflexology may reduce pain and fatigue and improve sleep quality of patients after kidney transplantation. [ABSTRACT FROM AUTHOR]

Fatigue is a common complaint in older adults living in rest homes. The aim of this study was to investigate the factors associated with fatigue among older adults living in a rest home. This cross-sectional study was carried out with a total of 92 older adults. Fatigue was evaluated by the Fatigue Severity Scale (FSS). The sociodemographic characteristics, quadriceps and handgrip strength, functional capacity and physical function were assessed using a structured questionnaire, digital dynamometers, 6-minute walking test and Short Physical Performance Battery, respectively. The prevalence of fatigue was 67.4%. FSS showed significant correlations with age, female gender, body mass index, physical activity habits, quadriceps strength, handgrip strength, functional exercise capacity, and physical function. However, in the regression analysis, only body mass index, physical activity habits and physical function were responsible for 51% of the variance in fatigue among rest home residents. Physical activity habits and physical function were the best predictors of fatigue explaining 47.5% of variance. This study demonstrated that body mass index, physical activity habits and physical function contributed to fatigue in rest home residents. These factors can be used to identify individuals at high risk of fatigue and to attenuate fatigue levels. [ABSTRACT FROM AUTHOR]

BACKGROUND: Mercury is one of the most well-known toxic metals for humans. Chloralkali workers are exposed to mercury vapours extensively, which may be associated with neurotoxicity. OBJECTIVE: The aim of this study was to determine the associations between mercury concentration in blood and air samples, and mercury's neuropsychological effects among chloralkali workers. METHODS: This study was conducted on 50 chloralkali workers as the exposed group and 50 non-industrial office workers as the unexposed group. All subjects were assessed using the Hamilton Depression Rating Scale, Piper Chronic Fatigue Scale and Essential Tremor Rating Scale. Mercury concentration was measured in blood and air samples using cold vapour atomic absorption spectrometry. RESULTS: There was significantly more severe fatigue, depression and tremor in the exposed group compared with the unexposed group. The mean concentration of blood mercury in the exposed group was 22.59±12.5μgL–1 which was significantly higher than the unexposed group (1.28±1.05μg L–1). Based on multiple linear regression, shift work, smoking, fatigue, depression and tremor were predictor variables for blood mercury concentration. CONCLUSIONS: This study indicated that this sample of chloralkali workers suffered from neuropsychological problems such as fatigue, depression and tremor, which is probably related to mercury exposure. [ABSTRACT FROM AUTHOR]

Low carbohydrate diets (LCD) may help body weight loss and glycemic control in diabetes but their long-term consequences are not known. The aim of this review is to highlight the contrast between the potential benefits of short term LCD and the adverse health effects of long-term consumption of LCD. LCD can enhance weight loss in the short term although its effect is small and not sustainable. In people with diabetes and insulin resistance, LCD is helpful in achieving glycemic control. However, there are untoward side effects especially when carbohydrates are severely restricted (< 50 gm a day) to induce ketosis. The latter curbs appetite but also may cause nausea, fatigue water and electrolyte losses and limits exercise capacity. In addition, observational studies suggest that low carbohydrate diets (< 40% energy form carbohydrates) as well as very high carbohydrate diets (> 70% energy from carbohydrate) are associated with increased mortality. The available scientific evidence supports the current dietary recommendations to replace highly processed carbohydrates with unprocessed carbohydrates as well as limiting added sugars in the diet. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Although frequent and debilitating, little is known about the characteristics of post‐dialysis fatigue (PDF). Objective: To characterise the intensity, duration and frequency of PDF and the associated variables in patients on chronic haemodialyses. Design: Prospective, observational and multicenter study. Patients: We studied 271 patients. Measurements: Patients were considered to be suffering from PDF if they spontaneously offered this complaint when asked the open‐ended question: "Do you feel fatigued after dialysis? Then, each patient was invited to rate the intensity, duration and frequency of PDF from 1 to 5. Results: One hundred sixty‐four patients (60.5%) had PDF. The median [95% confidence interval (CI)] scores of PDF intensity, duration and frequency were 3 (3–4), 3 (3–4) and 4 (4‐4), respectively. The median (95% CI) of the sum of the scores (Sum Score) of PDF intensity, duration and frequency was 11 (10–12). Seventy four patients had a Sum Score ≥ 12. Using multiple regression analysis, PDF intensity was associated with dialytic age and ultrafiltration rate (UFR), PDF duration with dialytic age, while PDF fatigue frequency was associated with height. The Sum Score was associated with dialytic age and recovery time and negatively associated with daily activity, height and UFR (ml/kg/h). Conclusion: The intensity, duration and frequency of PDF are high in a large percentage of patients, suggesting that PDF is an intense event in terms of quantity and quality. Understanding the relationship between the variables associated with PDF and its intensity, duration and frequency may help better understand the underlying mechanisms of this burdensome condition. [ABSTRACT FROM AUTHOR]

Background: Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents. Methods: We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors. Results: A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80). Conclusions: Our results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese. [ABSTRACT FROM AUTHOR]

The article discusses guidelines for the appropriate use of cardiac telemetry in the acute care setting in the U.S. Topics discussed include publication of guidelines for continuous cardiac monitoring by the American Heart Association due to the widespread misuse of telemetry in the hospital setting, the objective of its use which is to observe continuous electronic cardiac waveforms in patients at risk for cardiac deterioration, and the impact of its overuse on patient safety.

Background: Previous trials have suggested that elderly patients with non‐small‐cell lung cancer (NSCLC) could benefit from nanoparticle albumin‐bound paclitaxel (nab‐paclitaxel). Real‐world data on the elderly Chinese population are lacking. This study aimed to analyze the effectiveness and tolerability of nab‐paclitaxel in Chinese elderly patients (≥65 years) with advanced NSCLC. Methods: This study included 76 patients with a primary diagnosis of IIIB‐IV NSCLC from January 2010 to December 2017 at Peking University Cancer Hospital, who received nab‐paclitaxel (125 or 130 mg/m2 i.v.) every three weeks. The overall survival (OS), progression‐free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) were analyzed. Results: There were 12 patients who received nab‐paclitaxel as the first‐line treatment (seven also received carboplatin), and 64 received nab‐paclitaxel as the latter‐line treatment. The overall ORR, DCR, median PFS, and median OS were 14.5%, 69.7%, 5.2 months, and 12.2 months, respectively. The Eastern Cooperative Oncology Group performance status of one and the age of 70–74 years were independently associated with longer OS, while early treatment line of nab‐paclitaxel and age of 70–74 years were independently associated with longer PFS. The most common AEs were anemia, leukopenia, gastrointestinal reaction, fatigue, and peripheral neuropathy, which were all manageable. Dose adjustment or treatment discontinuation was encountered in 10 patients because of AEs. The incidence of AEs was not different among age subgroups. Conclusions: Nab‐paclitaxel has a good clinical response profile in Chinese elderly patients with stage IIIB–IV NSCLC. Prospective clinical trials are needed to confirm these results. Key points: Significant findings of the study: Nanoparticle albumin‐bound paclitaxel (nab‐paclitaxel) has a good clinical response profile in Chinese elderly (≥65 years) patients with stage IIIB‐IV non‐small‐cell lung cancer (NSCLC), with acceptable and manageable adverse events. What this study adds: Preliminary evidence shows a good clinical response from treatment with nab‐paclitaxel in Chinese elderly patients with advanced NSCLC. [ABSTRACT FROM AUTHOR]

Background: The addition of bevacizumab to chemotherapy improved outcomes for patients with metastatic colon cancer. E5204 was designed to test whether the addition of bevacizumab to mFOLFOX6, following neoadjuvant chemoradiation and definitive surgery, could improve overall survival (OS) in patients with stage II/III adenocarcinoma of the rectum. Subjects, Materials, and Methods: Patients with stage II/III rectal cancer who had completed neoadjuvant 5‐fluorouracil‐based chemoradiation and had undergone complete resection were enrolled. Patients were randomized to mFOLFOX6 (Arm A) or mFOLFOX6 with bevacizumab (Arm B) administered every 2 weeks for 12 cycles. Results: E5204 registered only 355 patients (17% of planned accrual goal) as it was terminated prematurely owing to poor accrual. At a median follow‐up of 72 months, there was no difference in 5‐year overall survival (88.3% vs. 83.7%) or 5‐year disease‐free survival (71.2% vs. 76.5%) between the two arms. The rate of treatment‐related grade ≥ 3 adverse events (AEs) was 68.8% on Arm A and 70.7% on Arm B. Arm B had a higher proportion of patients who discontinued therapy early as a result of AEs and patient withdrawal than did Arm A (32.4% vs. 21.5%, p =.029).The most common grade 3–4 treatment‐related AEs were neutropenia, leukopenia, neuropathy, diarrhea (without prior colostomy), and fatigue. Conclusion: At 17% of its planned accrual, E5204 did not meet its primary endpoint. The addition of bevacizumab to FOLFOX6 in the adjuvant setting did not significantly improve OS in patients with stage II/III rectal cancer. Implications for Practice: At 17% of its planned accrual, E5204 was terminated early owing to poor accrual. At a median follow‐up of 72 months, there was no significant difference in 5‐year overall survival (88.3% vs. 83.7%) or in 5‐year disease‐free survival (71.2% vs. 76.5%) between the two arms. Despite significant advances in the treatment of rectal cancer, especially in improving local control rates, the risk of distant metastases and the need to further improve quality of life remain a challenge. Strategies combining novel agents with chemoradiation to improve both distant and local control are needed. Despite advances in the treatment of rectal cancer, the risk of distant metastases and poor quality of life remain a challenge. Trial E5204 was designed to test whether the addition of bevacizumab to mFOLFOX6, following neoadjuvant chemoradiation and definitive surgery, could improve overall survival in patients with stage II/III adenocarcinoma of the rectum. [ABSTRACT FROM AUTHOR]