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PURPOSE: This study aimed to assess pain, fitness condition, physical activity (PA) level, comorbidities, cancer-related fatigue (CRF), mood state and health-related quality of life (HRQoL) in long-term breast cancer survivors (LTBCS) compared to women without cancer history, matched by age, weight, height, and educational level. METHODS: A cross-sectional study conducted in Granada between April 2018 and July 2023 involved 80 LTBCS and 80 matched controls. Pain, fitness condition, PA level, comorbidities, CRF, mood state, and HRQoL were evaluated ≥ 5 years post-diagnosis using validated instruments. RESULTS: LTBCS, compared to the controls, reported significantly higher levels of "pain intensity and interference", CRF (in all domains and > 40% exhibited moderate-to-severe fatigue levels), "sadness-depression", "anxiety", "anger/hostility", and "symptom scales" (All: P = .000 to .027). Moreover, 66.25% of LTBCS not only did not reach recommended PA levels (P = .035), but also presented significantly lower levels of "general physical fitness", "muscular strength", "happiness", "functioning scales" (except "emotional functioning"), and "global health status" (All: P = .000 to .048). CONCLUSION: LTBCS still suffer from physical (pain, fitness condition, and CRF), both mental and emotional (sadness-depression, anxiety and anger/hostility) long-term side effects as well as multiple HRQoL issues (including lower levels of physical functioning and higher levels of symptoms). These findings highlight the chronic nature of this disease and the importance of continuing long- term follow-up care for survivors many years after the diagnosis of breast cancer.
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Neoplasias de la Mama , Supervivientes de Cáncer , Fatiga , Salud Mental , Calidad de Vida , Humanos , Femenino , Neoplasias de la Mama/psicología , Neoplasias de la Mama/complicaciones , Supervivientes de Cáncer/psicología , Estudios Transversales , Persona de Mediana Edad , Fatiga/etiología , Fatiga/epidemiología , Estudios de Casos y Controles , Ejercicio Físico/fisiología , Anciano , Estado de Salud , Adulto , Aptitud Física/fisiología , EspañaRESUMEN
Background: Under the current pandemic of Corona Virus Disease 2019 (COVID-19), The relationship between fatigue and COVID-19 has been found. Infection with COVID-19 is associated with fatigue long after the acute phase of COVID-19. Understanding the association of thyroid hormones levels with post-COVID condition, such as fatigue, is necessary to improve quality of life. Methods: This population-based cohort study was conducted in Dalian, China, from December 2022, to March 2023, using a Yidu Core platform in the First Affiliated Hospital of Dalian Medical University, that integrates medical records, laboratory tests, and all diagnosis and treatment information based on patients in hospital. Eligible individuals were 40 patients with COVID-19, Divided them into fatigue group and non-fatigue group following up by telephone using the FS-14 scale after 6 months. The primary outcomes were the diagnoses of fatigue. The association between thyroid hormones levels and post-COVID condition, such as fatigue, was assessed using logistic regression analysis. Results: Compared with the non-fatigue group, the FT3 level in fatigue group was lower (p<0.05). FT3 was negatively correlated with fatigue after 6 months (OR 0.257, p<0.05). After adjusting for confounding factors such as age and gender, low FT3 was a risk factor for fatigue in patients with COVID-19, (OR 0.225, p<0.05). And the FT3 is less than 2.47 mol/L, it is the best critical value for predicting long-term fatigue, with a sensitivity of 92.3% and a specificity of 48.1%. Conclusions: Most people still have fatigue 6 months after COVID-19 infection. FT3 serves as the important index to predict fatigue in patients with COVID-19. it should be closely monitored during infection.
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COVID-19 , Fatiga , Triyodotironina , Humanos , COVID-19/complicaciones , COVID-19/epidemiología , Fatiga/etiología , Fatiga/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Triyodotironina/sangre , Adulto , China/epidemiología , SARS-CoV-2 , Anciano , Estudios de CohortesRESUMEN
OBJECTIVES: Exploring the effect of resilience and self-efficacy in mediating the chain between fatigue and quality of life(QOL) in patients with rheumatoid arthritis (RA). METHODS: From June 2022 to November 2022, 423 RA patients were chosen by a convenience sample method from two tertiary care facilities in Chengdu, Sichuan Province. General Information Questionnaire, Bristol Multidimensional Scale of Fatigue in Patients with Rheumatoid Arthritis, SF-12 Health Survey Short Form, Chinese version of the ten-item psychological Resilience Scale, and Chinese-language Arthritis Self-Efficacy Scale, an 8-element version, were among the questionnaires used. RESULTS: In the physical component summary( PCS), self-efficacy, psychological resilience, and self-efficacy were all significantly mediated by fatigue (total effect mediated 8.88%). In the mental component summary (MCS), fatigue (total effect mediated 10.79%), self-efficacy (total effect mediated 8.99%), psychological resilience, and self-efficacy (total effect mediated 2.01%) were all significantly mediated by fatigue. CONCLUSION: Fatigue in RA patients can affect the quality of life both directly and indirectly through the mediating effects of psychological resilience, self-efficacy, and the chain mediating effect of psychological resilience-self-efficacy.
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Artritis Reumatoide , Fatiga , Calidad de Vida , Resiliencia Psicológica , Autoeficacia , Humanos , Artritis Reumatoide/psicología , Artritis Reumatoide/complicaciones , Fatiga/psicología , Fatiga/etiología , Femenino , Masculino , Persona de Mediana Edad , Adulto , Encuestas y Cuestionarios , China , AncianoRESUMEN
BACKGROUND: Mirror movements (MM) are commonly caused by a defect of interhemispheric pathways also affected in multiple sclerosis (MS), particularly the corpus callosum. We investigated the prevalence of MM in MS in relation to functional and morphological callosal fiber integrity by transcranial magnetic stimulation (TMS), magnetic resonance imaging (MRI), as well as fatigue. METHODS: In 21 patients with relapsing-remitting MS and 19 healthy controls, MM were assessed and graded (Woods and Teuber scale: MM 1-4) using a bedside test. Fatigue was evaluated using the Fatigue Scale for Motor and Cognitive Functions (FSMC) questionnaire. TMS measured ipsilateral silent period latency and duration. MRI assessed callosal atrophy by measuring the normalized corpus callosum area (nCCA), corpus callosum index (CCI), and lesion volume. RESULTS: MS patients had significantly more often and pronounced MM compared to healthy controls (p = 0.0002) and nCCA was significantly lower (p = 0.045) in MRI studies. Patients with higher MM scores (MM > 1 vs. MM 0/1) showed significantly more fatigue (higher FSMC sum score, p = 0.04, motor score, p = 0.01). In TMS and MRI studies, no significant differences were found between patients with MM 0/1 and those with MM > 1 (ipsilateral silent period measurements, CCA, CCI and lesion volume). CONCLUSIONS: MM are common in MS and can easily be detected through bedside testing. As MM are associated with fatigue, they might indicate fatigue in MS. It is possible that other cerebral structures, in addition to the corpus callosum, may contribute to the origin of MM in MS.
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Cuerpo Calloso , Imagen por Resonancia Magnética , Estimulación Magnética Transcraneal , Humanos , Femenino , Masculino , Adulto , Cuerpo Calloso/diagnóstico por imagen , Cuerpo Calloso/patología , Estimulación Magnética Transcraneal/métodos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Esclerosis Múltiple Recurrente-Remitente/diagnóstico por imagen , Esclerosis Múltiple Recurrente-Remitente/fisiopatología , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/fisiopatología , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/patología , Fatiga/diagnóstico por imagen , Fatiga/fisiopatología , Fatiga/etiología , Fatiga/epidemiologíaRESUMEN
BACKGROUND: The Neurological Fatigue Index (NFI) is the instrument used to evaluate stroke patients' fatigue. There was no Urdu version of NFI available officially. OBJECTIVE: This study aimed to translate the Neurological Fatigue Index into Urdu and to determine the validity and reliability of Urdu NFI among stroke patients. METHODOLOGY: It is a cross-cultural validation study. According to international guidelines in phase I, a process of translation was carried out. In phase II, using the sample of 120 participants, validity and reliability of the Urdu version of the Neurological Fatigue Index scale was conducted. The Urdu version's content validity, convergent/concurrent validity, test-retest reliability, and internal consistency were determined. The latest version of SPSS was used for the data analysis. RESULTS: The Urdu version of NFI was drafted after the expert's review. The content validity index was used to analyze the content validity. The reliability and validity of the Urdu version NFI were evaluated by calculating Cronbach's alpha (α = 0.86), and intra-class correlation coefficient (ICC = 0.823). Correlations with other scales were the fatigue Severity Scale (FSS) (r = 0.76), Mental Fatigue Scale (MFS) (r = 0.68), Beck Depression Inventory (BDI) (r = 0.53) and Epworth Sleepiness Scale (ESS) (r = 0.47). CONCLUSION: The Urdu Version was linguistically acceptable for the fatigue assessment in post-stroke patients. It showed good content validity, convergent/concurrent validity, internal consistency, and test-retest reliability.
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Comparación Transcultural , Fatiga , Accidente Cerebrovascular , Humanos , Fatiga/diagnóstico , Fatiga/etiología , Femenino , Masculino , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/psicología , Persona de Mediana Edad , Reproducibilidad de los Resultados , Anciano , Adulto , Traducciones , Índice de Severidad de la Enfermedad , Psicometría/métodos , Psicometría/normasRESUMEN
The COVID-19 pandemic faced the public health sector with unprecedented challenges. While the immediate impact on society seems to diminish, reports of long-term health consequences persist. Among the most frequently reported symptoms are neurological complaints such as persistent fatigue and cognitive impairments. Scientific understanding is evolving rapidly, and first therapeutic approaches are emerging. However, many questions still remain unanswered.
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COVID-19 , Disfunción Cognitiva , Enfermedades del Sistema Nervioso , COVID-19/complicaciones , COVID-19/psicología , COVID-19/epidemiología , Humanos , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/virología , Enfermedades del Sistema Nervioso/terapia , Disfunción Cognitiva/etiología , Disfunción Cognitiva/psicología , Pandemias , Fatiga/etiología , SARS-CoV-2RESUMEN
BACKGROUND: Cancer-related fatigue is a common and distressing late effect of cancer that can persist for decades after treatment completion. Although negatively affecting survivors' quality of life, few, if any, efficacious interventions for persistent, or chronic, fatigue exist. AIMS: To inform future interventions, we explored how long-term, young adult cancer survivors (YACSs) with chronic fatigue live with, and manage their fatigue over time, including their experiences with nonpharmacological interventions (NPIs) for chronic fatigue. METHODS AND RESULTS: We conducted a qualitative focus group study with 15 YACSs (13 women) with chronic fatigue, on average 7.3 years post-diagnosis. The YACS were identified and recruited through a nationwide health survey of cancer survivors (the NOR-CAYACS study). Systematic content analysis was used to identify recurrent themes. Analysis revealed five themes: (1) manifestation of fatigue, detailing chronic fatigue experiences; (2) impact on daily life, highlighting the necessity to balance rest and activity, affecting relationships; (3) NPIs, where walks in nature were notably beneficial; (4) barriers to fatigue management, including energy deficits, treatment-related bodily changes, and self-care prioritization challenges; (5) facilitators to fatigue management, emphasizing the need for regular breaks, self-care practices, and the importance of fatigue management education. CONCLUSION: This study offers novel insights into the lived experiences of YACSs with chronic fatigue, a subject scarcely examined in prior research. Our findings highlight the significant impact of chronic fatigue and the individualized strategies YACSs use to cope. The research emphasizes the need for personalized interventions to support chronic fatigue management, marking a critical step forward in addressing this often-overlooked issue in survivorship care. Future research should focus on tailored approaches to improve YACSs' quality of life.
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Supervivientes de Cáncer , Grupos Focales , Neoplasias , Investigación Cualitativa , Calidad de Vida , Humanos , Supervivientes de Cáncer/psicología , Femenino , Masculino , Adulto , Neoplasias/psicología , Neoplasias/terapia , Neoplasias/complicaciones , Adulto Joven , Fatiga/etiología , Fatiga/terapia , Fatiga/psicología , Síndrome de Fatiga Crónica/psicología , Síndrome de Fatiga Crónica/terapia , Síndrome de Fatiga Crónica/etiologíaRESUMEN
This study aims to evaluate the impact of integrating pain nursing with hospice care on the quality of life among patients with advanced lung cancer. This study involving 60 advanced lung cancer patients admitted from January 2022 to January 2023. Participants were randomly assigned to 2 groups: the observation group received a combination of pain nursing and hospice care, while the control group received standard nursing care. The study assessed changes in the numeric rating scale for pain, self-rating anxiety scale (SAS), self-rating depression scale (SDS), cancer fatigue scale (CFS), death attitude, and various quality of life dimensions as measured by the Quality of Life Questionnaire-Core 30. Post-intervention, both groups exhibited reductions in numeric rating scale, SAS, SDS, and CFS scores compared to baseline, with more significant improvements observed in the observation group (Pâ <â .05). Additionally, post-intervention scores for death attitude and Quality of Life Questionnaire-Core 30 domains (physical, cognitive, social, role, and emotional functioning, as well as overall health) increased in both groups, with the observation group showing greater improvements than the control group (Pâ <â .05). The combination of pain nursing and hospice care significantly reduces pain, anxiety, and depression, decreases cancer-related fatigue, and improves the quality of life and death attitudes in patients with advanced lung cancer, highlighting the benefits of this integrative approach in palliative care settings.
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Cuidados Paliativos al Final de la Vida , Neoplasias Pulmonares , Calidad de Vida , Humanos , Neoplasias Pulmonares/enfermería , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/psicología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Cuidados Paliativos al Final de la Vida/métodos , Ansiedad/etiología , Manejo del Dolor/métodos , Manejo del Dolor/enfermería , Depresión/etiología , Actitud Frente a la Muerte , Fatiga/etiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: With prevalence estimates between 50% and 90% of people with cancer, cancer-related fatigue is one of the most common morbidities related to cancer and its treatment. Exercise is beneficial for the treatment of cancer-related fatigue. However, the efficacy of different types of exercise (i.e. cardiovascular training and resistance training) have not yet been investigated systematically and compared directly in a meta-analysis. OBJECTIVES: To compare the benefits and harms of cardiovascular training versus resistance training for treatment or prevention of cancer-related fatigue in people with cancer. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and five other databases in January 2023. We searched ClinicalTrials.gov and the International Clinical Trials Registry Platform for ongoing trials. We integrated results from update searches of previously published Cochrane reviews. In total, our searches included trials from inception to October 2023. SELECTION CRITERIA: We included randomised controlled trials investigating cardiovascular training compared with resistance training, with exercise as the main component. We included studies on adults with cancer (aged 18 years and older), with or without a diagnosis of cancer-related fatigue, for any type of cancer and any type of cancer treatment, with the intervention starting before, during, or after treatment. We included trials evaluating at least one of our primary outcomes (cancer-related fatigue or quality of life). We excluded combined cardiovascular and resistance interventions, yoga, and mindfulness-based interventions. Our primary outcomes were cancer-related fatigue and quality of life. Our secondary outcomes were adverse events, anxiety, and depression. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. For analyses, we pooled results within the same period of outcome assessment (i.e. short term (up to and including 12 weeks' follow-up), medium term (more than 12 weeks' to less than six months' follow-up), and long term (six months' follow-up or longer)). We assessed risk of bias using the Cochrane RoB 1 tool, and certainty of the evidence using GRADE. MAIN RESULTS: We included six studies with 447 participants with prostate, breast, or lung cancer who received radiotherapy or chemotherapy, had surgery, or a combination of these. All studies had a high risk of bias due to lack of blinding. Three studies had an additional high risk of bias domain; one study for attrition bias, and two studies for selection bias. Interventions in the cardiovascular training groups included training on a cycle ergometer, treadmill, an elliptical trainer, or indoor bike. Interventions in the resistance training group included a varying number of exercises using bodyweight, weights, or resistance bands. Interventions varied in frequency, intensity, and duration. None of the included studies reported including participants with a confirmed cancer-related fatigue diagnosis. The interventions in four studies started during cancer treatment and in two studies after cancer treatment. Before treatment No studies reported interventions starting before cancer treatment. During treatment The evidence was very uncertain about the effect of cardiovascular training compared with resistance training for short-term cancer-related fatigue (mean difference (MD) -0.29, 95% confidence interval (CI) -2.52 to 1.84; 4 studies, 311 participants; Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-Fatigue) scale where higher values indicate better outcome; very low-certainty evidence) and long-term cancer-related fatigue (MD 1.30, 95% CI -2.17 to 4.77; 1 study, 141 participants; FACIT-Fatigue scale; very low-certainty evidence). The evidence was very uncertain about the effect of cardiovascular training compared with resistance training for short-term quality of life (MD 1.47, 95% CI -1.47 to 4.42; 4 studies, 319 participants; Functional Assessment of Cancer Therapy - General scale where higher values indicate better outcome; very low-certainty evidence) and for long-term quality of life (MD 3.40, 95% CI -4.85 to 11.65; 1 study, 141 participants; Functional Assessment of Cancer Therapy - Anemia scale where higher values indicate better outcome; very low-certainty evidence). The evidence is very uncertain about the effect of cardiovascular training compared with resistance training on the occurrence of adverse events at any follow-up (risk ratio (RR) 2.00, 95% CI 0.19 to 21.18; 2 studies, 128 participants; very low-certainty evidence). No studies reported medium-term cancer-related fatigue or quality of life. After treatment The evidence was very uncertain about the effect of cardiovascular training compared with resistance training for short-term cancer-related fatigue (MD 1.47, 95% CI -0.09 to 3.03; 1 study, 95 participants; Multidimensional Fatigue Inventory-20 General Fatigue subscale where higher values indicate worse outcome; very low-certainty evidence). Resistance training may improve short-term quality of life compared to cardiovascular training, but the evidence is very uncertain (MD -10.96, 95% CI -17.77 to -4.15; 1 study, 95 participants; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 Global Health subscale where higher values indicate better outcome; very low-certainty evidence). No studies reported outcomes at medium-term or long-term follow-up. AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effects of cardiovascular training compared with resistance training on treatment of cancer-related fatigue in people with cancer. Larger, well-conducted studies including people with different cancer types receiving different treatments are needed to increase the certainty in the evidence and to better understand who may benefit most from cardiovascular or resistance training. Moreover, studies comparing the effects of cardiovascular and resistance training initiated before as well as after cancer treatment are needed to understand the prophylactic and rehabilitative effects of these exercise types on cancer-related fatigue.
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Sesgo , Fatiga , Neoplasias , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Entrenamiento de Fuerza , Adulto , Femenino , Humanos , Masculino , Ansiedad/terapia , Depresión/terapia , Depresión/etiología , Fatiga/etiología , Fatiga/terapia , Neoplasias/complicaciones , Entrenamiento de Fuerza/métodosRESUMEN
Poststroke aphasia hinders patients' emotional processing and social adaptation. This study estimated the risks of depression and related symptoms in patients developing or not developing aphasia after various types of stroke. Using data from the US Collaborative Network within the TriNetX Diamond Network, we conducted a retrospective cohort study of adults experiencing their first stroke between 2013 and 2022. Diagnoses were confirmed using corresponding International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patients were stratified by poststroke aphasia status and stroke type, with propensity score matching performed to control for confounders. The primary outcome was depression within one year post-stroke; secondary outcomes included anxiety, fatigue, agitation, emotional impact, and insomnia. Each matched group comprised 12,333 patients. The risk of depression was significantly higher in patients with poststroke aphasia (hazard ratio: 1.728; 95% CI 1.464-2.038; p < 0.001), especially those with post-hemorrhagic-stroke aphasia (hazard ratio: 2.321; 95% CI 1.814-2.970; p < 0.001). Patients with poststroke aphasia also had higher risks of fatigue, agitation, and emotional impact. Anxiety and insomnia risks were higher in those with post-hemorrhagic-stroke aphasia. Poststroke aphasia, particularly post-hemorrhagic-stroke aphasia, may increase the risks of depression and associated symptoms, indicating the need for comprehensive psychiatric assessments.
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Afasia , Depresión , Accidente Cerebrovascular , Humanos , Femenino , Masculino , Afasia/etiología , Depresión/etiología , Depresión/complicaciones , Accidente Cerebrovascular/complicaciones , Anciano , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Ansiedad/etiología , Fatiga/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Anciano de 80 o más AñosRESUMEN
OBJECTIVES: This study aims to describe the incidence, symptom clusters and determinants of post-acute COVID symptoms using data from the COVID RADAR app in the Netherlands. DESIGN: Prospective cohort. SETTING: General population in the Netherlands from April 2020 to February 2022. PARTICIPANTS: A total of 1478 COVID RADAR app users, with data spanning 40 days before to 100 days after positive SARS-CoV-2 test. OUTCOME MEASURES: Incidence and duration of 10 new symptoms that developed during acute infection, defined as 10 days prior and 10 days after positive test. Clustering of these post-acute COVID symptoms and associations between factors known in the acute phase and 100-day symptom persistence. RESULTS: The most frequent post-acute symptoms were cough, loss of smell or taste and fatigue. At 100 days postinfection, 86 (8%) participants still experienced symptoms. Three post-acute COVID symptom clusters were identified: non-respiratory (headache and fatigue; 49% of participants with post-acute COVID symptoms); olfactory (15%) and respiratory (8%). Vaccination was associated with a lower risk of post-acute COVID symptoms 100 days after infection, although CIs were wide (OR: 0.5; 95% CI: 0.2 to 1.5), but not with non-respiratory symptoms (OR: 1.0; 95% CI: 0.3 to 4.4). Severe acute disease increased the risk of post-acute COVID symptoms (OR: 1.4; 95% CI: 1.2 to 1.5; per additional acute symptom). CONCLUSIONS: In this cohort of infected community-dwelling app users, 5%-10% experienced post-acute COVID symptoms. The symptoms cluster in several distinct entities, which differ in incidence, patient characteristics and vaccination effects. This suggests multiple mechanisms underlying the development of post-acute COVID symptoms.
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COVID-19 , Aplicaciones Móviles , Síndrome Post Agudo de COVID-19 , SARS-CoV-2 , Humanos , COVID-19/epidemiología , COVID-19/complicaciones , Femenino , Masculino , Incidencia , Estudios Prospectivos , Persona de Mediana Edad , Países Bajos/epidemiología , Adulto , Vida Independiente/estadística & datos numéricos , Anciano , Fatiga/epidemiología , Fatiga/etiología , Tos/epidemiologíaRESUMEN
OBJECTIVE: This study aims to investigate the factors that influence fatigue in hemodialysis (HD) patients and to develop and validate a nomogram to estimate the probability of fatigue in this population. METHODS: This cross-sectional study collected 453 patients who underwent HD at the tertiary hospital in Hubei, China, from April to December 2023. They were randomly divided into a 70% training group (n = 316) and a 30% validation group (n = 137). In the training set, factors influencing fatigue were screened using multivariate logistic regression analysis, and a nomogram was developed to estimate fatigue probability in HD patients. The discrimination and calibration of the nomogram were validated in both the training and validation sets through the area under the receiver operating characteristic (ROC) curve (AUC) and the Hosmer-Lemeshow (H-L) test. RESULTS: In the training group, logistic regression showed that age, dialysis vintage, inter-dialysis weight gain, hemoglobin, depression, insomnia, and social support were variables associated with fatigue in HD patients. Based on these factors, a nomogram for assessing fatigue probability in HD patients was developed. The AUC was 0.955 (95% CI: 0.932-0.977) and 0.979 (95% CI: 0.961-0.997) in the training and validation sets. The results from the H-L test indicated a good fit. CONCLUSION: The nomogram can evaluate fatigue probability in HD patients and may serve as a convenient clinical tool.
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Fatiga , Fallo Renal Crónico , Nomogramas , Diálisis Renal , Humanos , Diálisis Renal/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Estudios Transversales , Fatiga/etiología , Fatiga/diagnóstico , Anciano , China/epidemiología , Fallo Renal Crónico/terapia , Fallo Renal Crónico/complicaciones , Curva ROC , Modelos Logísticos , Adulto , Factores de Riesgo , Depresión/etiología , Depresión/diagnósticoRESUMEN
INTRODUCTION: Post-COVID-19 condition (post COVID, also known as long COVID) is a global public health issue estimated to affect over 100 million people. Common symptoms include fatigue, dyspnoea and cognitive dysfunction ('brain fog'). Over time, these symptoms have an adverse effect on mental health, physical activity and quality of life (QoL). The condition requires innovative and feasible treatment approaches that can be effective and self-managed. Physical activity is essential for good health; however, aerobic exercise or weightlifting may not be suitable for post COVID patients who experience fatigue or breathlessness. The benefits of yoga include improved flexibility, mobility, body strength and balance. It is also shown to reduce symptoms of fatigue and improve breathing efficiency, mental health and QoL. This study protocol describes the rationale and methods for a randomised controlled trial (RCT) of a yoga-based intervention designed for adults with post COVID. METHODS AND ANALYSIS: A two-group, parallel, RCT with blinded follow-up assessments. Participants will be randomised with a 1:1 allocation to either a 12-week yoga-based intervention or a 12-week health promotion (active comparison) intervention. In total, 88 participants aged 30-65 years will be recruited and randomised. The primary outcome is health-related QoL (36-item Short-Form). Secondary outcomes are dyspnoea, fatigue, sleep quality, cognitive functions, mental fatigue, depression, anxiety, physical activity, demographic data and physical health measures. Data will be analysed as intention-to-treat basis, using linear mixed modelling. All assessments are conducted at Karolinska Institutet in Stockholm, Sweden. The yoga-based intervention will take place at a yoga studio centrally located in Stockholm city. ETHICS AND DISSEMINATION: The study is approved by the Swedish Ethical Review Authority, reference number 2023/06518-01. All participants must sign written informed consent before enrolment and are free to withdraw from the study at any point. Key results will be available through research articles and seminars. TRIAL REGISTRATION NUMBER: German Clinical Trials Register, DRKS00032837.
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COVID-19 , Promoción de la Salud , Calidad de Vida , Yoga , Humanos , COVID-19/psicología , COVID-19/terapia , Adulto , Promoción de la Salud/métodos , SARS-CoV-2 , Ensayos Clínicos Controlados Aleatorios como Asunto , Femenino , Masculino , Fatiga/terapia , Fatiga/etiología , Ejercicio Físico , Síndrome Post Agudo de COVID-19 , Persona de Mediana EdadRESUMEN
BACKGROUND AND OBJECTIVE: The impairments and duration of PASC (post-acute sequelae of COVID-19) symptoms in mental health have, to date, not been comprehensively examined. Our objective is to provide longitudinal data on the mental health of Post-COVID patients and to identify risk and protective factors associated with a severe or prolonged course. METHODS: The mental health of 265 Post-COVID patients of the outpatient Post-COVID centre of the University Hospital Erlangen was assessed 17.1 (T0) and 22.5 months after infection (T1). An online survey with validated questionnaires for Post-COVID symptoms (Post-COVID Syndrome Score), depression (Patient Health Questionnaire-9), somatic symptoms (Patient Health Questionnaire-15), anxiety (Generalized Anxiety Disorder-7), fatigue (Fatigue Severity Scale) and Post-Exertional Malaise (PEM) (DePaul Post-Exertional Malaise Screening) was conducted in the home environment. RESULTS: In total, 80% of patients experienced severe PASC at follow-up. Clinically relevant symptoms of depression, persistent somatic symptoms, anxiety and fatigue were reported by 55.8%, 72.5%, 18.9% and 89.4% of patients, respectively. Depressive, anxiety and somatic symptom severity decreased significantly over time; fatigue and PEM remained at an unchanged high level. The risk factor for higher depression scores was older age; prior psychiatric illness treated with psychotherapy was associated with more severe depressive, somatic, anxiety and PASC symptoms. PEM symptoms were significantly associated with longer duration between acute infection and initial presentation in the Post-COVID centre. CONCLUSIONS: Our findings align with previous research, claiming severe mental health symptoms in PASC syndrome, lasting for months after infection. In-depth assessment of risk and protective factors for the mental health implications of PASC is needed for the planning of health services and disease prevention.
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COVID-19 , Salud Mental , Medición de Resultados Informados por el Paciente , Síndrome Post Agudo de COVID-19 , Humanos , COVID-19/psicología , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Adulto , Estudios de Seguimiento , Anciano , SARS-CoV-2 , Depresión/epidemiología , Depresión/etiología , Encuestas y Cuestionarios , Ansiedad/epidemiología , Fatiga/etiologíaRESUMEN
BACKGROUND: Post-acute sequelae of COVID-19 (PASC) is incurring a huge health and economic burden worldwide. There is currently no effective treatment or recommended drug for PASC. METHODS: This prospective randomized controlled study was conducted in a hospital in China. The effect of intermittent hypoxia exposure (IHE; 5-min hypoxia alternating with 5-min normal air, repeated five times) on dyspnea and fatigue was investigated in patients meeting the NICE definition of PASC. Patients were computationally randomized to receive normoxia exposure (NE) and routine therapy or IHE and routine therapy. Six-minute walk distance (6MWD) and spirometry were tested before and after the interventions; the Borg Dyspnea Scale (Borg) and the modified Medical Research Council Dyspnea Scale (mMRC) were used to assess dyspnea; and the Fatigue Assessment Scale (FAS) and the Chalder Fatigue Scale-11 (CFQ-11) were used to assess fatigue. The study was registered in the Chinese Clinical Trial Registry (ChiCTR2300070565). FINDINGS: Ninety-five participants (33 males and 62 females) were recruited between March 1, 2023 and December 30, 2023. Forty-seven patients in the IHE group received 10.0 (9.0, 15.0) days of IHE, and 48 patients in NE group received 10.0 (8.0, 12.0) days of NE. 6MWD, forced vital capacity (FVC), FVC %pred, forced expiratory volume in 1 s (FEV1), FEV1 %pred, tidal volume (VT), and dyspnea and fatigue scales markedly improved after IHE (p < 0.05), and improvements were greater than in the NE group (all p < 0.05). Furthermore, participants in IHE group had better subjective improvements in dyspnea and fatigue than those in the NE group (p < 0.05). Compared with <10 days of IHE, ≥10 days of IHE had a greater impact on 6MWD, FVC, FEV1, FEV1 %pred, VT, FAS, and CFQ-11. No severe adverse events were reported. INTERPRETATION: IHE improved spirometry and 6MWD and relieved dyspnea and fatigue in PASC patients. Larger prospective studies are now needed to verify these findings.
Asunto(s)
COVID-19 , Disnea , Fatiga , Hipoxia , Síndrome Post Agudo de COVID-19 , Humanos , Disnea/fisiopatología , Disnea/etiología , Masculino , Femenino , COVID-19/complicaciones , COVID-19/fisiopatología , Fatiga/etiología , Fatiga/fisiopatología , Persona de Mediana Edad , Estudios Prospectivos , Hipoxia/fisiopatología , Adulto , Prueba de Paso/métodos , Anciano , Espirometría/métodos , ChinaRESUMEN
BACKGROUND AND OBJECTIVES: Cognitive impairment (CI) in multiple sclerosis (MS) is frequent and determined by a complex interplay between inflammatory and neurodegenerative processes. We aimed to investigate whether CSF parvalbumin (PVALB), measured at the time of diagnosis, may have a prognostic role in patients with MS. METHODS: In this cohort study, CSF analysis of PVALB and Nf-L levels was performed on all patients at diagnosis (T0) and combined with physical, cognitive, and MRI assessment after an average of 4 years of follow-up (T4) from diagnosis. Cognitive performance was evaluated with a comprehensive neuropsychologic battery: both global (cognitively normal, CN, mildly CI, mCI, and severely CI, sCI) and domain cognitive status (normal/impaired in memory, attention/information processing speed, and executive functions) were considered. Cortical thickness and gray matter volume data were acquired using 3T MRI scanner. RESULTS: A total of 72 patients with MS were included. At diagnosis, PVALB levels were higher in those patients who showed a worsening physical disability after 4 years of follow-up (p = 0.011). CSF PVALB levels were higher in sCI patients than in CN (p = 0.033). Moreover, higher PVALB levels significantly correlated with worse global cognitive (p = 0.024) and memory functioning (p = 0.044). A preliminary clinical threshold for PVALB levels at diagnosis was proposed (2.57 ng/mL), which maximizes the risk of showing CI (in particular, sCI) at follow-up, with a sensitivity of 91% (specificity 30%). No significant results were found for these associations with Nf-L. In addition, patients with higher levels of PVALB at diagnosis showed higher cognitive (p = 0.024) and global fatigue (p = 0.043) at follow-up. Finally, higher PVALB levels also correlated significantly with more pronounced CTh/volume at T4 in the inferior frontal gyrus (p = 0.044), postcentral gyrus (p = 0.025), frontal pole (p = 0.042), transverse temporal gyrus (p = 0.008), and cerebellar cortex (p = 0.041) and higher atrophy (change T0-T4) in the right thalamus (p = 0.038), pericalcarine cortex (p = 0.009), lingual gyrus (p = 0.045), and medial frontal gyrus (p = 0.028). DISCUSSION: The significant association found between parvalbumin levels in the CSF at diagnosis and cognitive, clinical, and neuroradiologic worsening after 4 years of follow-up support the idea that parvalbumin, in addition to Nf-L, might represent a new potential prognostic biomarker, reflecting MS neurodegenerative processes occurring since early disease stages.
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Disfunción Cognitiva , Fatiga , Sustancia Gris , Esclerosis Múltiple , Parvalbúminas , Humanos , Masculino , Femenino , Disfunción Cognitiva/líquido cefalorraquídeo , Disfunción Cognitiva/etiología , Disfunción Cognitiva/diagnóstico , Persona de Mediana Edad , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Adulto , Esclerosis Múltiple/líquido cefalorraquídeo , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/diagnóstico , Esclerosis Múltiple/diagnóstico por imagen , Parvalbúminas/líquido cefalorraquídeo , Fatiga/líquido cefalorraquídeo , Fatiga/etiología , Imagen por Resonancia Magnética , Pronóstico , Estudios de Seguimiento , Estudios de Cohortes , Progresión de la Enfermedad , Biomarcadores/líquido cefalorraquídeo , Proteínas de NeurofilamentosRESUMEN
BACKGROUND: Cognitive dysfunction is frequently seen in multiple sclerosis (MS). However, there are conflicting findings regarding the factors it is associated with. OBJECTIVE: To investigate the relationship between aerobic capacity, strength, disability, depression, fatigue, and cognitive reserve and function. METHODS: The mobile applications Trail Making Test (TMT A-B), Digit Span Test (DST), Visuospatial Memory Test (VSMT), and Tap Fast were used in the cognitive function evaluation. Functional performance was assessed with the 6-minute walk test (6MWT), 5-Time Sit-to-Sand (5STS) test, and grip strength. Cognitive Reserve Index (CRI), Beck Depression Inventory, Fatigue Severity Scale (FSS), and Nottingham Health Profile were also used. RESULTS: A significant difference was found between the MS and control groups only in the 6MWT, STS-5, grip strength, TMT, VSMT, and Tap Fast. Good correlation was found between the TMT-A and 6MWT and physical mobility. A fair correlation was shown between grip strength, energy, and pain status. A good correlation was found between TMT-B and 6MWT, and a fair relationship with disability, cognitive reserve, and pain. Good correlation was observed between the DST and 6MWT, left grip strength, pain, and energy status; fair correlations were found between right grip strength, cognitive reserve, and physical mobility. Good correlation was found between the VSMT and energy. A fair relationship between disability, cognitive reserve, and pain was demonstrated. Good correlation was observed between the Tap Fast score and disability, 5STS, FSS, energy, and physical mobility. A fair relationship was found between pain and social isolation. CONCLUSION: It has been shown that cognitive performance in MS is related to disability, functional performance, cognitive reserve, fatigue, and general health. TRIAL REGISTRATION: NCT06084182.
ANTECEDENTES: A disfunção cognitiva é frequentemente observada na esclerose múltipla (EM). No entanto, existem resultados conflitantes sobre os fatores aos quais está associada. OBJETIVO: Investigar a relação entre capacidade aeróbica, força, incapacidade, depressão, fadiga e reserva e função cognitiva. MéTODOS: Os aplicativos móveis Trail Making Test (TMT A-B), Digit Span Test (DST), Visuoespacial Memory Test (VSMT) e Tap Fast foram utilizados na avaliação da função cognitiva. O desempenho funcional foi avaliado por meio do teste de caminhada de 6 minutos (TC6), Teste de Sentar-Levantar Cinco Vezes (TSL5) e força de preensão manual. Também foram utilizados Índice de Reserva Cognitiva (IRC), Inventário de Depressão de Beck, Escala de Gravidade de Fadiga (EGF) e Perfil de Saúde de Nottingham. RESULTADOS: Foi encontrada diferença significativa entre os grupos EM e controle apenas no TC6, TSL5, força de preensão, TMT, VSMT e Tap Fast. Foi encontrada boa correlação entre o TMT-A e o TC6 e a mobilidade física. Foi demonstrada uma correlação razoável entre força de preensão, energia e estado de dor. Foi encontrada uma boa correlação entre o TMT-B e o TC6, e uma relação razoável com incapacidade, reserva cognitiva e dor. Foi observada boa correlação entre o DST e o TC6, força de preensão esquerda, dor e estado energético; correlações justas foram encontradas entre força de preensão direita, reserva cognitiva e mobilidade física. Foi encontrada boa correlação entre o VSMT e a energia. Foi demonstrada uma relação justa entre incapacidade, reserva cognitiva e dor. Foi observada boa correlação entre o escore Tap Fast e incapacidade, TLS5, EGF, energia e mobilidade física. Foi encontrada uma relação justa entre dor e isolamento social. CONCLUSãO: Foi demonstrado que o desempenho cognitivo na EM está relacionado com incapacidade, desempenho funcional, reserva cognitiva, fadiga e saúde geral. REGISTRO DE TESTE: NCT06084182.
Asunto(s)
Reserva Cognitiva , Evaluación de la Discapacidad , Fatiga , Esclerosis Múltiple , Tiempo de Reacción , Humanos , Masculino , Esclerosis Múltiple/fisiopatología , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/psicología , Reserva Cognitiva/fisiología , Femenino , Adulto , Persona de Mediana Edad , Fatiga/fisiopatología , Fatiga/etiología , Tiempo de Reacción/fisiología , Cognición/fisiología , Pruebas Neuropsicológicas , Fuerza de la Mano/fisiología , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/etiología , Depresión/fisiopatología , Estudios de Casos y Controles , Prueba de Paso , Estudios Transversales , Valores de Referencia , Estadísticas no ParamétricasRESUMEN
Patients consistently rate cancer-related fatigue (CrF) as the most prevalent and debilitating symptom. CrF is an important but often neglected patient concern, partly due to barriers to implementing evidence-based interventions. This study explored what an ideal intervention for CrF would look like from the perspectives of different stakeholders and the barriers to its implementation. Three participant populations were recruited: healthcare providers (HCPs; n = 32), community support providers (CSPs; n = 14), and cancer patients (n = 16). Data were collected via nine focus groups and four semi-structured interviews. Data were coded into themes using content analysis. Two main themes emerged around addressing CrF: "It takes a village" and "This will not be easy". Participants discussed an intervention for CrF could be anywhere, offered by anyone and everyone, and provided early and frequently throughout the cancer experience and could include peer support, psychoeducation, physical activity, mind-body interventions, and interdisciplinary care. Patients, HCPs, and CSPs described several potential barriers to implementation, including patient barriers (i.e., patient variability, accessibility, online literacy, and overload of information) and systems barriers (i.e., costs, lack of HCP knowledge, system insufficiency, and time). As CrF is a common post-treatment symptom, it is imperative to offer patients adequate support to manage CrF. This study lays the groundwork for the implementation of a patient-centered intervention for CrF in Canada and possibly elsewhere.
Asunto(s)
Fatiga , Personal de Salud , Neoplasias , Humanos , Neoplasias/complicaciones , Fatiga/terapia , Fatiga/etiología , Personal de Salud/psicología , Femenino , Masculino , Persona de Mediana Edad , Adulto , Investigación Cualitativa , Anciano , Grupos FocalesRESUMEN
BACKGROUND: After COVID-19 infection, 10-20% of patients suffer from varying symptoms lasting more than 12 weeks (Long COVID, LC). Exercise intolerance and fatigue are common in LC. The aim was to measure the maximal exercise capacity of the LC patients with these symptoms and to analyze whether this capacity was related to heart rate (HR) responses at rest and during exercise and recovery, to find out possible sympathetic overactivity, dysautonomia or chronotropic incompetence. METHODS: Cardiopulmonary exercise test was conducted on 101 LC patients, who were admitted to exercise testing. The majority of them (86%) had been treated at home during their acute COVID-19 infection. Peak oxygen uptake (VO2peak), maximal power during the last 4 min of exercise (Wlast4), HRs, and other exercise test variables were compared between those with or without subjective exercise intolerance, fatigue, or both. RESULTS: The measurements were performed in mean 12.7 months (SD 5.75) after COVID-19 infection in patients with exercise intolerance (group EI, 19 patients), fatigue (group F, 31 patients), their combination (group EI + F, 37 patients), or neither (group N, 14 patients). Exercise capacity was, in the mean, normal in all symptom groups and did not significantly differ among them. HRs were higher in group EI + F than in group N at maximum exercise (169/min vs. 158/min, p = 0.034) and 10 min after exercise (104/min vs. 87/min, p = 0.028). Independent of symptoms, 12 patients filled the criteria of dysautonomia associated with slightly decreased Wlast4 (73% vs. 91% of sex, age, height, and weight-based reference values p = 0.017) and 13 filled the criteria of chronotropic incompetence with the lowest Wlast4 (63% vs. 93%, p < 0.001), VO2peak (70% vs. 94%, p < 0.001), the lowest increase of systolic blood pressure (50 mmHg vs. 67 mmHg, p = 0.001), and the greatest prevalence of slight ECG-findings (p = 0.017) compared to patients without these features. The highest prevalence of chronotropic incompetence was seen in the group N (p = 0.022). CONCLUSIONS: This study on LC patients with different symptoms showed that cardiopulmonary exercise capacity was in mean normal, with increased sympathetic activity in most patients. However, we identified subgroups with dysautonomia or chronotropic incompetence with a lowered exercise capacity as measured by Wlast4 or VO2peak. Subjective exercise intolerance and fatigue poorly foresaw the level of exercise capacity. The results could be used to plan the rehabilitation from LC and for selection of the patients suitable for it.