Ingestion of taxifolin-rich foods affects brain activity, mental fatigue, and the whole blood transcriptome in healthy young adults: a randomized, double-blind, placebo-controlled, crossover study.

The antioxidant properties of polyphenols, which are found in most plants, have been shown to be useful for maintaining health, including enhancing brain function and alleviating stress. We aimed to investigate the effect of a single intake of taxifolin-containing foods on cognitive task performance and whole blood gene expression in healthy young adults. This study was a randomized, placebo-controlled, double-blind, crossover trial in which healthy young adults were administered a single dose of either a placebo or food containing taxifolin. Cognitive tests (serial 3s, serial 7s, and rapid visual information processing) to examine brain activity and visual analog scale questionnaires to analyze mental fatigue were applied. The set of tests was repeated four times. The findings showed that taxifolin intake improved calculation abilities and reduced mental fatigue. An analysis of whole blood gene expression before and after the test revealed that the expression of foreign substance removal-related genes increased following the ingestion of taxifolin and that most differentially expressed genes were enriched in granulocytes. Taxifolin intake was shown to affect the brain activity of healthy young adults and demonstrated an antifatigue effect, thereby reducing subjective fatigue. A single intake of taxifolin may enhance the removal of foreign substances by strengthening the innate immune system and suppressing the occurrence of injury.

Research on the relationship between sports scientific training and athletes' mental health / Pesquisa sobre a relação entre o treinamento científico do esporte e a saúde mental de atletas / Investigación sobre la relación entre el entrenamiento científico deportivo y la salud mental de los deportistas

ABSTRACT Introduction: Regarding sports mental fatigue research, foreign countries mainly discuss the theoretical model of mental exhaustion. Among them, Silva's theoretical model believes that sports mental fatigue is a negative training stress response. Domestic research mainly analyzes and discusses the concept, causes, and monitoring of mental fatigue. Objective: This study explores the relationship between sports fatigue and mental health of elite athletes through investigation and analysis; analyzes whether social support plays a moderating role in training stress and how aspect support plays an important role. Methods: Based on the stress theory and the negative training stress response model theory, the paper used the Mental Health Inventory (PHI), Athlete Exercise Fatigue Questionnaire, Social Support Rating Scale, and Perceived Social Support Scale to analyze 163 outstanding athletes above the first level. Carry out investigation, use SPSS10.0 software to carry out reliability analysis, Pearson correlation analysis, and multiple linear stepwise regression analysis. Results: The mental health level of elite athletes is closely related to the degree of sports fatigue, and the correlation coefficients between most factors have reached a significant level. The physical (emotional) exhaustion in sports fatigue is an important predictor of the mental health of elite athletes; age, sports grade, economic conditions, perceived family support, and mental health are important predictors of sports fatigue for elite athletes; social support is an important external "buffer" in the process of training stress, in which family support and emotional support play a major regulatory role. Conclusions: The research results can provide references for maintaining and promoting athletes' physical and mental health, provide some useful references for mental health education of sports teams, and provide empirical data for sports psychology and health psychology. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: Em relação à pesquisa sobre fadiga mental no esporte, os países estrangeiros discutem principalmente o modelo teórico de esgotamento mental. Entre eles, o modelo teórico de Silva acredita que a fadiga mental esportiva é uma resposta negativa ao estresse do treinamento. A pesquisa doméstica examina e discute principalmente o conceito, as causas e o monitoramento da fadiga mental. Objetivo: Este estudo explora a relação entre fadiga esportiva e saúde mental em atletas de elite por meio de pesquisa e análise; se o suporte social desempenha um papel moderador no treinamento de estresse e como os suportes de aparência desempenham um papel importante. Métodos: Com base na teoria do estresse e na teoria do modelo de resposta negativa ao estresse do treinamento, o artigo utilizou o Mental Health Inventory (PHI), o Athlete Exercise Fatigue Questionnaire, a Social Support Rating Scale e a Perceived Social Support Scale para analisar 163 atletas de destaque. Realizamos uma investigação e usamos o software SPSS10.0 para realizar a análise de confiabilidade, a análise de correlação de Pearson e a análise de regressão linear múltipla stepwise. Resultados: O nível de saúde mental de atletas de elite está intimamente relacionado ao grau de fadiga esportiva, e os coeficientes de correlação entre a maioria dos fatores atingiram um nível significativo. A exaustão física (emocional) na fadiga esportiva é um importante preditor de saúde mental em atletas de elite; idade, nível atlético, condições econômicas, apoio familiar percebido e saúde mental são importantes preditores de fadiga esportiva para atletas de elite; O suporte social é um importante "amortecedor" externo no processo de treinamento do estresse, no qual o suporte familiar e emocional desempenham um papel regulador importante. Conclusiones: Los resultados de la investigación pueden proporcionar referencias para mantener y promover la salud física y mental de los atletas, proporcionar algunas referencias útiles para la educación en salud mental de los equipos deportivos y proporcionar datos empíricos para la psicología del deporte y la psicología de a saúde. Nível de evidência II; Estudos terapêuticos: investigação dos resultados do tratamento.

RESUMEN Introducción: En cuanto a la investigación sobre la fatiga mental deportiva, los países extranjeros discuten principalmente el modelo teórico del agotamiento mental. Entre ellos, el modelo teórico de Silva cree que la fatiga mental deportiva es una respuesta negativa al estrés del entrenamiento. La investigación doméstica examina y discute principalmente el concepto, las causas y el seguimiento de la fatiga mental. Objetivo: Este estudio explora la relación entre la fatiga deportiva y la salud mental de los deportistas de élite a través de la investigación y el análisis; si el apoyo social juega un papel moderador en el entrenamiento del estrés y cómo los apoyos de aspecto juegan un papel importante. Métodos: Basado en la teoría del estrés y la teoría del modelo de respuesta negativa al estrés del entrenamiento, el documento utilizó el Inventario de Salud Mental (PHI), el Cuestionario de Fatiga del Ejercicio del Atleta, la Escala de Calificación de Apoyo Social y la Escala de Apoyo Social Percibido para analizar 163 atletas destacados. Realizamos una investigación, y utilizamos el software SPSS10.0 para realizar análisis de confiabilidad, análisis de correlación de Pearson y análisis de regresión lineal múltiple por pasos. Resultados: El nivel de salud mental de los deportistas de élite está estrechamente relacionado con el grado de fatiga deportiva, y los coeficientes de correlación entre la mayoría de factores han alcanzado un nivel significativo. El agotamiento físico (emocional) en la fatiga deportiva es un importante predictor de la salud mental de los deportistas de élite; la edad, el nivel deportivo, las condiciones económicas, el apoyo familiar percibido y la salud mental son predictores importantes de la fatiga deportiva para los atletas de élite; El apoyo social es un importante "amortiguador" externo en el proceso de entrenamiento del estrés, en el que el apoyo familiar y el apoyo emocional juegan un papel regulador importante. Conclusiones: Los resultados de la investigación pueden proporcionar referencias para mantener y promover la salud física y mental de los atletas, proporcionar algunas referencias útiles para la educación en salud mental de los equipos deportivos y proporcionar datos empíricos para la psicología del deporte y la psicología de la salud. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

The impact of reader fatigue on the accuracy of capsule endoscopy interpretation.

BACKGROUND AND AIMS: Capsule endoscopy (CE) interpretation requires the review of many thousands of images, with lesions often limited to just a few frames. In this study we aim to determine whether lesion detection declines according to the number of capsule videos read. METHODS: 32 participants, 16 of which were novices (NR) and 16 experienced (ER) capsule readers took part in this prospective evaluation study. Participants read six capsule cases with a variety of lesions, in a randomly assigned order during a single sitting. Psychomotor Vigilance Tests and Fatigue Scores were recorded prior to commencing and then after every two capsules read. Changes in lesion detection and measures of fatigue were assessed across the duration of the study. RESULTS: Mean agreement with the predefined lesions was 48.3% (SD:16.1), and 21.3% (SD:15.1) for the experienced and novice readers respectively. Lesion detection declined amongst experienced reader after the first study (p = 0.01), but remained stable after subsequent capsules read, while NR accuracy was unaffected by capsule numbers read. Objective measures of fatigue did not correlate with reading accuracy. CONCLUSION: This study demonstrates that reader accuracy declines after reading just one capsule study. Subjective and objective measures of fatigue were not sufficient to predict the onset of the effects of fatigue.

Endurance exercise-induced and mental fatigue and the brain.

NEW FINDINGS: What is the topic of this review? It provides an overview of the recent papers linking brain neurotransmission with exercise-induced and/or mental fatigue. What advances does it highlight? The noradrenergic neurotransmitter system hastens central fatigue during prolonged exercise, a finding that coincides with a faster rate of increase in the rating of perceived exertion. 2) Mental fatigue affects several neurotransmitter systems, with presumably an important role for dopamine and adenosine, in multiple brain regions such as the prefrontal cortex and the anterior cingulate cortex. ABSTRACT: In sports and exercise science, fatigue is an elusive concept that has important implications in performance during exercise. It has been described in many ways (tiredness, exhaustion, lethargy or weariness) and describes a physical and/or mental state of being tired and lack of energy. Exercise-induced fatigue can be defined as an acute impairment of exercise performance, and a distinction has been made between peripheral and central fatigue. Mental fatigue can be defined as a psychobiological state caused by prolonged exertion that has the potential to reduce cognitive performance and exercise performance. Recent studies have given clear indications that brain catecholamines are involved in the onset of fatigue during endurance exercise. Evidence is provided indicating that the noradrenergic neurotransmitter system hastens central fatigue, a finding that coincides with a faster rate of increase in the rating of perceived exertion. Brain neurotransmission is also suggested to play an important role in mental fatigue. Several neurotransmitter systems might be implicated (with the most important role for dopamine and adenosine) in multiple brain regions, such as the prefrontal cortex and the anterior cingulate cortex, and the summation of these alterations might explain the impairment in endurance performance in a mentally fatigued state. Obviously, we have to keep in mind that fatigue is a very complex construct and that, besides brain neurochemistry, several other factors play a role in its onset.

A multidimensional analysis of the longitudinal effects of roux en y gastric bypass on fatigue: An association with visceral obesity.

BACKGROUND AND OBJECTIVES: Severe obesity is associated with fatigue, however, the effects of weight loss after bariatric surgery on particular dimensions of fatigue are unknown. In a secondary analysis of a prospective cohort study of women undergoing roux-en-y gastric bypass (RYGB) we explored relationships among multiple dimensions of fatigue and improving adiposity, insulin resistance and inflammation. METHODS: Before, and 1 and 6 months after RYBG, dimensions of fatigue were assessed using the validated, self-report, Multidimensional Fatigue Inventory. Total, abdominal visceral (VAT) and subcutaneous (SAT) adiposity, insulin sensitivity (Si and HOMA) and plasma concentrations of leptin, C-reactive protein (CRP) and interleukin-6 (Il-6) were measured using air displacement plethysmography, computed tomography, glucose tolerance testing and enzyme-linked immunoassay. Associations were assessed using Spearman correlations and linear regression. RESULTS: At baseline, the majority of our female participants (N = 19, body mass index, 46.5 kg/m2, age 37.2 years) were experiencing elevated levels of fatigue. By 6 months, dimensions of physical (-43%), reduced activity (-43%), reduced motivation (-38%), general (-31%; all p < .005), and mental (-18%, p < .05) fatigue improved, concomitant with decreases in markers of adiposity, inflammation and insulin resistance. The decrease in VAT was associated with improvement in mental fatigue (beta, 0.447 ±â€¯0.203, p = .045), independent of other indices of adiposity, IL-6 concentrations, or Si. CONCLUSIONS: In the 6 months after RYGB, fatigue improved, especially physical fatigue. Decreases in mental fatigue were strongly associated with decreases in visceral adiposity. Nevertheless, the biologic mechanisms underlying changes in these specific fatigue dimensions remain undetermined.

Lower Fatigue in Fit and Positive Women with Fibromyalgia: The al-Ándalus Project.

OBJECTIVE: To analyze 1) the independent association of physical fitness, positive affect, and negative affect with the different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue) and 2) whether the interactions of physical fitness, positive affect, and negative affect were associated with fatigue over and above the independent association. DESIGN: Cross-sectional study in 420 women with fibromyalgia. SETTING: Fibromyalgia associations from southern Spain. METHODS: Physical fitness was measured by performance-based tests, and questionnaires were used to measure positive affect, negative affect, and different dimensions of fatigue (general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue). Age, body mass index, and current pain level were included as potential confounders in all analyses. RESULTS: Physical fitness was independently associated with general fatigue, physical fatigue, and reduced activity (all P ≤ 0.02). Positive affect was independently associated with all fatigue dimensions (all P < 0.001). Negative affect was independently associated with general fatigue, physical fatigue, reduced motivation, and mental fatigue (all P ≤ 0.04). The interaction of overall physical fitness and positive affect was related to general fatigue and physical fatigue (all P ≤ 0.02). Women with fibromyalgia with higher levels of overall physical fitness and positive affect showed the lowest general fatigue and physical fatigue. CONCLUSIONS: In women with fibromyalgia, positive affect was independently and consistently associated with all dimensions of fatigue. The combination of higher levels of overall physical fitness and positive affect might serve as a buffer against general and physical fatigue in women with fibromyalgia.

Effectiveness of cognitive-behavioral therapy (CBT) in improving the quality of life and psychological fatigue in women with polycystic ovarian syndrome: a randomized controlled clinical trial.

Introduction: Given the increasing prevalence of complications caused by the polycystic ovarian syndrome (PCOS) such as medical and psychological problems and also the chronicity of this disease, patients with the PCOS tend to experience lower quality of life and greater psychological fatigue similar to other patients with chronic diseases. This study was conducted to determine the effects of cognitive-behavioral therapy (CBT) on the quality of life and psychological fatigue in women with the PCOS. Methods: This randomized controlled clinical trial study, conducted from 2016 to 2017, enrolled 74 women aged between 18 and 35 years from the Iranian city of Saqqez. The participants were assigned to a CBT group and a control group via block randomization. The intervention group received 8 weekly CBT sessions between 45 and 60 minutes each. The Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ) and the Fatigue Impact Scale (FIS) were completed by the patients before and after the intervention. Results: No significant differences were observed between the two groups before the intervention in terms of sociodemographic characteristics and the mean scores of quality of life and psychological fatigue. After the intervention, the mean (standard deviation [SD]) of the quality of life score was 60.2 (13.3) in the intervention group and 24.4 (15) in the control group, with the mean score of quality of life being significantly higher in the intervention group than in the control group (adjusted mean difference = 33.1). The mean (SD) score of psychological fatigue was 28.2 (13.9) in the intervention group and 78.2 (37.1) in the control group, with the mean score of psychological fatigue being significantly lower in the intervention group than in the control group (-54.8). Conclusions: The results showed that CBT was able to reduce fatigue and improve quality of life in our sample of women with the PCOS and ultimately boost their health.

Effect of Yoga Therapy on Symptoms of Anxiety in Cancer Patients.

BACKGROUND: Many cancer patients suffer from symptoms of anxiety, depression, and fatigue. Supportive treatments are increasingly used to alleviate distress in cancer. In this study, the effects of yoga on these symptoms are examined. METHODS: We performed a randomized controlled study on cancer patients with mixed diagnoses comparing yoga therapy with a waiting list control group. We measured anxiety symptoms with the General Anxiety Disorder (GAD-7) scale, depressive symptoms with the Patient Health Questionnaire-2 (PHQ-2), and fatigue with the European Organisation for Research and Treatment of Cancer Fatigue scale (EORTC QLQ-FA13). Yoga therapy was carried out in weekly sessions of 60 min each for 8 weeks. The program provided restrained body and breathing exercises as well as meditation. The control group did not receive any yoga therapy while on the waiting list. RESULTS: A total of 70 subjects participated in the study. Anxiety was significantly reduced by the yoga therapy in the intervention group compared to the control group (p = 0.005). However, yoga therapy did not show any significant effects on depression (p = 0.21) and fatigue (p = 0.11) compared to the control group. CONCLUSION: Yoga therapy may be used to alleviate anxiety symptoms in cancer patients and should be the subject of further research.

Psychometric properties of the fatigue questionnaire EORTC QLQ-FA12 and proposal of a cut-off value for young adults with cancer.

BACKGROUND: Young adult patients with cancer have to deal with their disease in an eventful phase of life. A common side effect of cancer and its treatment is cancer-related fatigue (CRF), a phenomenon which can thwart successful coping with developmental tasks. The aims of this study were to assess the psychometric properties of the EORTC QLQ-FA12, a new instrument for assessing physical, emotional and cognitive fatigue, in young adults with cancer, and to propose a cut-off value that indicates a need for further more specific diagnostics. METHODS: In a sample of young adults who were first diagnosed with cancer between the ages of 18 and 39 years old, we assess the composite and item reliabilities as well as discriminant validity of the subscales for the EORTC QLQ-FA12. We also discuss two possible ways to calculate a summarizing score when conducting a receiver operating characteristic (ROC) analysis to find the cut-off value. RESULTS: The EORTC QLQ-FA12 fit the sample (CFI = 0.96, SRMR = 0.04), had discriminant validity regarding its subscales and every subscale showed convergent validity (composite reliabilities were 0.92 for physical, 0.89 for emotional and 0.74 for cognitive fatigue). The sum of the first ten items with a range of 0 to 30 revealed a cut-off value of twelve or more with 91% sensitivity and 77% specificity. CONCLUSION: The new instrument EORTC QLQ-FA12 is able to distinguish between physical, emotional, and cognitive fatigue in young adult patients. It enables us to study different concepts of general fatigue without the need for additional items, and can be used as a screening instrument for young adults. Future research should investigate the multidimensional character of CRF.

Assessment of cognitive function in patients with stress-related exhaustion using the Cognitive Assessment Battery (CAB).

INTRODUCTION: The health care system is facing an increased number of patients seeking care for burnout/stress-related exhaustion. One of the core features of this condition is cognitive impairment-effective and easy tools are needed to assess cognition in this patient group. Our objective was to determine whether the Cognitive Assessment Battery (CAB) could be used for this purpose. METHOD: Ninety-three patients diagnosed with exhaustion disorder (ED) and 111 controls were included in the study and tested with CAB. CAB consists of six short tests covering the cognitive domains speed and attention, episodic memory, visuospatial, language, and executive functions. The patients also completed questionnaires on subjective memory problems, degree of burnout, anxiety, and depression. RESULTS: The patients performed worse than the controls on four tests of speed and attention, language, and executive function. Subjective memory problems, degree of burnout, and anxiety did not influence cognitive performance, only degree of depression influenced performance negatively on an executive test. CONCLUSION: CAB is a useful instrument for rapid, comprehensive screening of cognitive status in patients with stress-related exhaustion. Using it, we confirmed the most replicated findings regarding cognitive impairments in patients with stress-related exhaustion.

A caffeine-maltodextrin mouth rinse counters mental fatigue.

INTRODUCTION: Mental fatigue is a psychobiological state caused by prolonged periods of demanding cognitive activity that has negative implications on many aspects in daily life. Caffeine and carbohydrate ingestion have been shown to be able to reduce these negative effects of mental fatigue. Intake of these substances might however be less desirable in some situations (e.g., restricted caloric intake, Ramadan). Rinsing caffeine or glucose within the mouth has already been shown to improve exercise performance. Therefore, we sought to evaluate the effect of frequent caffeine-maltodextrin (CAF-MALT) mouth rinsing on mental fatigue induced by a prolonged cognitive task. METHODS: Ten males (age 23 ± 2 years, physical activity 7.3 ± 4.3 h/week, low CAF users) performed two trials. Participants first completed a Flanker task (3 min), then performed a 90-min mentally fatiguing task (Stroop task), followed by another Flanker task. Before the start and after each 12.5% of the Stroop task (eight blocks), subjects received a CAF-MALT mouth rinse (MR: 0.3 g/25 ml CAF: 1.6g/25 ml MALT) or placebo (PLAC: 25 ml artificial saliva). RESULTS: Self-reported mental fatigue was lower in MR (p = 0.017) compared to PLAC. Normalized accuracy (accuracy first block = 100%) was higher in the last block of the Stroop in MR (p = 0.032) compared to PLAC. P2 amplitude in the dorsolateral prefrontal cortex (DLPFC) decreased over time only in PLAC (p = 0.017). CONCLUSION: Frequent mouth rinsing during a prolonged and demanding cognitive task reduces mental fatigue compared to mouth rinsing with artificial saliva.

International Psychometric Validation of an EORTC Quality of Life Module Measuring Cancer Related Fatigue (EORTC QLQ-FA12).

Background: The European Organisation for Research and Treatment of Cancer (EORTC) Group has developed a new multidimensional instrument measuring cancer-related fatigue to be used in conjunction with the quality of life core questionnaire (EORTC QLQ-C30). The module EORTC QLQ-FA13 assesses physical, cognitive, and emotional aspects of cancer-related fatigue. Methods: The methodology follows the EORTC guidelines for phase IV validation of modules. This paper focuses on the results of the psychometric validation of the factorial structure of the module. For validation and cross-validation confirmatory factor analysis (maximum likelihood estimation), intraclass correlation and Cronbach alpha for internal consistency were employed. The study involved an international multicenter collaboration of 11 European and non-European countries. Results: A total of 946 patients with various tumor diagnoses were enrolled. Based on the confirmatory factor analysis, we could approve the three-dimensional structure of the module. Removing one item and reassigning the factorial mapping of another item resulted in the EORTC QLQ-FA12. For the revised scale, we found evidence supporting good local (indicator reliability ≥ 0.60, factor reliability ≥ 0.82) and global model fit (GFI t1|t2 = 0.965/0.957, CFI t1|t2 = 0.976/0.972, RMSEA t1|t2 = 0.060/0.069) for both measurement points. For each scale, test-retest reliability proved to be very good (intraclass correlation: R t1-t2 = 0.905-0.921) and internal consistency proved to be good to high (Cronbach alpha = .79-.90). Conclusion: Based on the former phase III module, the multidimensional structure was revised as a phase IV module (EORTC FA12) with an improved scale structure. For a comprehensive validation of the EORTC FA12, further aspects of convergent and divergent validity as well as sensitivity to change should be determined.

Burnout syndrome prevalence in physiotherapists

Summary Objective: To evaluate burnout syndrome in its three aspects, jointly as well as independently, in physiotherapists from the Extremadura region (Spain). Method: Analytic descriptive epidemiological transversal trial in primary care and institutional practice, with physiotherapists practicing in Extremadura who met the inclusion criteria, after having signed an informed consent form. Emotional exhaustion, depersonalization and low professional accomplishment were the outcomes measured. Results: Physiotherapists from Extremadura show a 65.23 point level of burnout syndrome, according to the Maslach Burnout Inventory questionnaire. Therefore, they are positioned in the middle of the rating scale for the syndrome, and very near to the high level at starting score of 66 points. Conclusion: Physiotherapists in Extremadura present moderate scores for the three dimensions of burnout syndrome, namely, emotional exhaustion, depersonalization and low professional accomplishment. For this reason, they are in the moderate level of the syndrome and very near to the high level, which starts at a score of 66 points. No relation between burnout syndrome and age has been found in our study.

Room for depressed and exhausted mood as a risk predictor for all-cause and cardiovascular mortality beyond the contribution of the classical somatic risk factors in men.

BACKGROUND AND AIMS: Depressed mood and exhaustion (DEEX) have gained attention as a risk predictor for cardiovascular disease (CVD). Studies to estimate its ranking in prediction models are sparse. METHODS: The study included 3428 men aged 45-74 years who participated in one of three population-based MONICA/KORA Augsburg surveys conducted between 1984 and 1995. Within a follow-up time of 10 years (31,791 person-years), 557 cases of all-cause mortality and 269 fatal CVD events were observed. Adjusted Cox proportional hazards models were used to assess mortality risks for DEEX and five classical cardiovascular risk factors. The predictive ability was evaluated by the area under the receiver-operating characteristic curve, the integrated discrimination improvement statistics and the net classification improvement. RESULTS: The (crude) absolute mortality risk for DEEX was 23.1 cases per 1000 person-years for all-cause and 11.2 for CVD mortality. The adjusted hazard ratios of 1.52 for all-cause and 1.52 for CVD mortality (p < 0.01) were higher than those for hypercholesterolemia and obesity, but lower than for hypertension, smoking and diabetes. The improvements in risk prediction from DEEX were comparable to those of hypercholesterolemia and obesity, but substantially lower than those of hypertension, smoking and diabetes. The adjusted population-attributable risk (PAR) for DEEX accounted for about 15% for all-cause and CVD mortality, which gives DEEX a middle ranking amongst the classical risk factors. CONCLUSIONS: DEEX is a strong predictor of mortality risk, ranking in a medium position amongst classical somatic risk factors.

Long-Term Quality of Life in Adult Survivors of Pediatric Differentiated Thyroid Carcinoma.

Context: Little is known about long-term quality of life (QoL) of survivors of pediatric differentiated thyroid carcinoma. Therefore, this study aimed to evaluate generic health-related QoL (HRQoL), fatigue, anxiety, and depression in these survivors compared with matched controls, and to evaluate thyroid cancer-specific HRQoL in survivors only. Design: Survivors diagnosed between 1970 and 2013 at age ≤18 years, were included. Exclusion criteria were a follow-up <5 years, attained age <18 years, or diagnosis of DTC as a second malignant neoplasm (SMN). Controls were matched by age, sex, and socioeconomic status. Survivors and controls were asked to complete 3 questionnaires [Short-Form 36 (HRQoL), Multidimensional Fatigue Inventory 20 (fatigue), and Hospital Anxiety and Depression Scale (anxiety/depression)]. Survivors completed a thyroid cancer-specific HRQoL questionnaire. Results: Sixty-seven survivors and 56 controls. Median age of survivors at evaluation was 34.2 years (range, 18.8 to 61.7). Median follow-up was 17.8 years (range, 5.0 to 44.7). On most QoL subscales, scores of survivors and controls did not differ significantly. However, survivors had more physical problems (P = 0.031), role limitations due to physical problems (P = 0.021), and mental fatigue (P = 0.016) than controls. Some thyroid cancer-specific complaints (e.g., sensory complaints and chilliness) were present in survivors. Unemployment and more extensive disease or treatment characteristics were most frequently associated with worse QoL. Conclusions: Overall, long-term QoL in survivors of pediatric DTC was normal. Survivors experienced mild impairment of QoL in some domains (physical problems, mental fatigue, and various thyroid cancer-specific complaints). Factors possibly affecting QoL need further exploration.

Fatigue in sarcoidosis and idiopathic pulmonary fibrosis: differences in character and severity between diseases.

BACKGROUND: Sarcoidosis and idiopathic pulmonary fibrosis (IPF) are two common forms of interstitial lung disease. Fatigue is a recognised feature of sarcoidosis but an association between IPF and fatigue has not been investigated. RATIONALE: To investigate the frequency and severity of fatigue in these groups, and variables affecting fatigue scores. METHODS: A cross-sectional questionnaire study of patients with sarcoidosis and IPF followed-up at a single hospital was undertaken. Questionnaire data included validated measures of fatigue, anxiety, depression, sleepiness and dyspnoea, plus measures of disease severity including spirometry data. RESULTS: Questionnaires were administered to 232 patients (82 healthy volunteers, 73 sarcoidosis patients and 77 IPF patients). Sarcoidosis patients had statistically higher sleepiness scores but no significant difference was seen between overall measures of fatigue, anxiety or depression. Stratification by severity revealed a non-statistically significant tendency towards more severe fatigue scores in sarcoidosis. Regression analysis failed to identify any significant predictor variables measured in the sarcoidosis cohort, though in the IPF group both dyspnoea and sleepiness scores were significant predictors of fatigue (R2=0.74). CONCLUSIONS: Both sarcoidosis and IPF patients suffer with fatigue, although sarcoidosis patients tended towards reporting more severe fatigue scores, suggesting a subgroup with severe fatigue. The fatigue experienced by the two groups appears to be different; sarcoidosis patients report greater frequency of mental fatigue whereas IPF patients appear to suffer exhaustion, potentially related to dyspnoea. Dyspnoea and sleepiness scores modeled the majority of fatigue in the IPF group, whereas no single factor was able to predict fatigue in sarcoidosis.

A study into psychosocial factors as predictors of work-related fatigue.

OBJECTIVE: To explore and determine relationship between psychosocial factors and work-related fatigue among emergency and critical care nurses in Brunei. METHODS: Cross-sectional study conducted on all emergency and critical care nurses across Brunei public hospitals from February to April 2016. RESULTS: 201 nurses participated in the study (82% response rate). A total of 36% of the variance of chronic fatigue was explained by stress, trust in management, decision latitude, self-rated health, and work-family conflict. Burnout, self-rated health, commitment to workplace, and trust in management explained 30% of the variance of acute fatigue. Stress, work-family conflict and reward explained 28% of the variance of intershift recovery after controlling for significant sociodemographic variables. Smoking was identified as an important sociodemographic factor for work-related fatigue. CONCLUSIONS: Psychosocial factors were good predictors of work-related fatigue. A range of psychosocial factors were established, however more research is required to determine all possible causation factors of nurses' work-related fatigue.

Qualitative Analysis of the Experience of Mental Fatigue of Family Caregivers of Patients With Cancer in Phase I Trials.

PURPOSE/OBJECTIVES: To examine family caregivers' experience of mental fatigue, identify strategies they use to manage it, and ascertain the kind of help they would like from healthcare professionals.
. RESEARCH APPROACH: Descriptive, qualitative study that was part of a larger mixed-methods study.
. SETTING: Metropolitan comprehensive cancer center in the midwestern United States.
. PARTICIPANTS: 79 family caregivers of patients with advanced cancer who were participating in phase I clinical trials.
. METHODOLOGIC APPROACH: Caregivers completed a semistructured, open-ended questionnaire and demographic and health history forms.
. FINDINGS: Caregivers were able to define mental fatigue and give many examples of it. They reported that mental fatigue did not interfere with patient care, but that it did have a negative effect on their own self-care. They identified strategies to manage mental fatigue. They wanted more information and support from professionals.
. CONCLUSIONS: The majority of caregivers experienced mental fatigue, which manifested as trouble concentrating, difficulty remembering things, and irritability. The majority worked outside of the home and had health problems of their own.
. INTERPRETATION: Healthcare professionals need to assess caregivers for mental fatigue and find ways to help them reduce mental fatigue and restore their attention. Nurses are in a prime position to mobilize resources for caregivers to effectively manage burden and reduce mental fatigue.

[Inflammatory mechanisms of fatigue syndrome in Parkinson's disease].

OBJECTIVE: To study clinical characteristics of fatigue syndrome in patients with Parkinson's disease (PD) and a role of inflammation in its development. MATERIAL AND METHODS: We examined 98 patients with confirmed diagnosis of PD and 18 healthy people. Clinical examination included an analysis of anamnesis and objective somatic symptoms. The unified Parkinson's disease rating scale, The Hoehn and Yahr scale, the Multidimensional Fatigue Inventory (MFI-20) scale, the Modified Fatigue Impact Scale (MFIS), the Hospital Anxiety and Depression Scale (HADS), The Epworth Sleepiness Scale (ESS), Vein's Autonomic Symptoms Questionnaire (VASQ) were used for quantitative assessment. Serum concentrations of IL-6 were measured in 65 patients and 18 controls using ELISA. RESULTS AND CONCLUSION: In PD patients, fatigue assessed with MFI-20 was recorded in 46 (47%) cases and fatigue as assessed with MFIS in 45 (46%) of cases. High frequency and severity of fatigue syndrome were observed. The most prominent components in the structure of fatigue were physical fatigue, reduced motivation and decreased activity. Signs of fatigue increased with disease progression. Correlation between fatigue and axial motor symptoms of PD is of interest. Patients had higher serum IL-6 levels compared to the controls. Concentrations of IL-6 were correlated with fatigue severity and its main components (general and physical fatigue, decreased activity) and with depression level.

Tertiary prevention in cancer care: understanding and addressing the psychological dimensions of cancer during the active treatment period.

Tertiary prevention refers to care aimed at reducing morbidity and disability in people diagnosed with, and being treated for, disease. This article focuses on psychological aspects of tertiary prevention during the active phase of cancer treatment. Research in this area gained momentum in the 1970s, a time that coincides with changing public attitudes about discussing cancer and the origins of health psychology and behavioral medicine as fields of study. Over the past 40 years, much has been learned about the psychological impact of cancer and the beneficial effects of psychological interventions on patients' mental and physical well-being. The amount of research in this area necessitates a selective, rather than comprehensive, review approach. The focus here is on issues that affect a large proportion of people with cancer and for which research has generated an in-depth understanding. Accordingly, the article summarizes findings regarding the prevalence, etiology, and contributing factors, and the clinical management of, two of the most common psychological reactions to cancer diagnosis and treatment (i.e., depression and anxiety) and two of the most common physical symptoms related to cancer and its treatment (i.e., fatigue and pain). The review also summarizes emerging lines of research on psychological reactions to recurrent and second cancers, and on cancer diagnosis and treatment as a "teachable moment" for promoting health behavior change. Finally, important future directions are identified, including the need to adopt a team science approach to tertiary care and to better translate findings from intervention research into clinical practice.