Guía de tratamiento de la alteración aguda del estado mental. Academia Iberoamericana de Neurología Pediátrica / Guide for the treatment of acute altered mental status. Iberoamerican Academy of Pediatric Neurology

La alteración aguda del estado mental en pediatría se refiere a un cambio repentino y significativo en la función cerebral y el nivel de conciencia de un niño. Puede manifestarse como confusión, desorientación, agitación, letargo o incluso pérdida de la conciencia. Esta condición es una emergencia médica, y requiere una evaluación y una atención inmediatas. Existen diversas causas de alteración aguda del estado mental en niños, algunas de las cuales incluyen infecciones del sistema nervioso central, como la meningitis o la encefalitis, los traumatismos craneoencefálicos, los trastornos metabólicos, las convulsiones o las intoxicaciones, entre otras. Este estudio tuvo como objetivo analizar, preparar y calificar la bibliografía actual para determinar las mejores recomendaciones sobre el tratamiento ante casos de alteración aguda del estado mental en pediatría de diferentes causas. El estudio se basó en la calificación de expertos en el campo para poder determinar la calificación de las recomendaciones, además de ser sometido a la revisión por parte del comité científico de la Academia Iberoamericana de Neurología Pediátrica. Nuestra guía representa una ayuda para el tratamiento de este síntoma inespecífico desde un enfoque básico y avanzado, aplicable por cualquier neurólogo pediatra.(AU)

In pediatric patients, an acute altered mental status refers to a sudden and significant change in a child’s brain function and level of consciousness. It may manifest as confusion, disorientation, agitation, lethargy or even a loss of consciousness. This condition is a medical emergency, and requires immediate evaluation and attention. There are several causes of acute altered mental status in children, including infections of the central nervous system such as meningitis or encephalitis, traumatic brain injury, metabolic disorders, seizures and poisoning, among others. The aim of this study was to analyse, prepare and classify the current literature in order to determine the best recommendations for the treatment of cases of acute altered mental status with various causes in pediatric patients. The study was based on opinions from experts in the field in order to classify the recommendations, and was submitted to the scientific committee of the Iberoamerican Academy of Pediatric Neurology for review. Our guide is an aid for the treatment of this non-specific symptom based on a basic and advanced approach, which can be applied by any pediatric neurologist.(AU)

Hormonal basis of brain fog in cancer treatment.

The cognitive side effects of cancer treatment are common, but no targeted therapy exists yet to treat or prevent such neurological sequelae. We explore the role of hormones as mediators between cancer therapy and cognitive impairment, discussing potential future directions.

Effect of mental fatigue on hand force production capacities.

Mental fatigue is common in society, but its effects on force production capacities remain unclear. This study aimed to investigate the impact of mental fatigue on maximal force production, rate of force development-scaling factor (RFD-SF), and force steadiness during handgrip contractions. Fourteen participants performed two randomized sessions, during which they either carried out a cognitively demanding task (i.e., a visual attention task) or a cognitively nondemanding task (i.e., documentary watching for 62 min). The mental fatigue was evaluated subjectively and objectively (performances and electroencephalography). Maximal voluntary contraction (MVC) force, RFD-SF, and force steadiness (i.e., force coefficient of variation at submaximal intensities; 25, 50, and 75% of MVC) were recorded before and after both tasks. The feeling of mental fatigue was much higher after completing the cognitively demanding task than after documentary watching (p < .001). During the cognitively demanding task, mental fatigue was evidenced by increased errors, missed trials, and decreased N100 amplitude over time. While no effect was reported on force steadiness, both tasks induced a decrease in MVC (p = .040), a force RFD-SF lower slope (p = .011), and a reduction in the coefficient of determination (p = .011). Nevertheless, these effects were not explicitly linked to mental fatigue since they appeared both after the mentally fatiguing task and after watching the documentary. The study highlights the importance of considering cognitive engagement and mental load when optimizing motor performance to mitigate adverse effects and improve force production capacities.

The effects of mental fatigue on fine motor performance in humans and its neural network connectivity mechanism: a dart throwing study.

While it is well known that mental fatigue impairs fine motor performance, the investigation into its neural basis remains scant. Here, we investigate the impact of mental fatigue on fine motor performance and explore its underlying neural network connectivity mechanisms. A total of 24 healthy male university students were recruited and randomly divided into two groups: a mental fatigue group (MF) and a control group (Control). Both groups completed 50 dart throws, while electroencephalography (EEG) data were collected. Following the Stroop intervention, participants in the MF group exhibited a decrease in Stroop task accuracy and throwing performance, and an increase in reaction time along with VAS and NASA scores. The EEG data during dart-throwing revealed that the network connectivity strength of theta oscillations in the frontal and left central regions was significantly higher in the MF group compared with the Control group, while the network connectivity strength of alpha oscillations in the left parietal region was significantly enhanced. The interregional connectivity within the theta and alpha rhythm bands, particularly in the frontal-central-parietal network connections, also showed a significant increase in the MF group. Mental fatigue impairs dart throwing performance and is accompanied by increased connectivity in alpha and theta.

[Brain Fog: A Concept Analysis].

Brain fog is a symptom that has gained increasing attention worldwide since the start of the COVID-19 pandemic, as patients affected by COVID-19 may experience cognitive dysfunction, colloquially known as brain fog, for a period of time after recovery. Brain fog affects activities of daily living and work performance and has the potential to negatively impact society and the economy. However, a clear definition and concept analysis of brain fog is lacking in the literature. In this article, a concept analysis of brain fog is conducted using Walker and Avant's concept analysis steps to verify the source and definition of brain fog, clarify related concepts similar to brain fog, and establish the defining attributes, antecedents, and consequences of this condition. Model, borderline, contrary, and related cases are listed to illustrate and provide related empirical references in the literature. The authors hope this article will provide a clearer understanding of brain fog, which then may be applied in nursing clinical practice and future research to develop strategies and care methods for improving brain fog symptoms.

Prevalence of mental health conditions and brain fog in people with long COVID: A systematic review and meta-analysis.

OBJECTIVE: Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and meta-analysis to estimate their prevalence and to explore relevant factors associated with the incidence of impaired cognition and mental health conditions. METHODS: Searches were conducted in Medline and PsycINFO to cover the start of the pandemic until August 2023. Included studies reported prevalence of mental health conditions and brain fog in adults with long COVID after clinically-diagnosed or PCR-confirmed SARS-CoV-2 infection. FINDINGS: 17 studies were included, reporting 41,249 long COVID patients. Across all timepoints (3-24 months), the combined prevalence of mental health conditions and brain fog was 20·4% (95% CI 11·1%-34·4%), being lower among those previously hospitalised than in community-managed patients(19·5 vs 29·7% respectively; p = 0·047). The odds of mental health conditions and brain fog increased over time and when validated instruments were used. Odds of brain fog significantly decreased with increasing vaccination rates (p = ·000). CONCLUSIONS: Given the increasing prevalence of mental health conditions and brain fog over time, preventive interventions and treatments are needed. Research is needed to explore underlying mechanisms that could inform further research in development of effective treatments. The reduced risk of brain fog associated with vaccination emphasizes the need for ongoing vaccination programs.

Counteracting mental fatigue for athletes: a systematic review of the interventions.

The deleterious effects of mental fatigue (MF) on athletes have been carefully studied in various sports, such as soccer, badminton, and swimming. Even though many researchers have sought ways to ameliorate the negative impact of MF, there is still a lack of studies that review the interventions used to counteract MF among athletes. This review aims to report the current evidence exploring the effects of interventions on MF and sport-specific performance, including sport-specific motor performance and perceptual-cognitive skills. Web of Science, Scopus, PubMed, and SPORTDicus (EBSCOhost) were combed through to find relevant publications. Additionally, the references and Google Scholar were searched for any grey literature. For the current review, we included only randomized controlled trials that involved athletes, a primary task to induce MF, interventions to counter MF with comparable protocols, and the outcomes of sport-specific motor performance and perceptual-cognitive skill. The selection criteria resulted in the inclusion of 10 articles. The manipulations of autonomous self-control exertion, person-fit, nature exposure, mindfulness, and transactional direct current stimulation showed that positive interventions counteract MF and improve sport-specific performance in different domains, including strength, speed, skill, stamina, and perceptual-cognitive skills. The selected interventions could significantly counteract MF and improve subsequent sport-specific performance. Moreover, self-regulation and attention resources showed the importance of the potential mechanisms behind the relevant interventions.

Visual perceptual processing is unaffected by cognitive fatigue.

Cognitive fatigue (CF) can lead to an increase in the latency of simple reaction time, although the processes involved in this delay are unknown. One potential explanation is that a longer time may be required for sensory processing of relevant stimuli. To investigate this possibility, the current study used a visual inspection time task to measure perceptual processing speed before and after a CF (math and memory) or non-fatiguing (documentary film) intervention. Subjective fatigue and simple reaction time significantly increased following the CF, but not the non-fatiguing intervention, confirming that CF was induced. Conversely, there was no effect of CF on inspection time task performance. It was therefore concluded that the speed of perceptual processing is not significantly impacted by CF, and thus is unlikely to underlie CF-related reaction time increases. Instead, increases in simple reaction time latency in CF may be due to delays in response preparation or initiation.

The influence of the perceived requirements of the next match and motivation on the mental fatigue of soccer players.

The high cognitive and/or emotional demands of competition can lead to a state of mental fatigue which has shown to be detrimental to soccer performance. However, there is a need to further understand the true mental demands of soccer players. The aim of the present study was to analyze the influence of motivation and the perceived requirements of the next match on mental fatigue perceived by soccer players over the passing of a season. The combined effect of both variables on the perception of mental fatigue, as well as the influence of the time of the season on perceived mental fatigue, were also analyzed. Twenty-six semi-professional Spanish male players (M = 26.31 ± 5.18 years) participated in the present study, conducted during the 2020-2021 season. Perceived mental fatigue and motivation were measured at each training session. The perceived requirements of the next match were also measured in each of the competitive weeks. Linear mixed models were run with R Studio to examine the influence of motivation and the perceived difficulty of the next match on perceived mental fatigue, the combined effect of both variables on perceived mental fatigue, and the influence of the passing of the season on perceived mental fatigue. The results showed a negative and significant influence of motivation on perceived mental fatigue (p < 0.001) and a positive and significant influence of the perceived requirements of the next match on perceived mental fatigue (p < 0.001). Regarding the combined effect, there was a positive and significant effect (p < 0.01) of the perceived difficulty of the next match on the relation between motivation and perceived mental fatigue. A negative influence of season passage on perceived mental fatigue levels was found (p < 0.001). We recommended coaches to consider using the most motivating training tasks when higher next-match requirements are perceived and to be careful with avoidance strategies for mental fatigue, especially at the beginning of the season.

[Mental fatigue state recognition method based on convolution neural network and long short-term memory].

The pace of modern life is accelerating, the pressure of life is gradually increasing, and the long-term accumulation of mental fatigue poses a threat to health. By analyzing physiological signals and parameters, this paper proposes a method that can identify the state of mental fatigue, which helps to maintain a healthy life. The method proposed in this paper is a new recognition method of psychological fatigue state of electrocardiogram signals based on convolutional neural network and long short-term memory. Firstly, the convolution layer of one-dimensional convolutional neural network model is used to extract local features, the key information is extracted through pooling layer, and some redundant data is removed. Then, the extracted features are used as input to the long short-term memory model to further fuse the ECG features. Finally, by integrating the key information through the full connection layer, the accurate recognition of mental fatigue state is successfully realized. The results show that compared with traditional machine learning algorithms, the proposed method significantly improves the accuracy of mental fatigue recognition to 96.3%, which provides a reliable basis for the early warning and evaluation of mental fatigue.

Blood-brain barrier disruption and sustained systemic inflammation in individuals with long COVID-associated cognitive impairment.

Vascular disruption has been implicated in coronavirus disease 2019 (COVID-19) pathogenesis and may predispose to the neurological sequelae associated with long COVID, yet it is unclear how blood-brain barrier (BBB) function is affected in these conditions. Here we show that BBB disruption is evident during acute infection and in patients with long COVID with cognitive impairment, commonly referred to as brain fog. Using dynamic contrast-enhanced magnetic resonance imaging, we show BBB disruption in patients with long COVID-associated brain fog. Transcriptomic analysis of peripheral blood mononuclear cells revealed dysregulation of the coagulation system and a dampened adaptive immune response in individuals with brain fog. Accordingly, peripheral blood mononuclear cells showed increased adhesion to human brain endothelial cells in vitro, while exposure of brain endothelial cells to serum from patients with long COVID induced expression of inflammatory markers. Together, our data suggest that sustained systemic inflammation and persistent localized BBB dysfunction is a key feature of long COVID-associated brain fog.

Brain fog in central disorders of hypersomnolence: a review.

Brain fog is an undefined term describing a cluster of symptoms related to fatigue and impaired memory, attention, and concentration. Brain fog or brain fog-like symptoms have been reported in central disorders of hypersomnolence and in a range of seemingly unrelated disorders, including coronavirus disease 2019, major depressive disorder, multiple sclerosis, lupus, and celiac disease. This narrative review summarizes current evidence and proposes a consensus definition for brain fog. Brain fog is prevalent in narcolepsy and idiopathic hypersomnia, with more than three-quarters of patients with either disorder reporting this symptom in a registry study; it has also been reported as particularly difficult to treat in idiopathic hypersomnia. Studies directly evaluating brain fog are rare; tools for evaluating this symptom cluster typically are patient reports, with few objective measures validated in any disorder. Evaluating brain fog is further complicated by confounding symptoms, such as excessive daytime sleepiness, which is a hallmark of hypersomnolence disorders. No treatments specifically address brain fog. The paucity of literature, assessment tools, and medications for brain fog highlights the need for research leading to better disambiguation and treatment. Until a clear consensus definition is established, we propose brain fog in hypersomnia disorders be defined as a cognitive dysfunction that may or may not be linked with excessive sleepiness, related to an underlying neuronal dysfunction, which reduces concentration and impairs information processing, leading to a complaint of lack of clarity of mental thinking and awareness. CITATION: Rosenberg R, Thorpy MJ, Doghramji K, Morse AM. Brain fog in central disorders of hypersomnolence: a review. J Clin Sleep Med. 2024;20(4):643-651.

SARS-CoV-2 infection is associated with physical but not mental fatigue - Findings from a longitudinal controlled population-based study.

OBJECTIVE: Fatigue has been identified as the core symptom of long-Covid, however, putative pandemic-related influences remain largely unclear. We investigated trajectories of total, physical and mental fatigue and the factors associated with it in previously infected and non-infected individuals up to one year post- infection. METHODS: We used data from a longitudinal cohort study of German adults with two samples: A representative probability sample and a sample of individuals with proven SARS-CoV-2 infection. Surveys were conducted in spring 2020(T1), autumn 2020(T2) and summer 2021(T3). Fatigue was assessed using the FAS, distinguishes between physical and mental fatigue. Depression, anxiety and stress were assessed using PHQ-4 and PSQ. RESULTS: 1990 participants [mean age 47.2 (SD = 17.0), 30.5% previously infected] were included in the survey at T1 (n = 1118 at T2, n = 692 at T3). Total and physical fatigue, but not mental fatigue were significantly higher in the previously infected compared to the non-infected sample at T2, but this group difference disappeared at T3. We identified Covid-infection as a factor associated with transient total and physical fatigue at T2. Depression, anxiety and stress at T1 were associated with total, physical and mental fatigue at both follow-ups. CONCLUSIONS: Our results highlight the importance of considering physical and mental fatigue as separate entities, while suggesting a greater relevance of the physical signs of fatigue in understanding long-Covid. The results further showed that baseline mental health symptoms were the most strongly associated with fatigue trajectories.

Analyzing the psychological variables linked to performance in beach volleyball: an integrative review and practical recommendations / Análisis de las variables psicológicas vinculadas al rendimiento en voleibol playa: una revisión integradora y recomendaciones prácticas / Análise das variáveis psicológicas ligadas ao desempenho no voleibol de praia: uma revisão integrativa e recomendações práticas

Beach volleyball is an important team sport in which physical, technical, tactical,and psychological/social aspects are fundamental to sporting performance. However, this is the first review to analyse scientific production on psychological variables in beach volleyball. This is an integrative review in which a systematic search was carried out in five electronic databases (PubMed/MEDLINE, SPORTDiscus/EBSCO, SciELO, Scopus and BIREME) until September 2022. The terms used were "beach volleyball" OR "voleibolde praia" OR "vôlei de praia". In addition, the search included research with athletes, acute and chronic outcomes, and studies of various methods (e.g.,experimental, observational) involving psychological variables. The initial search identified 652 articles, and after the manual search and application of the inclusion criteria, 18 studies were integrated into a final synthesis.Most of the studies were published between 2011 and 2022 (n= 14; 77.78%). Observational design was the main method used (n= 10; 55.56%). The studies were grouped into nine major topics for synthesis: stress situation, activation levels, concentration, goal orientation and motivation, mental fatigue and performance, anxiety,and performance, discouraging environments, relationships between team members, coping strategies. In general, social relationships and self-control appear significant for performance; thus,coaches must serve as role models for players and sports psychologists can aid in monitoring psychological variables, team dynamics, and develop psychological skills.(AU)

El vóleyplaya es un importante deporte de equipo en el que los aspectos físicos, técnicos, tácticos y psicológicos/sociales son fundamentales para el rendimiento deportivo. Sin embargo, esta es la primera revisión que analiza la producción científica sobre variables psicológicas en vóleyplaya. Se trata de una revisión integradora en la que se realizó una búsqueda sistemática en cinco bases de datos electrónicas (PubMed/MEDLINE, SPORTDiscus/EBSCO, SciELO, Scopus y BIREME) hasta septiembre de 2022. Los términos utilizados fueron "beach volleyball" OR "voleibol de praia" OR "vôlei de praia". Además, la búsqueda incluyó investigaciones con atletas, intervenciones agudas y crónicas, estudios de diversos métodos (e.g., experimentales, observacionales) que implicaran variables psicológicas. La búsqueda inicial identificó 652 artículos y, después de la búsqueda manual y la aplicación de los criterios de inclusión, 18 estudios se integraron en una síntesis final. La mayoría de los estudios fueron publicados entre 2011 y 2022 (n= 14; 77.78%). El diseño observacional fue el principal método utilizado (n= 10; 55.56%). Los estudios se agruparon en nueve grandes temas para la síntesis: situación de estrés, niveles de activación, concentración, orientación a objetivos y motivación, fatiga mental y rendimiento, ansiedad y rendimiento, entornos desalentadores, relaciones entre los miembros del equipo, estrategias de afrontamiento. Las relaciones sociales y el autocontrol parecen ser importantes para el rendimiento, por lo quelos entrenadores deben comportarse como modelos para los deportistas. Además, los psicólogosdeportivos pueden ayudar a controlar las variables psicológicas, la dinámica del equipo y a desarrollar habilidades psicológicas.(AU)

O voleibol de praia é um importante esporte coletivo em que aspectos físicos, técnicos, táticos e psicológicos/sociais são fundamentais para o desempenho esportivo. No entanto, esta é a primeira revisão que teve como objetivo analisar a produção científica sobre variáveis psicológicas no voleibol de praia. Essa é uma revisão integrativa em que foi realizada uma busca em cinco bases de dados eletrônicas (PubMed/MEDLINE, SPORTDiscus/EBSCO, SciELO, Scopus e BIREME) até setembro de 2022, de forma sistemática. Os temos usados foram “beach volleyball” OU “voleibol de praia” OU “vôlei de praia”. Além disso, foram incluídos nessa busca pesquisas com atletas, intervenções agudas e crônicas, estudos de vários métodos (e.g., experimental, observacional) que envolviam variáveis psicológicas. A busca inicial identificou 652 artigos, após a busca manual e aplicação dos critérios de inclusão, 18 estudos foram integrados a uma síntese final. A maioria dos estudos foi publicada entre 2011 e 2022 (n= 14; 77.78%). O desenho observacional foi o principal método utilizado (n= 10; 55.56%). Os estudos foram agrupados em nove grandes tópicos para síntese: situação de estresse, níveis de ativação, concentração, orientação para metas e motivação, fadiga mental e desempenho, ansiedade e desempenho, ambientes desanimadores, relacionamento entre as partes da equipe, estratégias de enfrentamento. As relações sociais e o autocontrole parecem importantes para o desempenho, portanto treinadores devem se comporta como modelo para os atletas. Além disso, psicólogos do esporte podem ajudar a monitorizar as variáveis psicológicas, na dinâmica da equipa e desenvolver de competências psicológicas.(AU)

Age and Type of Task-Based Impact of Mental Fatigue on Balance: Systematic Review and Meta-Analysis.

The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the type or difficulty of the balance task and age. Steady-state balance tasks, such as quiet standing, are well-learned tasks executed automatically through reflex activities controlled by the brainstem and spinal cord. In contrast, novel, and challenging balance tasks, such as proactively controlling balance while walking over rugged terrain or reacting to unexpected external perturbations, may require cognitive processing. Furthermore, individuals with preexisting balance impairments due to aging or pathology may rely on cognitive processes to control balance in most circumstances. This systematic review and meta-analysis investigated the effect of mental fatigue on different types of balance control tasks in young and older adults. A literature search was conducted in seven electronic databases and 12 studies met eligibility criteria. The results indicated that mental fatigue had a negative impact on both proactive (under increased cognitive load) and reactive balance in young adults. In older adults, mental fatigue affected steady-state and proactive balance. Therefore, mentally fatigued older individuals may be at increased risk of a loss of balance during steady-state balance task compared to their younger counterparts.

Characteristics and burden of acute COVID-19 and long-COVID: Demographic, physical, mental health, and economic perspectives.

BACKGROUND: COVID-19 infection and its associated consequence, known as long-COVID, lead to a significant burden on the global healthcare system and limitations in people's personal and work lives. This study aims to provide further insight into the impact of acute and ongoing COVID-19 symptoms and investigates the role of patients' gender and vaccination status. METHODS: 416 individuals (73.9% female) between the ages of 16 and 80 years (M = 44.18, SD = 12.90) with self-reported symptoms of long-COVID participated in an online survey conducted between March and May 2022. RESULTS: 6.0%, 74.3%, and 19.7% of all respondents reported having had an asymptomatic, mild, or severe acute illness, respectively. Out of all participants, 7.8% required hospitalization. The most prevalent symptoms during the acute infection (Mdn = 23.50 symptoms, IQR = 13-39) included fatigue, exhaustion, cough, brain fog, and memory problems. The median long-COVID disease duration was 12.10 months (IQR = 2.8-17.4). Among 64 inquired long-COVID symptoms (Mdn = 17.00 symptoms, IQR = 9-27), participants reported fatigue, exhaustion, memory problems, brain fog, and dyspnea as the most common ongoing symptoms, which were generally experienced as fluctuating and deteriorating after physical or cognitive activity. Common consequences of long-COVID included financial losses (40.5%), changes in the participants' profession (41.0%), stress resistance (87.5%), sexual life (38.1%), and mood (72.1%), as well as breathing difficulties (41.3%), or an increased drug intake (e.g., medicine, alcohol; 44.6%). In addition, vaccinated individuals exhibited a shorter acute illness duration and an earlier onset of long-COVID symptoms. In general, women reported more long-COVID symptoms than men. CONCLUSION: Long-COVID represents a heterogeneous disease and impacts multiple life aspects of those affected. Tailored rehabilitation programs targeting the plurality of physical and mental symptoms are needed.

"A sprained ankle is the biggest sign of mental fatigue": A qualitative study of the perceptions and experiences of mental fatigue in professional ballet.

Mental fatigue is known to influence endurance, skill, and tactical performance in sport. Research investigating the impact of mental fatigue on tasks that combine physical, cognitive, and aesthetic performance such as professional ballet does not exist. OBJECTIVE: To understand the perceptions and experiences of mental fatigue in professional ballet. DESIGN: Qualitative, focus groups and semi-structured interviews. SETTING: The Australian Ballet. PARTICIPANTS: Thirty-nine professional ballet dancers (53% of the company) and six dance staff members aged 18 years or above (53% female). MAIN OUTCOME MEASURES: N/a. RESULTS: The average focus group and interview length was 48 ± 7 min and 41 ± 8 min. Key categories were; (1) Dancers and dance staff perceive that new learning contributes to mental fatigue, (2) Dancers perceive changes to their mood and perception of effort when they are mentally fatigued, and (3) Dancers and dance staff perceive that mental fatigue negatively affects their physical and cognitive performance and, increases their risk of injury. CONCLUSION: This is the first study where participants associated mental fatigue with injury risk and provides a springboard to measure the impact of mental fatigue on learning, injury, and performance in professional ballet.

Boosts for walking: how humorous messages increase brisk walking among cognitively fatigued individuals.

BACKGROUND: A well-studied internal barrier to regular physical activity, and more specifically brisk walking, is cognitive fatigue. However, thus far little research examined how cognitively fatigued individuals can be motivated to exercise, more specifically to engage in brisk walking. This study investigates whether humorous intervention messages might be an effective strategy to motivate cognitively fatigued individuals to brisk walk, and through which underlying processes. METHODS: An online experiment was performed in which variation in cognitive fatigue was induced through mental arithmetic questions. Afterwards, participants (n = 250) recruited through Prolific, randomly received either humorous or non-humorous intervention messages related to brisk walking. Potential mediators of the relations between physical activity, humour and cognitive fatigue were measured, were self-efficacy, self-control, and motivation. RESULTS: First, regression analyses confirmed that cognitive fatigue negatively influences brisk walking intentions and that the perceived humour of the intervention messages moderated this relationship. Second, results showed that self-control and self-efficacy are mediators explaining the relationship between cognitive fatigue and brisk walking intentions. Lastly, this study found that perceived humour of the intervention messages moderated the relationship between cognitive fatigue and self-control, indicating that perceptions of self-control were positively changed after receiving messages that were perceived as humorous compared to messages that were not perceived as humorous, subsequently increasing brisk walking intentions. CONCLUSIONS: This study is the first to unravel the underlying relationship between humorous intervention messages and brisk walking intentions through positive changes in perceptions of self-control within a cognitively fatigued sample. Results of this study suggest that existing smartphone applications monitoring and promoting brisk walking should integrate tailored message strategies within their cues to brisk walk by implementing humour as a strategy to motivate users when they are cognitively fatigued.

Long-term health consequences of COVID-19 in survivors hospitalised at a tertiary care hospital and their correlation with acute COVID-19 severity and associated risk factors.

OBJECTIVES: To determine post-COVID syndromes in the Indian population, correlating a wide spectrum of post-COVID manifestations with acute disease severity and associated risk factors. BACKGROUND: Post-COVID Syndrome (PCS) is defined as signs and symptoms that develop during or after acute COVID-19 infection. DESIGN OF STUDY: This is a prospective observational cohort with repetitive measurements. METHODS: The study followed RT-PCR confirmed COVID-19-positive survivors discharged from HAHC Hospital, New Delhi, for a period of 12 weeks. The patients were interviewed over the phone at 4 weeks and 12 weeks from the onset of symptoms for evaluation of clinical symptoms and health-related quality of life parameters. RESULTS: A total of 200 patients completed the study. At the baseline, 50% of the patients were categorised as severe based on their acute infection assessment. At 12 weeks after symptom onset, fatigue (23.5%), hair loss (12.5%) and dyspnea (9%) were the main persistent symptoms. The incidence of hair loss (12.5%), memory loss (4.5%) and brain fog (5%) were found to be increased as compared to the acute infection period. Severity of the acute COVID infection behaved as an independent predictor for the development of PCS, with high odds of experiencing persistent cough (OR = 13.1), memory loss (OR = 5.2) and fatigue (OR = 3.3). Further, 30% of subjects in the severe group experienced statistically significant fatigue at 12 weeks (p < .05). CONCLUSION: From the results of our study, it can be concluded that there is a huge disease burden of post-COVID Syndrome (PCS). The PCS comprised multisystem symptoms ranging from serious complaints of dyspnea, memory loss and brain fog to non-serious complaints of fatigue and hair loss. Severity of the acute COVID infection behaved as an independent predictor for the development of PCS. Our findings strongly recommend vaccination against COVID-19, for protection from disease severity as well as prevention of PCS. RELEVANCE TO CLINICAL PRACTICE: The findings of our study support the multidisciplinary approach required for the management of PCS with a team comprising of physicians, nurses, physiotherapists and psychiatrists working in close coordination for the rehabilitation of these patients. As nurses are considered the most trusted professionals in the community and the class of health workers associated with rehabilitation, focus should be given to educating them on PCS, which would prove to be an important strategy for efficient monitoring and long-term management of COVID-19 survivors.