Factors associated with postpartum fatigue: an exploration of the moderating role of resilience.

Background: Postpartum fatigue (PPF) can impair the physical and mental well-being of women. The aims of this study were to assess the associations between fatigue and maternal health-related variables, specifically, sleep quality, depression symptoms, and resilience, and to explore the moderating role of resilience in the relationships between sleep quality, depression symptoms, and fatigue. Methods: This cross-sectional study used data collected from mothers during the postpartum period via an online platform. PPF was assessed using the Fatigue Severity Scale, whereas sleep quality and depression symptoms were assessed using the Pittsburgh Sleep Quality Index and Edinburgh Postnatal Depression Scale, respectively. The Brief Resilience Scale was used to assess resilience. Simple and multiple binary logistic regression analyses were performed to examine the association of each independent variable with PPF and to determine the most significant predictors of PFF. The data were analyzed using SPSS, and structural equation modeling was performed using AMOS 23. A moderation analysis was performed to explore the moderating role of resilience using the Hayes PROCESS macro. Results: A total of 1,443 postpartum mothers were included in the analysis. The simple binary logistic regression analysis showed that having chronic disease (odds: 1.52; p = 0.02), mother's age (odds: 0.97; p = 0.03), mother's body mass index (BMI; odds: 1.03; p = 0.01), depression symptoms (odds: 1.09; p ≤ 0.0001), sleep quality (odds: 1.17; p ≤ 0.0001), and resilience (odds: 0.42; p ≤ 0.0001) all contributed to fatigue during postpartum. Multivariate logistic regression showed that the mother's BMI, sleep quality, depression symptoms, and resilience were significant predictors of PPF. Moderation analyses showed that resilience was not a significant moderator between the main effects of sleep quality and fatigue (interaction effect: ß = 0.01, p = 0.31, 95% CI: -0.01 to 0.04) or between the main effects of depression symptoms and fatigue during postpartum (interaction effect: ß = 0.01, p = 0.82, 95% CI: -0.01 to 0.02). Conclusion: Given the deleterious effects of PPF on maternal health outcomes, factors associated with PPF should be assessed regularly. In addition to mothers' BMI, sleep quality, and depression symptoms, resilience could also be a crucial factor in predicting fatigue severity during this critical time for mothers even though it was not a significant moderator among this sample.

Multifaceted associations between walking performance, physical fitness, extremity function, health status, and depression in individuals with COPD.

BACKGROUND/OBJECTIVE(S): Chronic obstructive pulmonary disease (COPD) can precipitate a deterioration of an individual's physical performance and overall health. Evidence suggests that, along with pulmonary functions, several other factors are related to the significant impairment of walking performance in individuals with COPD. This study compared the depressive symptoms, health status, upper and lower extremity functions, and peak oxygen uptake (VO2peak) in a group of individuals with COPD based on walking performance using a cutoff distance of 350 m in the six-minute walking test (6MWT). The study also investigated the associations between these factors and walking performance. MATERIALS AND METHODS: Participants performed the 6MWT according to the guidelines and were classified into high (>350 m; n = 40) or low (<350 m; n = 30) walking performance groups according to distance. The forced expiratory volume (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were recorded. Participants completed the Patient Health Questionnaire-9 (PHQ-9), St. George's Respiratory Questionnaire (SGRQ), and the Upper and Lower Extremity Functional Index (UEFI/LEFI). Predicted VO2peak was measured using the Duke Activity Status Index (DASI). RESULTS: Seventy participants with a mean age of 63 ± 11 years (20% female) were enrolled in this study. Patients with high walking performance demonstrated significantly better health status than those with low walking performance (SGRQ: 49 ± 25 vs. 56 ± 21, p = 0.03). Participants with low walking performance had lower predicted VO2peak compared to their higher performing counterparts (p = 0.002). The overall model was significant (F(8, 61) = 7.48, p = 0.0006), with PHQ-9, SGRQ, UEFI/LEFI, VO2peak, and FEV1/FVC explaining approximately 49.5% of the variance in the 6MWT distance. CONCLUSION: This study shed light on the association of depressive symptoms, health status, extremity function, and VO2peak with walking performance, providing valuable insights that may impact the management and care of individuals with COPD.

COPD is a global health issue that significantly impairs physical performance, particularly walking.Depressive symptoms, health status, extremity function, and predicted peak oxygen uptake can predict walking performance in patients with COPD, offering insight into potential interventions.

The measurement of fatigability severity in individuals with multiple sclerosis and healthy controls.

BACKGROUND: Multiple Sclerosis (MS) is a chronic disease that substantially diminishes one's ability to undertake daily living activities. Fatigue has been reported by at least 80 % of persons with MS (PwMS). Yet, little is known concerning the quantification of fatigability using prolonged walking tests. OBJECTIVES: To compare fatigability severity measures using the 10-minute walk test for PwMS against age- and gender-matched healthy controls (HCs). METHODS: Participants included 53 ambulatory PwMS and 49 HCs. Perceived fatigability was measured by dividing a participant's change in self-reported tiredness by the number of meters walked. Performance fatigability was calculated by dividing the change in walking speed (at 2.5 and 10 min) by the total distance walked in meters. RESULTS: There was a significant difference in perceived fatigability between PwMS and HCs (mean difference: 2.73 ± 0.83; p = 0.001) and in performance fatigability (mean difference: 0.24 ± 0.11; p = 0.01). Moreover, there were significant differences in speed and distance at all time points (p ≤ 0.05) between PwMS and HCs. CONCLUSIONS: PwMS have significant walking deficits as reflected by greater fatigability in both perceived and performance measures. These methods can enhance therapeutic strategies that improve the walking performances of PwMS.

Translation and population-based validation of the Arabic version of the brief resilience scale.

PURPOSE: This study aimed to translate the Brief Resilience Scale (BRS) into the Arabic language and to assess the reliability and validity of the translated version of the scale among a sample of the Saudi population. MATERIAL AND METHODS: The internal consistency and test-retest reliability of the translated BRS were analyzed. Factor analyses were conducted to examine the factor structure of the scale. Convergent validity was measured by correlating BRS scores with those from the Hospital Anxiety and Depression Scale (HADS), Satisfaction with Life Scale (SWLS), Perceived Stress Scale (PSS), and WHO-5 Well-Being Index (WHO-5). RESULTS: A total of 1072 participants were included in the analysis. The score of the Arabic version showed excellent internal consistency (alpha = 0.98) and good test-retest reliability (ICC = 0.88, 95% CI: 0.82-0.92, p ≤ 0.0001). The results of factor analyses showed that the two-factor model is a good model fit with [CMIN/DF = 9.105; GFI = 0.97; CFI = 0.99; RMSEA = 0.09]. The BRS scores were negatively correlated with levels of anxiety (r = -0.61), depression (r = -0.6), and stress (r = -0.53) and positively correlated with levels of satisfaction with life (r = 0.44) and mental well-being (r = 0.58). CONCLUSIONS: Our findings firmly support the reliability and validity of the Arabic version of the BRS to be used in research and clinical settings with the Saudi population.

Resilience, defined as the ability to bounce back from stressors, is a psychological factor that may buffer the harmful effects of health-related stress.The Arabic version of the BRS demonstrates strong reliability and validity for assessing resilience among the Arabic-speaking Saudi population.The scale will provide the rehabilitation field in the Arabic-speaking population and other health communities with a tool for research and clinical practice. The scale will also guide the development of strategic plans and psychological protective and rehabilitative intervention protocols for those in health-related stressful circumstances.

Factors contributing to falls in people with multiple sclerosis: The exploration of the moderation and mediation effects.

BACKGROUND: The prevalence of multiple sclerosis (MS) has significantly increased in recent decades. People with MS have a high risk of falling; these falls may lead to serious injuries, affecting their quality of life PURPOSE: The aim of this study is to assess the factors affecting falls in people with MS and map out the most significant ones. This study also aims to determine whether fatigue has a moderation effect and balance has a mediation effect on falls in people with MS METHODS: In total, 103 people with MS with a mean age of 32.09 ± 7.17 were enrolled. All subjects were assessed for multiple variables including balance using the Berg Balance Scale (BBS), speed of gait using the Timed Up and Go (TUG) test, fear of falling using the Falls Efficacy Scale-International (FES-I), level of fatigue using the Modified Fatigue Impact Scale (MFIS), and lower limb muscle strength using a handheld digital dynamometer RESULTS: Simple binary logistic regression analysis showed significant results for BBS (OR: 10.88; 95% CI: 4.24-27.96; p < 0.0001), TUG (OR: 1.18; 95% CI: 1.09-1.28; p < 0.0001), FES-I (OR: 1.06; 95% CI: 1.02-1.10; p = 0.001), and MFIS (OR: 1.04; 95% CI: 1.02-1.07; p < 0.0001) as factors affecting falls. According to multivariate analysis, balance (OR: 3.924; 95% CI: 1.307-11.780, p = 0.015), speed of gait (OR: 1.122; 95% CI: 1.023-1.231; p = 0.015), and fatigue (OR: 1.029; 95% CI: 1.002-1.058; p = 0.038) were the strongest predicting factors of falls. Hayes's PROCESS analysis showed that fatigue had a significant moderation effect on the relationship between gait speed and falls (MFIS; ß; 0.10; p < 0.0001; 95% CI: 0.07-0.14) and balance had a mediation effect on the relationship between gait speed and falls (BBS; indirect effect; 0.08; 95% CI: 0.02-0.13) CONCLUSIONS: People with MS with impaired balance, slower gait speeds, higher levels of fatigue, and a fear of falling were at a high risk of falling. The relationship between gait speed and falls can be mediated by impaired balance and moderated by the level of fatigue. Our data suggest that targeting balance and fatigue while developing rehabilitation interventions could decrease the incidence of falls among people with MS.

The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: an emphasis on maternal mental health.

BACKGROUND: Several factors can contribute to the development of postpartum depression (PPD) and negatively affect mothers' mental and physical well-being. The objective of this study was to determine the relationship between fatigue, sleep quality, resilience, and the risk of PPD development. METHODS: A cross-sectional study was conducted using an online questionnaire distributed to mothers during their postpartum period. The risk of PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS), postpartum fatigue (PPF) was assessed using the Fatigue Severity Scale (FSS), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and resilience was assessed using the Brief Resilience Scale (BRS). The Pearson correlation coefficient was calculated to determine the relationship between the study variables. Simple and multiple linear regression analyses were performed to explain the contributions of PPF, sleep quality, and resilience as independent predictors of PPD development. RESULTS: A total of 1409 postpartum women were included in the analysis, with 75% of the participants reporting a risk of PPD, 61% reporting PPF, 97% reporting having sleep problems, and 36% being in the "low resilience level" category. In terms of correlations, the scores of FSS and the PSQI showed moderate positive relationships with the EPDS scores (r = 0.344 and r = 0.447, respectively, p = .000). The BRS scores were negatively associated with the EPDS scores (r = -0.530, p = 0.000). Fatigue, sleep quality, and resilience were predictors of depressive symptoms (ß = 0.127, ß = 0.262, and ß = -0.393, respectively, R2 = 0.37, p = 0.000). The association remained significant in the regression model after adjusting for mother's age, mother's BMI, child's age, smoking status, full-term pregnancy, having a chronic disease, and taking anti-depressant. CONCLUSIONS: Mothers with higher levels of fatigue, poor sleep quality, and low resilience levels were at high risk of developing PPD. Healthcare providers should identify these factors and thus set better rehabilitation goals to improve overall maternal health.

Barriers and facilitators affecting physical activity among adults in Saudi Arabia during COVID-19 quarantine.

The quarantine period in Saudi Arabia from May to June 2020 due to the coronavirus disease (COVID-19) pandemic prevented many people from engaging in physical activity (PA), which may have had negative effects on their health. Therefore, it is important to understand the factors, barriers, and facilitators affecting PA of people during quarantine. This cross-sectional study was conducted using an electronic survey that was distributed to adults between 18 and 69 years old. The survey included demographic-related questions and the International Physical Activity Questionnaire-Short Form. The survey was completed by 1859 participants ranging in age from 18 to 69 years old (42.5% male, 57.5% female). The major factors influencing exercise were being male (odds ratio [OR] = 1.26; 95% confidence interval [CI] 1.03-1.53), being single (OR = 1.37; 95% CI 1.12-1.67), completing higher education at a Master/Doctorate level (OR = 1.83; 95% CI 1.23-2.72), and being resilient (OR = 1.05; 95% CI 1.03-1.08). The facilitators for doing regular exercise were having enough space at home (OR = 1.62), free time (OR = 1.77), good motivation (OR = 1.56), and being free from work (OR = 1.43) and family responsibilities (OR = 1.40). Sex, marital status, level of education and resilience were important factors affecting the type and level of PA during the quarantine period resulting from the COVID-19 pandemic.

Saudi Arabia, like many countries, implemented social distancing, quarantining, travel restrictions and closing recreation facilities to prevent the spread of coronavirus disease (COVID-19). As a result, many people were prevented from engaging in physical activity (PA), which may have had negative effects on their health. This study aims to understand the barriers and facilitators affecting PA of people during quarantine due to COVID-19. We distributed an electronic survey to adults aged between 18 and 69 years old. The survey included demographic-related questions and the 'International Physical Activity Questionnaire-Short Form' to measure their PA levels. There were 1859 survey respondents, of which 42.5% were male and 57.5% were female. The results showed that being a male, being single, completing higher education at a Master/Doctorate level and being resilient were the major factors influencing exercise. In addition, having enough space at home, free time, good motivation and being free from work and family responsibilities were the facilitators for doing exercise regularly.

Knowledge, Attitude, and Practice among Physical Therapists toward COVID-19 in the Kingdom of Saudi Arabia-A Cross-Sectional Study.

To curb the COVID-19 pandemic, the knowledge, attitude, and practice (KAP) of preventive measures play an essential role, and healthcare workers have had to endure a burden to care for COVID-19 patients. Thus, this study aimed to assess the weight of the KAP of physiotherapists in Saudi Arabia during the COVID-19 pandemic. This was a cross-sectional study, where we circulated an online KAP questionnaire to 1179 physical therapists, and among those, 287 participated and completed the questionnaire. The collected responses were analyzed using descriptive statistics, t-test, ANOVA, correlation, and regression analyses, and p-value ≤ 0.05 was considered statistically significant. Both males and females participated in almost equal numbers; most of the participants were <40 years, had a bachelor's level of education, and were from the central region of Saudi Arabia. Social media and the internet were the primary sources of COVID-19-related information (74.6%). Knowledge components A (92%) and B (73.9%) were excellent among most participants. Approximately half of the participants (50.5%) had a moderate attitude toward COVID-19, and regarding the practice component, most participants (74.6%) scored moderately. Correlation analysis showed a low positive relationship between knowledge A, attitude, and practice components. Still, there was a very low positive relationship between knowledge B, attitude, and practice components, but both were statistically significant. Our study showed that physical therapists in Saudi Arabia exhibit good knowledge, attitude, and practice toward COVID-19.

Physical activity patterns in adult population during the coronavirus pandemic: consideration of the role of resilience.

BACKGROUND: The aim of this study was to characterize patterns of physical activity (PA) and to examine whether resilience contributed to PA levels among adults during the COVID-19 pandemic. METHODS: This cross-sectional study was conducted during the COVID-19 quarantine period among adult population in the Kingdom of Saudi Arabia. The International Physical Activity Questionnaire Short Form (IPAQ-SF) and the Brief Resilience Scale (BRS) were used to assess the participants' activity and resilience levels. The Kruskal-Wallis Test was used to examine differences in PA across resilience levels. Spearman's correlation coefficient was used to assess the relationship between resilience and PA levels. Data were reported as medians and interquartile ranges. RESULTS: In total, 1859 individuals were included in the study (40% aged 26-35 years). The findings showed that 85% of the respondents engaged in PA and 15% were physically inactive. The majority (71%) participated in moderate-intensity PA. The median resilience score was 3.50 (0.85), indicating a medium level of resilience. A positive correlation was shown between the average resilience score and both walking (rs=0.01, P<0.001) and vigorous-intensity PA (rs=0.08, P=0.007). Data did not show a significant correlation between moderate-intensity PA and resilience score. CONCLUSIONS: Greater emphasis on PA engagement after the period of quarantine is needed. Resilience may play an important role in buffering the deleterious impact of quarantine on PA.

Melanocytic nevi of the auricular region: histologic characteristics and diagnostic difficulties.

We examined auricular melanocytic nevi to evaluate their architectural and cytologic features. A retrospective analysis of 21 auricular melanocytic nevi was conducted during 3 years. The nevi were evaluated for cytologic atypia, architectural disorder, location of epidermal nests, pagetoid spread, growth pattern (symmetry versus asymmetry), demarcation of lateral borders, and host response (lymphocytic infiltrate and/or lamellar fibroplasia). Eleven cases (52.4%) measured at least 6 mm in greatest dimension and 6 cases (28.6%) were asymmetric. Fourteen cases (66.7%) were ill demarcated. Pagetoid spread was present in 12 cases (57.1%). Ten cases (47.6%) showed moderate to severe cytologic atypia. Nucleoli were prominent in 9 cases (42.8%). None of the cases showed mitoses or apoptotic melanocytes. Auricular melanocytic nevi, like those occurring in the acral, flexural, and genital areas, may exhibit some histologic features commonly found in melanomas. Careful histologic interpretation of these lesions is recommended.

Neutrophilic eccrine hidradenitis mimicking cutaneous vasculitis in a lupus patient: a complication of cyclophosphamide.

Neutrophilic eccrine hidradenitis (NEH) is an unusual self-limited skin disorder characterized by an inflammatory cell infiltrate in the deep dermis involving the eccrine sweat glands, commonly presenting as painful cutaneous nodules. NEH occurs most frequently in patients receiving chemotherapy for haematologic malignancies. We report a case of NEH masquerading as cutaneous vasculitis in a woman receiving cyclophosphamide for lupus nephritis. The association of NEH and the use of cytotoxic agents for SLE or other autoimmune diseases has not been reported previously. NEH must be considered in lupus patients receiving cytotoxic agents to avoid inappropriate use of corticosteroids or antibiotics in this self-limited condition.

Immunofluorescence in dermatology.

The accurate diagnosis of bullous and other immune diseases of the skin requires evaluation of clinical, histologic, and immunofluorescence findings. Immunofluorescence testing is invaluable in confirming a diagnosis that is suspected by clinical or histologic examination. This is especially true in subepidermal bullous diseases that often have overlap in the clinical and histologic findings. Direct immunofluorescence is performed on perilesional skin for patients with bullous diseases and lesional skin for patients with connective tissue diseases and vasculitis.

Neutrophilic eccrine hidradenitis in a patient with Behçet's disease.

Patients with Behçet's disease may develop multiple mucocutaneous manifestations, several of which are mediated by neutrophils. These include aphthous ulcers, pseudofolliculitis, acneform lesions, and pathergy. We report another neutrophil-mediated disorder, neutrophilic eccrine hidradenitis (NEH), in a patient with Behçet's disease. NEH should be added to the list of mucocutaneous lesions that may be seen in patients with Behçet's disease.

Karate cicatrices.

A 46-year-old male presented with linear scars on the dorsal aspects of both hands. The lesions were caused by trauma occurring during the practice of karate. Sports-related scars should be included in the differential diagnosis of scars on the dorsal aspects of the hands.

Annular lichen sclerosus et atrophicus.

Lichen sclerosus et atrophicus (LSA) is an idiopathic skin condition characterized by ivory-colored, atrophic papules and plaques. Many variants of LSA have been described. Only rarely has an annular variant been noted. We present a case of annular LSA and discuss the other reported cases exhibiting an annular shape.

Chronic eyelid lymphedema and acne rosacea. Report of two cases.

OBJECTIVE: The authors describe the clinical findings and surgical treatment of two patients affected by chronic eyelid lymphedema associated with facial acne rosacea. DESIGN: Two interventional case reports. METHODS AND INTERVENTION: The clinical diagnosis of acne rosacea was based on the physical examination and confirmed by the histopathologic findings obtained from biopsy of the involved tissue. Surgical treatment was required to address the disfiguring chronic eyelid lymphedema and to correct the resultant mechanical lower eyelid ectropion in both patients. RESULTS: Surgical debulking of the affected soft tissue resulted in very satisfactory cosmetic and functional improvement in both patients. CONCLUSIONS: To our knowledge, this is the first series of cases of chronic eyelid lymphedema secondary to acne rosacea reported in the ophthalmic literature. Six similar cases have been described previously in the dermatologic literature; all of which had been treated medically without satisfactory results. Surgical debulking of the involved eyelids should be considered in patients affected by persistent symptomatic rosacea lymphedema.

Periorbital comedones and their relationship to pitch tar: a cross-sectional analysis and a review of the literature.

BACKGROUND: Comedones, often in a periorbital distribution, have been claimed to be associated with pitch tar. OBJECTIVE: This cross-sectional study compares the incidence of periorbital comedones between a group of individuals exposed to pitch tar and a control group. METHODS: The incidence of periorbital comedones was determined in workers (n = 55) at a tar distillation plant. A comparison group (n = 55) not exposed to pitch tar was also examined for the presence of facial comedones. The respective incidence rates were compared by using the Fisher exact test. RESULTS: Eighteen percent (10/55) of the study group and 4% (2/55) of the control group had periorbital comedones. The study group had a significantly greater incidence of periorbital comedones (P =.01). CONCLUSION: The incidence of periorbital comedones is significantly greater in individuals exposed to pitch tar. Further studies are needed to elucidate the potential relationship between pitch tar and periorbital comedones.