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1.
Br J Nurs ; 30(17): S24-S30, 2021 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-34605263

RESUMEN

Myeloproliferative neoplasms (MPNs) are associated with a high disease burden, reduced quality of life and shortened survival. The aim of this questionnaire was to gain patients' and caregivers' perspectives on the impact of living with an MPN in the Republic of Ireland. An Irish adaptation of the 'Global MPN Landmark survey' was conducted. Fifty-one patients and 44 caregivers completed the questionnaire. Patients reported a wide variety of symptoms at the time of questionnaire completion; fatigue, bone pain and pruritus being most frequently reported. Approximately one-third of respondents from each of the groups (patients and caregivers) reported a negative impact of MPNs on their emotional wellbeing and daily lives. The study findings revealed that, despite treatment, symptom burden remains high, and several unmet needs exist, including educational, emotional and peer group support. Interventions that focus on reducing symptom burden and addressing these unmet needs, may improve the quality of life for patients with MPNs and their caregivers.


Asunto(s)
Cuidadores , Calidad de Vida , Costo de Enfermedad , Fatiga , Humanos , Irlanda
2.
Sensors (Basel) ; 21(19)2021 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-34640722

RESUMEN

Physical exercise contributes to the success of rehabilitation programs and rehabilitation processes assisted through social robots. However, the amount and intensity of exercise needed to obtain positive results are unknown. Several considerations must be kept in mind for its implementation in rehabilitation, as monitoring of patients' intensity, which is essential to avoid extreme fatigue conditions, may cause physical and physiological complications. The use of machine learning models has been implemented in fatigue management, but is limited in practice due to the lack of understanding of how an individual's performance deteriorates with fatigue; this can vary based on physical exercise, environment, and the individual's characteristics. As a first step, this paper lays the foundation for a data analytic approach to managing fatigue in walking tasks. The proposed framework establishes the criteria for a feature and machine learning algorithm selection for fatigue management, classifying four fatigue diagnoses states. Based on the proposed framework and the classifier implemented, the random forest model presented the best performance with an average accuracy of ≥98% and F-score of ≥93%. This model was comprised of ≤16 features. In addition, the prediction performance was analyzed by limiting the sensors used from four IMUs to two or even one IMU with an overall performance of ≥88%.


Asunto(s)
Caminata , Dispositivos Electrónicos Vestibles , Algoritmos , Fatiga/diagnóstico , Humanos , Aprendizaje Automático
3.
Sensors (Basel) ; 21(19)2021 Sep 27.
Artículo en Inglés | MEDLINE | ID: mdl-34640768

RESUMEN

This paper presents a camera-based prototype sensor for detecting fatigue and drowsiness in drivers, which are common causes of road accidents. The evaluation of the detector operation involved eight professional truck drivers, who drove the truck simulator twice-i.e., when they were rested and drowsy. The Fatigue Symptoms Scales (FSS) questionnaire was used to assess subjectively perceived levels of fatigue, whereas the percentage of eye closure time (PERCLOS), eye closure duration (ECD), and frequency of eye closure (FEC) were selected as eye closure-associated fatigue indicators, determined from the images of drivers' faces captured by the sensor. Three alternative models for subjective fatigue were used to analyse the relationship between the raw score of the FSS questionnaire, and the eye closure-associated indicators were estimated. The results revealed that, in relation to the subjective assessment of fatigue, PERCLOS is a significant predictor of the changes observed in individual subjects during the performance of tasks, while ECD reflects the individual differences in subjective fatigue occurred both between drivers and in individual drivers between the 'rested' and 'drowsy' experimental conditions well. No relationship between the FEC index and the FSS state scale was found.


Asunto(s)
Conducción de Automóvil , Fatiga/diagnóstico , Humanos , Vehículos a Motor , Descanso , Vigilia
4.
Trials ; 22(1): 696, 2021 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-34641961

RESUMEN

BACKGROUND: Fear of cancer recurrence, depressive symptoms, and cancer-related fatigue are prevalent symptoms among cancer survivors, adversely affecting patients' quality of life and daily functioning. Effect sizes of interventions targeting these symptoms are mostly small to medium. Personalizing treatment is assumed to improve efficacy. However, thus far the empirical support for this approach is lacking. The aim of this study is to investigate if systematically personalized cognitive behavioral therapy is more efficacious than standard cognitive behavioral therapy in cancer survivors with moderate to severe fear of cancer recurrence, depressive symptoms, and/or cancer-related fatigue. METHODS: The study is designed as a non-blinded, multicenter randomized controlled trial with two treatment arms (ratio 1:1): (a) systematically personalized cognitive behavioral therapy and (b) standard cognitive behavioral therapy. In the standard treatment arm, patients receive an evidence-based diagnosis-specific treatment protocol for fear of cancer recurrence, depressive symptoms, or cancer-related fatigue. In the second arm, treatment is personalized on four dimensions: (a) the allocation of treatment modules based on ecological momentary assessments, (b) treatment delivery, (c) patients' needs regarding the symptom for which they want to receive treatment, and (d) treatment duration. In total, 190 cancer survivors who experience one or more of the targeted symptoms and ended their medical treatment with curative intent at least 6 months to a maximum of 5 years ago will be included. Primary outcome is limitations in daily functioning. Secondary outcomes are level of fear of cancer recurrence, depressive symptoms, fatigue severity, quality of life, goal attainment, therapist time, and drop-out rates. Participants are assessed at baseline (T0), and after 6 months (T1) and 12 months (T2). DISCUSSION: To our knowledge, this is the first randomized controlled trial comparing the efficacy of personalized cognitive behavioral therapy to standard cognitive behavioral therapy in cancer survivors. The study has several innovative characteristics, among which is the personalization of interventions on several dimensions. If proven effective, the results of this study provide a first step in developing an evidence-based framework for personalizing therapies in a systematic and replicable way. TRIAL REGISTRATION: The Dutch Trial Register (NTR) NL7481 (NTR7723). Registered on 24 January 2019.


Asunto(s)
Supervivientes de Cáncer , Terapia Cognitivo-Conductual , Neoplasias , Depresión/diagnóstico , Depresión/etiología , Depresión/terapia , Fatiga/diagnóstico , Fatiga/etiología , Fatiga/terapia , Miedo , Humanos , Estudios Multicéntricos como Asunto , Neoplasias/complicaciones , Neoplasias/terapia , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
5.
Aerosp Med Hum Perform ; 92(10): 786-797, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34641999

RESUMEN

OBJECTIVE: This research was conducted to compare short haul (SH) and long haul (LH) pilots regarding sleep restrictions and fatigue risks on flight duty, stress, sleep problems, fatigue severity, well-being, and mental health. METHOD: There were 406 international SH and LH pilots who completed the cross-sectional online survey. Pilots sleep restrictions and fatigue-risk profiles (e.g., time pressure, late arrivals, minimum rest), sleep problems, fatigue severity, well-being, and symptoms of depression, anxiety, and common mental disorders (CMD) were measured and compared for SH and LH pilots. RESULTS: Although SH and LH pilots were scheduled for only 51.465.4% of the legally allowed duty and flight hours, 44.8% of SH pilots reported severe fatigue (FSS 4 to 4.9), and an additional 31.7% high fatigue (FSS 5), compared with 34.7% and 37.3% LH pilots. Considerable sleep problems in 8 nights/mo were reported by 24.6% SH vs. 23.5% LH pilots. Positive depression screenings were reported by 18.1% SH and 19.3% LH pilots. Positive anxiety screenings were reported by 9.6% SH and 5% LH pilots. Of all investigated pilots, 20% reported significant symptoms of depression or anxiety, and 7.23% had positive depression and anxiety screenings. LH pilots reported significantly better well-being than SH pilots. CONCLUSIONS: Our results show that even far less duty and flight hours than legally allowed according to flight time limitations lead to high levels of fatigue, sleep problems, and significant mental health issues among pilots. SH pilots were even more affected than LH pilots. Pilots fatigue should be considered an immediate threat to aviation safety and pilots fitness to fly by promoting fatigue and burnout. Venus M, grosse Holtforth M. Short and long haul pilots rosters, stress, sleep problems, fatigue, mental health, and well-being. Aerosp Med Hum Perform. 2021; 92(10):786797.


Asunto(s)
Pilotos , Trastornos del Sueño-Vigilia , Estudios Transversales , Fatiga/epidemiología , Humanos , Fatiga Mental/epidemiología , Salud Mental , Trastornos del Sueño-Vigilia/epidemiología , Tolerancia al Trabajo Programado
6.
Aerosp Med Hum Perform ; 92(10): 806-814, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34642001

RESUMEN

BACKGROUND: Fatigue is an insidious and costly occurrence in the aviation community, commonly a consequence of insufficient sleep. Some organizations use scheduling tools to generate prescriptive sleep schedules to help aircrew manage their fatigue. It is important to examine whether aircrew follow these prescriptive schedules, especially in very dynamic environments. The current study compares aircrew sleep during missions to prescriptive sleep schedules generated by a mission scheduling tool. METHODS: Participating in the study were 44 volunteers (Mage= 28.23, SDage= 4.23; Proportionmale= 77.27%) from a C-17 mobility squadron providing 25 instances of sleep and mission data (80 flights total). Aircrew wore actigraph watches to measure sleep during missions and prescriptive sleep schedules were collected. Actual and prescriptive sleep was compared with calculated performance effectiveness values per minute across mission flights. RESULTS: Prescriptive schedules generally overestimated effectiveness during missions relative to estimated actual sleep, potentially causing shifts in effectiveness to ranges of increased risk requiring elevated fatigue mitigation efforts. Actual and prescriptive effectiveness estimates tended to increasingly diverge over the course of missions, which magnifies differences on longer missions. DISCUSSION: The current study suggests that aircrew sleep during missions often does not align with prescriptive sleep schedules generated by mission planning software, resulting in effectiveness estimates that are generally lower than predicted. This might discourage aircrew from using mission effectiveness graphs as a fatigue mitigation tool. Additionally, because fatigue estimates factor into overall operational risk management processes, these schedules might underestimate risks to safety, performance, and health. Morris MB, Veksler BZ, Krusmark MA, Gaines AR, Jantscher HL, Gunzelmann G. Aircrew actual vs. prescriptive sleep schedules and resulting fatigue estimates. Aerosp Med Hum Perform. 2021; 92(10):806814.


Asunto(s)
Medicina Aeroespacial , Aviación , Adulto , Preescolar , Fatiga , Humanos , Masculino , Sueño , Privación de Sueño
7.
Artículo en Ruso | MEDLINE | ID: mdl-34481432

RESUMEN

OBJECTIVE: To study the effectiveness of a course of intravenous administration of cytoflavin in combination with a standard rehabilitation program for post-COVID fatigue syndrome caused by mitochondrial dysfunction. MATERIAL AND METHODS: The dynamic examination of 45 patients with post-COVID syndrome at the second stage of rehabilitation was carried out. The patients were subdivided into 2 groups comparable in gender and age. The volume of lung damage in patients of both groups was also comparable at range of 25-80%. Twenty-four patients of the control group were treated with the standard post-COVID rehabilitation protocol: pulse magnetic therapy, inhalation therapy, aeroion therapy, infrared laser therapy, course aerobic training, psychotherapy, and standard drug therapy. Twenty-one patients of the main group additionally received intravenous administration of cytoflavin daily for 10 days. The dynamics of the scores on the Rehabilitation Routing Scale, HDRS, the Asthenic Status Scale, and the 6-minute walk test was analyzed. RESULTS AND CONCLUSION: The additional intravenous administration of cytoflavin at the complex rehabilitation of post-COVID syndrome can significantly improve the therapeutic results: it significantly improves the overall functional state, reduces depression and fatigue level and increases tolerance to physical exertion.


Asunto(s)
COVID-19 , Fatiga/rehabilitación , Mitocondrias/patología , COVID-19/rehabilitación , Fatiga/virología , Humanos , Resultado del Tratamiento
8.
BMJ Open ; 11(9): e047251, 2021 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-34475160

RESUMEN

AIM: The aim of this systematic review was to assess the effectiveness of rehabilitation interventions on the secondary physical, neurological and psychological consequences of cardiac arrest (CA) for adult survivors. METHODS: A literature search of electronic databases (MEDLINE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Psychological Information Database, Web of Science and Cochrane Central Register of Controlled trials) was conducted for randomised controlled trials (RCTs) and observational studies up to 18 April 2021. The primary outcome was health-related quality of life (HRQoL) and main secondary outcome was neurological function with additional secondary outcomes being survival, rehospitalisation, safety (serious and non-serious adverse events), psychological well-being, fatigue, exercise capacity and physical capacity. Two authors independently screened studies for eligibility, extracted data and assessed risk of bias. RESULTS: Three RCTs and 11 observational studies were included (total 721 participants). Study duration ranged from 8 weeks to 2 years. Pooled data from two RCTs showed low-quality evidence for no effect on physical HRQoL (standardised mean difference (SMD) 0.19, (95% CI: -0.09 to 0.47)) and no effect on mental HRQoL (SMD 0.27 (95% CI: -0.01 to 0.55)).Regarding secondary outcomes, very low-quality evidence was found for improvement in neurological function associated with inpatient rehabilitation for CA survivors with acquired brain injury (SMD 0.71, (95% CI: 0.45 to 0.96)) from five observational studies. Two small observational studies found exercise-based rehabilitation interventions to be safe for CA survivors, reporting no serious or non-serious events. CONCLUSIONS: Given the overall low quality of evidence, this review cannot determine the effectiveness of rehabilitation interventions for CA survivors on HRQoL, neurological function or other included outcomes, and recommend further high-quality studies be conducted. In the interim, existing clinical guidelines on rehabilitation provision after CA should be followed to meet the high burden of secondary consequences suffered by CA survivors. PROSPERO REGISTRATION NUMBER: CRD42018110129.


Asunto(s)
Terapia por Ejercicio , Paro Cardíaco , Adulto , Fatiga , Humanos , Calidad de Vida , Sobrevivientes
9.
Psychol Aging ; 36(6): 679-693, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34516172

RESUMEN

Emotions and symptoms are often overestimated in retrospective ratings, a phenomenon referred to as the "memory-experience gap." Some research has shown that this gap is less pronounced among older compared to younger adults for self-reported negative affect, but it is not known whether these age differences are evident consistently across domains of well-being and why these age differences emerge. In this study, we examined age differences in the memory-experience gap for emotional (positive and negative affect), social (loneliness), and physical (pain, fatigue) well-being. We also tested four variables that could plausibly explain age differences in the gap: (a) episodic memory and executive functioning, (b) the age-related positivity effect, (c) variability of daily experiences, and (d) socially desirable responding. Adults (n = 477) from three age groups (21-44, 45-64, 65+ years old) participated in a 21-day diary study. Participants completed daily end-of-day ratings and retrospective ratings of the same constructs over different recall periods (3, 7, 14, and 21 days). Results showed that, relative to young and middle-aged adults, older adults had a smaller memory-experience gap for negative affect and loneliness. Lower day-to-day variability partly explained why the gap was smaller for older adults. There was no evidence that the magnitude of the memory-experience gap for positive affect, pain or fatigue depended on age. We recommend that future research considers how variability in daily experiences can impact age differences in retrospective self-reports of well-being. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Asunto(s)
Envejecimiento/psicología , Memoria Episódica , Recuerdo Mental , Adulto , Afecto , Anciano , Fatiga , Femenino , Humanos , Soledad , Masculino , Persona de Mediana Edad , Dolor , Estudios Retrospectivos , Adulto Joven
10.
Niger J Clin Pract ; 24(9): 1332-1337, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34531346

RESUMEN

Background: Hemodialysis patients develop many physical and psychosocial symptoms associated with chronic kidney disease and its treatment. The presence of these symptoms also adversely affects an individual's activities of daily living. Aim: The aim of this study was to evaluate the symptoms seen in hemodilaysis patients and to examine the effect on daily living activities. Materials and Methods: This was a cross-sectional descriptive study carried out on 126 patients in two dialysis centers in Turkey. Patient Information Form, Dialysis Symptom Index (DSI) and Katz Activities of Daily Living Scale (KADL) were used as data collection tools. Results: The most frequent symptoms described by the patients undergoing hemodialysis were tiredness, sadness, and muscle-joint pain. The mean of the DSI was 30.03 (SD: 14.7). There was a statistically significant relationship between dialysis symptom index and disease duration and hemodialysis vintage (P < 0.05). In addition, the mean score of the Patients' KADL was 14.48 (SD: 2.55). Eighty-two (65.1%) patients maintain their daily living activities independently. On the other hand, 26.2% of the dialysis patients maintained their daily living activities as semi-dependent, while 8.7% were totally dependent on others. A statistically significant relationship was found between KADL, marital status, year of dialysis and presence of another chronic disease (P < 0.05). There was statistically significant relationship between DSI and KADL. In hemodilaysis patients, as the DSI score increased, the dependence on daily living activities increased. Conclusion: The symptoms seen in patients have a negative effect on maintaining their daily living activities. Health workers should perform symptom evaluation in patients undergoing dialysis. Thus, each patient-specific individualized care plan should be designed for effective management of these symptoms in patients. Effective symptom management will be effective in maintaining patients' daily living activities.


Asunto(s)
Actividades Cotidianas , Calidad de Vida , Estudios Transversales , Fatiga , Humanos , Diálisis Renal
11.
Best Pract Res Clin Anaesthesiol ; 35(3): 269-292, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511219

RESUMEN

Coronaviruses belong to the family Coronaviridae order Nidovirales and are known causes of respiratory and intestinal disease in various mammalian and avian species. Species of coronaviruses known to infect humans are referred to as human coronaviruses (HCoVs). While traditionally, HCoVs have been a significant cause of the common cold, more recently, emergent viruses, including severe acute respiratory syndrome coronavirus (SARS-CoV-2) has caused a global pandemic. Here, we discuss coronavirus disease (COVID-19) biology, pathology, epidemiology, signs and symptoms, diagnosis, treatment, and recent clinical trials involving promising treatments.


Asunto(s)
Antivirales/administración & dosificación , COVID-19/epidemiología , COVID-19/terapia , SARS-CoV-2 , Adenosina Monofosfato/administración & dosificación , Adenosina Monofosfato/análogos & derivados , Corticoesteroides/administración & dosificación , Alanina/administración & dosificación , Alanina/análogos & derivados , Animales , COVID-19/diagnóstico , COVID-19/inmunología , Coronavirus/efectos de los fármacos , Coronavirus/inmunología , Tos/epidemiología , Tos/terapia , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , Fatiga/epidemiología , Fatiga/terapia , Fiebre , Cardiopatías/epidemiología , Cardiopatías/terapia , Humanos , Respiración con Presión Positiva/métodos , Pronóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/terapia , SARS-CoV-2/efectos de los fármacos , SARS-CoV-2/inmunología , Resultado del Tratamiento
12.
N Engl J Med ; 385(10): 885-895, 2021 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-34469646

RESUMEN

BACKGROUND: Immune thrombocytopenia is a rare autoimmune disorder with associated bleeding risk and fatigue. Recommended first-line treatment for immune thrombocytopenia is high-dose glucocorticoids, but side effects, variable responses, and high relapse rates are serious drawbacks. METHODS: In this multicenter, open-label, randomized, controlled trial conducted in the United Kingdom, we assigned adult patients with immune thrombocytopenia, in a 1:1 ratio, to first-line treatment with a glucocorticoid only (standard care) or combined glucocorticoid and mycophenolate mofetil. The primary efficacy outcome was treatment failure, defined as a platelet count of less than 30×109 per liter and initiation of a second-line treatment, assessed in a time-to-event analysis. Secondary outcomes were response rates, side effects, occurrence of bleeding, patient-reported quality-of-life measures, and serious adverse events. RESULTS: A total of 120 patients with immune thrombocytopenia underwent randomization (52.4% male; mean age, 54 years [range 17 to 87]; mean platelet level, 7×109 per liter) and were followed for up to 2 years after beginning trial treatment. The mycophenolate mofetil group had fewer treatment failures than the glucocorticoid-only group (22% [13 of 59 patients] vs. 44% [27 of 61 patients]; hazard ratio, 0.41; range, 0.21 to 0.80; P = 0.008) and greater response (91.5% of patients having platelet counts greater than 100×109 per liter vs. 63.9%; P<0.001). We found no evidence of a difference between the groups in the occurrence of bleeding, rescue treatments, or treatment side effects, including infection. However, patients in the mycophenolate mofetil group reported worse quality-of-life outcomes regarding physical function and fatigue than those in the glucocorticoid-only group. CONCLUSIONS: The addition of mycophenolate mofetil to a glucocorticoid for first-line treatment of immune thrombocytopenia resulted in greater response and a lower risk of refractory or relapsed immune thrombocytopenia, but with somewhat decreased quality of life. (Funded by the U.K. National Institute for Health Research; FLIGHT ClinicalTrials.gov number, NCT03156452; EudraCT number, 2017-001171-23.).


Asunto(s)
Glucocorticoides/uso terapéutico , Inmunosupresores/uso terapéutico , Ácido Micofenólico/uso terapéutico , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Adolescente , Adulto , Anciano , Quimioterapia Combinada , Fatiga/inducido químicamente , Femenino , Glucocorticoides/efectos adversos , Hemorragia/etiología , Hemorragia/prevención & control , Humanos , Inmunosupresores/efectos adversos , Masculino , Persona de Mediana Edad , Ácido Micofenólico/efectos adversos , Recuento de Plaquetas , Púrpura Trombocitopénica Idiopática/complicaciones , Calidad de Vida , Adulto Joven
13.
Res Nurs Health ; 44(5): 796-810, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34515341

RESUMEN

Optimal sequencing of complementary therapies can help improve symptom management through nonpharmacological approaches. A 12-week sequential multiple assignment randomized trial comparing home-based reflexology and meditative practices on severity of fatigue and other symptoms was conducted among patients with cancer and their informal caregivers. Dyads were initially randomized to reflexology (N = 150), meditative practices (N = 150), or control (N = 47). If patient's fatigue did not improve (nonresponse) after 4 weeks of reflexology or meditative practices, the dyad was rerandomized to either add the other therapy or continue with the original therapy for weeks 5-8. Four decision rules (DRs) were compared: (1) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, continue with reflexology for another 4 weeks, thus providing a higher dose; (2) Initiating reflexology, and if nonresponse on fatigue after 4 weeks, add meditative practices for the next 4 weeks; (3) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, continue meditative practices for another 4 weeks, thus providing a higher dose; and (4) Initiating meditative practices, and if nonresponse on fatigue after 4 weeks, add reflexology for the next 4 weeks. Symptoms were evaluated weekly using the M.D. Anderson Symptom Inventory (MDASI). Clinically, nurses can recommend either therapy since no differences were found among the 4 DRs, with the exception of lower severity for summed MDASI symptoms at week 8 for the use of reflexology only (DR-1) versus DR-2 (sequencing reflexology to meditative practices). Adding the other therapy for nonresponders after 4 weeks may not be warranted.


Asunto(s)
Cuidadores/psicología , Fatiga/terapia , Meditación/métodos , Manipulaciones Musculoesqueléticas/métodos , Neoplasias/psicología , Neoplasias/terapia , Pacientes/psicología , Adulto , Anciano , Anciano de 80 o más Años , Fatiga/etiología , Fatiga/psicología , Femenino , Humanos , Masculino , Meditación/psicología , Persona de Mediana Edad , Manipulaciones Musculoesqueléticas/psicología , Neoplasias/complicaciones , Resultado del Tratamiento
15.
Am J Nurs ; 121(10): 16, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34554973

RESUMEN

Patients report a wide range of symptoms as researchers work to pinpoint their cause.


Asunto(s)
COVID-19/complicaciones , COVID-19/fisiopatología , Dolor en el Pecho/etiología , Fatiga/etiología , Fiebre/etiología , Cefalea/etiología , Humanos , Estudios Longitudinales
16.
N Z Med J ; 134(1542): 38-49, 2021 09 17.
Artículo en Inglés | MEDLINE | ID: mdl-34531582

RESUMEN

AIMS: To review the demographic and clinical characteristics of confirmed COVID-19 cases within the Greater Wellington Region (GWR). METHODS: A retrospective, observational study of all 96 confirmed COVID-19 cases in the GWR. The primary outcome was time taken from onset to complete resolution of symptoms. Secondary outcomes were the epidemiological and clinical characteristics of cases. RESULTS: The mean (SD) time from symptom onset to complete resolution was 19.1 (1.1) days. The mean (SD) age was 43.1 (16.9). 51% were male. The majority were of European ethnicity (84%), resided in the top five decile neighbourhoods (76%) and had travelled to New Zealand (69%). The mean (SD) time from onset of symptoms to obtaining RT-PCR testing results was 5.3 (0.4) days. The most common symptoms at onset were cough (36%), sore throat (22%) and fatigue (21%); the overall most common symptoms were cough (65%), sore throat (43%), headache (43%) and fatigue (42%); many symptoms were late manifestations. The most common co-morbidity reported was asthma (20%), with no reported exacerbations. The rate of secondary infections within households was 0.05 per primary infection. CONCLUSION: The demography of COVID-19 cases reflected the imported nature of cases. The clinical presentation of COVID-19 was highly variable and there were no particular symptoms that could accurately predict infection.


Asunto(s)
COVID-19/diagnóstico , COVID-19/epidemiología , Examen Físico , Adulto , Causalidad , Tos/diagnóstico , Fatiga/diagnóstico , Cefalea/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Faringitis/diagnóstico , Estudios Retrospectivos
17.
PLoS Med ; 18(9): e1003773, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34582441

RESUMEN

BACKGROUND: Long-COVID refers to a variety of symptoms affecting different organs reported by people following Coronavirus Disease 2019 (COVID-19) infection. To date, there have been no robust estimates of the incidence and co-occurrence of long-COVID features, their relationship to age, sex, or severity of infection, and the extent to which they are specific to COVID-19. The aim of this study is to address these issues. METHODS AND FINDINGS: We conducted a retrospective cohort study based on linked electronic health records (EHRs) data from 81 million patients including 273,618 COVID-19 survivors. The incidence and co-occurrence within 6 months and in the 3 to 6 months after COVID-19 diagnosis were calculated for 9 core features of long-COVID (breathing difficulties/breathlessness, fatigue/malaise, chest/throat pain, headache, abdominal symptoms, myalgia, other pain, cognitive symptoms, and anxiety/depression). Their co-occurrence network was also analyzed. Comparison with a propensity score-matched cohort of patients diagnosed with influenza during the same time period was achieved using Kaplan-Meier analysis and the Cox proportional hazard model. The incidence of atopic dermatitis was used as a negative control. Among COVID-19 survivors (mean [SD] age: 46.3 [19.8], 55.6% female), 57.00% had one or more long-COVID feature recorded during the whole 6-month period (i.e., including the acute phase), and 36.55% between 3 and 6 months. The incidence of each feature was: abnormal breathing (18.71% in the 1- to 180-day period; 7.94% in the 90- to180-day period), fatigue/malaise (12.82%; 5.87%), chest/throat pain (12.60%; 5.71%), headache (8.67%; 4.63%), other pain (11.60%; 7.19%), abdominal symptoms (15.58%; 8.29%), myalgia (3.24%; 1.54%), cognitive symptoms (7.88%; 3.95%), and anxiety/depression (22.82%; 15.49%). All 9 features were more frequently reported after COVID-19 than after influenza (with an overall excess incidence of 16.60% and hazard ratios between 1.44 and 2.04, all p < 0.001), co-occurred more commonly, and formed a more interconnected network. Significant differences in incidence and co-occurrence were associated with sex, age, and illness severity. Besides the limitations inherent to EHR data, limitations of this study include that (i) the findings do not generalize to patients who have had COVID-19 but were not diagnosed, nor to patients who do not seek or receive medical attention when experiencing symptoms of long-COVID; (ii) the findings say nothing about the persistence of the clinical features; and (iii) the difference between cohorts might be affected by one cohort seeking or receiving more medical attention for their symptoms. CONCLUSIONS: Long-COVID clinical features occurred and co-occurred frequently and showed some specificity to COVID-19, though they were also observed after influenza. Different long-COVID clinical profiles were observed based on demographics and illness severity.


Asunto(s)
COVID-19/complicaciones , Sobrevivientes , Adulto , Anciano , COVID-19/epidemiología , Estudios de Cohortes , Disnea/epidemiología , Disnea/etiología , Fatiga/epidemiología , Fatiga/etiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/etiología , Humanos , Incidencia , Gripe Humana/complicaciones , Gripe Humana/epidemiología , Masculino , Trastornos Mentales/epidemiología , Trastornos Mentales/etiología , Persona de Mediana Edad , Dolor/epidemiología , Dolor/etiología , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiología , Adulto Joven
18.
JAMA Netw Open ; 4(9): e2127403, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34586367

RESUMEN

Importance: The long-term health outcomes and symptom burden of COVID-19 remain largely unclear. Objective: To evaluate health outcomes of COVID-19 survivors 1 year after hospital discharge and to identify associated risk factors. Design, Setting, and Participants: This retrospective, multicenter cohort study was conducted at 2 designated hospitals, Huoshenshan Hospital and Taikang Tongji Hospital, both in Wuhan, China. All adult patients with COVID-19 discharged between February 12 and April 10, 2020, were screened for eligibility. Of a consecutive sample of 3988 discharged patients, 1555 were excluded (796 declined to participate and 759 were unable to be contacted) and the remaining 2433 patients were enrolled. All patients were interviewed via telephone from March 1 to March 20, 2021. Statistical analysis was performed from March 28 to April 18, 2021. Exposures: COVID-19. Main Outcomes and Measures: All patients participated in telephone interviews using a series of questionnaires for evaluation of symptoms, along with a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Logistic regression models were used to evaluate risk factors for fatigue, dyspnea, symptom burden, or higher CAT scores. Results: Of 2433 patients at 1-year follow-up, 1205 (49.5%) were men and 680 (27.9%) were categorized into the severe disease group as defined by the World Health Organization guideline; the median (IQR) age was 60.0 (49.0-68.0) years. In total, 1095 patients (45.0%) reported at least 1 symptom. The most common symptoms included fatigue, sweating, chest tightness, anxiety, and myalgia. Older age (odds ratio [OR], 1.02; 95% CI, 1.01-1.02; P < .001), female sex (OR, 1.27; 95% CI, 1.06-1.52; P = .008), and severe disease during hospital stay (OR, 1.43; 95% CI, 1.18-1.74; P < .001) were associated with higher risks of fatigue. Older age (OR, 1.02; 95% CI, 1.01-1.03; P < .001) and severe disease (OR, 1.51; 95% CI, 1.14-1.99; P = .004) were associated with higher risks of having at least 3 symptoms. The median (IQR) CAT score was 2 (0-4), and a total of 161 patients (6.6%) had a CAT score of at least 10. Severe disease (OR, 1.84; 95% CI, 1.31-2.58; P < .001) and coexisting cerebrovascular diseases (OR, 1.95; 95% CI, 1.07-3.54; P = .03) were independent risk factors for CAT scores of at least 10. Conclusions and Relevance: This study found that patients with COVID-19 with severe disease during hospitalization had more postinfection symptoms and higher CAT scores.


Asunto(s)
COVID-19/complicaciones , Hospitales , Alta del Paciente , Enfermedad Pulmonar Obstructiva Crónica/etiología , Índice de Severidad de la Enfermedad , Sobrevivientes , Anciano , Ansiedad/etiología , China , Ciudades , Disnea/etiología , Fatiga/etiología , Femenino , Hospitalización , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Mialgia/etiología , Pandemias , Estudios Retrospectivos , SARS-CoV-2 , Encuestas y Cuestionarios
19.
Work ; 70(1): 209-217, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34511525

RESUMEN

BACKGROUND: Municipality cleaners are exposed to food insecurity, Musculoskeletal Symptoms (MSs), and fatigue. OBJECTIVE: This study aimed to investigate the effect of food insecurity on MSs, fatigue, and productivity among municipality cleaners. METHODS: This study was conducted on 399 Iranian male municipality cleaners with at least one year of working experience. The data were gathered via a demographic/occupational questionnaire, the Persian version of the Household Food Insecurity Access Scale (P-HFIAS), the Persian version of Nordic Musculoskeletal Questionnaire (P-NMQ), the Persian version of the Multidimensional Assessment of Fatigue scale (P-MAF), and the Persian version of Health and Work Questionnaire (P-HWQ). Data were analyzed using descriptive statistics, multiple logistic regression (Forward Wald), and multiple linear regression (Stepwise). RESULTS: The findings revealed that 42.6%of the municipality cleaners were in the 'severely food insecure' category. The highest prevalence of MSs in the past week were related to knees (35.8%), lower back (35.1%), and ankles/feet (28.8%). Based on the results, the chance of MSs in the shoulders (OR = 1.66) and ankles/feet (1.60) regions, and MSs at least in one body region (OR = 1.47) was higher in the individuals with severe food insecurity than the others. Considering the P-MAF, food insecurity was associated with the 'degree and severity', 'distress that it causes', and 'timing of fatigue' subscales and 'total fatigue'. Considering the P-HWQ, food insecurity was associated with 'productivity', 'other's assessment', 'concentration/focus', 'supervisor relations', 'non-work satisfaction', and 'impatience/irritability' subscales. CONCLUSION: The study revealed an association between food insecurity and MSs in some body regions and fatigue and productivity subscales among the municipality cleaners. Nutritional and ergonomic programs are recommended to reduce municipality cleaners' food insecurity, MSs, and fatigue and enhance their productivity.


Asunto(s)
Fatiga , Inseguridad Alimentaria , Estudios Transversales , Fatiga/epidemiología , Humanos , Irán/epidemiología , Satisfacción en el Trabajo , Masculino
20.
Comput Biol Med ; 137: 104839, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34520991

RESUMEN

OBJECTIVE: User-independent recognition of exercise-induced fatigue from wearable motion data is challenging, due to inter-participant variability. This study aims to develop algorithms that can accurately estimate fatigue during exercise. METHODS: A novel approach for wearable sensor data augmentation was used to generate (via OpenSim) a large corpus of simulated wearable human motion data, based on a small corpus of human motion data measured using optical sensors. Simulated data is generated using detailed kinematic modelling with variations based on human anthropometry datasets. Using both the recorded and generated data, we trained three different neural networks (Convolutional Neural Network (CNN), Recurrent Neural Network (RNN), DeepConvLSTM) to perform person-independent fatigue estimation from wearable motion data. RESULTS: The estimation performance increased with the amount of simulated training data. Accuracy and correlation values were higher with the proposed data augmentation method as compared to other general time series augmentation methods (e.g, rotation, jettering, magnitude wrapping) with the same amount of training data. An accuracy of 87% and a Pearson correlation coefficient of 90% were achieved on unseen data when the DeepConvLSTM model was trained with the proposed augmented dataset. CONCLUSION: The enlarged dataset significantly improves the prediction of inter-individual fatigue. SIGNIFICANCE: Appropriate augmentation techniques for biomechanical data can improve model accuracy and reduce the need for expensive data collection.


Asunto(s)
Ejercicio Físico , Redes Neurales de la Computación , Fenómenos Biomecánicos , Fatiga , Humanos , Rotación
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