Association between the Ile164 ß2 Adrenergic Receptor Polymorphism and Fatigue in Patients with Rheumatoid Arthritis.

INTRODUCTION: In the present work, the frequency of inherited polymorphisms of the beta 2 adrenergic receptor (ß2AR) gene and their association with fatigue in patients with rheumatoid arthritis (RA) was examined. METHODS: An allele-specific polymerase chain reaction was used to determine the common variants of the ß2AR at position 16, 27, and 164 in 92 German RA outpatients. Health Assessment Questionnaire (HAQ-DI), Beck Depression Inventory (BDI), Perceived Stress Questionnaire (PSQ-30), Multidimensional Fatigue Inventory (MFI-20) were utilized. RESULTS: 34.7% of German RA patients were diagnosed with associated fatigue. Fatigued patients were more likely to carry the Ile allele at position 164 (OR 7.33, 95% CI 1.09-59.8, p = 0.049). Comparing these risk factors' contribution to different fatigue dimensions revealed that Ile164 carriers only had significantly higher MFI-20 mean values for general fatigue (p = 0.014) while the clinical difference among other MFI subscales was the largest for mental fatigue (carrier: 8.23, SD: 4.22, noncarrier: 5.67, SD: 1.56, p = 0.089, Cohen's d = 0.629). Disease activity, perceived stress, and depression were also associated with fatigue with higher mean values for DAS28CRP (p = 0.038), PSQ (p < 0.001), and BDI-II (p < 0.001) in fatigued patients. Physical fatigue was correlated with disease activity (p = 0.009) and depression (p = 0.001) while mental fatigue showed associations with depression (p = 0.001) and perceived stress (p = 0.028). CONCLUSION: The discovery study indicates that the Ile164 polymorphism might in contrast to other ß2AR polymorphisms affect fatigue levels in RA patients. This association was observed especially with mental fatigue. Further replication studies are warranted to determine further role of ß2AR polymorphisms in RA patients.

Coping strategies in patients with good outcome but chronic fatigue after aneurysmal subarachnoid hemorrhage.

BACKGROUND: Fatigue is a highly prevalent and debilitating symptom among patients in the chronic phase of aneurysmal subarachnoid haemorrhage (aSAH) with no identified effective treatment. Cognitive therapy has been shown to have moderate effects on fatigue. Delineating the coping strategies used by patients with post-aSAH fatigue and relating them to fatigue severity and emotional symptoms could be a step towards developing a behavioural therapy for post-aSAH fatigue. METHODS: Ninety-six good outcome patients with chronic post-aSAH fatigue answered the questionnaires Brief COPE, (a questionnaire defining 14 coping strategies and three Coping Styles), the Fatigue Severity Scale (FSS), Mental Fatigue Scale (MFS), Beck Depression Inventory (BDI-II) and Beck Anxiety Inventory (BAI). The Brief COPE scores were compared with fatigue severity and emotional symptoms of the patients. RESULTS: The prevailing coping strategies were "Acceptance", "Emotional Support", "Active Coping" and "Planning". "Acceptance" was the sole coping strategy that was significantly inversely related to levels of fatigue. Patients with the highest scores for mental fatigue and those with clinically significant emotional symptoms applied significantly more maladaptive avoidant strategies. Females and the youngest patients applied more "Problem-Focused" strategies. CONCLUSION: A therapeutic behavioural model aiming at furthering "Acceptance" and reducing passivity and "Avoidant" strategies may contribute to alleviate post-aSAH fatigue in good outcome patients. Given the chronic nature of post-aSAH fatigue, neurosurgeons may encourage patients to accept their new situation so that they can start a process of positive reframing instead of being trapped in a spiral of futile loss of energy and secondary increased emotional burden and frustration.

Physical and mental fatigue in myasthenia gravis and its correlation with other symptoms.

INTRODUCTION: Muscle weakness and easy fatigability are the clinical hallmarks of myasthenia gravis (MG). However, fatigue perception, which can be seen quite often in myasthenic patients, and its effect on the quality of life, irrespective of motor deficit, has not been elucidated yet. The aim is to evaluate the frequency of fatigue in myasthenic patients with nearly full muscle strength and the effect of fatigue on quality of life by assessing its correlation with other symptoms. METHODS: Fifty-three patients with ocular or mild generalized MG in remission or minimal manifestations completed the questionnaires measuring the severity of MG and quality of life (MG Composite Scale and MG-Activities of Daily Living Profile). Both patient group and control group (53 healthy volunteers)completed the scales assessing fatigue [Fatigue Assessment Scale (FAS) and Fatigue Impact Scale (FIS)], depression [Beck Depression Inventory (BDI)] and sleep (Epworth Sleepiness Scale). Disease severity was assessed using MG Foundation of America (MGFA) and MGFA Post-Intervention Status classifications. RESULTS: FAS, FIS physical and BDI scores were significantly higher in patients compared to the control group (p = 0.003, p = 0.001, and p = 0.003, respectively) and fatigue was associated with depression and daytime sleepiness. Inpatient group, depressive symptoms and daytime sleepiness were higher in females (p = 0.019 and p = 0.013). The mean values of FIS total and cognitive scores were higher in patients with generalized MG (p = 0.033 and p = 0.045). Fatigue scores correlated with motor signs. DISCUSSION: Fatigue can be seen in MG independently from muscle weakness and is an important symptom worsening the quality of life.

Independent and interactive effects of thermal stress and mental fatigue on manual dexterity.

Many occupations and sports require high levels of manual dexterity under thermal stress and mental fatigue. Yet, multistressor studies remain scarce. We quantified the interactive effects of thermal stress and mental fatigue on manual dexterity. Seven males (21.1 ± 1.3 yr) underwent six separate 60-min trials characterized by a combination of three air temperatures (hot, 37°C; neutral, 21°C; cold, 7°C) and two mental fatigue states (MF, mental fatigue induced by a 35-min cognitive battery; no-MF, no mental fatigue). Participants performed complex (O'Connor test) and simple (hand-tool test) manual tasks pre- and posttrial to determine stressor-induced performance changes. We monitored participants' rectal temperature and hand skin temperature (Thand) continuously and assessed the reaction time (hand-click test) and subjective mental fatigue (5-point scale). Thermal stress (P < 0.0001), but not mental fatigue (P = 0.290), modulated Thand (heat, +3.3°C [95% CI: +0.2, +6.5]; cold, -7.5°C [-10.7, -4.4]). Mental fatigue (P = 0.021), but not thermal stress (P = 0.646), slowed the reaction time (∼10%) and increased subjective fatigue. Thermal stress and mental fatigue had an interactive effect on the complex manual task (P = 0.040), with cold-no-MF decreasing the performance by -22% [-39, -5], whereas neutral-MF, cold-MF, and heat-MF by -36% [-53, -19], -34% [-52, -17], and -36% [-53, -19], respectively. Only mental fatigue decreased the performance in the simple manual task (-30% [-43, -16] across all thermal conditions; P = 0.002). Cold stress-induced impairments in complex manipulation increase with mental fatigue; yet combined stressors' effects are no greater than those of mental fatigue alone, which also impairs simple manipulation. Mental fatigue poses a greater challenge to manual dexterity than thermal stress.

'Brain fag': a syndrome associated with 'overstudy' and mental exhaustion in 19th century Britain.

The relationship between mental exhaustion and somatic sensations has been described across cultures for millennia, including the contextual relationship with studying and learning. In 19th century Britain, concern regarding the impact of 'excessive' study ('overstudy') and the mental impact on 'brainworkers' led to the coining of the term 'Brain Fag' in 1850. Anxiety became heightened following the promulgation of the Education Acts from 1870 with compulsory child education. This was felt to be a public health crisis with social class distinctions. Brain fag anxiety subsequently transmitted across the British colonies while declining in Britain. Over a century later, this linguistic and colonial residue was observed in British West Africa where it was described as a culture bound syndrome.

Physical and mental fatigue across the menstrual cycle in women with and without generalised anxiety disorder.

Subjective, disabling fatigue is a common complaint and a key feature of numerous medical conditions, and is a transdiagnostic feature of psychiatric disorders. Despite physical and mental fatigue being associated with functional impairment and reduced quality of life, little is understood about its underlying mechanisms or modulating factors. Women commonly experience exacerbation of other (non-fatigue related) psychiatric symptoms during the luteal phase of the menstrual cycle, and report greater fatigue prevalence compared to men. It is therefore plausible that subjective fatigue may similarly fluctuate across the menstrual cycle. Here we compared physical and mental fatigue in the early-follicular (lower ovarian hormones) and mid-luteal (higher ovarian hormones) phases of a single menstrual cycle, while controlling for sleep disruption, in women with (n = 18) and without (non-anxious; n = 20) generalised anxiety disorder (GAD). As expected, women with GAD reported greater physical and mental fatigue than healthy women. Further, although there were no changes in physical fatigue from the early-follicular to mid-luteal phases in both groups, mental fatigue in non-anxious women increased to levels equivalent to those experienced by their GAD counterparts in the mid-luteal phase. Although salivary levels of estradiol and progesterone increased from the early-follicular to mid-luteal phase, hormones did not significantly predict fatigue in either phase. These findings are consistent with the exacerbations of state anxiety and mood disturbance recognised to occur in the luteal phase of the menstrual cycle. We speculate that increased mental fatigue in the luteal phase may represent a vulnerable period for the development and maintenance of psychiatric disorders, potentially via compromised emotional regulation.

Cognitive and physical fatigue are associated with distinct problems in daily functioning, role fulfilment, and quality of life in multiple sclerosis.

OBJECTIVE: To examine whether cognitive and physical fatigue are differentially associated with problems in self-care, mobility, relationships, participation, psychological well-being, and quality of life in people with multiple sclerosis. METHODS: A cross-sectional study involving seventy-four community-dwelling people with MS was undertaken. Between-groups analysis was used to compare ratings on the Perceived Impact of Problem Profile (PIPP) in a range of functional domains and the SF-36 quality of life measure, across median-split groups based on level of both physical and cognitive fatigue using the Modified Fatigue Impact Scale. RESULTS: The impact of poor psychological well-being (p = .005), and associated distress (p = .008) on PIPP was greater in the 'high-level' cognitive fatigue group than the 'low-level' cognitive fatigue group. By contrast, the 'high-level' and 'low-level' physical fatigue groups differed significantly in their self-reported impact of problems in the areas of mobility (p = .002), relationships (p = .014), participation (p = .001), and psychological well-being (p = .004). Overall mental quality of life was significantly lower (p < .001) in those high in cognitive fatigue comparative to the low-level group, and overall physical quality of life was significantly lower (p = .002) in people with multiple sclerosis high in physical fatigue as opposed to low. CONCLUSION: Cognitive and physical fatigue were associated with distinct problems in daily functioning, which impact differentially on role fulfilment and quality of life in multiple sclerosis. Therefore, these two types of fatigue should be considered distinct domains of the fatigue experience in MS.

Mentally tiring work and type 2 diabetes in women: a 22-year follow-up study.

Hypothesis Previous work suggested no or inconsistent associations between components of work-related stress and type 2 diabetes risk, but suggested sex-specific differences should be further investigated, as women potentially had higher risks. Methods We analyzed data from 73 517 women, mostly teachers, from the E3N cohort study followed for 22 years (1992-2014), to study the association between mentally tiring work, used as a proxy of job demands, and type 2 diabetes risk. Univariate and multivariable Cox regression models were used to estimate hazard ratios and 95% confidence intervals. Results A total of 4187 incident cases of type 2 diabetes cases were observed. There was a higher type 2 diabetes risk for women with a 'Very mentally tiring work' when compared to women with 'Little or not mentally tiring work' (HR = 1.21 (1.09-1.35)). This association was independent of unhealthy lifestyle and traditional metabolic factors. An interaction between mentally tiring work and BMI was detected (P < 0.0001), with a stronger association being observed in non-overweight women, HR = 1.26 (1.08-1.47) vs HR = 1.14 (0.98, 1.32), in overweight women. Conclusions We observed an increased risk of type 2 diabetes associated with mentally tiring work, used as a proxy of job demands. These observational results suggest the importance of taking into consideration the potential long-term metabolic impact of work-related stress for women working in a demanding environment. Increased support for such women should be investigated in intervention studies.

Predictive Models of Cognitive Fatigue in Multiple Sclerosis.

OBJECTIVE: Cognitive fatigue (CF) can be defined as decreased performance with sustained cognitive effort. The present study examined the interrelatedness of disease severity, fatigue, depression, and sleep quality in order to evaluate their predictive roles of CF in MS. Four theoretical models examining these variables were assessed. METHODS: Fifty-eight individuals with a diagnosis of MS were recruited. CF was measured by examining last third versus first third performance on the Paced Auditory Serial Addition Test (PASAT). The PASAT and self-report measures of fatigue, depression, and sleep quality were administered. Path analysis was used to evaluate each of the models. RESULTS: CF was correlated only with depression (r = .362, p = .006) and sleep quality (r = .433, p = .001). Sleep quality was the greatest significant independent predictor of CF (ß = .433, t(1,55) = 3.53, p < .001), accounting for 17.3% of the total variance. The best fitting model showed sleep quality as the largest contributor to CF; however, depression played a smaller predictive role. Furthermore, depression emerged as the strongest predictor of sleep quality and fatigue. Disease severity weakly predicted depression. CONCLUSIONS: Sleep quality is the most significant predictor of CF in MS. As such, sleep quality may be a treatable cause of CF. Sleep quality itself, however, accounted for only 17.3% of the variance in CF suggesting that other variables which were not formally assessed in this sample (e.g., anxiety, etc.) may also play a predictive role. Follow-up studies should evaluate how results may differ with a larger sample size.

Mental fatigue does not affect heart rate recovery but impairs performance in handball players / Fadiga mental não altera a recuperação da frequência cardíaca, mas afeta o desempenho de jogadores de handebol / Fatiga mental no varía la reparación de frecuencia cardiaca y muda el rendimiento en balonmano

INTRODUCTION: This study involved an analysis of the impact of mental fatigue on heart rate recovery (HRR), subjective measures of fatigue and intermittent running performance in handball players. OBJECTIVE: This study was aimed at (1) examining the effects of an induced state of mental fatigue on the aerobic performance of handball players, as measured by the Yo-Yo IR1 test, and (2) exploring possible changes in heart rate regulation through HRR analysis. METHODS: Twelve handball players (age: 17.50 ± 3.63 years; 5 ± 2.2 years of practice) undertook a Yo-Yo IR1 test on two occasions, separated by an interval of at least 72 hours. The Yo-Yo IR1 test was preceded by a 30-min treatment, consisting of the Stroop Color-Word Test, to induce mental fatigue. Participants in the control condition watched an emotionally neutral video. RESULTS: Higher ratings of mental fatigue and mental effort following the Stroop Test were observed for the experimental group. No differences in motivation were observed between conditions. Moreover, the induction of mental fatigue impaired running performance and led to a higher RPE during the Yo-Yo IR1 test. Notwithstanding, no changes in HRR or blood lactate levels were observed across conditions. CONCLUSION: Altogether, these results suggest that mental fatigue impairs intermittent running performance, without affecting HRR values. Level of Evidence III; Case-Control study.

INTRODUÇÃO: Este estudo envolveu uma análise do impacto da fadiga mental sobre a recuperação da frequência cardíaca (RFC), medidas subjetivas de fadiga e desempenho de corrida intermitente em jogadores de handebol. OBJETIVO: Este estudo visou (1) examinar os efeitos de um estado induzido de fadiga mental no desempenho aeróbico de jogadores de handebol, medido pelo teste Yo-Yo IR1 e (2) explorar possíveis alterações na regulação da frequência cardíaca através da análise da RFC. MÉTODOS: Doze jogadores de handebol (idade: 17,50 ± 3,63 anos, 5 ± 2,2 anos de prática) realizaram um teste Yo-Yo IR1 em duas ocasiões, com pelo menos 72 horas de intervalo. O teste Yo-Yo IR1 foi precedido por tratamento de 30 minutos que consistiu no teste Stroop Color-Word para induzir estado de fadiga mental. Os participantes na condição de controle assistiram a um vídeo emocionalmente neutro. RESULTADOS: Foram observadas taxas mais elevadas de fadiga mental e esforço mental após o teste Stroop para o grupo experimental. Não foram observadas diferenças na motivação entre as condições. Além disso, a indução de fadiga mental prejudicou o desempenho de corrida e levou a maior PSE durante o teste Yo-Yo IR1. Não obstante, não foram observadas alterações na RFC nem nas concentrações de lactato sanguíneo entre as condições. CONCLUSÃO: Em conjunto, esses resultados sugerem que a fadiga mental afeta o desempenho de corrida intermitente, sem alterar os valores de RFC. Nível de Evidência III; Estudo de caso-controle.

INTRODUCCIÓN: En el presente estudio se analizó el impacto de la fatiga mental en la recuperación de la frecuencia cardíaca (RFC), las medidas subjetivas de fatiga y el rendimiento intermitente en atletas de handball. OBJETIVO: los objetivos de este estudio fueron (1) examinar los efectos de un estado inducido de fatiga mental en el rendimiento aeróbico de atletas de handball, medida por el Yo-Yo IR1, y (2) explorar las posibles alteraciones en la regulación de la frecuencia cardíaca a través del análisis RFC. MÉTODOS: Doce atletas (edad: 17,50 ± 3,63 años, 5 ± 2,2 años de práctica) realizaron un test Yo-Yo IR1 en dos ocasiones, separados por un intervalo de al menos 72 horas. El test Yo-Yo IR1 fue precedido por un tratamiento de 30 minutos, consistente en el Stroop Color-Word Test, para inducir un estado de fatiga mental. Los participantes en la condición de control asistieron un video emocionalmente neutro. RESULTADOS: Se observaron altas percepciones de fatiga y esfuerzo mental después del test de Stroop para el grupo experimental. No se observaron diferencias de motivación entre las condiciones. Además, la inducción de fatiga mental perjudicó el desempeño de carrera y llevó a un mayor PSE durante el test Yo-Yo IR1. No obstante, no se observaron alteraciones en la RFC y en las concentraciones de lactato sanguíneo entre las condiciones. CONCLUSIÓN: En conjunto, estos resultados sugieren que la fatiga mental afecta el rendimiento intermitente de la carrera, sin alterar los valores de FCR. Nivel de Evidencia III; Estudio de caso-control.

Mental versus physical fatigue after subarachnoid hemorrhage: differential associations with outcome.

BACKGROUND AND PURPOSE: Fatigue is a major consequence of subarachnoid hemorrhage (SAH), but the specific characteristics are unclear. Our objective was to investigate the nature of post-SAH fatigue (mental or physical) and to determine the relationship with functional outcome in the chronic stage. Also, the possible influence of mood disorders and acute SAH-related factors [SAH type and external cerebrospinal fluid (CSF) drainage] on the presence of fatigue was investigated. METHODS: Patients with an aneurysmal SAH (aSAH) or angiographically negative SAH (anSAH) were assessed 3-10 years post-SAH (N = 221). Questionnaires were used to investigate mental and physical fatigue and mood. Functional outcome was examined with the Glasgow Outcome Scale Extended. Between-group comparisons and binary logistic regression analysis were performed. RESULTS: Frequencies of mental and physical fatigue were 48.4% and 38.5%, respectively, with prevalence of mental fatigue being significantly higher. A two-way anova with SAH type and external CSF drainage as independent variables and mental fatigue as dependent variable showed a significant main effect of CSF drainage only (P < 0.001). Only mental fatigue explained a significant part of the variance in long-term functional outcome (model χ2 = 52.99, P < 0.001; Nagelkerke R² = 0.32). CONCLUSIONS: Mental fatigue after SAH is a serious burden to the patient and is associated with impaired long-term functional outcome. Distinguishing different aspects of fatigue is relevant as mental post-SAH fatigue might be a target for treatment aimed to improve long-term outcome.

Subjective Fatigue in Children With Hearing Loss Assessed Using Self- and Parent-Proxy Report.

PURPOSE: The primary purposes of this study were to examine the effects of hearing loss and respondent type (self- vs. parent-proxy report) on subjective fatigue in children. We also examined associations between child-specific factors and fatigue ratings. METHOD: Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS; Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002). We compared self- and parent-proxy ratings from 60 children with hearing loss (CHL) and 43 children with normal hearing (CNH). The children ranged in age from 6 to 12 years. RESULTS: School-age CHL experienced more overall and cognitive fatigue than CNH, although the differences were smaller than previously reported. Parent-proxy report was not strongly associated with child self-report, and parents tended to underestimate their child's fatigue, particularly sleep/rest fatigue. Language ability was also associated with subjective fatigue. For CHL and CNH, as language abilities increased, cognitive fatigue decreased. CONCLUSIONS: School-age CHL experience more subjective fatigue than CNH. The poor association between parent-proxy and child reports suggests that the parent-proxy version of the PedsQL-MFS should not be used in isolation when assessing fatigue in school-age children. Future research should examine how language abilities may modulate fatigue and its potential academic consequences in CHL.

Working memory and attention are still impaired after three years in patients with stress-related exhaustion.

Cognitive impairment is one of the most pronounced symptoms reported by patients with stress-related mental health problems. Impairments related to executive function and to some extent speed and attention are therefore common in patients with stress-related burnout/exhaustion. In this paper we present a follow-up of cognitive performance in patients with stress-related exhaustion several years after they initially sought medical care. Thirty patients and 27 healthy controls, mean age 49 years (SD 6.5) and 55 years (SD 6.7) respectively, were included, all of whom had undergone baseline measurements of neuropsychological functioning. The mean follow-up time was three years. Half of the patients still reported mental health problems at follow-up and over time no major changes in cognitive performance were noted. The patients still performed significantly poorer than controls with regard to cognitive functions, mainly related to speed, attention and memory function. Long-lasting impairment of cognitive functions related to speed, attention and memory function noted in patients with stress-related exhaustion should be acknowledged and taken into consideration during treatment and when discussing a return to work. Follow-up periods longer than three years are needed to explore the persistence of the cognitive impairment.

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

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

The effect of Fampridine-SR on cognitive fatigue in a randomized double-blind crossover trial in patients with MS.

BACKGROUND: Cognitive fatigue (CF) is a common complaint in persons with MS (PwMS). Fampridine-SR improves ambulation, fatigue and endurance, due to enhancing action potential formation by blocking potassium channels in demyelinated axons. Thus, through this same mechanism, it is hypothesized that Fampridine-SR could improve CF. OBJECTIVE: To determine if Fampridine-SR objectively improves CF in PwMS. METHODS: Sixty PwMS of any type with CF, defined as 3 or less correct responses when comparing the last third to the first third on the Paced Auditory Serial Addition Test (PASAT), were recruited from a tertiary care MS clinic in London (ON) Canada. Subjects also had to be between 18 and 64 years of age, inclusive, not had a relapse in the last 60 days or corticosteroids in the last 30 days, EDSS 0.0-7.0, and no other diagnosis that could cause cognitive impairment. A randomized double blind crossover design was used: subjects were randomized to either placebo or Fampridine-SR for 4 weeks, then after at least a one week washout, received the opposite treatment. Subjects were assessed before and after each treatment block. The primary outcome was the PASAT CF score after treatment with Fampridine-SR compared to placebo. T-tests and chi-square were used to compare demographics between the two groups (placebo-Fampridine-SR vs. Fampridine SR-placebo). Treatment effects were assessed using factorial ANOVA, with treatment (Fampridine-SR vs. placebo) and time (before and after treatment) as within-subject variables. RESULTS: Of the 60 subjects randomized, 48 completed the study; three were removed due to an adverse event while in the treatment arm (one due to relapse while on placebo, one due to urinary retention and one due to dizziness and headache while on Fampridine-SR). The subjects had a mean age of 46.5±10.0 years, education of 13.6±1.9 years, and were diagnosed with MS 10.6±9.6 years ago. The majority were female (46, 76.7%), had relapsing remitting MS (41, 68.3%) with median EDSS of 3.5 (range 1.0-7.0). There were no significant demographic differences between the two groups. The treatment x time interaction within the factorial ANOVA on PASAT CF scores was statistically significant, F(1, 45)=8.28, p=0.006, suggesting there is a difference between the treatments (placebo vs. Fampridine-SR), over the course of the study. An evaluation of the mean scores suggests, however, that subjects saw a greater improvement when they were given the placebo, than when they were given the active medication. Similarly, individuals showed a greater increase in their information processing speed (as measured by the PASAT) over the course of treatment when they were given the placebo, as compared with the active medication F(1,45)=4.17, p=0.047. CONCLUSION: Although this small pilot study does not suggest that Fampridine-SR results in a statistically significant improvement of CF in MS patients, as compared to placebo, individuals demonstrated an improvement in both information processing speed and CF, suggesting further studies are warranted.

Implicancia de la sobrecarga horaria y cansancio en el error médico / Implication of time overload and fatigue in medical error

Introducción: El exceso de horas de trabajo, la sobrecarga laboral y la falta de descanso llevan a la fatiga mental y física que afectan consecuentemente al rendimiento y al manejo de los pacientes que son el prefacio de una realidad cada vez más frecuente: el error médico. En los profesionales de la salud, la fatiga constituye un peligro importante desde la perspectiva de los factores humanos porque afecta a la mayoría de los aspectos de la capacidad de la persona, repercutiendo en la seguridad de sus pacientes. Objetivos: Exponer la importancia de establecer las acciones tendientes a reducir los eventos adversos por la sobrecarga horaria. Material y Método: Se analizaron 205 encuestas confidenciales y anónimas realizadas a profesionales médicos pertenecientes al servicio de Emergencias del Hospital de Morón Ostaciana C. de Lavignole y el Hospital Aeronáutico Central, en el período comprendido entre el 1de Mayo de 2016 y el 30 de Septiembre de 2016. La población analizada corresponde a 205 médicos, 95 (46,34%) hombres y 110 (53,66%) mujeres, distribuidos según rango etario. Resultados: De la totalidad de los médicos encuestados, solo el 2,43% realiza guardias de 12 horas semanales. 31,7% realizan guardias de 24 horas semanales. 9,75%, guardias de 36 horas semanales. 31,7% cumplen con 48 horas de guardias semanales y el 24,39%, exceden las 48 horas de guardias semanales. El 73,17%, luego de finalizar su guardia, continúa con actividad de planta o quirúrgica, según sea su especialidad. Esto pone de manifiesto que el 73,16% posee pluriempleo. Conclusión: En los profesionales de la salud, la fatiga constituye un peligro importante desde la perspectiva de los factores humanos porque afecta a la mayoría de los aspectos de la capacidad de la persona, repercutiendo en la seguridad de sus pacientes. Los sistemas deberán rediseñar los aspectos sustantivos en la identificación y notificación de errores; como en la prevención del mismo.

Introduction: Excessive hours of work, work overload and lack of rest lead to mental and physical fatigue, affecting performance and patient ́s management that lead to an increasingly frequent reality: the medical error. In health professionals, fatigue is an important danger from human ́s factors perspective because it affects most of the aspects of the professional ́s capacity, affecting patient ́s security. Objective: Expose the importance of establishing action tending to reduce the adverse events of work overload. Material and method: 205 confidential and anonymous surveys were made to health professionals of the Emergency Service from Hospital de Morón Ostaciana C. de Lavignolle and Hospital Aeronáutico Central, between May 1st, 2016 to September 30th, 2016. Results: 2,43% do 12hs weekly guard. 31,7% do 24hs weekly guard. 9,75% do 36hs weekly guard. 31,7% do 48hs weekly guard and 24,39% exceed 48hs weekly guard. 73, 17% after finishing their guard, continuo with their professional activities, having 73,16% more than one job. Conclusions: Fatigue constitute an important danger in health professionals because it affects most of the aspects of the professional ́s capacity, affecting patient ́s security. Mistakes identification and notification must be redesigned including the prevention of them

Mental fatigue impairs soccer-specific decision-making skill.

This study aimed to investigate the impact of mental fatigue on soccer-specific decision-making. Twelve well-trained male soccer players performed a soccer-specific decision-making task on two occasions, separated by at least 72 h. The decision-making task was preceded in a randomised order by 30 min of the Stroop task (mental fatigue) or 30 min of reading from magazines (control). Subjective ratings of mental fatigue were measured before and after treatment, and mental effort (referring to treatment) and motivation (referring to the decision-making task) were measured after treatment. Performance on the soccer-specific decision-making task was assessed using response accuracy and time. Visual search behaviour was also assessed throughout the decision-making task. Subjective ratings of mental fatigue and effort were almost certainly higher following the Stroop task compared to the magazines. Motivation for the upcoming decision-making task was possibly higher following the Stroop task. Decision-making accuracy was very likely lower and response time likely higher in the mental fatigue condition. Mental fatigue had unclear effects on most visual search behaviour variables. The results suggest that mental fatigue impairs accuracy and speed of soccer-specific decision-making. These impairments are not likely related to changes in visual search behaviour.

Mental Fatigability and Heart Rate Variability in Mild Cognitive Impairment.

OBJECTIVES: Adaptive physiological stress regulation is rarely studied in mild cognitive impairment (MCI). Here we targeted mental fatigability (MF) as a determinant of altered high frequency heart rate variability (HF-HRV) reactivity in individuals with MCI, and examined frontobasal ganglia circuitry as a neural basis supporting the link between MF and HF-HRV reactivity. METHODS: We measured mental fatigability and HF-HRV during a 60-minute cognitive stress protocol in 19 individuals with MCI. HF-HRV responses were modeled using a quadratic equation. Resting state functional connectivity of intra- and inter-network frontobasal ganglia circuitry was assessed using blood-oxygen-level-dependent magnetic resonance imaging among seven of the participants. RESULTS: Lower MF was associated with faster and greater rebound in U-shape HF-HRV reactivity, which linked to a stronger connectivity between right middle frontal gyrus and left putamen. CONCLUSIONS: Results suggest that MF may contribute to abnormal physiological stress regulation in MCI, and fronto basal ganglia circuitry may support the link.

Comparison of precipitating factors for mania and partial seizures: Indicative of shared pathophysiology?

OBJECTIVES: Mania in bipolar disorder (BD) and partial (focal) seizures (PS) arising from the temporal lobes, have a number of similarities. Typically, a chronic course of the disorders is punctuated by acute illness episodes. Common features of episodes may include sensory, perceptual, cognitive and affective changes. Both respond to anticonvulsant treatment. Common mechanisms imputed include neurotransmitters and kindling processes. Further investigation may improve understanding of the occurrence of both mania and PS, casting light on the relevance of temporal lobe mediated processes and pathology. One avenue of investigation is to compare aetiological factors and determine the extent of overlap which may indicate shared brain localization or pathophysiology. Aetiology includes predisposing, precipitating or perpetuating factors. This paper examines the literature on precipitating factors of mania, first or subsequent episode, and of PS in diagnosed epilepsy, which is the second or subsequent seizure, to identify the extent and nature of their overlap. METHOD: Narrative review based on a literature search of PubMed and Google Scholar. RESULTS: Precipitating factors for both mania and PS were stress, sleep deprivation, antidepressant medication and, tentatively, emotion. For mania alone, goal-attainment events, spring and summer season, postpartum, and drugs include steroids and stimulants. For PS alone, winter season, menstruation and specific triggers in complex reflex epilepsies. Those not substantiated include lunar phase and menopause. A wide range of chemicals may provoke isolated seizures but by definition epilepsy requires at least two seizures. CONCLUSIONS: The overlap of precipitating factors in mania and PS imply that common brain processes may contribute to both, consistent with findings from neuroscience research.